Campaign for ethical marketing
WHO estimates that “Some 1.5 million children still die every year because they are not adequately breast fed” . This figure brings into account children who are fed inappropriate, unhygienic, and nutritionally poor foods such as rice water, sugar water, cassava or other starchy material which are not infant formula and which are wholly inadequate nutritionally. Our studies have shown that, in developing countries, infant formula is overwhelmingly purchased by the middle and upper classes, and working women who have to leave their infants with others for long periods in order to support their families. For these infants, formula is a vital product, and a factor which enables the mother to earn income necessary to purchase food for the rest of the family preventing them from suffering malnutrition and starvation.
 WHO Global Strategy for feeding infants and young children, WHA Resolution 54.7, 2001.
[****Baby Milk Action comment: Let us quote UNICEF: "Marketing practices that undermine breastfeeding are potentially hazardous wherever they are pursued: in the developing world, WHO estimates that some 1.5 million children die each year because they are not adequately breastfed. These facts are not in dispute." Nestlé targets not just the 'middle and upper classes', but mothers in rural areas in the poorest countries - as with the labels described below. Nestlé's promotion of powdered whole milk is also a serious concern - Nestlé displays its Nido whole milk in the infant feeding section of pharmacies alongside the more expensive formula, picking up sales, but endangering health.****]
While Nestlé does not promote infant formula in the developing world, we have found that in countries such as Pakistan, India, and Bangladesh, infant formula sales have been increasing over time and this is happening at the same time that infant mortality is decreasing. When used properly, infant formula saves lives. [****Baby Milk Action comment: Aggressive marketing in these countries has also been exposed by Baby Milk Action and IBFAN. In Bangladesh, for example, Nestlé has distributed prescription pads to doctors for Lactogen formula, for them to tear off and give to mothers. It is also wrong to imply that infant mortality decreases are due to increased use of infant formula. It is generally increased access to health care and public health messages that improves survival. Breastfeeding has a key role to play to save more lives: according to a Lancet study (table page 67), increased breastfeeding would save more lives than universal provision of safe water, sanitation and HIB vaccination****]
The International Code of Marketing of Breast Milk Substitutes cannot be a ‘requirement’ for all countries: no policy of WHO is such. Rather WHO adopted the Code as a recommendation to countries to set policy and legislation according to each country’s specific health needs and socio economic conditions. While former WHO General Secretary Gro Harlem Brundtland has stated that the WHA resolutions have the same weight as the WHO Code, they do not override nor replace the Code. Thus where the WHA resolutions are in conflict with the WHO Code, there is a gap in understanding. Until such gaps can be filled, the WHO Code should stand as the gold standard. [****Baby Milk Action comment: Nestlé ignores the fact that Resolution 34.22 under which the Code was adopted. Its second line states: "Recalling that breastfeeding is the only natural method of infant feeding and that it must be actively protected and promoted in all countries." It also states the Code is a 'minimum standard' to be implemented in 'its entirety'. Nestlé never mentions the provisions of Article 11.3: "Independently of any other measures taken for implementation of this Code, manufacturers and distributors of products within the scope of this Code should regard themselves as responsible for monitoring their marketing practices according to the principles and aim of this Code, and for taking steps to ensure that their conduct at every level conforms to them."****]
Something which seems to be neglected is that one of the aims of the Code is to “ensure the proper use of breast-milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution”. [****Baby Milk Action comment: Nestlé is wrong to say this is neglected: Baby Milk Action calls on Nestlé to respect this aspect of the Code. For example, we are call on it to warn on labels that powdered formula is not sterile and to give the simple steps to reduce possible contamination with pathogens such as Enterobacter Sakazakii. Nestlé has had to recall formula after deaths linked to such contamination, but refuses to provide this information. Instead it has launched new labels claiming its formula 'protects'****]
Presence of infant formula at the Nestlé annual General Assembly
The Nestlé General Assembly is an annual gathering of persons who hold shares in the company.
As is generally the case at shareholder meetings, participants are provided with information and data about the company’s operations, product portfolio, business prospects, community projects and other information. Shareholders, who are in fact the owners of the company, know that infant formula is part of our product portfolio and have a legitimate interest in being informed of scientific advances in it. Our shareholder meetings are not events for the general public. Therefore the presence of infant formula cannot be associated to a marketing practice nor to an effort on Nestlé’s part to ‘push infant formula’, even less to ‘undermine breastfeeding’.
Infant formula is a vital product when breast milk is unavailable, and WHO recognises that infant formula is the single product that is appropriate for nourishing non breastfed infants.
[****Baby Milk Action comment: Nestlé is defending itself against a criticism that was not made. Baby Milk Action highlighted that the formula was on display at the shareholder meeting because Nestlé sometimes claims violations are due to mistakes of local management and that the Chief Executive personally investigates any hint of a violation. When the violations were on display at the shareholder meeting it is obvious such strategies come from the very top of the company.****]
Philipphines Supreme Court
Nestlé hails the decision of the Philippines’ Supreme Court to back the Department of Health regulations on formula marketing. Nestlé was never a part of the legal challenge referred to that was instigated by other companies. To the contrary, Nestlé fully encouraged the Department of Health’s efforts to implement the revised regulation, and had written a letter supporting this work to the Secretary of Health and to UNICEF at that time. Nestlé supports strong enforcement of national codes to protect mothers and children and to create a level commercial playing field. [****Baby Milk Action comment: Nestlé was not accused of being part of the legal challenge, but putting pressure on WHO and UNICEF over the support the country representatives were giving to breastfeeding. The pressure from Nestlé and its associates was reported in the media, with comments from the UNICEF Philippines country head who said (editing as in original): "I [now] realize the enormity of the challenge that we're facing and how big the opposition from the milk companies is going to be. I think the fact that they are able to penetrate [UN] organizations to the point of trying to undermine representatives is an indication that they feel that they have enough influence to challenge individuals who represent [these organizations] in their respective countries." Nestlé was breaching and continues to breach the marketing requirements in the Philippines.****]
The “My Baby Records” booklet referred to in the Philippines is made available to health care professionals upon their request. It contains information on immunization schedule, growth chart, diagnosis, medications and is a useful tool for doctors and mothers if the doctors have chosen to provide it to her. It contains explanations and WHO’s recommendations on breastfeeding. There is also guidance on correct weaning practices and information on Nestlé infant cereals which are recommended for 6 months of age or beyond. Infant cereal for children after the age of 6 months is not a breast milk substitute and does not fall within the scope of WHO Code.
The fact that mothers receive this booklet only from health care professionals, never from Nestlé personnel, is fully in line with Art. 4.3 of the WHO Code, which allows donations of informational and educational equipment or materials by manufacturers, to be distributed through the health care system. This activity is also completely consistent with the Philippines Regulations.
[****Baby Milk Action comment: This is a gift. Gifts are prohibited under Article 5 of the Code. Regarding Article 4.3, cited by Nestlé, this states: "Donations of informational or educational equipment or materials by manufacturers or distributors should be made only at the request and with the written approval of the appropriate government authority or within guidelines given by governments for this purpose". Article 6(b) of the Philippines Regulations prohibit items such as this, so Nestlé is also violating Article 4.3 of the Code.****]
The Nestlé Club
The Nestlé Club exists for consumers who wish to receive communication on various homemaking topics such as household management or culinary applications. It relates to food and beverage products that do not fall under the scope of the WHO Code like coffee, flavoured drinks, cooking aids, breakfast cereals, powdered milk (for grown-up children and adults), or growing up milks (given to children over 1 year of age). Feedback from consumers who subscribe to the Club shows that they appreciate the information on topics ranging from recipes to homemaking tips, nutrition, health and wellness advices and events being held. There is no communication about breast-milk substitutes in any of the information sent to or requested from the Nestlé Club members. This activity does not contradict in any way the articles of the WHO Code.
[****Baby Milk Action comment: Our concern related to the fact that the Club is not only a general promotional tool as Nestlé is suggesting here. It specifically targets parents of infants and young children (defined as children up to 3 years of age). UNICEF is charged under Article 11.1 of the Code to provide advice to governments on its implementation and so its interpretation of the Code requirements are authoritative. It has previously stated (click for its statement) that: "any form of contact with mothers of children under 3 years is prohibited, irrespective of the motivation behind the contact."]
Infant formula in Malawi
There is no question about breast milk being the best start a baby can have in life. But when mothers are not able to breastfeed, it is critically important that a safe, effective, high-quality alternative be made available.
Nestlé makes significant investments in R&D and technology to deliver innovative products with scientifically proven nutritional benefits. While our infant nutrition products meet the needs of non-breastfed babies during the first critical months of life, the functional benefits that are encapsulated in the ‘Protect’ logo are scientifically substantiated - the result of many years of intensive research on how best to improve the formula composition to stimulate the infant’s immune system.
[****Baby Milk Action comment: These are the logos on display at Nestlé's shareholder meeting. Nestlé's justification for them is simply untrue. They promote the addition of Long-Chain Polyunsaturated Fatty Acids (LCPUFAs) - DHA, ARA and one Nestlé refers to as Opti-pro to give the impression it aids eye development, a claim sometimes made about them. However, the respected Cochrane Library has investigated the impact of adding LCPUFAs to infant formula and concluded: "It has been suggested that low levels of long chain polyunsaturated fatty acids (LCPUFA) found in formula milk may contribute to lower IQ levels and vision skills in term infants. Some milk formulas with added LCPUFA are commercially available. This review found that feeding term infants with milk formula enriched with LCPUFA had no proven benefit regarding vision, cognition or physical growth."****]
The logo helps distinguish this particular formula from other less advanced products but does not claim in any manner that infant formula is superior to breast milk.
[****Baby Milk Action comment: A comparison comment, with no scientific basis for it, would be misleading, but this is not a comparison comment. The logo simply says 'Protect Start' on the infant formula and 'Protect Plus' on the follow-on formula, an absolute claim that the formula will protect. This undermines the legally-required warning that breastmilk is best for babies. In the Philippines, Nestlé has used logos promoting 'brain building blocks' that it claimed promote 'Experts recognize DHA as essential for brain development and good vision.'. UNICEF Philippines has produced a film examining the impact of such claims: they lead some parents to believe their children will be more intelligent and have better eyesight if fed on formula. Click here to watch the film.****]
In line with the WHO Code recommendations, the label content is translated into the national language and reminds mothers of the superiority of breast milk.
[****Baby Milk Action comment: As we explained on the action sheet, Nestlé refused to translate the labels citing 'cost restraints' and it took a Baby Milk Action campaign, gaining national media attention, to force a change.****]
In actual fact, Malawi is a country where breastfeeding is overwhelmingly practiced and overall usage of infant formula very low, even in comparison with other African countries. Nevertheless, mortality of infants and young children is still very high, according to UNICEF’s statistics. This means that main causes of health problems and mortality of babies are not related to infant formula. All stakeholders need to be constructively engaged in the search for effective policies to help infants and young children in countries like Malawi.
[****Baby Milk Action comment: Nestlé's promotion of formula with its 'protect' logos does nothing useful. As this communication demonstrates, it is refusing to 'constructively engage' on this and the other issues, instead making demonstrably untrue claims in an attempt to divert criticism.****]
End of aisle display of Nestlé formula
Nestlé policy prohibits promotional display of our infant formula in retail outlets, such as “end of aisle” displays. We take pains to explain this to distributors of our products and we ask them to sign contracts to respect these policies which are in line with the WHO Code. However, sometimes among the many thousands of retailers and shopkeepers who sell infant formula, there are some who have not yet understood, or who make mistakes.
Article 11.4 of the WHO Code states that persons and organizations monitoring infant formula marketing practices should inform manufacturers when and where violations are taking place so that corrective action can be taken. Had we had information about the retail outlet in Malawi that displayed infant formula in this incorrect fashion, we could have taken steps to correct it. Be this as it may, we are trying to identify the store and will definitely renew information to our distributors about marketing practices at shop level, that are in line with the Code recommendations.
[****Baby Milk Action comment: Baby Milk Action contacted Nestlé directly with concerns about this end-of-aisle display and asked it to take action. Its response, given below, made no effort to address our concerns, nor did it request additional information - it seems to be making this comment on its site in an attempt to discredit Baby Milk Action. If Nestlé needs more specifics, then the display is in the People's Trading Centre chain - the name of the store can actually be seen in the photograph. It would be welcome if Nestlé took steps to ensure senior management stop all such displays, not just in the one store where the photograph was taken.****]