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Don't Judge a Book by its Cover

The truth behind Nestlé's book: Nestlé implementation of the WHO Code - Official Responses of Governments.

Paper copies of this briefing paper can be ordered from Baby Milk Action. Contact us for further details.

December 1999


Also see: Does Nestlé's Monitoring Report Comply with The International Code? - A Legal Evaluation of The Nestlé Report "Nestlé Implementation of the WHO Code" by a Consultant for The International Baby Food Action Network (IBFAN) and The Geneva Infant Feeding Association (GIFA)

Nestlé's public relations disaster

Nestlé has launched a new book entitled Nestlé implementation of the WHO Code as part of a public relations offensive on the baby milk issue. This follows a wave of bad publicity.

Nestlé is the target of worldwide criticism for marketing baby foods in ways that violate marketing requirements adopted to protect infant health. The World Health Organisation estimates that 1.5 million infants die around the world every year because they are not breastfed. Where water is unsafe a bottle-fed child is up to 25 times more likely to die as a result of diarrhoea than a breastfed child. Even in the most hygienic of conditions a breastfed child is less likely to become ill in both the short and long term.

Cover story prompted by the ASA ruling (see below)

The World Health Assembly adopted the International Code of Marketing of Breastmilk Substitutes in 1981 to protect breastfeeding and to ensure the safe use of breastmilk substitutes when these are necessary. Subsequent resolutions have been adopted to clarify interpretation and to address changes in marketing practices and scientific knowledge.

Nestlé loses ASA battle

Nestlé claims it does nothing wrong. Yet on 12th May 1999 the UK Advertising Standards Authority upheld all of Baby Milk Action's complaints about a Nestlé advertisement after a two-year investigation. Nestlé had claimed that it markets infant formula "ethically and responsibly" but could not support this and other claims in the face of evidence presented by Baby Milk Action.

Nestlé has been faced with a new wave of bad publicity, including an investigation by a UK national television programme, broadcast on 5th October 1999, and public protests around the country, particularly at universities.

Bad publicity prompts PR offensive

Nestlé has now launched a global public relations offensive on the baby milk issue. Nestlé's Chief Executive, Mr. Peter Brabeck, has written to key politicians, organisations, journalists and individuals around the world and sent a 180-page book entitled Nestlé implementation of the WHO Code - official responses from governments.

Mr. Brabeck claims that 54 countries have officially verified that Nestlé complies with the WHO Code - the book contains letters which Nestlé presents as proof of this claim. Baby Milk Action only received a copy of the book after hearing about the book on the Internet and writing to Nestlé's Chairman, Helmut Maucher, asking to be put on the mailing list.

Those concerned about infant health are pressing us for our reaction - this is an analysis based on reading the statements Nestlé has reproduced in its report. Nestlé claims that the statements "verify Nestlé's compliance with the International Code." Closer inspection and investigation demonstrates that Mr. Brabeck has misrepresented letters in the book. This response will be updated as we receive further information from our partners in the countries featured in Nestlé's report and responses from those whose letters have been published.

What does Nestlé's report show?

  • Nestlé concludes that it is doing nothing wrong despite the many violations reported to it by governments, IBFAN and others. In 1998 WHO called on companies to "respond promptly to correct all the violations that are reported."
  • In May 1999 Nestlé's Assistant Vice President, Niels Christiansen, claimed that over 70 governments had verified Nestlé's compliance and there were question marks in only three cases. Nestlé refused to provide further information about this statement when asked by Baby Milk Action. Strangely, in October '99 Chief Executive, Peter Brabeck, said: "We now have 54 countries verifying our compliance, with only one government writing to say that we don't follow the Code."
  • Nestlé states that the countries represented in the book account for "over half our infant formula sales in developing countries". What about the other countries where Nestlé has operations? Why are critical responses from countries such as Samoa and South Africa not included?
  • In some cases it is bizarre that Nestlé suggests that the statement "verifies Nestlé compliance." For example, the letter from the Ministry of Health in the Cook Islands states: "I have not noticed any of their products being sold here."
  • Only six of the statements refer to monitoring or something similar conducted by the authority providing the statement - and three of these note violations were found or reported.
  • A further five statements suggest concern about violations.
  • A quarter of the statements relate only to materials or information Nestlé presented to the government authority.
  • Many statements appear to be a standard form of words, presumably suggested by Nestlé.
  • Many statements include expressions such as "to the best of my knowledge..."
  • Nestlé claims that it conducts international audits. Why hasn't it published the reports resulting from these? Will Nestlé accept independent auditing of its activities?


The International Code and Resolutions

As early as the 1930's health workers were concerned about infants dying as a result of unsafe bottle feeding (ref. 1). This grew as a scientific link was made between unsafe bottle feeding and diarrhoea, malnutrition and death (ref. 2).

Breastfeeding rates declined rapidly during the 1960's as baby food companies expanded their activities into developing countries. For example, in Singapore in 1951 over 80% of 3-month-old babies were breastfed, by 1971 it was only 5% (ref. 3).

Explaining the expansion at the time, Nestlé's Norris Willat said: "The high birth rates permit a rapid expansion in the domain of infant nutrition" (ref. 4).

Concern about this unnecessary death and suffering led to the launch of the Nestlé Boycott in 1977, hearings in the US Senate in 1978 and the drafting of a marketing code, commencing in 1979. The International Code of Marketing of Breastmilk Substitutes was adopted by the World Health Assembly in 1981 as a "minimum requirement" to be implemented in its "entirety" by Member States. Companies were also called on to ensure that their conduct at every level conforms with the provisions of the International Code. (See the Baby Milk Action briefing paper History of the Campaign for further details).

The International Code basically bans the promotion of breastmilk substitutes and gives the responsibility for advising parents to health workers. Companies are limited to providing scientific and factual information to health workers. The International Code also sets labelling and quality requirements and aims to protect those who use breastmilk substitutes as well as those who breastfeed.

Using India's law to protect infant health

The Indian law empowers listed Non-Governmental Organisations (NGOs) to file cases in the courts and the courts appoint a government prosecutor if it is decided there is a case to answer. Sanctions include confiscation of violating materials and imprisonment of executives - in some cases imprisonment is mandatory. Nestlé's Managing Director in India faces a prison sentence if convicted in a long-running court case concerning labelling. Nestlé has reacted by taking the Indian Government to court and is attempting to have key parts of the law revoked. There is no reference to India in Nestlé's book.

Subsequent Resolutions have been adopted to clarify interpretation of the International Code and to address changes in marketing practices and scientific knowledge. Nestlé has refused to acknowledge the subsequent Resolutions and claims that interpretation of the International Code is confusing. It has introduced a "Charter" and instructions to employees which are more limited than the International Code and Resolutions. If national measures are more limited, Nestlé says it will follow these rather than the Code and Resolutions.

Baby Milk Action works with partners in the International Baby Food Action Network (IBFAN) to end the avoidable suffering and death. Today IBFAN consists of over 150 groups in over 90 countries.

Groups conduct independent monitoring of the baby food industry against the International Code and Resolutions and work for the introduction of government measures which are independent, transparent and enforceable.

Implementing the International Code and Resolutions

IBFAN monitors baby food companies and reports violations of the International Code and Resolutions to companies and governments, as requested by Article 11.4 of the International Code. Nestlé has repeatedly dismissed reports of violations. For example, it described the IBFAN monitoring report Breaking the Rules, Stretching the Rules 1998 as "biased and misconceived." Nestlé also led the attack on the report Cracking the Code, published in 1997 following research commissioned by the Interagency Group on Breastfeeding Monitoring (ref. 5). This found "systematic" violations of the International Code and Resolutions. UNICEF stated: "IBFAN's monitoring is vindicated by this report." The research has since been peer reviewed and was published by the British Medical Journal in 1998 (ref. 6).

Nestlé attacks independent monitoring, but sometimes by exposing Nestlé's marketing practices we can bring about change. This picture shows an advertisement for Nestlé Nan infant formula on a distribution van in Yerevan, Armenia in August 1997. Following a Baby Milk Action campaign, Nestlé had the advertisement removed.

WHO calls for action

At the 1998 World Health Assembly, the Director of Family and Reproductive Health made the following call on behalf of World Health Organisation (WHO) (ref. 7):

"In summary, Mr. Chairman, if we are serious about wanting to improve the health, nutrition and well-being of our children, all governments need to urgently reflect the recommendations of the Code and subsequent resolutions in their own laws and regulations and take suitable action accordingly. NGOs must be supported to intensify their monitoring efforts specially in view of the HIV epidemic.

"Infant-food industry needs to be proactive and more responsible to monitor its own marketing practices and respond promptly to correct all the violations that are reported."

Nestlé does not like to receive reports of violations in practice. In 1997 Nestlé was asked to acknowledge the important role of IBFAN's monitoring and reporting and stated (ref. 8):

"Monitoring by third parties, using questionable definitions
and methodology, simply leads to confusion and controversy."

A member of the public acted on Nestlé's "Charter" which encourages people to report violations. After receiving a fourth letter about separate violations, Nestlé responded (ref. 9):

"In view of the fact that I am now replying to your fourth letter on this
issue, I do not think further dialogue will be to our mutual benefit."

Television satirist/investigator Mark Thomas attempted to present specific violations to Nestlé (Mark Thomas Product, Channel 4, 5th October 1999, see the website nestle1.html). Nestlé refused to be interviewed and dismissed his genuine concerns as "your interpretation."

In its new book Nestlé pointedly ignores WHO's call on it to respond promptly to correct all the violations that are reported. Instead it claims it is being more proactive in monitoring its own activities. Its conclusion is, however, that there are virtually no violations and those found are generally due to others misinterpreting the Code. The statements from government representatives do not support this view. A detailed analysis forms an appendix to this report. Next, we present an overview.

Nestlé's statements - what they really say

Baby Milk Action is pleased that Nestlé recognises the need to do more to monitor its baby food marketing activities. The letter from Kiribati contained in Nestlé's book makes it clear why it is important to market breastmilk substitutes responsibly:

"Breastmilk substitutes are discouraged at all costs by the Ministry of Health. The main reasons are: Breastfeeding is the best food for a child (every mother is capable of providing when managed well). It has been proven that children have often fallen sick due to poor hygiene during the preparation."

The International Code and Resolutions?

Company activities should be monitored against the International Code and the Resolutions which clarify it. Yet in only one case (South Africa) does the statement reproduced by Nestlé refer to the subsequent Resolutions, and this notes that marketing activities are the target of "extensive criticism by the defenders of breastfeeding" and notes: "The Nutrition Directorate does not have the capacity to monitor transgressions of the Code..."

It is not clear whether other government authorities intended to include the Resolutions when referring to the International Code. It is known, however, that Nestlé has refused to acknowledge the importance of the subsequent Resolutions and has repeatedly attacked them. Has it done the same in its approaches to governments? The sample request letter, reproduced in Nestlé's book, refers only to the International Code. (It is also interesting to note that the sample letter does not inform the authority that Nestlé intends to publish any response and distribute it around the world.)

Further information is needed, but the cases of Bulgaria and Russia give an interesting insight. In Bulgaria and Russia the statements refer to a European Union Internal Directive which is only a partial implementation of the International Code. The Directive does not apply to Bulgaria and Russia. Even if these countries join the European Union, the Directive does not prevent them from fully implementing the International Code and Resolutions (Georgia did just this in September 1999). Has Nestlé mis-led the governments about the status of the Directive in order to obtain these statements?

Systematic violations

IBFAN conducts independent monitoring of baby food company marketing practices against the International Code and Resolutions. The report Breaking the Rules, Stretching the Rules 1998 reports on monitoring in 31 countries. Nestlé is again found to be the largest source of violations using methods that even violate its own weak "Charter".

Responsibility for monitoring

Baby Milk Action and IBFAN encourage governments to fulfil their obligations under Resolution 34.22 and Article 11.2 to implement the International Code and Resolutions in legislation and to take action to monitor these measures independently of companies.

IBFAN acts on Article 11.4 and reports violations to governments and companies. The report Breaking the Rules, Stretching the Rules 1998 included the results of monitoring from 31 countries. Interestingly, Nestlé appears to have been unable to obtain statements from 20 of the countries covered by the IBFAN monitoring report. This perhaps indicates the importance of IBFAN's work in alerting governments to company malpractice.

Nestlé and all companies have responsibility under Article 11.3 to "ensure that their conduct at every level conforms" to the International Code "independently of any other measures taken for implementation..."

Nestlé has claimed elsewhere that it conducts international audits of its companies. Why hasn't it published the audit reports? Will it accept independent auditing of its activities?

The letter from Norway sets out Nestlé's responsibility:

"The agreement between the Norwegian Baby Food Industry and the, at the time called, Health Directorate, was, as you know, made in 1983. In Article 11a-11.1, which deals with the execution and supervision of the voluntary agreement, it is stated that 'manufacturers of products which are covered by this code, the WHO Code, are themselves responsible that their marketing practices conform with the Code."

Nestlé received the "Lot of Bottle" award from the UK Food Group on World Food Day, October 1998, for shameful violation of the International Code and Resolutions in the Philippines. Nestlé's "Health Educators" have been found promoting Nestogen infant formula to new mothers in the community. A "Health Educator" is shown at work above. (Photo: IBFAN Philippines, 1997).

It appears that Nestlé S.A. (Swiss Headquarters) does not take this responsibility seriously. For example, in 1996 Dr. Imelda Ben travelled to Switzerland from the Philippines for the Nestlé S.A. shareholder meeting. She informed shareholders and the Board of Directors that the activities of Nestlé Philippines were endangering infant health. The letter from the Secretary of Health in the Philippines, reproduced by Nestlé, although generally complimentary, acknowledges that violations have been reported. Baby Milk Action has also raised violations with Nestlé, such as its practice of employing graduate nurses on contract as "Health Educators" who have been found promoting Nestogen infant formula to new mothers in the community.

Nestlé has denied this outright. It wrote on 27th September 1999 that "Nestlé Philippines assures us that we do not have such a practice." Why is Nestlé accepting the assurance of Nestlé Philippines when it has received repeated reports of violations? Even Nestlé Philippines website refers to Nestlé's "health education on nutrition for village mothers."

Direct and indirect contact of marketing staff with pregnant women and the mothers of infants and young children is banned by Article 5.5 of the International Code (Article 6(e) of the Philippine Code also bans direct contact for specific products). Yet in September 1999, the marketing firm OgilvyOne received three Asian Direct Marketing Awards for its work with Nestlé Philippines. Dickie Sorian, OgilvyOne Manila, told BusinessWorld:

"When we designed Nestlé's infant nutrition program, we made full use of direct marketing insights and breakthroughs that are now reshaping the way we market brands as well as the relationships between consumers and brand."

Baby Milk Action has asked Nestlé S.A. (13th October 1999) if it has conducted an audit of Nestlé Philippines and, if so, to release the audit report. At the time of writing we have not received a response.

What has government monitoring found?

Only 6 letters refer to monitoring or similar (e.g. "spot checks") conducted by the authority writing the letter (Dominican Republic, Egypt, Zimbabwe, Philippines, Germany and Romania).

The Dominican Republic found violations:

"The majority [of violations] were related to advertising
activities of popular products, and have since been corrected."

This is Baby Milk Action's aim - a monitoring system that is effective in stopping violations.

The report from Germany notes violations:

"A number of Lander authorities reported that they had received
complaints from interested parties."

The reports from Egypt, Zimbabwe and Romania are complimentary. It is known, however, that Zimbabwe only agreed to comment on Nestlé's activities judged against the International Code and would not state it was also abiding by the subsequent Resolutions. Nestlé also opposed the implementation of the International Code and Resolutions in legislation in Zimbabwe, and threatened to close down its operations in the country if a law was introduced. Dr. Timothy Stamps, Minister of Health, described this as "an idle threat" on the TV programme, Mark Thomas Product, 5th October 1999.

Other statements also refer to violations...

  • Colombia refers to the need for "corrective action."
  • Jordan refers to the need for "control and follow-up."
  • Kenya refers to "consultations that have been held... I am aware that matters have been sorted out amicably."
  • South Africa refers to "extensive criticism by defenders of breastfeeding."
  • Switzerland states "Manufacturers have been requested to limit donations of samples."

According to Nestlé's Chief Executive, Peter Brabeck, the countries in the book only amount to about half of its market for infant formula in developing countries. What about the others?


Do the statements really "verify Nestlé's compliance" with the International Code and Resolutions?

Some of the letters Nestlé has reproduced are very clearly not "verifying that Nestlé complies with the International Code."

For example, the letter from the Cook Islands states:

"I have discussed this matter with our Nutritionist and she has provided me the following informations... 'At present, I have not noticed any of their products being sold here.'"

As a monitoring strategy, Nestlé's approach is fundamentally flawed if it is prepared to present such a letter as proof that its marketing practices comply with the requirements.

Dane's "surprised" by Nestlé's spin

Baby Milk Action asked Bente Koch of the Danish Veterinary and Food Administration if she was aware that Nestlé would use a letter from her in its new book: Nestlé implementation of the WHO Code: Official Response of Governments. The letter has also been published on the Internet.

She said: "We are very surprised. We had the impression that Nestlé would use the letter in connection with export of infant formulas to countries outside the EU in order to inform about the fact that Denmark had implemented the Commission's Directives." Asked if the letter was "official verification of Nestlé's compliance" as Nestlé claims, she explained: "It is the responsibility of the marketer or distributor to ensure their marketing is in accordance with Danish Regulations. We never certify that a producer is marketing in accordance with the Danish Regulations. We have only given a description of the system."

The letter from Denmark states:

"The ongoing food control system is currently supervising that the law is being respected."

This appears to be a statement setting out the responsibility of the food control system, not an endorsement of Nestlé's activities. Our view has been confirmed by the author of the letter (see box). STOP PRESS 23rd January 2000 - Nestlé apologises to Denmark

Nestlé has also received letters from a local authority informing it that it has broken the Danish law in a direct mailing to mothers as part of its "Parents Club". At the time of writing, the Veterinary and Food Administration is considering Nestlé's appeal.

The letter from Oman thanks Nestlé for attending a meeting and does not refer to its marketing policy or practice:

"This is to express our sincere gratitude and thanks for your co-operation in attending the meeting on the Omani Code for BMS at the Ministry of Health on Sunday 22nd November 1998 on behalf of Nestlé. We are happy to know that you all have the same goals in improving the health of mothers and children in Oman."

Many of the letters refer only to materials or information presented to the authors by Nestlé. Many only state the official "has no knowledge" or is "not aware of violations." For example, the letter from Hong Kong states:

"To the best of my knowledge, mothers are not being solicited by Nestlé's representatives to use infant milk formula with free sampling in all of our maternal and child health centres and maternity homes."

This statement is only of any use if there are no other verifiable reports of free samples. In addition, the International Code and Resolutions cover far more than free sampling.

The letter from Rwanda states:

"I have received the annual report from the Manager of Nestlé, Great Lakes Region, concerning the Nestlé company's activities in Rwanda. I have no particular comments regarding the report, however I encourage Nestlé to continue implementing the instructions of WHO Code."

Baby Milk Action also encourage Nestlé to implement the instructions of the International Code and Resolutions. This does not mean we endorse its activities.

Missing statements

In May 1999 Nestlé claimed to have endorsements from over 70 countries with questions only from 3. In the report, which is dated July 1999, the situation had changed - Nestlé claims endorsements from 54 countries with questions from only one unnamed country and states it has not received any other responses.

Yet Nestlé received a letter from Samoa (21st April 1999) stating:

"...In summary Nestlé marketing practices in Samoa at the present time not only contravene the WHO Code of Marketing of Breastmilk Substitutes and the subsequent WHA resolutions, but also seriously undermine the current nutrition education programme in Samoa which promotes exclusive breastfeeding to about six months."

Nestlé received a letter from the Department of Health, Western Cape, South Africa (19th May 1999) stating: "There are violations of WHA 39.28, WHA 47.5 and 49.15."

Nestlé received a letter from Ministry of Health, Gabon (8th July 1997) relating to Nestlé's promotion of Cerelac complementary food at health facilities. It described Nestlé's promotional methods of providing gifts and free samples and showing film shows as "flagrant violations" of a Ministerial Decision brought to Nestlé's attention in 1991, and the International Code. Other countries are known to have refused to sign Nestlé's "Certificates".


Nestlé's irresponsible marketing of breastmilk substitutes contributes to unnecessary suffering and death of infants around the world. It is disturbing that Nestlé has obviously spent a considerable amount of money on its new "monitoring" strategy, but concluded it is doing nothing wrong. This suggests that the strategy is more concerned with polishing Nestlé's image than protecting infant health.

Baby Milk Action suggests that Nestlé addresses the following specific concerns to improve its "monitoring" strategy:

  1. While it is welcome that Nestlé recognises that it needs to do more to monitor its baby food marketing activities it is necessary to monitor these against the International Code of Marketing of Breastmilk Substitutes and subsequent, relevant Resolutions of the World Health Assembly. The subsequent Resolutions clarify interpretation of the International Code and address changes in marketing practices and scientific knowledge. Nestlé has refused to accept the validity of the subsequent Resolutions even though WHO has made it clear that they have equal status to the International Code.
  2. Nestlé must accept that the International Code was adopted under World Health Assembly Resolution 34.22 as a "minimum" requirement to be implemented in "its entirety", and that governments may put in place additional measures if they find this appropriate.
  3. The International Code (Article 11.3) requires companies to take responsibility for monitoring their own activities "independently of any other measures taken for implementation." Nestlé claims to conduct audits of its companies. Its stated policy of "openness" should include releasing these reports. If it has nothing to hide, it should open itself up to independent, external audits to enable verification of any reports it has produced.
  4. Nestlé's report refers to a call on the baby food industry made at last year's World Health Assembly, but does not present that call fully. WHO said: "Infant food industry needs to be proactive and more responsible to monitor its own marketing practices and respond promptly to correct all the violations that are reported." (Director Family and Reproductive Health - WHA 1998 - emphasis added). Nestlé has attacked monitoring reports such as Breaking the Rules, Stretching the Rules 1998 (produced by the International Baby Food Action Network) and Cracking the Code (produced by the Interagency Group on Breastfeeding Monitoring in 1997) instead of taking action to end the violations. Nestlé has also failed to end violations as requested by a number of governments (such as Malawi, which has been asking Nestlé to include the national language on labels since at least 1994). If it took action to end all violations reported to it, its professed willingness to abide by the International Code might have more credibility.
  5. Nestlé is marketing specialist breastmilk substitutes in the UK at the present time and is expected to launch a wider range in the near future. Nestlé pointedly failed to give an undertaking to fully abide by the International Code and Resolutions in the UK when asked by Baby Milk Action and is breaking these measures. It should stop seeking direct contact with mothers (for any infant or young child product) in line with Article 5.5 of the International Code.

Baby Milk Action welcomes your support. Please tell your friends and colleagues about our work and consider helping us by becoming a member, if you are not already. And, of course, donations are always welcome.

Baby Milk Action, 34 Trumpington Street, Cambridge, CB2 1QY, UK.

Tel: +44 (0)1223 464420 Fax: +44 (0)1223 464417


  1. Milk and Murder - Address to the Rotary Club of Singapore in 1939. Reproduced by the International Organization of Consumers Unions, October 1986.
  2. Derrick Jelliffe coined the term "Commerciogenic malnutrition" in an article in Food Technology, vol. 25, no. 55, 1971, following research in Jamaica (referenced in The Politics of Breastfeeding by Gay Palmer, Pandora, ISBN 0-86358-2200-6).
  3. Berg. A.; The Nutrition Factor, Brookings Institute, Washington, DC, 1973 (referenced in The Politics of Breastfeeding by Gay Palmer, Pandora, ISBN 0-86358-2200-6).
  4. Willat, Norris; How Nestlé adapts products to its markets, Business Abroad, June 1970 (referenced in The Politics of Breastfeeding by Gay Palmer, Pandora, ISBN 0-86358-2200-6).
  5. Cracking the Code. Interagency Group on Breastfeeding Monitoring, January 1997.
  6. Violations of the international code of marketing of breastmilk substitutes: prevalence in four countries. British Medical Journal Volume 316, 11 April 1998.
  7. Statement on Infant and Young Child Nutrition by WHO Executive Director of Family and Reproductive Health to the 1998 World Health Assembly.
  8. Letter from Nestlé Vice President, G. A. Fookes, to Baby Milk Action, 24th July 1997.
  9. Letter from Nestlé (UK) Corporate Affairs Manager, Ralph Claydon, to a concerned member of the public, 16th October 1998.