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
http://www.channel4.com/mark_thomas/
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".
Recommendations
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:
- 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.
- 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.
- 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.
- 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.
- 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
References
-
Milk and Murder - Address to the Rotary Club
of Singapore in 1939. Reproduced by the International
Organization of Consumers Unions, October 1986.
-
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).
- 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).
- 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).
- Cracking
the Code. Interagency Group on Breastfeeding
Monitoring, January 1997.
- Violations
of the international code of marketing of breastmilk
substitutes: prevalence in four countries. British
Medical Journal Volume 316, 11 April 1998.
-
Statement on Infant and Young Child Nutrition by
WHO Executive Director of Family and Reproductive
Health to the 1998 World Health Assembly.
- Letter
from Nestlé Vice President, G. A. Fookes,
to Baby Milk Action, 24th July 1997.
-
Letter from Nestlé (UK) Corporate Affairs
Manager, Ralph Claydon, to a concerned member of
the public, 16th October 1998.
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Cover
story prompted by the ASA ruling (see below)
