This is in response to your recent letter regarding the labels of Wyeth's infant formula products in Malawi. Wyeth's infant formulas S-26 and SMA which are sold in Malawi are manufactured in Ireland. Previously they had English language labels with graphic preparation instructions which are easily understood by mothers regardless of their language skills. In order to comply with the requests of the Ministry of Health, products shipped to Malawi by Wyeth in the future will have local language underlid inserts. Your letter quoted Dr. Sangala from the MoH stating "S-26 label instructions in English and Afrikaans...".English/Afrikaans labels are produced by Infacare in South Africa. You may wish to contact them directly for information about their business. The labels cited in your letter were not shipped to Malawi by Wyeth, although there is some cross-border trade in that area by independent retailers over whom we have no control. Sincerely, Beverly Halchak Director Maternal-Child Health.

Baby Milk Action's evaluation:

I refer to your letter of July 2nd addressed to the Nestlé Chief Executive Officer, Mr. Peter Brabeck-Letmathe, and I am enclosing for your information the reply we have received from our colleagues in South Africa. [* quoted below] For the sake of accuracy I should point out that Mr. Brabeck did not say that Nestlé was unaware of the request from the Malawi authorities for instructions in Chichewa to be included on labels of Nestlé infant formula sold in Malawi. He simply alluded to the fact that the Department of Linguistics of the University of Malawi has yet to provide us with a translation of the label texts which we requested. [* Nestlé is claiming that it was unable to obtain a translation in the three years that passed since the Government's request] With regard to your remark about monitoring conducted by Baby Milk Action and others, I already expressed our appreciation to you for drawing our attention again to the language issue in Malawi, and the appropriate action was immediately taken [*four years after the original request]. However as pointed out in my letter of 9th April, the only sensible way to make progress is for governments to implement the aim and principles of the International Code as most appropriate to national requirements, to issue clear definitions and implementation instructions, and to establish effective and impartial monitoring procedures under government responsibility (providing a forum for permanent dialogue with all concerned parties - including consumers and manufacturers). [*...but this case shows Nestlé is prepared to ignore governments as well as independent monitoring organisations] As my colleagues in Vevey [*Nestlé HQ, Switzerland] pointed out in their July 25th letter to your Public Relations co-ordinator, Mrs. Rundall [*Patti Rundall is Baby Milk Action's International Coordinator, but Nestlé attempts to portray our genuine concerns as a PR exercise], monitoring by third parties, using questionable definitions and methodology, simply leads to confusion and controversy. I hope the above clarifies our position. Yours sincerely, Ralph Claydon Corporate Affairs Manager

Dear Ralph, I refer to your letter of July 2nd addressed to Mr. Brabeck by Baby Milk Action. I had a constructive meeting with the Chief of Health Services, Dr. Sangala, last month and we agreed that this matter should be reactivated. Dr. Sangala has kindly undertaken to pass our labels to Professor Moto, Head of Linguistics at the University of Malawi, and once the necessary translations are completed they will be returned to me for preparation of the layouts. The bromides will then be sent to Malawi for checking and as soon as they [sic] necessary approvals are received, we can go to print. Provided there are no further delays in obtaining the translation, the labels should be available on the market by October 1997. I should point out, however, that in view of the problem of infiltration from neighbouring countries, it is impossible to guarantee that all infant formula sold in Malawi will have the new label. Dr. Sangala understands this. I hope this information will be useful. Kind regards, MC Alcock.

Infant Formula and Follow-on Formula Regulations 1995 I refer to your enquiry regarding the advertisements which have appeared in "Health Visitor" and "Midwife" publications. Although I am still waiting comments from LACOTS labelling panel I have now received contact from representatives of the above mentioned publications. Both professional organisations have responded positively by indicating that they do not intend to publish these specific Milupa advertisements again until the matter has been resolved. I am informed that both representatives considered carefully the advertisements before having them published and were of the opinion that they did not contravene the regulations. Further they were adamant that the journals were for the professional officers only. They also maintain from their experience that the journals were not shown to members of the general public and therefore people would not be influenced by the style and contents of the advertisement. I will contact you again when I have further information.

I understand from my colleague at our Head Office in Switzerland, Susan Jongeneel, that you are seeking information concerning the country of origin of Lactogen, Cerelac and Nespray products sold in Bangladesh. I can confirm that such information is not available, however, I can assure you that all labels comply with the relevant laws. Yours sincerely, Ralph Claydon Corporate Affairs Manager.

Nestlé responded to a letter writer [Baby Milk Action comments in green after the * symbol]:

Thank you for your letter about Nestlé and baby milk. Nestlé has always believed that breast-feeding is the best way to feed a baby, and we continue to fully support that view. We are committed to helping to promote breast-feeding, for example by the production of leaflets, posters and videos [* which generally serve to promote Nestlé's logo and often contain suspect information] by clear statements on our packs and any educational materials about the benefits of breast-feeding [*often such statements are then undermined by additional text as many of the examples we feature demonstrate] and by co-operation with other parties in educational programmes [* this violation itself demonstrates lack of co-operation!]. We market baby milk ethically, within the guidelines of the World Health Organisation (WHO) Code and within any national laws. For example in all developing countries we do not advertise baby milk to mothers or to the public [* follow-on milks are advertised in many countries], we do not use pictures of babies on our packs [* following pressure from the Nestlé boycott] and we do not give free supplies to mothers [* see other violation reports]. In Gabon there has been a degree of confusion over the scope of the local legislation implementing the WHO Code, which Nestlé has been attempting to clarify with the appropriate authorities [* Nestlé has received a very clear message which it has stated it will ignore]. We have also been encouraging the government to set up local monitoring procedures of the WHO Code [* which Nestlé wishes to be part of]. [Two paragraphs referring to violation ref: comp/97/11 not quoted] Nestlé is extremely proud of its record of achievement in developing countries, where we have a long term commitment to working with local communities. We believe that it is through co-operation and sensitivity to the needs and cultures of these communities that real benefit can be brought to these countries, for example through the creation of employment, education and training, health and environmental projects. I enclose a copy of our Charter which outlines our infant feeding policy and practices in developing countries, along with some further information. I hope this will be of interest. Yours sincerely, Denise Briggs, BSc (Hons), SRD Specialist in Dietetics Nestlé UK.

Nestlé responded to a letter writer [Baby Milk Action comments in green after the * symbol]:

[The bulk of this letter is quoted with regard to violation ref: comp/97/10] In the Philippines Nestlé's practices are fully in line with the requirements of the WHO Code and our Charter. Article 7.3 of the Code states that, No financial or material inducement to promote products within the scope of the Code should be offered by manufacturers...to health workers...., nor should these be accepted by health workers... Nestlé's practice is in full compliance with this requirement. We are also saddened that Baby Milk Action should see fit to misrepresent an issue in the Philippines regarding a television item, and are even more amazed because the incident occurred over 14 years ago! [*Nestlé is referring to another example of its meddling with the media in the Philippines, possibly the visit of the UNICEF Ambassadress of Goodwill for Breastfeeding, Liv Ulmann]. We believe that in all news items all aspects of the issue should be included.

Thank you for your further letters to Mr. Brabeck and Mr. Harris about our marketing of mineral water. The allegation made with regard to Valvert mineral water in Russia is not an infringement of the WHO Code, and our waters are not marketed as breast-milk substitutes. But in view of our policy of support for breast-feeding, we have decided that in future we will not make references to bottles and formula in materials produced. However, please note that thanks to its low mineral content Valvert is suitable for use with infants and this fact will be mentioned where appropriate. Yours sincerely Denise Briggs, BSc (Hons), SRD Specialist in Dietetics.

We kindly refer to your above mentioned letter and would like to answer as follows: We are an European company and produce baby food according to the guidelines of the EC. These guidelines correspond to the latest scientific findings for baby and infant food. Teas from the 1st week onwards: Fennel- and Camomile Tea are very popular with mothers because of the calming effect and have also been recommended and frequently used for a very long time. Teas for infants are not regulated in the EU-decree for baby food and there is no ESPGAN-comment on tea drinks either. Our teas include sugar and herbal extracts. According to the EU guide-lines it is allowed to use sugar for starting foods which are fed to babies from birth onwards. Therefore there are no reasons against feeding infants with teas including sugar. [* Hipp's logic is that infant formula is allowed to contain sugar and its teas also contain sugar, therefore they are suitable for infants!] In addition we would like to inform you that all our products sold in Russia are labelled with German/Russian lables [sic]. Best regards, Mag. Kaindlstorfer Marketing and Sales Director.

Thank you for your letter of the 29th October addressed to the Nestlé Chief Executive Officer, Mr. Peter Brabeck. We are about to appoint official importers in Armenia who will be aware of our responsibilities under the WHO Code. Up to now, many [* but not all?] Nestlé products are imported indirectly through traders in Europe and Russia. We are in the process of reviewing our distribution arrangements in Armenia [* so Nestlé is distributing?] which will enable the monitoring of compliance with the International Code. Thank you once again for bringing these matters to our attention. Yours sincerely Ralph Claydon Corporate Affairs Manager.

This is in response to your letter addressed to Mr. J. R. Stafford regarding Wyeth infant formulas in Kenya. I have been asked to reply to your concerns. Your letter states that our infant formula literature implies equivalence to breast milk. Your impression must be based on incorrect information. All of our literature for our infant formulas states that breast milk is best for babies and that infant formula is intended for babies who are not breast-fed. This is true regardless of where the literature is produced. We do not claim that our products are equivalent to breast milk, nor do we use misleading claims. In fact, all of our infant formula literature contains the wording required by Article 4.2 of the WHO Code. Our literature for health professionals is factual and scientific as per Article 7.2 of the WHO Code. Please be assured that we view our responsibilities regarding the WHO Code very seriously. We are committed to providing the highest quality products for babies who are not breast fed and we market those products in ways which do not interfere with the promotion of breast-feeding. We believe that decisions regarding infant feeding are best made by and informed mother with the advice of her health professional. Thank you for allowing us the opportunity to respond to your concerns. Sincerely, Beverly Halchak Director Maternal-Child Health.

I have been asked by Mr. Brabeck [Nestlé's Chief Executive Officer] to respond to your letter of 7th January concerning the marketing of Nestlé's weaning foods. First let me assure you that Nestlé does not market weaning foods in ways that undermine exclusive and sustained breastfeeding. Nestlé does however endorse WHO's International Code of Marketing of Breast-milk Substitutes and enforces company guidelines based on the Code in developing countries. Nestlé supports the Code because it was preceded by extensive consultation with all parties, ending in a negotiated consensus which included industry. The Code does not apply to any food, whether commercial or not, which is introduced during the weaning process, unless it is marketed as a breast-milk substitute. The official WHO recommendation for the introduction of weaning foods is 4 to 6 months of age. Therefore, Cerelac would fall outside of the scope of the Code i.e. Cerelac is marketed as a weaning food that should not be used before 4 to 6 months of age. Unfortunately the same scrutiny that was given to the Code was not used in the development of the World Health Assembly Resolution 49.15. Less than one third of Member States took part in the discussion of the text. No written scientific information was produced to justify the change in the official recommendation of WHO. However, since then activists have unilaterally used WHA Resolutions to claim that such Resolutions change the Code. WHO has acknowledge that Resolutions do not alter the Code. Secondly, I share your concern about the weaning period of a child's development. While I believe that Nestlé has been very responsible in its approach to the marketing of it's weaning foods, this in and of itself does not resolve the weaning dilemma that faces many mothers in the developing world. I was the founder and director of a hospital in the developing world that treated third degree malnutrition in children. Virtually all of these had been breast-fed. Let me hasten to say it was not the breast-milk that was inadequate but that most of the problems were related, in one way or another, to the critical period of the introduction of weaning foods. If we are to reduce morbidity, mortality and the awful consequences of growth faltering, solutions must be found to address the issues that surround the weaning dilemma. I feel that the solutions can be found by utilizing the resources and the cooperation of the private sectors, governments and international agencies. This is a very complex issue and I could gone on for pages... but I want [sic]. However if you would like to discuss this further I would be pleased to hear from you. Sincerely yours, Dr Thad M. Jackson.