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Intervention by Ms Tracey Wagner-Rizvi,
The Network for Consumer Protection in Pakistan

European Parliament
Committee on Development and Cooperation
22nd November 2000

President and Members of the European Parliament,

I am very pleased to have been invited to present to you information about how transnational corporations based in and exporting from the European Union are affecting the health and survival of infants in Pakistan and around the world.

I represent a public interest group called The Network for Consumer Protection in Pakistan. We are a member of the International Baby Food Action Network (IBFAN), a global network of over 150 groups in more than 90 countries. IBFAN has been working for more than 20 years for implementation of and compliance with internationally agreed marketing standards for the baby food industry.

I come here today with three requests of the European Parliament:

  1. That the Council Resolution and Export Directive on the marketing of breastmilk substitutes are reviewed so that they become effective tools to stop malpractice by European companies, wherever they operate outside the European Union.

  2. That the European Union does all that it can to support full implementation of the International Code of Marketing of Breastmilk Substitutes and subsequent, relevant Resolutions adopted by the World Health Assembly by every country as minimum requirements and works to incorporate these measures in international frameworks, such as Codex Alimentarius and the World Trade Organisation agreements.

  3. That a framework is set up, as proposed in the Code of Conduct paper, with an appropriate legal basis, so that governments, public-interest groups and individuals in third countries have a clearly defined set of procedures to follow to report violations.

Although we are discussing infant feeding in the context of dry regulations, the issue is actually about ensuring that mothers everywhere, including in Europe, are protected from commercial exploitation and enabled to make informed decisions about infant feeding.

WHO and UNICEF estimate that reversing the decline in breastfeeding could save the lives of 1.5 million infants around the world every year. Where water is unsafe an artificially-fed child is up to 25 times more likely to die as a result of diarrhoea than a breastfed child. Indeed, in a country like Pakistan, where nearly half the population does not have access to safe drinking water, breastfeeding, which provides protection against infections, can make the difference between life and death.

1. The European Union Council Resolution and Export Directive

The European Union's adoption of a Council Resolution and Directive has great potential, but let me share my experience of what happens when you try to use them.

In January 2000, The Network registered a complaint concerning labelling. The Export Directive says that "products shall be labelled in an appropriate language and in such a way as to avoid any risk of confusion between infant formula and follow-on formula". Our complaint stated that complete information in the local language (Urdu) is not available on the labels of Nestlé's Pre-Nan and that the colouring and design of the labels of Pre-Nan, Nan 1 and Nan 2 are similar to the point of being easily confused. Because only 24% of women in Pakistan can read, there is an increased likelihood of a mother giving this product (Nan 2) to her baby instead of this product (Nan 1). The higher level of salt and protein allowed in follow-on formula exacerbates the risk of dehydration and increases the renal solute load.

Nestlé is fully aware of the risks of such marketing and has promised for many years to phase out such product branding. Yet these products were introduced into Pakistan less than three years ago -- that is, more than 5 years after the adoption of the Export Directive.

The Netherlands Embassy say they have taken up the matter with Nestle but we are still awaiting a promised response from the company. I bought these in Islamabad on Sunday. This one was manufactured as recently as August . As you can see, the labels still violate the Directive.

I also complained to the European Commission because the Council Resolution says the Community will contribute to the application of appropriate marketing practices for breastmilk substitutes in third countries and references the International Code as the standard. Despite several exchanges of correspondence, the Commission has been unable to inform me who is the competent authority for registering complaints. As the International Code itself calls upon Non-Governmental Organisations (NGOs) to bring violations to the attention of concerned manufacturers and relevant authorities, then why does not the Commission? When the Council Resolution was adopted in 1992, IBFAN was led to believe that NGOs were included under the term "competent authority".

Sadly, other IBFAN groups in many other countries have faced similar difficulties. Reports have been made to the Commission and/or national authority as appropriate for violations in Argentina, Hungary, Indonesia, Kenya, Russia, Ukraine and Tanzania with no resulting action being taken.

2. Implementation of the International Code and Resolutions in legislation

I now come to my second point about the need for strong national legislation backed up by international frameworks. As the author of two reports about Pakistan in the last two years, I would like to explain the complex and devious ways that companies seek to expand markets in countries like Pakistan with scant regard for the impact on health and, when exposed, the lengths to which they will go to suppress evidence in order to maintain their company reputation.

Our evidence comes from extensive independent monitoring of company compliance with the International Code and Resolutions. Our nationwide survey covered 33 cities and towns, visiting 217 health facilities, 562 medical stores and interviewing 662 mothers and numerous health workers. A conservative estimate of one-to-one encounters is more than 2,500. We collected 400 specimens of promotional and informational materials and other objects. We also analysed product packaging.

The findings, published as the report "Feeding Fiasco", showed that not a single company was abiding by the International Code and Resolutions. It is necessary to keep in mind when discussing violations of the International Code, some of which appear insignificant to the uninformed, that each violation can result in a mother making decisions that will put her child's life at risk.

We found products that were not labelled in the correct language. Specialised formulas, such as Al-110 for lactose intolerant babies, being promoted to doctors as "A nutrition that helps prevent diarrhoea" when diarrhoea is more likely due to infection and mothers are best advised to breastfeed. We found gifts being given to doctors as inducements to promote products. One of the five company representatives we interviewed spoke of "Jackpots" - doctors or hospitals which will recommend a company's products for 6 months or a year in exchange for a cash payment. One hospital was even known as a "Lactogen hub" as promotion there had been so securely sewn up by Nestlé.

The company representatives we interviewed during the survey all wished to remain anonymous. Shortly before Feeding Fiasco was released, however, a former employee of Nestlé, Syed Aamar Raza, came forward with internal company documents that further substantiated the evidence published in Feeding Fiasco and again demonstrated the institutionalised nature of the malpractice. Executives' signatures appear on cheques used to bribe doctors and on the sales targets set for marketing staff, among many other things. Examples were subsequently published as the report "Milking Profits".

Nestle has gone to great lengths to keep this evidence out of the media. They have attempted to intimidate Syed Aamar Raza and have attacked his character in an attempt to distract from the substance of the evidence.

These two reports are not unique. Monitoring in other countries by IBFAN and others have exposed routine and systematic violations of the International Code and Resolutions around the world. If any of you have any doubt that there is a need for enforceable instruments implementing the International Code and Resolutions please read these reports. Companies have a moral obligation to abide by these measures, but are not legally bound until governments enact legislation to that effect. With legislation comes the power of enforcement and questions of interpretation can be resolved in the courts.

The Government of Pakistan has been preparing legislation to regulate baby food industry marketing since 1992. The delay in enactment has been caused at least in part by the interventions of the baby food industry, especially by Nestle. These companies have complained about the proposed law's "draconian clauses" and that the proposed law was being "shoved down the throat" of the industry. Their lobbying against the law has seen key sections weakened and the independence of monitoring bodies challenged. Industry representatives continue to meet with the Minister for Health and even the highest office of the land, the Chief Executive General Pervaiz Musharaf.

I am appalled that Nestle shows such disregard to the democratic process and this Committee that it has refused the invitation to appear on the panel here today, especially when Nestlé's Chairman, Helmut Maucher, told shareholders last year that the company welcomed these hearings. Instead we have a gentleman who can only speak about his very narrow experience with the company as a consultant for a short period earlier this year.

I would like to comment on the audit he prepared into the marketing practices of its Pakistan subsidiary. I have with me a detailed analysis of the audit report, the study's methodology and its findings, which is being publicly launched today. In short, the audit is a whitewash. For example, it uses Nestle's widely criticised interpretation of the International Code and subsequent Resolutions rather than the interpretation used by World Health Assembly and UNICEF. Its methodology is biased. Its conclusions are not supported by its findings. Too much evidence has been ignored. The company should answer these charges and address the real issues. Why are they not prepared to do so?

3. "Code of Conduct" provisions

As my third request, I would like to ask all MEPs to support the Committee in fully implementing the provisions in its Code of Conduct paper. The framework proposed could go a long way to implementing the International Code and Resolutions globally and protecting infant health . The European Union has a special role to play to ensure that the economic interests of companies in the world's richest countries do not take precedence over the health and well-being of the citizens of the rest of the world.

Thank you.

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