Your questions answered Got a question? You may find the answer below. Also see the briefing papers and other publications in the resources section or look at the behaviour of companies in the codewatch section. If you can't find the answer to your question or our answers raise others then contact us. Most recent posting: 2 November 2005 Q. On what basis has Novartis/Gerber been included in the FTSE4Good ethical listing if it is still violating the baby food marketing requirements? Q. What about mothers who cannot or don't want to breastfeed? Don't you care about them and their infants? Q. Is it wrong of companies to cut the price of their breastmilk substitutes? Q. Doesn't HIV change the situation? Q. What is the legal status of the International Code and Resolutions? Q. Where does this figure of 1.5 million infant deaths per year come from and why is it being dismissed by Nestle?

Q. Where does this figure of 1.5 million infant deaths per year come from and why is it being dismissed by Nestle?

A. (5 August 2004) According to WHO and UNICEF...

The World Health Organisation estimates that 1.5 million infants die around the world every year because they are not breastfed. This figure has been stated in this and other forms by WHO and UNICEF many times over the years.

For example, see UNICEF's publication State of the World's Children 2001 which states:

"Improved breastfeeding practices and reduction of artificial feeding could save an estimated 1.5 million children a year."

The UNICEF statistics website states:

"It has been estimated that improved breastfeeding practices could save some 1.5 million children a year. Yet few of the 129 million babies born each year receive optimal breastfeeding and some are not breastfed at all. Early cessation of breastfeeding in favour of commercial breastmilk substitutes, needless supplementation, and poorly timed complementary practices are still too common. Professional and commercial influences combine to discourage breastfeeding, as do continued gaps in maternity legislation."

In a 1997 press release (14th January 1997), in response to the monitoring report Cracking the Code, UNICEF stated:

"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."

In 1995 Baby Milk Action was required to defend the statistic before the Advertising Standards Authority after stating in a Nestle boycott advertisement:

"Every day, more than 4,000 babies die because they're not breastfed. That's not conjecture, it's UNICEF fact."

We did so successfully and, as the ASA report notes, this was with the support of WHO.

At the World Health Assembly in May 2001 WHO presented its Global Strategy for Infant and Young Child Feeding (download as a pdf file for reading with Acrobat Reader from the WHO site). This report opens:

"Some 1.5 million children still die every year because they are inappropriately fed, less than 35% of infants worldwide are exclusively breastfed for the first four months of life, and complementary feeding practices are frequently inappropriate and unsafe."

Although not from WHO, a study published in the Lancet provides another view. The study How many child deaths can we prevent this year? Lancet, Vol 362, July 5, 2003 (click here - you will have to register before you can access the document) considered under-5 deaths in 42 countries (accounting for 90% of all under-5 deaths). Many of the over 10 million under-5 deaths occuring in these countries are preventable using presently available interventions.

Topping the list of interventions is breastfeeding, which the authors estimate could prevent 13% of these deaths, saving 1.3 million lives in the 42 countries.

Researchers note: "Promotion of breastfeeding in countries with a high prevalence of HIV among women of reproductive age may increase mother-to-child transmission of this virus. This drawback was taken into account in the modelling exercise; otherwise, breastfeeding would have been estimated to prevent 15% instead of 13% of child deaths." This demonstrates the importance of the World Health Assmebly guidance on infant feeding advice for mothers infected with HIV (see the YQA Doesn't HIV change the situation?). Following such guidance would help to reduce the risk of transmission and increase the number of lives saved still further.

Nestlé disputes the facts

On its website Nestlé is attempting to dismiss this death and suffering. It selectively quotes from a WHO letter from November 1992 which criticised the way the statistic had been interpreted in materials produced by a boycott group in the United States.

WHO objected to the statement: "The World Health Organisation (WHO) estimates that 1.5 million babies die each year of bottle baby disease resulting from the use of infant formula." WHO stated in its letter that the term "bottle baby disease" is imprecise and that its figure of infant deaths relates to infants not breastfed.

This is because the estimate does not specifically state that the infants were fed infant formula. They may have been fed follow-on formula, whole milks, cereals or unprocessed animal milks. Research demonstrates that introducing any of these substances where water supplies are unsafe increases risk of death from diarrhoea and malnutrition. Risk increases as more substances are introduced and breastfeeding is reduced. An artificially-fed child is up to 25 times more likely to die as a result of diarrhoea than a breastfed child.

Unsafe bottle feeding may, therefore, involve substances other than infant formula. This is why the Code calls for warning labels on products which are not suitable for use from birth (Article 9.3).

World Health Assembly Resolution WHA 49.15 extends this to other baby foods by stating there should be measures: "to ensure that complementary foods are not marketed or used in ways that undermine exclusive and sustained breastfeeding."

Unfortunately companies have ignored this and other Resolutions by promoting complementary foods for use from too early an age and continuing to put pictures of young infants on labels. There is concern that illiterate mothers use inappropriate milks or cereal products from birth because of the picture of the healthy baby on the label and some countries now ban such pictures.

Baby Milk Action has also highlighted cases of whole milks which have not included warnings stating that the product should not be used for infant feeding (see the case of Nestlé Nido in Armenia, for example).

Nestlé does not address these issues, but mis-uses the WHO letter of November 1992 in an attempt to suggest that any infant that dies from unsafe bottle feeding was being fed unprocessed animal milk.

Profits before health

Nestlé also refuses to acknowledge the role the baby food industry has played in changing breastfeeding cultures into bottle-feeding cultures. 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%. 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"

The decline in breastfeeding is at the root of the problem we are addressing. UNICEF stated in State of the World's Children 1991 (page 24):

"Reversing the decline of breastfeeding in the developing world could save the lives of an estimated 1.5 million lives every year."

Yet, Nestlé continues in its attempts to increase sales. It states in its third-quarter statement on 20th October 2000:

"Milks and nutrition saw good progress, mainly as a result of infant nutrition sales in Asia and of the powdered milk business."

The baby food industry sees a massive market to be tapped in many developing countries where breastfeeding is still common. Instead of reversing the decline in breastfeeding, breastfeeding will decline further if the baby food industry is not stopped from its aggressive practices. Not all will be buying infant formula, which can cost half a families income in a poor country. A mother who aspires to the 'modern way' or who experiences problems breastfeeding after her confidence is destroyed may well seek cheaper alternatives.

UNICEF warned of the impact of this in State of the World's Children 1991:

"In the industrialized world, after a steep decline, there is today a pronounced trend back towards breastfeeding. A similar decline in the developing world, where bottle feeding entails much greater risks, would lead to millions of infant deaths."

---

Have we answered the question?
Has our answer prompted further questions?
Please send us an email to let us know.