Q. (9 August 2006) What is the story behind the British Journal of Midwifery article being distributed by Nestlé?
A. Although it claims to be 'evidence based' the article is notably lacking in evidence and misrepresents or excludes the key facts....
Nestlé (UK) has posted an article from the British Journal of Midwifery in the 'Developing World Issues' section of its website and has been sending this out as part of its strategy to undermine action to hold it to account over its baby food marketing activities. (Apparently Nestle posted the article on its website without permission and was asked by BJM to remove it. Baby Milk Action has asked for permission to post it or link to it, but this has been denied. To obtain a copy of the article you have to register at the BJM site for which there is a fee - click here).
The article is entitled: "The Nestlé issue from an evidence based midwifery perspective". However, the most striking feature of the article is its lack of evidence.
It is based upon an expenses-paid visit made by the authors to Nestlé global HQ in Vevey, Switzerland. The 'evidence' presented to support Nestlé's claims that it is abiding by the marketing requirements for baby foods consists of assertions such as:
The fact that Nestlé misrepresents the Code and subsequent, relevant Resolutions of the World Health Assembly - and has been criticised for doing so by authorities such as UNICEF - is not considered.
The documentary evidence provided by global monitoring projects is not countered by anything that might have been made available to the midwives during their visit to the Nestle HQ. Rather than seeking to verify if the reports on systematic violations of the Code and Resolutions are true and get detailed evidence to the contrary, the authors simply state:
This is a very poor basis for dismissing the documentary evidence. It also denies the fact that monitoring conducted independently of Baby Milk Action and peer-reviewed studies in the British Medical Journal support our findings. In response to one such study UNICEF stated that the monitoring done by Baby Milk Action with its partners in the International Baby Food Action Network was 'vindicated'.
While claiming 'we cannot rely on one source', the authors draw selectively on the work of Lisa Newton Truth is the the Daughter of Time: The Real Story of the Nestle Case (1999) (click here - there is a fee to access this paper).
In several key areas important information from the Lisa Newton paper has been excluded or claims have been attributed to the wrong body. In addition the authors have not acknowledged information from other sources that conflicts with that given in the paper. In this response Baby Milk Action quotes the relevant text from the Lisa Newton paper and refers to the source documents to show how the history of the baby milk issue has been misrepresented.
Baby Milk Action asked the BJM to clarify the review process the article underwent as even the primary reference is so poorly used. We were told reviewers are not expected to check every reference and the editor could not say whether they would have, or even should have, read the Lisa Newton paper. This is very surprising given the article begins by stating: "Anyone who has a genuine desire to know the background to the boycott, rather than relying on the views of Baby Milk Action alone, should read the work of Lisa Newton Truth is the Daughter of Time: The Real Story of the Nestlé Case (1999)" and over 1,000 words of the article relate to the history covered by the paper. If the reviewers did indeed read the Lisa Newton paper then why were the errors and omissions documented in detail below allowed to remain in the article?
The authors appear to have an agenda in attempting to persuade midwives that Nestlé is complying with the marketing requirements. They state:
This not only shows a lack of solidarity for mothers and health workers around the world who experience the impact of Nestlé's aggressive marketing practices, it shows a lack of understanding of the World Health Assembly Resolutions on conflicts of interest and the provisions of the UK Infant Formula and Follow-on Formula Regulations 1995.
The authors also advocate Nestlé management techniques be imported to the National Health Service:
Before pressing their managers to follow Nestlé methods, midwives may find it wise to first consider the cases where Nestlé has locked out staff, sacked a workforce, denounced trade unionists as 'enemies of the company' (who have then been targetted by paramilitaries), ignored high court orders on negotiating with trade unions and closed down a factory as the bulk of the workforce was nearing retirement and trade unionists believe the company thought it cheaper to pay redundancy than pensions (you can listen to interviews with some of those affected by following the links in the full presentation of these cases below).
Nestlé is now using the article in its lobbying against action to hold it to account. The article was posted on the Nestlé website (without permission, it has emerged) and copies are being sent to Baby Milk Action's partners and others who question the company's practices.
The article states the group was: "invited to join a Nestlé nutritionist, Zelda Wilson, in a visit to Nestlé headquarters in Vevey, Switzerland, on a fact-finding mission."
However, Nestle's Senior Policy Advisor, Beverley Mirando, suggests their staff member led the team that produced the article. Beverley wrote in a cover letter sent with the article:
The article contains many factual errors and omissions. These will be discussed in detail below with links to supporting information and original documents.
Nestlé is an advertisers in the British Journal of Midwifery. In July 2004 Baby Milk Action reported an advertisement for Nestlé Nan HA infant formula that appeared in the magazine to the Advertising Standards Authority as we believed its claims to be misleading and we asked if they were supported by the references. Unfortunately the ASA told us that it does not investigate claims in marketing addressed to health professionals. We understand this is because the editors of the journal are assumed to be better qualified to check references. Two years later it was revealed on Canadian television that the study used to justify some of the claims had never even been conducted (see Nestlé Scientist's False Claims Exposed by Canadian Broadcasting Corporation (CBC)).
If you come across Nestlé using the BJM article in its PR campaign, please let us know.
The need to protect breastfeeding
The authors begin by giving an overview of the issue, drawing on materials favourable to Nestlé or produced by the company itself such as one of Nestlé's own booklets Infant Feeding in the Developing World (click here to download from the Nestlé website - please let us know if the link dies). The authors quote this as evidence for the claim that mothers in Sri Lanka use 'cow's milk and full cream milk powder' as substitutes, not infant formula.
The authors highlight that there are cases when breastmilk substitutes are necessary. This is not disputed (see our article Baby Milk Action is not anti-baby milk. Our work helps to protect all mothers and infants from irresponsible marketing - this predates the BJM article and it is unfortunate the authors did not reflect our position).
In the authors' history they refer to Dr Derrick B Jelliffe who did research in Jamaica in the 1960s and coined the term 'commerciogenic malnutrition' for malnutrition resulting from the aggressive marketing of breastmilk substitutes which encourages mothers and health workers to artificially feed rather than breastfeed.
Dr Jelliffe's findings continue to be supported. The following is taken from the UNICEF website (click here - accessed 26 July 2006 - let us know if the link dies):
Commercial influences - the promotion of baby foods in breach of the World Health Assembly International Code of Marketing of Breastmilk Substitutes and subsequent, relevant Resolutions - are accepted as part of the problem.
In countries where these measures have been implemented in legislation and independently monitored and enforced violations are stopped, which helps breastfeeding rates to recover. See, for example, UNICEF Progress of Nations 1999 (click here - let us know if this link dies), which states:
Where legislation does not exist or is not enforced, monitoring shows that aggressive marketing continues (as discussed below).
The Baby Killer trial
The authors refer to the Baby Killer booklet. They state:
The original version of the Baby Killer booklet can be downloaded by clicking here. This too acknowledges that formula is a legitimate product and that social changes are complex, but it also highlighted the evidence that marketing undermines breastfeeding:
The same type of promotional techniques are used today (see below). In the UK most mothers who stop breastfeeding early say they did not want to stop, but experienced problems. These problems can in the vast majority of cases be overcome if there is adequate support. Baby food companies exploit a mother's concerns, encourage supplementation of breastfeeding (which interferes with lactation) and promote formula as the solution when a mother experiences difficulties.
The authors of the BJM article present Nestlé's challenge to the Swiss version of the Baby Killer booklet as if Nestlé had disproved the claims against it:
This presentation is, at best, disingenuous. The truth is a little more complex. Nestlé sued on several charges, but experts attended the trial and substantiated the allegations of aggressive marketing.
Just as the two-year case was coming to an end in 1976 Nestlé withdrew three counts of its charge that the allegations were libellous.
This meant the claims could be repeated by campaigners. Nestlé clearly knew it would lose if it had pursued the case and according to The Guardian (28 June 1976 - click here to download) "Nestlé's chief executive, Arthur Fuerer, told jounalists last November that he and other directors concerned with the company's baby foods would resign in all probability if the claim that Nestlé's baby food advertising was 'unethical and immoral' was proved correct."
The final Judgement stated (translated by Berne Third World Action Group):
Nestlé won on the single remaining claim which was against the title, as translated, Nestlé Kills Babies.
In the opinion of the Judge:
In other words, Nestlé won on the grounds it was not guilty of premeditated killing.
Significantly the editors of Konzept who had published accusation in an article given the title The Gentle Killers were acquitted because they said that the title was directed not against Nestlé, but against the baby's feeding bottle (see letter from Nestlé referred to below).
The fact that this was a technical victory was evidenced by the fact that the defendants were fined a token amount of 300 Swiss Francs each.
Click here to download a scan of the Berne Third World Action Group translation of the key sections of the ruling (we have not been able to find the original court documents archived on-line).
Nestlé's Managing Director, A Furer, sent a letter to staff (click here for Berne Third World Action translation - letter dated 2 July 1976) in which he said:
Had Nestlé continued to challenge the substance of the allegations it is clear it would have lost.
The Lisa Newton paper which the authors used selectively does explain: "In June 1974, Nestle sued the [Swiss group] for libel on several counts, eventually narrowing them down to the title alone."
The authors of the BJM article do not give this important information, but simply state: "Nestlé sued and won but it damaged their public profile." The reader is, therefore, unaware of why the trial and the Judge's comments were so devastating to Nestlé.
Senate hearings into Nestlé
The year following the trial the Nestlé boycott was launched and the year after, in 1978, prompted by the boycott, Senator Edward Kennedy organised public hearings in the US Senate.
The authors state:
The insinuation is that Senator Kennedy was misled. However, Dr. Jelliffe was open in saying his 10 million figure was 'based on figures, but partly a guesstimate'. The Lisa Newton paper does give this information.
Dr. Jelliffe did not place all the blame on baby food companies, but said: "I regret to say that the promotion - and it is not just advertising - through the health services has been a very large part in this story."
Would the need for action have been any less compelling if Dr. Jelliffe had used the figure of 1.5 million deaths cited above, or the 1.3 million that lives that could be saved through breastfeeding in the 42 countries where most infant mortality occurs (as given in the Lancet study How many child deaths can we prevent this year? Lancet, Vol 362, July 5, 2003 (click here - you need to register to access the document)?
The most devastating impact on Nestlé's image came not from Nestlé's critics, however. It came from Oswaldo Ballarin, Chairman and President of Nestlé, Brazil, in the following exchange (one of several reported in a briefing by the Corporate Information Centre - click here to download a scan of the briefing):
Dr. Ballarin attacked the health experts who had spoken of the impact of aggressive marketing on infant feeding practices. According to The Washington Post (24 May 1978 - click here to download a scan):
Senator Kennedy had opened the hearing asking:
WHO/UNICEF collaborative Study into breastfeeding
Following the hearing Senator Kennedy asked WHO and UNICEF to look into the matter at international level. A meeting was held in 1979 under the auspices of WHO and UNICEF to discuss a solution, involving health experts, campaigning groups and the industry.
WHO and UNICEF prepared the first phase of a study on breastfeeding for the meeting. The authors of the BJM article state:
This claim is not made in the collaborative study. The Lisa Newton paper (page 374) gives the statement in a quote attributed to Dana Raphael of the Human Lactation Center based on her own research. If the BJM reviewers looked only to the primary reference, the Lisa Newton paper, they should have seen the authors were incorrectly attributing the claim to the collaborative study. However, when asked the editor of BJM could not say whether the reviewers had read the paper.
The WHO/UNICEF collaborative study (click here for PubMed entry) itself speaks of significant bottle-feeding, even amongst poor groups, which were classified as:
Group A: Economically advantaged, educated families in an urban area.
Group C: Poor, disadvantaged and usually poorly educated families in an urban area.
Group R: Families in rural areas, usually following a traditional way of life and often dependent on subsistence agriculture and local marketing.
The influence of relatives on decisions to give supplementary feeds was considerable, along with medical advice. 'Advice from husbands, friends or from the media was not commonly quoted in any country or group'. [page 41] (subsequent studies have found a link between promotional materials and infant feeding decisions - click here for details).
An impact from free supplies was found:
Free gifts of milk or feeding bottles in health facilities were investigated:
National or international aid organisations were also distributing foods in some countries in the study.
Companies donated large amounts through the health care system:
Today it is found that products such as Nestlé Nido whole milk is displayed in infant feeding sections alongside infant formula, which can cost three times the price. Poor mothers are more likely to purchase the whole milk, which is unsuitable for infant feeding (click here for details). The same approach was found in the collaborative study:
The study noted that the most common reasons cited for supplementation were problems such as 'lack of milk' and 'child will grow better' [page 40]. 'Milk or milk-based products' were the most common supplements given' (no breakdown of milk-based products into infant formula, other breastmilk substitutes and whole milk is given).
So while there are factors other than marketing by baby food companies at play, aggressive marketing was found to be widespread as was significant use of feeding bottles with milk or milk-based products.
The authors of the BJM article have not given a true impression of the collaborative study by misapplying the Dana Raphael quote to it.
The authors continue regarding the collaborative study:
This is quoting from the Lisa Newton paper, but the authors omit the sentence that follows: "Babies still got sick from environmental contamination, but mothers were able to take sick babies to clinics for rehydration, vitamins, and antibiotics, and these simple remedies were saving children who otherwise would have died."
The WHO/UNICEF meeting that considered the collaborative study issued a statement (click here to download) which said:
The statement opened:
Development of the International Code
The authors of the BJM article state:
This is inaccurate and misleading. The Lisa Newton paper (page 376) explains accurately:
It was the industry that was proceeding with its own Code instead of accepting the consensus of a Code developed under the auspices of WHO. Again, the authors have misrepresented the history as set out in their primary reference, the Lisa Newton paper, and this does not appear to have been spotted by the reviewers.
The actual statement adopted by consensus at the 1979 meeting states (click here to download):
From the start, NGOs were invited participants in the process. As WHO's invitation letter (15 March 1979) to War on Want (one of the founders of the Baby Milk Action Coalition) states (click here to download):
So Non-Governmental Organisations (NGOs), including a founders of Baby Milk Action, were a legitimate part of the consultation.
The authors of the BJM article imply, however, the NGOs somehow acted in bad faith stating:
This is inaccurate on several counts. The consensus was for a Code developed under the auspices of WHO (not a voluntary code developed by industry) and NGOs were invited to participate in its development. IBFAN was formed by 6 groups at the initial 1979 meeting to do so. The boycott had already been launched in 1977 in the US and rapidly spread to other countries. National coordinating organisations only formed INBC when discussions started with Nestlé about ending the first boycott in 1984.
The industry opposed the measures in the draft Code, just as health advocates were calling for loopholes to be removed.
In a 1981 submission the International Council of Infant Food Industries (of which Nestlé Vice-President, Ernest Saunders, was President) set out its Summary position statement re proposed WHO International Code for the Marketing of Breast Milk Substitutes (click here to download). This included:
ICIFI also submitted detailed commentaries and responses to the arguments of health advocates - or the industry's misrepresentation of these. One such document submitted by ICIFI in March 1981 provides an insight into company thinking on its target market for breastmilk substitutes. Click here to download pages from Feeding Babies in the Third World - Industry Responds to Misinformation. This includes:
So the industry, led by Nestle, was arguing that the majority of mothers in poor communities would need to use breastmilk substitutes.
As the Lancet study referred to above makes clear, promotion of exclusive breastfeeding for the first six months followed by continued breastfeeding with local complementary foods into the second year of life and beyond could prevent 13% of under-five deaths in the 42 countries where the majority of these deaths occur. Appropriate complementary feeding, including an end to introduction before 6 months, could save an additional 6%.
Even today Nestlé targets pregnant and lactating women suggesting they will be unable to breastfeed unless they take expensive food supplements themselves or supplement breastfeeding with formula (see examples in the codewatch section).
It would perhaps have been useful if the authors of the BJM article had informed their readers of Nestlé's view of the Code. Nestlé Vice President, Ernest Saunders, as the head of ICIFI and wrote to the President of the World Health Assembly with the industry view, which included (click here to download the full letter):
So much for the consensus the authors of the BJM article claim existed between industry and governments and was not being respected by IBFAN.
In the discussion in the Assembly over the Code many governments stressed the importance of strong marketing requirements. Click here to download a contemporary compilation of government quotes. These include:
Mrs. Indira Ghandi
Fortunately the industry attack on the Code failed and it was adopted by 118 votes to one against (the United States) with three abstentions.
Click here for the Resolution 34.22 adopting the Code as a minimum requirement for all countries, to be implemented in its entirety.
The boycott was launched in 1977 in the United States and rapidly spread to other countries.
The first boycott was called off in 1984 after Nestlé gave undertakings to the International Nestlé Boycott Committee (INBC) and Nestlé claims that today only extremists are keeping it going. Yet Nestlé not only broke the 1984 agreement, prompting the re-launch of the boycott in 1988, but continues to break it. For example:
The authors of the BJM article suggests support for the boycott had ended. They state:
The situation with the Church of England is again more complex than the authors present. In 1994, after Nestlé aggressively opposed a move at the Synod for disinvestment, confused as to who to believe, the Church suspended its support for the boycott while conducting its own monitoring independently of Baby Milk Action (see the details of the Cracking the Code report below). This monitoring found 'systematic' violations by Nestlé and other companies. UNICEF said our monitoring was 'vindicated'.
However, when the issue came back to Synod in 1997 it decided against resuming support for the boycott in favour of trying to use its investment in Nestlé to exert pressure. The implication by the authors that the Church withdrew support because it thought Nestlé malpractice had stopped is disingenuous.
Many other groups in the UK were and are supporting the boycott. A list of endorsers can be found by clicking here. In June 2006, the Methodist Conference adopted text stating that in addition to trying to 'engage' with Nestlé to prompt change (click here for full details):
The authors of the BJM article imply the boycott is only active in the UK. In the abstract it states:
The boycott was not rejected in 1989. In June 1988 our US partner gave Nestlé until the end of October to address the specific practice of distributing free and low-cost supplies. Nestlé failed to do so and the boycott was relaunched by groups in the US, Germany and Canada at the end of October. Groups in Ireland, Finland, Mauritius, Mexico, Norway, Sweden, and the UK launched the boycott in 1989. One might have thought the authors would have asked INBC about the history of the boycott or looked at the chronology of the campaign on the IBFAN website.
The second boycott has now been launched by groups in 20 countries, including in Cameroon, Africa, after campaigners found Nestlé promoting formula in health centres. It is possible to hear interviews with boycotters in Europe in the broadcasts section.
Thanks to the support of boycotters around the world, Nestlé is today one of the four most boycotted companies on the planet. The Guardian newspaper reported on 1 September 2005:
Nestlé won a global internet poll for the world's 'least responsible company' coinciding with the World Economic Forum in Davos in January 2005. Nestlé received 29% of the votes. This was more than twice that of joint second Monsanto and Dow Chemicals (of Bhopal infamy), each on 14% (click here for details).
The boycott keeps this issue in the public eye and the pressure on Nestlé. During national demonstrations in 2003 Nestlé agreed to stop promoting complementary foods from too early an age. Baby Milk Action had been asking for this since 1994 when the World Health Assembly called for complementary feeding to be fostered from about 6 months, not earlier. Click here for details.
In 2000 after exposure on national television Nestlé agreed to label products in the appropriate language for where they are sold - 19 years after the Code made this a requirement. Click here for details.
Baby Milk Action has put a four-point-plan to Nestlé aimed at saving infant lives and ultimately ending the boycott. Nestlé refuses to accept the first point - that it should be abiding by the Code and Resolutions - or the second point - that it needs to make changes to its policy and practices to bring them into line. If it did so we would then discuss the timetable for it making necessary changes and, if there were no violations for 18 months, would call off the boycott with our partners in the International Nestlé Boycott Committee. It is imperative to keep up the pressure.
Campaigns against malpractice by other companies
The authors of the BJM article state:
It is a little difficult to understand this reasoning.
The authors are aware of malpractice by other companies because Baby Milk Action and IBFAN conduct global monitoring projects and launch reports exposing violations, bringing malpractice to media and public attention. Companies are shamed and excluded from ethical investment lists.
The report referred to was launched at the House of Commons - click here for IBFAN's press release. A DVD of the launch is available in the on-line Virtual Shop and is used to expose the practices of the biggest baby food companies.
The reason for singling Nestlé out for boycott action is a matter of public record - for example, see the boycott section of this website. An evidence-based article would surely have answered this question instead of leaving it hanging. The authors might have thought to ask Baby Milk Action if they did not know the answer. Nestlé is targetted with the boycott because monitoring conducted by IBFAN finds it to be responsible for more violations of the World Health Assembly marketing requirements for baby foods than any other company.
As well as the reports and media campaigns which alerted the BJM article authors to malpractice by other companies, Baby Milk Action uses letter writing campaigns. See the Campaign for Ethical Marketing action sheets.
The authors refer to the case of the prosecution Wyeth for illegal advertising in the UK. Again the authors are aware of this case because of the work of Baby Milk Action. Our materials were used in court by the prosecution and we attended the 8-day hearing to report on it ourselves and to raise awareness in the media. Click here for our press release on the case. This links to some of the media coverage we generated.
Baby Milk Action actively monitors baby food companies in the UK, coordinating a monitoring project on behalf of the Baby Feeding Law Group (click here for details). We report cases to the Advertising Standards Authority, Ofcom and Trading Standards as appropriate.
In addition Baby Milk Action and IBFAN work for implementation of the marketing requirements in legislation, in the face of lobbying (principally by Nestlé) opposing independently monitored and enforced measures in favour of voluntary codes of conduct.
The boycott of Nestlé is one strategy amongst many used to hold the baby food industry as a whole to account.
Nestlé's misrepresentation of the Code
The authors of the BJM article went on an expenses-paid trip to Nestlé's global HQ in Vevey, Switzerland and met with staff.
Although the article claims "all the professionals that we met appeared to be very open, honest and eager to answer our difficult and challenging questions" there appears to have been no critical analysis of the assurances given by Nestlé.
For example, reference is made to the Nestlé Instructions for the Implementation of the WHO International Code of Marketing of Breastmilk Substitutes and these are portrayed as being in line with the Code.
The International Baby Food Action Network (IBFAN) has conducted an in-depth legal analysis of the Nestlé Instructions against the Code and subsequent, relevant Resolutions and discovered numerous shortcomings - click here for the full analysis.
Similar findings were made in a legal review commissioned by IBFAN conducted by an outside legal expert - click here for the full review.
Independently UNICEF has written to Nestlé (click here) and presented evidence at a European Parliament public hearing on some of the ways in which the Instructions misrepresent and fall short of the provisions of the Code and Resolutions (click here).
Evidence of on-going malpractice
The authors of the BJM article suggest that Nestlé malpractice is in the past. They ask:
As mentioned above a four-point-plan has been put to Nestlé aimed at saving infant lives and ultimately ending the boycott. This has been rejected by Nestlé as it refuses to accept the validity of the Code and Resolutions and that it needs to change its policies and practices to bring them into line.
The fact Nestlé policies are not in line has been addressed above.
The fact Nestlé systematically violates the Code and Resolutions in its practices is demonstrated by monitoring evidence.
Mention is made by the authors of the monitoring conducted by Baby Milk Action and IBFAN.
IBFAN consists of over 200 groups in more than 100 countries. Groups monitor what is happening in their communities, report violations to governments and companies (as they are mandated to do under Article 11.4 of the International Code) and periodically global reports are produced with examples of violations.
The report Breaking the Rules, Stretching the Rules 2004 included examples from 69 countries. Of the 16 companies profiled Nestlé was found to be responsible for more violations than any other company and to have violated more provisions of the Code and Resolutions than any other company. This is why Nestlé is singled out for boycott action. Other companies are targeted by exposés, such as the monitoring report, and letter-writing campaigns, such as Baby Milk Action's Campaign for Ethical Marketing action sheet.
The case against Nestlé is evidenced based. The BJM article concludes 'reliance on Baby Milk Action alone is not professionally sound'. Yet it is possible for midwives and members of the public to view the evidence for themselves. Much of it consists of the promotional materials produced by baby food companies. In the monitoring reports and elsewhere we analyse and explain how the materials violate the Code and Resolutions, so undermining breastfeeding and hiding the risks of artificial feeding. The authors of the article make no comment on whether they have viewed this documentary evidence or disagreed with the analysis.
Nestlé does, of course, disagree with IBFAN's evidence. This prompted the Church of England to join together with other faith, development and academic organisations to conduct independent research. The 27-member Interagency Group on Breastfeeding Monitoring (IGBM) published the report Cracking the Code in 1997, noting 'systematic' violations by Nestlé and other companies (click here). UNICEF commented that IBFAN's monitoring was 'vindicated'.
The British Medical Journal has published peer-reviewed studies based on this (click here) and other monitoring (click here).
The authors of the BJM article did not have to look very far for the desired other sources of information as the Lisa Newton paper refers to both IGBM's monitoring results and UNICEF's letter to Nestle setting out "the oustanding and significant differences in our views on the content and application of the International code" (page 384). The authors not only excluded this information from their article, but suggested the only source of criticism is Baby Milk Action.
The evidence is there for those prepared to look at it.
The ethical investment sector
Thanks to the documentary evidence of malpractice every credible ethical investment organisation in the world excludes Nestlé from its lists. If the authors had examined the criteria for the FTSE4Good listing, for example, they would have seen that the Nestlé Instructions do not comply with the policy section.
The only organisation that does include Nestlé is the one mentioned by the authors: GES Investment Services. GES is unusual in that it refuses to consider independent monitoring evidence, it only accepts reports from companies (click here for further details).
Of course, Nestlé's reports and the audits it commissions to its own Instructions (rather than the Code and Resolutions) clear Nestlé of most wrong-doing. Again IBFAN has prepared an in-depth analysis of the one report made public by Nestlé (that of Emerging Market Economics) into Nestlé activities in Pakistan and exposed its shortcomings.
Relevant issues missing from the BJM article
Important points included in the Lisa Newton paper but excluded or misrepresented in the article. Aside from these there are many other issues an evidence-based article could have included.
For example, in 1999 Nestlé published and distributed around the world a book of letters which it claimed were official verification by governments that Nestlé complies with the Code. This quickly became an embarrassment for Nestlé as it became clear the letters were no such thing. Far from commenting after a detailed analysis of Nestlé marketing policies and practices, as the company claimed, many of the letters were simply thanking Nestlé for attending a meeting or setting out the way the government had implemented the marketing code. Nestlé had to apologise for misrepresenting the letter from Denmark, which made no mention of Nestlé marketing. Click here for a detailed analysis.
Baby Milk Action has never faced a legal challenge from Nestlé. We write to it frequently to raise our concerns and take part in public debates, where Nestlé has been defeated time after time (click here or borrow a video or listen to radio interviews).
We have also invited Nestlé to participate in an independent, expert tribunal which could go over the evidence in depth, calling witnesses as necessary. Nestlé has refused to even discuss the terms of reference for such a tribunal. Why? Because it knows its claims do not stand up to scrutiny. Click here to send a message calling for Nestlé to attend.
In 1999 we won a case before the Advertising Standards Authority after Nestlé published an anti-boycott advertisement in which it claimed it markets infant formula 'ethically and responsibly'. All our complaints were upheld, but Nestlé continues to make similar claims in its public relations materials which cannot be challenged before the ASA. (click here for details of the complaints and here for the final ruling and here for the Chief Executive's response).
Authors desire for further funding from Nestlé
The authors of the BJM article appear to have an agenda of seeking funding from Nestlé, stating:
Analysis of materials shows these often contain misleading messages and promote the company name. The World Health Assembly has adopted Resolutions 49.15 and Resolution 58.32 calling for care over conflicts of interest. Taking action to bring Nestlé materials onto the wards and into pre- and post-natal classes inevitably presents a conflict of interests.
It is also worth reminding midwives that under the UK Infant Formula and Follow-on Formula Regulations 1995 information materials can only be provided by companies if explicitly requested and they have the written approval of the Secretary of State for Health and approved. Article 21 states:
As guidelines have not been issued companies producing information and educational materials should be able to produce a letter from the Secretary of State approving the donation. If they cannot, they are breaking the law (Baby Milk Action has urged the UK authorities to take action over such cases).
It is Baby Milk Action's view that it is far better for midwives to advocate the NHS produce any materials that are necessary than seeking to bring Nestlé materials into the health service.
It is worth recalling that for many years the Indian Paediatric Association refused to accept funding from baby food companies and this is now enshrined in law.
In Brazil, a country that is only now recovering breastfeeding rates thanks in part to strong law and monitoring systems for the Code and Resolutions, the provision of company-sponsored materials is illegal.
It is not surprising that Nestle was apparently urging the authors on this visit to accept Nestle materials - it is one of the company's favoured promotional techniques to link its name with the health care system.
The named lead author has worked with Nestle in the past on a breastfeeding video which was presented to midwives with the suggestion they question their support for the boycott (see Update 36).
Nestlé management techniques
The authors advocate Nestlé management techniques be imported to the National Health Service:
Before pressing their managers to follow Nestlé methods, midwives may find it wise to first consider the following cases:
While Nestlé may argue some of these tactics are normal business practices, midwives may wish to consider carefully whether it is so wise to advocate Nestlé-style management techniques be applied in the NHS.
The Lisa Newton paper
The authors of the BJM article have taken aspects of the Lisa Newton paper out of context, confused issues and misapplied quotes. The flaws with the paper itself are less glaring (it can be purchased by clicking here).
Although it is also selective in its presentation of issues such as the Baby Killer trial and the WHO/UNICEF collaborative study, its central argument is that health advocates were mistaken to believe what Lisa Newton refers to as the 'Jelliffe scenario' - that irresponsible marketing of baby foods undermines breastfeeding and contributes to the unnecessary death and suffering of infants. Evidence gathered since then, and the success in reversing the decline in breastfeeding where aggressive promotion has been stopped, support Dr. Jelliffe's view, even if the figures of infants affected are different to his original 'guesstimate'. Lisa Newton, however, states: "as far as we can tell, the advertising and other promotional practices of the infant formula companies have little to do with any mother's choice to bottle or breast feed".
Lisa Newton's dismissal of the role of aggressive marketing on undermining breastfeeding is principally based on a study by Dana Raphael: "The fact that the despised infant formula maufacturing corporations, whose research departments missed nothing, pounced on the findings of their own innocence and trumpeted the results to the Kennedy Hearings and to anyone else who would listen, only made the findings more suspect." The fact that there was contradictory evidence was surely more significant. However, the issue of industry involvement in distributing the Raphael study was indeed questioned by activists such as Fred Clarkson in an article in the Fairfield County Advocate in 1983 (click here to download). After the initial grant used for the study ran out, Raphael's Human Lactation Center was largely financed by the industry purchasing its papers and later making direct grants, according to Clarkson, particularly during the critical time when the Code was being developed.
Lisa Newton takes the cynical view that NGOs maintain the controversy to maintain their power and quotes the bizarre suggestion: "NGOs are able to push around even the largest governments". Those who support Baby Milk Action's campaigns to bring in legislation will know how hard this is to achieve, particularly in the face of lobbying by transnational corporations with public relations budgets many many times larger than our entire operating budget (Nestle's turnover is about £39 billion and it spends about 15% on marketing and public relations - more in 15 minutes than Baby Milk Action's annual operating budget).
She describes the boycott as 'senseless'. Yet it has very clear objectives. As described above Baby Milk Action has put a four-point plan to Nestle to save infant lives and ultimately end the boycott. The plan asks nothing unreasonable from Nestle, other than the apparently impossible requirement that it stops putting its own profits before infant health. If it accepted the validity of the Code and Resolutions and brought its policy and practices into line there would be no more violations and the boycott would end.
Calling on Nestle to marketing breastmilk substitutes appropriately does not deny that they are legitimate products, nor are health advocates 'anti-industry' as Lisa Newton suggests.
To date Nestle gives every impression of having taken a strategic decision to continue aggressive marketing to grow its market at the expense of breastfeeding. The marketing requirements seem to be seen as an inconvenience to be watered down in internal policies and in lobbying against legislation. The efforts of health advocates are undermined through a strategy of denials and deception and investing in persuading third parties to come to the defence of the company in articles such as that published by the BJM.
How did the BJM article come about?
Nestlé is using the BJM article in its lobbying of Baby Milk Action partner organisations.
The article states the group producing the article was: "invited to join a Nestlé nutritionist, Zelda Wilson, in a visit to Nestlé headquarters in Vevey, Switzerland, on a fact-finding mission."
While admitting that travel, accommodation and food was funded by Nestlé, there is a closer relationship with Nestle.
Zelda Wilson earlier worked with one of the named authors, Chris Sidgwick, on a video project as part of a strategy aimed at improving Nestle's image. In a paper describing the launch in 2004 Chris Sidgwick commented:
Describing one launch event, Chris Sidgwick, wrote:
Nestle's Senior Policy Advisor, Beverley Mirando, suggests that their staff member led the team that produced the article, writing in one letter (click here to download):
The authors open the article stating:
Hopefully midwives will be reassured by the evidence presented above and continue to support action to hold the baby food industry to account and the Nestlé boycott.
They may also wish to reflect on whether the authors of the article have complied with the points they highlight in the NMC Code of professional conduct in producing their article, or whether they should have questioned Nestlé's assurances and investigated whether they could be substantiated.
The way in which information from their primary reference, the Lisa Newton paper, has been misrepresented is also a cause for concern: the misapplication of comments made by Dana Rapahel to WHO/UNICEF, the confusion over the 'consensus' arising from the 1979 meeting, the incomplete information regarding the Baby Killer trial, the failure to relate the criticisms of organisations such as IGBM and UNICEF.
Baby Milk Action asked the BJM to clarify the review process the article underwent as even the primary reference is so poorly used. We were told reviewers are not expected to check every reference and the editor could not say whether they would have, or even should have, read the Lisa Newton paper. This is very surprising given the article begins by stating: "Anyone who has a genuine desire to know the background to the boycott, rather than relying on the views of Baby Milk Action alone, should read the work of Lisa Newton Truth is the Daughter of Time: The Real Story of the Nestlé Case (1999)" and over 1,000 words of the article relate to the history covered by the paper. If the reviewers did indeed read the Lisa Newton paper then why were the above errors and omissions allowed to remain in the article?
Baby Milk Action has asked the named lead author and the editor of the BJM to extend an invitation to all those associated with the article to comment on this critique of their article (a courtesy not extended to Baby Milk Action). The editor refused to pass on our invitation, saying it was not her role and, at the time of writing, we have had no response from the named lead author. Should we receive any responses we will post them at the foot of this page if appropriate. We are also requesting the BJM publish an edited version of this critique with equal prominence to the article.
NestlÚ is an advertisers in the British Journal of Midwifery. In July 2004 Baby Milk Action reported an advertisement for NestlÚ Nan HA infant formula that appeared in the magazine to the Advertising Standards Authority as we believed its claims to be misleading and we asked if they were supported by the references. Unfortunately the ASA told us that it does not investigate claims in marketing addressed to health professionals. We understand this is because the editors of the journal are assumed to be better qualified to check references. Two years later it was revealed on Canadian television that the study used to justify some of the claims had never even been conducted (see NestlÚ Scientist's False Claims Exposed by Canadian Broadcasting Corporation (CBC)).
Conclusion - look to the evidence
Baby Milk Action has no concern about midwives looking to the evidence for the campaign against Nestlé. It is a concern that the authors of the BJM article claim to have done so, but have produced a highly flawed text. The flaws raise questions about the peer-review process the article underwent. Did the reviewers even read the reference on which over 1,000 words of the article are based, let alone question why other sources were excluded? And if they did read the Lisa Newton paper, why did they not ask for a re-write of the article to correct the errors described above?
Perhaps if the authors had looked to the documentary evidence and spoken to Baby Milk Action and those who are living day by day with Nestlé malpractice and its impact on mothers and families in their communities there would not be so many errors and omissions.
Nestlé's involvement in funding the initiative and misleading those involved comes as no surprise. We have seen similar tactics many times as Nestlé tries to divert criticism instead of making the necessary changes to its baby food marketing policies and practices.
While it has been interesting and useful to prepare this material, it has diverted staff time and resources from the work we had planned. Further staff time will be lost as we try to bring these facts to the attention of anyone who may have been targeted by Nestlé using the BJM article. Nestlé will be able to use the article for years to come not only in the UK, but around the world and in many cases we will not be aware of this and so will be unable to set the record straight. The authors and the BJM has done a disservice to mothers and infants.
Baby Milk Action relies on public support to keep operating and meet these challenges. If you are able to help by becoming a member, sending a donation or buying some merchandise, please visit our on-line Virtual Shop. In any case, please spread the word to inform your colleagues that the BJM article gives a false presentation of the baby milk issue and the past and present involvement of Nestlé and Baby Milk Action. If you come across Nestlé using the article to try to undermine our work, please do let us know.
See Baby Milk Action's briefing paper Nestlé's Public Relations Machine Exposed and the Cornerhouse briefing paper Engineering of Consent for further background.
For further information contact us.
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