Baby Milk Action Update 19, August 1996

Issue number 19: August 1996

The news items which appear on this page are abridged versions of stories which appear in full in the printed version of Update, which is available to members of Baby Milk Action. Membership costs just £18 waged, £7 unwaged, £25 family, £50 organisations - for prices in other countries, please contact us.

International News

Monitoring works

By keeping an eye on the Internet, Lactivist, Ros Escott was able to get a Japanese bottle feeding competition stopped. Reported in "Tokyo Newspaper" on July 23, the infant feeding bottles manufacturer, 'Pigeon' planned to hold a Baby Olympics. Called 'Neo Baby Pigeonpic' it was to take place on September 18 in Yoyogi, Tokyo. Non-Japanese babies - 50 in all - were invited to participate in the contests, which included a 10 metre crawling race and a 'milk drinking competition'. The baby who finished a bottle of 50cc milk the quickest would win. Prizes ranged between 30,000 - 1000,000 yen ($300 - 1,000).

World Health Assembly 1996 - Sponsorship and Monitoring

On 25 May 1996 a World Health Assembly Resolution was unanimously adopted which addressed the issue of commercial sponsorship, the need for independent monitoring and the need to ensure safe marketing of complementary foods.

The baby food industry, anxious to expand the market for complementary foods and to be included in all monitoring programmes, was out in force opposing the key points of the Resolution. They claimed that if we all learn to collaborate and trust each other, the issue could safely be taken off WHO's busy agenda. However, in the two-hour debate every amendment in favour of the companies was thrown out, and the Assembly voted unanimously to step up its advocacy.

Rush Ashton, speaking on behalf of the International Confederation of Midwives (ICM), explained to delegates why in 1986 the ICM took the decision not to accept sponsorship from infant formula manufacturers at any congresses, conferences or meetings, "Our experience, like that of others, is that the needs of mothers for the professional support of midwives in achieving successful breastfeeding can be undermined by pressures associated with both the offer and acceptance of financial or other support from manufacturers involved in the infant formula industry, including manufacturers of bottles and teats".

Dr Timothy Stamps, Minister of Health and Child Welfare for Zimbabwe lambasted the companies and Nestlé in particular, explaining how the inappropriate marketing of baby milks and foods encourages mothers to buy expensive imported products rather than the traditional foods. Supporting the call for control of commercial sponsorship he described how Nestlé attempts to buy the allegiance of health workers with special awards and gifts.

On July 1 BBC Radio 4's You and Yours programme in the UK addressed the issue of sponsorship. David Swarbrick, marketing director of a medical products company, explained how obligations to the company are implicit in any sponsorship deal:

"There's an ethical dilemma, because to enter into a sponsorship arrangement with the hospital is a promotional decision that requires the investment of money. To invest that money you will look for a return. The only way you can really secure a return, is to have more patients discharging with more of your product than would otherwise have been the case. So the patients may not leave the hospital using the right product for them, they may leave the hospital using the right product for the sponsoring company. It's also a straightforward commitment from the hospital that they will do what they can to help the company achieve its commercial objectives."

On the same programme, Vicky Dugbartey, a senior midwife and infant feeding specialist, explained how Queen Charlotte's Maternity Hospital in London used to fund professional courses but stopped when it became a Trust. Vicky reluctantly turned to baby milk manufacturers who were only too happy to oblige. However, some of the speakers Vicky invited would not talk on the course because of the sponsorship and two years ago she decided to stop taking baby food industry money:

"I cannot support breastfeeding fully if I'm taking handouts from our rivals, so to speak. My own conscience says that this is not right. I cannot be telling a mother breast is best and don't give formula milks, while at the same time taking handouts. It wasn't right."

Companies must monitor their practices according to the Code, but in addition, the WHA Resolution highlighted the vital need for additional, truly independent monitoring.

The UK Churches, UNICEF, Save the Children and a number of other UK NGOs have formed a group called the Interagency Group on Breastfeeding Monitoring (IGBM). IGBM will be carrying out a monitoring project during the next year. It will accept no money from the baby food industry.

Baby Friendly world

The number of Baby Friendly Hospitals around the world has almost doubled since the beginning of the year. According to UNICEF figures in June, 7,779 hospitals are officially designated as Baby Friendly - up from 4,282 at the end of 1995.

The Baby Friendly Initiative is a UNICEF/WHO joint endeavor that encourages hopsitals to promote exclusive breastfeeding through specific practices such as rooming-in and the prohibition of free and low-cost supplies of breastmilk substitutes.

"A Baby-Friendly Hospital ensures that a woman's right to choose how to feed her baby is preserved, free from adverse influences", said Lida Lhotska, UNICEF's Project Officer in Infant Feeding and Care. "Evidence is increasing that when women have full information and a supportive environment, the vast majority will choose to breastfeed."

New law update

The International Code Documentation Centre (ICDC) in Penang, Malaysia, reported that 13 more countries have been added to the list of those with laws, regulations or other legal measures to implement the International Code of Marketing of Breastmilk Substitutes. The additions more than doubled the number listed in the 1994 ICDC State of the Code by Country, which identified 11 countries that had acted to implement the Code since it was drafted in 1981.

UK News

UK Panic over phthalates

For many people working on the baby milk issue the major focus of concern are the problems faced by babies living in some of the poorest conditions in the world. For these babies artificial feeding can be a death sentence. However, there are known and proven risks from artificial feeding for all babies, including those living in wealthier societies. For this reason the WHO International Code of Marketing of Breast-milk Substitutes bans the promotion of artificial feeding in all countries.

The failure of the UK Government to implement the Code or to protect parents from misleading commercial promotion has led to the routine use of artificial feeding by the majority of British parents, who believe this to be almost as safe as breastfeeding.

Consumer confidence in the safety of UK food was badly damaged by the BSE and beef crisis. It plummeted further in May when news broke that 9 brands of baby milk on sale in the UK were contaminated with phthalates - man-made chemicals which have been linked with cancer and a lowering of sperm count.

For weeks afterwards the Baby Milk Action office was flooded with media enquiries and calls from alarmed and anxious parents. While we did not want to exacerbate the situation, we were placed in a difficult situation - knowing that the problem with phthalates is only one of a long line of concerns that exist about formula milks.

The risk from contaminants which may be present in baby milks (heavy metals, phthalates, lindane and phytoestrogens for example) are often long term and impossible to measure. Risks are also posed by other substances which are added to formulas: egg, peanut oil, genetically engineered materials etc. We need to question the adequacy of existing controls on the composition, labelling and promotion of all foods, not just baby feeding products.

With the Government firmly set on a course of deregulation this questioning has become urgent and vital. Amendments to the European Directive on baby milks calling for: "Necessary maximum levels [of contaminants to] be established without delay..." will come into force in March 1999 but this is small comfort for parents of babies born in the meantime. And even then, can they be confident that the standards will be adequate?

Although the Ministry of Agriculture (MAFF) was the only agency to carry out tests for phthalates and had already published information about its surveys in March, its refusal to name the brands with the highest levels and its insistence that all baby milks are 'safe' resulted in the issue being viewed as another British cover up. The Infant and Dietetics Foods Association would say nothing either, on the basis that the information was 'commercially sensitive.'

Few acknowledged that most UK baby milks are imported and that phthalates are likely to occur wherever the manufacture of PVC is permitted.

Baby Milk Action joined Greenpeace, Friends of the Earth and the Women's Environmental Network to present a gift of a 20-foot-long plaster baby to the UK Minister of Agriculture, calling on the Government to ban PVC - the main source of phthalates.

Having delivered the 20ft baby to MAFF, Greenpeace, Baby Milk Action, Friends of the Earth and the Women's Environmental Network representatives had a meeting with Junior Minister, Tony Baldry. He was asked to give wholehearted support to the campaign to ban PVC and to ensure that baby milks are not promoted. Mr Baldry advised us to take our concerns about PVC to Emma Bonino, the European Commissioner for Consumer Affairs, and reminded us that the Scientific Committee for Food (the EU advisory body) had issued a statement saying that existing levels of phthalates were safe. He could not say whether members of the SCF had links with either the food or petro-chemical (PVC) industry.

Following the meeting, Parliamentary Secretary, Angela Browning, wrote to Greenpeace. She said there is "a gap in the knowledge relating to both levels of environmental exposure and to dose-response of effects of these potentially hormone-disrupting chemicals...When further scientific evidence becomes available the Government will consider, with European partners, the need for further restrictions." She said the UK has no plans to take unilateral action to restrict the use of PVC, but as parents still have concerns, baby milk manufacturers are being pressed to take action to reduce phthalate levels where possible.

Soya alert

Barely two months after the phthalates scare, baby milk was in the news again. This time it was about phytoestrogens in soya. Phtyoestrogens are chemicals which occur naturally in high levels in soya protein and have weak oestrogenic effects. However phytoestrogens also seem to have some beneficial effects in adults. The Government's Food Advisory Committee is recommending further research and is advising manufacturers to investigate means of reducing levels of phytoestrogens. The Department of Health is urging parents to consult health workers before using soya formula. (This is a prerequisite of the UK baby milk law which should apply to all baby milks!)

The possible dangers of soy infant formulae were identified in scientific literature in the early 1980s. More recently researchers in New Zealand, have called for soya formulas to be removed from the market. Concerns about soya were first raised in the UK by the Food Commission 18 months ago.

Babies fed soya formula milk have been shown to consume several times the amount of phytoestrogens which has caused changes in women's menstruation patterns.

By releasing the information in a more controlled way, through health professionals and by consulting public health advocates (including Baby Milk Action) and the industry, the Government avoided the media hype and panic that occured with phthalates.

But manufacturers and retailers have not been asked to withdraw the products, stop promotion, or to put warnings on labels or in shops. The responsibility for informing parents about the potential risks has been placed on health professionals alone. Soya baby milks have not been placed on a prescription-only list and can still be bought over the counter. This means that it is unlikely that all parents using soya will be made aware of the potential risks.

Soya, a growing market

According to the Infant and Dietitic Foods Association (IDFA) the UK soya baby milk market is worth £8.2 million (the baby milk market is worth £134 million) and soya is fed to 2-3% of artificially fed babies in the UK (7-10,000 babies each year). The worldwide market for soya babymilks is considerably larger and is growing. Companies argue that 'specialised formulas' such as soya do not fall under the scope of the European Directive (which covers formulas "intended for use by infants in good health") and so often fail to include the required warnings. They also promote the notion that allergy to cow's milk and lactose intolerance is far more common than it is. One Indian company, for example, promotes soya as "The ideal food replacement for infants with diarrhoea."

In answer to questions at the UK Department of Health meeting in July, Niall Bowen, Chair of IDFA and Marketing Director of Cow & Gate, said that manufacturers did not seek to expand the UK soya baby milk market, but no statistics or commitments were given regarding world markets.

Legal action?

Concern remains about the aluminium content of soya milks and about its high levels of glucose syrup (under EU regulations soya formulas can contain 50% glucose and still be labelled 'sucrose free'). Only one manufacturer - Cow & Gate - suggests on its labels that glucose syrup may cause dental caries. A number of parents are taking legal action over dental caries resulting from the use of baby drinks and from soya babymilk. Any one who feels that they may have a case to make against manufacturers could contact the Allied Lawyers Response Team (Alert). Alert is a pro-active network of UK solicitors, promoting and co-ordinating large-scale litigation relating to injury caused by consumer products, medicines, environmental and workplace conditions. Alert will provide free information and advice by e-mail and can be contacted by telephoning the BT operator and asking for Freephone Alert or by dialling 0151 283 8585.

A herbal estrogenic capsule, Evanesce, containing phytoestrogens is being recommended by The Phoenix Project Transition Support Services, for men undergoing sex change.

Peanut scare

In March the UK Sunday Times newspaper carried an article which mentioned the dangers of peanut oil in baby milks and nipple creams and highlighted once again the need for clear labelling. Peanut can cause a very severe reaction in a small number of babies and even a tiny trace can trigger a life-threatening reaction in a susceptible individual. The number of children in the UK who suffer from peanut allergy is growing. Many allergy specialists believe it is because infants are becoming sensitised when they encounter peanuts at an inappropriate stage in the development of their immune systems, particularly in the first few months of life.

The Infant and Dietetics Foods Association (IDFA) alleges that since June 1996 peanut oil has not been used in the manufacture of any UK baby milks. However, Nutricia, manufacturers of Cow and Gate, admit that traces of the oil have been used as a carrier for Vitamin A and may still be present in some old stocks of 'specialised formulas' such as Infasoy, Pepti Junior and 'ready to feed' baby milks. All of these can be bought 'over the counter' or ordered by parents through pharmacies. Baby milks generally have a long (2-year) shelf life and ingredients are not clearly marked. Anyone concerned about allergies should contact the manufacturer, quoting the batch number. (Let us know what they say!) We have no information about exports.

The manufacturers of Kamillosan, have still not withdrawn peanut oil from its nipple cream but are considering doing so. There is no evidence that nipple creams do any good.

Further information on allergies available from: Anaphylaxis Campaign PO Box 149, Fleet, Hampshire, GU13 9XU

Tourists told don't breastfeed in UK

A leaflet produced by the British Tourist Authority, Days Out 1996 , claims that in the UK "breastfeeding in public is not considered generally acceptable." The Authority included the advice in their leaflet following reports that some tourists had received negative comments whilst breastfeeding in public in the U.K. The leaflet, which is sent free to people in 34 countries, caused outrage at the Royal College of Midwives AGM. The RCM is urging its members to complain about it.

Baby milks trials - science or promotion?

From time to time Baby Milk Action receives letters from parents who are concerned at the way baby milk trials are carried out, especially the way in which mothers are recruited. The following stories show how companies have used trials to promote their products:

European News

New amendments to the EU Directive brings risks to the UK

New amendments to the European Directives on the marketing of baby milks will soon come into force. They mainly affect composition but could open the door for some potentially dangerous new marketing techniques. Member states are required to bring in laws which comply with the Directive by March 1997.

The amendments allow companies to add manufactured components such as nucleotides, selenium, carnitine, and long-chain fatty acids - constitutents which are naturally present in human milk. However, manufacturers will not be allowed to make claims for these components as such claims could be misleading.

But manufacturers could possibly be allowed to make health claims relating to 'Reduction of risk to allergy to milk proteins' for milks containing 'partially hydrolysed proteins.'

Although milks with fully hydrolysed proteins have been shown to be useful, the scientific basis for claims for the cheaper partially hydrolised proteins has not been established.

A 1993 paper by a leading Swedish allergy specialist, Prof Bengt Bjorksten, called into question a paper on hypo-allergenic milks by Prof Jean Rey, a member of the the European Scientific Committee for Food and the European Committee ESPGAN:

"The conclusions drawn by the Committee regarding what immunilogical characterization should be recommended for antigen-reduced infant formulae differ substantially from what most American and European researchers suggest, and they are almost identical to those suggested by the company marketing the partially hydrolysed product direct to the public... Why did the Committee not properly address this important controversy but merely uncritically quote a review published in a company sponsored book by an employee of the company?"

When these products were first launched in 1988 in the US several cases of anaphylactic shock in allergic babies were reported. New York and eight other states and the Food and Drug Administration investigated and forced Nestl? Carnation to stop using 'hypo allergenic' claims which were described as: "Misleading and deceptive...Those babies who had severe reactions to Carnation Good Start have paid a high price for the company's irreponsible conduct."

Allergy claims may also conflict with Codex Alimentarius, 'Draft guidelines for use of Nutrition Claims' (ALINORM 97/22 Appendix 11) which are under discussion.

Although the new amendments will not allow claims relating to other components, such as LCPs and nucleotides, many companies are already promoting these components on adverts to health workers, labels and under-the-lid leaflets. The ads are misleading and subtly imply that the new 'enriched' formulas match breastmilk. An editorial in The Journal of Paediatric Gastroenterology and Nutrition (Ref. 1) states:

"Nucleotides present in human milk may also be modified by specific factors ...Further studies will be needed to clarify the modification that human milk nucleotides undergo prior to absorption. This may lead to a better definition of how to supplement and at what level.... dietary nucleotides do have significant biological effects and that benefits for formula-fed infants are possible. But, even if clear benefits are demonstrated in animal experiments, further long-term human studies that demonstrate what levels of dietary nucleotides are effective and well tolerated are needed... Further research needs to be done to determine the optimal and upper limit for safe and effective supplementation. Without a sound knowledge base, infant feeding choices are likely to be dictated by marketing practices."

Ref 1 Do Infants need Nucleotide Supplemented Formula for Optimal Nutrition? Jornal of Paediatric Gastroenterology and Nutrition (11:429-437 1990)

In drawing up legislation the European Commission is advised by a body called the Scientific Committee for Food. The work of the SCF covers extensive range of aspects relating to food safety and composition. Although the SCF is planning to address the issue in September, SCF members still do not have to publicly declare any financial links they may have with the food or other industry. Consequently, SCF opinions - however sound - are likely to be viewed with suspicion. For example, the amendments call for maximum levels of substances 'which endanger the health of infants ' to be '... established without delay' but worries will remain that the levels of phthalates and phytoestrogens permitted in baby milks will be influenced by the interests of the PVC industry.

Research

HIV and breastfeeding

As the number of infants born with HIV infection grows and the role of breastmilk in transmission becomes clearer, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has issued a new statement, 'HIV and infant feeding: An Interim Statement.' (UNAIDS July 1996)

The main message is that parents have the right to receive information and should be encouraged to make up their own minds about how to feed their babies. In addition, a high priority must be given to reducing women's vulnerability to HIV infection.

The statement reinforces the general principle that breastfeeding should be protected, promoted and supported in all populations regardless of HIV infection rates. However, preliminary studies suggest an average risk of one in 7 children born to, and breastfed by, a woman living with HIV (ie infected with HIV). UNAIDS states that where there is uninterrupted access to adequate, safely prepared substitutes, children of HIV positive mothers will be at less risk of illness and death if they are not breastfed. Where there is not such access, artificial feeding substantially increases the risk to children of illness and death.

Manufacturers and distributors of breastmilk substitutes "should be reminded of their responsibilities under the Code and continue to take the necessary action to ensure that their conduct at every level conforms to the principles and aim of the Code."

The statement gives no information on cup feeding which is the WHO preferred option for artificial feeding.

Breastfeeding promotion - the best preventative medicine

A number of scientific institutions from all over the world have collaborated to conduct a study into the effect of breastfeeding promotion on the morbidity and mortality of infants. They have found that breastfeeding promotion can be one of the most cost effective health interventions for preventing cases of fatal and non-fatal diarrhoea, and for gaining Disability Adjusted Life Years (DALYs). DALYs are an indicator of the economic loss caused by disease assuming that individuals disabled by their disease cannot work to earn money. The benefits are greatest in communities with little breastfeeding support, and are consistent between Brazil, Honduras and Mexico. It was conclusively shown that in countries where breastfeeding is not widely practised in the early months and where a significant proportion of women give birth in health facilities, priority should be given to the promotion of breastfeeding in these facilities. The study has allowed the benefits of breast feeding promotion to be quantified and will provide concrete data for presentation to funding bodies by those wishing to prevent disease in developing countries.

Horton et al. Breast feeding promotion and priority setting in health, Health policy and planning 1996, 11(2): 156-168

Breastfeding and tonsillectomy

A study conducted by the Department of Paediatrics at the University of Naples reveals that children whose tonsils had to be removed were less likely to have been breast fed. Nearly 3000 questionnaires were sent out with an 82 % return, 9.6% of children had had their tonsils removed, the main reason being recurrent throat and ear infection. The protection conferred by human milk against respiratory infections may persist for several years. The antibodies are protective, but also decrease the severity of infection and might be associated with more tolerant tonsillar lymphoid tissue. Less severe tonsillar infections in breastfed babies would therefore result in fewer tonsillectomies.

Formula milk linked to diabetes

Scientists are investigating the possible links between insulin dependent diabetes (IDD) in young children and the use of powdered baby milk following a two-fold increase in diabetes in under fives in Britain. A genetic factor is thought to be important with 2% of children predisposed to develop IDD, but the different expression of it in identical twins suggest environmental factors also play a part. (Ref 2)

Three observations support the suggestion that cows milk may trigger the onset of IDD (Ref 1). People who were breastfed for a short time, or not at all, are at an increased risk of IDD (Ref 2). The frequency of disease in animal models of IDD can be modified by altering the cows' milk components in their feeds. 3 100% newly diagnosed IDD patients have antibodies against a cows' milk protein (Ref 1).

There are, however, studies finding little linkage between IDD and infant feeding habits (Ref 3). The European Commission is funding further research into why European IDD is on the increase in young children.

Publications

Infant feeding in Transition

A new report by IBFAN has found numerous violations of the International Code in Central and Eastern Europe.

The report is a continuation of Baby Milk Action and IBFAN's broader work in the region. Violations vary from labels appearing in an inappropriate language to advertising on TV. The pressures on breastfeeding vary between countries according to factors such as the rate of economic development and the provision of emergency relief.

Defining exactly what is an emergency has proved a difficult problem with some agencies regarding countries going through severe economic upheaval as being 'in emergency'. This has often led to a proliferation of supply-based aid, including baby milk, which has flooded local markets, creating a new demand for artificial feeding. In some instances, where aid has been more tightly controlled, as in UN programmes in Bosnia, positive work has resulted in increased breastfeeding rates.

The main thrust of the report remains that in the absence of enforceable laws, baby milk companies have chosen to ignore the International Code. Fortunately, new IBFAN groups are forming throughout the region to challenge such marketing.

Infant Feeding in Transition An IBFAN report on infant feeding in emerging markets in Europe. 1996 £2 Contact Baby Milk Action for further information.

Baby Friendly /Mother Friendly

This book, the second in the series on the role of the midwife in the provision of high quality maternity care, explores how 'baby friendliness' can be achieved in practice. It includes a chapter by Gabrielle Palmer and Saskia Kemp and one entitled The Commercial pressures against Baby Friendliness by Patti Rundall. Baby Friendly /Mother Friendly Writings on Quality of Care. International Midwifery Perspectives Volume 2 ISBN 0-7234-2123-4 Mosby: London. 1995 £14.95. Available from Baby Milk Action.

Crucial Aspects of Infant Feeding in Emergencies

IBFAN groups throughout Europe have been focussing on the problem of emergency relief. This report of the round table meeting with UN agencies and IBFAN in Geneva in October 1995 has been published by AGB in Germany. It includes background papers and policy statements relating to this important issue. An essential document for any agency involved in emergency relief for children. Available from Baby Milk Action (£2.50)

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