number 20, February/March 1997
The news items which appear on this page are abridged versions
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For too long the marketing
strategies of the baby food industry have put profits before
health leaving others to count the cost.
As Governments are urged
to liberalise trade rules and to encourage private investment
under international agreements and through pressure from Structural
Adjustment Programmes, truly independent monitoring of marketing
practices, not funded by industry with a vested interest, becomes
even more essential. It should form part of all international
and national frameworks.
Aware of the power of such
monitoring, companies argue for 'collaboration.' Yet companies
already have a responsibility to monitor their own practices
thoroughly. They should also accept and act on the findings
of independent agencies which maintain a healthy distance.
Baby Milk Action, and our
IBFAN partners, have been monitoring and reporting to governments
and companies since before 1980. We have also been working for
the implementation and strengthening of policies which protect
consumers and practices such as breastfeeding - with UN committees,
the European Union, and nationally. Our education programmes,
grass roots support and company campaigns (such as the 17-country
boycott of Nestle) are other important tools which raise public
awareness and give people a voice. The world in which we live
must give citizens - including the world's poorest citizens
- an equal hearing to that of business.
of malpractice revealed by new research findings
A new report, commissioned
by the Interagency Group on Breastfeeding Monitoring (IGBM),
reveals the massive scale of company violations of the International
Code of Marketing of Breast-milk Substitutes.
27 academic institutions,
churches and non-profit organisations formed IGBM to see for
themselves whether the baby food industryÍs claims of
ethical behaviour were true.
IGBM - history
International Baby Food Action Network (IBFAN),
to which Baby Milk Action belongs, has been reporting violations
of the Code since it was adopted by the World Health Assembly
in1981. The Church of England Synod joined the Nestle boycott
in 1991 as the result of our findings. In 1994 Nestle conducted
a much criticised PR exercise which led to the Synod suspending
its support for the boycott whilst it sought further evidence.
This resulted in the formation of IGBM. The research was conducted
independently of IBFAN and the industry. However, both IBFAN
and the International Association of Infant Food Manufacturers
(IFM) were invited to comment on the research protocol in June
1996. Monitoring started in August 1996.
IGBM commissioned research
in four countries: Bangladesh (Dhaka), Poland (Warsaw), South
Africa (Durban) and Thailand (Bangkok). These countries were
selected because of the contrasts they offer in geography, economics
and level of Code implementation. In addition, the national
authorities of each country gave their agreement for the research
and IGBM member organisation field staff were available to support
the activity. The research was published on 8th January 1997
in a report entitled Cracking
the Code available from UNICEF, Unit 1, Rignals
Lane, Chelmsford, Essex, CM2 8TU, UK. Tel: (01245) 476315. Price
proves that many companies are taking action which violates
the Code, and in a systematic rather than one-off manner."
Companies were found to
be promoting artificial infant feeding in breach of the marketing
code. The main companies at fault were Nestle, Gerber, Nutricia
and Wyeth. The scale of the violations is shocking:
- promotion was found
in retail outlets and the media in all four countries
- company personnel visited
health facilities univited in each country to make contact
with mothers and to give inducements to health professionals
for promoting company products
- information leaflets
were given to mothers which promoted bottle feeding or discouraged
breastfeeding (more than a third of mothers in Poland reported
- mothers and health facilities
were provided with free samples or supplies (ranging from
7.5% of health facilities in Bangladesh to 50% of those in
According to the report
"...a strong correlation was found in all four countries
between the proportion of mothers who received negative information
associated with a company name and the proportion who bottle
fed their infants."
Reaction to the report
Before even seeing a copy
of IGBM's report, the International Association of Infant Food
Manufacturers issued a press release headed, "Baby Milk
Code Monitoring Report Rejected as Biased" alleging
that, "IFM was not made aware of the project until the
protocol was completed and monitoring had begun." IGBM
responded by releasing the letter sent to IFM asking for its
comments on the research. IFM responded to the invitation over
a month before monitoring began.
UNICEF issued a public
"It is both
unfortunate and ill-advised that the [IFM] saw fit to ignore
the findings, and to reject the report... It is also noteworthy
that the findings of IBFAN, in its regular monitoring activities,
are clearly vindicated by this report.... [UNICEF] proposes
that IBFAN be given renewed encouragement to continue monitoring
compliance with the International Code. UNICEF views this as
an issue of great consequence... It speaks, quite simply, to
child survival and development."
Many organisations which
have accepted sponsorship from companies cited in the report
are questioning whether it is appropriate to do so.
conceals salmonella risks
Recent salmonella infection
of babies in the UK and France raises important questions about
the quality of baby milks and the adequacy of surveillance throughout
Europe and worldwide. Baby Milk Action calls for the withdrawal
of all Milupa products manufactured in France, for much more
explicit warnings on labels and for a halt to the promotion
of these products.
On Friday 24 January Dutch
baby food company Nutricia's German subsidiary, Milupa, was
asked by the UK Department of Health to withdraw its infant
formula Milumil from sale following evidence from the
Public Health Laboratory Service (PHLS) that a number of Milupa-fed
infants had been infected with a rare strain of salmonella called
Two more cases of salmonella
anatum infection in Milupa fed babies were confirmed in France.
Microbiological tests proved that the salmonella had the same
genetic profile as the one in the UK and must have came from
the same primary material. The French authorities ordered the
withdrawal of Lemiel 2 on 8 Feb. Milupa's factory in Colmar,
France was closed for one week for disinfection but the source
of infection was not found.
Throughout this time Milupa
and Nutricia have issued contradictory and misleading statements.
Claiming to put infant health before profit, they accepted the
evidence when talking to the Department of Health. However,
to the press and to us they said the problem was unique to the
UK, that the link was not really proven and that the British
authorities had "reacted over zealously." Mr Klaas de Jonge,
Director of Nutricia denied that there could be a problem with
the factory or that other products could be affected. He suggested
that because from January 1997 the company would no longer use
milk bought in from French and Dutch farms, the problem was
French authorities and
the European Commission admit that the same source material
used for the French and UK milks is also in babymilks on sale
in Belgium, Italy and Holland. It is also in the follow-on milk
Forward still on sale in the UK. All have expiry dates of 1998.
Until the source of contamination is identified and until Nutricia
gives a full account of all its export markets, all Milupa products
made in France must be suspect.
- It takes only a few organisms to infect a formula-fed infant.
- When the Farley's factory was infected in 1985 it took
months before the source was identified. Holes in a spray
dryer caused intermittent contamination. Salmonella was found
in only 4 out of 267 packets of the product. The factory was
eventually closed down. (Lancet Oct 17 1987)
- Breastmilk contains anti-bodies to salmonellae and also
contains general anti-infective factors which paint the gut
and protect the baby from infections.
- Even in the best social conditions a baby has a five-fold
risk of gastrointestinal illness if it is artificially fed,
while in poor social conditions in the UK there is a ten-fold
has relaunched Milumil now that the Irish factory is
operational. Baby Milk Action is still concerned that milk from
the French factory is still in sale across Europe and around
the world. The milks withdrawn from the UK and France had an
expiry date in 1998. Please inform us if French-made Milupa
products are on sale in your region, especially Eastern Europe,
Latin America and the Middle East. After the Chernobyl disaster
contaminated milk from Europe found its way all over the world.
Code of Marketing of Breast-milk Substitutes states that
"Information provided by manufacturers and distributors
to health professional regarding products within the sope of
this Code should be restricted to scientific and factual matters....Such
materials should not use any pictures or text which may idealize
the use of breast-milk substitutes." The UK law says
"an advertisement for an infant formula shall contain
only information of a scientific and factual nature."
"scientific and factual" information for
UK health workers, Health Visitor, November 1996.
PHLS stays in the public sector
The centralised surveillance of the UK Public Health Laboratory
Service (PHLS) is unique in Europe, and in a recent Government
review (costing ú4.8 m) it was accepted that the PHLS should
remain in the public sector, rather than be privatised and
fragmented. Sir Leslie Turnberg, Chairman of PHLS, commented:
"The vital importance of infectious disease surveillance
is clear from the global increase in infectious diseases
and the looming threat of antibiotic resistance... The effectiveness
of the PHLS is beyond question, and the astonishingly swift
identification of the cause of the recent outbreak of salmonellosis
from powdered baby milk undoubtedly saved many babies from
During the debate in
the House of Commons in March 1995 on whether the UK╩baby
milk law should allow advertising, Michael Shersby MP declared
a constituency interest in Milupa. Mr Shersby gave a vigorous
defence of advertising which he claimed
the brands to parents ...branding provides a guarantee of
safety and nutritional quality backed by a reputable company
He won the debate of
course and wasn't he so right about Milupa?
is a human rights issue
World Alliance for Breastfeeding Action (WABA)
Global Forum was held in Bangkok from 2 to 6 December 1996.
Anwar Fazal, WABA chairperson, from Malaysia said, "The
single most important issue at this Forum has been the human
rights dimension of the breastfeeding issue." WABA add,
"This shall in no way be understood or perceived as
the mother having a duty to breastfeed since it is the circumstances
which lead to the choice not to breastfeed that must be altered."
The Forum decided that
the theme for World Breastfeeding Week (1st-7th August) will
be "Breastfeeding: Nature's Way!" The week
will focus on the ecological aspect of breastfeeding.
flood into Pakistan
As Indian tough baby food
marketing law takes effect companies are putting increased effort
into developing the market in neighbouring Pakistan. Pakistan's
draft marketing law has been pending with the Ministry of Health
since 1992, and was only recently presented to the Cabinet prior
to introducing it to Parliament.
According to a report in
the newsletter of the Network of Association for Rational Use
of Medication in Pakistan, the cost of Pakistan's imports of
milk powder and baby food doubled during the first 10 months
of the 1995-96 financial year compared with the previous year.
Pakistan imported 9,550 tonnes of baby foods at a cost of US$43.5
million between July '95 and April '96. The upsurge coincides
with new aggressive marketing tactics from Nestl?, including
the donation of free samples to hospitals, direct advertising
and sponsorship of a TV talk show about baby care, says the
Baby Friendly Hospitals
In 1991 UNICEF launched
the Baby Friendly Hospital Initiative to encourage hospitals
to better care for breastfeeding mothers. The number of Baby
Friendly Hospitals around the world reached 8,394 in January
1997. The United States and Spain entered the Baby Friendly
fold with one hospital each. In Europe the latest figure is
202 Baby Friendly hospitals, 105 of these being in Central and
Eastern Europe. Turkey leads the way with 56.
In Armenia the programme
is described by UNICEF as being strong despite little financial
support. One hospital reported a 50% reduction in the need for
antibiotics for new-borns, demonstrating how support for breastfeeding
reduces sickness and saves money. Armenia has been a particular
challenge as the proliferation of infant formula as emergency
aid following the 1988 earthquake caused breastfeeding rates
to fall. Poland has 14 Baby Friendly Hospitals. Company promotion
of baby milks has been challenged as baby friendly slogan and
poster competitions generate media interest. Elektrostal Hospital
in the Russian Federation, starting from a breastfeeding rate
of 18%, reports a three-fold increase since becoming Baby Friendly.
The benefits are already evident; an 18% decrease in infant
infection and a 48% decrease in infant pneumonia.
Everything about the
International Code Documentation Centre has packaged its training
materials on the WHO/UNICEF
International Code as a 250 page "Code Handook".
The handbook is suitable for governments, libraries, health
and development associations, companies and individuals interested
in protecting breastfeeding. Send a banker's cheque or international
money order payable to "IBFAN" to the address which
follows. The handbook is US$130 retail, US$50 for non-profit
organisations, surface mail delivery. Add US$10 for airmail
or US$40 for courier delivery per book. Send orders to: IBFAN/ICDC,
PO Box 19, 10700 Penang, Malaysia.
Global data bank on
WHO's Nutrition Unit recently
published details of its Global Data Bank on Breastfeeding.
The Data Bank pools information from surveys and studies dealing
with breastfeeding prevalence and duration. The aim is to achieve
worldwide coverage, using standard definitions and indicators,
to enable comparisons between and within countries, to assess
trends and advise and evaluate the progress of programmes. Information
and data is available from: Randa Saadeh, Nutrition Unit, WHO
1211 Geneva 27, Switzerland. Fax: +4122 791 4156. E-Mail:
Food Summit recognises breastfeeding
The Declaration and Plan
of Action adopted by Governments at the World Food Summit in
Rome in November 1996 includes a call for legislation and institutional
structures that "Enhance the special contribution that
women can make to ensuring family and child nutrition with due
emphasis on the importance of breastfeeding."
to protect mothers and infants
IBFAN and Codex
The UN Codex Committee
on Nutrition and Foods for Special Dietary Uses met in Germany
from 7th to 11th October last year. Industry makes up 45% of
the committee, which had no public interest group representatives
until 1991. Baby Milk Action and our partners in the International
Baby Food Action Network (IBFAN) were part of an international
NGO working group which presented recommendations to Codex on
a draft trading standard on health claims and the composition
and labelling of baby foods. Work continues to have these adopted.
At the UK preparatory meeting, a Sandoz (Gerber) representative,
suggested that Codex should follow the weaker European Directive
rather than the World Health Organisation's International
Code of Marketing of Breast-milk Substitutes.
invited on advertising regulations for the European Union
The European Commission
has produced a Green Paper on Commercial Communications in the
Internal Market which could have an impact on advertising restrictions
in Europe and worldwide. Baby Milk Action has
submitted comments outlining its concerns as they relate
to the baby milk issue. The Commission meanwhile argues that
the proposed regulatory framework does not necessarily favour
the advertising industry, and that provided advertising bans
can be proved to be 'proportionate and in the public interest',
they could even be extended. The European Parliament will vote
on this in May and the Commission is inviting comments until
the end of March 1997.
Send for the Green Paper
from the European Commission. Tel: +322 296 0110 Fax: +322 295
7712; Contact your MEP to ask that the proposal protects consumers.
European Union Scientific
Committee for Food to declare interests
Baby Milk Action has been
pressing for greater accountability from the Scientific Committee
for Food (SCF) which advises the European Commission. SCF decisions
have far-reaching commercial and health implications. At the
September 1996 meeting it was agreed that SCF members and ad
hoc experts would be required to declare their interests. However,
no declarations were made at the November meeting on Genetically
Modified Maize. To receive minutes of meetings contact: Dr.
Naomi Rees, MAFF, Ergon House, c/o Nobel House, 17 Smith Square,
London, SW1P 3JR.
New food safety advisor
for the UK
An independent food safety
advisor is to chair a newly-created Food Safety Council and
will advise Government Ministers on matters including the safety,
quality, labelling and authenticity of foods. The move has been
taken as politicians admit they have lost credibility in the
eyes of the general public following the handling of recent
food safety problems. The advisor will not be appointed until
after the General Election and it remains to be seen if the
body will be truly independent of Government and industry.
shows no clear benefit from breastmilk fortifiers
?Human milk has been shown
to confer important clinical benefits on preterm infants Ref.1.
Because they have greater nutritional requirements than term
babies it has become common practice to supplement their breastmilk
feed with one of the many multinutrient "fortifiers"
now available. In a recent study Ref. 2 (which
is the largest to date in the literature) infants weighing under
1850g at birth were randomly allocated to receive Mead Johnson
Enfamil fortifier in addition to human milk and pre-term infant
formula (if this was used). Early growth of babies receiving
fortifier, and their developmental outcome at 18-months of age,
was no better than in those fed unfortified milk and the "fortified"
group suffered significantly more infections and a higher incidence
of necrotising enterocolitis. When sub-groups of babies who
had received most human milk were studied it was found that
adding "fortifier" to the milk gave a small growth
advantage of 1.6 g/kg/day in the short term. The authors conclude
that more research into the increasingly widespread practice
of "fortification" is clearly needed.
1. Lucas A, Cole TJ. Breast
milk and neonatal necrotising enterocolitis. Lancet 1990;336:1519-231.
A, et al. Randomized outcome trial of human milk fortification
and developmental outcome in preterm infants. American Journal
of Clinical Nutrition 1996;64:142-51.
- no thanks
Guys Hospital and Powys
Health Care Trust in the UK have implemented strict policies
in support of breastfeeding. Both have banned company sponsored
materials including Bounty packs (commercially produced packs
containing promotional material and samples which are given
free to mothers on maternity wards). Free gifts to staff, company
contacts with staff and the display of any materials with a
company logo are also prohibited. Head of Maternity Services
at Guy's Hospital, addressed the advisory committee of the UNICEF
- UK Baby Friendly Hospital Initiative in October last year.
She explained that the funding lost by refusing corporate sponsorship
has been replaced following appeals to the trustees. A benefit
of pursuing Baby Friendly at Guy's has been the improved morale
of midwives which has reduced the turnover of staff.
Milk Action Annual General Meeting 1997
Baby Milk Action held its
AGM on 25th January at the London Voluntary Sector Resource
Centre. The possibility of taking legal action against baby
milk manufacturers for the sickness and death which their unethical
marketing is causing was addressed by Richard Meeran, product
liability lawyer from Leigh, Day and Co. A working group will
examine the possibilities further.
We next discussed the need
to expand membership and ensure adequate future funding. Baby
Milk Action has never accepted commercial sponsorship as a matter
of policy and, after some discussion, the meeting felt this
policy should continue as our ability to speak the truth without
fear of censure from commercial interests is a key strength
of the organisation. In the feedback session the possibility
of organising boycotts of companies in addition to Nestlé
was discussed. It was noted, however, that the recently published
research commissioned by the Interagency Group on Breastfeeding
Monitoring (IGBM) and the renewed calls for effective legislation
were prompted by the Nestlé Boycott, showing how focusing
on one company can have an impact on the whole industry. Action
will be taken to expand the Nestlé boycott in the UK
and internationally and the possibility of adding other company
products to an extended boycott list will be investigated. We
will continue to urge health bodies and other organisations
to refuse sponsorship from baby milk manufacturers or distributors.
Baby Milk Action
for more information.