Baby Milk Action Update 21, October 1997

Issue number 21, October 1997

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 members outside the UK there is an extra postage charge. You can join on-line in the Virtual Shop.

Boycott news

Editorial: Checks and Balances

A key goal of Baby Milk Action and our partners in the International Baby Food Action Network (IBFAN) is the worldwide implementation of the International Code of Marketing of Breastmilk Substitutes in legislation and trading standards. The International Code and subsequent resolutions have been adopted through the democratic processes of the World Health Assembly (WHA), the policy setting body of the World Health Organisation.

Over half the world's population is now protected by laws which broadly incorporate the International Code. The baby food industry has fought hard against this process. Over the years Update has exposed how companies have attempted to undermine legislation. In this issue we examine how companies are attempting to change the climate in which they operate to achieve this.

Companies are also attempting to undermine standards adopted by international bodies. The World Trade Organisation requires member governments 'to base their [food safety] measures on international standards, guidelines and recommendations..' One would think that the WHA resolutions would be ideal standards. Not so, according to the baby food industry, which points to weaker measures, such as the European Directives and the UN Codex Alimentarius standards, over which the industry has had undue influence. The Codex Commission, for example, had no consumer representation until 1991 and is still dominated by industry. Likewise the influential advisory body to the European Commission, the Scientific Committee for Food, has only recently agreed that its members should publicly declare their interests. Baby Milk Action has campaigned for transparency in regulatory bodies for many years.

We are concerned that industry codes and self-regulation are sometimes promoted in other fields in preference to independent, enforceable measures. Companies have a responsibility to abide by the International Code independently of others measures, yet they continue to violate it. Our experience demonstrates that checks and balances are necessary. We believe that citizens have a right to know how the world of tomorrow is being shaped and must have a say in the process themselves.

Engineering Consent

In this special feature we examine how the baby food industry has attempted to change the way people perceive its activities. It is not about how it persuades impoverished mothers to purchase products which may result in the death of their children. It is about how it changes the minds of those who could influence their marketing practices, be they politicians, health professionals, NGOs or the general public. Do not doubt that it happens, instead question whether it is happening to you.

Massaging midwives

The annual conference of the Royal College of Midwives (RCM) in the UK was attended by the main baby milk companies. Most of the companies had no scientific and factual information available to inform participants about their products. A variety of promotional methods were in evidence, however.

SMA distributed cards which could be redeemed for a gift voucher. Any midwives prepared to provide SMA with details of mother support classes at their place of work and a contact address and phone number were entered into a £100 prize draw. Cow & Gate provided an aromatherapist to massage midwives under the apt slogan "nurturing the present - building the future."

Meanwhile the RCM Conference passed an emergency motion noting that "abuse of voluntary regulations restricting the advertising and promotion of infant formulae in developing countries is widespread amongst major manufacturers.? The Conference called on the RCM Council to "reconsider its hypocritical position of boycotting Nestlé whilst continuing to accept sponsorship from other infant feeding manufacturers."

Many participants had high hopes that the RCM Council would put an end to the sponsorship deals. Yet in July the RCM Council responded to the motion by stating that it had decided to drop its support for the boycott of Nestlé to work with the companies from "the inside."

The Council also suggested that working with companies would "ensure the flow fo accurate information to mothers."

While we question the logic of this approach we are pleased that the RCM has agreed to join our UK Law Working Group, which will address sponsorship and baby food production. (See also UK Law Campaign Renewed and Boycott News)

UK industry body invites MPs to dine on distortion

In March INFORM held a buffet at the House of Commons to present findings of a questionnaire it had commissioned. INFORM, an initiative of the Infant and Dietetic Food Association (IDFA), the UK baby food industry body, suggested that mothers want advertising of infant formula because it provides information. Martyn Jones, MP, obtained details of the poll and "embarrassed MORI by spotting vital question gaps in their survey, highlighting a bias....it papers over any dis-benefits, thereby making infant formula appear to be as good as breastmilk." A result which INFORM did not bring to the attention of MPs was that mothers who chose to bottle-feed their infants had less knowledge of the benefits of breastfeeding.

In July 1997 INFORM representative Helen Messenger told Precision Marketing magazine that the industry is concerned that Tessa Jowell, the new Minister for Public Health, may be looking at the UK law on marketing of breastmilk substitutes and that the industry is determined to fight any tightening of the regulations.

Industry orchestrates the attack on Cracking the Code

The baby food industry continues to attack Cracking the Code, a report published in January and commissioned by the Interagency Group on Breastfeeding Monitoring (IGBM), a group of 27 leading development, academic and church organisations (Update 20). Nestlé is taking a leading role: it has hired Henderson Group One PR consultants and published a booklet entitled A Missed Opportunity disputing the conclusion that companies continue to violate the International Code in a "systematic, rather than a one-off manner." The arguments used in Nestlé's booklet are so obviously flawed that it appears to have been withdrawn. Nestlé is still attempting to set the agenda, however, by planning to convene a series of workshops to discuss strategies for tackling infant malnutrition.

Two "independent experts" have been cited in criticisms of Cracking the Code. One, Mr. James Rothman, "market researcher" is not in fact independent of industry, but was employed by the UK industry body to give his comments. He asserts that Cracking the Code really proves that baby food companies are "not systematically violating the code." The other "independent expert" is Professor Jean Rey (see below) who has a long association with the baby food industry

Transparency check - Scientific Committee for Food

The Scientific Committee for Food advises the European Commission on food safety and composition and has had an important influence on European legislation. Glenys Kinnock, Member of the European Parliament for South Wales East, tabled a question in July requesting full disclosure of members interests and asking, "is the Commission aware that one prominent member of the committee, who has for many years had close links with the baby food industry, has only so far declared publicly an interest in mineral water?"

Water - a new marketing strategy

Several baby food companies are marketing mineral waters as suitable for infants and Nestlé is promoting bottle feeding in magazine advertisements for Valvert water in Russia. Around the world impoverished mothers dissuaded from breastfeeding already struggle to buy infant formula and fuel for sterilising, so look closely at who argues for the promotion of bottled water for use with infant formula, particularly in developing countries. Supporting breastfeeding and treating locally available water will have greater health benefits at much less cost. The International Code covers beverages (e.g. water) marketed "with or without modification" as a replacement for breastmilk.

Baby food money comes into UK National Childbirth Trust...

After years of providing British mothers with sound independent advice and speaking out for the International Code, the fundraisers of the National Childbirth Trust (NCT) have jeopardised this valuable service and placed its members in a crisis of conscience. The NCT Trustees? decision to accept sponsorship from Sainsbury's - a supermarket chain which markets its own brand of babymilks and baby foods - has prompted the resignation of over 70 of its voluntary breastfeeding counsellors and tutors - ironically costing the NCT far more than the £40,000 they got from Sainsbury's.

NCT members have been important partners in all our campaigns, supporting breastfeeding mothers, assisting our monitoring and writing in their hundreds for strong UK legislation. We hope that NCT Trustees will encourage their volunteers to continue this valuable work.

We welcome the NCT onto our new UK Law Working Group and are sharing information with its working group on sponsorship.

...and breastfeeding counsellors leave

Counsellors who left NCT started a new organisation in September. The Breastfeeding Network will offer independent information and support for breastfeeding mothers. It will not accept any money from baby feeding companies. Mary Broadfoot, of Glasgow, a founder member and Trustee, says "We believe that parents have the right to independent information about breastfeeding to enable them to make an informed choice as to how to feed their babies - we want parents to know that we will never make money from their choice, and so give them real freedom to choose the best for themselves and their babies." We send our best wishes to the new agency, which is also a member of our UK Law working group.

Boasting over loose change

According to figures provided by the UK National Council for Voluntary Organisations, business provided just 4% of the income received by charities in the period 1994/95. The general public contributed 36% and the Government 28%. So the idea that charities are dependent on business may be based more on corporate PR than on hard evidence.

PR firm says focus on "symbols, not logic"

A report advising biotechnology companies to focus on "symbols that elicit hope, satisfaction and caring - not logic" was leaked to the Guardian newspaper in the UK (6th August), exposing the cynical methods of the food industry. The report was prepared for EuropaBio (the European industry body) by Burson Marstellar consultants. The company advised the industry that it could not win the argument over the risks associated with genetically modified food and so should use PR methods to persuade the public to accept the new products, which are cheaper to produce.

Wyeth subsidiary SMA has launched a series of "information" leaflets and a "Careline" in the UK. The leaflet on soya based formulations for infants explains that beans from genetically modified plants "will be used worldwide as ingredients in products containing soya...their production is more friendly to the environment." No mention is made of the Department of Health's concern about the high levels of phytoestrogens in soya baby milks and the need to consult a health worker before their use.

Remote control of TV in the Philippines

In the Philippines at the end of July there was a special programme on RPN Channel 9 TV to mark world breastfeeding week. The programme gave advice on how to breastfeed successfully and Ines Fernandez of ARUGAAN, a partner in the International Baby Food Action Network (IBFAN), presented evidence of the unethical marketing of breastmilk substitutes. The principal violator of the 1986 Philippine Milk Code is Nestlé and viewers heard how Nestlé uses midwives, traditional birth attendants and community based health workers as extended sales agents by giving money or gifts on a commission basis. Doctors appearing on the programme supported the description of how Nestlé promotes bottle feeding within hospitals.

Nestlé was quick to respond to the allegations, but not in any constructive way. The next day RPN Channel 9 received a memo in which Nestlé threatened to withdraw all of its advertising from the TV station. The TV executives placated Nestlé by reprimanding the programme?s host and work is now taking place to counter the adverse publicity generated by the show.

Nestlé also made threats to TV stations in the Philippines in 1987 following their coverage of a visit by Liv Ulmann, UNICEF Ambassadress of Goodwill for Breastfeeding, and again in 1989 following a protest march to Nestlé headquarters in Makati City. Such examples are far from unique. In its home country of Switzerland few editors dare print critical reports of the company.

The extent of its business interests gives Nestlé an influence not enjoyed by the other manufacturers of baby foods. This is one of the reasons why Nestlé is targeted with a boycott. We also encourage members of the public to complain to all companies which violate the International Code. This case has been highlighted in our Campaign for Ethical Marketing.

Infection rate plummets in Panama

Panama's Amador Guerrero Hospital has recorded a dramatic reduction in both diarrhoeal and respiratory tract infections since implementing the "Ten steps to successful breastfeeding" as part of UNICEF's Baby Friendly Hospital Initiative. Reported rates of diarrhoeal infection in children under one year have dropped from 92 per 1000 to 78 per 1000, and rates of respiratory disease have also decreased substantially from 43 per 1000 to 18 per 1000.

Nigeria has recorded a dramatic increase in the number of hospitals designated as Baby Friendly with the addition of 239 new hospitals in 1996 bringing the grand total to 567. European countries have declared 9 hospitals as baby friendly in the past year.

Postmen deliver the message in Brazil

Postmen in Port Alas, North East Brazil are taking part in a pilot scheme which is helping many mothers to breastfeed. The postmen, who are taught by a breastfeeding counsellor how to answer concerns about breastfeeding, deliver breastfeeding advice at the same time as the mail. Although initially greeted with scepticism from husbands and mothers, the Government initiated health education programme has doubled the number of breastfeeding mothers in some areas, especially among poor families.

Fire-fighters are making a difference in Brasilia where they collect milk from 12,000 donating mothers in an around-the-clock, door-to-door operation which provides for abandoned babies and other infants. The local hospital has reported that, after just one year of the scheme, infant deaths are down by 50%.

Farley's donates expired milk to Ukraine

Heinz subsidiary Farley's donated 20 tonnes of baby milks months past their sell-by date to charities sending aid to the Ukraine. It cost the Charities Jubilee Outreach and Air Bridge Association, £2,250 to ship the milks which were turned back by the Frontier Health Controls Unit. Raisa Bakhtyn, head of the unit said, "It is disgraceful that a respectable British company is sending potentially dangerous food here."
An attempt to divert the load to Slovakia failed, according to news reports. The UK Environment Agency said it was investigating the case as a possible illegal export of waste.

WHO spells it out

In response to a straightforward question from NCT Counsellor Mary Broadfoot, the World Health Organisation (WHO) has confirmed that the Resolutions of the World Health Assembly (WHA) have equal status to the International Code . Baby food companies have long denied the validity of the Resolutions, ignoring the Constitution of WHO which clearly states:

The clarification came from Dr Tomris Turman, Executive Director for Family & Reproductive Health at WHO who now has overall responsibility for matters relating to infant feeding and the International Code.

World Breastfeeding Week 1997

The World Alliance for Breastfeeding Action (WABA) chose the theme "Breastfeeding Nature?s Way" for World Breastfeeding Week (WBW) this year. Events took place around the world to celebrate the week from 1st to the 8th August.

As WABA says: "Breastfeeding benefits all sectors of society economically, ecologically and socially. Breastmilk is a natural and renewable resource, often overlooked. Breastfeeding protects the environment by reducing the demands made on it and eliminates waste and pollution."

Model law

The IBFAN International Code Documentation Centre (ICDC) in Penang, Malaysia, continues to conduct training seminars on the International Code. ICDC has trained 300 Government policy makers during these annual training events.

ICDC has published a Code Handbook full of information on the Code and its implementation in national laws. A draft model law is included for those working on introducing or strengthening legislation.

Respect for Malawi at last?

After a long-running Baby Milk Action campaign Nestlé and Wyeth have admitted that it is appropriate to label baby food in Malawi in Chichewa, the national language of the country. We wait now for concrete results of this stated commitment.

It was in 1993 that a Baby Milk Action supporter based in Malawi first made the request to Nestlé. Nestlé said then that it was not possible due to "cost constraints." In their responses to the 1994 IBFAN report Breaking the Rules both Nestlé and Wyeth claimed that English labels were sufficient even though Government statistics show that 43% of women who can read, cannot read English. In March this year Nestlé continued to dispute the necessity to label in the national language. On hearing of the Baby Milk Action campaign Dr. Sangala, Chief of Health Services, Malawi, confirmed that the Government required Chichewa to be included on labels and stated that Nestlé had promised to do so after meeting with the Government in 1994, but nothing had happened and Nestlé had not responded to the Government's follow-up letter.

The violation was featured in Baby Milk Action's regular column in Corporate Watch magazine and in the July Campaign for Ethical Marketing action sheet, which is posted on the Internet. The matter was also raised by a supporter before shareholders at Nestlé?s AGM this year. The adverse publicity finally prompted a response from Nestlé. At the end of July Mr. Ralph Claydon, Corporate Affairs Manager, Nestlé (UK) responded to Baby Milk Action?s earlier letter of complaint and said that the issue had been "reactivated."

Wyeth has offered to include leaflets in Chichewa under the lid, which will not help people seeing the product on the shelves. The situation is being monitored.

Call to end tax breaks for EU firms

The report Cracking the Code, published by the Interagency Group on Breastfeeding Monitoring in January, highlighted the incorrect labels on My Boy infant formula in Bangladesh. The Government has taken action and prosecuted the local agent who has now been convicted and fined. Danish company MILCO was also named in the report.

Glenys Kinnock MEP presented a question in the European Parliament asking "Can the Commission confirm that MILCO violated the WHO Code ..and the Council Resolution [calling for the Code to be followed]....Is it the case that the Commission offers tax rebates to companies such as MILCO, promoting breastmilk substitutes outside the EU, even when these activities are in breach of the WHO Code and the Council Resolution? If so, does the Commission not agree that...these tax rebates should be immediately stopped?"

The Commission replied that as it had not yet received a complaint from Bangladesh the questions raised were not applicable.

US and ILO move to protect breastfeeding

Over the past four years fourteen States in the USA have enacted legislation to protect a mother's right to breastfeed in public. The legislation typically clarifies that breastfeeding is not indecent exposure. Some States go further and clarify that a woman may breastfeed anywhere she happens to be.

Meanwhile, in the UK, a shop-owner tipped a rubbish bin of dirty water over a mother after she refused to stop feeding her child while sitting discreetly on a nearby wall. He had earlier berated her with the accusation that breastfeeding was akin to urinating. The police were called, but the man was not charged with assault.

The International Labour Organisation (ILO) is to frame recommendations on maternity legislation and is seeking examples of workplace schemes.

UK Law campaign renewed

Although in many international fora the UK has consistently endorsed the International Code and all subsequent relevant WHA Resolutions in their entirety,the Law* adopted in March 1995 implements only part of the Code. With the new Labour administration now in place, Baby Milk has called on the Minister for Public Health, Tessa Jowell, to consider closing the loopholes and expanding its remit. Some of the changes can only be tackled with changes in European legislation, some with changes existing in UK Law, others with new health guidelines. When the Law was adopted the Labour Party led the campaign highlighting its weaknesses so we are hopeful that the new Minister will take action now to ensure that all the mothers who want to breastfeed are supported in their decision.

The UK Law stems from two European Directives which were adopted in 1991 and 1992. It contains a number of very important safeguards for infant health such as a ban on free samples and free supplies. However, it is contradictory and has weaknesses which need to be addressed if is to be brought into line with the minimum requirements of the International Code and Resolutions. The key areas are:

SCOPE The UK Law covers only infant formula and to a limited extent, follow-on milks - the International Code covers bottles and teats and all breastmilk substitutes. This includes anything which mothers use instead of breastmilk - baby drinks, follow-on milks and any products marketed for use in a feeding bottle. The 1996 WHA Resolution states that the marketing of complementary foods should not undermine exclusive and sustained breastfeeding

PROMOTION TO THE PUBLIC The International Code does not permit the promotion of any breast milk substitute (see above) within the health care system or outside it. The UK Law allows advertising to the public provided it is in the health care system. The 1986 WHA Resolution states that follow-up milks are "not necessary."

PROMOTION TO HEALTH WORKERS The UK Law does not include the provisions of Article 6 or Article 7 of the International Code or the 1996 WHA Resolution - which call for an end to promotion within the health care system and an end to inducements, gifts and sponsorship which create conflicts of interest for health workers.

BABY FOOD COMPANY CONTACT WITH MOTHERS The UK Law does not include Article 5 of the International Code which stops manufacturers from making direct or indirect contact with mothers.

LABELS The UK Law bans baby pictures but allows adverts to be carried on labels or under the lid. Other aspects of labelling must be changed if parents are to be fully informed.

DEFINITIONS The UK Law should define ?proprietary brand? to stop the deliberate confusion between company names and brand names. The word "independent" should also be defined.

The Trading Standards Advisory Body, LACOTS, has now issued its clarifications of the law and the Department of Health has produced its good practice guidelines on infant feeding materials. The two papers contain some important safeguards and address some of our concerns, but key marketing strategies such as sponsorship and advice phone lines are evaded. Below are two of the areas in LACOTS that have changed for the better:

1- reward points go LACOTS have now agreed with us that supermarkets should not include infant formulas in ?reward point? schemes which give refunds on previous purchases. The inclusion of baby milks in such schemes is a point of sale promotion and is a breach of the law and the International Code. Supermarkets are still promoting these schemes for other baby products and are not making it clear that baby milks are excluded.

2 - more discretion called for . The Milupa Newborn Hearing Centre at Hillingdon Hospital (pictured here) which promotes the Milupa brand name may be a thing of the past. The LACOTS guidelines allow only the "discreet" use of company names and logos. When the room opened in 1994 sales of Milupa formula in a nearby clinic increased by 589%

... but what about phone lines? The UK Law allows companies to provide information to the public, but only in response to unsolicited requests. The LACOTs guidelines are unclear on this point and it remains to be seen if they will stop the abuses that are occuring. For example, Wyeth is giving away a free Fridge Magnet advertising its SMA Careline number.

UK Breastfeeding figures

The results of the 1995 Infant Feeding Survey in the UK have now been published. Initial breastfeeding rates have risen slightly from 64% in 1990 to 68% in 1995. The rate at 2 weeks is 53% compared with 50% in 1990, and at 4 months 27% compared with 25% in 1990. Breastfeeding rates for different age, educational and social class groups has not altered.

By two weeks only 1% of mothers who stopped breastfeeding did so because they intended to. This indicates a real failure of the health service to provide the support that mothers need.

UK Food Safety

Baby Milk Action has written to Prof Philip James, responsible for the new Food Standards Agency, which the Government is setting up to handle food safety and nutrition issues. Many of our concerns about the need for transparency are in the draft proposals the final proposals are due in November.

The Ministry of Agriculture (MAFF) has announced that it will release brand names when reporting the results of food chemical surveillance. In 1996 we called for babymilk brands which contained phthalates to be named.

HIV and infant feeding

Baby Milk Action has prepared an issue paper on the subject of HIV and infant feeding in consultation with partners in IBFAN and the UK AIDS Consortium.

Although more research is needed, studies to date show that breastfeeding can be a route of HIV transmission and that 1 in 7 uninfected children born to mothers living with HIV become infected if they are breastfed. Mothers, health professionals and organisations such as IBFAN are faced with a dilemma concerning decisions about infant feeding. In order to make the most appropriate decision, mothers must be fully informed about the risks and benefits of both breastfeeding and artificial feeding according to individual circumstances.

Many questions about HIV transmission and alternative methods of infant feeding still need to be answered, for example, the possible use of pasteurised breastmilk or locally available foods. If optimum infant and maternal health is to be achieved it is essential that the infomation given to parents is unbiased and that it is based on research conducted independently of companies which have a vested interest in the outcome.

The Interagency Group on Breastfeeding Monitoring (IGBM) reported in January 1997 that Nestlé and other companies were donating free supplies to hospitals in Thailand. When the Church of England Synod, a member of IGBM, considered the report in July, Nestlé representatives were on hand to dispute the allegations (see boycott news) claiming that the free supplies reported in Thailand were part of a Government scheme for mothers infected with HIV. In his speech to Synod, the Bishop of Coventry explained that UNICEF Thailand had just visited a hospital where Nestlé and other companies were routinely providing free supplies for general use and that this had nothing to do with the Government programme. Aprox 1% of mothers are registered as HIV positive in Thailand, yet 25% of mothers in IGBM?s study reported receiving free samples (Nestlé provided 15% of these samples).

The new Freedom of Commercial Speech Trust in South Africa argues that baby food companies should be allowed to advertise because of the risks of HIV transmission. In the national paper The Star on 3rd August the Executive Director stated, "Responsible advertising ...would provide the mother with knowledge of the correct use of the product, preventing unnecessary deaths. Mistakes of the past, such as mothers using too little formula, malnourishing the child and using contaminated water would be prevented - removing cause for concern that breast-milk substitutes are not a healthy choice."

Work is not the reason

A recent study conducted in developing countries tested the hypothesis that breastfeeding and maternal employment are mutually exclusive, as so often argued by baby milk companies (see the Nestlé advertisement reported in Boycott News 20).

The authors examined in detail the type of employment, and whether or not the mother was able to take her baby to the work place. Between 1% (Niger) and 19% (Peru) of mothers never took their baby to work. Statistical analysis revealed that, in the countries studied, employment reasons accounted for 5% or less of women's use of breastmilk substitutes. Further, the use of breastmilk substitutes is high amongst women who are not employed, leading the authors to conclude that: ?alternative explanations must be considered for the use of breastmilk substitutes by women who are at home with their babies?. The dire economical impact, on both families and the country, when breastfeeding is not practised and promoted was acknowledged.

Ref: Hight-Laukaran. V. et al (1996) The use of breast milk substitutes in developing countries: The impact of women?s employment. American Journal of Public Health. Vol 86, p.1235-40.

LCPs good for business

More and more brands of baby milks are boasting they are "closer to breastmilk" because they include long chain fatty acids or LCPs. Science is far behind nature and researchers continue to identify new substances in breastmilk and then rush to include these in artificial milks. Market analysts Hambrecht & Quist strongly recommended investors to buy shares in Martek Biosciences following its development of Formulaid, a blend of two fatty acids:

"The history of infant formula has shown that virtually all similar examples have led to wide-scale introduction of such additives into infant formula, even if there was no evidence that the additives were important. Infant formula is currently a commodity market with all products being almost identical and marketers competing intensely to differentiate their product. Even if Formulaid had no benefit we think that it would be widely incorporated into most formulas as a marketing tool and to allow companies to promote their formula as '"closest to human milk.'"

But how close is "close"? Many constituents of breastmilk have not yet been identified or cannot be replicated commercially.

Formulaid is made from microalgae and fungi. An alternative product has been developed by a rival firm using fish oil. This comes from "natural sources such as tuna eye sockets." according to Hambrecht and Quist.

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