Baby Milk Action Update 22, June 1998

Issue number 22, June 1998

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

On the 14th March Baby Milk Action took part in the international launch of Breaking the Rules - Stretching the Rules 1998, the latest in a long line of monitoring reports produced with our partners in the International Baby Food Action Network (IBFAN). We knew how the industry would react - we have long experience of corporate Public Relations strategies. Sure enough, a press release headed, "IBFAN report is misconceived and biased says baby food industry," was fired off by the UK Infant and Dietetic Foods Association (IDFA).

On 6th April we presented the findings of Breaking the Rules 1998 to the UK press and launched a paper, Engineering of Consent, which analyses how the baby food issue has influenced corporate PR strategies. So-called "issues management" is now a recognised discipline, involving intelligence gathering, image transfer, suppression and manipulation of debate, PR laundering and attacks on critics. Please read this paper, published by Corner House (contact us for details), to better understand the strategies companies use to protect their vested interests.

One strategy companies use is to call for "dialogue" with their critics. A more appropriate term is "negotiation" as companies expect a pay-back for any concessions. NGOs should question whether their principles are up for negotiation.

Contact is sometimes appropriate - indeed Baby Milk Action frequently corresponds with the baby food companies - but this should not compromise being a balancing force or a dissenting voice.

The United Nations Children's Fund (UNICEF) sat down with NestlŽ at the end of last year, after calling for companies to set out their marketing activities on a country by country basis. UNICEF Executive Director, Carol Bellamy, wrote to NestlŽ CEO, Peter Brabeck: "Our meeting... regrettably reconfirmed the historic and on-going divergence between the best interests of children... and those of the infant feeding industry.... It continues to be clear that the divergent views are simply not reconcilable in specific and critical areas. Therefore, much as we appreciate the opportunity to have had the meeting, it does not seem to us to be useful to maintain such contact in the future."

Similarly, the Interagency Group on Breastfeeding Monitoring, which published the report Cracking the Code in 1997, has stated that the industry's reaction to the findings make meetings futile.

If someone breaks the rules, continuously and unashamedly, "dialogue" is not the solution. Independent, transparent and effective controls are needed.

Special Feature: IBFAN

IBFAN was created on 12 October 1979 by public interest organisations attending the joint meeting of the World Health Organisation (WHO) and the United Nations Children's Fund (UNICEF) on Infant and Young Child Feeding. These original IBFAN groups played a fundamental role in bringing about this meeting which led to the drafting and adoption of the International Code of Marketing of Breastmilk Substitutes. Baby Milk Action was a founder member of IBFAN and has worked to strengthen and build the network ever since.

IBFAN Europe - looking eastwards

IBFAN Europe held its regional meeting in Malta last September with 63 people from 28 European countries (plus Palestine) attending. Many of the participants came as a result of the work conducted to make contacts in the emerging markets of the Commonwealth of Independent States (former Soviet Union) and Central and Eastern Europe. Baby Milk Action has been involved in training seminars held over the past few years in Czech Republic, Kazakhstan, Latvia and Russia for participants from these and surrounding countries.

Training was an important element of the meeting with sessions on the International Code and Resolutions, monitoring the baby food industry, working with the media, fundraising, the Internet and a variety of other topics. The meeting developed a statement on HIV and infant feeding and reiterated IBFAN's policy of refusing financial support from the baby feeding industry. Representatives were elected to attend the IBFAN Coordinating Council.

ICDC Code Training Workshop

IBFAN's International Code Documentation Centre (ICDC), based in Penang, Malaysia, conducts training workshops on implementing the International Code and Resolutions. The courses are designed for policy makers and legislators and have played a key role in assisting governments to implement measures to protect infant health. The latest State of the Code publication produced by ICDC lists 20 countries with legislation which broadly implements the International Code and Resolutions. The next training course will take place from 28 September to 6 October 1998 in Penang. The details of suitable participants can be passed to your national IBFAN group (Baby Milk Action in the UK).

The IBFAN Coordinating Council

IBFAN is a network. Structured like a net, it encompasses the Earth. Groups are diverse: they may work on infant feeding issues alone, or they may be mother support groups, consumer associations, development organisations or citizen's rights groups. Some are staffed by volunteers, some have full-time staff. Baby Milk Action is IBFAN in the UK. We provide support to the network through regular mailings, this newsletter, publications, personal contact and training seminars.

The IBFAN Coordinating Council (IBCoCo) is made up of representatives from the different regions of the IBFAN world, who meet every two years to coordinate policy. Representatives are elected at regional meetings. A number of IBFAN groups serve the network in specific ways. Baby Milk Action represents European IBFAN groups on company campaigns and coordinates the international NestlŽ Boycott.

IBCoCo met in Antigua, Guatemala for one week in March 1998. A packed agenda was rounded off by the international launch of IBFAN's global monitoring report Breaking the Rules, Stretching the Rules, 1998.

A snapshot of baby food marketing around the world

Breaking the Rules, Stretching the Rules 1998, a recent International Baby Food Action Network (IBFAN) publication, illustrates hundreds of examples of violations of the International Code of Marketing of Breastmilk Substitutes by the baby food industry. Shanti Thiagarajah, one of the-authors of the report, presents an overview of the evidence.

Concerns about the growing trend of bottle feeding in the mid-1960s and early 1970s, and the effect it had on infant morbidity and mortality, resulted in the World Health Assembly (WHA) adopting the International Code in May 1981. Since then, subsequent WHA Resolutions have clarified and added to the provisions of the International Code.

Although infant food manufacturers vehemently deny claims of non-compliance with the provisions of the International Code, the report clearly shows continuing violations of the Code, and the subsequent relevant Resolutions, both in letter and in spirit.

IBFAN monitors interviewed mothers and health professionals and surveyed health care facilities and retail outlets in 39 countries. The survey, carried out between January and September 1997, show every major infant food manufacturer failing to comply with many of the provisions of the Code and Resolutions.

Health care system

The health care system is still the main focus of the companies, for this is the most direct route to mothers and babies. The International Code prohibits product promotion in health care facilities, but this provision is widely flouted. Hospitals, healthworkers and mothers receive free supplies and samples from numerous companies. Ingenious means are employed to get around the prohibition on free supplies, such as making private arrangements with hospitals and clinics to supply small quantities of free formula as and when requested. Posters, calendars, wall clocks, growth charts and other paraphernalia which adorn the walls of maternity wards and consultation rooms advertise particular brands and/or company names and logos. Naturally, mothers would infer that any company material seen in a health care facility is an endorsement of the company's products.

Inducements

Companies provide health professionals with gifts such as membership to Club Med, gold jewellery and sponsored conferences. Clearly such gifts and sponsorships are "inducements" and would influence the recipients in their choice of product recommendation to mothers and babies they come in contact with.

Follow-on milks

Since the promotion of infant formula has been explicitly prohibited in the Code, companies invented the follow-up formula for the older baby and widely promote these to make up for any potential loss in sales. Clever marketing strategies, however, such as using labels of very similar design and colour, ensure that both the infant formulas and the follow-up formulas are promoted at the same time. NestlŽ's Nan 1 and Nan 2, and Lactogen 1 and Lactogen 2, Milupa's Aptamil 1 and Aptamil 2, Wyeth's Bonna and Bonamil, Mead Johnson's Similac Advance 1 and Advance 2 are few such examples.

Milks for mothers

Now companies have gone one step further with the introduction of milks for pregnant women and lactating mothers! These products, understandably, are not within the scope of the Code since they were not in existence at the time of drafting the Code. The aggressive promotion of these milks through the media, health care facilities and retail outlets create a new market for an unnecessary product and more importantly, create company name and brand recognition.

Surfing the Internet

The monitoring shows that the baby food industry has been quick to capitalise on the latest phenomenon, advertising on the Internet, which has the potential to reach more consumers than all other media forms combined. Companies such as Abbott Ross, NestlŽ, Mead Johnson and Babelito advertise their range of formulas, other breastmilk substitutes, as well as bottles and teats, all products which clearly fall within the scope of the Code, on their own websites. This trans-boundary advertising not only breaches of provisions of the International Code, but also national legislations based on the Code, where such exists. Take a look at NestlŽ's Carnation page. It pays lip-service to the International Code by asking people who do not live in the US to click on the message "read this special notice." Those doing so gain access to information about breastfeeding. Although the US is now a signatory to the International Code it has not yet implemented it as law, so only non-US citizens are asked to read the information!

Labels

The monitoring shows how labels of infant formula and other breastmilk substitutes still do not comply with all the requirements of the Code. Although mother and baby pictures on labels of infant formula are quite uncommon nowadays, the use of subtle phrases which create anxiety and doubts about whether or not breastfeeding is possible and which therefore inhibit lactation, is the norm on many labels.

Promotion not information

There is a fine line between "information" and "promotion" and companies are quick to identify the need for information and supply their own materials, using this to their advantage. The International Code sets out certain criteria which informational and educational materials intended for pregnant women and mothers must adhere to. Almost all company-produced materials analysed were found to be more promotional than informational or educational.

The damage done

The report confirms that violations of the Code have hardly abated in the last 16 years. Companies continuously devise new ways and new products to get around the provisions of the Code. The results of this monitoring show only the tip of the iceberg. It is obvious, for example, that where one or two mothers have received samples or company booklets, or where one health professional admits to receiving gifts, many more unrecorded violations would have occurred.

The lives of millions of infants and young children are at risk if companies are allowed to continue with the unethical marketing which is almost universally practised. Bottle feeding not only endangers the lives of infants in the third world, but also in the first world. There is therefore an urgent need for all governments to enact and enforce strong legislation to curb many of the baby milk industry's marketing practices in order to protect the lives of infants and young children everywhere.

Breaking the Rules, Stretching the Rules 1998 is available from Baby Milk Action. Reports from Europe, Ireland and Pakistan are also available - contact us for details.

Industry responds

The baby food industry response to Breaking the Rules and the national reports has varied. In Europe press releases and letters attacking it were issued, while in Brazil Nestlé offered to sponsor it! Then in May 1998 at the World Health Assembly, IFM thanked NGOs for bringing the violations to their attention.

The Interagency Group on Breastfeeding Monitoring report Cracking the Code, launched last year, was also attacked by the industry. Following peer review the research was published in the British Medical Journal on 11 April 1998.

Governments under attack

The World Health Assembly adopted the International Code of Marketing of Breastmilk Substitutes as a "minimum requirement" to be adopted by "all member states...in its entirety." Subsequent Resolutions have clarified articles in the International Code in the light of on-going scientific investigation and to address questions of interpretation. Under Article 18 of the constitution of the World Health Organisation subsequent Resolutions have the same status as the International Code. IBFAN has been working for many years to assist governments in implementing these measures.

The Campaign for Ethical Marketing gives recent examples showing how the baby food industry puts pressure on governments and falsely portrays the International Code and the Resolutions as a maximum requirement. Governments have the sovereign right to adopt any laws which they think are necessary to protect infant health and to put any child feeding product within the scope of its national regulations or laws.

51st World Health Assembly - Gro Harlem Brundtland inaugurated - IFM issues guarded apology.

At this year's Assembly in Geneva, amid the 50 year birthday celebrations, speeches, elections and prize-giving to quests such as Hillary Clinton and Fidel Castro, the time for discussion of the urgent health issues that face the world today was cut very short.

Gro Harlem Brundtland, former Prime Minister of Norway, was sworn in as Director General of WHO. A keen advocate of breastfeeding, Dr Brundtland, expressed a welcome note of caution about partnerships in her inaugural speech. Stressing the need for governments to provide public finance which would ensure universal coverage of health services, she said: "We have seen evidence that growing reliance on private financing mechanisms, including private voluntary insurance, risks massive cost escalation." She acknowledged the role of the private sector but added "...We need open and constructive relations with the private sector and industry, knowing where our roles differ and where they may complement each other."

Throughout the Assembly, the role of the pharmaceutical and baby food industry, their suitability as 'partners' and the role of 'dialogue' seemed to be key concerns, but they were never openly debated. Following her speech we asked Dr Brundtland about this and whether WHO would accept donations of formula. She was adamant that it would not.

During the Assembly, IBFAN's national and international monitoring reports, many of which were produced with the support of UNICEF and governments, showed delegates how the industry systematically and deliberately undermines the policies set by the Assembly, and how companies pressure governments to ignore the Resolutions. We stressed the need for WHO to guard its independence and to recognise that companies that compete with breastfeeding should never be considered appropriate partners.

For the first year since the International Code was adopted in 1981, the WHO Secretariat openly advised governments not to table any Resolution on infant feeding. The Secretariat expressed concerns about raising the issue of HIV in the short time available and proposed dialogue with all parties and a Global Technical Consultation in 1999.

The baby food industry was relieved. Before and during the Assembly, Nestlé and the former US Ambassador to the UN (now a lawyer for American Home products) had been lobbying governments hard to achieve this. During the debate on infant feeding, IBFAN, Save the Children, and delegates from Zimbabwe, the Netherlands and many other countries stressed the need for continued vigilance and for independent research on HIV. The Secretariat stressed the importance of the work of NGO's, including IBFAN. The IFM statement, included the following:

"Notwithstanding the best endeavours of our members, there are instances where companies may not be in full compliance with the Code at national level, particularly when we rely on third party distributor organisations, irrespective of intentions at company headquarters."

Pakistan report launched at the Assembly

"They are using science to scare mothers and coerce doctors... they shut up governments by flooding investments and hush world bodies by threatening to withdraw millions. They never felt obligated to abide by their commitments. They picked and chose from the Code. Selected some of its parts to use as feather in their hat and moulded some into more useful things."

This new report from Pakistan which was launched at the World Health Assembly, provided delegates with vivid evidence that the baby food industry should never be seen as appropriate partners for an agency striving to protect public health.

Written by the Network Association for the Rational Use of Medication in Pakistan, it analyses the results of monitoring in 1997 in 33 cities and towns. Company representatives, doctors and mothers were interviewed in 66 hospitals, clinics and medical stores. The report uncovers the strategies used by companies to get around their moral obligations to the International Code and the extent of their efforts to pursue baby food sales. It demonstrates the need for the Pakistan Government to resist the attempts by industry to undermine their strong draft legislation

UN agencies in dilemma over HIV

WHO, UNICEF and UNAIDS have issued two new sets of guidelines on HIV and breastfeeding.

In her speech to the World Health Assembly, Dr Tomris Turmen, WHO's Executive Director of Family and Reproductive Health, highlighted the dilemma that policies on HIV pose. She stressed that infant feeding is "... one component of a bigger, comprehensive, integrated strategy of prevention and care in mother-to-child transmission of HIV." She stated that the guidelines aim to "actively protect, promote and support breastfeeding for the majority of infants whose mothers are HIV(-) or of unknown HIV status. No child should be denied the benefits of breastfeeding based on ignorance or unfounded fears..." Dr Turmen urged Governments to take strong measures to prevent "spill-over " - the spread of artificial feeding to infants of mothers not infected with HIV.

Recent trials in Thailand found that if pregnant mothers who are HIV positive are given a short course of AZT (an anti-retroviral drug) and do not breastfeed their babies, the proportion of babies infected drops by over 50%. The guidelines advocate that mothers who choose to be tested and are positive should be offered AZT and breastmilk substitutes.

In addition to the concerns about the impact of this new policy on breastfeeding rates, many agencies are expressing concern about the feasibility and expense of providing AZT, counselling, testing and conditions which would enable all HIV+ women to carry out artificial feeding with minimal risk. Lola Gostelow, speaking at the Assembly, expressed some of Save the Children's concerns: "SCF has concerns about the feasibility and appropriateness of some of these measures, particularly in developing countries with few resources. SCF believes that there is an urgent need for independent research into interventions that are accessible and affordable by the poorest; appropriate to the country concerned and sustainable in the long term."

Independent research

It is vital that independent credible research - which has not yet been done - is initiated to clarify the benefits and disadvantages of breastfeeding for the children of HIV positive mothers. The research must be funded and conducted in a transparent, independent manner by those who do not have a commercial interest in the outcome. Commercial involvement can affect study design and research outcome. It is only those who are concerned about public health who are advocating research into how to make breastfeeding safer, the value of breastfeeding and the impact of artificial feeding in settings, especially in settings where it is known to be unsafe.

The Code and Resolutions

In her speech Dr Turmen stressed the need for universal application of the International Code and Resolutions: "If we are serious about wanting to improve the health, nutrition and well-being of our children, all governments need to urgently reflect the recommendations of the Code and subsequent Resolutions in their own laws and regulations... NGOs must be supported to intensify their monitoring efforts specially in view of the HIV epidemic." (See Update 21 for how companies used HIV to lobby against the adoption of the International Code in South Africa.)

Commercial donations

The guidelines do not allow commercial donations of breastmilk substitutes to the health care system, but do allow non-governmental organisations (NGOs) to receive and distribute them. National governments can decide whether these donations are generic or branded. IBFAN is concerned that donations could be channelled through NGOs who may not be aware of the risks involved in artificial feeding - or worse still - bodies such as INFORM which is owned and funded by the baby food industry.

We were pleased that WHO's new Director General indicated that formula donations would not be accepted by WHO.

Generic milks and appropriate labelling

It is important that labels of the breastmilk substitutes which are to be distributed are generic (no brand names) and culturally appropriate.

The baby food industry invests heavily in brand promotion and as a result the safety and quality of generic supplies is often unjustifiably called into question. In fact, there are a number of companies who do not promote branded baby milks, but who can supply appropriately labelled, bona fide breastmilk substitutes in the quantities needed.

Cashing in on organics

German companies Hipp and Babynat, are cashing in on the organic movement by promoting organic follow-on milks in wholefood and organic magazines in the UK. No mention is made of the environmental harm that the production and packaging of artificial feeding presents.

The milks are labelled as suitable for use from 4 months of age despite the fact that UK manufacturers have so far voluntarily agreed to stick to 6-months as advocated by WHO, Codex and health professionals. Will Hipp and Babynat's action prompt the other companies to risk health professional censure?

Engineering of Consent: Uncovering Corporate PR

"NGOs have to be taken seriously, and dialogue rather than confrontation offers the best avenue." Mining Journal, 12 Sept 1997

"Major progress in improving infant nutrition and child health will only be achieved if all concerned sectors - governments, industry, health professionals and researchers - work together." Nestlé brochure sent to Synod members July 1997

Engineering of Consent - Uncovering Corporate PR, a new briefing paper by Judith Richter, was published by Corner House in March. It is essential reading for NGOs, UN agencies and policy makers who may be considering entering into dialogues or partnership with transnational companies.

Judith Richter is a researcher and development sociologist, with an MA on the history of corporate PR. Drawing on her experience as a health activist working on the politics of pharmaceuticals and contraceptive research, she examines the strategies that companies have used to undermine public debates on corporate accountability. The paper shows the impact that the baby food issue has had on the development of corporate PR strategies since the early 1980s.

"Many TNCs say they have seen the error of their ways and have rectified their mistakes... Eager to do their best for "our common future", they claim to be keen to listen to their critics. Thus 'dialogues' with companies or industry organisations are frequently portrayed as the way ahead for citizen groups seeking corporate accountability, rather than 'confrontational' strategies such as boycotts.

But how are industry critics to know whether, when and how entering into 'dialogue' with corporations will be effective? What are the dangers and limits of doing so? An answer requires exploring the ways in which calls for 'dialogue' or 'cooperation' have masked attempts to manipulate public debates; to silence or neutralise critics; and to create an image of socially-concerned business. In short, it requires an introduction to contemporary corporate public relations or PR."

The final section revalues the role of conflict in the political process: "The tension which is unavoidable because of the contradictory objectives of the actors involved will hopefully continue in the years to come, because, if it stops, it means that the most powerful have won." WHO presentation on Pharmaceutical Policies of NCIH, Washington, Nov 1989

""Conflict is the essential core of a free and open society. If one were to project the democratic way of life in a musical score, its major theme would be the harmony of dissonance" Alinsky S.D, 1971

Engineering of Consent: Uncovering Corporate PR is available from Baby Milk Action. Contact us for details.

Image transfer in action

Engineering of Consent shows how companies - especially those facing serious charges of misconduct - benefit from 'image transfer' - and the 'halo effect' of endorsements and links made with prestigious NGOs and UN bodies such as WHO and UNICEF. Below are some examples of image transfer in action:

Send examples of any PR strategies involving industry (not just baby food) to Baby Milk Action.

World Breastfeeding Week

With the theme of 'Breastfeeding - the best investment', this years World Breastfeeding Week (1st - 7th August 1998) aims to highlight the economic benefits of breastfeeding - both to the mother and the economy. See the WABA web site.

Companies polish off midwives...

After the Royal College of Midwives (RCM) voted last year to drop the Nestlé boycott, the College wrote that it "continues to monitor all sponsorship to ensure it is ethical and appropriate, and does not breach WHO guidelines on the advertising and promotion of infant formulae".

Clearly this policy does not extend to the RCM's own conference which was once again sponsored by baby milk manufacturers whose stalls lacked scientific and factual information (see photos below). For example, Heinz/Farleys had a café and adverts proclaiming that their follow-on milks were the cheapest. Nutricia was the only company to carry a comparison chart, but this failed to include any information about the deficiency of immunilogical factors in artificial baby milks.

Baby Milk Action's photographer was asked to stop taking pictures, we believe at the request of Wyeth/SMA. SMA offered free manicures (nail polishing) to delegates and displayed tins of formula with completely blank labels - no brand names - but no warnings, instructions or ingredients either. The representative explained that these were the only labels certain "activists" would allow.

"As a healthcare professional you invest time in educating parents in all aspects of childcare and keeping yourself up to date with the latest developments in infant health and nutrition."

Cow&Gate is ready to help with "educational materials, parent literature and study days."

Nutricia subsidiary, Cow&Gate has launched an information service called "in practice." Multi-page advertisements in health professional journals encourage health workers to sign up to receive information on "good and safe practice in infant feeding." A Cow&Gate stall promoted the scheme at the RCM Conference. What information can be expected? One application form for the scheme asks health workers questions such as: "What percentage of mothers miss out on bottle-feeding education? Which product helps catch-up growth in preterm infants at discharge?" Those showing expert knowledge of Cow&Gate products have the chance to win a VIP trip to an event in the Cow&Gate Symposia Programme.

An SMA rep, invited by a health visitor in Somerset to give a talk about weaning to mothers, gave out freebies - promotional leaflets, beakers, fridge magnets, promoting its advice phone line (See Update 21) - and some pretty dubious information. Implying that expressing breastmilk is a bit of a chore, the rep advised ready-to-drink cartons of SMA Progress as a solution. She also suggested mixing baby rice with artificial milk rather than breastmilk to get a better consistency.

Despite the SMA goody bags, the numerous plugs for SMA Progress and the SMA weaning video which the mothers were shown, the health visitor still commented at the end that it had been a "very impartial talk."

SMA are blatantly promoting their talks to health workers - promising to "reduce their workload" and giving them "more time to tackle other important matters." Boots is promoting the free "confidential and impartial" service of its Baby & Childcare Advisors claiming that - "because of their background, the Advisors can show sympathy for, and empathise with, the customer and their needs"

The health workers who are allowing this to happen seem unaware that such direct contact with mothers is a gross exploitation of a loophole in the UK law, a clear violation of Article 5 of the International Code and the 1996 World Health Assembly Resolution, and a contravention of Articles 70, 71 & 75 of the UKCC Guidelines for Professional Practice.

UK law working group

The UK Law Working Group, which has representatives from the main health professional bodies and mother-support groups in the UK, reconvened in September last year, and has met 3 times since. In November, several participants from the group (and others) met with Tessa Jowell, Minister for Public Health, to discuss their concerns about the UK infant feeding policy, including the draft Department of Health good practice guidelines and the consultation document Our Healthier Nation which was to be issued in February 1998. The participants of the working group expressed their concerns to Tessa Jowell about the widespread promotion of artificial feeding in the UK and the urgent need for the UK law (including the draft documents) to be reexamined and brought more into line with the International Code and the subsequent WHA Resolutions.

Companies lobby MPs on UK law

UK baby food companies pay an anuual subscription of about £40,000 to the Infant & Dietetic Foods Association (IDFA) for lobbying of MPs and public relations cover. One of IDFA's bright ideas was to create INFORM - a campaign to promote mothers' rights to free and informed choice in infant feeding. (See Update 21). Fearing that the UK law may soon be strengthened Inform sent a leaflet to all MPs suggesting ways to lobby the Government to prevent further restrictions on advertising.

Food Standards Agency - how independent will it be?

Baby Milk Action has responded to the Government's White Paper, The Food Standards Agency - A force for Change. When it is set up, the FSA will deal with many issues regarding baby milk labelling, advertising and safety - reporting primarily to the Department of Health. In the White Paper, the Prime Minister, Tony Blair, hails the independence of the Agency and says it sets out to 'do away with the old climate of secrecy and suspicion.'

Like other consumer groups we are pleased that the White Paper has a wide remit and contains many strong proposals regarding transparancy. However there are still concerns about the structure and financing of the FSA. At present the White Paper proposes that members of the food industry will sit on the Commission itself and that the effectiveness of the agency depends on "close collaboration with the food industry."

The food safety crises of the last few years have demonstrated the failures of de-regulation. If the new Agency is to deserve the public's confidence it must be able to take tough decisions on behalf of public health, which are not compromised in any way by commercial concerns.

NCT does U-Turn on sponsorship

Following the furor over its decision to accept sponsorship from Sainsbury's, the National Childbirth Trust has decided not to accept sponsorship from manufacturers of breastmilk substitutes. We welcome this move but are concerned that the new guidelines still permit sponsorship from 'distributors' such as Tesco. This decision could still cause a conflict of interest and may compromise NCT's ability to give truly independent advice to parents.

The Breastfeeding Network was officially launched on 21 May. For details contact: BfN, PO Box 11126, Paisley, PA2 8YB

Infant feeding in emergencies

The report of the Ad Hoc Working Group on Infant Feeding in Emergencies, a group convened by Baby Milk Action involving 15 UK development NGOs, is now available.

Infant feeding in Emergencies - Defining Policy, Strategy & Practice - Contact us for details.

Monitoring in the UK

In the last few months we have been inundated with calls and letters from our supporters about the on-going promotional tactics of baby food companies, ranging from ads on TV (SMA Progress, Milupa) to product placement in TV programmes, unsolicited mailings to pregnant women and numerous reports of baby food company reps giving talks to mothers, handing out gifts and promoting advice phone lines.

Our supporters are the eyes and ears of our campaign and it is vital that you keep us informed of what is going on, even though we cannot follow-up every enquiry ourselves. Part of our campaign is to ensure that everyone - parents, health workers, policy makers, and companies - see it as their duty to report anything which undermines breastfeeding and infant health. Laws and regulations are only effective if they are monitored, and in the UK, where there is no routine surveillance by the Government, it is up to all of us to do this.

We have a number of briefing papers and guidelines explaining the difference between the UK Law and the International Code and the types of things that you can complain about to your local Trading Standards Office (their address is in the phone book). Almost all the baby milk marketing in the UK violates the International Code and Resolutions, and much of it is also a breach of the Law. If enough people complain there is every chance that it can be stopped. Contact us for details.

AAP recommends exclusive breast feeding till "around 6 months"

In December 1997 the American Academy of Pediatrics issued a strong statement in support of "...human milk as the preferred method of infant feeding for the first year of life and longer as mutually desired by mother and child." The AAP statement follows years of work by 11 key breastfeeding experts who have been reviewing the evidence regarding the advantages of breastfeeding. AAP will recommend breastmilk for all infants, including premature and sick newborns, rooming-in, and most importantly, that infants should have nothing other than breastmilk for around the first 6 months. This mirrors the recommendations of the World Health Assembly so hotly contested by manufacturers arguing for 4-6 months.

Pioneering firms bring breastfeeding to work

Yet more research has revealed that breastfeeding mothers save their employers money. The Los Angeles Department of Water and Power found that medical claims for workers' children dropped 35%, and absenteeism among mothers was cut by 27% when good breastfeeding support services were offered to mothers. The Los Angeles Department has a counsellor who advises mothers on how to continue breastfeeding their babies when they return to work. (USA Today 9/12/97)

Breastfeed for health

A study at Ninewells Hospital in Dundee using a cohort of 545 children has produced evidence which affirms the benefits of exclusive breastfeeding. The results of this research clearly showed that "the probability of respiratory illness occurring at any time during childhood is significantly reduced if the child is fed exclusively breast milk for 15 weeks... breastfeeding and the late introduction of solids may have a beneficial effect on childhood health and subsequent adult disease". Infants who had been bottle fed were also found to have higher systolic blood pressure in early childhood.

(Ref: Wilson A et al (1998) Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. In: British Medical Journal 316:21-25)

Breastmilk best for small babies

In this study of infants who are small for their gestational age, it was shown that those who were breastfed had faster postnatal growth and were more likely to show significant catch-up growth than those who were given artificial baby milk. Of particular interest was the faster growth of head circumference of the breastfed infants, this is likely to reflect faster brain growth at this critical time. Explanations for these results include the specific nutrients and composition of breastmilk, such as hormones and growth factors, and protein levels in breastmilk which fluctuate according to need. The authors concluded that the long term health and development of infants born small for gestational age would be significantly enhanced by breastfeeding.

(Ref: Lucas A et al (1997)Breastfeeding and catch-up growth in infants born small for gestational age. In:Acta Pediatrica 86:564-569)

Bedsharing promotes breastfeeding

A study in California to examine nocturnal breastfeeding using direct observation showed that infants who slept in the same bed as their mothers breastfed 3 times longer during the night than infants who usually slept separately. The authors suggested that such increased breastfeeding could have important implications for infant health and maternal fertility.

(Ref: McKenna et al Pediatrics 1997: 100(2):214-19. In: Breastfeeding Abstracts (7) 1997)

Breastfeeding and infant mortality

A review of the evidence linking artificial feeding to infant and early childhood mortality found that falling death rates are primarily related to better health care facilities and social conditions. The paper acknowledged the difficulty of attributing mortality solely to artificial feeding. The authors state:

" from the available published data, which it must be emphasised is scant, there does appear to be a protective effect of exclusive breastfeeding in developing countries which results in reduction of death from gastro-enteritis and also possibly to a less pronounced effect from respiratory and other infections."

The authors developed a mathematical formula (based on figures for Pakistan) which can be used to estimate the number of deaths that would be prevented by exclusive breastfeeding according to the prevalence of artificial feeding, whether or not as a supplement to breast milk - in a country with similar conditions to Pakistan. The authors conclude:

"Thus in a country with 90% breastfeeding at six months and a post-neonatal death rate of 90 per 1000 children, an estimated 13% of deaths might have been prevented if all mothers had breastfed fully."

Water and infant feeding

We reported in the last issue of Update how baby food companies were using bottled water to promote artificial infant feeding. Baby Milk Action has now produced a briefing paper on this topic.

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Research News