Table of Contents

• Editorial: Making an impact
• Saving lives
• Giving the Code teeth
• Encouraging companies to change
• The Feeding Fiasco - Pakistan report extracts
• Violations in Ireland
• Zimbabwe resists Nestlé threats
• GM formula
• UN in HIV dilemma
• Proposed European Commission Medical Products Directive opens the door wider
• Research and sponsorship - BMJ debates sponsorship and other stories
• A year of awards for IBFAN
• Inform fails to inform
• Breastfeeding Network phone line

Boycott news

supplement with the latest on the Nestlé boycott

Editorial: Checks and Balances

We are pleased to report in this issue that Baby Milk Action and our partners in the International Baby Food Action Network (IBFAN) have been awarded one of four Right Livelihood Awards. The Award, worth about US$60,000 to the network, is often referred to as "the alternative nobel prize" and will be presented in a ceremony at the Swedish Parliament on 9th December.

We are often asked "How's the campaign going?" and quite rightly so. This award provides one answer. The Right Livelihood Award Jury chose IBFAN for its "committed and effective campaigning over nearly twenty years." In this issue of Update we are attempting to answer the question "How is it going?" in other ways, remembering that the ultimate prize is to save lives and end the avoidable suffering caused by inappropriate infant feeding. It is not always obvious how our work contributes to this. For example, we may have helped to defend a national law which the industry had been trying to weaken. But what is there to show for the victory if the status quo is maintained? We may have extracted a promise from a company to label its products in the appropriate language for the country where it is selling them. How many lives are saved if mothers can now understand the instructions? Or perhaps we have succeeded in stopping a promotional technique such as the advertising of infant formula on the side of vans distributing the products. But to what extent is a mother's choice to breastfeed less likely to be undermined as a result? Evaluating the impact at this level is not straightforward.

It is easier to demonstrate the impact of IBFAN's work in terms of the introduction of independent, transparent and effective controls on the marketing of the baby feeding industry and changes in company marketing practices. This suggests an even harder question to answer. If no-one had challenged the industry, how do you think things would be going today? We often start the story of the campaign with Dr. Cicely Williams' 1939 speech "Milk and Murder" which highlighted the damage caused to infant health in Asia by the use of sweetened condensed milk, promoted by Nestlé as "the food par excellence for delicate infants." Nestlé continued to market sweetened condensed milk as infant food up until 1977, the year the boycott began.

The Right Livelihood Award endorses our belief that IBFAN's work is making an impact. But it is the ultimate prize of protecting infant health which motivates us.

Saving lives

Does the International Code save lives?

When the World Health Assembly (WHA) adopted the International Code of Marketing of Breastmilk Substitutes in 1981 its Resolution stated that it was "convinced that the protection and promotion of infant feeding, including the regulation of the marketing of breastmilk substitutes, affect infant and young child health directly and profoundly..." Has the regulation of the marketing of breastmilk substitutes made a difference to infant and young child health?.

Breastfeeding saves lives

Before looking at the impact of the International Code and Resolutions it is necessary first to remind ourselves that there is a wealth of undisputed evidence that breastfeeding reduces the risk of infant sickness and death. It is important not to lose sight of this as we address the risk of HIV transmission through breastfeeding. The World Health Organisation (WHO) estimates that 1.5 million infants die every year because they are not exclusively breastfed. Commenting on the decline in breastfeeding in the industrialised world the United Nations Children's Fund (UNICEF) said "A similar decline in the developing world, where bottle feeding entails much greater risks, would lead to millions of infant deaths." (Ref: State of the World's Children, 1991).

The International Code enables more mothers to breastfeed

WHO's Director General published a report on 8th April 1998 on the implementation of WHA Resolutions. This noted that the International Code was one of four measures which "have contributed significantly to increasing breastfeeding rates in many countries." The other measures are: an authoritative breastfeeding coordinator; the baby friendly hospital initiative and legislation to protect the breastfeeding rights of working women. (IBFAN supports these activities in addition to working on marketing issues.) The report states that "as awareness of the advantages grows in both developing and developed countries, more Member States are taking steps to protect and promote breastfeeding, and rates are increasing." The report acknowledged the work of IBFAN and the Executive of WHO distributed a report to delegates at the Assembly giving an overview of IBFAN's activities.

Baby Friendly Hospitals

Another means of protecting infant health is through the WHO/UNICEF Baby Friendly Hospital Initiative (BFHI). To achieve "baby friendly" accreditation a hospital has to demonstrate that it has measures in place to support breastfeeding. This includes complying with the relevant sections of the International Code and Resolutions. BFHI provides compelling evidence of the impact of a supportive environment for breastfeeding on infant morbidity and mortality. For example, Electrostal Hospital in Russia reported that after becoming baby friendly infant infections fell by 18%, including a 48% decrease in pneumonia.

In a report on BFHI entitled Evidence for the ten steps published this year WHO presents the case for implementation of the International Code and Resolutions. It cites a 1991 study conducted by Margen et al in Mexico which found that 80% of the 59 facilities surveyed received all infant formula free from companies. Only 3% reported receiving formula at full price. On admission 95% of mothers said they planned to breastfeed at home, 54% exclusively, but while in hospital only 40% breastfed their infants. At discharge, 36% had changed their intentions at admission in various ways, most of them deciding to increase bottle-feeding or add formula, and only 43% planned exclusive breastfeeding. WHO states that stopping such practices, as the International Code and Resolutions seek to do, is a crucial aspect of the success of BFHI.

(Interestingly, the Mexico study was the only one ever commissioned by the Nestlé Infant Formula Audit Commission, which was disbanded by the company before the results were published.)

Information on WHO publications is available from: WHO, 1211 Geneva 27, Switzerland. The WHO web site is: http://www.who.org Tel: + 41 22 791 2111 Fax:+ 41 22 791 4857

Giving the Code teeth

The International Code is a voluntary measure. It was adopted by the World Health Assembly (WHA) as a recommendation in 1981. The WHA is the highest international body in the field of health and its judgements carry moral and political weight. Governments are called on to implement the International Code in its "entirety" as a "minimum requirement" to protect infant health. Companies are called on to abide by it "independently of other measures". So how is it going?

State of the Code by Country

Our IBFAN partner ICDC has tracked implementation of the International Code over the years and publishes charts revealing the State of the Code by Country. The graph on the right demonstrates how the number of countries with legislation implementing the code has increased over the years. IBFAN has been working for the implementation of the International Code since 1981 and its training is acknowledged by WHO. Today the state of implementation in national measures is as follows:

• 20 countries - all or nearly all provisions in law.
• 27 countries - many provisions in law.
• 21 countries - all or nearly all provisions as policy or voluntary measures.
• 19 countries - few provisions in law.
• 21 countries - some provisions voluntary.
• 22 countries - measures drafted, awaiting final approval.
• 35 countries - being studied.
• 14 countries - no action.
• 11 countries - no information.

Compare the situation in the United States with almost any of these countries. In the home of free trade and deregulation, no action has been taken to implement the International Code since a voluntary ban on advertising collapsed when Nestlé entered the market in the late 1980's. Today infant formula is advertised with slogans such as "Bring out the best in your baby" (Nestlé) and unsolicited free samples are sent to pregnant women to arrive when their babies are due (Abbott Ross). However, having a law on the statute books is not the end of the story. Some countries which have had laws for many years, such as the Philippines, are still besieged by promotional activity - Nestlé has even resurrected its old strategy of portraying its sales representatives as nurses (or so-called "Health Educators") who target new mothers directly. On the other hand in India a number of companies have been taken to court and have changed their marketing practices as a result. Johnson & Johnson even stopped marketing feeding bottles and stated that it would no longer sell its baby feeding products in countries where bottle-feeding is "inappropriate".

Baby Milk Action is compiling a database of actions which have been taken using different national measures. For example, in Brazil an IBFAN campaign against labels which broke the law led to their removal from supermarket shelves. In the UK, many cases have been reported to the Trading Standards Authorities which are responsible for enforcing the UK Infant Formulae and Follow-on Formulae Regulations 1995. This has brought about some changes to the practices of manufacturers and distributors. However, it appears that court cases will have to be brought for the law to be effective and we are encouraging the Authorities to take this step. We continue to work with health bodies to bring the UK law into line with the International Code and Resolutions.

Contact Baby Milk Action with information for our legal action database or to request a quote for ordering the State of the Code charts and ICDC's Code Handbook on implementation in national measures. Please give your country so we can calculate postage rates.

National measures under threat

The industry actively works against strong implementation of the International Code and Resolutions in national measures (see Update 22). As implementation gathers pace its latest strategy is to exploit concerns about the risk of transmission of HIV through breastfeeding to argue for regulations to be scrapped. Addressing this topic at the 1998 World Health Assembly, WHO stated, "It is essential that we safeguard the gains that have been made in protecting breastfeeding, ensuring the survival of millions of infants."

Encouraging companies to change

IBFAN's latest monitoring report, Breaking the Rules, Stretching the Rules 1998, demonstrates how companies continue to violate the International Code and Resolutions. Increasingly IBFAN groups are using laws which implement these measures to take action against companies. But what can be done if laws do not exist or are difficult to enforce? Baby Milk Action is a resource centre within IBFAN for encouraging companies to change.

State of the Code by Company

Our IBFAN partner, ICDC, evaluates the marketing practices of leading baby food and bottle and teat manufacturers and produces a chart evaluating their performance relative to the International Code and Resolutions. The 1998 chart rates Nestlé and Milupa (part of Numico) as the worst companies for violating the International Code's Articles. ICDC continues, "They are closely followed by the French manufacturer Danone/Diepal. No company was found to comply with more than three out of eight key Code requirements. Japanese Meiji and the Dutch Friesland company improved their 1994 scoring but both were still found to give infant formula through the health care system."

Targeting violations

One way in which Baby Milk Action supports its IBFAN partners is by targeting specific violations. Every month we produce a Campaign for Ethical Marketing action sheet. This keeps policy makers and supporters informed of current practices and encourages people to write letters to the Chief Executives of the companies concerned. More often than not companies respond by disputing the interpretation of the Code or by denying the evidence. Sometimes, however, they make changes. For example:

• Malawi: Nestlé's CEO finally agreed to label its products in the national language after 4 years of campaigning. Wyeth said it will include under-lid labels in the national language, which is an improvement, but still does not fulfil the labelling requirements of the International Code.
• Armenia: Nestlé removed advertisements for Nan infant formula from the vans of its distributors and pledged to review its activities. It introduced wholemilk powder labels with a warning against feeding to infants - but as the labels are only in English, this is inadequate.
• Russia: Nestlé has promised to stop promoting artificial infant feeding in advertisements for bottled water.
• UK: Milupa's notorious advertisements featuring teddy-bears have been suspended.

Free supplies plot foiled in West Africa

In September 1997 the consultancy firm Sar International wrote to the Ghanaian Ministry of Health on behalf of the company US Foods & Pharmaceuticals with a proposal for "launching My Baby infant formula in Ghana." Sar suggested that the Ministry identify non-profit organisations to solicit free supplies of the product. According to the letter, aid donors would then be asked to fund the supplies. Sar stated that My Baby formula would be for "distribution free of charge to the childrens hospitals, clinics and women clinics hospitals [sic]," and suggested that non-profit organisations "should express an interest in the products and that it will be responsible to distribute the products, nationally, free of charge." Sar indicated that US Foods & Pharmaceuticals would sponsor and conduct seminars on infant nutrition as part of the project. The IBFAN group, Ghana Infant Nutrition Action Network (GINAN), worked on the case nationally, sent a letter of complaint to Sar and alerted the IBFAN network. Sar claimed to have similar schemes planned for Cote d'Ivoire, Guinea, Liberia and Senegal.

Baby Milk Action contacted both Sar and US Foods & Pharmaceuticals and informed them that free supplies are banned by the International Code and Resolutions. The case was featured on the Campaign for Ethical Marketing February 1998 action sheet. Sar subsequently demanded an apology, stating its project had been misrepresented. Baby Milk Action's solicitor responded. Sar apologised for any "misunderstanding" and announced that the project had been dropped. An international aid organisation, which Sar implied endorsed the project, also sent a solicitor's letter to the consultancy and received an apology for misuse of its name.

Mr. Rajan Vembu, President of US Food & Pharmaceuticals, failed to respond to Baby Milk Action's telephone calls or letters. However, he did respond to a campaign supporter who complained about the project with the suggestion: "you may want to consider volunteering with either Africare or the Peace Corps."

View the Campaign for Ethical Marketing action sheets on this web-site. Company responses are posted at intervals. Contact us to be added to a mailing list so we can e-mail you an alert when the latest sheet is posted (sheets are not posted on a set date as other committments and the need for urgent action by staff can interupt schedules.)

The Feeding Fiasco

Below we reproduce extracts from a powerful report published by our IBFAN partner in Pakistan, The Network, Association for Rational Use of Medication in Pakistan. Pakistan first attempted to regulate the marketing of breastmilk substitutes in 1992 by adding them to a list of products that could only be sold at pharmacies. They were removed from the list three months later following complaints from the baby food industry and a visit by a senior Nestlé executive. Now Pakistan is on the verge of introducing a law implementing the International Code and Resolutions. This report shows why this is such a necessary step, which all concerned parties should support.

Undermining the Code

"First it was cracked and then broken. Now it has been decimated into small, profitable pieces. They have invented new products and changed old strategies to get around the International Code. Their approach has become more vicious and operations more clandestine. "They never felt obligated to abide by their commitments. They picked and chose from the Code. Selected some of its parts to use as feathers in their hat and moulded some into useful things. They took the teeth out of the dangerous sections and murdered its spirit.

"Yes, they have curtailed promotion to mothers and on the mass media. But only to invest more on their ultimate ally - the doctor. Yes, they have taken baby faces of formula tins. But only to put them on other products they themselves have deemed legitimate. Yes, they have reduced free supplies and made sampling deceptive. But have they lost a single penny in sales? "The market is thriving. Companies are growing. Profits are mounting. More and more babies are sucking rubber in a vain search for the juice of life.

"In an age when capital has conquered nation states, corporations have overshadowed governments and profit has become a supra territorial reality, the Code as a global instrument, as humanity's promise to its children, seems too little, too late.

"It took us generations to ask profit to respect life. But has the Code been successful in stopping more babies being put on artificial feeds? The companies are still having a field day with the Code with an opportunistic drive.

"Shall we as a generation be defensive, apologetic about our contribution towards the future of humanity? Can we look into the eyes of our children and say that this is all we could do? No. We shall not be cowed down by the sheer size of the mega houses of profit. We shall not be overwhelmed by the strength of globalized capital and the extent of sprawling marketing networks.

"We need a new system that stands up to current realities. We need a system that does not offer the greedy room to manipulate. We need instead regulations that are binding on the corporations themselves. We need a system that serves its purpose."

Monitoring in Pakistan

"The monitoring exercise was carried out in the first half of March 1997 by 11 teams of 34 monitors. It covered 33 cities, towns and small towns in the whole of Pakistan except the mountainous Northern Areas and the coastal belt of Balochistan, which are far flung and difficult to reach.

"The monitors visited 66 public and private hospitals, 151 private clinics and 562 medical stores and interviewed 662 mothers. A conservative estimate of total one-to-one encounters in the monitoring exercise is more than 2,500. Besides this, the exercise included an extensive study and analysis of product labels and 400 specimens of promotional and information materials and other objects submitted by the monitors."

Covert operations

"Of 96 doctors, 71 said they received samples from Nestlé. Thirty-seven of these had received Cerelac samples, six Nestlé Rice (Nestum) and five Neslac. Fourteen doctors said they had received Lactogen samples during the last three months. 28 were receiving Moringan samples. Twenty doctors reported receiving samples from Abbott and 16 from Meiji. There were another 20 claims of receiving free samples from Nutricia, Mead Johnson, Snow Brand and Wyeth. A former area manager of an infant formula company revealed, "Lucrative hospitals and doctors are known as JKs or jackpots among company circles. These are 'purchased' by companies for up to US$5,000, after which the doctor or hospital is bound to recommend the company's formula for six months or one year, depending upon the deal. Mission Hospital, Multan is a 'Lactogen hub.' The deal is a 20% cut to doctors for every tin recommended." A former Nestlé representative told The Network in an interview that they were told repeatedly by the management that one prescription of Lactogen ensures the company a profit of Rs. 50,000 (US$1,250)."

Nestlé employee speaks out

"Pakistan has the highest infant mortality rates (IMR) in Southeast Asian region. This high IMR is attributed mainly to diarrheal diseases, the ever-increasing incidence of which is due to a growing trend of bottle-feeding. For this, the baby food manufacturers are the main culprits as they make use of all kinds of unethical marketing practice to convince mothers to initiate artificial feeding. I, as a former employee of Nestlé Milkpak Ltd., have been a part of this malpractice, but a stage came where I could not bear it any more and ultimately decided to quit this company."
Syed Aamar Raza, Ex-employee, Nestlé Milkpak Ltd., Sialkot

The report contains detailed information on the whole range of marketing practices used in Pakistan today. Please contact us for a quote for ordering a copy - please give your country so that we can calculate postage.

Send a message of support to our IBFAN partner in Pakistan:
The Network,
60-A,
St: 39,
F-10/4,
Islamabad,
Pakistan.

International News

Violations in Ireland

Ireland continues to have the lowest breastfeeding rates in Europe, with only 31.7% of mothers initiating breastfeeding at all. It is known that this figure drops dramatically in the weeks after birth, but no recent figures are available.

Ireland is a signatory to the International Code and the Irish IBFAN group, Baby Milk Action Ireland, conducted monitoring between January and August 1997 and has published the results as The Code Report. The report concludes:

• The monitoring results indicate that the International Code is being violated in Ireland on a wide scale. There is little restriction on company promotion of artificial feeding products other than self-regulation through a voluntary code which is substantially weaker than either Irish Law (which is not being enforced) or the International Code.
• The scale of the violations would suggest that they are a systematic strategy rather than one-off incidents and that companies consistently put profits before infant health.
• The Irish Government is failing to meet its responsibility under the Code to ensure objective and consistent information is provided for parents on infant feeding and to implement the provisions of the Code in national law.
• Parents are being denied informed choices on infant feeding and adequate support for breastfeeding. The rights of parents and infants to consumer protection from commercial promotion of artificial feeding is not being upheld.
• Many obstacles still exist which prevent mothers having positive breastfeeding experiences, due to lack of support and appropriate facilities, hospital routines, minimum maternity leave and insufficient workplace accommodation for breastfeeding mothers.
• There is a low level of awareness among health workers of their responsibilities under the Code.
• The pervasiveness of the bottle as a symbol of infant feeding indicates the extent to which Ireland is a bottle feeding culture.
• Ireland's continuing low rates of breastfeeding and failure to implement the National Breastfeeding Policy indicate that infant health is not being protected or prioritised by the Government.

For full information contact Baby Milk Action, Ireland for a quote for ordering a copy of The Code Report - give your country so that postal rates can be calculated.

Zimbabwe resists Nestlé threats

On 1st March 1998 Zimbabwe adopted strong legislation implementing the International Code and Resolutions. Nestlé, which often claims to aid development by creating jobs, threatened to close its factory if the law was introduced. While governments may have to make a choice between foreign investment and infant health when introducing legislation, it appears this is simply a case of Nestlé flexing its muscles. Nestlé's best known product is reportedly a breakfast cereal which will not be affected by the law. Denise Briggs of Nestlé UK confirmed the threat had been made and added "This would result in job losses for about 200 people and an extremely negative economic impact on local farmers who supply us with milk, wheat, maize and sugar."

GM formula

Tests in the United States have shown that genetically modified (GM) soya is being used in some soya-based formulas reports INFACT, our Canadian IBFAN partner. Although none of the labels declare this, it is likely that formula in the UK already contains GM soya. Soya is genetically engineered by the US firm Monsanto by adding genes from a virus, a bacterium and a petunia (yes, a petunia). This makes the plants more resistant to Roundup weedkiller, which Monsanto also manufactures. The modified soya is in infant formula in Australia, where Monsanto has applied for a 200-fold increase in allowable Roundup residues in foods.

Hungry for profits

In Update 21 we reported how a PR company advised the bio-tech industry to counter its critics by focusing on "symbols, not logic." Monsanto seems to be taking this advice in its attempt to solicit support from Third World leaders for its £1m promotion campaign. One Monsanto advert in August claimed: "Worrying about starving future generations won't feed them. Food biotechnology will." Ten companies own 40% of the world's commercial seed. Six of these companies - based in Europe and the US - are driving the development of GM foods and their strategy seems to be far more about achieving a quick return for the millions already invested than searching for sustainable solutions which might be useful or relevant to Third World farmers. At its AGM in May, Nestlé also claimed to be "the world's leading transformer of such materials" and promoted GM as a solution for world hunger.

UN in HIV dilemma

As reported in Update 22, WHO, UNICEF and UNAIDS Secretariat have issued Guidelines on HIV and Infant feeding. The guidelines are part of the UN's aim to have a comprehensive, integrated strategy of prevention and care in mother-to-child transmission of HIV and are intended to provide guidance to policy makers and health managers who are faced with the problem of developing policies on this subject.

Following recent trials in Thailand pilot studies are to be conducted in 11 other countries to examine not only the feasibility of offering AZT to mothers who choose to be tested and are found to be infected with HIV, but also how realistically mothers can be supported in carrying out their chosen method of infant feeding.

Impact of the new policies

Despite the careful wording, the fact that the UN is considering providing AZT and breastmilk substitutes to mothers who may have little or no access to the basics of primary health care, sends a powerful message to the public. This has caused concern to those working on the protection of infant health, especially in the South. The guidelines have been widely misinterpreted in the media and this has led to inaccurate and damaging reports. It has been suggested that all women who are infected with HIV should not breastfeed, and that the problems associated with artificial feeding are a 'thing of decades past'.

Although the guidelines themselves contain statements such as "the risk of giving replacement feeds must be less than the risk of HIV transmission through breastfeeding or there is no point in using them", these are buried in the text. Much more emphasis is placed on the need to prevent 'spillover' to mothers who are not infected with HIV and those whose HIV status is unknown.

There is concern that:

• the guidelines shift the emphasis from protecting mothers from HIV/AIDS to discouraging mothers from breastfeeding their infants - as if breastfeeding is the cause of the problem;
• more emphasis will be placed on procuring formula and AZT than on ensuring safe water supplies, improving health care provision or finding ways of making breastfeeding safer;
• the provision of AZT for a minority of women will be seen as a 'right' above the needs and concerns of the population as a whole (this is of particular concern in resource-poor settings);
• AZT administered as a short course protects only the unborn child, not the mothers themselves;
• the guidelines encourage the notion that artificial feeding can be made safe in all circumstances and the notion that not to provide alternatives is unethical;
• the risks of artificial feeding will be overlooked as agencies struggle to solve the problem of HIV transmission;
• the new policies will encourage NGOs and governments to seek support from commercial companies to allay the substantial costs of the programme - breastmilk substitutes, distribution, information, etc.
• the additional health costs resulting from a shift in practice to artificial feeding are likely to be borne by the family and the health care system, not the agency responsible for providing the AZT and formula;
• the guidelines do not specify that research in this area should be conducted independently of those with a vested interest in the outcome.

Financing, partnership and companies

Although, in the short term, donations from baby milk companies may appear to minimise some of the costs involved in putting the guidelines into practice, this is likely to cause serious problems in the long term. The companies (who face criticism for their aggressive promotion of artificial feeding) have a special interest in the HIV pandemic since it may provide them with an opportunity to be seen as partners with respected agencies. Such partnerships could enhance their image and ultimately help them to promote their products - products which remain unnecessary for the vast majority of infants.

Companies whose products compete with breastfeeding have demonstrated that they are not appropriate partners for NGOs wishing to protect infant and maternal health, or appropriate advisors for mothers, especially those infected with HIV.

UN Guidelines available from WHO. Other briefing papers available: Caring with Confidence, from AHRTAG, +44 171 242 0606; The HIV threat to breastfeeding:virus, fear and greed, by Ted Greiner from his website:

Proposed European Commission Medical Products Directive opens the door wider

A new directive being considered by the European Commission for Foods for Special Medical Purposes (111/5318/98-EN-Rev.1) creates new opportunities for the unethical marketing of breastmilk substitutes.

Two earlier European Directives (91/321/EEC and 92/52/EEC) gave rise to the existing law which covers the marketing of infant formula and follow-on formula in the UK. The UK Law (Infant Formula and Follow-on Formula Regulations 1995, S.I. No 77, Amendment S.I. 1997 No 451) is more limited than the International Code, but it does at least contain some important labelling and advertising restrictions. However, it has many loopholes - an important one is that it applies only to infant formulas and follow-on milks intended for "infants in good health." The International Code in contrast applies to all breastmilk substitutes (BMS).

The Medical Foods Directive will cover a range of foods intended for adults and infants with special medical needs. These products are intended for use under medical supervision but can be on retail sale and do not have to be on the NHS prescription list. A fine line has been drawn here, since the UK Law already states that 'normal' formulas should be used only on the advice of an independent health worker.

In recent years baby food companies have focused much research on specialised formulas - many of which share the same brand name and packaging as formulas for 'healthy infants' but vary slightly in composition. Companies could choose to market products under the new rules and so avoid the advertising and labelling restrictions which apply to formulas for 'healthy' infants.

The Directive could also encourage the use of health claims, which will be difficult, if not impossible, for health workers, let alone worried parents, to evaluate. In its submission to MAFF, Baby Milk Action and other health bodies are calling for the marketing of all BMS to be controlled in line with the International Code and WHA Resolutions. The Standing Committee for Foodstuffs will discuss the Directive in Brussels in December.

Send comments on the draft EU proposals to Jeff Allder, Room 325d, MAFF, Ergon House, 17 Smith Square, London, SW1P 3JR. Tel: 0171 238 6283. Baby Milk Action submission also available. Contact us for details.

Research and sponsorship

BMJ debates sponsorship

The British Medical Journal (BMJ) edition on 1 August was a theme issue on the subject of 'conflict of interest.' Baby Milk Action was invited to contribute to the debate on baby food sponsorship.The following excerpt from the Editorial explains why the BMJ has changed its declaration of interest policy:

"Several studies have shown that financial benefit will make doctors more likely to refer patients for tests, operations, or hospital admission, or to ask that drugs be stocked by a hospital pharmacy. Now we are beginning to have data on the effects of conflict of interest on publications...

"Authors of all original papers, editorials, and review articles will be asked to complete our questionnaires. Competing interests will be disclosed, and if authors tell us they have none (the usual case) we will write "none declared" rather than "none." If we learn after publication that authors had competing interests that they did not disclose then we will tell readers.

"Some readers will regret such moves and remember a golden age when conflict of interest was not an issue. Times have changed however, and transparency and accountability are increasingly expected in all aspects of society. We doubt that the changes ..will solve the problem, but they seem to us to be a step in the right direction."

Professor Alan Lucas, wrote in favour of commerical sponsorship:"The low prevalence of breast feeding causes concern, and some find the industrial input to maternal education upsetting. But in reality, manufacturers of infant formula have a major role in the health care of infants."

Patti Rundall, for Baby Milk Action, wrote about the influence that commercial sponsorship has on health internationally and the conflicts which arise when people try to find solutions for public health problems using funds which have already been set aside for the specific purpose of marketing.

The issue prompted numerous responses, many of which are on the BMJ's Website. One letter from the Royal College of Paediatrics and Child Health (formerly the British Paediatric Association - at the centre of conriversy in1995 when it accepted a research grant from Nestlé) says: "The College takes the issue of commercial sponsorship seriously... At the 1997 AGM the College's ethics committee was asked to investigate the marketing of breastmilk substitutes. Its report will be ready later this year. In the meantime no further research funding or donations have been or will be accepted from manufacturers of infant formula."

SCF keeps mum

Baby Milk Action has been pressing for greater accountability of the Scientific Committee for Food. The SCF advises the European Commission and plays an important role in the formation of many EU directives. In March the SCF published its revised statute. Article 6, on Independence, states that SCF members should inform the Commission once a year of any interests which might be 'considered prejudicial to their independence.' In addition members are asked to declare specific relevant interests at each meeting. Sounds good, except that members can choose whether their annual declarations are made public or not! And although the minutes are now public, many relevant links have so far failed to appear.

Blinded by science

The fight for market share continues as companies argue over research findings. Milupa claims endorsement by the 'medical profession' for its formulas with LCPs but will not say who by. A spokesman for Wyeth/SMA meanwhile, says "...despite all the expensive research, we are not yet convinced.. and neither is the medical profession, about the case for adding LCPs to infant formula."

A Milupa-funded study in Dundee of just 44 babies, published in the Lancet in August, found that babies fed with LCP-supplemented milk scored significantly higher in intelligence tests than those without supplements. However, the study has provoked many criticisms: A letter from Esther Culpin in The Scotsman, states: "The Dundee trial ..involved two groups of children: around half had formula supplemented with long-chain polyunsaturated fatty acids, the other half had formula without them. Where was the control group of breastfed babies who received long-chain polyunsaturated fatty acids naturally? ..the study was supported by Milupa UK. ... Researchers and a commercially-based baby milk manufacturing company are looking into developing a better milk for babies, which will always be inferior to breastmilk, never be readily available and always be costly."

Best brain food

A longitudinal study in New Zealand of 1000 children over an 18-year period has been published. Breastfeeding duration was associated with a small but detectable increase in cognitive ability and educational achievement. These effects are broad and last well into early adulthood. Children who were breastfed for 8 months or more were less likely to leave school without any qualifications than those who were not breastfed.

Breastfeeding and later cognitive and academic outcome. Horwood L J and D M Fergusson. Pediatrics 98; 101(1): 99

A year of awards for IBFAN

The International Baby Food Action Network (IBFAN), of which Baby Milk Action is the UK member, was awarded the Right Livelihood Award on 7th October 1998. Commonly known as the "alternative Nobel Prize", the RLA International Jury awarded it to IBFAN for "its committed and effective campaigning over nearly twenty years for the rights of mothers to choose to breastfeed their babies." The $60, 000 award will be presented at a ceremony in the Swedish Parliament in December.

IBFAN Brazil was given a prize for its work in implementing the International Code by the Brazilian Minister of Health. IBFANers, Marina Rea, Marcus Renato Carvalho and Zuleika Thomson also received individual prizes.

Annelies Allain, Director of IBFAN's International Code Documentation Centre was awarded the Order of the Royal House of Orange-Nassau for her work in providing counterveilling power in the public interest. Awards are given annually on the Dutch Queen's Birthday, like the OBE in the UK.

Inform fails to inform

Inform, an initiative of the Infant and Dietetic Food Association (IDFA) was present at the Labour Party Conference, distributing leaflets and a free phone card. The leaflet argues against restrictions on the promotion of artificial feeding, suggesting that British mothers are prevented from receiving important information on how best to feed their babies. Strangely the leaflet and the phone card omit any mention of Inform's links to IDFA, the UK body which represents baby food companies including Cow & Gate, Heinz Farley's, Milupa and SMA/Wyeth.

These companies all claim to abide by the International Code, yet actively mis-represent its purpose and campaign against its adoption. They fail to mention that the purpose of the International Code is to ensure that all women, regardless of how they feed their babies, receive full, impartial information.

Breastfeeding Network phone line

The UK mother-support group The Breastfeeding Network launched its Supporterline on the 25th September. For the first time in the UK you can dial a single number to reach your nearest breastfeeding supporter. You will be calling another mum's home, so she may be busy and you may find an answering machine but your call will be returned. The number is: 0870 900 8787