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Issue 27: May 2000

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.


Table of Contents

How Nestlé puts sales ahead of infant health

  • UK news and more

    • Mutant milk for baby
    • The Baby Feeding Law Group (UK)...
    • SMA advertise for staff to violate the Code
    • UK Food Standards Agency - a good start ?
    • Nestle in deep water

  • Research and reviews
    • Negative impact of commercial materials
    • Baby Friendly video
    • Long -terme breastfeeding protects infant health
    • ILO - breastfeeding at work
    • Artificially fed babies at greater risk of scalds
    • WHO study on infant mortality

  • Round-up

    • Breastfeeding : It's your right !
    • Calendar 2001
    • Skydive for Baby Milk Action
    • New Year's Honours for Patty

Boycott news

Supplement with the latest on the Nestlé boycott



EU breakthrough - industry links uncovered at last

The European Commission has decided to make public the annual declarations of the members of its Scientific Committee for Food (SCF) - a key advisory body which assesses the safety of European food ingredients and processes. The move follows years of lobbying by Baby Milk Action and IBFAN. IBFANers in 28 European countries wrote to David Byrne Commissioner for Health and Consumer Protection, in November 1999 calling for action.

The Commission is reviewing all its food safety policies and looking for ways to gain consumer confidence and, in April 2000, invited IBFAN to meet the secretariat of the scientific committees. Traditionally, EU support for farming and the food industry has disadvantaged breastfeeding - the optimum nutrition for infants which is not 'on sale.'

We explained how EU baby food legislation had been influenced by SCF experts who had close, undeclared links with the baby food industry and how full transparency and greater involvement of public health advocates in all aspects of policy making could reduce these influences. The campaign is supported by Glenys Kinnock, MEP, and was highlighted in the European Voice and the British Medical Journal.


IBFAN meets with WHO

IBFANers meet senior WHO staff during the Executive Board meeting in Geneva in January.

 

Left to Right: Dr. Arun Gupta (IBFAN - India), Annelies Allain (IBFAN - Malaysia), Dr. James Tulloch (WHO - Director, Child and Adolescent Health and Development), Dr. Graeme Clugston (WHO - Director, Nutrition), Mrs Randa Saadeh (WHO - Nutrition), Poonan Singh (WHO - Dir, Sustainable Dev.), Dr. Tomris Türmen (WHO - Senior Policy Adviser to the Director General), Patti Rundall (IBFAN - UK), Alison Linnecar (IBFAN - Geneva), Dr. Felicity Savage-King (WHO - Med Officer), Giselle Laviolle (LLL - France), Marcelle Epoulou (IBFAN - Gabon). Dr Nafsiah Mboi (WHO -Dir, Women's Health) was present and took the photo.

IBFAN representatives met Senior WHO staff during the Executive Board meeting in Geneva in January. This was one of a series of meetings during which we presented our concerns. We discussed inaccuracies in some of WHO's reports and public statements and Nestlé's use of WHO in its new public relations strategy. We also discussed our joint contribution to the Convention on the Rights of the Child and the forthcoming Global Technical Consultation. WHO promised that in future all contact with the media would be consistent with WHO policy and that the International Code and WHA Resolutions would be referred to as one and the same policy.

Dr. Arun Gupta, of the Breastfeeding Promotion Network of India, addressed the Executive Board on behalf of Consumers International and IBFAN. WHO staff asked us to remove a section of the speech which was critical of Nestlé's book (see below), but IBFAN insisted on keeping this in and is now calling for this section to be included in the official summary record.


Nestlé's PR offensive falls to pieces

Last October Nestlé's Chief Executive, Peter Brabeck-Letmathé, distributed a 180-page book Nestlé implementation of the WHO Code around the world claiming that 54 countries had officially verified that Nestlé complies with the International Code of Marketing of Breastmilk Substitutes (see Update 26). The high profile public relations offensive is turning into a disaster.

  • In December, Carol Bellamy, Executive Director of UNICEF, wrote to Mr. Brabeck saying that requesting letters from government officials does not fulfill Nestlé's self-monitoring obligations under the International Code.

  • Her letter goes on to question his claim that the letters are "official verification of compliance" by citing problems with 21 of the 54 letters. For example, the Minister of Health in Oman informed UNICEF that he wrote to Nestlé thanking its staff for attending a meeting and his letter in no way verifies compliance.

  • In another example, UNICEF questions how Nestlé obtained a letter from the Philippines at the same time as winning an industry prize for a direct marketing campaign - direct contact with mothers is banned by the Code.

  • In its January Code "Action" report Nestle admitted that it had misrepresented a letter from Denmark, as we claimed in Update 26 (also see our briefing paper Don't Judge a Book by its Cover. Nestlé has now apologised to the Danish authorities (see Baby Milk Action press release 23rd January 2000).

(IBFAN has commissioned a legal evaluation of Nestlé's book).


WHO suppresses critical debate meeting

Events at the WHO/UNICEF Technical Consultation on Infant and Young Child Feeding in Geneva in March 2000 raised concerns about whether, and to what extent, the push for "private-public partnerships" affects policies and prevents open and transparent debate.

Before the meeting, some background papers, which had been prepared by invited experts, were radically censored by WHO. Critical reflection on corporate behaviour relating to marketing and policy making was removed. In addition invited experts were told that they could not discuss the issue of the appropriate age of complementary feeding.

This caused so much concern that twenty of the experts signed a statement for inclusion in the official record: "The Technical Consultants who have gathered here in Geneva to assist WHO and UNICEF believe that it is essential for the strategic plan for the first decade of the new millenium which will result from our work, to reflect the current scientific evidence and refer to the recommended duration of exclusive breastfeeding as about six months. Such guidance...will significantly improve the survival and the health and development of all the world's infants and children."

Over the past 4 years, WHO representatives have made statements advocating complementary feeding at 4-6 months at meetings of Codex (the body that sets world food standards) in contradiction with scientific evidence and with the 1994 WHA Resolution which cites 'about six months.' Industry has used WHO's statements to push for a 4-6 months global standard and to defend their promotion of early complementary feeding. The next Codex meeting is in June. WHO & business WHO has produced a summary of the comments it has received on its guidelines on Interaction with Commercial Enterprises. This illustrates WHO's dilemma in attempting to reconcile the interests of for-profit and not-for profit sectors. IBFAN has submitted a detailed critique of the guidelines which did not sufficiently address the risks of close interaction with industry. The International Federation of Pharmaceutical Manufacturers Association (IFPMA) in contrast found them to be too 'industry unfriendly'. IFPMA complained that they did not cover key industry concerns such as confidentiality, respect for intellectual property and market forces. That said the guidelines had a "negative bias against the private sector which goes against WHO's expressed interest in partnerships." See Reply Form.

...then changes

Following these events WHO has revised its submission to Codex Alimentarious - the body that sets world food standards, proposing new wording for the Codex Standard on cereal-based babyfoods: "by phrasing it positively - and to call attention to the importance of not promoting infant foods for use at too early an age: The label shall clearly state that the product is recommended for use from the age of about 6 months and not before 4 months."

WHO has also said that it will submit a report of all the published literature to the Cochrane Library for endorsement in November 2000. This will be peer reviewed and submitted to a small expert committee for final endorsement.


WHO & business

WHO has produced a summary of the comments it has received on its guidelines on Interaction with Commercial Enterprises. This illustrates WHO's dilemma in attempting to reconcile the interests of for-profit and not-for profit sectors. IBFAN has submitted a detailed critique of the guidelines which did not sufficiently address the risks of close interaction with industry. The International Federation of Pharmaceutical Manufacturers Association (IFPMA) in contrast found them to be too 'industry unfriendly'. IFPMA complained that they did not cover key industry concerns such as confidentiality, respect for intellectual property and market forces. That said the guidelines had a "negative bias against the private sector which goes against WHO's expressed interest in partnerships."


EU public hearings

The Public Hearings into the baby food industry at the European Parliament are scheduled to take place in July.

The Hearings were proposed by Richard Howitt MEP acting on a Resolution which aims to make companies accountable for their activities in developing countries. He decided to focus on the baby food issue following the ASA ruling against Nestlé.

First-hand evidence of malpractice will be presented and companies will be called to answer charges.

You can help the campaign by contacting your MEP (See Campaign for Ethical Marketing action sheet May/June 2000).


HIV debate continues

The findings of the research conducted by Anna Coutsoudis and her team in South Africa (Update 26) regarding HIV transmission rates still seems to be largely ignored. Media reports continue to state that 'breastfeeding' is dangerous for an infant of a mother who is diagnosed as being HIV positive. Without qualification such information is inaccurate and potentially harmful.

There is no evidence that breastmilk by itself transmits the virus. On the basis of the Coutsoudis study it appears that HIV transmission postnatally only occurs through breastfeeding when it is combined with the ingestion of other substances. It is the introduction of anything supplemental to breastmilk when breastfeeding which is dangerous.

A study by Ndauti et al in Kenya, published in JAMA (March 2000) had findings which reiterated the phrase that 'breastfeeding transmits HIV' - although the breastfeeding was not exclusive - but interestingly it also found that, at 2 years of age, there was no overall mortality difference between the breastfed and artificially fed infants. "This implies that there was a trade-off between HIV related and artificial-feeding related mortality, even in a controlled situation in an urban area with clean water, access to free infant formula and education on how to use it."


Violations - how do companies respond?

Zimbabwe Case Study

When Zimbabwe implemented the International Code and Resolutions in legislation, Nestlé threatened to close down its operations there. The law was introduced and Nestlé remains in the country. The law is overseen by an Infant Nutrition Committee (INC). In October the Secretariat of the INC asked Baby Milk Action to help in stopping violations by Abbott Ross, Infacare, Wyeth and, surprisingly, UNICEF.

Manufacturers and distributors of breastmilk substitutes are supposed to ensure that their activities at every level conform to the marketing requirements. Baby Milk Action is in regular correspondence with companies that fall short of the requirements. Here we present some recent examples and responses we have received.

UNICEF - immediate

The Zimbabwe legislation allows for products breaking its provisions to be seized. This happened to formula supplied for a UN pilot project to reduce mother to child transmission of HIV in October 1999. The formula, provided by UNICEF Supplies Division, was labelled in English and French. The law requires labels to be in English, Shona and Ndebele. Baby Milk Action immediately contacted UNICEF New York, which responded the same day to acknowledge that the labels should include all three languages and would be changed. On the next working day, the UNICEF representative in Zimbabwe met with the Minsitry of Health and a plan was agreed to approve labels and to re-package the formula already delivered to the country. The Supply Division has since issued new instructions making it clear that labels must be in the appropriate languages.

Wyeth, Abbott and Infacare - poor

At the same time as contacting UNICEF, Baby Milk Action faxed the three companies, asking them to investigate their violations. Companies do not generally respond to reports of violations and so Baby Milk Action seeks help from the public and partner organisations by publicising cases on the Campaign for Ethical Marketing action sheet. In this case we gave the companies two weeks to respond to the letters to see if they would act as quickly as UNICEF.

  • Abbott Ross: Three months later and no response has been received.

  • Infacare: Baby Milk Action received no response from Infacare. However, a Campaign for Ethical Marketing letter writer received a response in which Infacare denies providing formula for sale in Zimbabwe and has says it will no longer be manufacturing the product.

  • Wyeth: Wyeth responded to Baby Milk Action after the action sheet was published. It also denies selling formula in Zimbabwe, but has given an undertaking to follow the labelling requirements.

Companies often blame distributors for placing products on the market with inappropriate labels, yet they have a responsibility to ensure that only correctly labelled products are sold for export. The Zimbabwe authorities tell us they are taking action against the distributors.

INC membership

A Nestlé representative is Vice Chair of the INC. While noting that this did not stop the INC asking Baby Milk Action to help, we believe that the law should be monitored independently of the baby food industry.

  • Nestlé's involvement in the INC did not stop the Minister of Health criticising the company (see Boycott News 27), but it may have influenced the INC statement used in Nestlé's book.


Nestlé fined in Costa Rica

Nestlé was fined in Costa Rica at the end of 1999 for breaking laws relating to the labelling of breastmilk substitutes. After the law was adopted in1994, companies were given one year to bring their labels into line. Nestlé was repeatedly warned that its labels did not comply. In August 1996, Nestlé presented labels which satisfied the Ministry of Health and Economy, but these were not placed on the market. Instead it continued to use labels which had been rejected. In September 1999, legal action was taken and Nestlé was fined.


Infant feeding in Emergencies

Africa is the continent with the highest number of conflicts and also faces persistent natural disasters, such as floods, drought and famine. It is home to more than 60% of the world's refugees - an estimated 50 million people. A figure expected to increase by 12% annually. Two million of these are infants for whom breastfeeding is a lifeline.

Baby Milk Action joined IBFANers and policy makers from 18 countries at a Meeting on Emergencies in Tanzania in November. The meeting reviewed the current situation regarding emergencies in Africa and looked at ways to harmonise policies and strategies to protect ensure optimim survival and development of infants.

The meeting called for the principles and aims of the International Code and subsequent relevant Resolutions to be applied in all emergency situations.


UK news and more ...

Mutant milk for baby

On his second Channel 4 TV programme on 13th Jan, Mark Thomas interviewed David Ayares from PPL Therapeutics in Virginia, USA. PPL is conducting research, sponsored by Wyeth (the makers of SMA), which he said aims to develop "a completely humanised milk product where you would milk a cow and almost human milk would come out...We now have a mini-herd of transgenic cattle that are making human alphalact-albumin...in their milk." Ayares said the product would be ready to be launched in 30 months, that negotiations were already underway with major US and European companies and as it was a "nutritional product" "you don't need to go through the same type of clinical trial process that you would for a pharmaceutical..."

On the same programme, a statement from PPL's UK HQ was read out reassuring listeners that the products would undergo clinical trials. This story shows the urgent need for a ban on all claims and promotion of breastmilk substitutes. Without such controls, we are all likely to be misled. Breastfeeding involves an irreplacable living substance and process, which is tailor made for every baby. It is not replicated by matching just one or two ingredients which are then bottle-fed.

In her book 'GE Genetic Engineering and You. Moyra Bremner points out the folly of this approach:"Solving these problems [increasing the number of babies who receive breastmilk] by engineering a bull to create cows with human milk is like losing your front-door key and hiring a Sherman tank to get you in, instead of going to a locksmith. It may be rather fun to use a tank - but is it wise?"

'GE Genetic Engineering and you' (1999 Moyra Bremner, Harper Collins, ISBN 0-00-653190-3) addresses the issue of GM in a wide context, exploring not only the immediate concerns regarding food safety, but also the global impact and the effect on humanity as a whole.

The Baby Feeding Law Group (UK)...

...is the new name of the UK Law Working Group. The group comprises agencies working to protect breastfeeding and infant health by bringing UK legislation into line with the International Code and subsequent, relevant WHA Resolutions. Members include professional organisations, such as the Royal College of Nursing and the Health Visitors' Association and lay organisations such as La Leche League and the Food Commission. The group has tackled issues such as INFORM (see Update 23 & Update 25), sponsorship, medical foods and UK legislation. Organisations wishing to join should contact Baby Milk Action.

SMA advertise for staff to violate the Code

In adverts in the local press SMA, who say they are "UK's number 1 baby milk company", have advertised for reps to present topics to mothers. This is in direct contravention of article 5.5 of the International Code which prohibits marketing personnel from seeking contact with mothers or pregnant women.

Write to SMA to complain about this at:

SMA/Wyeth, Huntercombe Lane South, Taplow, Maidenhead, SL6 0PH

UK Food Standards Agency - a good start?

The UK's new food Standards Agency came into being on 1 April, with Prof Sir John Krebs as the Chair, and the Deputy Chair, the campaigner on food and poverty issues, Suzi Leather. The Agency aims to: "protect public health from risks which may arise in connection with the consumption of food, and... protect the interests of consumers in relation to food."

It has three core values, to:

  • put the consumer first

  • be open and accessible

  • be an independent voice.

Many of the UK scientific committees, are being re-organised and will fall under the remit of the FSA. It is too early to say what the Agency will do for infant health, but as a start, the issue of additional controls on medical foods for infants has already been raised with the EU Commission in Brussels. FSA information can be found on http://www.foodstandards.gov.uk

Nestlé in deep water

Meanwhile Nestlé has decided to withdraw its Junior foods (see Boycott News 27) but is still promoting its "growing range" of specialised infant formulae - in time for the new Medical Foods Law which came into effect in May. It will soon face Trading Standards in court regarding its use of allegedly illegal medical claims on Shredded Wheat breakfast cereal.


Research and reviews

Negative impact of commercial materials

A US study has found that the use of materials produced by baby milk companies has a detrimental effect on breastfeeding. Women (n=547) were randomly assigned into 2 groups, one receiving a pack of information containing baby milk company materials, and the other group receiving a pack which had no information from baby milk companies. Both packs contained information about breastfeeding and artificial feeding, but stressed breastfeeding as the optimal feeding method. The authors concluded that "although breast-feeding initiation and long-term duration were not affected, exposure to formula promotion materials increased significantly breast-feeding cessation in the first two weeks... [additionally] among women with uncertain goals or breast-feeding goals of 12 weeks or less, exclusive, full, and overall breast-feeding duration were shortened... formula promotion products should be eliminated from prenatal settings."

Ref: Howard et al (2000) Office Prenatal Advertising and Its Effect on Breast-Feeding Patterns, Obstetrics and Gynaecology; 95(2):296-303

 

 

Baby Friendly video

In November 1999 the UK Baby Friendly Initiative launched a new training video which covers the 10 steps to Successful Breastfeeding and the 7-point plan for successful breastfeeding in the community.

This excellent video explains clearly why each of the best practice standards are so important.

Available from the Baby Friendly Initiative, tel: 020 7836 5901, or email: bfi@unicef.org.uk. The new BFI UK website: http://www.babyfriendly.org.uk, has a full list of Baby Friendly accredited units http://www.babyfriendly.org.uk/list.htm

Long-term breastfeeding protects infant health

A prospective study (n=264) in Kenya examined the association between breastfeeding and nutritional status and growth. This study was partly initiated because of the controversy regarding the nutritional basis for recommending breastfeeding to 2 or more years. The researchers' findings support the WHO recommendation to "continue breastfeeding for at least 2 years, especially in settings with poor sanitation and inadequate water supply." They conclude: "Our results suggest that breastfeeding in the second year is a strong positive contributor to linear growth and that when early weaning is unavoidable, interventions to improve household sanitation could limit its potential negative impact on child growth."

Ref: Onyango et al (1999) Continued breastfeeding and child growth in the second year of life: a prospective cohort study in Western Kenya. The Lancet, vol 354, pp 2041-2045
 

ILO - breastfeeding at work

The International Labour Organisation Maternity Protection Convention is being revised in June. We are working to ensure that working mothers who want to breastfeed their children are provided with as much support as possible to be able to combine breastfeeding with work. Contact Baby Milk Action for information about how you can help and check out ILO website www.ilo.org/public/english/standards/relm/ilc/ilc88/reports.htm

 

Artificially fed babies at greater risk of scalds

Over a 3 year period Doctors in a hospital in Sussex recorded 23 cases of scalding in children aged between 2 weeks and 3 years. These scalds had been caused by accidental spilling of hot water used to heat up bottles of milk. Ten of these children have been left with permanent scarring. The authors believe that this represents only "the tip of the iceberg". They conclude that "the danger associated with warming milk bottles in jugs or bowls of boiling water could also be listed as a disadvantage of bottle feeding that could be avoided by breastfeeding".

Ref: Jeffery et al (2000) Lesson of the week, British Medical Journal, 319:815-9

WHO study on infant mortality

This pooled analysis of existing studies attempts to assess the extent to which breastfeeding protects against infant and child mortality, particularly in the light of the debate about breastfeeding and HIV. All of the studies showed significant protective effects of breastfeeding - although it was not possible to differentiate between different breastfeeding patterns, such as exclusive, predominant or partial. The analysis shows that infants who are not breastfed have a 6-fold greater risk of dying from infectious diseases in the first 2 months of life than those who are breastfed. The level of protection decreases with age. The authors comment: "Of direct relevance to the debate on HIV and breastfeeding are the higher levels of protection seen among less educated women...our results suggest that it will be difficult, if not impossible, to provide safe breastmilk substitutes to children from underpriveledged populations."

Ref: WHO Collaborative Team (2000) Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. The Lancet, vol 355, pp451-455

Round-up

Breastfeeding: It's your right!

World Breastfeeding Week this year (1st - 7th August) focuses on "It's your right". The aims of the week include raising awareness about the fact that a mother has a right to breastfeed; providing information about measures available on an international and national level and to stimulate a shift in public thinking so that this right is respected, protected, facilitated and fulfilled at household, community and government levels in every country. The World Alliance for Breastfeeding Action (WABA) has produced a 6-page full colour A4 leaflet which is available from Baby Milk Action (50p each, for bulk orders contact us).

For more details see the WABA website: http://www.waba.org.br

CALENDAR 2001

The Baby Milk Action/IBFAN calendar is now being prepared, along with a new range of greetings cards, and will be ready at the end of August 2000. It is an ideal resource for NGOs, health workers, campaigners and breastfeeding mothers. If you are interested in ordering more than 50 please contact us now to avoid disappointment. The calendar will remain at £5, with discounts on orders of 5 or more.

Skydive for Baby Milk Action

Baby Milk Action member, Amy Forbes, is going to jump out of a perfectly good aeroplane at 12,000 feet! By doing this she is hoping to raise in excess of £1,000 for Baby Milk Action. Amy will do the tandem skydive later in the year at Langar Airfield in Nottingham. Please offer your support to Amy and Baby Milk Action, by sponsoring her. Sponsor forms are available from Baby Milk Action.

New Year's Honours for Patti

We are delighted that Patti Rundall, Policy Director of Baby Milk Action, has been awarded an OBE for her 'services to infant nutrition' (see Patti receiving her OBE - Baby Milk Action press release 6 June 2000. Patti has worked at Baby Milk Action for twenty years, campaigning for legislation in the UK and Europe and on campaigns such as the Nestlé Boycott - all in an effort to stop the unethical marketing practices of the babyfood industry.

Baby Milk Action was started in 1978 as a coalition of NGOs (including OXFAM, War on Want and NCT) and individuals such as Gay Palmer, Jean Rowe, Andy Chetley and Sadru Kheraj. Initially work was co-ordinated from the War on Want office in London and by Sadru, who was a medical student at Trinity College, Cambridge. In 1980 Patti joined as a full-time volunteer and for the next few years it was run from her kitchen and then from a neighbour's spareroom. When in 1985 we became a Company Limited by Guarantee, we started to receive more financial support and Patti was able to take a small salary which was augmented with art teaching. From this modest start Baby Milk Action has grown and now has an office in Cambridge, five paid staff and many more volunteers. Over the years Patti has developed an extensive knowledge, not just about infant feeding, but also about legislation, development issues, politics and company marketing strategies.

By Lisa Woodburn, who joined Baby Milk Action in 1980 and has worked alongside Patti since then.

 

 

 


 

 


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