Date: Wed, 22 Jan 1997 06:37:14 +0200
From: tobygish <[log in to unmask]>
Subject: breaches of marketing code -BJM (long)
British Medical Journal No 7075 Volume 314
News Saturday 18 January 1997
Baby milk companies accused of breaching marketing code
Jacqui Wise, BMJ
Leading baby milk manufacturers are violating the international code on marketing breast
milk substitutes, according to a damning report by a group of 27 religious and health
organisations.
The World Health Organisation's international code of marketing of breast milk substitutes
was adopted in 1981 to ensure safe and adequate infant nutrition by protecting and promoting
breastfeeding. A report by the Interagency Group on Breastfeeding Monitoring, which includes
Unicef, Save the Children, and Voluntary Service Overseas, says that there is conclusive evidence
that many infant formula manufacturers regularly breach this code.
The report, Cracking the Code, criticises Nestle and Gerber of Switzerland, Mead Johnson
and Wyeth of the United States, and Nutricia of the Netherlands (marketed as Cow and Gate in
Britain). The research was immediately condemned by the International Association of Infant Food
Manufacturers as biased in design and execution.
The research was carried out in Thailand, Bangladesh, South Africa, and Poland. A random
sample of 800 pregnant women and mothers of infants under 6 months old and 120 health workers in
each country were interviewed.
Women in all four countries were found to have received company sponsored information that
broke the code by promoting artificial feeding without recognising breast feeding as the optimal
form of infant nutrition. The results were highest in Poland, where one in three mothers had
received such information-39% of it from Nutricia and 17% from Gerber In South Africa 28% of
mothers had received such information, with Nestle supplying nearly half of it.
An example of information that breaks the code is a Nutricia leaflet "Mummy, I'm
hungry," which was found in a facility in Poland. It contains pictures that idealise the use of
breast milk substitutes, with the caption "Mummy, if I was given a particular formula milk, don't
change it to a different one at home."
Women in all the countries studied had received free samples of products, most of them from
within the healthcare system. The proportion ranged from 0.3% of mothers in Bangladesh to 26% of
mothers in Thailand. Health workers also received samples of baby milk, other than for professional
research or evaluation, in 50% of facilities in Thailand, 21% in Poland, and 20% in South Africa.
The report also details examples of unrequested visits from company staff to give product
information to mothers,to give incentives to health workers to promote products, and to promote
products outside healthcare facilities.
Dr John Seaman, senior policy adviser with Save the Children, said: "Bottle feeding is a
problem in the developing world because the cost of a can of milk can be a month's disposable
income, the instructions can't always be read and so babies can be underfed, and there often
aren't the facilities to sterilise bottles and equipment." WHO etimates that some 1.5 million
infant deaths every year could be averted through effective breast feeding.
A spokesman for Nestle said: "We take this report seriously, but are concerned that its
statistics are based on a subjective interpretation of the code. An early review of the
allegations published in the report does not justify the author's claim that there is a
"systematic" violation of the code." They added that if any breaches are confirmed they will be
dealt with immediately.
Andrew Tomkins, professor of international child health at the Institute of Child Health in
London, defended the research, saying that it used standardised methods and that the study design
could not be faulted. "For the first time we have reliable, objective data on the scale of the
problem. It is clear we have a totally unacceptable situation which needs radical solutions."
The Interagency Group on Breastfeeding Monitoring was set up after the Church of England
decided in 1994 to suspend its support for a boycott of Nestle until independent research had been
carried out. The Church of England Synod will now consider whether to reinstate the boycott.
The Bishop of Coventry said: "Previously I felt we had to say that the jury was still out
on this subject. But this report provides compelling evidence from countries around the world that
the international code is still being violated."
The Royal College of Paediatrics and Child Health in London has come under renewed pressure
to stop accepting donations from Nestle. Nestle is one of the five companies featured in the
report, "Cracking the Code", which criticises baby milk manufacturers for breaking the
international code on marketing of infant formula.
At the launch of the report Andrew Tomkins, professor of international child health at the
Institute of Child Health in London and a member of the Royal College of Paediatrics and Child
Health, strongly criticised the college's acceptance of money from Nestle. He said: " I think it's
now totally untenable for the royal college to accept money on this basis."
Professor Tomkins said that the Institute of Child Health had decided not to accept money
from baby milk manufacturers and urged other organisations to do the same.
The Royal College of Paediatrics and Child Health receives $53,000 annually from Nestle to
help fund the activities of the research unit. The money was secured in July 1993 for four years.
After criticism of its decision the college held a referendum of its 2265 members in 1995. The
result was clearly in favour of continuing to accept the money - 73.9% of the 64% of members who
voted said yes and 26.1% said no.
Keith Dodd, honorary secretary to the college, said: "Given the clear cut result we agreed
not to reopen this debate for five years." He added: "The Royal College of Paediatrics and
Child Health believes that breastfeeding is best for children and supports initiatives to promote
breast feeding.
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Ritter <[log in to unmask]>
"If not now, when? If not us, who?" R. Hillel
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