BMJ 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 breast feeding. 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 (see picture, right). 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
estimates 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 Nestlé.
Nestlé 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 Nestlé. 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
£35000 ($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.
Dr 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 breast feeding is best for children
and
supports initiatives to promote breast feeding.
( Whole article sent)
Sincerely, Toby
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