Getting the message

When Mark Thomas presented his first TV programme about Nestlé in 1999 he wore a t-shirt with a message written on it. Something like:

KLR
LEE
LAY
BLD

He made no reference to it in the programme and it was only afterwards I realised what it was meant to say. His programme focused on Nestlé's failure in some countries to include the appropriate language on product labels. Famously, Nestlé wrote to a Baby Milk Action campaigner on one occasion explaining why: "Due to cost restrainsts of small runs it has not been viable to change languages for specific export markets". Hmm. It took 7 years of campaigning after that, and Mark's TV programmes, to prompt Nestlé's Chief Executive to promise a review of all labels.

But there is more to clearly labelling products than translating them into a language mothers will understand (if they are literate). Though obviously that is an important step and not one that should be neglected just because it eats into company profits a little.

I've just received a pack of product packaging from the Philippines. And they are not good. You will be able to see examples on the Baby Milk Action website as an update to our Campaign for Ethical Marketing action sheet calling for international solidarity with the Philippines as it stands up to pressure from the baby food industry and US Chamber of Commerce.

But the first thing to notice with the labels is the message across the top: "Breastmilk is best for babies up to two years old". A statement on the superiority has been required since the International Code of Marketing of Breastmilk Substitutes was adopted by the World Health Assembly in 1981. Again, in line with the Code and national measures the label contains instructions on how to mix up the formula states: "Breastmilk is best for babies up to two years old. Before using an infant formula, consult your doctor or clinic for advice. The improper use of breastmilk substitutes may be dangerous to baby's health."

The form text takes is very much dependent on the measures taken by governments to specify and enforce it. In Brazil warnings have specified text and font size, headed "Ministry of Health Warning" in a black box. It is so striking the industry lobbied hard to have it less prominent, without success.

In some countries however, companies can get away with using the 'breast is best' almost as a product endorsement as we have exposed in the past. For example after the 2001 global monitoring project we noted (see the June/August 2001 Campaign for Ethical Marketing action sheet):

Nestlé complies with the 'Breast is best' statement requirement, but in many countries it adds text. The message it attempts to portray becomes in effect: 'Breast is best and this formula is similar to breastmilk so it must be good'.

For example: Breast is best and...

* Nativa 1 (Côte d'Ivoire): "Its composition is based on mother's milk."
* Lactogen 1 (Ghana): "Composition is based on that of breastmilk."
* Nan (Mexico): "Based on mother's milk."
* Nan (Uruguay): "Composition qualitatively and quantitatively based on mother's milk."
* Nidina 1 (Italy): "Similar to mother's milk."
* Good Start (Canada) is the "next best alternative to breastmilk"
* Good Start (USA) is "100% whey protein, the primary type of protein in breastmilk" and the "ideal formula choice to bring out the best in your baby."

Nestlé's current label for Nestogen infant formula in the Philippines is using a slightly different approach. It is:

"New improved NESTOGEN 1."

It has a prominent, colourful logo, saying it contains "Brain Building Block - DHA" and "More Calcium - Bone Builder".

On the back, under the message about breastmilk being best for baies, it states:

"Nestogen 1 is a starter formula made specially to meet the needs of infants
0 to 6 months old. It provides all the vitamins and minerals needed by the
young infant. Plus, it is now improved with:

"DHA - Experts recognize DHA as essential for brain development and good
vision.

"More Calcium - Ensures stronger bone and teeth formation."

These are 'health claims' of the type being discussed at the Food Code (Codex Alimentarius) meeting at the end of last month. They were one of the hot discussions over the recently updated European Union Directive.

If something is necessary for infant health, then stick it in the formula, but
why do companies battle so hard to be able to put claims about the ingredients on labels? Because they are promotional. They are intended to encourage mothers to use the product, to be reassured that even if 'breastmilk is best' the artificial milk is not so different. But they are misleading as I explored in the entry on Long Chain Polyunsaturated fatty acids, such as DHA. Who are the experts Nestlé refers to? Certainly not the influential Cochrane Library that reviewed the scientific evidence for the value of adding LCPs to formula and found claims about benefits to brain development are not supported by the evidence.

The complementary foods in the Philippines are plastered with these type of claims as well, for reasons I might write about another time. However, something did strike me with the Nestlé label. Nestlé told us during national demonstrations in May 2003 that it would comply with World Health Assembly Resolutions setting out the appropriate age of use for complementary foods. Since 1994 the Assembly has said this should be fostered from about 6 months of age, that is exclusive breastfeeding until 6 months of age.

The Nestogen feeding table suggests introducing its 'New Improved Nestlé Baby Food' in the 5th or 6th month. That is from as young as 4 months of age - the age of a baby at the start of its 5th month.

Well, no surprise to find Nestlé has not delivered on a public undertaking. We shall raise it with the company.

These things do not end up on labels by accident. Strong warnings and clear instructions come from strong regulation. Idealizing comments come from companies ignoring their responsibilities under the World Health Assembly marketing requirements and national measures.

So back to Mark Thomas's t-shirt. Was it obvious to you? If not, leave a comment and maybe someone will explain it.

We lend out the video of his programmes, so contact us for details.

I couldn't find a picture of the t-shrit on a web search, but found this interview with Mark from that time.