Tuesday, December 05, 2006

Brazil - an example to the world

Apparently when my colleague Patti Rundall was at Congress in the Philippines to speak about the industry attack on the baby food marketing regulations there, the subject of Brazil came up.

It seems there is an argument that the Philippines already has strong regulations and when Brazil was cited as a country that has gone even further than the proposed new regulations it was suggested Brazil's law is not so strong.

Well, excuse me. Being married to a Brazilian paediatrician, who has also coordinated the International Baby Food Action Network (IBFAN) in Brazil and national monitoring projects, I feel qualified to differ.

As with the Philippines, it has taken concerted campaigning, backed by monitoring evidence, to bring in laws implementing the World Health Assembly marketing requirements. Brazil's law has gone through three versions (1988, 1992 and 2002) with the most recent version closing down loopholes in the previous law and addressing new marketing practices.

While the regulations currently under attack by the baby food industry in the Supreme Court cover products up to two years of age, the Brazilian regulations cover products for children up to three.

They cover feeding bottles, teats, nipple shields, specialised formulas and breastmilk fortifiers.

They have provisions for complementary foods and whole milks.

The Brazilian law bans humanized images from breastmilk substitutes. The legislators have had experience of how companies try to get around this, so the law tries to cover all angles. You can see it in the Portuguese on the IBFAN Brazil website. See http://www.ibfan.org.br/rdc222.htm

Here is my translation of the regs. regarding images on infant formula and follow-on formula it is forbidden to (article 4.6.1 of RDC 222):

use illustrations, photos or images of babies, young children, infants or any other form that resembles these, human or not, including humainzed fruits, vegetables, animals or flowers amongst others, which aim to induce the use of the product by these age groups.

I can imagine the legislator setting down the pen and saying: "That just about covers it".

And it has worked. Companies that use baby figures, soft toys, vegetables or whatever in neighbouring countries do not have any such images on labels in Brazil.

The regulations also specify Ministry of Health Warnings that should appear on various types of product.

Infant formula and follow-on formula has, in large text in a box:

Ministry of Health Warning: This product should only be used to feed children under one year of age on the express indication of a doctor or nutritionist. Breastfeeding prevents infections and allergies and strengthens the bond between mother and child."

What companies sometimes call 'growing up milks' have the text:

Ministry of Health Warning: This must not be used to feed children under one year of age. Breastfeeding prevents infections and allergies and is recommended up to two years of age or more.

Feeding bottles, teats and dummies (pacifiers) have to have the warning (Article 5.1.4 of RDC 221 - see http://www.ibfan.org.br/rdc221.html)

Ministry of Health Warning: A breastfed child does not need a feeding bottle, nipple or dummy. The use of a feeding bottle, nipple or dummy undermines breastfeeding and prolonged use can harm the teeth and speech of a child.

There are similar prohibitions on use of humanized images - though cartoon characters are still seen on the products of the likes of Gerber.

Complementary foods have to have a warning that they must not be used for infants under 6 months of age. Special display stands have this appearing prominently on them as well as on labels.

Whole milks have the warning:

Ministry of Health Warning: This product must not be used to feed children under one year of age, except on the express indication of a doctor or nutritionist. Breastfeeding prevents infections and allergies and is recommended until two years of age or more.

Companies do try to get around this all the same. We have a gallery of shame showing how Nestlé promotes whole milks alongside more expensive formula in the infant feeding section of pharmacies and supermarkets. See http://www.babymilkaction.org/resources/yqsanswered/yqanestle03.html. Studies have found that poor mothers are likely to use whole milk rather than formula if not breastfeeding (70% in one study in Ouro Preto), yet Nestlé refuses to stop this practice.

Another favoured route for reaching parents has been closed down though. Companies are forbidden from sponsoring education materials. The regulations (Portaria 2,051, Article 8, paragraph 2) states, after defining the information and warnings that must appear in educational materials:

Educations materials that deal with feeding young children cannot be produced or sponsored by distributors, importers or producers of products within the scope of the regulations.

Well, I think that is enough to be going on with. A good set of provisions, though not perfect (unlike India's law, commercial sponsorship of health workers is permitted - Nestlé sponsors publications and events of the paediatric society). They are enforced as well. When in Brazil we have called up the relevant body on seeing a promotion in a supermarket and it has quickly been removed. In some cities monitoring and confiscation of products breaking the law is carried out routinely by authorities.

If the Philippines moves some way in the direction of the Brazilian legislation and monitors and enforces it, as they do in Brazil, a similar effect is likely. A curtailing of aggressive promotion. And, coupled with breastfeeding promotion, an increase in breastfeeding rates. Rates in Brazil have been increasing markedly having collapsed following the entry of Nestlé and other companies at the beginning of the last century.

Leading to reduced sickness and deaths of infants.

So go for it. Brazil is one of the countries showing the way.

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