Thursday, May 31, 2007
I often ponder this when seeing how Nestlé tries to deceive over events I have observed closely. Some believe Nestlé’s version because they know no better. How much is that true of what we think we know about the past?
An example today prompts me to think of this again. Nestlé and the Church of England. In Nestlé’s telling of history, the Church of England investigated Nestlé’s marketing and decided not to renew its support of the boycott at its Synod meeting in 1997.
In truth, the independent research arranged by the Church of England found ‘systematic’ violations by Nestlé and other companies and UNICEF said our monitoring was ‘vindicated’. Though the boycott was not supported, action by other means was demanded.
Historians are used to examining the documentary evidence and that is the bed rock of Baby Milk Action’s work. So with this re-writing of history cropping up again, I’ve posted key source documents on the Baby Milk Action website. You can find them in the Your Questions Answered section at:
As I’ve remarked before, it sometimes appears easier to assert an untruth than to tell the truth. The truth can take longer. I’ve tried to set out the documents on the website. Here, to save you downloading the source documents yourself, are some key quotes and facts. And some of the back story, because I was there for some of it.
The Church of England Synod voted to support the boycott in 1991. It had a measurable effect. In 1992 Nescafé sales fell by 3%. In 1993 Nestlé increased its Nescafé advertising spend by 75% to 14 million pounds. Nestlé's profits were hit. And while Nestlé sometimes attacks the boycott as being a threat to jobs, no-one was dismissed. Indeed jobs may even have been created in advertising as Nestlé tried to regain market share. (Figures from MEAL and A.C. Neilson).
In 1994 there was a move by the Oxford Diocese for the Church to sell its Nestlé shares. Nestlé went into overdrive, making statements at the Synod meeting where this was discussed that were demonstrably untrue and denounced not just by Baby Milk Action, but by development agency experts.
It was enough to muddy the waters, however, and the Synod voted to suspend the boycott while gathering evidence independently of Baby Milk Action and the International Baby Food Action Network, to which we belong.
The Interagency Group on Breastfeeding Monitoring (IGBM) was formed, consisting of 27 church, academic and development organisations. IGBM arranged research in Bangladesh, Poland, South Africa and Thailand. It concluded: "The research proves that many companies are taking action which violates the Code, and in a systematic rather than one-off manner."
Companies were found to be promoting artificial infant feeding in breach of the marketing code. The main companies at fault were Nestle, Gerber (now part of Nestlé), Nutricia and Wyeth. The scale of the violations was shocking:
* promotion was found in retail outlets and the media in all four countries
* company personnel visited health facilities univited in each country to make contact with mothers and to give inducements to health professionals for promoting company products
* information leaflets were given to mothers which promoted bottle feeding or discouraged breastfeeding (more than a third of mothers in Poland reported such information)
* mothers and health facilities were provided with free samples or supplies (ranging from 7.5% of health facilities in Bangladesh to 50% of those in Thailand)
According to the report "...a strong correlation was found in all four countries between the proportion of mothers who received negative information associated with a company name and the proportion who bottle fed their infants."
I attended the launch in January 1997. It was a few months after I had joined Baby Milk Action and we had not a clue what the report would say. Other than the knowledge that if they had done their work properly they would have found widespread and institutionalised malpractice. As anyone who does a proper job will.
You can download UNICEF’s statement from our website. I scanned the document from the files today. UNICEF reminded people that: “Marketing practices that undermine breastfeeding are potentially hazardous wherever they are pursued: in the developing world, WHO estimates that some 1.5 million children die each year because they are not adequately breastfed. These facts are not in dispute.”
UNICEF commented not only the violations documented in a report published as Cracking the Code, but on the industry attack on the research.
The industry – principally Nestlé – went to extraordinary lengths to attack the findings and the research protocol. The industry had been invited by IGBM to comment on the protocol before it was used, but failed to do so, so it was a typically dishonest attack. If you want to know the details, see our analysis from the time at:
UNICEF stated: “It is also noteworthy that the findings of the International Baby Food Action Network (IBFAN), in its regular monitoring activities, are clearly vindicated by this report.”
The Synod met in July that year in York. I went along with Patti, our Policy Director. A fascinating experience. There were those campaigning for infants and mothers, such as the Bishop of Conventry, Simon Barrington-Ward.
There was Nestlé with a hospitality room and a new ‘Charter’ setting out is ‘infant formula marketing policy for developing countries’ (this is the ‘Charter’ that was later the subject of one of our successful complaints before the Advertising Standards Authority after Nestlé referred to it in an anti-boycott advertisement).
Nestlé resorted to leafleting Synod members as they arrived for the meeting, a rather bizarre turnaround.
There were also Synod members who were fighting Nestlé’s corner and using procedural methods (specifically calling for a ‘vote by houses’) to try to undermine anything critical of Nestlé. I remember sitting next to someone from Ashbourne at a presentation of the Cracking the Code report who was sensitive to Nestlé on the basis it employed people in her town. Nestlé has not shown the same loyalty, closing down its operations there a few years ago.
Nestlé tried all sorts of tricks to divert criticism. For example, it suggested the free supplies of infant formula found by IGBM in Thailand were for HIV-infected mothers. The Bishop of Coventry spoke in the debate and said he had communicated with someone in UNICEF Thailand and found the number of HIV cases were far less than the amount of formula found.
Nestlé also made an important policy shift because of its fear of the boycott being reinstated.
Various Resolutions had been adopted since the 1981 marketing code, to address questions of interpretation and changes in scientific knowledge and marketing practices. Nestlé refused to accept the validity of these. It even attacked them in its PR materials. At Synod, for the first time, it acknowledged the Resolutions. Not that it agreed to change its policies to bring them into line (it was during national demonstrations we held in 2003 that Nestlé at last agreed to respect, to some degree, provisions in a 1994 Resolution).
Synod supported the official motion condemning company malpractice and calling for companies to comply and for action by governments.
There was a move from the floor to try to reinstate the boycott, but this did not have official support. It was argued that the Church Commissioners would use investment in Nestlé to ‘engage’ and encourage change. To my mind, there was official reluctance to support the boycott again because the calls for disinvestment would return, and even more loudly. Once money enters the picture, holding to a moral and ethical line seems to be more complicated. So the boycott was not renewed. We subsequently reported violations to the Church Commissioners, but cannot say we ever heard a report back about Nestlé’s response when these were raised, or that they were raised.
The Church of England issued a press release after the Synod. It can be downloaded from our website and makes interesting reading for anyone under the impression that the Synod refused to renew the boycott because Nestlé had changed its practices. This is what it states:
"The main conclusion of the report is that major manufacturers of breastmilk substitutes continue to contravene the international code of marketing of breastmilk substitutes thereby jeopardising the lives of infants. Violations include the donation of free samples, the publication of information materials which undermine breastfeeding and unsolicited visits by company representatives to health facilities."
This is the text of the resolution actually passed by Synod:
That this Synod
a) affirm the need to promote infant and maternal health by all available means;
b) affirm the conclusions of the report Cracking the Code, produced by the Interagency Group on Breastfeeding Monitoring, its emphasis on the International Code of Marketing of Breastmilk Substitutes, and the subsequent resolutions of the World Health Assembly which clarify and amplify the Code;
c) endorse the efforts of UNICEF and the World Health Organisation to achieve universal implementation of the Code and Resolutions;
d) call upon all national governments to establish the legal basis and adequate instruments to ensure national compliance with the Code and Resolutions; and
e) call upon the manufacturers of breastmilk substitutes and health workers to ahere fully to the letter and spirit of the Code and Resolutions.
So Synod affirmed that the companies exposed in the report, including Nestlé, were responsible for ‘systematic’ violations and called upon them to comply with the Code and Resolutions.
That is what the history should tell us.
IGBM went on to meet with the International Association of Infant Food Manufacturers (IFM). It found that IFM insisted the implementation of the Code is a matter of national government legislation. Whereas the Code is very clear in Article 11.3 that companies should ensure their activities comply independently of government measures.
IGBM broke off discussions with IFM, stating: “… it is clear that your position is so at variance with ours in terms of acceptance of the International Code that there are, at present, no grounds for embarking on further discussion or meetings.”
Nestlé met with UNICEF at the end of 1997, accepting its request to set out its marketing practices. This prompted a letter from UNICEF saying Nestlé’s policies were not in line with the marketing requirements adopted by the World Health Assembly and concluded:
Our meeting thus regrettably reconfirmed the historic and on-going divergence between the best interests of children as represented by UNICEF and those of the infant feeding industry. As you well know, we have endeavoured in the past, unsuccessfully, to resolve those differences. It continues to be clear that the divergent views are simply not reconcilable in specific and critical areas.
Therefore, much as we appreciate the opportunity to have had the meeting, it does not seem to us to be useful to maintain such contact in the future.
So that is what happened. Systematic violations were found. Discussions with the industry and Nestlé in particular got nowhere and were suspended.
The boycott continues. And continues to force changes.
Nestlé should not be permitted to turn history into bunk.
We have a duty to remember.
The Emergency Nutrition Network brings together experienced field workers to share and disseminate best practice. Marie McGrath, co-director of the Emergency Nutrition Network, and IFE Core Group coordinator and author of the article in today’s Guardian, recalls a recent example showing the importance of supporting breastfeeding. For the full article see:
Moorhead [author of the article on Nestlé in Bangaldesh] - in her description of a ward in the "diarrhoea hospital" in Dhaka, where most patients are babies and "not one is crying: they are all much too weak for that" - very clearly showed the acute risks that formula feeding presents to infants where there aren't the resources to safely support it. Put these infants in the face of a humanitarian disaster and the risks multiply. This was highlighted most blatantly in an outbreak of diarrhoea among artificially fed infants in Botswana in 2006, due to contaminated water supplies. Babies who were not breastfed were 50 times more likely to be hospitalised with diarrhoea, and seven times more likely to die, than babies who were breastfed.
She also recalls that in the Kosovo crisis, UNICEF gathered 27 tonnes of breastmilk substitutes.
While UNICEF was trying to stop the indiscriminate distribution of formula in refugee camps, we were working to try to stop well-meaning people filling trucks with formula to send. Our partners in the International Baby Food Action Network (IBFAN) went into action in other countries.
The International Baby Food Action Network (IBFAN – Baby Milk Action is the UK member) forms part of the ENN Infant Feeding in Emergencies core group. This has produced training modules for agencies so that mistakes of the past are not repeated, while what works to save lives is. You can find out more at:
IBFAN’s Infant Feeding in Emergencies (IFE) working group has information here:
Our IBFAN partners in Albania worked in the refugee camps supporting mothers with breastfeeding – some needing assistance in re-lactating after the stress of fleeing their homes, perhaps having left men folk behind.
They also worked to ensure formula was correctly prepared for those infants who needed it. At one of our regional meetings where we evaluated the experience, we heard how someone - agency or company or well-meaning members of the public - distributed formula indiscriminately in the camp, leaving a tin of formula outside each tent where there was a child. There was no discussion as to whether it was needed or how it should be prepared. The labels were in the wrong language.
We knew the same would happen when the tsunami hit Indonesia and other countries on the Indian Ocean on Boxing Day 2004. We immediately made our briefing on infant feeding in emergencies live, and put up the banner advertisement we have ready for such times:
Next time there is an emergency, drop it onto your site or blog if appropriate, with a link to:
We contacted people and the media when we heard of appeals for formula. But the voice of experience is not always appreciated. People want to do something and in a culture where bottle-feeding is seen by many as the same or almost the same as breastfeeding, sending formula seems a caring thing to do.
We finally invoked the fact that it was illegal under UK law against exporting formula with labels in the wrong language. See:
Still formula gets through. Marie McGrath recalls that some of the donations during the Kosovo crisis were huge, suggesting a commercial source. In past emergencies there has been a definite commercial link.
Flooding a country with formula in an emergency can have an impact for years - a disaster for the population and big profits for baby food companies. When I interviewed our IBFAN partner from Armenia in 2006, she recalled that breastfeeding rates there had only recently recovered to the levels before the Armenian earthquake of 1988. Donations of formula coming from rich nations had undermined breastfeeding to the point that only 20% of infants were predominantly breastfed at 4 months (that is breastfed exclusively or fed breastmilk with water, tea or juice). You can listen to the interview, included alongside those with other IBFANers, here:
You can find a written interview about the Armenian experience here:
The interviewer in the Armenian Weekly raises questions over the risk of HIV through breastfeeding. This brings me to the second article of today. This is an article based on a report on BBC television breakfast news. It is by Kate Silverton who travelled to Lesotho with UNICEF. Here is a quote. The full article is at:
If [Lesotho] is to survive it needs to find a way of creating a new generation that is born free of HIV and UNICEF is supporting a government campaign that aims to do just that.
It wants everyone in the country to be tested for the virus, and has committed the drugs for treatment should they test positive.
It's also actively promoting a programme that teaches HIV positive mothers how to avoid passing on the virus to their children.
The risk of passing on the virus can fall from 35% to just 2% if a mother follows a few simple steps.
If she takes the right drugs during pregnancy and after birth and exclusively breastfeeds for six months, her child is likely to be born HIV free.
It sounds incredibly simple - and goes against local customs where young infants are given a mix of traditional food as well as breast milk - but new research from the World Health Organisation has found that breast milk can actually protect the child from the virus.
The feeding has to be exclusive however because anything other than breast milk can serve as an irritant in the gut and allow the virus to pass through.
In the HIV emergency the baby food marketing requirements are also critically important. We have exposed in the past how companies have exploited HIV to try to have regulations over turned.
It is great this information is finally finding its way into the mainstream news.
I even had the opportunity to post a comment on the Guardian article addressing Nestlé’s untrue comments about its marketing activities, rectifying somewhat the situation I described on Monday. See:
Tuesday, May 29, 2007
All pregnant women and new mothers have a right to receive good quality, evidence based information about infant feeding in an environment which is free from commercial pressure.
Bin it! is a campaign to raise awareness by calling an amnesty on baby milk company sponsorship in the UK healthcare system.
Bin it! is encouraging health workers to check their facility and dispose of any materials sponsored by baby milk companies.
Bin It! is collecting baby milk company marketing materials. So just before you Bin it! please photograph any materials and send them in. You can use a camera phone for this, and can text photo's to 07816 268103 or e-mail
The organisers will send images on to Baby Milk Action for the monitoring campaign we coordinate for the Baby Feeding Law Group.
The Binit site links to the monitoring pages of the BFLG site.
So spread the word and lets clean up the UK health care system!
Corporate-free materials exist. Some of it you may have to pay for, like that in the Baby Milk Action on-line Virtual Shop.
If you have other suggestions for sources of corporate-free materials leave the details as comments below.
Check back for details of how the Binit campaign is going. Remember you be notified when new entries are made to this blog using an RSS feed reader or blog subscription service. Have a search around on the internet. There are a lot out there.
Monday, May 28, 2007
The first is my letter to The Guardian addressing some of the untrue claims in the letter from Nestlé published last week. The Guardian had run an article after a journalist went to Bangladesh to investigate if Nestlé is still aggressively marketing baby milk. She found hospitals full of both sick babies and Nestlé promotional fliers for giving to mothers for its Lactogen infant formula.
Nestlé responded saying the fliers were permitted under the World Health Assembly marketing requirements. Looking at what the requirements actually says shows very clearly that Nestlé is not telling the truth. As I explained last week. See:
I made some of the same points in a much shorter letter for publication. It has not appeared. But newspapers have to let someone have the last word. At least for now. And there are some other things going on in the world, so I won't complain too much. Particularly after it published the eye-witness account of what Nestlé is doing in Bangladesh.
A while ago it was suggested that Nestlé and Baby Milk Action engage in an exchange of emails, to be published. We agreed. Nestlé refused.
Just as it refuses our suggestion of an independent expert tribunal to examine the evidence. A tribunal could investigate claim and counter-claim, hear witnesses and come to a conclusion on who is telling the truth, taking the time necessary to do a proper job.
Time is necessary, because Nestlé tries to deceive people so it can continue with business as usual. As I have written previously, the truth does not lie somewhere between what we say and what Nestlé says. We are telling the truth and can prove it. See:
Nestlé's dismisses the tribunal proposal as a mock trial. But as I said directly to its Head of Corporate Affairs (now Head of Corporate Social Responsibility) who wrote Nestlé's letter in the Guardian, we are offering it the opportunity to kill this campaign once and for all.
Nestlé has even been offered the chance to go first by setting out its terms and conditions for the tribunal - who can be on the panel, its terms of reference etc. etc. It refuses to do so, knowing its denials do not stand up to scrutiny. Just as they didn't stand up to the scrutiny of the Advertising Standards Authority, which upheld all of Baby Milk Action's complaints about a Nestlé anti-boycott advertisement in 1999 after a two-year investigation.
Nestlé relies on its untrue claims not being exposed. By having the last word when it can.
Another way in which Nestlé is trying to have the last word is by refusing to send me a copy of its reply to my letter about its activities in the Philippines. You can see its initial letter and my reply here:
Nestlé chose to copy people in on its initial letter. Its follow up has gone to them, I understand, but not to me. It does not want Baby Milk Action to be able to respond.
I asked Nestlé new Head of Corporate Affairs to meet me with a copy of the letter, or leave one for me when I went to Nestlé (UK) HQ last weekend. There was no letter and no message.
Beverley has written since then. A letter arrived last week, admitting that Nestlé had indeed sent a reply to people in the Philippines.
It has no intention of sending me a copy.
Mmmm. May not be the last word on this particular story.
Friday, May 25, 2007
Here is my blog about The Guardian investigation, which links to the article and to Nestlé's published response and my analysis of that:
Someone posted the link to the Guardian article on Netmums, the mother-support site that is sponsored by Nestlé. There is a thread there now running to 91 pages and 1,362 posts. It has been a sometimes heated discussion. Someone posted on my earlier blog saying members have left as a result of the Nestlé link, correcting an earlier comment on the blog saying no-one has left.
While definitely some have left, there are still some members on the Netmums site trying to raise awareness of Nestlé malpractice. Someone posted a link to the UNICEF Philippines film last week. You can watch the film here:
There has not been one comment on the Netmums thread in response to the film link posted last Saturday.
The thread continued with comments about ‘trolls’ and calls for the moderators to lock the thread to stop further discussion with the claim there was nothing new, but not one comment about the new film showing the reality of aggressive marketing and its impact.
I am confused by this. When I looked through the thread and saw someone had posted the links to the Guardian article and UNICEF film I expected the subsequent comments to be alive with debate about what was happening on the ground and what could be done to support mothers and infants – just as on other mother support sites. But no. There are comments about trying out the new Nescafé range and whether people had broken site etiquette or not, but not responding to the links.
Why should it be? Netmums is not defending Nestlé nor censoring the discussion. The coordinators have posted Baby Milk Action’s statement with equal prominence to that from Nestlé and brought it to the attention of users of the forums.
I'm not encouraging new people to join in the thread. And this is not intended as an attack on those willfully ignoring the evidence. I am bemused by the lack of reaction.
This apparent reluctance to look at - or at least comment on - the evidence should concern anyone campaigning to hold corporations to account or considering taking funding from a questionable company. There is probably a research study in here somewhere. It is probably something Nestlé has already researched!
It seems there is something about having the Nestlé advertisement there at the top of each page saying “Netmums is delighted to welcome Nescafé” that diverts attention from the discussion of Nestlé malpractice and whether it is an appropriate sponsor.
Perhaps it just comes down to not wanting to be rude about a guest, so looking away when anyone points to evidence about the guest is contributing to the death and suffering of infants around the world.
Perhaps it is wanting to feel good about the sponsor and think only of the good the money can do to those who use the site, so not daring to listen to people in other countries asking for help.
I don’t know. I'll drop by from time to time to see how the thread continues.
We can, at least, take comfort from the fact that there have been over 40,000 views of the thread, so many people who did not know about the boycott and campaign now do. Baby Milk Action has gained some members and campaign supporters as a result.
Anyway, anyone who does want to look to evidence, can follow the links above and download the Save the Children report.
It refers not only to aggressive marketing in Bangladesh, but in Botswana. It references monitoring conducted by the Interagency Group on Breastfeeding Monitoring (IGBM) which consists of 27 academic, church and development organisations operating totally independently of Baby Milk Action and our partners in the International Baby Food Action Network (IBFAN). When it published its first report back in 1997, UNICEF stated that IBFAN's monitoring was 'vindicated'.
We have exposed aggressive marketing by Nestlé in Botswana in the past. As the result of one of our campaigns Nestlé said it would change some of the materials it was distributing. See:
This is what the Save the Children report says about Botswana. It refers to companies in general, but it is the Nestlé product which seems to be have gained the highest profile amongst health workers and the public. As far as I am aware, the full IGBM report has not been made public:
Research in Botswana, supported by Save the Children, has revealed that violations of the Code by baby food companies are still common. Baby milk and food are indiscriminately advertised in the public domain; product labels are not written in the appropriate local language, posing a serious health hazard for babies; and companies still distribute information materials to public health centres and hospitals in open violation of the Code. More than a third of all young mothers and pregnant women in the capital, Gaborone, have seen or heard advertisements for infant formulas and food targeted at babies of less than six months.
Almost 30 per cent of mothers also reported having been advised by either health professionals or peers and family to use infant formula, usually of a specific brand (most commonly Nestlé’s NAN) or other food and drinks for their babies under six months.
Save the Children seeks ways to pressure “Nestlé, the industry’s colossus, to rectify its unethical ways.”
The boycott is one of the tools Baby Milk Action uses. The principal target of the boycott is Nescafé. Which seems to be a more potent brew than I thought.
Thursday, May 24, 2007
The mother, Janipher Maseko, was separated from her one-year-old daughter and three-week-old son, who she had been breastfeeding. While campaigning by Baby Milk Action and our partners has seen her reunited with her children there is much of concern about this case.
We were contacted by a partner organisation at the weekend. The message came to me as I was posting up pictures from the demonstration at Nestlé (UK) HQ. See:
We had been here before. We worked on two similar cases last year which the Home Office Minister responsible, Liam Byrne MP, said were isolated incidents. Breastfeeding mothers should not be separated from their infants. See:
On Monday, we posted a statement from Baby Milk Action on our website and asked people to send messages, while following up with our own contacts. This helped to generate media coverage. See The Guardian, 22 May 2007 at:
We do not know all the details of Ms Maseko's application to stay in the UK, or why it has been rejected, but she has been in a very vulnerable situation, being picked up by the police living rough with her young daughter, while pregnant. After giving birth she was soon after separated from her children and sent to Yarl's Wood.
The detention centres are controversial, being run by private companies for the government as part of a crack down on illegal immigration. There have been allegations about an overly tough regime exercised by the companies. See, for example, The Observer, 20 May 2007 at:
Separately from the rights and wrongs of the UK policy on treatment of failed asylum seekers and the merits of Ms Maseko's case, the conditions she has suffered do not recognise her rights or the rights of her children. Here is an extract from the letter from our Policy Director, Patti Rundall, to the Home Office (full letter on our website):
I find it very shocking that the officials in charge of this case seem to be showing no regard for or understanding of the needs and rights of the child or the mother and that Home Office Guidance continues to be ignored.
Baby Milk Action is the UK member the International Baby Food Action Network (IBFAN) a network of over 200 citizens groups in over 100 countries and together the world’s health community we work to ensure that the critical value of breastfeeding and the importance of keeping mothers and babies together is recognised. Apart from its psychological importance, breastfeeding reduces the incidence of infectious diseases, chronic diseases and auto-immune diseases, offers optimal development and growth, cognitive and visual development and evidence suggests that it decreases the risk of obesity. The seven-year study carried out by the WHO shows that babies exclusively breastfed for six months are healthier and leaner than artificially fed babies.1 The benefits of breastfeeding extend throughout the whole life cycle. In the global context, breastfeeding and appropriate complementary feeding help fulfil the Millennium Development Goals and have the potential to reduce under-5 mortality by 19%.
The decision to separate Ms Maseko from her baby flies in the face of a number of UN Resolutions and conventions, including the International Code of Marketing of Breast-milk Substitutes and the 12 subsequent WHA resolutions, the Global Strategy on Infant and Young Child Feeding, UNICEF’s Baby-friendly Hospital Initiative and the Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding, which all stress the critical importance of exclusive breastfeeding for the first six months of life with nutritionally adequate and safe complementary feeding alongside continued breastfeeding up to the age of two years and beyond. Article 24 of the Convention on the Rights of the Child also recognizes the contribution breastfeeding makes to the fulfilment of the right of the child to the highest attainable standard of health.
Having raised the issue with politicians who were quick to act on the cases last year, action followed swiftly. At the beginning of the week it was agreed that Ms Maseko should have her children with her in a family unit.
Efforts have been made by breastfeeding counsellors to help her, enduring the rigorous security checks and searches to be able to visit her to help her re-establish breastfeeding.
There are questions being asked over Ms Maseko's asylum application and the way it has been rejected and a deportation order arranged.
What we can be sure of, is that a mother should not be separated from her children in this way.
The authorities have acted to reunite the family after being contacted, but the situation should never have arisen.
If you wish to write to the authorities appealing for them to ensure systems are strengthened so the same does not happen again, you will find contact details on our website. If you do write, please be polite. See:
Wednesday, May 23, 2007
Last week I spoke at an event in Cardiff at the start of National Breastfeeding Awareness Week.
In the interests of boring as many people as possible, I have made my talk available on line. You can read it, download the powerpoint show and listen to the podcast. Go to:
All for no charge!
Though donations are welcome and if you do want a speaker in person we have to ask for our costs to be covered, including a preparation fee (though we can be flexible). It is important to get the information out there, but as a small office stretched to the limit timewise and financially we do have to ask for money, I'm afraid.
In my Cardiff talk I examined how the baby food companies in the UK bombard mothers with promotional information and try to co-opt health workers to promote their products.
I also questioned whether we can trust companies to give scientific and factual information to health workers on their products or there should be other mechanisms for evaluating their claims to ensure that health workers are aware of the findings of independent research. Many health facilities have a designated person to meet company representatives, but that puts the onus on one person to evaluate what are often misleading claims from companies. And company reps. try to meet other staff off health service premises to get around such policies.
If you have views on this or anything else in the talk, please do contact me or leave comments here.
While we have had some recent success in cracking down on the claims companies make on labels in the UK, there is still a long way to go. I ended my talk looking at a tin of formula from Brazil.
Compare this to the labels we have with teddy bears or other animals and claims about ingredients.
As I said at the end of my talk: "What does this tin look like? A tin of nutritional medicine perhaps? Not a children’s toy or some advertising hoarding? It even carries a Ministry of Health warning in stipulated text."
It is hardly surprising breastfeeding rates are increasing in Brazil while the latest figures in the UK show most breastfeeding duration figures are either static or moving in the wrong direction.
I've posted my talk with the title: "Protecting a mother's right to independent information on infant feeding."
Mothers need independent information, support if they have difficulties breastfeeding and, if formula-feeding, information on how to reduce the risks.
Tuesday, May 22, 2007
You can read its letter, published in today's Guardian, at:
It really demonstrates how important and necessary it is to keep up pressure on this most unethical of companies through the boycott and by working for legislation.
Nestle falsely claims the formula fliers found by The Guardian in Bangladesh are permitted by the World Health Assembly marketing requirements. Nestlé states: "This is the action of a company committed to improving the health and nutrition of mothers and infants, rather than one trying to exploit grey areas of the code."
It is perhaps easier to make an untrue assertion than it is to explain the truth of the situation. I hope you will have patience to see what the marketing requirements actually say to understand how and why Nestlé is flouting the provisions.
Here is how Nestle attempts to justify the promotional fliers for its Lactogen infant formula which were found by The Guardian in hospitals in Bangladesh:
Save the Children alleges that Nestlé gives health professionals pictures of Lactogen to pass on to mothers in order to get around the code's prohibition of direct contacts between mothers and companies. The article describes these leaflets as "to all intents and purposes flyers for the product concerned". But giving information to health workers is permitted by the code.
Had the article illustrated a copy of one of our so-called flyers, readers may have been more sceptical of the assertion of exploitation.
Nestlé sells three types of Lactogen in Bangladesh. The products have different formulations and feeding frequency. Should an infant consume the wrong product, this would have an adverse effect on the child's health. The leaflets are essentially a safety measure to ensure that the right product is bought for a child of the corresponding age and that the mother understands how frequently she should feed the child.
Nestle states that giving information ot health workers is permitted by the code. This is what it says in Article 7.2 of the Code.
7.2 Information provided by manufacturers and distributors to health professionals regarding products within the scope of this Code should be restricted to scientific and factual matters, and such information should not imply or create a belief that bottle feeding is equivalent or superior to breastfeeding.
So far, so good. Nestlé can provide scientific and factual information to health workers. But Nestlé goes on to admit the fliers are for handing on to mothers so the correct product is bought. Nestlé's Robin Tickle was quoted in the original Guardian article stating: "Individual sheets of these are then indeed handed over to mothers, but only after the infant formula has been prescribed by a doctor."
The Code is very clear. Yes, companies may give scientific and factual information to health workers. But the health care system may not be used to promote breastmilk substitutes to parents. Nor may information on infant feeding refer to brand names.
This is Article 6.2:
6.2 No facility of a health care system should be used for the purpose of promoting infant formula or other products within the scope of this Code. This Code does not, however, preclude the dissemination of information to health professionals as provided in Article 7.2.
So, yes, the information can be given to health workers, but explicitely not for handing on to mothers.
If that is not clear enough, this is Article 6.3:
6.3 Facilities of health care systems should not be used for the display of products within the scope of this Code, for placards or posters concerning such products, or for the distribution of material provided by a manufacturer or distributor other than that specified in Article 4.
Nestlé has admitted its fliers are for mothers. A clear breach of both these articles.
But what of Article 4? That concerns educational materials prepared with the written permission of the appropriate government authority or within its guidelines. But even if we view Nestlé's product fliers as education material Article 4 is abundantly clear:
...Such equipment or materials may bear the donating companys name or logo, but should not refer to a proprietary product that is within the scope of this Code, and should be distributed only through the health care system.
In other words, fliers handing on for mothers cannot have information about Lactogen infant formula. This is a clear breach however you look at it.
Nestle refers to Save the Children's comments on the prohibition on seeking direct or indirect contact with mothers. This is what the Code says in Article 5.5:
5.5 Marketing personnel, in their business capacity, should not seek direct or indirect contact of any kind with pregnant women or with mothers of infants and young children.
The reps. distributing the fliers to health workers to hand on to mothers are clearly seeking indirect contact with mothers. Evidence from other countries shows the reps. sometimes hand such fliers to mothers directly. We recently exposed such a case in India. See:
Okay, so Nestlé is violating the Code by providing these fliers for distribution to mothers. But, could it be the Code is wrong to have this prohibition and Nestlé's claim that such fliers are a 'safety measure' is justified?
Well, if the mothers targeted by these fliers need a picture to be able to identify the product (rather than a generic doctor's prescription to buy 'infant formula for use from birth', for example), how is she expected to understand the warnings and instructions on the labels?
Nestlé is admitting the purpose of the flier is to promote its products. If a health worker is going to advise a mother to use infant formula, why should they advise her to use NESTLÉ infant formula? Formulas have to comply with Codex standards. Here in the UK the Department of Health does not recommend one formula over another because they all have to have the composition specified in legislation.
Nestle may want to argue it is fine for it to promote Nestle products over the products of other companies. The problem is, however, that they also inevitably compete with breastfeeding.
This is why the International Code of Marketing of Breastmilk Substitutes states: "in view of the vulnerability of infants in the early months of life and the risks involved in inappropriate feeding practices, including the unnecessary and improper use of breastmilk substitutes, the marketing of breastmilk substitutes requires special treatment, which makes usual marketing practices unsuitable for these products."
Nestle claims its fliers have a 'breast is best' message - but again, if Nestle claims the fliers are for mothers who need a picture of the tin to be able to buy the correct product, how are they expected to read and understand the messages?
The Guardian investigation explains graphically the impact of aggressive marketing of breastmilk substitutes. For example:
No shortage of mothers, and no shortage of sad tales. Because bottlefeeding is more than a health tragedy in this country: it is an economic tragedy, too. Happi Akther, 35, talks to me as she waits to see a doctor about her nine-month-old son's flaky-skin problem: Nur has been bottlefed, she says, since he was about a month old. "I felt I didn't have enough milk," says Happi, whose two previous babies both died soon after birth. "What else could I do? No one had any other ideas." (In fact, breastfeeding experts believe at least 98% of women - even those on nutritionally deficient diets in developing countries such as Bangladesh - can make sufficient milk to feed their babies, given proper advice and support.) Nur has been fed on Lactogen from the outset, but his formula, she says, costs her and her husband Gias, who works in a mustard-dyeing factory, around 800 taka (£2) a week. And if that doesn't sound much, set it against the fact that Gias earns only £6 a week. "We can't afford it at all," says Happi, shaking her head. "The milk uses up all our money." All the mothers I spoke to - most of whom were non-working wives whose husbands worked in factories or did manual jobs - had similar stories. (Of the 10 women I interviewed in the clinics, only one said she had begun using formula because she needed to go back to work.)
For some families, the burden of buying formula milk is simply too much. "They can't afford to mix it at the required proportion, so to make it go further they use too little powder," says Dr Roy. "Or they resort to using ordinary powdered milk, which is a lot cheaper to buy than branded baby formula. The result is babies whose milk is little more than what you might call white water."
According to Save the Children's report, infant mortality in Bangladesh alone could be cut by almost a third - saving the lives of 314 children every day - if breastfeeding rates were improved. Globally, the organisation believes, 3,800 lives could be saved each day. Given that world leaders are committed to cutting infant mortality by two thirds by 2015 as one of the Millennium Development Goals, protecting and promoting breastfeeding is almost certainly the biggest single thing that could be done to better child survival rates.
However deluded, is Nestlé really motivated to hand out the fliers to reduce risks of formula? If that was its motivation wouldn't Nestlé take other steps to reduce the risks from formula? Infants have died because of intrinsic contamination of powdered infant formula with pathogens such as Enterobacter Sakazakii. New guidance has been issued stating that formula should be mixed with water at a higher temperature, 70 deg. C, to kill pathogens. Nestlé still refuses to revise its labels. It is left to organisations such as UNICEF to issue its own instructions with the correct information for mothers who formula feed.
You can find the leaflets prepared for use in the UK on the UNICEF website, because this is not only an issue for developing countries. A small number of infants in Europe have died after being fed with contaminated formula. Despite the deaths, Nestlé and other companies are refusing to change labels and are fighting moves for this to be a requirement in Codex standards. Why? Because any suggestion that powdered formula is not sterile may harm its image and sales. See:
So safety is not at the forefront of Nestlé's formula marketing strategy. Sales are.
Nestle uses similar marketing strategies in the Philippines, where it has also been exposed giving health workers inducements, a violation of article 7.3. See our Campaign for Ethical Marketing action sheet:
You can view a film from UNICEF Philippines here:
While pretending to respect the Code and referring misleadingly and selectively to is provisions, Nestle is admitting to a systematic breach - providing promotional fliers for infant formula to mothers via the health care system.
That it attempts to defend this practice is truly shocking - though nothing new. It wishes to divert criticism so it can continue, building sales for infant formula regardless of the impact on health.
I am not surprised that it has done so in this misleading way. I have debated with Nestle many times - including the author of the Guardian letter. We have won every debate where there has been a vote and now Nestle is refusing to attend any more.
We hope the Guardian will publish a response from us. Other than trying to raise awareness of what the World Health Assembly requirements actually say, there is little that we can do about Nestle's untrue claims when it makes them in a letter. When they claimed in an advertisement to market infant formula 'ethically and responsibly' we were able to challenge this before the Advertising Standards Authority. All of our complaints were upheld. See:
To stop the aggressive marketing we work for legislation and keep up the pressure on Nestlé through the boycott. For information on some of the gains we have made see:
You can help add to the pressure on Nestlé by signing up in support of the boycott if you haven't done so already. Click here.
If you are supporting the boycott, why not give Nestlé a call to let it know, perhaps pointing out you are unimpressed by its attempt to justify its aggressive marketing in Bangladesh. This is what happens when you call:
Monday, May 21, 2007
I hope to have a film clip available before too long about the event. The aim was to raise awareness of the practices Nestlé continues to use in attempts at undermining breastfeeding and increasing sales of breastmilk substitutes. It is Nestlé’s stated aim to grow its infant nutrition business year-on-year – though it does claim that it promotes breastfeeding in the process.
Monitoring by the International Baby Food Action Network (IBFAN) shows otherwise and our evidence was substantiated last week by the publication of two independent investigations.
On Tuesday The Guardian newspaper published the results of its journalist’s investigation in Bangladesh. See:
On Thursday UNICEF Philippines posted film clips on Youtube showing the aggressive marketing practices used there and the impact. See:
We did a stunt at the demonstration showing how the techniques used by Nestlé and other companies work. More about that in a second.
Firstly, I just want to thank everyone who has been sending on my email alert about the Bangladesh and Philippines reports. I see there are several bulletin boards generating significant traffic to this blog and new sign-ups to our petition of solidarity are flooding in. I’ll quote some of the messages of support at the end of this message. In particular I see there is a campaign being promoted by members of Mumsnet, supported both by mothers who breastfed and bottle fed, as the campaign should be.
(Mumsnet is not to be confused with Nestlé-sponsored Netmums. Hopefully members of Netmums will also view the film and give their support to mothers in the Philippines, despite the Nestlé sponsorship – I see someone posted the link to the films on the long-running thread there on Saturday. This shows how boycotting Nescafé works to raise awareness of Nestlé malpractice as well as keep up pressure on the worst of the baby food companies).
The marketing requirements introduced by the World Health Assembly, which are the standards we monitor companies against, exist to protect all mothers and infants. They aim to stop breastfeeding being undermined AND to ensure breastmilk substitutes are used safely, if necessary. In the Philippines 16,000 infants die every year due to inappropriate feeding, according to the World Health Organisation, which is why the Ministry of Health introduced new marketing regulations. These are being challenged in the courts by pharmaceutical companies.
Nestlé is not part of that legal challenge and claims to support the new regulations, though in reality it has challenged aspects of them and continues to violate the existing weaker measures. Nestlé has also written to some key policy makers attacking Baby Milk Action’s campaign of solidarity with the Philippines. I did ask Nestlé’s Head of Corporate Affairs to leave a copy of its letter at reception for me to collect on Saturday as I was not copied in on it, despite it being a response to a letter I had sent to Nestlé after the company first wrote to me. Unfortunately there was no sign of the letter and no message from the Head of Corporate Affairs. See:
As well as setting up our displays and leafleting passers by, we did our stunt, showing the practices Nestlé uses in the Philippines and elsewhere.
Materials used were Nestlé originals and all the techniques have been substantiated. First up was a Nestlé Medical Delegate (played by me) entering the office of a doctor (a volunteer from the crowd). Medical Delegates try to ingratiate themselves with doctors by keeping record cards with details such as their birthdays and details of their spouses and children. They have offered air conditioners, which are expensive items and obviously much sought after in countries such as the Philippines. Doctors are offered air tickets to seminars in expensive hotels, where sight seeing and dinners sometimes appear as much as a draw as any speakers that may have been arranged. Other health workers receive lesser gifts, such as food packs and other items (these techniques were also exposed by Syed Aamar Raza, Nestlé whistle blower from Pakistan – see:
In its attack on our campaign of solidarity with the Philippines, Nestlé suggested we were wrong to criticise it for such activities. It has since emerged, however, that is not only Baby Milk Action that finds Nestlé is violating the marketing requirements. The Bureau of Food and Drugs in the Philippines has told Nestlé that items such as umbrellas, which the company claims are ‘cheap’ and ‘of professional utility’, are not permitted under existing regulations. They are seen as inducements.
Nestlé and other companies promote formula to health workers and mothers with misleading claims. This is shown graphically in the UNICEF film. Some mothers believe that formula will make their children more intelligent as a result of this promotion.
In our role play I presented the doctor with Nestlé Nestogen infant formula. Nestlé undermines the 'breast is best' message required by the regulations by promoting it as containing DHA, which it calls‘Brain Building Blocks’. It states on the label: “"DHA - Experts recognize DHA as essential for brain development and good vision."
In reality, experts have found that research has shown no benefit of adding these ingredients to formula. See:
Nestlé's Nan HA 2 formula in the Philippines claims: "Nan HA 2 provides your baby with all nutrients esential for optimal physical and mental development. Thanks to Protect Plus (TM), a unique combination of protective ingredients, it also helps to modulate your baby's natural immune defenses and to reduce the risk of allergy in the critical period of weaning."
In Bangladesh, The Guardian, found promotional fliers for Nestlé Lactogen infant formula distributed widely to doctors for handing on to mothers. Nestlé claimed these are for use only after formula has been prescribed, despite the fact that the Code does not permit such items.
In the Philippines film, several mothers interviewed say they were advised to artificially-feed by their doctors.
The promotional methods lead to doctors promoting formula rather than helping mothers to overcome any problems they may experience with breastfeeding. As the promotion suggests formula is nearly as good as, or even better, than breastfeeding, it is seen as making little difference to the health outcomes for the infants whatever feeding method is used.
The differences are apparent in all countries from epidemiological research. But where there is not access to health care the shortcomings of formula are much starker and costs lives. Here is a section of the Guardian article, which you can find in its entirety at:
Eti Khuman's face lies cradled on her mother's shoulder, her cheek resting in against Mina's collarbone. Eti is beautiful, but she is poorly: her breathing is heavy, and Mina has the distracted look of a mother who is very worried indeed. Eti's illness - first vomiting, then diarrhoea - struck without warning. Like all mothers in Bangladesh, Mina knew to fear diarrhoea: in this country, diarrhoea can kill. So she wasted no time in bringing her eight-week-old daughter here, to the main diarrhoea hospital near her home in the capital, Dhaka.
Eti was admitted, and now she and Mina are in the main ward, a sweltering room so packed with beds that there is barely space to walk between them. It's a general ward, but most of the patients are babies. Some, like Eti, are being held by their mothers: others lie quietly on their beds attached to drips. Not one is crying: they are all much too weak for that.
Twenty-five years ago, when Dr Iqbal Kabir first came to work at this hospital, small babies were almost unknown as patients. Today, he says, infants make up as many as 70% of admissions.
The reason? Kabir shakes his head, and points to a poster on the wall above Eti's bed. The same poster is displayed, many times, around the ward. It shows a baby's bottle, with a big cross drawn heavily through it. The message is clear. "Bottlefeeding is harmful," says Kabir. "Because bottlefed babies get diarrhoea, since their formula is mixed with dirty water and since their bottles are not sterile. Do you know how many breastfed babies are admitted here with diarrhoea? The number is almost zero."
Eti has been bottlefed almost since birth: Mina says she wanted to breastfeed, but when she had difficulties there was no one to give advice or support. Mina's story was typical of those of many of the mothers I met in Bangladesh: when she hit problems and went to a doctor, the suggestion was to try formula. In doctors' surgeries and pharmacies across the country, it seems, health professionals are quick - far too quick, say breastfeeding campaigners - to suggest bottlefeeding as the way forward.
Health workers should also meet their obligations under the marketing requirements and should provide the support mothers need. IBFAN groups try to provide training on the marketing requirements (just as I did last Monday in Cardiff). UNICEF's Baby Friendly initiative is helping to change hospital practices so mothers are better supported. And mother support groups help mothers to help each other. But there needs to be far much of all of this. Which is partly a question of funding, but also political will, both for governments and professional associations. At the same time, it is essential the promotion and the bribary stops.
With medical help, infants who have suffered diarrhoea and become malnourished can recover, though may suffer longer-term impact. With help, mothers who have been persuaded to introduce feeding bottles can relactate. The doctor in The Guardian article says as many as 70% of mothers are able to begin breastfeeding again if given support and advice.
It is not just a question of lack of access to health care that leads to infants dying if they are not breastfed – and in Bangladesh 314 infants could be saved every day if breastfeeding rates improved, according to Save the Children.
There is the expense of the formula. In our second role play I pretended to sell a volunteer mother from the crowd a tin of Nestlé Nan for £50. The two tins for the week would cost £100, or about half the minimum wage in the UK. That is the reality for poor mothers who formula-feed in many countries – half the family income may go on formula. If you are in the UK, imagine being on the minimum wage and having to pay out £100 per week for a product that increases the chances of your child becoming sick. Sometimes mothers over-dilute the formula to make it last longer. Other family members may miss out on essentials as parents try to meet the cost.
The label on the tin used in the role play was in Russian – which fortunately my volunteer did not understand – to illustrate the point that still labels are sometimes in the wrong language (though with Nestlé this has much improved thanks to the boycott campaign as in 2000 the Chief Executive said labels would be translated – 19 years after this became a requirement). See:
At the same time, some mothers will be illiterate and dependent on the images on the labels.
The mother could see she needed water. So I handed her a bucket and directed her to the river, two miles away.
The water mothers use for making up formula, may be extremely dangerous. This is from a report about water in Manila, capital of the Philippines. See:
---Quote from UNDP report begins
The problem is that sludge treatment and disposal facilities are rare. The result: indiscriminate disposal of inadequately treated effluents into the Pasig River - a complex network of waterways that links the Laguna de Bay Lake to Manila Bay through a huge urban conurbation. Another 35 tons of solid domestic waste is deposited in the Pasig annually by squatters dwelling in makeshift settlements on the river's banks. In total, some 10 million people discharge untreated waste into the river. This has serious consequences for public health. The Pasig is one of the world's most polluted rivers, with human waste accounting for 70% of the pollution load. Faecal coliform levels exceed standards set by the Department of the Environment and Natural resources by several orders of magnitude - and around one-third of all illness in Manila is water related. The 4.4 million people living along the river face particularly acute problems, especially during the floods in the June to October rainy season. During the low flow season the Pasig River reverses direction and carries pollution into Laguna Lake, creating further public health problems.
Hopefully mothers will understand the importance of boiling water or understand this from the label. So my volunteer was asked to fetch some firewood. As there were no trees we could chop nearby, I sold her some for £10, a rough adjustment to UK prices.
We set up the little fire and while pretending to wait for the water to boil, I gave her some of the presents Nestlé distributes to mothers around the world, including a little flag for her child and a baby-gro with the words “I love my Nestlé mum”. She was also invited to join a Nestlé baby club for further information and offers from the company.
I assembled the bottle – which like many bottles, looked like a toy, covered in cartoon characters. Nestlé doesn’t make bottles – we hold other companies to account for this. I handed the bottle to the mother, wishing her luck and pointing out that if her child did become sick, it had nothing to do with me. It was her fault.
So we tried to bring to Nestlé’s doorstep the reality of what it is doing around the world to push its products and its impact.
For a more realistic view, watch the UNICEF film. We are taking orders for this on DVD, which we hope to be able to send out fairly soon. See our on-line Virtual Shop. While you are there, please take a look around. We rely on membership fees, donations and merchandise sales to keep operating.
Remember you can support sign the petition of solidarity with the Philippines and find our campaign sheet at
You can find a press release on the above event with hi-res versions of some of the photos at:
Find other photos at our growing picture archive. We are experimenting using flickr. If you see rogue advertising on the site, please let us know. See:
We ended our demonstration with a message of support to mothers and campaigners in the Philippines from those present. I hope to be able to post the clip soon.
Here are some of the messages of support that have come in with the latest petition sign ups since we posted links to the UNICEF film:
Jane, UK: “These women and their babies deserve to know that breastfeeding is the best thing for their babies. They are being misled for profit, and their babies being put fatally at risk for money and that is something that needs to be stopped.”
Roslyn, Scotland: “Hopefully one day the international community will stop standing up for business and instead recognise the 'little people'. Until then, we will keep fighting!”
Pauline, England: “Best wishes and good luck from England.”
Clair, Wales: “Well done for getting together to fight for the things you believe in; many of us could learn from you. Best wishes with your campaign.”
Victoria, UK: “Women in the West breastfeed whenever they can.”
Jewant, UK: “Protect infant health, promote protect and support breastfeeding now!! Stop the promotion of breastmilk substitutes.”
Stephanie, UK: “Breastfeeding is best for babies, their mothers and the wider society they live in. It doesn't matter what marketing campaigns say no artificial "milk" can be as good as breastmilk. Your babies will be happier and healthier if they are breastfed - and there are wider positive economic implications to breastfeeding.”
Liz, UK: “Good luck baby milk action, you need to stop this terrible thing happening.”
Friday, May 18, 2007
We have some Nestlé violations and will use them to show how Nestlé targets health workers and mothers. You can see the impact, and hear from witnesses to this happening on the ground, in the new film from UNICEF Philippines. See:
Of course, Nestlé is not the only company at fault. The clips include malpractice of others such as Wyeth and Mead Johnson. But globally Nestlé is found to be responsible for more violations than any other company and for violating more provisions of the marketing requirements than any other company. That's why Nestlé is singled out for boycott action. But the others do not get off the hook. They are targeted with letter writing campaigns and media exposure. And our work for legislation is effective in stopping violations from all of them, though there are still too many countries without measures in place.
We are campaigning to defend the regulations introduced by the Ministry of Health in the Philippines. These have been blocked by the Supreme Court, following legal action by pharmaceutical companies and pressure on the President from the Chamber of Commerce. That's why we are asking you to write to the companies responsible and send a message of support to the Philippines. See:
Nestlé is not a member of the pharmaceutical assocation that has brought the legal action - being a food company. It has claimed to support the regulations, but breaks the current weaker measures and has opposed some aspects of the new ones.
Nestlé Philippines wrote to us last year, objecting to us including it in our campaign in support of the Philippines, copying its letter to the Secretary of Health, WHO and various others. It said our reports of violations were years old and incorrect. I responded, giving further substantiation for our information. You can read the letters at:
Nestlé has replied to this letter picking up on the points we made. Though it does not agree with our assessment of its marketing, it does at least admit to some of the things we have highlighted. It puts these down to flaws in its marketing systems and admits that authorities in the Philippines have told it gifts for healthworkers we highlighted as violations are just that.
Strangely, though, Nestlé did not send this reply to my letter to me. A little rude seeing as Nestlé initiated this correspondence.
Perhaps it was an oversight. I have asked Nestlé's Head of Corporate Affairs to meet me tomorrow with a copy or to leave it at reception.
Find out what happened in Monday's blog.
Thursday, May 17, 2007
Now you can see for yourself what is happening in the Philippines. This is a new film from UNICEF Philippines. We are contacting UNICEF to see if we can make this available on DVD. You can register your interest in having a copy - see below. In the meantime you can watch the clips UNICEF has posted today on Youtube. They are gathered together below.
We have just a few weeks left to save the marketing regulations that could stop the type of practices you see in the film. At present the industry is winning and the regulations have been suspended by the Supreme Court. We need your help to make the regulations law. Details follow the clips.
Here are the companies behind some of the brands promoted in the Philippines:
Mead Johnson: Alacta, Enfapro
Nestlé: Bear Brand, Nan, Nestogen (see its 'Brain Building Blocks' claim), NIDO (whole milk promoted in many countries alongside infant formula).
Clip one Youtube address:
Clip two Youtube address:
Clip three Youtube address:
Clip four Youtube address:
Clip five Youtube address:
The clips show how baby food companies undermine breastfeeding, contributing to the unnecessary death and suffering of infants.
You can see the conditions under which mothers are using formula. You can see some of the company promotions. You can hear health workers explaining the pressure they are under to recommend company products. You can listen to recordings given by hidden company representatives, who explain the strategies they are taught to use.
The film also explains how the government has introduced regulations to try to stop the aggressive marketing which undermines breastfeeding. Some mothers are convinced that their babies will be more intelligent if they use formula. If mothers have problems with breastfeeding, the promotion means they are more likely to think switching to formula will give their child the same or better benefits as breastfeeding and so will be less likely to seek support for breastfeeding.
The marketing regulations have been challenged by the Pharmaceutical and Health Care Association of the Philippines (which does not include Nestlé, which has opposed the measure in other ways). They want to carry on with business as usual.
After the US Chamber of Commerce put pressure on the President of the Philippines, the Supreme Court blocked the regulations. Next month the Supreme Court will rule on whether the regulations will stand or be struck down.
We have been campaigning in support of the Philippines and many of you will already have signed our petition of solidarity. If you have not, please do so now. The campaign to date has generated newspaper headlines in the Philippines and other countries. See:
If you would like a DVD of the film if we can make it available, you can register your interest via our on-line Virtual Shop and we will contact you on a first-come, first-served basis with the price once we have set this up. While there, please do look around the rest of the shop.
Check back to the blog tomorrow as I will be revealing how Nestlé, one of the companies whose violations are exposed in the film, has secretly tried to undermine Baby Milk Action's campaign in support of the Philippines.
Wednesday, May 16, 2007
So why do we need a Breastfeeding Manifesto?
According to UK Government research, 9 out of 10 mothers who stopped breastfeeding by 6 weeks said they did not want to stop.
Wouldn’t it be great if 10 out of 10 mothers could say they stopped because they decided the time was right?
However long a mother breastfeeds, she is giving her child advantages compared to formula-feeding her child. Some breastmilk is better than no breastmilk, while the World Health Organisation recommends exclusive breastfeeding for the first 6 months, followed by the introduction of other foods and continued breastfeeding into the second year of life and beyond.
The important thing is that a mother should be able to decide when she will stop breastfeeding. Her decision shouldn’t be undermined by lack of support if she experiences breastfeeding difficulties. Or undermined because she is made to freel embarrassed breastfeeding if others are around, whether at home or in public. Or undermined because of promotion from baby food companies that idealizes artificial feeding and makes it appear the same, or almost the same, as breastfeeding.
You can sign up to the Breastfeeding Manifesto campaign, send a message to your Member of Parliament and find out full details at:
Here are the 7 points, with some of my reflections on them. For the official explanation, see the Breastfeeding Manifesto website.
1. Implement the Global Strategy on Infant and Young Child Feeding.
This was adopted by the World Health Assembly in 2002. As part of the International Baby Food Action Network (IBFAN), Baby Milk Action was very active during the drafting process to ensure that the strategy was as good as it could be. In particular we wanted it to reiterate the importance of implementing the International Code of Marketing of Breastmilk Substitutes and subsequent, relevant Resolutions. The Code was adopted in 1981 as a ‘minimum requirement’ to be implemented by all member states in ‘its entirety’ (to quote the Resolution bringing in the Code).
2. Implement postnatal care guidance from the National Institute for Health and Clinical Excellence and the accompanying Public Health Evidence into Practice Document.
The evidence for the benefits of breastfeeding and risks of formula feeding is overwhelming. What works and does not work in helping mothers to breastfeed has been well researched. If we are serious about enabling all mothers to breastfeed as long as they want to, then best practice has to be implemented.
3. Improve training for health professionals.
And one of the most important ways to do that is to improve training for health professionals.
Part of this I would like to flag up here in reflecting on recent experiences. We should remember the role of peer-to-peer support.
On Monday I spoke at a Breastfeeding Awareness Week event in Cardiff. See:
There I heard how in the most disadvantaged communities breastfeeding rates tend to be lower and the importance of breastfeeding more marked. Breastfeeding reduces health inequalities (as we reported in our Update 39 newsletter). Research presented at the meeting suggested peer-to-peer support groups, particularly in disadvantaged communities with low breastfeeding rates, are the most effective way to help mothers breastfeed. So we need health workers to be trained not only on how to support breastfeeding themselves, but how to nurture mother support groups. The groups themselves need better government support.
We have just seen Netmums embroiled in controversy for going to Nestlé for funding. It is a forum with 300,000 members accessing it for support. While we disagree with Netmuims decision to go to Nestlé, we have to acknowledge there is a lack of government funding for the mother support sector as a whole and this needs to change.
4. Work with employers to create a supportive environment for breastfeeding mothers.
Caroline Flint, the Minister for Public Health, commented that existing Health and Safety guidelines call for support for pregnant and breastfeeding mothers, including comfortable environments for breastfeeding (which does not mean the toilet). Employers need to be encouraged to provide this. Some countries provide for statutory breastfeeding breaks, which mothers can use to feed their children or to express milk.
My wife, Sonia, who set up a human donor milk bank in Brazil, worked with businesses to set up comfortable facilities for mothers to express and store milk.
An aside about Brazil's experience
In Brazil, milk banks are appreciated as centres of excellence for breastfeeding support, having full-time staff assigned to them. Sonia was the paediatrician for her milk bank. There were also nurses, a psychologist and a speech therapist. It is hardly surprising that breastfeeding rates in Brazil are so much higher and increasing year-on-year. Sonia wrote an article for Practising Midwife in 2003 about her experiences in promoting, supporting and protecting breastfeeding. You can download the article at:
This gives the statistics for our home town in Brazil, São José dos Campos, São Paulo:
The latest breastfeeding figures (based on interviews with the guardians of 1,882 children under one during the 2001‘vaccination day’) for the city show its strategies are working. At four months, 36.6 per cent of babies are ‘exclusively’ breastfed. At six months, 26.7 per cent are exclusively breastfed and 21.5 per cent ‘predominantly’ breastfed (breastfed with some water, tea or juice), making a total of 48.2 per cent ‘completely’ breastfed.
In the UK at 6 months 7% of mothers are exclusively breastfeeding in the UK, according to the latest government statistics.
We can take some encouragement from an increase in breastfeeding initiation rates in the UK. However the news on duration is not so good. While initiatives such as UNICEF Baby Friendly are doing much to improve support in hospital, once mothers have left they may lack support systems and are bombarded by formula promotion. The new UK Government report states:
Among mothers who did breastfeed initially the proportion still breastfeeding at six
weeks and at six months was the same in 2005 compared to 2000. Only at nine
months was the proportion of mothers still breastfeeding higher in 2005 compared with
2000. However, in Scotland the proportion of mothers still breastfeeding at six weeks
and six months fell in 2005 compared with 2000.
So why are rates relatively high in Brazil and increasing, but low in the UK with some of the rates static or moving in the wrong direction?
A quick answer is that Brazil long ago decided to implement something very much like the 7-point Breastfeeding Manifesto.
Successive governments have put in the required resources and legislation to promote, support AND protect breastfeeding, and reaped the benefits as breastfed infants are less likely to become sick.
5. Develop policy and practice to support breastfeeding in public places.
This requires cultural change. So education, backed by enshrining the right to feed an infant in public in law, is required.
6. Include breastfeeding education (free from commercial influence) in the curriculum
Views on infant feeding are generally formed before women and their partners come into contact with information through ante-natal care. Also, in the more deprived areas where breastfeeding may be uncommon a child may grow up without seeing a sibling or neighbour’s child breastfed. Baby dolls usually have feeding bottles as a standard accessory.
Schools are essential to provide accurate and independent information about breastfeeding.
7. Adopt the WHO International Code and subsequent, relevant Resolutions.
In the UK advertising of breastmilk substitutes is widespread and there are no regulations at all on the promotion of feeding bottles and teats.
The UN Committee on the Rights of the Child called for the Government to introduce the Code in 2002 and we hope the current review of our current weak law will bring it into line.
We are asking supporters to write to Public Health Minister, Caroline Flint MP, who spoke very supportively at the launch event tonight. Please do write and send the postcards available on the Breastfeeding Manifesto website to your MP. Even if a politician supports the campaign, the more they can demonstrate the public are calling on them to take action, the more strongly they can argue the case in government. For our suggested letter see:
I had the opportunity to speak with the Minister and hand her a copy of our Hard Sell Formula pamphlet which exposes the integrated strategies baby food companies use to undermine breastfeeding and promote their brand names and products, even before a mother's baby is born.
Here I am pointing out at a mail shot pictured on the pamphlet. It was sent by Cow & Gate to a new mother. Here is the image. This is the back of the folded card.
'I’m thinking of getting a t-shirt made – ‘Danger! Sore boobs!’
It is branded with the Cow & Gate logo used for the formula and inside encourages mothers to go to the Cow & Gate website, which promotes the formulas, and to telephone the Cow & Gate careline. Ostensibly offering to support mothers, it preys on a mother's concerns and pain she may be experiencing to promote its formula brand name on the card and specific products on the site.
Some mothers do experience pain as they and their child get used to breastfeeding. As Caroline Flint said at the event, we should not pretend breastfeeding is immediately an easy and pleasurable act for all mothers.
But if a mother experiences problems she needs help from health care professionals and mother support groups, not a mailshot dropping through the letter box promoting Cow & Gate. This mailshot seems to have been timed for when a mother is most vulnerable. The person who sent it to us in July 2006, wrote:
My daughter had a baby 3-4 weeks ago. She did receive a Bounty pack and did join the Boots baby club (or whatever it is called!) But nowhere did she ask for any formula information or careline etc. This appears to be unsolicited mail. Does this contravene the Code? I feel it does.
It most definitely does breach the Code. Article 5.5 prohibits companies seeking direct or indirect contact with mothers, whether it refers specifically to infant formula in the first instance or not.
But in the UK, companies can argue they have broken no law in promoting their infant formula brand name in this way. And they get away with it and many, many other forms of promotion, some of which are described in the Hard Sell Formula pamphlet.
Article 11.3 of the Code calls on companies to abide by the marketing provisions independently of government action. They don’t. The best way to stop companies from undermining breastfeeding and ensuring that mothers receive accurate and independent information, however they decide to feed their infants, is by putting the Code and Resolutions into law and enforcing it.
We can all play our part in making all 7 points of the Breastfeeding Manifesto a reality. Even young men. Perhaps especially young men.
So the final word goes to Theo Walcott:
I have grown up knowing how important breastfeeding is as my mum was a La Leche League breastfeeding leader. Healthy eating is a very important part of my life as a professional footballer. I support the Breastfeeding Manifesto as it would help to ensure the first step to a healthy lifestyle for all children.