Wednesday, June 06, 2007

It is illegal to promote formula in UK clinics

We have been contacted repeatedly in recent months about clinics in the UK promoting infant formula with special displays and discounts. These practices violate the World Health Assembly marketing requirements, are illegal under UK law and are against Department of Health policy. If you see such practices then please bring the following information to the attention of those responsible.

It seems the promotions have arisen as the UK introduces the Healthy Start scheme. This provides vouchers to low-income mothers for purchasing fruit, vegetables, milk or infant formula. The scheme has already been exploited by formula companies, such as Heinz Farley’s, encouraging health workers to promote its formula to mothers receiving the vouchers. See our Hard Sell Formula pamphlet.

It appears that some clinics are trying to clear stocks of formula by special displays and price cuts. Think about it. They are trying to increase the turnover of the formula they sell by encouraging people to buy formula from them they would not otherwise have bought.

The intention may be to help mothers who would have bought formula anyway to save some money by buying it at the clinic rather than the supermarket or pharmacy. But as mothers on low income who use formula can use the Healthy Start vouchers in any case, it is not really a valid argument.

A negative impact is that people may buy the discounted formula to pass on to those they think may benefit. Mothers or mother-in-laws for daughters who continue to breastfeed, perhaps. Studies have shown that such family pressure is a major obstacle to breastfeeding, particularly in disadvantaged communities. See:

As the International Code of Marketing of Breastmilk Substitutes, adopted by the World Health Assembly, 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.”

So that is the logic for why retailers - whether they are shops or clinics - should not try to clear formula out the store cupboard in the same way a shop would clear stocks of last year’s hot toy.

There are several articles of the International Code that apply specifically to clinics selling formula.

Article 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.”

Article 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…”

Article 5.3: “…there should be no point-of-sale advertising, giving of samples, or any other promotion device to induce sales directly to the consumer at the retail level, such as special displays, discount coupons, premiums, special sales, loss leaders and tie-in sales, for products within the scope of this Code….”

Article 5.3 continues: “This provision should not restrict the establishment of pricing policies and practices intended to provide products at lower prices on a long-term basis.”

On this basis, we campaign for companies to stop profiteering from formula – a product with one of the highest mark-ups. It also means the government Healthy Start vouchers are permitted.

We campaigned successfully for the previous voucher scheme to be changed, because that provided equal volumes of milk to mothers whether they were breastfeeding or formula-feeding. As the doorstep milk that breastfeeding mothers were entitled too had a lower cost than the equivalent amount of formula, this effectively devalued breastfeeding.

The new vouchers are of equal monetary value and a breastfeeding mother can use them to purchase fruit, vegetables and milk. This can help her own diet or make savings on the family budget, perhaps freeing up money for nursing bras or other items the mother may wish to purchase. For information on our past campaign see Update 35:

What does the UK law have to say about clinics doing special displays of formula and discount prices? In this instance as far as inant formula is concerned, it is in line with the International Code. See:

---Quote begins
Restrictions on promotion of infant formulae

19. No person shall at any place where any infant formula is sold by retail—

(a) advertise any infant formula;
(b) make any special display of an infant formula designed to promote sales;
(c) give away—
(i) any infant formula as a free sample; or
(ii) any coupon which may be used to purchase an infant formula at a discount;
(d) promote the sale of an infant formula by means of premiums, special sales, loss- leaders or tie-in sales; or
(e) undertake any other promotional activity to induce the sale of an infant formula.
----quote ends

So clinics with special displays and discounts could be prosecuted by Trading Standards for illegal promotion.

We have discussed this issue with the umbrella body for Trading Standards and with the Department of Health.

The Department of Health has informed us that the price at which strategic health authorities (SHAs) can sell formula is strictly regulated under the 1976 Sale of Goods to Mothers and Children (Designation and Charging) Regulations. The regulations allow SHAs to sell goods they consider appropriate for use by mothers and babies - which includes infant formula - at a price that is precisely the cost price to them plus a margin of 10%.

The Department's regular updates to NHS contacts about Healthy Start make clear that
it does not encourage Trusts to sell formula to the public at all and many have acted on this by stopping completely. But if they consider they must do so in order not to make a loss on any remaining formula they have over from the old Welfare Food Scheme then they must do so fully in accordance with these regulations, with the knowledge/consent of their SHA.

Trusts that do sell formula under the regulations, have been encouraged to do so for the shortest period of time possible and to make very clear that this does not signal that the NHS endorses formula use or that formula sales are in any way linked to the Healthy Start scheme.

So Baby Milk Action asks that if you find a clinic selling formula at discount then please do report this to us via our monitoring project with the Baby Feeding Law Group and inform the clinic of the above facts.

You could also suggest they contact they contact the Department of Health if they require further clarification. The best person to ask for is probably the Maternal & Infant Nutrition Policy Manager.

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