Formula advertising in the British Journal of Midwifery

The British Journal of Midwifery has published a letter from Baby Milk Action after a member of its editorial board defended accepting infant formula advertising, which has been criticised by readers. Professor Lewis suggested that concerns about such advertising are due to "enmity and distrust" and suggested the priority should be on "resolving differences".

My letter is reproduced below.

In the guest editorial "Breast is best but choice is paramount" published in BJM 20(6), Prof. Lewis suggests that "concern and conflict must at some point give way to careful consideration, cooperation and hopefully, conciliation", but then attacks Baby Milk Action with bogus arguments. Indeed, the title of the editorial and its suggestion that stopping advertising restricts choice or denies information is itself bogus. Advertising, branded free gifts and branded competitions are not providing information, they are strategies designed to sell products.

The article states: "there is little evidence that Baby Milk Action are willing to acknowledge any positive changes within the food and infant feeding industry and against such enmity and distrust all future opportunities for an alliance and attainment of our wider aspirations for improved infant feeding is likely to founder." 

Baby Milk Action, which works to protect the right of all pregnant women and mothers to accurate, independent information, does acknowledge positive changes. For example, we welcomed Danone’s statement that it had taken action to stop 50% of the violations of the International Code of Marketing of Breastmilk Substitutes and subsequent, relevant Resolutions of the World Health Assembly in the last global monitoring report produced by the International Baby Food Action Network (IBFAN). We continue to communicate with Danone over ongoing systematic violations and it recently agreed to stop distributing materials in the health care system targeted at parents. While we publicly welcome these steps, we will continue to call for full compliance with the International Code and Resolutions, and for Danone to stop targeting health workers and parents in violation of these measures.

We are also in ongoing communication with Nestlé. Nestlé executives agreed to act on only 3% of violations (four out of 130) in the last monitoring report. I attended the Nestlé shareholder meeting this year and began by welcoming the fact that Nestlé had dropped a claim that one of its formula milks is "The new 'gold standard' in infant nutrition" after we campaigned on this. However, Nestlé continues to be the worst of the companies in terms of the scale and scope of violations and also takes the lead in opposing or undermining implementation of the Code and Resolutions in legislation. It is for this reason that it is the target of a boycott. The article refers to FTSE4Good without mentioning that Nestlé was only included in this ethical listing because the relevant criteria were weakened in September 2010 as no companies are complying with the previous criteria and FTSE wanted to bring some onto the list.
Article 7.2 of the Code states: "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". Formula advertising self-evidently does not provide scientific and factual information.

The Advertising Standards Authority (ASA) has upheld complains about formula advertising to the public, but refuses to consider complaints about advertising in professional journals on the grounds they should self-regulate. It is welcome to learn that there are health workers calling on the BJM to stop accepting formula advertising. This does not prohibit proper peer-reviewed scientific articles on formula appearing.

There is much more that could be said, but to finish, the article argues that various actors are "caught up on the particulars of the Code rather than finding a resolution for our differences." It is entirely sensible to expect companies to abide by these internationally agreed minimum standards for marketing of nutritional products for the most vulnerable people on the planet - babies. Putting priority on "resolving differences" with baby food companies, which in the BJM case coincidently involves profiting financially from the relationship, does a disservice to babies, their carers and readers of the BJM.

Yours sincerely,

Mike Brady
Campaigns and Networking Coordinator
Baby Milk Action

In a further response, Professor Lewis comments: "The ASA... accepts that adverts in healthcare journals are aimed at professionals who should be capable of considering the information and making up their own minds as to it benefits or disadvantage to the ways in which they practice – Baby Milk Action rather sadly, does not credit midwives with that capacity."

So if I understand this argument correctly, the British Journal of Midwifery abdicates its editorial responsibility and justifies pocketing money from baby food companies for publishing misleading advertising on the grounds that it is the responsibility of midwives to disregard it. To which I can only think, surely that's no way to run a journal.

Take a look at our September 2012 Campaign for Ethical Marketing to see how companies target healthworkers. And please let us know if you find Danone's leaflets in health facilities anywhere in the world.