Danone rationing formula and Nestlé discounts

Campaigners are pointing to new aggressive baby milk marketing practices in the UK as a sign of increased competition with Nestlé entering the UK market, where Danone is currently the largest company.

Nestlé and Danone are respectively the world's biggest and second-biggest manufacturers of breastmilk substitutes. They have been engaged in an increasingly aggressive marketing war, particularly in Asia, since Danone purchased the NUMICO brand in 2007 (Nutricia, Milupa, Aptamil, Cow & Gate etc).

This marketing war has now reached the UK following Nestlé's takeover of Pfizer Nutrition/Wyeth in 2012, manufacture of the SMA brand. Both Danone and Nestlé have launched new strategies to promote their products - the former gaining media coverage by claiming individuals in the UK are buying up formula to send to China thus causing a shortage in the UK, the latter taking advantage of any formula panic buying by putting its follow-on formula on prominent price promotion to increase sales. Nestlé has told the BBC: 'We do not have any evidence of bulk purchase of SMA for export.'


Further details and analysis on the Baby Milk Action press release at:
http://info.babymilkaction.org/pressrelease/pressrelease09apr13

Comment on UNICEF breastfeeding report: Preventing disease and saving resources

UNICEF has published a report today called: "Preventing Disease and Saving Resources: the potential contribution of increasing breastfeeding rates in the UK". 

UNICEF'S press release states: "The report findings show that for just five illnesses, moderate increases in breastfeeding would translate into cost savings for the NHS of £40 million and tens of thousands of fewer hospital admissions and GP consultations."
See:
http://www.unicef.org.uk/BabyFriendly/News-and-Research/News/Breastfeeding-could-save-the-NHS-millions/

Here's a quick response from me, Mike Brady, Campaigns and Networking Coordinator at Baby Milk Action:

"This report is very welcome. The finding that babies who are not breastfed are more likely to become ill and require hospital and other medical treatment is neither surprising or new. The big question is will the present Government act when others have failed to do so in the past? Unfortunately, the current administration has taken steps backwards by, for example, scrapping the Infant Feeding Coordinator posts at the Department of Health despite these being one of the initiatives included in the Global Strategy on Infant and Young Child Feeding, which the UK claims to support. Some of the countries that have followed the strategy, including prohibiting the promotion of breastmilk substitutes in line with internationally agreed minimum marketing standards, have seen marked increases in breastfeeding rates, Brazil being a particularly good example. Of course, in parts of the world without the same level of health service support babies who are not breastfed are not only more likely to become ill, but more likely to die.

"Stopping baby milk company promotion has to be part of the public health policy response to this unnecessary illness and suffering. That is not to say that mothers who use formula should be made to feel guilty for doing so. Formula should be available for those who need it and everyone benefits if there is accurate independent information on infant feeding, instead of promotion from baby milk companies with a vested interest in selling their products. Don't forget, the millions companies spend on their promotion campaigns ultimately goes onto the price they charge for formula."

The following advertisements all appeared in the same health worker journal showing how each of the companies claims its formula is closer to breastmilk than the other brands. They cannot all be telling the truth. Unfortunately, the Advertising Standards Authority (ASA) refuses to investigate advertising in health journals. When Baby Milk Action has brought complaints about follow-on formula advertising to the public, the ASA has ruled against the claims that Aptamil and SMA are the best formulas. The claims do not stand up to scrutiny. Baby milk companies have shown they cannot be trusted to provide accurate information to parents or health workers. See: http://info.babymilkaction.org/cem/cemsep12

The Government has known about the health and financial impact for years of course. For example, in 2006 the National Institute for Clinical Excellence costed the savings to the NHS from a modest increase in breastfeeding rates (a 10% increase in initiation) and found many thousands of babies would not suffer illness and millions would be saved.

As UNICEF points out, the National Infant Feeding Survey tells us that 90% of mothers who stopped breastfeeding their babies by the time they were 6 weeks old wanted to breastfeed for longer. With greater support, many would have been able to do so, fewer babies would have become sick or even died and there would have been cost savings.

It is not just about support, of course. Breastfeeding is the normal way to feed a child. Denying a child breastmilk and giving it an alternative type of milk, even one processed to the best of current knowledge, is inevitably not going to be as beneficial. Breastmilk is a living substance and is a continuation of the nurture a mother has provided to her child through the placenta.

Formula is sometimes described a fourth best after breastfeeding, the mother's expressed breastmilk and donor breastmilk. Formula can save lives when breastmilk is unavailable either from the mother or donors, but modified cow's milk will always have limitations. In the UK, composition of formula is closely regulated so that those on the market have the ingredients known to be necessary. As scientific knowledge changes, the regulations are updated to change the composition. Mothers who do not breastfeed, or carers without access to breastmilk, can base their choice on their baby's preference and/or cost. Every company tries to claim its formula is better than the other brands, but this is marketing hype designed to inflate prices.

So aside from the short and long-term health impacts, financially the public is suffering a double whammy. As more tax money goes to paying for the care of babies who are not breastfed, parents who use formula are paying over the odds as prices are inflated to pay for the multi-million pound marketing campaigns run by the baby milk companies.

Based on figures from dairy farmers, the proportion of the selling price of formula that goes towards promotion and profit is between 53% and 80%. That means parents who use formula for 12 months are paying anything between about £231 and £884 towards promotion and profit. See:
http://info.babymilkaction.org/news/campaignblog310712

The latest marketing strategy of the baby milk companies is to claim they are friends of breastfeeding, wanting to offer advice and support to mothers. Danone claims that 3,000 mothers are signing up to its Cow & Gate branded baby club every week.

We have seen that companies have ostensibly given up on the first 6 months period, promoting their follow-on milk for use after breastfeeding for six months. This follows campaigns exposing their misleading claims and public health messages about the importance of breastfeeding. But companies ignore the fact that it is exclusive breastfeeding that is recommended for 6 months, with breastfeeding continuing beyond this age with the introduction of complementary foods. Companies also break the UK Infant Formula and Follow-on Formula Regulations (2007) and associated Guidance Notes by using the same brand names for follow-on milks and infant formula for use from birth and making the brand the focus of the advertising. See examples in the Baby Feeding Law Group monitoring project:
http://www.babyfeedinglawgroup.org.uk/reports/bflgreports
Involving baby milk companies in breastfeeding promotion is like putting the fox in charge of the chicken coop. We receive complaints about the outrageous emails mothers have received from companies. For example, Pfizer/Wyeth has promoted its SMA brand in an email headed: "How is feeding going?". It then plants seeds of doubt about breastfeeding:

"If you’re breastfeeding, do you sometimes wonder if your baby is getting enough milk?"

Although purporting to offer supportive advice, it highlights negatives:

"Feeling sore? .... If the pain continues or your nipples start to crack or bleed...."

Wyeth suggests people contact their midwife or public health nurse, "or call the SMA Careline".

After all that comes the closing punch: "Thinking of bottle feeding?" This is accompanied by an advertisement for SMA infant formula (which it is illegal to advertise) and the idealising claim (also prohibited) boasting the formula has "a new fat blend closer to that of breast milk".

The information that babies fed on the formula are more likely to become sick, be hospitalised and cost the NHS money treat is missing. As is the fact that these email marketing campaigns, the Careline, the cuddly toys, free gifts, free lunches for health workers and so on all go onto the price of formula.


What do parents really need? A free bear from Danone branded with its Aptamil formula name and logo (left) paid for by premiums on the price of formula - or accurate independent information on infant feeding from the health care system, no company promotion and cheaper formula?

Not for nothing are mothers supporting Baby Milk Action's "No promotion, cheaper formula" campaign. It doesn't matter if they are breastfeeding or using formula.
Everyone benefits by stopping baby milk company promotion:
http://www.change.org/petitions/baby-milk-companies-no-promotion-cheaper-formula

So why doesn't the Government act?

Why didn't it act in 2006 when the law was last revised and all health professional organisations, mother support groups and its own Scientific Advisory Committee on Nutrition called on it to prohibit company advertising, promotion and claims?

Why does it ignore the repeated calls from the UN Committee on the Rights of the Child to implement the internationally agreed minimum marketing standards, which companies should already be abiding by in the UK?

These are very good questions. Ask your Member of Parliament.

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.

Mumsnet questions to Mike Brady

Q and A with Mike Brady

The Mumsnet parenting website invited their followers to post questions to be answered by Mike Brady, Campaigns and Networking Coordinator at Baby Milk Action, and selected the following.

Edited versions of these answers will be posted on the Mumsnet site - full answers are given here.

Browse the questions provided by Mumsnet below and click on the links to go straight to Mike Brady's full answer.

1. Lowercase

what drives you to carry on campaigning?

what has been the single most positive/encouraging change you have seen during your campaign?

2. Ceidlihgirl

Bottlefeeding mums perceive Baby Milk Action to be anti formula. Whilst this may not be the case, that perception will affect the credibility of anything you say. Does your organisation need a makeover?

3. Lagrandissima

Do you work with schools to raise awareness of issues around the formula industry? Do you think it might be useful to educate future parents at an early age about the pros/cons of formula/BFing?

Also, just wanted to say thank you for standing up to the big corporations. Shame our politicians don't have the balls to.

4. FrozenNorthpole

My question is this: if there is one message you would like the 18-21 year old mums / dads of the future to receive about breastfeeding, what would it be?

5. Tiktok

I would like to ask Mike how Baby Milk Action can explain that concern about formula is not the same as judging mothers who use it.

Maybe an idea to respond to this one !

6. Funnysinthegarden

Along with other posters, I too am uncomfortable with this discussion. I'm afraid that BMA and it's followers really do appear to be anti formula, and to me that is unacceptable.

I am not sure if politically it is wise for Mumsnet to host a chat with an organisation which holds such one sided views. Of course they say they support both types of infant feeding, but a glance at their site would suggest otherwise.

Suffice to say I won't be posting a question.

Incidentally, why is a man fronting this campaign. Surely there are many women who would be better placed to do so?

7. Tabblouleh

Question 1: Mike how did you get involved with BMA?

Question 2: What practical actions can MNers do to support BMA and are there any tasks which MNers could volunteer to help out with?

Question 3: How can we launch an effective campaign to ensure HCPs know/understand and communicate the safe methods of preparing formula?

FORMULA

8. Lyns12

My question is what you would suggest to a mother who does not want to use formula but still requires, for whatever reason, milk to supplement her own?

9. HermyaTheRedNosedReindeer

I've come across some health care professionals who aren't as clued up on breastfeeding as what they are on formula feeding. It seems that the information is so readily available to those who want to find it, do you think there is any way of correcting the inbalance that seems to exist in some quarters?

10. Organiccarrottcake

Mike Brady My question is, how can the marketing of formula properly be controlled in the UK when the only apparent organisation to control it, the ASA, is a toothless waste of time. As it stands, if an advert is found to breach the regulations (such as the big-cup advert) the company is simply told to stop running it. Often they don't (I've seen this advert since its banning despite C&G telling me they were not running it again) and even if it isn't run again there's no requirement for retraction so viewers simply assumed it's run its course.

11. Jean Kelly

Hey Mike I have two questions:

1. Why do you think our food safety authorities don't test and approve formula? Surely it should be regulated so it doesn't contain such harmful things; bisphenol-A, aluminum, enterobacter sakazakii and salmonella enterica.

2. A lot of people are unaware of the risks of using formula so cant make an informed decision when deciding how to feed their babies. Do you think formula should be labeled with the health risks like tobacco boxes are?

12. Cuppateajanice

Powdered formula is impossible to make and store in a sterile manner, and therefore liquid formula is theoretically 'safer' in terms of potential hazardous contents.

Why, then, is there no concentrated sterile liquid formula product available on the market which can be diluted with cooled boiled water to provide a safer drink for babies.

Are current liquid sterilization/pasteurisation etc. techniques effective enough to allow a bottle of concentrated liquid formula to be kept in a fridge and used safely for a number of days? Are any formula companies looking into such a product or would it not be viable?

13. Himalaya

Do you think that the other baby milk companies that also violate the marketing code are relieved that the singular focus of the campaign on Nestle takes the heat off them? Is there any competition amongst baby milk companies to be recognised and seen as the most ethical in marketing, or do they all keep their heads down to stay out of the way of bad publicity?

NESTLE

14. Scrappydappydo

Do you think the boycott of nestle is having an impact. I haven't brought nestle products for 10 years but sometimes wonder if its worth it as they are such a huge company - not sure if little old me makes much of dent (not that I'll stop the boycott).

15. Lactivist

Hi Mike - How can I get across to people that it is important to boycott Nestle - my sons school seem to think it is something that happens abroad and nothing to do with us.

16. Maisyandpanduluce

I live overseas. Nestle is ubiquitous - in the way that, oh I don't know, bread, is in the UK. Any hints for boycotting things here?

FOLLOW-ON MILK

17. Marzipananimal

Hi Mike - How can I get across to people that it is important to boycott Nestle - my sons school seem to think it is something that happens abroad and nothing to do with us?

There’s a mix-up with the questions, as this appears above.

FORMULA IN 3RD WORLD COUNTRIES

18. Milamae

Do you think the use of formula in developed countries is over demonized in order to protest against it's use in 3rd world countries?

Can you see how this alienates many parents and do you think a different approach would be more beneficial?

19. Snugglepops

I am interested in inappropriate formula feeding during disasters and the aftermath, such as Haiti.

How do we ensure that aid money we give is not used to provide formula and thereby increase the suffering or babies and children at such a difficult point of their lives?

Is formula safe only in countries with good water supply, good standard of living, hygiene etc?

20. Himalaya

As I understand it from "UNICEF stats www.childinfo.org/breastfeeding_infantfeeding.html etc..the majority of babies in the developing world who are not exclusively breastfed are not given other milk or given formula, but water or complimentary foods traditional in that community such as maize meal porridge.

So the challenge of enabling more women to exlusively breast feed for longer and save the lives of 140 million children a year is not simply one of breastmilk vs formula (or of poor people vs big corporates) it is also about challenging some of the traditional practices handed down from Grandmas etc...

So the question is, do you think that there is any hope, that a company such a Nestle could be a force for good. They have has so much marketing expertise, scientific research and global reach, and an interest in selling products to children and families throughout their lives - do you think there is any hope that they might become a force for good in promoting sound nutrition, from breastfeeding to eventual weening and beyond. Do you see any sign of companies doing this?

Bonus question: What is the story behind the famous twins photo?

I have seen that there was a discussion about the famous ‘twins’ picture used on a postcard sold by Baby Milk Action and so have given the background to this and the issues it raises.

Midwives should tell Danone to keep its ill-gotten Aptamil loot

We are receiving many outraged reports from people who have seen that Danone is offering midwives grants of up to £1,000 from a fund of £20,000. This sponsorship is branded with the Danone formula name and logo, Aptamil (Danone is also behind the Nutricia, Milupa and Cow & Gate formula brands).

The money is being handled by the charity Tommy's. I would say Danone is using the charity to 'launder' the money in an attempt to make it more acceptable.

Firstly, for Tommy's and midwives to accept funds from Danone violates World Health Assembly marketing requirements.

Article 7.3 of the Code states:

"No financial or material inducements to promote products within the scope of this Code should be offered by manufacturers or distributors to health workers or members of their families, nor should these be accepted by health workers or members of their families."

Danone is promoting the Aptamil formula brand by linking the funding to it. The Aptamil logo features prominently on the charity's webpage and this links to an Aptamil-branded website that promotes the products with misleading claims.

It is not only a concern that Danone's money is linked to the Aptamil formula brand, accepting money from a formula company creates a conflict of interest for health workers. The World Health Assembly has adopted several Resolutions addressing conflicts of interest, such as Resolution 58.32, which calls for measures: "to ensure that financial support and other incentives for programmes and health professionals working in infant and young-child health do not create conflicts of interest."

A baby food company providing midwives with grants creates a conflict of interest, whatever the purported purpose of the grant.

Secondly, aside from these issues, we should not forget that Danone is second only to Nestlé for worldwide violations of the International Code and Resolutions. The only reason that Danone is not the target of a boycott like Nestlé is that after taking over the Aptamil and other brands from NUMICO in 2007, it promised to conduct a 'root and branch' review of marketing practices. All indications are that it has not taken the required action to end violations - quite the opposite. The next global monitoring report from the International Baby Food Action Network (IBFAN), due this year, will inform campaigners whether it is time to launch a consumer campaign against Danone to stop its aggressive marketing practices. The boycott of Nestlé has forced it to change some practices and is currently putting pressure on Nestlé to stop its latest global marketing campaign - click here.

In the UK, Danone brands have rulings against them from the Advertising Standards Authority for misleading parents. For example, the ASA upheld Baby Milk Action's complaints against advertising claims that Aptamil is the 'best follow-on formula' and protects against infection. See our press release from 22 July 2009.

Any health worker that has accepted Danone money is required to disclose this to their employers. Article 7.5 of the International Code states:

"Manufacturers and distributors of products within the scope of this Code should disclose to the institution to which a recipient health worker is affiliated any contribution made to him or on his behalf for fellowships, study tours, research grants, attendance at professional conferences, or the like. Similar disclosures should be made by the recipient."

Here is a quote from me, Mike Brady, Campaigns and Networking Coordinator, Baby Milk Action, for anyone that needs one:

"Danone is second only to Nestlé in the global baby milk market and pushes its products almost as aggressively. If it does not deliver on its promise to clean up the marketing for brands it took over when it purchased NUMICO, it will find itself, like Nestlé, the target of a consumer campaign.

"The money on offer is linked to a Danone formula brand name, Aptamil, and so is serving a promotional purpose. It is a breach of World Health Assembly marketing standards for companies to offer such financial benefits and health workers are also in breach of standards on conflicts of interest if they accept them. Even if this was not the case, the fact that Aptamil is promoted with misleading claims, some of which have rulings against them from the Advertising Standards Authority, shows this is a company that puts its own profits before the health and well-being of mothers and babies and its ill-gotten loot should be untouchable by those wanting to protect and support mothers and babies."

You can see examples of Danone violations of the International Code and Resolutions in the UK in the monitoring reports Baby Milk Action produces for the Baby Feeding Law Group.