Hipp on BBC Radio 4 You and Yours - ignoring safety guidance on making up formula

A representative of the Hipp baby food company was interviewed on BBC Radio 4 You and Yours programme on 5 November 2012, together with Dr. Helen Crawley of the First Steps Nutrition Trust (click here to listen again).

The discussion was about the refusal of Hipp to provide correct guidance on how to reconstitute its powdered infant formula. The facts, as Dr. Crawley explained, are clear. The Department of Health confirmed its guidance had not changed, despite Hipp claiming in the programme that it had been given permission to flout the guidance.

Powdered formula is not sterile and may contain harmful pathogens, such as cronobacter sakazakii (previously known as enterobacter sakazakii) and salmonella. Although studies have found contamination levels as high as 14% of tins (research cited by the US Food and Drugs Administation), ill effects are very rare, but can included meningitis and death.

The risks can be reduced by killing the bacteria by reconstituting the formula with water above 70 deg. C. In practice this temperature can be achieved by boiling a full kettle and allowing it to cool, but for no more than 30 minutes. The formula should then be allowed to cool to a safe temperature before feeding. The following resources provide this information:

The Department of Health Guide to Bottle Feeding booklet includes the instructions - click here.

A clear leaflet to follow if you are using formula (Hipp or any other) or advising parents, can be downloaded from the Department of Health - click here.

The World Health Organisation Guidelines for the safe preparation, storage and handling of powdered infant formula are also clear about using water above 70 deg. C. Its report includes background information on the risks and the reasons for the guidance - click here.

Baby Milk Action produced the Infant Formula Explained DVD on behalf of the Baby Feeding Law Group (consisting of leading UK health professional and mother support groups), which includes a short film for parents on how to reconstitute powdered formula correctly to reduce the risks - click here.

Despite the clear guidance for parents from the Department of Health and WHO, Hipp told Radio 4 that the guidance is unclear.

Why is Hipp putting babies at risk by telling people to use water at a lower temperature on its labels?

It comes down to its own profits and marketing campaigns. Hipp's current advertising and promotion is based on so-called probiotics added to its formula. There is no proven benefit of adding probiotics to formula, despite the impression given by Hipp in advertising such as that shown below (left, advertising to health workers, exposed on Baby Milk Action's Campaign for Ethical Marketing action sheet September 2012).

The First Steps Nutrition Trust guide to Infant Milks in the UK was updated in November 2012 to include information on Hipp's new probiotic formula and states:

A few clinical trials have shown health benefits for specific bacterial strains, however, on the strength of a review of randomised control trials in healthy term infants, the ESPGHAN (European Society of Paediatric Gastroenterology, Hepatology and Nutrition) Committee on Nutrition have found that there is too much uncertainty to draw any reliable conclusions on the efficacy of probiotics in infant milks. They did not recommend their routine use in formula milks for infants.

Water hot enough to kill harmful pathogens will also kill the probiotic bacteria and this is the reason Hipp is trying to hide the risks and ignore the safety guidance.

However, in doing so, Hipp is showing its contempt for the Infant Formula and Follow-on Formula Regulations (2007), adopted by the four countries of the UK. The Guidance Notes from the Food Standards Agency that accompany the Regulations and "shows how the regulations should be interpreted" is also very clear:

Labelling relating to the preparation, storage and disposal of infant formula and follow-on formula

24. Regulation 17 (1)(d) and 18(1)(d) require that instructions are provided for appropriate preparation, storage and disposal of the product. The Agency recommends that these instructions should include information noting that:

• Powdered infant formulae and follow-on formulae are not sterile, and as such can contain harmful bacteria. It is therefore important to be very careful when preparing formula to reduce the risks. Boiled tap water (not bottled water) cooled for no more than 30 minutes should be used to prepare infant feeds.

• All equipment used for feeding and preparing feed must be thoroughly cleaned and sterilised before use, and bottles should be made up fresh for each feed, as storing made-up formula milk may increase the chance of a baby becoming ill.

25. Further advice about the preparation and storage of formula can be found at the website below: http://www.breastfeeding.nhs.uk/en/materialforclients/index.asp (advice to consumers) http://www.dh.gov.uk/en/Healthcare/Maternity/Maternalandinfantnutrition/DH_ 4123674 (advice to health professionals)

The links mentioned in the Guidance Notes take you to the Department of Health booklet on formula feeding mentioned above, which states:

Bacteria in infant formula

Even when tins and packets of powdered infant formula are sealed, they can sometimes contain bacteria such as Cronobacter sakazakii (formerly know as Enterobacter sakazakii) and more rarely Salmonella. Although these bacteria are very rare, the infections they cause can be life-threatening.

To reduce the risk of infection, make up each feed as your baby needs it, using boiled water at a temperature of 70oC or above. Water at this temperature will kill any harmful bacteria that may be present.

Unfortunately, the regulatory authorities in the UK are not acting to enforce the regulations.

As Baby Milk Action also recently reported, the Advertising Standards Authority (ASA) is also failing to protect babies and their families in the UK when it comes to misleading claims made in advertisements. For example, it refuses to even investigate advertisments like that shown above. See our 24 October 2012 press release.

What can you do?

• Direct people using formula to the above guidance so they know how to prepare it correctly.
• Join Baby Milk Action (or send gift membership to a friend or collague).
• Support our Campaign for Ethical Marketing.
• Report examples of questionable promotion to the Baby Feeding Law Group monitoring project, which Baby Milk Action coordinates - click here.

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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.

SMA formula pricing

Wyeth is embarking on yet another national advertising campaign for its SMA formula.

This must be costing millions of pounds - a bill ultimately paid by those who buy formula.

The subvert below made me think about how much mark up there is on formula.



Companies won't reveal the breakdown of their costs, so the calculation below is based on speculation.

A 250 ml bottle of Wyeth's new SMA ready-to-feed formula costs 89 pence.

The dairy farmer will have received less than 7 pence for the milk (according to Farmers for Action farmers currently receive 27 pence per litre for milk from processors - click here).

Changing the fat content, pasteurising, packaging and distributing whole milk costs about 3 pence for 250 ml (Farmers for Action figures suggest 27 pence processing costs for 2.3 litres). Let's speculate and say that changing the protein content, adding vitamins, extracts from algae (LCPs) and other additives triples the processing costs of formula milk compared with whole milk. That would be 9 pence for 250 ml. This would make the total cost of the milk and production 16 pence per 250 ml.

The remaining 73 pence of the 89 pence selling price will be split between company and retailer profit and the costs of marketing, including advertising campaigns, baby clubs, "carelines", events for health workers, and other promotion.

Although marketing figures are hard to come by, it is known that Wyeth awarded a contract for £2 million to a PR agency in 2008 for targeting pregnant women, new mothers and health workers. In 2012 it must surely have already spent far more than this, having run two national billboard advertising and mass media campaigns by the end of July and planned the SMA Baby Know How roadshow to launch its new formula packaging (which was cancelled following protests).

Wyeth already has a criminal conviction for breaking advertising regulations and complaints have been upheld by the Advertising Standards Authority. Its Self-serving Marketing Activities benefit no-one and inflate prices through the costs of these and by positioning the product with misleading, idealising claims.

All formulas on the UK market have to comply with composition regulations and optional ingredients (which have been added to most formulas) have no proven benefit, so there is no health advantage from buying more expensive formula.

Formula is said to have the highest profit margins of any product on the supermarket shelves. For example, New Zealand’s Economic Development Minister Gerry Brownlee stated in October 2010: "A kilo of infant formula is worth ten times the value of a kilo of milk powder, so it’s obvious which product New Zealand should be selling."

These are obviously rough calculations, but not for nothing are hundreds of people signing the 'No promotion - Cheaper formula' petition on Change.org at:
http://www.change.org/petitions/baby-milk-companies-no-promotion-cheaper-formula

If you can help improve this calculation, please contact Baby Milk Action.

Department of Health responds to Baby Milk Action email campaign

Over 1,000 people have sent emails to the Secretary of State for Health, Mr. Andrew Lansley, asking the Government to reconsider its decision to scrap its Infant Feeding Coordinator posts and its support for National Breastfeeding Awareness Week. The response from the Department of Health is given below.

It is welcome that the Department of Health recognises the health benefits of breastfeeding and the savings to the National Health Service. However, the Government has not only failed to meet its obligations under the Global Strategy for Infant and Young Child Feeding, which it supported at the World Health Assembly, it is backtracking on action that had been taken.

Please sign the ePetition on the Prime Minister's website calling on the Government to deliver on its infant feeding obligations - click here. Petitions receiving 100,000 signatures will be debated in Parliament.

If you have not signed up to receive email alerts from Baby Milk Action, please do so now to be kept informed of the next steps in this and other campaigns.

Thank you for your email of **** to Andrew Lansley about infant feeding which was forwarded to the Department of Health on ****. I have been asked to reply.

The Department of Health is committed to supporting healthier choices, including breastfeeding, through the ‘Healthy Child Programme’ as set out in the Public Health White Paper ‘Healthy Lives, Healthy People: our strategy for public health in England’.

The Department recognises the evidence-based health benefits of breastfeeding both for the mother and her baby and the savings to the NHS. The Department’s approach is to support all parents and parents-to-be with information to enable them to make an informed choice when deciding how to feed their baby.

Due to reduced budgets this year, the Department was unable to co-ordinate the National Breastfeeding Week and provide free resources for local events. However, support and information is currently available to health professionals and parents via NHS Choices, the National Breastfeeding Helpline, UNICEF UK Baby Friendly Initiative and localpeer support programmes.

At present, the Department is reshaping the whole health and social care system, and looking at how this can work to deliver the best possible health and social care outcomes. Public health will remain a key component in all of this. It is important that organisations working to promote better health engage with all parts of the new health system as it develops to ensure that we make the most of the available evidence on infant feeding to drive the greatest health gains. The Department is also already actively encouraging local groups to nominate representatives from their networks to attend national meetings to continue to share positive practice and information on infant feeding. This will help the Department to ensure continued communication and support to the current infrastructure until the new system is operating.

The Department received a large number of responses to its recent consultation on the White Paper and the associated proposals for a new public health outcomes framework, and for funding and commissioning of public health services in the newly defined system. Responses to the consultation were used to inform ‘Healthy Lives, Healthy People: Next Steps and Way Forward’, which sets out the key elements of the new public health system. This can be accessed at the link below:

http://www.dh.gov.uk/en/Publichealth/Healthyliveshealthypeople/index.htm

Following this publication, the Department of Health will issue a series of policy statements including the final outcomes framework in the autumn.

I hope this information is helpful.

Yours sincerely,

Customer Service Centre

Department of Health

Nestle's brave new world. Good Grief!

It has been a busy month for Nestlé as it tries to remake the world in its own image. It culminated in Nestlé announcing "The first comprehensive nutrition system for babies", a machine that squirts out milk into feeding bottles for new borns. How on earth has the human race survived without there being a way to provide nutrition to its young? In Nestlé's world, the past is prelude and the fact that babies were once nurtured by milk produced by their mothers' bodies is to be consigned to our primitive past it seems. Nestlé, Good Grief! (Click here for the ringtone).

In the old days, people sometimes talked of the mother-baby pair. Once breastfeeding was established - which sometimes required a little guidance as breastfeeding became an increasingly lost art - the mother would produce milk in response to cues from her child and it would change during the day and over time, tailored to the needs of the child. Milk was available on demand, at the right temperature. In Nestlé’s brave new world, it says of its BabyNes machine:

"The composition of the six consecutive formulas meets the evolving nutritional needs in the first three years of life: four formulas in the first year, and one formula for each of the following two years. The customised composition of these products is tailored to suit the growth pattern in early life and the baby’s changing nutritional needs, while taking into account the steady introduction of solid food into the infant’s diet."

The language has been appropriated. The machine produces milk 'tailored' to the baby we are to believe. Human milk is a living substance and not only adapts in its nutritional content, it is truly tailored to the needs of the baby as the mother’s body produces protective factors in response to infections in the environment, a medicine that is essential for reducing risk of infections. Without breastmilk babies are more likely to become sick and, in conditions of poverty, more likely to die.

Nestlé further extols the virtues of its magical machine thus:

"The single-serve portions are sealed in capsules, used in the proprietary BabyNes machine, which recognises each capsule and prepares the bottle with precisely the right dosage and temperature, at the push of a button, in less than one minute. The BabyNes machine combines state-of-the-art technology with the utmost safety and convenience, and ensures a hygienic, quick and easy bottle preparation."

So we are to believe BabyNes knows how to produce precisely the right dosage. Yet it is a false picture. A breastfed baby takes as much as it needs, not so easy to do when a plastic nipple is held in its mouth, no matter how precisely the volume in it has been decreed by the Nestlé machine.

Most misleading of all is to describe the machine's output as hygienic. The water used to make the formula is not boiled, just filtered. The World Health Organisation recommends all water be boiled, even bottled water. The capsules contain powder, and as they are sealed might appear to offer sterile certainty, but powdered formula is itself not sterile and may contain harmful pathogens such as Salmonella and Enterobacter Sakazakii. Nestlé knows this well as it has had to recall thousands of tins of formula in the past after such contamination has been found in its powder. The US Food and Drug Adminstration has cited a study of tins on the market that found 14% contained Enterobacter Sakazakii, which in rare cases can lead to fatal illness, though there are simple steps to reduce the risks - steps Nestlé’s machine seems not to take.

It was the death of a child in Belgium fed on contaminated Nestlé formula in 2002 that was a catalyst for a World Health Organisation investigation leading to its recommendations on reconstituting powdered formula. This includes reconstituting formula with water above 70 degrees Celsius to kill any harmful bacteria, then cooling the formula. Nestlé says its machine mixes feed in one minute without boiling the water.

Baby Milk Action recently produced on behalf of the Baby Feeding Law Group called Infant Formula Explained to show how to prepare a bottle in line with this guidance - necessary because companies are reluctant to tell parents that powdered formula is not sterile and how to reduce the risks. We have asked Nestlé many times to bring its warnings and instructions into line, and it has refused. Now we know part of the reason why: its machine has been under development for six years and if it acknowledged that formula should be prepared with water above 70 degrees, it would have had to go back to the drawing board.

Instead a potentially dangerous method of preparing formula is being touted as offering the "utmost safety".

In the world of marketing, of course, everything is always new and improved.

Last year we exposed Nestlé claiming the formula in its tins was 'The new "Gold Standard" in infant nutrition', another attempt to appropriate the language of breastfeeding, long described as the "Gold Standard". After thousands of emails from boycott supporters, Nestlé said it had discontinued the leaflet - after attempting to argue that the 'Gold' referred to the colour of the formula labels.

The withdrawal of the leaflets was one of four actions highlighted by Nestlé in its response to the Breaking the Rules, Stretching the Rules 2010 monitoring report which profiles the practices of 22 formula and feeding bottle companies with examples of violations from 46 countries.

The report contains page after page of examples of Nestlé materials showing how the company systematically violates the International Code of Marketing of Breastmilk Substitutes and subsequent, relevant Resolutions of the World Health Assembly. Earlier this month I joined Annelies Allain from the International Code Documentation Centre to present the report in Geneva prior to the World Health Assembly (you can watch the film below).

While promising action on just four of these examples - including the ‘Gold Standard’ leaflet - Nestlé defended the rest of the 130 violations it counted in the report.

So Nestlé intends to continue with 97% of the violations exposed.

In Nestlé's brave new world this open contempt for the marketing requirements adopted by the world's highest health policy setting body - which repeated its call last year for companies to meet their responsibilities - is turned on its head. Nestlé cites the fact that it decided only four violations were valid as proof it is doing little wrong - whereas in reality this shows it is doing virtually nothing to put things right (Danone, by contrast, said action it has taken would stop 50% of the violations in its profile and it promised to make other changes such as removing the Immunofortis claims from its formula labels).

Nestlé continues with marketing strategies such as claiming its formula 'protects' babies, with colourful logos on labels and promotion to health workers and mothers. This is despite acknowledging to Baby Milk Action in our ongoing correspondence that actually there is 'no proven benefit' from adding highlighted ingredients such as DHA to formula. Nestlé's argument is that it refers to the benefits of DHA in breastmilk, not in its formula - though whether parents who are drawn in by the logos appreciate this sophistry is debatable.

Where Nestlé does make changes it is either because legislation gives it no choice, or because of campaign pressure. Although Nestlé prefers to invest in diverting criticism, when executives judge bad publicity is fuelling the boycott to too great a degree, or it is bombarded with messages, then it changes policies and practices. Even though Nestlé is one of the four most boycotted companies on the planet, further pressure is needed.

To this end some of us gathered at Nestlé (UK) HQ last Saturday to record some campaign clips that will be available soon. You can already download a Nestlé, Good Grief! jingle as a ringtone - click here.

The boycott means that even in some of the reporting about BabyNes, journalists are questioning Nestlé on violations of the Code.

How Nestlé responds is illuminating. Nestlé told Nutraingredients:

"We have the industry’s toughest system in place to enforce WHO Code compliance. Indeed, we are the only infant formula manufacturer listed by FTSE4Good, the London Stock Exchange’s Ethical Index.”

The first statement is demonstrably false given the systematic way Nestlé violates the Code. The second statement ignores the fact that in order for Nestlé to be listed by FTSE4Good, FTSE changed the criteria. Systematically violating the Code on the ground is not an obstacle to being listed and FTSE has not yet conducted any evaluation of Nestlé marketing practices. In Nestlé's brave new world something becomes true just because Nestlé says it is true and FTSE decided to believe Nestlé rather than monitoring evidence when Nestlé said it had put policies and systems in place to stop violations.

Nestlé is promoting its new BabyNes product with a press release, news conference and postings on its website and in social media. However, all forms of promotion of breastmilk substitutes are prohibited by the Code and Resolutions.

If Nestlé tried these tactics in a country that has implemented the Code and Resolutions in legislation it could find itself in court, as Johnson and Johnson did in India in the 1990s for press releasing information about a new feeding bottle. India has exemplary legislation with a sanction of imprisonment for the Managing Director under what is criminal law. Johnson and Johnson apologised and later said it realised it was inappropriate to be marketing feeding bottles in India and discontinued its feeding bottle business. Nestlé has also been taken to court in India, for failing to translate warnings on formula labels. It continues to fight the case and unsuccessfully took the government to court to have the law struck down on the grounds it was infringing its rights.

All this is as nothing to Nestlé's master stroke last week in tyring to usher in its brave new world. Thirty years after the adoption of the International Code, "top government officials" met to discuss "Future Directions in Nutrition, Water, Rural Development". I'm not talking about the World Health Assembly gathering in Geneva, where the world's health ministries discussed these and other issues such as the growing problem of non-communicable diseases caused by the diets promoted by junk food companies such as Nestlé (for that is what much of its food is, despite its attempt to rebrand itself as a Nutrition, Health and Wellness company).

No, the "top government officials" were in Washington at Nestlé's Creating Shared Value Forum. This was not only an attempt by Nestlé to appropriate the language of development, portray itself and its model as beneficial, and set the policy agenda. It was surely also a shot across the bows of the World Health Assembly meeting at the exact same time across the Atlantic, a warning that in Nestlé’s brave new world the world’s highest health policy setting body was close to being irrelevant.

In Geneva the Director General of the World Health Organisation, Margaret Chan, was presenting a report to Member States on funding as WHO's budget is being squeezed. The solution the DG proposed is to bring in business by setting up the World Health Forum. Perhaps with an eye on Nestlé's event in Washington she said this would be a "multi-stakeholder forum" which will "identify future priorities in global health".

Baby Milk Action and its partners in the International Baby Food Action Network (IBFAN) and other organisations raised concerns over conflicts of interest. Corporate Accountability International joined us in delivering a letter to Dr. Chan signed by over 100 organizations and individuals from more than 24 countries.

The same week as Nestlé Creating Shared Value Forum, Save the Children Australia, Oxfam, Care and 13 other Aid agencies working in Laos wrote a letter to Nestlé stating that they will not be applying Nestle's Creating Shared Value Prize because the company's continued marketing of formula "still jeopardizes the health of infants and children in Laos." - Click here.

However, we can expect some organisation to accept Nestlé’s money and Nestlé will publicise this as if it is some kind of development agency.

The campaign against Dr. Chan’s proposed partnership with corporations in a World Health Forum continues. The stated aim of the Forum is to “Improve health outcomes, with WHO meeting the expectations of its Member States and partners”.

Well, we already know what Nestlé expects.

Nestlé wants people to believe that its refusal to act on 97% of the violations of the WHO Code is a good thing and that those experts on the ground who state the company "jeopardizes the health of infants and children" are to be ignored because a FTSE committee sitting in London examining Nestlé’s policy statements and other presentations.

While Nestlé continues to undermine breastfeeding and refuses to warn parents who use formula of the risks, in its brave new world it wants people to believe that thanks to Nestlé the human race has finally been delivered "The first comprehensive nutrition system for babies".

Nestlé, Good Grief!

Hype about 'human breastmilk' from GM cows tells us much about existing formula

Headlines claiming that scientists have produced 'breastmilk' from Genetically Modified (GM) cows should sound alarm bells for policy makers as they vote this week in the European Parliament on whether to improve measures for approving health claims on formula. Firstly, this story demonstrates once again that existing formulas lack many of the components found in breatmilk, three of which the researchers claim now to be able to produce from different GM cows. Given the existing misleading claims that formula companies put on labels, about how their formula boosts the immune system and supports brain and eye development for example, over a third of parents already believe formula is "very similar or the same" as breastmilk according to a survey by the UK Department of Health. Secondly, the GM cow's are not producing 'human breast milk' (hence the quotes in the reports), but are potentially a source of some of the missing components. Other components, some of which may still need to be discovered, and living substances, are not being produced by the cows and the milk will still require subsequent processing even if it was found to be beneficial and safe (aside from animal welfare and environmental considerations).

Members of the European Parliament will be voting on a Resolution on Wednesday 6 April about the approval process for health claims and deciding whether to block a claim for an ingredient, DHA, generally produced by microalgae fermentation. Companies claim this is important for eye and brain development, but independent research has found "no proven benefit" from adding it to formula - if there was, it would have been made a required ingredient in the European Union's composition regulations. The industry is lobbying hard to stop the Resolution from the Environment, Public Health and Food Safety Committee from being approved by the full Parliament. Click here to send a message to your representatives in the European Parliament.

Here is a quote from Mike Brady, Campaigns and Networking Coordinator, Baby Milk Action for any journalists that need one:

"Every time we see these types of headlines it reinforces the fact that formula currently on the market is not the same as breastmilk and scientists are still seeking ways to reduce its shortcomings - yet misleading claims made on labels and in advertising have convinced a third of parents in the UK that existing formula is the 'very similar or the same' as breastmilk. The Advertising Standards Authority has already ruled against claims that formula boosts the immune system and the suggestion these cows are producing 'human breastmilk' is just as misleading - scientists are actually claiming they have found a way to produce three components missing from current formulas and change fat and protein levels. This is not going to be a living substance tailored to the baby like breastmilk. Baby Milk Action is working for the composition of formula to be improved for those babies who are not breastfed and it will be interesting to see if the missing components that these scientists claim to be able to produce can be proven to be beneficial and safe if included in a formula. The European Parliament has the chance to vote on Wednesday 6 April in support of a Resolution from the Environment, Public Health and Food Safety Committee that will improve the process for approving health claims and block misleading claims. I urge all MEPs to vote in favour of the Resolution."

To protect babies fed on formula we need to look behind the hype and put in place a system that requires benefits and safety to be proven. If ingredients are beneficial and safe, they should not be promoted with marketing claims, but required as an ingredient in all formulas, so inferior formulas are not being fed to babies. This chance of a mass market attracts investors backing new wonder ingredients to add to formula, but policy makers need to keep clear heads and do what is right for infant health - and in this case, also consider the animal welfare and environmental issues.

The current regulatory system means that companies can add ingredients to formula and make health claims about them, at least on follow-on formula, without evidence of benefit. In the case of DHA, in 1996 investment advisors Hambrecht & Quist suggested investing in Martek Bio-sciences Corporation, that had developed Formulaide, an additive produced by microalgae fermentation, saying:

"Even if Formulaide (DHA/AHA) had no benefit we think that it would be widely incorporated into most formulas as a marketing tool and to allow companies to promote their formula as ‘closest to human milk’."

Beware of the hype. Left: Mead Johnson suggests its formula improves babies eye sight, although there is 'no proven benefit' from adding DHA to formula.

Baby Milk Action takes the view that if there truly is evidence for a health claim that should trigger a review of the list of ingredients required in formula by law and the evidence - including a substantial amount of independent research, not just company-funded research - should be examined. This happened when the EU Infant Formula and Follow-on Formula Directive was updated in 2006 and it was decided not to add DHA to the required list of ingredients because there was 'no proven benefit'. There is also evidence of possible adverse reactions amongst some infants, which suggests a warning is more appropriate than a health claim. In the United States, manufacturers are required to record and report cases of adverse reactions - and the US Food and Drug Administration had recorded 98 cases itself by 2007. Those backing the baby food industry's DHA claim are lobbying hard to stop the European Parliament voting to improve the health claim approval system - click here.

Research in the public interest should take place to try to reduce the poorer health outcomes amongst babies fed on formula. With regard commercial research there are two different approaches as to how to motivate it.

The health claims approach: Advocates of allowing companies to make health claims have suggested: "In the future, manufacturers might not be willing to invest major financial resources into the development, clinical evaluation and implementation of further improvements, if there is no chance to communicate such improvements." This encourages companies to seek ingredients about which they can make a claim, regardless of the benefits (as with DHA). If improvements have a genuine benefit, then making them optional in this way will mean some babies receive inferior formula.

The evidence-based approach: Baby Milk Action's view is that breastmilk substitutes (the only food for a child for about the first 6 months of life) is too important a product and that adding new ingredients should be based on scientific evidence. Adding ingredients without approval effectively means a mass uncontrolled trial is being conducted on the population at large. Requiring companies to prove ingredients are beneficial and safe will not stop ingredients from being added and will not stop companies from profiting from their investment - advances are generally driven by biotech companies who will find a greater market if their products are added to the list of required ingredients.

Following the evidence-based approach means companies and investors profit from producing something that will benefit health, rather than producing something to be used in a marketing campaign.

If policy makers are serious about infant health, then supporting an evidence-based approach is the way to go.

Press reports with 'human breast milk' from cows headlines cite publications in the Public Library of Science One by Professor Ning Li and name three ingredients. From searching the Public Library of Science One website, these appear to be the papers (to be confirmed):

Lysozyme (results from four GM cows): Characterization of Bioactive Recombinant Human Lysozyme Expressed in Milk of Cloned Transgenic Cattle

Lactoferrin (results from two GM cows): Cattle Mammary Bioreactor Generated by a Novel Procedure of Transgenic Cloning for Large-Scale Production of Functional Human Lactoferrin

Alpha-lactalbumin: paper not yet found.

Please contact us if you have further information on the actual research. We would also like to track how this story is reported around the world, so please post links to articles as comments to this blog.

Offensive from those defending industry DHA health claim

Thank you so much to everyone who has contacted their representatives in the European Parliament asking them to vote in favour of a Resolution to protect the rights of parents and carers to accurate information on infant formula. We know it is having an impact because those defending the rights of the baby food industry to put misleading claims onto formula are becoming more active and Mead Johnson has apparently hired a Public Relations firm to lobby politicians. We need the voices of the public to counter this offensive. Click here if you have not yet sent a message to your representatives in the European Parliament yet or to spread the word if you have. If you want to know the detail of what is taking place, read on.

The European Commission has just written to all Members of the European Parliament (MEPs) supporting authorisation of a claim about DHA and eye development and attacking the Resolution adopted by the European Parliament Environment, Public Health and Food Safety (ENVI) Committee that would prevent this and lead to improvements in the authorisation process. The arguments the Commission presents show even more clearly that the evidence has not been adequately scrutinised, as will be explained. We have also seen a Professor wading into the debate and calling Baby Milk Action a 'loud-mouthed lobbying organisation' - while failing to reveal his relationship with the company that produces the DHA additives added to formula and the company that has applied for the right to use the health claim. More than ever, we need voters to send messages to their representatives asking them to put the scientific evidence and the well-being of infants before the vested interests of the formula industry and unelected European Commission officials who seem intent on providing a boost to the formula industry regardless of the evidence - click here.

UNICEF gives its strong support to the Resolution

On the side of mothers and babies, we see that UNICEF has responded to a request from MEPs for an opinion indicating its strong support for the Resolution opposing the claim. And from the responses sent to our supporters its clear that many MEPs are determined to back the Resolution. But when the vote goes to the full Parliament on the 5th or 6th of April we will need 369 of the 736 MEPs on side - even if only 400 are in the room at the time. We are trying to directly contact those who say they are intending to vote against the resolution (and FOR the claim) to find out their reasons for doing so. There seems to be some confusion that prohibiting the claim will stop DHA being added to formula, which is incorrect. DHA is a permitted ingredient, though it is not a required ingredient, because it has no proven benefit.

MEPs opposing the Resolution use an argument that makes support more sensible

The argument put by some MEPs explaining their opposition to the Resolution actually makes more sense as a reason for voting in favour. We have seen several state: "If an ingredient is proven to be safe and important for baby health, then it should be included." That is the position of those supporting the Resolution: if an ingredient is proven safe and beneficial it should be a requirement in all formulas and added to the list of essential ingredients in the EU Infant Formula and Follow-on Formula Directive. Nobody who really cares about infant health would want an inferior formula on the market, it is too important a product.

DHA is not a required ingredient because it has no proven benefit

When the composition requirements were updated in 2006, DHA was not included on the list of required ingredient because of the lack of evidence of benefit. Those opposing the Resolution are opposing the principle that safe and important ingredients should be included and if successful will allow an unproven ingredient to be added and promoted to mothers with an unsubstantiated claim. The image on the left shows how Mead Johnson promotes its formula as if it will transform a child's eyesight.

The Commission has written to MEPs attempting to defend the scientific basis of the claim, including a letter from the European Food Safety Authority (EFSA). However, the arguments prove the point that consideration of the evidence of benefits and risks is incomplete.

Cochrane Library review attacked

EFSA's letter suggests that the independent, systematic Cochrane Library review, which found 'no proven benefit' from adding DHA to formula, did not separately consider DHA supplementation at the levels specified by Mead Johnson, which filed the original claim of benefit for the ingredient. Yet Cochrane explicitely refers to the Birch study used as justification and would surely have mentioned the evidence of benefit at higher levels had the evidence been convincing. It states: "Only one group of researchers have shown some beneficial effects on VEP [visually evoked potential] acuity.... Further research is needed to see if the beneficial effects demonstrated by Dallas 2005 trial of Birch et al can be replicated in different settings."

Kathy Kennedy, Professor Alan Lucas and Mary Fewtrell, authors of a study (see below) that has found possible negative health impacts of DHA-supplemented formula, pointed out in defending their study from industry attack in the Archive of Diseases in Childhood: "Birch's study, which may have been one of the most influential trials driving the addition of LCPUFA to US formulas, was based on an incomplete follow up where only 19 subjects remained in the relevant intervention group, providing inadequate power to provide any realistic estimation of the treatment effect." [emphasis added]

Evidence of risks ignored in EFSA letter

The EFSA letter dismisses the need for further research on possible risks from DHA supplementation, rejecting a study by Kennedy et al published in the Archive of Disease on Childhood as having 'considerable weaknesses (e.g. a very low number of subjects)' - in fact a study group of 105. The Kennedy paper itself states that further research is needed to see if the evidence of high blood pressure etc. found in the 10-year follow-up is replicated. Significantly EFSA seems to ignore the evidence we raised in our submission about the evidence held by the US Food and Drug Administration (FDA) of parents and carers reporting adverse reactions to formulas supplemented with Long Chain Polyunsaturated Fatty Acids (such as DHA). The FDA noted in its response to a filing from Martek Biosciences, manufacturer of the DHA additive, for Generally Recognised As Safe approval (click here):

"Some studies have reported unexpected deaths among infants who consumed formula supplemented with long-chain polyunsaturated fatty acids. These unexpected deaths were attributed to Sudden Infant Death Syndrome (SIDS), sepsis or necrotizing enterocolitis. Also, some studies have reported adverse events and other morbidities including diarrhea, flatulence, jaundice, and apnea in infants fed long-chain polyunsaturated fatty acids."

The FDA requires formula companies to do post market surveillance - yet in the 9 years since this stipulation no industry reports appear to have been made, while the FDA had recorded 98 cases of parents and carers reporting adverse reactions by 2007.

EFSA 'unaware' of other factors in breastmilk relevant to DHA effect

EFSA also dismisses the point that DHA is in a different environment in formula than in breastmilk, yet the FDA stated in its response to Martek:

"In addition, CFSAN [Center for Food Safety and Applied Nutrition] noted that your notice had not accounted for the fact that the bioactive fatty acids ARA and DHA when consumed in mature human milk are part of a complex matrix that includes, for example, linoleic acid, alpha-linolenic acid, and other polyunsaturated fatty acids and that important physiologic considerations relative to the matrix are not accounted for by the simple addition of LCPUFAs to infant formula."

EFSA states:

"We are unaware of any factor in breast milk which is needed for DHA to exert its 'optimal' effect."

This raises questions about gaps in the scientific basis for EFSA's position.

EFSA dismisses the call for further research by pointing out:

"DHA levels in formula as proposed for the claim are in the normal range of DHA content naturally present in mother's milk."

It is over-simplistic simply to look at breastmilk as a template in setting levels; health outcomes need to be properly considered. Even when there is benefit from adding an ingredient to formula, it may be required at different levels to those in breastmilk. It should be remembered, for example, that the iron levels in formula are around 5 times that in breastmilk because a child absorbs it differently from the different environment - if formula simply followed the levels in breastmilk, children fed on formula would not absorb enough iron.

Professor with links to Martek and Mead Johnson attacks Baby Milk Action

Wading into the issue in extended comments in Nutraingredients is Professor Berthold Koletzko, calling the EFSA investigation a "profound scientific evaluation", ignoring the shortcomings mentioned above and the findings of independent scientists.

Professor Koletzko attacks Baby Milk Action for 'pseudo-scientific' arguments and is entitled to his opinion, but it is relevant to examine his conflicts of interest, which were not declared in the article. Professor Koletzko was lead author of a 2008 paper recommending DHA be added to formula. The declaration included in that paper states:

"The scientific workshop held at Barcelona was financially supported by Martek Biosciences Corporation. BK is the recipient of a Freedom to Discover Award of the Bristol Myers Squibb Foundation, New York, NY, USA."

Martek Biosciences manufactures the DHA additives used by the majority of formula companies.

Until recently (December 2009), Bristol Myers Squibb owned Mead Johnson, the company that filed the application to use the DHA claim which Prof. Koletzko is seeking to defend by labelling Baby Milk Action as a 'load-mouthed lobbying group'.

The need for objectivity

We believe that policy should be based on objective evidence. This is even more important for foods for infants and young children, which is a multi-billion pound industry. There is a need to ensure that research free from commercial influence forms the main basis for policy setting and that the totality of the evidence is independently reviewed. It is impossible to know with industry funded research how much inconvenient data has been hidden.

We agree that if an ingredient is of proven benefit and safe then it should be included in formula. No claims should be made about these ingredients; claims only have the purpose of boosting sales. Inferior formula should not be on the market and parents and carers have a right to accurate information.

The wider harm that will be caused by opposing the Resolution

As UNICEF points out: "There can be little doubt that the use of such health claims can mislead parents into thinking that the formulas are as good as, if not better than breastmilk."

We saw in the Philippines how claims about DHA led some parents and carers to believe it was better to use formula rather than breastfeed. You can watch a UNICEF film about this online by clicking here.

Even in the UK, where companies get away with many health claims, access to midwives, health visitors and others is not enough to correct the misleading impression given by baby food industry promotion. According to a Department of Health survey a third of mothers incorrectly believe that infant formula is the same or almost the same as breastfeeding. See Myths stop mothers giving their babies the best start in life.

Protecting babies fed on formula

There is an argument that allowing companies to make health claims encourages investment on new ingredients that may be of health benefit. Professor Berthold Koletzko sent a statement dated 28 February to all MEPs attacking the Resolution as the German Society for Paediatrics and Adolescent Medicine. There is no declaration of Prof. Koletzko's links with the baby food industry, as described above. Prof. Koletzko states:

Preventing the communication of scientifically assured benefits of optimised products bears the risk that it may slow or stop the significant quality improvements of foods for infants has occurred over the last years and decades in numerous single steps, and which has led to large benefits for child health. In the future, manufacturers might not be willing to invest major financial resources into the development, clinical evaluation and implementation of further improvements, if there is no chance to communicate such improvements.

There are several issues with this argument.

Firstly, while it is true that the possibility of making claims about some new ingredient encourages investment, this is not necessarily going to lead to benefits for infant health. In the case of DHA, investment advisors Hambrecht & Quist suggested investing in Martek Bio-sciences Corporation in 1996, saying:

"Even if Formulaide (DHA/AHA) had no benefit we think that it would be widely incorporated into most formulas as a marketing tool and to allow companies to promote their formula as ‘closest to human milk’."

They understood the value comes from health claims as a marketing tool, not from any health benefit from the ingredient. This approach advocated by Prof. Koletzko also drives a search for something to make a claim about - and we have seen this result in unnecessary and even potentially harmful products such as so-called Goodnight milks (click here for analysis by the UK Scientific Advisory Committee on Nutrition of Goodnight milks and associated claims).

Secondly, the US Food and Drug Administration requires companies there to record evidence on ill effects and keeps its own record (see above). Effectively, an uncontrolled mass trial is taking place amongst those who use formula, based on parents self-selecting whether to buy formula with DHA or not. If this was a scientific study, participants would have the right to free and informed consent. Health claims not only negate that principle, they turn it on its head.

Thirdly, science IS conducted in the public interest on new ingredients.

Fourthly, if an ingredient is of benefit, should it be denied to babies by allowing inferior formula to be marketed? Note that in this case, Martek does not produce formula itself. If DHA had been accepted as beneficial and added to the list of required ingredients when this was discussed when the EU Directive was updated in 2006, it would have found an even larger market. Pre-approval would not prevent development, it would simply require the benefit and safety of new ingredients to be proven through experiments with proper informed consent, preferably with a significant level of independent studies.

To ensure that formula is as safe and as beneficial as it can be and that information about it is accurate, we need the Resolution to be supported by the European Parliament at the beginning of April.

So please do keep sending messages. Our multilingual campaign page tells you how to do so quickly and easily - click here. If you have already sent your own messages, use the tools on that page to ask friends and colleagues to do the same.

Is breast best? book launch - a bit less polarisation please for the sake of the children

Get ready for another round of 'Breast not best' headlines in the UK that will echo around the world as a book by Joan Wolf, a political scientist, is launched here. It has the title: "Is Breast Best?: Taking on the Breastfeeding Experts and the New High Stakes of Motherhood" and Joan Wolf is speaking on it at a conference on 21 March.

We saw similar headlines last month with the publication of an article in the British Medical Journal questioning the World Health Organisation's recommendation that babies be exclusively breastfed for 6 months, with continued breastfeeding beyond this alongside the introduction of complementary foods. Interestingly one of the co-authors of that paper pops up on the panel at the book launch. In fairness to Mary Fewtrell, she did not question the benefits of breastfeeding in her article, even if that's what some newspaper headlines said. She was questioning the duration of exclusive breastfeeding, when no other liquids or foods are introduced.

Also on the panel is Guardian journalist, Zoe Williams, who also has a book to sell on her take on childcare. Personally, I have always liked Zoe's writing in The Guardian and I note she always prefaces her pieces relating to breastfeeding with comments like: "So before I start, can I just reiterate how good it is for baby; and I think I've mentioned already a million times, it's an incredibly beautiful thing, when it works."

But I do wonder about Zoe's understanding of how science works when I read her criticism that in research on health outcomes: "these haven't been adjusted for social class and environment. It boils down to: 'Middle-class babies do better; middle-class babies tend to be breastfed.'"

Now, I'm not a scientist, political or medical, but I've read plenty of research papers and know that adjusting for confounding variables is one of the most basic aspects of research. It's not always easy to do, but the class factor is not something that slipped the minds of scientists in analysing their data. I don't see them reading Zoe Williams and rushing back to their ivory towers, hitting their foreheads and exclaiming, 'How could we have been so stupid!'

I haven't read Joan Wolf's book yet, so I'm not going to critique the argument she has with 'breastfeeding experts' at this stage.

There are two points that I would like to make, however.

Firstly, 'breastfeeding experts', sometimes labelled more emotionally as the 'breastfeeding mafia' and worse, are often really objective 'health experts' basing their comments on evidence. And the evidence is that babies who are not breastfed, as a population, have poorer health outcomes in the short and longer term than babies who are breastfed. It is an uncomfortable fact when in the UK a quarter of babies receive no breastmilk at all, but fact it is.

Saying so does not make someone anti-baby milk. Baby Milk Action is sometimes attacked as anti-baby milk, even though our work is, as our slogan says, about 'Protecting breastfeeding - Protecting babies fed on formula'.

I have been working with experts in a range of disciplines (pharmacy, midwifery, paedology etc) over the past 18 months to produce a DVD called Infant Formula Explained. Yes, you've got me - we too have something to sell, well license for use in health facilities. The DVD has been produced by the Baby Feeding Law Group (BFLG), which consists of 23 health professional, mother support and consumer protection organisations, and Mark-it Television. This is my quote from our DVD press release - Mike Brady, who appears in the film speaking about the BFLG monitoring project which examines company marketing materials, said:

"The media and people with books to sell sometimes like to sensationalise health advocates as breastfeeding zealots, but the fact is we want the best for babies. In the UK nearly a quarter of babies are never breastfed and many mothers who start breastfeeding will use formula at some point. We believe they all have a right to accurate information. As the BFLG monitoring projects shows, company information for both health workers and parents and carers is designed to push the brand and so the Baby Feeding Law Group decided to produce an independent, objective film."

After trying to persuade others to produce such a film, we took it on as the BFLG because of the lack of objective information for mothers and carers who use formula. All baby food companies claim that their particular brand is better than their competitors, leaving people confused.

I asked the Advertising Standards Authority to investigate the claims of one company that its formula, the most expensive on the market, is the 'best'. The ASA ruled two years ago, after a long investigation, that the company could not substantiate its claim.

Paying more for expensive brands does not give a health benefit, it provides the company's marketing department with more money for television advertisements, free cuddly toy gifts, jollies for health workers and whizzy websites (examples here).

However, price can be used as a basis for choosing formula, in terms of not wasting your money: all formula on the market has, by law, to contain what is know to be necessary and beneficial to health. Optional ingredients are allowed, but the reason they are not on the required list of ingredients is exactly because there is no proven benefit from them. If there was a benefit, we would be campaigning for the ingredients to be a legal requirement so that inferior formula is not on the market. All the same, companies base their multi-million pound marketing campaigns on them. In the Infant Formula Explained films, the health experts dig into the research to give health workers the information and confidence they need to answer questions from parents and carers about formula and these optional ingredients.

It also includes films for use with parents showing how to mix up formula in line with World Health Organisation and Department of Health guidance.

You see, what we and our partners in the BFLG want is the best for babies.

Which brings me to my second point: this constant fuelling of the so-called 'breastfeeding versus bottle feeding debate' may help to sell books and bring traffic to websites, but it is unhelpful for mothers and babies. For many mothers in the UK, it is pitching them against themselves.

According to the Infant Feeding Survey from the Office of National Statistics, only 63% of mothers who started breastfeeding were still breastfeeding at 6 weeks and only a third were still breastfeeding at 6 months (pg. 35). Many mothers in the UK both breastfeed and use formula.

Another statistic tells us that 90% of mothers who stopped breastfeeding by 6 weeks would have preferred to breastfeed for longer. Of those who stopped by 6 months, 40% wanted to breastfeed for longer.

We can decide how we want to respond to these figures - and the feelings of distress that may lie behind the statement that mothers wanted to breastfeed for longer.

The response of the formula companies and people who try to negate the evidence regarding infant feeding and health outcomes is to suggest it doesn't matter, formula is almost as good as breastfeeding - or maybe even better if you take the formula companies' claims about benefits to eyesight, brain development and building the immune system at face value. The more 'breast not really best' headlines they can generate, the better they seem to think it is.

Alternatively, we can acknowledge that there are differences in health outcomes. We can use the fact that the National Health Service spends millions of pounds every year treating some of the extra illness amongst formula fed babies (according to NICE, the National Institute of Clinical Excellence) to make the case for better support for mothers.

I think we should be shocked that 90% of mothers who stopped breastfeeding at 6 weeks wanted to breastfeed for longer and be calling for better support. We should also be shocked that formula companies target mothers so aggressively in breach of international marketing standards, profiteer by playing on mothers fears over which is the 'best' formula and market unnecessary, expensive, heavily-advertised products. Aside from exceptional cases of medical need, the only formula that a baby needs when not breastfed is whey-based formula used from birth. Follow-on milks and growing up milks are unnecessary products - any extra nutrients a baby requires can be supplied by solid foods introduced alongside breastfeeding or the whey-based first milk.

So-called 'hungry baby' and 'good-night' milks do not have any evidence to support the claims they are more satisfying - and as you have to clean a baby's teeth after feeding with 'good-night' milk because of the risk of tooth decay from its sugar content (check the instructions), it is counterproductive even if it did do what it says on the tin.

We should also be concerned that some of the unnecessary illness comes from formula not being reconstituted properly.

I would like to ask everybody to write to the Secretary of State for Health, Andrew Lansley, complaining that the Department of Health is planning to scrap its Infant Feeding Coordinator posts and its support for National Breastfeeding Awareness Week. These were manifestations of government commitment to the Global Strategy for Infant and Young Child Feeding and the Innocenti Declaration. It seems that commitment is being forgotten under the cuts agenda. This is one of the worst examples of short-term penny pinching that will lead to medium and long-term costs to the health service and growth in health inequalities.

The Department of Health was not only promoting and supporting breastfeeding, it was working to help mothers who bottle feed. The Infant Feeding Coordinators have just updated the guide to bottle feeding that we used the basis for the guidance in the Infant Formula Explained DVD (alongside that from the World Health Organisation). The DVD is in line with the new guide and is also appropriate for use in UNICEF Baby Friendly accredited facilities.

No doubt we will have a spate of 'breast not best' headlines in response to Joan Wolf's book launch and these will echo around the world, undermining breastfeeding cultures in other countries.

What we really need are headlines saying, 'Department of Health plans to abandon mothers and babies'. Those might help reverse the decision to scrap efforts to improve breastfeeding rates and reduce unnecessary illness amongst formula-fed babies.

That would benefit ALL mothers and babies.

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.