DECEMBER 1984 / JANUARY 1985 - VOLUME 5. NO 12 / VOLUME 6, NO. 1
Babies At Risk
Companies Still Violate Infant Formula Code
On January 25, 1984, bowing to the pressure of a seven year boycott, Nestle agreed to comply with the WHO/UNICEF Code of Marketing of Breastmilk Substitutes. The agreement, signed with representatives of the International Nestle Boycott Committee, marked a historic victory for infant health advocates. The WHO/ UNICEF code was adopted in 1981 amid growing international outrage over reports of death and disease from the use of powdered infant formula. UNICEF estimates that code compliance and increased breastfeeding could save a million lives per year. The boycott has been terminated but sponsors are continuing their monitoring efforts to assure that Nestle - which controls 50% of the market - lives up to its commitment.
Attention has now shifted to the more than twenty other companies -Bristol Myers, Abbott/Ross, and American Home Products among them - in the breastmilk substitute business. In a fourteen-country survey of marketing practices during 1984 , the International Baby Food Action Network (IBFAN) found over 400 violations of the WHO code. Nestle appears to have improved its conduct, though a number of violations persist. Other firms, however, continue to ignore the code, aggressively promoting their formulas with prohibited giveaways to medical personnel and inaccurate and misleading advertising.
The following sampling is excerpted from the IBFAN study, "Breaking the Rules in 1984." Further information is available from IBFAN at 310 E. 38th St-Suite 301, Minneapolis, MN 55409.
Major Provisions of the WHO/UNICEF Code
Limited free supplies.
Large quantities of milk should not be routinely donated to hospitals. Supplies should only be given for infants who have to be fed on breastmilk substitutes, and then should be provided for the term of need;
No free samples; no free gifts
Free samples or gifts should not be given to parents;
Information about infant feeding should be clear and consistent and include the hazards of bottlefeeding. It should not be promotional and should not idealize bottlefeeding;
No consumer advertising
There should be no direct promotion or advertising of infant feeding products or utensils to the public;
No promotion in hospitals
Health care facilities should not be used as a promotional channel for these products;
No gifts to doctors
There should be no personal gifts to health workers, and gifts of professional utility may not advertise products;
Labels should be nonpromotional and include clear warnings about the hazards of bottlefeeding.
Abbott/Ross Laboratories: Giving More to Sell More
Abbott/Ross is the newcomer in the Dominican Republican market, and it is promoting aggressively to make up for lost time. For example, at the Centro de Pediatria y Especialidades, a clinic in Santo Domingo, Abbott donates 120 ready-to-feed bottles of Similac every week. The donated milk is fed to all of the 50-70 babies born monthly.
At Centro Medcio Oriental Abbott donates nearly 200 bottles of Similac every month. All infants born here are bottlefed from birth on Similac, and samples are given to mothers upon discharge.
Abbott donates excessive quantities of infant formula to hospitals not only in the Dominican Republic, but also in Hong Kong, Malaysia, the Philippines, and Taiwan. As a doctor from the Dominican Republic said, "I guess their policy is to give in order to sell." In the Dominican Republic, Hong Kong, the Philippines, and Taiwan, Abbott advertises infant milks with text and pictures that idealize bottlefeeding.
One Abbott book, distributed in Taiwan, advertises Similac PM 60/40 as "Humanized Infant Food."
American Home Products/Wyeth
In March, 1984 Wyeth began for the first time to provide large quantities of free infant formula to Peruvian hospitals, just two months after Nestle agreed to stop this practice. AHP is attempting to capture a public hospital market that has been Nestle's for years, by taking advantage of Nestle's promise to abide by the WHO Code.
Similar sample and supply violations of the Code were found with great regularity in virtually every surveyed country in which AHP/Wyeth markets its infant formula.
Wyeth's book for mothers in Taiwan and Hong Kong features a full-page picture of a pretty, white mother bottlefeeding a fat baby. The book includes photos of Wyeth S-26 and Promil formula packages as well as a two page advertisement for Promil.
Bristol-Myers: It's on the House
Enfamil is the "house formula" at Metropolitan Hospital in the Philippines. Hospital policy prescribes bottlefeeding with Enfamil because Mead Johnson has donated all of the nursery's equipment and cribs. The company gave P$8,000 for the purchase of 43 staff uniforms. Bristol Myers keeps the hospital stocked with a continuous supply of Enfamil. Here, breastfeeding is practically non-existent and bottlefeeding is routine.
Bristol-Myers advertised Emphatic in the Malaysian Star newspaper. The ad "announced " Enflac's new label, supposedly "in compliance with the WHO Code ...", while the ad itself violated the Code. In a July meeting, Bristol Myers pledged that this was a one-time exception to the company's policy against mass media promotion of infant milks.
In the Dominican Republic, Mexico, Peru, the Philippines, Taiwan, and other Bristol-Myers markets, the company's literature for mothers violates the Code. For example, in Mexico a booklet distributed to new mothers at a Yucatan hospital advertises Enflac, recommends a late reunion of mother and baby, and discourages breastfeeding in several other ways.
Cooperative Condens Fabrick (CCF)
The CCF book given to mothers in Malaysia includes two pages on breastfeeding and twice as many on bottlefeeding. The book has a hazy, gloomy, drawing of a mother breastfeeding and a colorful cheery photo of a mother bottlefeeding. The book includes photos of a Dutch Baby full cream powder package conspicuously located on the back page. This may confuse mothers, and may lead to the dangerous practice of feeding infants non-modified full cream milk powder.
The International Code applies to infant feeding utensils as well as foods, yet companies like Curity ignore that fact and continue to violate the Code. A two page ad in Kena Practica magazine promotes the company's bottles and plastic nipples. The ad pictures a mother bottlefeeding and says, "the best for your baby."
Evenflo advertises its bottles and nipples in Activia magazine, sold in Mexico City. The ad shows a baby feeding from an Evenflo bottle. In Pardres e Hijos magazine, also in Mexico, Evenfol advertises sterilized bags for use in feeding bottles, The ad states "don't wash the bottles anymore ... the new way of feeding your baby... Evenflo takes care of your baby's health."
Gerber gives free samples of juice and cereal, and pamphlets to mothers of newborns in at least seven different hospitals and clinics in Yucatan, Mexico. This promotional practice encourages the disruption of breastfeeding and the premature introduction of complementary foods.
Gerber also advertises its weaning foods in Activia magazine. The ad gives no recommended safe age for first use of the products, yet claims "we know the importance ... of a new life."
Gujarat Cooperative: No Substitute for Mother's Milk
A poster advertising Amulspray hangs in the reception room of a hospital in India. The poster pictures a happy baby and claims "Amulspray - An Excellent Substitute for Mother's Milk."
Glaxo posters picturing babies and advertising infant milks hang in Ganatras Maternity and Gynecological Hospital in Bombay, India. The posters read "Glaxo The Glow of Health," "Ostermilk - The Trusted Milk Food," "Ostermilk--Next to Mother's Milk." These posters violate the International Code and the Indian Code.
Lijempf/Holland Milk Products
This company named its infant milk "Bebleac Humanized No. 1," and claims the milk composition "approaches very closely to that of mother's milk." The label fails to warn against the hazards of inappropriate use of breastmilk substitutes, and does not state the superiority of breastfeeding. The label also lacks pictorial preparation instructions. Written instructions are incomplete. For example, they do not say to sterilize feeding utensils.
Milupa: Sugar Tea for Babies
Milupa Camomile Tea, sold in Malaysia, is promoted for "babies from the first day of life... to help to have a peaceful, undisturbed sleep." The tea consists of more than 94% sugar. Use of this product will interfere with breastfeeding, may harm a baby's soft teeth, and increase the potential for early passivity and obesity, The tea's sedative effect may also conceal other ills. The label includes no warning of the dangerous effect this product may have on infant health.
Milupa recommends its mixed fruit cereal starting at 3-4 months, far too early. The label pictures a baby, which also encourages the premature use of the product. The label does not include pictorial preparation instructions, fails to state the hazards of inappropriate use of the product and the benefits of breastfeeding, and does not list the necessary storage conditions.
Nestle: Better, But Not a Clean Bill of Health
Sustained non-boycott pressure is still needed to bring full adherence. Among the examples of continued Nestle' violations of the International Code: A Nestle' representative donates 16 cans of Lactogen to the Galang Medical Center, the Philippines, which delivers 50-60 infants each month. The representative also gives free samples to pediatricians, and then copies the record book of patients' prescribed milk and the name of the attending physician.
A physician at the Far Eastern Memorial Hospital in Taiwan complains that that his infant got diarrhea after being fed on Lactogen, and the local Nestle' representative at once gives the doctor free cereal products "to remedy his loss."
A Nestle' book for health workers in India asks on the cover "Are you keeping pace with the latest international pediatric thinking on infant feeding?" and shows an open tin of "no-brand" milk powder. This implies that artificial infant feeding is medically superior to breastfeeding. The book does not state the benefits of breastfeeding nor the health hazards of bottlefeeding, and lacks other important information required by the Code.
These three instances are representative of continuing areas of Nestle' noncompliance: samples/supplies, gifts to health professionals, and literature for mothers and health workers.
Nestle has also increased its promotion of weaning foods. In India, a glass bowl is given free with the purchase of Cerelac infant cereal. The package label fails to warn against the health hazards of inappropriate use.
In Malaysia, Nestum Baby Cereals are advertised on TV, and with posters and "wave tags" in retail shops, and a free cup is given with each purchase.
Nestle' advertises Cerelac on TV in Mexico City. The ad pictures a family - baby included - and the announcer says that Cerlac is good for the whole family, Similar promotion of Cerlac and Nestum runs in other Nestle' markets throughout the world.
In April 1984, the British Advertising Standards Authority ruled that all water given to babies should first be boiled. Volic claims its Natural Mineral Water, sold in Malaysia, can be used straight from the bottle for baby feeding, without boiling. The label claims "it's already widely used in French hospitals and maternity units." This product is dangerous and only adds to the problems of costly artificial feeding practices.
Overall, IBFAN monitors uncovered over 400 violations of the Code during their research in 14 countries. The largest companies, Abbott/ Ross, American Home Products, Bristol Myers, Cooperative Condens Fabrick and Nestle' committed 75% if these. The companies most often violated the samples and supplies provisions of the Code (159 times); labelling violations were second (103 times). Literature for mothers was frequently found in violation of the Code (36 times). Monitors also reported an increase in the aggressive promotion of weaning foods.