Albion Monitor /News

Nestle, Others Break Baby Milk Agreement

by Dipankar De Sarkar

Code passed in 1981 to prevent inappropriate advertising and promotion
(IPS) LONDON -- Fifteen years after its adoption, the World Health Organization's code for marketing breastmilk substitutes is being openly violated by leading baby milk manufacturers, according to new research.

The code was adopted by the World Health Assembly in 1981 to ensure safe and adequate infant nutrition by protecting and promoting breast feeding.

It aims to ensure that mothers are protected from "inappropriate promotional activities" of manufacturers and distributors of baby milk. It also aims to ensure that women's decisions about how to feed their infants are informed by the knowledge that breast feeding is the healthiest way.

Gifts given to poorly trained health workers, who violate WHO code by distributing samples to mothers
The new research, conducted in four countries by the London-based Interagency Group on Breastfeeding Monitoring (IGBM) and published yesterday, shows that the marketing practices of infant formula manufacturers and distributors are in breach of the WHO code.

"The research proves that many companies are taking actions which violate the code, and in a systematic rather than one-time manner," said the IGBM, a coalition of churches, academic institutions, health experts and leading agencies including the British chapter of the United Nations Children's Fund and the aid group Save the Children.

"Companies serious about their responsibility to child and maternal health must take steps now to ensure that these violations become a thing of the past. Lives are at stake," it added.

The IGBM's study, which was immediately rejected by baby milk manufacturers, said there is evidence of violations in all the four countries studied -- Bangladesh, Poland, South Africa and Thailand.

In what is believed to be the first major community-based study of the code's violations, researchers in each of the four countries interviewed 800 pregnant women and mothers of infants under six months of age and 120 health workers in 40 health facilities.

Women in all four countries were found to have received company-sponsored information which promoted artificial feeding without noting that breast-feeding is the best form of infant nutrition.

The most violations occurred in Poland, where over one-third of mothers (36 percent) received such information. In South Africa, 28 percent of mothers had received such information.

In addition, health workers in all four countries received information which violated the code. Over half the health facilities in Poland were given such information.

Other code violations included the distribution of free samples among women and health workers by companies; unrequested visits from company personnel to give production information to mothers; incentives to health workers to promote products; and product promotion through retailers and the media.

Women in all four countries had received free samples of products, most of them from within the health care system. This ranged from 0.3 percent of mothers in Bangladesh to 26 percent in Thailand.

Health workers also reported having received free samples but said they were for professional research evaluation, which is permitted by the WHO code. Such cases were found in 50 percent of health facilities in Thailand, 21 percent in Poland and 20 percent in South Africa.

The study, titled "Cracking the Code," named five companies as having breached the code: Gerber, Mead Johnson, Nestle, Nutricia and Wyeth.

It said that in all four countries, health workers were also found to violate the code by accepting gifts from companies and passing on samples to individual women. But it added the health care system in all four countries lacks basic supplies and is staffed by poorly paid workers with varying levels of training.

"This under-resourcing must be a factor in how these violations are considered. For example, the scarcity of information materials on infant feeding may mean that any information will be readily accepted, whether or not it contravenes the code."

Industry association calls report biased
In an immediate rejoinder, the Paris-based International Association of Infant Food Manufacturers (IFM) described the study as "biased in design and execution."

IFM Secretary General Andre Bronner said the IFM supports the WHO code, which recognizes a legitimate role for infant formula when mothers cannot breast feed for any reason.

"The WHO Director-General has called for cooperation of all parties to work together to improve infant nutrition, so IFM is deeply disappointed by the IGBM approach," Bronner said.

The IGBM research was supported by the Bishop of Coventry, former chair of the Church of England's International and Development Affairs Committee.

The support was significant because IGBM was only formed after the Church of England Synod decided in 1994 to suspend its support for a boycott of Nestle in order to examine the evidence of code violations.

"The Church of England wanted to see further independent research into the worldwide marketing of breast milk substitutes," the Bishop of Coventry said.

"Previously I felt that we had to say 'the jury is still out' on this subject. But this report provides compelling evidence from countries around the world that the international code is still being violated."

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Albion Monitor January 23, 1997 (

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