action to stop these violations of the International
Code of Marketing of Breast-milk Substitutes.
The people responsible have names and addresses - call on them to
market their products ethically.
The tables below give
details of some recent violations. The date when the violation
was last reported to Baby Milk Action or confirmed to be current
is given. The violation reference is for Baby Milk Action's records.
Please quote it if forwarding correspondence to us, if possible.
company responses received so far
exposed for violating Vietnams regulations
by Save the Children
(SCF - UK) and the Ministry of Health in Vietnam documents widespread
violations of the governments measures implementing the International
Code and Resolutions.
Monitoring took place over 7 days between 19 and 27th June 2001
in Hanoi, but release of the results was delayed while companies
were invited to respond to the findings.
Vietnam has a tradition
of breastfeeding but SCF notes:
social and economic changes are impacting on the choices women
make about how they feed their children. South-east Asia is
also a growing market for multi-national companies and the
numbers of companies marketing breastmilk substitutes in Vietnam
has increased rapidly over recent years.
Baby Milk Action
noted that in its third-quarter statement commenting on increased
profits (20th October 2000) Nestlé, the global market
leader, stated: "Milks and nutrition saw good progress,
mainly as a result of infant nutrition sales in Asia and of
the powdered milk business." Between 1996 and 2000
global sales of baby food increased by 13.6% by volume, with
the Asia-Pacific region growing faster than any other region
(ref: Euromonitor 2001 - see Press Release "African
and Asian campaigners urge support for Nescafé boycott
as Nestlé announces increased baby milk sales"
24th October 2000).
The Vietnamese government
first moved to regulate the marketing of breastmilk substitutes
with a Prime Ministerial decision in 1994. This was strengthened
by a Decree in December 2000. According to the SCF/MoH report,
of the 30 brands of breastmilk substitute reviewed, not one
fully complied with the labelling requirements set out in the
legislation. The labels on feeding bottles were also assessed
and only 1 out of 13 brands was found to meet the legal requirements.
5 companies in a popular newspaper were found to violate the
legislation which requires a statement at the beginning of adverts
for follow-on milks confirming that breastmilk is the best food
for infants (Article 5.1
of the Code bans advertisements for all breastmilk substitutes,
the Decree presently only bans advertisements for infant formula).
In Vietnam violations include:
promotional literature, which is not scientific
and factual, and contains company and brand names given
to hospital staff. Abbott Gain and Nestlé Baby
World and infant feeding leaflets.
A range of violations
were found in health facilities, indicating that companies are
continuing to contact hospital staff and providing them with
Failure to abide
by these measures endangers infant health. For example, one
mother is quoted in the report: the instructions are
not in Vietnamese so I guess how to make up the formula.
the governments regulations included: Abbott, Dumex, Australia
Milk, France Bebe Nutrition, Friesland, Heinz (Camera feeding
bottles), Mead Johnson, Meiji, Nestlé, Nuk and Snow.
SCF notes that four companies responded to the report and agreed
to change their labels, although they disputed other violations.
Nestlé, which claims it invites reports of violations:
Disputed the authority of Save the Children to undertake
the assessment of companies marketing practices.
and Snow Brand campaigned against the Vietnamese legislation
last year. In particular they objected to the requirement to
show cups rather than bottles for using formula. Numerous studies
have shown that cups can be a safer feeding option, especially
when sanitation and water are a problem. The companies falsely
claimed that no other countries require cups rather than bottles
of support to the Vietnamese Ministry of Health. Please address:
The Minister of Health, Vietnam, via Baby Milk Action, 23 St.
Andrews Street, Cambridge, CB2 3AX. Fax: 01223 464417 (in
the UK) +55 1223 464417 (outside UK). Or email to email@example.com.
We will arrange
presentation of the letters at an appropriate time in the near
I wish to inform
you of my support for your implementation of the International
Code of Marketing of Breastmilk Substitutes and subsequent,
relevant Resolutions of the World Health Assembly. I am
aware that baby food and bottle and teat companies have
been violating the government Decision of 1994 and Decree
of 2000 (Decree 74/2000/ND-CP). I encourage you to continue
monitoring company practices and to take appropriate action
to call these companies to account.
I am also concerned
that companies have attempted to undermine the Decree,
by, for example, opposing the requirement to show feeding
with a cup rather than a bottle on the labels of breastmilk
substitutes. Other countries, such as Tanzania and Malawi
require cups to be shown for good health reasons. I urge
you to continue to put infant health first.
war using new improved formulas threatens breastfeeding
Breastmilk is a complex,
living substance and its constituents are still being discovered.
Inert artificial milks cannot replicate the anti-infective factors
in breastmilk. However, efforts are made to synthesize and add
to formula other substances found in breastmilk. Often, the
formula is then promoted as closer to breastmilk,
even if there is little evidence that the substances will act
in the same way and give the same benefits as in breastmilk.
On 10th January 2002,
Martek Biosciences Corporation announced that two of its products
would be used in an Abbott formula. Docosahexaenoic acid (DHA)
and arachidonic acid (ARA) are found in breastmilk and are claimed
to benefit neural development. In a press release that did not
acknowledge that breastmilk remains superior to formulas containing
these products, the CEO of Martek, Henry Linsert, Jr., claimed:
American babies won a big one today. The source
of the acids is not revealed, though it is known that Martek
has previously sourced long-chain fatty acids from tuna fish
eye sockets and genetically modified mould.
Within two hours
of the Martek press release, Mead Johnson struck back, issuing
a press release claiming that a new Enfamil product was the
first and only infant formula to contain additional nutrients
important to babies mental and visual development,
referring to the same DHA and ARA fatty acids. Mead Johsons
strategy worked, and it was named alongside Abbott in a subsequent
report from Reuters.
According to Martek,
fatty-acid fortified formulas have been shown to improve the
mental and visual development of formula fed babies. This suggests
that babies fed on formula to date have had their mental and
visual development compromised because of the shortcomings of
the products. Whether that is appreciated by mothers reading
the Breast is Best message on labels is open to
question. As Mead Johnson acknowledges in its press release:
Experts agree that breast milk is the gold standard.
Hence, even the new-improved formulas fall short
and the development of infants fed on them is not optimal. This
fact is likely to be lost in the hype which is about to surround
the new formulas as Abbott, Mead Johnson and the rest of the
industry embark on a new marketing war.
Whether the claims
made by manufacturers can be believed is also open to question.
A systematic review of available research on Longchain Polyunsatuarated
Fatty Acid (LCPUFA) supplementation was made by the Cochrane
Library (review dated 15th June 2001). This concluded:
there is little evidence from randomised trials of LCPUFA
supplementation to support the hypothesis that LCPUFA supplementation
confers a benefit for visual or general development of term
infants. Minor effects on VEP [Visual Evoked Potentials -
measuring visual development] acuity have been suggested but
appear unlikely when all studies are reviewed. A beneficial
effect on information processing is possible but larger studies
over longer periods are required to conclude that LCPUFA supplementation
provides a benefit when compared with standard formula. Data
from randomised trials do not suggest that LCPUFA supplements
influence the growth of term infants.
to the men ultimately responsible for the way these products are
Miles D. White,
CEO, Abbott Laboratories, 100 Abbott Park Road, Abbott Park, Illinois
60064-3500, USA. Fax:1 847 938 6277
R Dolan, CEO, Mead Johnson, Bristol-Myers Squibb Company,
345 Park Avenue New York, NY 10154, USA. Fax: +1 212 546 4020.
is understood to be marketing or preparing to market
infant formula containing Docosahexaenoic Acid (DHA)
and Arachidonic Acid (ARA). According to a press release
referring to your product, these long-chain fatty acids
improve the mental and visual development of formula
I would be grateful if you could respond to the following
have suggested no benefit is conferred by supplementation
with Longchain Fatty Acids, but your information disregards
such findings. Do you have any scientific grounds for
ignoring studies that do not support your marketing
2. Do you
accept that infants fed on previous versions of your
products not containing DHA and ARA have had their mental
and visual development compromised?
babies have been benefiting from DHA and ARA throughout
history. Do you feel that the warnings on your product
labels sufficiently informed mothers of this fact?
is the gold standard and contains factors as yet undiscovered
which make it the optimal way to feed an infant. Will
you ensure that your product labels and information
materials, including those for the new formulas, acknowledge
this fact and do nothing to idealise the formulas?
can be a Code Monitor.