Baby Milk Action Update 20, Feb/March 97

Issue number 20, February/March 1997

The news items which appear on this page are abridged versions of stories which appear in full in the printed version of Update, which is available to members of Baby Milk Action. Membership costs just £18 waged, £7 unwaged, £25 family, £50 organisations - for members outside the UK there is an extra postage charge. You can join on-line in the Virtual Shop.

India - special report

Boycott news issue 20

The healthy distance

For too long the marketing strategies of the baby food industry have put profits before health leaving others to count the cost.

As Governments are urged to liberalise trade rules and to encourage private investment under international agreements and through pressure from Structural Adjustment Programmes, truly independent monitoring of marketing practices, not funded by industry with a vested interest, becomes even more essential. It should form part of all international and national frameworks.

Aware of the power of such monitoring, companies argue for 'collaboration.' Yet companies already have a responsibility to monitor their own practices thoroughly. They should also accept and act on the findings of independent agencies which maintain a healthy distance.

Baby Milk Action, and our IBFAN partners, have been monitoring and reporting to governments and companies since before 1980. We have also been working for the implementation and strengthening of policies which protect consumers and practices such as breastfeeding - with UN committees, the European Union, and nationally. Our education programmes, grass roots support and company campaigns (such as the 17-country boycott of Nestle) are other important tools which raise public awareness and give people a voice. The world in which we live must give citizens - including the world's poorest citizens - an equal hearing to that of business.

Scale of malpractice revealed by new research findings

A new report, commissioned by the Interagency Group on Breastfeeding Monitoring (IGBM), reveals the massive scale of company violations of the International Code of Marketing of Breast-milk Substitutes.

27 academic institutions, churches and non-profit organisations formed IGBM to see for themselves whether the baby food industryÍs claims of ethical behaviour were true.

The International Baby Food Action Network (IBFAN), to which Baby Milk Action belongs, has been reporting violations of the Code since it was adopted by the World Health Assembly in1981. The Church of England Synod joined the Nestle boycott in 1991 as the result of our findings. In 1994 Nestle conducted a much criticised PR exercise which led to the Synod suspending its support for the boycott whilst it sought further evidence. This resulted in the formation of IGBM. The research was conducted independently of IBFAN and the industry. However, both IBFAN and the International Association of Infant Food Manufacturers (IFM) were invited to comment on the research protocol in June 1996. Monitoring started in August 1996.

IGBM commissioned research in four countries: Bangladesh (Dhaka), Poland (Warsaw), South Africa (Durban) and Thailand (Bangkok). These countries were selected because of the contrasts they offer in geography, economics and level of Code implementation. In addition, the national authorities of each country gave their agreement for the research and IGBM member organisation field staff were available to support the activity. The research was published on 8th January 1997 in a report entitled Cracking the Code available from UNICEF, Unit 1, Rignals Lane, Chelmsford, Essex, CM2 8TU, UK. Tel: (01245) 476315. Price £6.50

"The research proves that many companies are taking action which violates the Code, and in a systematic rather than one-off manner."

Companies were found to be promoting artificial infant feeding in breach of the marketing code. The main companies at fault were Nestle, Gerber, Nutricia and Wyeth. The scale of the violations is shocking:

According to the report "...a strong correlation was found in all four countries between the proportion of mothers who received negative information associated with a company name and the proportion who bottle fed their infants."

Before even seeing a copy of IGBM's report, the International Association of Infant Food Manufacturers issued a press release headed, "Baby Milk Code Monitoring Report Rejected as Biased" alleging that, "IFM was not made aware of the project until the protocol was completed and monitoring had begun." IGBM responded by releasing the letter sent to IFM asking for its comments on the research. IFM responded to the invitation over a month before monitoring began.

"It is both unfortunate and ill-advised that the [IFM] saw fit to ignore the findings, and to reject the report... It is also noteworthy that the findings of IBFAN, in its regular monitoring activities, are clearly vindicated by this report.... [UNICEF] proposes that IBFAN be given renewed encouragement to continue monitoring compliance with the International Code. UNICEF views this as an issue of great consequence... It speaks, quite simply, to child survival and development."

Many organisations which have accepted sponsorship from companies cited in the report are questioning whether it is appropriate to do so.

Nutricia conceals salmonella risks

Recent salmonella infection of babies in the UK and France raises important questions about the quality of baby milks and the adequacy of surveillance throughout Europe and worldwide. Baby Milk Action calls for the withdrawal of all Milupa products manufactured in France, for much more explicit warnings on labels and for a halt to the promotion of these products.

On Friday 24 January Dutch baby food company Nutricia's German subsidiary, Milupa, was asked by the UK Department of Health to withdraw its infant formula Milumil from sale following evidence from the Public Health Laboratory Service (PHLS) that a number of Milupa-fed infants had been infected with a rare strain of salmonella called salmonella anatum.

Two more cases of salmonella anatum infection in Milupa fed babies were confirmed in France. Microbiological tests proved that the salmonella had the same genetic profile as the one in the UK and must have came from the same primary material. The French authorities ordered the withdrawal of Lemiel 2 on 8 Feb. Milupa's factory in Colmar, France was closed for one week for disinfection but the source of infection was not found.

Throughout this time Milupa and Nutricia have issued contradictory and misleading statements. Claiming to put infant health before profit, they accepted the evidence when talking to the Department of Health. However, to the press and to us they said the problem was unique to the UK, that the link was not really proven and that the British authorities had "reacted over zealously." Mr Klaas de Jonge, Director of Nutricia denied that there could be a problem with the factory or that other products could be affected. He suggested that because from January 1997 the company would no longer use milk bought in from French and Dutch farms, the problem was now contained.

French authorities and the European Commission admit that the same source material used for the French and UK milks is also in babymilks on sale in Belgium, Italy and Holland. It is also in the follow-on milk Forward still on sale in the UK. All have expiry dates of 1998. Until the source of contamination is identified and until Nutricia gives a full account of all its export markets, all Milupa products made in France must be suspect.

Milupa has relaunched Milumil now that the Irish factory is operational. Baby Milk Action is still concerned that milk from the French factory is still in sale across Europe and around the world. The milks withdrawn from the UK and France had an expiry date in 1998. Please inform us if French-made Milupa products are on sale in your region, especially Eastern Europe, Latin America and the Middle East. After the Chernobyl disaster contaminated milk from Europe found its way all over the world.

The International Code of Marketing of Breast-milk Substitutes states that "Information provided by manufacturers and distributors to health professional regarding products within the sope of this Code should be restricted to scientific and factual matters....Such materials should not use any pictures or text which may idealize the use of breast-milk substitutes." The UK law says "an advertisement for an infant formula shall contain only information of a scientific and factual nature."

picture: Milupa's "scientific and factual" information for UK health workers, Health Visitor, November 1996.

PHLS stays in the public sector

The centralised surveillance of the UK Public Health Laboratory Service (PHLS) is unique in Europe, and in a recent Government review (costing £4.8 m) it was accepted that the PHLS should remain in the public sector, rather than be privatised and fragmented. Sir Leslie Turnberg, Chairman of PHLS, commented:

Breastfeeding is a human rights issue

The World Alliance for Breastfeeding Action (WABA) Global Forum was held in Bangkok from 2 to 6 December 1996. Anwar Fazal, WABA chairperson, from Malaysia said, "The single most important issue at this Forum has been the human rights dimension of the breastfeeding issue." WABA add, "This shall in no way be understood or perceived as the mother having a duty to breastfeed since it is the circumstances which lead to the choice not to breastfeed that must be altered."

The Forum decided that the theme for World Breastfeeding Week (1st-7th August) will be "Breastfeeding: Nature's Way!" The week will focus on the ecological aspect of breastfeeding.

Baby foods flood into Pakistan

As Indian tough baby food marketing law takes effect companies are putting increased effort into developing the market in neighbouring Pakistan. Pakistan's draft marketing law has been pending with the Ministry of Health since 1992, and was only recently presented to the Cabinet prior to introducing it to Parliament.

According to a report in the newsletter of the Network of Association for Rational Use of Medication in Pakistan, the cost of Pakistan's imports of milk powder and baby food doubled during the first 10 months of the 1995-96 financial year compared with the previous year. Pakistan imported 9,550 tonnes of baby foods at a cost of US$43.5 million between July '95 and April '96. The upsurge coincides with new aggressive marketing tactics from Nestl?, including the donation of free samples to hospitals, direct advertising and sponsorship of a TV talk show about baby care, says the report.

Over 8,000 Baby Friendly Hospitals

In 1991 UNICEF launched the Baby Friendly Hospital Initiative to encourage hospitals to better care for breastfeeding mothers. The number of Baby Friendly Hospitals around the world reached 8,394 in January 1997. The United States and Spain entered the Baby Friendly fold with one hospital each. In Europe the latest figure is 202 Baby Friendly hospitals, 105 of these being in Central and Eastern Europe. Turkey leads the way with 56.

In Armenia the programme is described by UNICEF as being strong despite little financial support. One hospital reported a 50% reduction in the need for antibiotics for new-borns, demonstrating how support for breastfeeding reduces sickness and saves money. Armenia has been a particular challenge as the proliferation of infant formula as emergency aid following the 1988 earthquake caused breastfeeding rates to fall. Poland has 14 Baby Friendly Hospitals. Company promotion of baby milks has been challenged as baby friendly slogan and poster competitions generate media interest. Elektrostal Hospital in the Russian Federation, starting from a breastfeeding rate of 18%, reports a three-fold increase since becoming Baby Friendly. The benefits are already evident; an 18% decrease in infant infection and a 48% decrease in infant pneumonia.

Breastfeeding data

The IBFAN International Code Documentation Centre has packaged its training materials on the WHO/UNICEF International Code as a 250 page "Code Handook". The handbook is suitable for governments, libraries, health and development associations, companies and individuals interested in protecting breastfeeding. Send a banker's cheque or international money order payable to "IBFAN" to the address which follows. The handbook is US$130 retail, US$50 for non-profit organisations, surface mail delivery. Add US$10 for airmail or US$40 for courier delivery per book. Send orders to: IBFAN/ICDC, PO Box 19, 10700 Penang, Malaysia.

WHO's Nutrition Unit recently published details of its Global Data Bank on Breastfeeding. The Data Bank pools information from surveys and studies dealing with breastfeeding prevalence and duration. The aim is to achieve worldwide coverage, using standard definitions and indicators, to enable comparisons between and within countries, to assess trends and advise and evaluate the progress of programmes. Information and data is available from: Randa Saadeh, Nutrition Unit, WHO 1211 Geneva 27, Switzerland. Fax: +4122 791 4156. E-Mail:

World Food Summit recognises breastfeeding

The Declaration and Plan of Action adopted by Governments at the World Food Summit in Rome in November 1996 includes a call for legislation and institutional structures that "Enhance the special contribution that women can make to ensuring family and child nutrition with due emphasis on the importance of breastfeeding."

Lobbying to protect mothers and infants

The UN Codex Committee on Nutrition and Foods for Special Dietary Uses met in Germany from 7th to 11th October last year. Industry makes up 45% of the committee, which had no public interest group representatives until 1991. Baby Milk Action and our partners in the International Baby Food Action Network (IBFAN) were part of an international NGO working group which presented recommendations to Codex on a draft trading standard on health claims and the composition and labelling of baby foods. Work continues to have these adopted. At the UK preparatory meeting, a Sandoz (Gerber) representative, suggested that Codex should follow the weaker European Directive rather than the World Health Organisation's International Code of Marketing of Breast-milk Substitutes.

The European Commission has produced a Green Paper on Commercial Communications in the Internal Market which could have an impact on advertising restrictions in Europe and worldwide. Baby Milk Action has submitted comments outlining its concerns as they relate to the baby milk issue. The Commission meanwhile argues that the proposed regulatory framework does not necessarily favour the advertising industry, and that provided advertising bans can be proved to be 'proportionate and in the public interest', they could even be extended. The European Parliament will vote on this in May and the Commission is inviting comments until the end of March 1997.

Send for the Green Paper from the European Commission. Tel: +322 296 0110 Fax: +322 295 7712; Contact your MEP to ask that the proposal protects consumers.

Watching the advisors

Baby Milk Action has been pressing for greater accountability from the Scientific Committee for Food (SCF) which advises the European Commission. SCF decisions have far-reaching commercial and health implications. At the September 1996 meeting it was agreed that SCF members and ad hoc experts would be required to declare their interests. However, no declarations were made at the November meeting on Genetically Modified Maize. To receive minutes of meetings contact: Dr. Naomi Rees, MAFF, Ergon House, c/o Nobel House, 17 Smith Square, London, SW1P 3JR.

An independent food safety advisor is to chair a newly-created Food Safety Council and will advise Government Ministers on matters including the safety, quality, labelling and authenticity of foods. The move has been taken as politicians admit they have lost credibility in the eyes of the general public following the handling of recent food safety problems. The advisor will not be appointed until after the General Election and it remains to be seen if the body will be truly independent of Government and industry.

Research shows no clear benefit from breastmilk fortifiers

?Human milk has been shown to confer important clinical benefits on preterm infants Ref.1. Because they have greater nutritional requirements than term babies it has become common practice to supplement their breastmilk feed with one of the many multinutrient "fortifiers" now available. In a recent study Ref. 2 (which is the largest to date in the literature) infants weighing under 1850g at birth were randomly allocated to receive Mead Johnson Enfamil fortifier in addition to human milk and pre-term infant formula (if this was used). Early growth of babies receiving fortifier, and their developmental outcome at 18-months of age, was no better than in those fed unfortified milk and the "fortified" group suffered significantly more infections and a higher incidence of necrotising enterocolitis. When sub-groups of babies who had received most human milk were studied it was found that adding "fortifier" to the milk gave a small growth advantage of 1.6 g/kg/day in the short term. The authors conclude that more research into the increasingly widespread practice of "fortification" is clearly needed.

1. Lucas A, Cole TJ. Breast milk and neonatal necrotising enterocolitis. Lancet 1990;336:1519-231.

2. Lucas A, et al. Randomized outcome trial of human milk fortification and developmental outcome in preterm infants. American Journal of Clinical Nutrition 1996;64:142-51.

Sponsorship - no thanks

Guys Hospital and Powys Health Care Trust in the UK have implemented strict policies in support of breastfeeding. Both have banned company sponsored materials including Bounty packs (commercially produced packs containing promotional material and samples which are given free to mothers on maternity wards). Free gifts to staff, company contacts with staff and the display of any materials with a company logo are also prohibited. Head of Maternity Services at Guy's Hospital, addressed the advisory committee of the UNICEF - UK Baby Friendly Hospital Initiative in October last year. She explained that the funding lost by refusing corporate sponsorship has been replaced following appeals to the trustees. A benefit of pursuing Baby Friendly at Guy's has been the improved morale of midwives which has reduced the turnover of staff.

Baby Milk Action Annual General Meeting 1997

Baby Milk Action held its AGM on 25th January at the London Voluntary Sector Resource Centre. The possibility of taking legal action against baby milk manufacturers for the sickness and death which their unethical marketing is causing was addressed by Richard Meeran, product liability lawyer from Leigh, Day and Co. A working group will examine the possibilities further.

We next discussed the need to expand membership and ensure adequate future funding. Baby Milk Action has never accepted commercial sponsorship as a matter of policy and, after some discussion, the meeting felt this policy should continue as our ability to speak the truth without fear of censure from commercial interests is a key strength of the organisation. In the feedback session the possibility of organising boycotts of companies in addition to Nestlé was discussed. It was noted, however, that the recently published research commissioned by the Interagency Group on Breastfeeding Monitoring (IGBM) and the renewed calls for effective legislation were prompted by the Nestlé Boycott, showing how focusing on one company can have an impact on the whole industry. Action will be taken to expand the Nestlé boycott in the UK and internationally and the possibility of adding other company products to an extended boycott list will be investigated. We will continue to urge health bodies and other organisations to refuse sponsorship from baby milk manufacturers or distributors.

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