The Truth About Nestle

Nestlé & Infant Formula.

Since 1977, Nestlé, the world's largest food company, has been the target of the most global, long-standing and highly publicized of all consumer boycotts. The food giant has scores of brands, but the controversy focuses on the product that launched the company right back in the 1860s: infant formula, also called breastmilk substitute, baby milk or bottle milk.

Where breast feeding is impossible or impractical – as is often the case- infant formula can be a life saver, but it also comes with certain health risks. Even in rich countries, babies fed on formula milk during the first few months are more likely to suffer certain health problems, since breastmilk provides a perfect combination of nutrients and antibodies. But in developing countries the dangers are more acute. Formula milk needs to be prepared with water and served in sterilized bottles, which can be problematic if pure water or fuel are in short supply. And if parents find themselves stuck with it but unable to afford sufficient quantities (a real possibility, because moving back to breast feeding is often impossible once formula milk has been used) they may over dilute it, mix it with unsuitable solids or substitute it for cheaper but completely unsutable alternatives, such as cows milk or tea.

These risks have been known for decades. Right back in the 1930s pioneering paediatrician Dr Cicely Williams published and spoke about the hazards of inappropriate bottle feeding. But for much of the twentieth century the formula milk manufacturers- of which Nestlé was and is the biggest- aggressively promoted their products around the world. Pictures of plump “first world” babies were used on tins and posters and free samples (sometimes given out by marketing “nurses”) were provided for hospitals and given out to new mothers, often making breastfeeding impossible and forcing mothers into months of purchasing. The result was a huge decline in the exclusive use of breastfeeding and the completely avoidable deaths of hundreds of thousands of babies each year around the world.

Things came to a head in the early 1970s, after exposés by New Internationalist magazine and War on Want. The latter's article was translated into German as “Nestlé Tötet Babies” (Nestlé Kills Babies) and Nestlé sued for libel. It won the court case on the grounds of this title, but it generated massive negative publicity for itself in the process. Things didn't really improve, so a few years later a consumer boycott began- first in the US and then internationally- co-ordinated by the International Baby Food Action Network (IBFAN).

In 1981, the World Health Assembly drew up the International Code of Marketing of Breastmilk Substitutes, a set of recommended minimum standards relating to the promotion (or non-promotion) of formula milk. A few years later Nestlé agreed to implement the Code voluntarily and the boycott was lifted. But four years later, the campaign was revived, as IBFAN determined that Nestlé hadn't lived up to its promises and was still supplying cheap or free formula milk to hospitals.

A decade and a half on, the situation is still dire: in 2001 the World Health Organisation reported that “some 1.5 million children die every year because they are inappropriately fed…less than 35% of infants worldwide are exclusively breastfed for the first four months of life”. And though there have been many positive developments- explicit formula milk marketing has been almost stamped out, and breastfeeding rates in the developing world are rising- the question remains as to whether Nestlé, who have gone to great lengths to promote themselves as an ethical company, are acting responsibly.

According to IBFAN, the answer is unquestionably no, since Nestlé and other firms are “continuing their unethical promotional activities whilst claiming to abide by the international Code”. The campaigners continue to document some direct violations of the Code- which they display on their website- though their accusations today relate to more subtle things such as Nestlé lobbying against regulation relating to infant formula, and refusing to accept that the Code should apply to all “breastmilk substitutes”- including those aimed at older babies- not just “infant formula”.

Nestlé denies such allegations, pointing to its widespread promotion of breastfeeding, its regular audits, and its internal ombudsman for reporting bad practice. Peter Brabeck-Letmathe, the CEO, even claims to look personally into each reported breach of the Code, while acknowledging that- in a company of nearly a quarter of a million staff- slip ups are bound to happen occasionally. Nestlé also claims that formula milk products are “legitimate and useful”, allowing mothers in poor countries the option of returning to work instead of staying at home- something which mothers in the west take for granted. And they claim that the only reason why the receive all the negative publicity is because they're the easiest targets: while their food and drink brands are household names, the other baby milk firms are pharmaceutical companies, so couldn't easily really be boycotted.

However, criticism of Nestlé's formula milk activities- albeit less fierce than it was- keeps coming from sources as wide ranging as UNICEF and, in 2003, the British Medical Journal. And the boycott continues.

The Rough Guide to Ethical Shopping by Duncan Clarke.

Following are some excerpts from the IBFAN website. The address is www.ibfan.org

What is IBFAN?

The International Baby Food Action Network, IBFAN, consists of public interest groups working around the world to reduce infant and young child morbidity and mortality. IBFAN aims to improve the health and well-being of babies and young children, their mothers and their families through the protection, promotion and support of breastfeeding and optimal infant feeding practices.

IBFAN'S Seven Principles

• The right of infants everywhere to have the highest level of health.

• The right of families, and in particular women and children, to have enough nutritious food.

• The right of women to breastfeed and to make informed choices about infant feeding.

• The right of women to full support for successful breastfeeding and for sound infant feeding practices.

• The right of all people to health services which meet basic needs.

• The right of health workers and consumers to health care systems which are free of commercial pressures.

• The right of people to organise in international solidarity to secure changes which protect and promote basic health.

  
  

The International Code of Marketing of Breast-milk Substitutes 1981.

Baby food companies may not:

• Give free supplies of baby milk to hospitals;

• Promote their products to the public or health workers;

• Use baby pictures on their baby milk and bottle and teat labels;

• Give gifts to mothers or health workers;

• Give free samples to parents;

• Promote baby foods or drinks for babies under 6 months old;

• Labels must be in a language understood by the mother and must include a prominent health warning.

The Code is intended as a minimum requirement for countries in both the North and the South.

What does IBFAN say is happening now?
Most baby food manufacturers are continuing their unethical promotional activities whilst claiming to abide by the International Code. They are increasingly "investing" in health workers and health care systems, spending more money promoting their products than most governments spend on health education.
Companies know that if they persuade a health worker to recommend their milk, they have gained a lifetime's brand loyalty. This is much more cost effective than persuading mothers individually. Advertising in hospitals implies that the product is endorsed by the health service: coupled with misinformation, this has created the false impression amongst mothers and health workers that many women cannot breastfeed.
Even more effective is the practice of giving free or subsidised supplies of baby milk to hospitals and maternity wards. This encourages artificial infant feeding, which interferes with lactation. Once a mother leaves hospital formula is no longer free, the company has another captive customer, and the mother and baby are denied the best start in life.

There is more detailed information about how Breastfeeding is undermined by Breastmilk substitute making firms on the website.

The following are excerpts from the Nestle website. www.babymilk.nestle.com

Are babies more “at risk” if bottle fed? Taken from the Nestlé website.

Firstly, infant formula is not the same as bottle-feeding. e.g. in Sub-Saharan Africa when a feeding bottle is used, it most likely does not contain infant formula but rather plain water, cornstarch water or other traditional food mixtures. Infant formula can be fed by bottle, cup or cup and spoon.

If the mother is healthy, it is likely that the baby will be healthy and breastfeeding will be successful. Mothers should first and foremost be encouraged and supported to breast feed their baby. However, there are cases when babies are "at risk" (e.g. low birth weight, premature or when the mother has died) and may need supplements to compensate for this. These babies are more "at risk," than healthy, breast-fed babies. In cases like those it is unlikely that bottle-feeding has caused the risk. Both the risk and the need for a breast-milk substitute are possibly due to the baby's disadvantage at birth. Infant formula can be a life-saving product, if prepared and used correctly.

It may seem paradoxical to some, but the developing countries that have the highest use of infant formula also have the lowest rates of infant mortality. This is obviously not a cause and effect relationship - what the two statistics show is that as a country develops economically and as more women enter into paid employment, infant health and nutrition improves and the use of infant formula increases.

Of the total Nestlé sales, Infant Formula represents approx. 1%. Only about 5% of this is consumed in Sub-Saharan Africa. In fact more Infant Formula is sold in Belgium , with a population of 10 million, than in the whole of Sub-Saharan Africa covering a population of more than 650 million.

Does the World Health Organisation say that 1.5 million babies die annually because of bottle-feeding?

The fact that the lives of 1.5 million babies could be saved if exclusive breastfeeding was successfully promoted and maintained is often distorted to suggest the fault lies with the use of infant formula. The distorted use of this statement is expressed through campaign slogans like: "A baby dies every 30 seconds from unsafe bottle feeding" or "The World Health Organization (WHO) estimates that 1.5 million infants die as a result of diarrhea every year because they are not breastfed. Despite this, companies continue to promote artificial feeding in ways that undermine breastfeeding..."
 
This statistic is often attributed to the World Health Organization. In fact, the WHO has clarified that it has never made such a statement either in relation to infant formula or to bottle-feeding in general.
 
"... WHO has made no statement quantifying the impact on either morbidity or mortality of infants being fed on bona fide infant formula, i.e. breast-milk substitutes manufactured in accordance with the relevant standards of the Codex Alimentarius. In contrast, WHO has estimated that [this] number of infant deaths... that could be averted annually through effective breastfeeding promotion, and this irrespective of the breast-milk substitutes used to feed them or, for that matter, the feeding utensils employed for this purpose".
(WHO, 19 November 1992).
 
The challenge is to educate and encourage mothers to exclusively breast feed their baby during the first 6 months of life, and breastfeed along with the introduction of complementary food, for as long as possible. Because infant mortality is actually highest after 6 months of age efforts to improve complementary feeding practices are equally important.
 
The use of misleading statements should be stopped. Instead, the tackling of the root problem and proactive educational efforts about proper infant feeding are needed, as part of a global and structured solution that offers the most hope in improving infant health and reducing infant mortality in developing countries and regions.

There are answers to other related questions on the Neslte baby milk website.

There are a number of interesting articles at the web site of the British Medical Journal www.bmj.com . To find them type Nestle into the search box.

Also see the Baby Milk Action website for detailed information about the Nestlé boycott, its history, aims and the arguments behind it. www.babymilkaction.org

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