Breaking the rules on breastmilk substitutes
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Breaking the Rules, Stretching the Rules 2004
Evidence of Violations of the International Code of Marketing of
Breastmilk Substitutes and subsequent Resolutions
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This Overview sums up the main points of the Report: Breaking
the Rules, Stretching the Rules 2004, which analyses the promo-
tional practices of 16 trans-national baby food companies and 14
bottle and teat companies between January 2002 and April 2004.
It is based on reports by IBFAN groups working independently or
with governments in 69 countries.
The benchmark standards used for measuring marketing practices
are the International Code of Marketing of Breastmilk Substi-
tutes and relevant World Health Assembly (WHA) resolutions. More
than 3,000 complaints were received from around the world and
after legal checking, some 2,000 Code violations were analysed
and reported on, company by company. The report also holds a se-
lection of 712 pictures as illustrations of Code violations.
* Swiss-based Nestlé controls 40% of the global baby food market
and that dominant position is unfortunately matched with its re-
cord as the worst Code offender. Nestle markets from Taiwan to
Trinidad and from China to Costa Rica. It was the company with
the greatest number of reported violations of nearly all key
provisions of the International Code. Nestlé maintains it abides
by the Code but that means it abides by its own in-house 'In-
structions', which fall short of the International Code. Even
within its own narrow interpretation of the Code, Nestlé vio-
lates several provisions by promoting infant formula and follow-
up formula and by disseminating information materials which are
more promotional than 'scientific and factual' as required by
the Code. In countries where the Code is not enforced like Thai-
land and Armenia, Nestlé and other companies shower gifts on
health workers and mothers.
* Dutch NUMICO which owns Nutricia, Cow & Gate, Milupa, Sari
Husada and a string of smaller baby food companies worldwide
comes in as a close second worst violator. Like Nestlé, its in-
ternal 'Guidelines' restrict the scope of the Code to 'starter
formula' to suit the company's own ends. Numico companies are
pervasive in health facilities in Indonesia, Curacao and the
Middle-East. Some maternities in Indonesia seem commercially
bonded to Nutricia which provides them with supplies, samples,
calendars, neonatal wristbands, cribcards and brochure
* Of the three American companies, Mead Johnson's violations are
worse than those of Abbott-Ross and Wyeth. All three, however,
infringe the Code in a blatant manner. Wyeth, in particular, has
had a few brushes with national authorities on Code matters.
Both Mead Johnson and Abbott-Ross have committed much of their
marketing budgets to substantiate claims that their DHA enriched
formulas make babies smarter.
* Dumex (Danish) seems bent on infiltrating the health facili-
ties in South East Asian countries and in China. In terms of
violations, Dumex runs neck to neck with Hipp (Germany), another
mid-sized company, which is the most aggressive marketer in
Eastern Europe. Friesland (Dutch) Meiji (Japan), Humana (Ger-
many) and Heinz (USA) were all caught advertising to the public
and to health workers.
* Danone (France), Gerber (USA/Switzerland) and Snow (Japan)
show up less bad than the others, probably because very little
monitoring was carried out in the countries where Danone and
Gerber do most of their marketing. Snow seems to perform well
because its violations were only recorded in Thailand and Hong
Kong and because the company withdrew from the baby food market
in many countries including Japan, where it was involved in sev-
eral product liability scandals.
* Finally, Morinaga (Japan) grades better than others but viola-
tions still occur especially in health care facilities.
No company was found to fully comply with all the requirements
of the Code and WHA resolutions. All claim their products to be
more or less similar to breastmilk, if not better.
Bottles and Teats
Bottle and teat companies continue to violate the Code through
unrestrained advertising and misleading labelling which often
equates bottle feeding with breastfeeding.
A Japanese company, Pigeon, appears the most aggressive in its
marketing practices and outstripped other companies by far. It
is followed by the UK-based Avent/Cannon, while Italian Chicco
has the doubtful honour to be third. Camera (Taiwan), Gerber
(USA), Nuk (Germany), Huki (Indonesia) and Evenflo (USA) also
frequently violate the Code.
Overall trends
The latest phenomenon in baby food marketing seems to be in
'functional' claims. Companies try to differentiate their formu-
las by adding a string of additives and then claiming perform-
ance benefits for these. 11 out of the 16 companies jumped on
the fatty acids (DHA etc.) bandwagon and are competing using
misleading claims, esp. with regard to improved intelligence and
the similarity to mother's milk. Regulatory agencies have been
slow to challenge these claims, although in Canada, Mead Johnson
was told to stop such claims in April 2004.
Many companies still close their eyes to the fact that the Code
covers all breastmilk substitutes, not just infant formula. This
deliberate misinterpretation contributes significantly to their
poor rating. Donations of free and low-cost supplies continue
despite the many resolutions which ban this practice. Monitoring
reveals that promotion is most rampant in affluent societies.
Even within developing countries, companies focus on the richer
parts, disproving the claim that free formula is charity. Public
hospitals hardly receive free donations; private hospitals have
to fight to keep them out. The free formula is often passed on
as samples to mothers which undermines breastfeeding.
Exclusive breastfeeding for six months. Only Nestlé has changed
the labels of its complementary foods to six months in partial
compliance with WHA 54.2 (2001). Partial, because it has done so
only in developing countries. Other companies producing comple-
mentary foods continue to label and promote their products as
suitable from a much earlier age, sometimes as early as the
first week, generally from 'the fourth month' (end of three
months) or from four months.
All selected companies abuse the Code provision allowing scien-
tific and factual information to health professionals. They in-
clude text and images that are promotional and misleading. Of-
ten, these materials fail to contain warnings specified by the
Code and are given in bulk to health facilities for distribution
to mothers.
Health facilities and health workers continue to be targeted for
company promotion especially in countries where the Code has not
been implemented or is not properly enforced. Health workers re-
ceive lots of gifts and display items sporting the company
and/or brand names. Such gestures are effective to indirectly
influence mothers in making infant feeding decisions. When com-
pany materials are displayed in health facilities, they implic-
itly gain the added value of medical endorsement and companies
capitalise on this useful avenue of promotion.
Sponsorship of medical seminars, conferences and associations of
medical professionals is becoming more widespread, creating de-
pendency and giving rise to conflicts of interests.
With companies competing to get their share of an estimated
USD20 billion market, breaking the rules becomes a common occur-
rence. One thing, however, is clear: where a country has a
strong national law, properly implemented and enforced, Code
compliance improves. This should spur governments to implement
the Code at the national level. Mothers can then make informed
choices on infant and young child feeding free from commercial
pressures and breastfeeding will receive the protection, promo-
tion and support it deserves.
This Overview is based on "Breaking the Rules, Stretching the
Rules 2004", a 98-page report on how and where companies break
the Code. The evidence is illustrated by over 700 photos of Code
violations.
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"Breaking the Rules, Stretching the Rules 2004" is available
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P.O. Box 19, 10700 Penang, Malaysia
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mailto:ibfanpg@tm.net.my
http://www.ibfan.org
About IBFAN
The International Baby Food Action Network (IBFAN) is a coali-
tion of voluntary organisations in both developing and industri-
alised nations, working for better child health and nutrition
through the promotion of breastfeeding and the elimination of
irresponsible marketing of artificial infant foods.
About ICDC
The International Code Documentation Centre (ICDC) was set up in
1985 to keep track of Code implementation worldwide. It holds
training courses in legal drafting and monitors marketing prac-
tices of baby food companies for compliance with the Code.