Frontlines

The mother's-milk formula for health

André McNicoll October 15 1979
Frontlines

The mother's-milk formula for health

André McNicoll October 15 1979

The mother's-milk formula for health

Frontlines

André McNicoll

In Venezuela, 5,000 babies die each year of gastroenteritis and an equal number of pneumonia. Almost all have been bottle-fed. One Venezuelan doctor says: "A totally breast-fed baby just does not get sick like this. ”A study in seven Punjab villages in India showed that infants bottle-fed from birth died at the rate of 950 per 1,000, compared to 120 for breast-fed babies. Found throughout the Third World, such cases have spawned a new term—“commerciogenic malnutrition,” or malnutrition linked to commercial practices.

Born in North America and nursed into a brawling adolescence by the Ralph Naders of the industrialized world, the notion of corporate responsibility—or “business with a social conscience”—has always found its focus in particularly Western issues. But now the same concern that has been turned to car brakes, food preservatives and exploding pop bottles has been focused

upon the Third World, where the advertising practices of Western manufacturers of baby-bottle formula are being blamed for thousands of cases of infant malnutrition, disease and even death.

This has taken the form of a worldwide boycott promoted by church groups and private organizations against Nestlé, the $ll-billion-a-year Swiss-based food conglomerate that has captured more than one-third of the developing world’s lucrative infant formula market. Supporters of the boycott include the United Church of Canada, the Anglican Church of Canada, the Canadian Council of Churches, Senator Edward Kennedy, Dr. Benjamin Spock and the Interfaith Centre on Corporate Responsibility in New York. Third World groups such as the PanAmerican Health Organization have expressed concern but have not joined the boycott. And this week the World Health Organization is holding meetings in Geneva, where the misuse of infant formula is being investigated.

Nestlé’s intense promotion of artifi-

cial infant milk in Third World countries has been severely criticized since at least 1970 when the PanAmerican Health Organization urged that “strong action be taken to prevent the advertising of commercial milk products and the distribution of ‘free’ milk to nursing mothers.” Seven years later, after the Interfaith Center on Corporate Responsibility in New York had compiled a compelling case against formulafeeding in developing nations, the Third World Institute at the University of Minnesota’s Newman Center launched the boycott against many Nestlé products. Its aim is to force a halt to all promotion of infant formulas in the Third World. Now run by the Infant Formula Action Coalition (INFACT) in Minneapolis, the boycott claims at least 500 separate action committees in the U.S. and support in about 75 communities in Canada as well as in at least 10 other countries. “The movement is snowballing,” says Gwen Willems of INFACT. “We’re getting over 300 letters of support every day.”

Throughout the controversy, a distinction has been made between the actual product and the way it is advertised and sold. As a Nestlé publication puts it, “The issue is whether the advertising and marketing of such products have discouraged breast-feeding among Third World mothers and have led to misuse of the products, thus contributing to infant malnutrition and disease.”

At U.S. Senate hearings in 1978, Kennedy’s Health and Scientific Research Subcommittee called witnesses on the use and promotion of artificial baby formulas in developing countries. Kennedy put the purpose of the hearings into clear perspective with the question: “Can a product which requires clean water, good sanitation, adequate family income and a literate parent to follow printed instructions be properly and safely used in areas where water is contaminated, sewage runs in the streets, poverty is severe and illiteracy is high?”

Dr. Derrick Jelliffe, head of the Department of Population, Family and International Health at the University of California, conservatively estimates that the trend toward artificial feeding in the Third World may be resulting in some 10 million cases of infectious disease and malnutrition each year. In 15 rural communities in Chile, deaths were three times as high for infants fed with bottles in the first three months of life as among those exclusively breast-fed during that same period. Fatima Patel,

a Peruvian nurse with Canadian University Services Overseas (CUSO), told Kennedy’s Senate hearings that formula had found its way to Amazon tribes deep in the jungle of northern Peru. There, where the only water comes from a highly contaminated river—which also serves as the local laundry and toilet—formula-fed babies quickly come down with constant attacks of diarrhea and vomiting. Throughout the Third World not only is water contaminated, but many parents dilute the formula to make, for example, a four-day supply last anywhere from five days to three weeks. Some mothers even believe the bottle itself has nutrient qualities and merely fill it with water. Another reason for the much lower death rate of breast-fed babies is that natural milk provides protection against a host of infectious diseases. Breast-fed babies are more resistant to respiratory infections, otitis media (middle-ear infection) and irondeficiency anemia.

Meanwhile, the trend against breastfeeding continues. In rural Mexico, the Philippines, Central America and the whole of Africa there has been a dramatic decrease in the incidence of breast-feeding. Nestlé takes the view that this trend is due to urbanization and the increasing number of working mothers who “simply don’t have the time anymore,” or that many mothers are incapable of breast-feeding. However, many studies have shown that not more than one per cent of mothers are physically incapable of breast-feeding, and other inquiries have revealed that a very low proportion of mothers cite wanting to work as a reason for turning to formula-feeding.

Nestlé’s critics blame the decline largely on the intense advertising and promotion of infant formula—no longer carried on, the companies say—by Nestlé and some 20 other companies plying their $1.5-billion-per-year trade in the developing world. Clever radio jingles extolled the wonders of the “white man’s powder that will make baby grow and glow.” Doctors with the largest number of patients have been targeted for special attention by company representatives. “Milk nurses,” sales agents dressed in appropriate white uniforms (now changed to blue), visited nursing mothers in hospitals and their homes, generously providing one-week supplies of formula. Huge billboards depicted chubby, happy tots surrounded by pyramids of milk cans, looking up at smiling mothers. “Baby shows” were organized where colorful banners splashed the virtues of the Nestlé line—Lactogen, Pelargon and Nespray—and participating mothers

were given plastic bags with Nestlé promotional gadgets and free samples of formula.

For its part, Nestlé says that it has stopped advertising baby food to its customers—all except for medical personnel in the Third World. Nestlé says this sort of activity (explaining the proper use of their product, and the different baby formulas available) is not promotional, but rather, educational. “We have an instructional and educational responsibility as marketers of these products and, if we failed in that responsibility, we could justly be criticized,” explains a Nestlé public relations pamphlet. But the boycotting organizations disagree and take the position that this sort of activity exerts a subtle but compelling pressure for doctors to recommend formula-feeding, and particular brand-name products, to their patients.

In an interview last month in Toronto, Marianne King-Wilson, a supervisor of corporate communications with Nestlé, denied the charge that Nestlé discourages breast-feeding. “Even on our labels we say breast-feeding is best, and should you need additional nourishment for your child then this is how you use this product,” she said. “Infant malnutrition is the problem that we’re all here to solve, really.”

However, many Third World governments have concluded that baby formula is so likely to be misused, with such tragic consequences, that they are taking steps against its importation. Jamaica, Ghana, Papua New Guinea and Guinea-Bissau have enacted legislation to restrict imports of infant formula or

else to make nipples and bottles available only by prescription. In Washington, Congress is faced with the Infant Nutrition Act, a bill aimed at restricting the sale of infant formula to developing countries. And because of pressure from—among other sources—the United Nations Protein-Calorie Advisory Group (PAG), a number of infant formula companies, led by Nestlé, formed the International Council of Infant Food Industries (ICIFI) which quickly proclaimed a marketing Code of Ethics. But PAG thought the code dangerously vague, while Abbott and Bristol-Myers, two other multinationals in the artificial infant-feeding business, refused to join ICIFI (Abbott because the code was too vague; Bristol-Myers because it said it feared anti-trust action as a result).

Nestlé appears to be feeling the bite of the boycott. When the U.S. National Council of Churches endorsed it, Nestlé’s anxious response was to send out letters to all pastors denouncing the boycott. Company officials later travelled across the U.S. meeting with church, laity and medical groups trying to convince critics to abandon the boycott. About a year ago, in a direct effort to counter its badly stained public image, Nestlé hired the New York public relations firm of Hill and Knowlton. But last summer H&K were abruptly replaced by Daniel J. Edelman Inc. Asked to explain the sudden change in consultants, William J. Brooks, Nestlé’s new vice-president for corporate affairs, said, “We’re getting a very bad rap, our story just has to be conveyed.” It seems, however, that the boycotters have heard Nestlé’s story. They just don’t accept it.