Briefing Paper on the Ethical Issues Concerning the Marketing of Breast -

Milk Substitutes, and Other Ethical Issues Relating to Nestl

Introduction
This briefing paper has been produced by the Central Finance Board of the Methodist
Church (CFB). It attempts to set out the ethical issues, not to reach conclusions. Where
any opinions appear to be gien they should not be ie!ed as representing CFB policy.
"imilarly, they should not be considered as representatie of the ie!s of the Methodist
Church in general or the #ublic $ife and "ocial %ustice team in particular.
The paper constitutes the initial stage of a consultation process designed to enable the
Methodist Church through its %oint &disory Committee on the 'thics of Inestment (%&C'I)
to assess the ethical suitability of (estl) as a potential inestment, and to adise the
Central Finance Board of the Methodist Church accordingly. The consultation !ill pay
particular attention to (estl)*s performance !ith respect to the International Code of
Mar+eting of Breast,mil+ "ubstitutes. -ther aspects of (estl)*s business !ill also be
considered in arriing at a conclusion.
Contents
The structure of this paper is as follo!s.
/. 0eie! of 1ey 'thical Issues Concerning Breast,Mil+ "ubstitutes
2. (estl) #olicy on Infant Formula Mar+eting
3. Criticisms 0aised by Baby Mil+ &ction
4. FT"'45ood*s Criteria on Infant Formula Mar+eting
6. The Methodist Church*s #osition on Breast,Mil+ "ubstitutes
7. -ther 'thical Issues 0elating to (estl)
!" Re#ie$ of %e& Issues Relating to Breast-'ilk Substitutes
!"! (efinitions
The ma8or ethical concern regarding (estl) relates to the mar+eting of breast,mil+
substitutes, as described in the International Code of Breast,Mil+ "ubstitutes.
These concerns essentially refer to mil+,based substitutes, although &rticle 2 of the
Code states. 9The Code applies to the mar+eting, and practices related thereto, of
the follo!ing products. breastmil+ substitutes, including infant formula: other mil+
products, foods and beerages, including bottle,fed complementary foods, !hen
mar+eted or other!ise represented to be suitable, !ith or !ithout modification,
for use as a partial or total replacement of breast,mil+: feeding bottles and teats.
It also applies to their ;uality and aailability, and to information concerning their
use.<
there is a dispute bet!een campaigning groups and manufacturers !hether they
also apply to =complementary infant foods* such as fruit 8uices and infant cereal.
Manufacturers such as (estl) deny that fruit 8uices and infant cereal are coered by
the Code, !hereas Baby Mil+ &ction insists that they are. (estl) disputes that
=complementary infant foods* are coered by the Code, despite the fact that
>(IC'F has stated in !riting to (estl) that they are coered as set out in &rticle 2.
In its monitoring IBF&( includes complementary foods mar+eted as replacements
for breastmil+ (e.g. for feeding during the 7 month period !hen e?clusie
breatfeeding is recommended). In addition >(IC'F has clarified, in !riting, that
company representaties cannot use complementary foods to circument the
prohibition on see+ing direct or indirect contact !ith pregnant !omen or mothers
of infants and young children (children up to three years of age), specified in
&rticle 6.6 of the Code. >(IC'F has stated the prohibition is absolute.
Complementary foods are other!ise outside the scope of the Code and subse;uent,
1
releant 0esolutions adopted by the World @ealth &ssembly, e?cept for the general
point in 0esolution 4A./6 (/AA7) that. that complementary foods are not
marketed for or used in ways that undermine exclusive and sustained breast-
feeding. "o, for e?ample, (estl)*s practice of promoting po!dered !hole mil+ in
the infant feeding sections of pharmacies alongside more e?pensie infant formula
is coered by this 0esolution.
The controersy relating to mil+,based nutritional products described in this
briefing paper refers e?clusiely to standard infant formula. It is important to
distinguish bet!een standard formula and other nutritional supplements. Mil+,
based nutritional supplements are mostly used to feed indiiduals !ith impaired
digestie systems. These include premature babies, children, or adults !ith
diseases of the digestie system, people !ith @IBC&IDs, and the elderly !ho can no
longer eat ordinary food. &s such products are clearly life enhancing and are not
controersial. (ote that this definition is at odds !ith that used in the
International Code of Mar+eting of Breastmil+ "ubstitutes, !hich coers all
breastmil+ substitutes and not 8ust =standard infant formula*. (estl), in common
!ith other baby food companies, is increasingly =medicalising* infant feeding. For
e?ample, it has launched a =hypo,allergenic* formula in the >1 mar+eted for use
!ith infants at ris+ of allergy. The same claim cannot be made in the >" after legal
action !as ta+en against (estl) after infants fed on the formula suffered from
anaphylactic shoc+. (estl)*s promotion of formula for use in @IB interentions and
of breastmil+ fortifiers is something that continues to cause concern.
The !hole ;uestion of the production and sale of standard infant formula products
is, on the other hand, hugely controersial. Certain groups and indiiduals beliee
that the benefits of breastfeeding are so great that sales of standard infant formula
products should be strongly discouraged, if not banned. (ote. this is not the
position of Baby Mil+ &ction and it is misleading to suggest other!ise. Baby Mil+
&ction stresses that the International Code and subse;uent, releant 0esolutions
are intended to protect mothers !ho artificially feed their infants as !ell as to
protect breastfeeding. Much of Baby Mil+ &ction*s !or+ is aimed at improing
labelling and composition of baby foods. Infant formula is produced by 27
companies, but the standard formula mar+et is dominated by three companies.
(estl) is the largest, trading under the =(estl) (idina* and =(estl) Beba* labels in
'urope, and =(estl) (an* in &frica. "econd largest is the >" pharmaceutical
company Wyeth (formerly +no!n as &merican @ome #roducts) !hich sells the ="M&*
and =(ursoy* brands, follo!ed by the Dutch company (umico !hich trades under
the (utricia label. It should be noted that both (estl) and Wyeth are also leading
producers of other nutritional supplements.
!") Infant *or'ula in (e#eloped Countries
From the beginning of the t!entieth century until the /A7Es medical opinion in
deeloped countries such as the >1 faoured bottled infant formula oer breast,
feeding. There !ere a number of reasons for this. It !as thought that boiling
bottled feed made it more hygienic than breast,mil+. &s a result of the 5reat
Depression of the /A3Es, and !artime austerity in the /A4Es, many children in the
>" and 'urope suffered from malnutrition. @ence goernments at that time
thought it desirable for babies to gro! as rapidly as possible, so infant formula,
!hich may hae a higher calorific alue than breast,mil+, !as the preferred choice
of many doctors.
@o!eer since that time the consensus of medical opinion has s!ung round so that
breast,mil+ is no! regarded, !ithout doubt, as the best choice for young babies.
There hae also been other ma8or changes in standard medical adice about the
best !ay to feed babies. >ntil the /AFEs many doctors adocated =training* the
baby by limiting feeding to once eery four hours, but no! it is accepted that
babies, particularly young ones, should be fed upon demand.
2
It is generally accepted that in normal circumstances breast,mil+ proides the ideal
nutrition for babies prior to !eaning. @o!eer, the primary reason for adocating
breastfeeding lies in the fact that in the first si? months of life an infant*s immune
system is not fully deeloped. The child*s mother*s mil+ contains her antibodies,
!hich help the infant fight infection: if both the mother and baby are e?posed to
an infection, the mother*s immune system automatically produces antibodies !hich
protect the baby. -biously standard mil+ formula cannot contain such custom,
made antibodies. It is for this reason that the World @ealth -rganiGation
recommended in 2EE/ that mothers should e?clusiely breast feed for the first si?
months, but that they could then use breast,mil+ substitutes until the baby !as
fully !eaned at /H months , 2 years. World @ealth &ssembly adopted a 0esolution
in /AA4 (4F.6) calling for complementary feeding to be fostered from about 7
months of age. & 2EE/ 0esolution (64.2) !as adopted re,stating this as a global
public health recommendation of. 9e?clusie breastfeeding for si? months I !ith
continued breastfeeding for up to t!o years of age or beyond.< This !ording is
used in the 5lobal "trategy on Infant and Joung Child Feeding adopted in 2EE2
under 0esolution 66.26
The benefits of breastfeeding as regards anti,bodies are un;uestioned. @o!eer,
medical science suggests that there are a number of additional health benefits from
breast,feeding, particularly in terms of reduced ris+ of childhood diabetes and
allergic diseases such as asthma. It is also claimed that breastfeeding helps
deelop an emotional bond bet!een mother and child, !hich is beneficial for the
later psychological deelopment of the child. $astly, research indicates that a
prolonged period of breastfeeding is also beneficial for the mother in terms of a
slightly reduced ris+ of breast cancer.
@o!eer, apart from the important e?ception of antibodies in the first si? months
of life, the medical benefits from breastfeeding compared to using infant formula
in deeloped countries are not particularly great. The campaign against standard
formula baby mil+ is based upon the principle that =breast is best*. @o!eer, this
seems to ignore the social changes that hae ta+en place in 'urope and (orth
&merica oer the past thirty years. It might hae been possible for most Western
!omen to breastfeed their ne!born babies eery fe! hours in the /A6Es, !hen they
stayed at home. (o!, it is simply impractical, if not impossible, for !omen !ho go
out to !or+ to breastfeed their child e?clusiely. While a minority of !omen may
!or+ in places !here crKches are readily aailable, for most !omen such an option
is not aailable. In such cases the use of standard formula mil+,based feeds are
essential, unless society decides that a !omen*s right to !or+ should be
do!nplayed, as it !as in deeloped countries in the /A6Es, and may be today in
some deeloping nations. (ote. this s!eeps aside a great deal of research on
health benefits of breastfeeding in industrialised countries, ignores the fact that
breastfeeding rates in countries such as (or!ay are oer AEL at 4 months and
negates the 5oernments targets for increasing breastfeeding rates. It also typifies
the campaign as =against standard formula baby mil+* !hen the ethical issue relates
to appropriate mar+eting not the aailability of the product.
3
!"+ ,he -se of Infant *or'ula in (e#eloping Countries
The aboe issues are also applicable to the sales of infant formula in deeloping
countries. @o!eer, there are also ery real concerns !hich are specific to
deeloping countries. In particular they relate to the mar+eting of infant formula
in countries !here there is no general access to pure !ater. There is little dispute
that standard infant formula is safe in deeloped countries !here high ;uality
drin+ing !ater is aailable, and !here bottles and preparation e;uipment can be
effectiely sterilised and !here increased ris+ of illness can be treated (for
e?ample, an artificially,fed child in the >1 is up to /E times more li+ely to be
hospitalised !ith gastro,enteritis than a breastfed child).d.
In deeloping countries these factors are often not present, so using impure !ater
can easily lead to the baby deeloping stomach infections such as amoebic
dysentery. In adults such infections are unpleasant, but the patient usually
recoers. @o!eer for a young child they can be fatal. It is alleged that during the
/A7Es and /AFEs !hen infant formula !as !idely used in deeloping countries, the
use of such products may hae resulted in the deaths of hundred of thousands, if
not millions, of babies each year. Baby Mil+ &ction claims that this is still the case.
Its !ebsite alleges ;uotes >(IC'F (press release %anuary /AAF) that.
"Marketing practices that undermine breastfeeding are potentially
hazardous wherever they are pursued in the developing world! "#$ %the
"orld #ealth $rganization& estimates that some '.( million children die
each year because they are not ade)uately breastfed. *hese facts are not
in dispute."
@o!eer, although the W@- has referred to infant death from malnutrition or
!ater,borne disease, it has neer made any official statement about infant death
being due to infant formula mar+eting, nor has Baby Mil+ &ction suggested that it
has. It should be recalled, ho!eer, than !hen Baby Mil+ &ction !as called on to
defend a boycott adertisement before the &dertising "tandards &uthority,
including the use of the statistic, "+very day! more than ,!--- babies die because
they.re not breastfed. *hat.s not con/ecture! it.s 0123+4 fact it did so successfully
and one of the organisations sending supporting statements !as W@-..
It seems fair to state that the mar+eting standards of the leading infant formula
companies in deeloping countries in the /A7Es and early /AFEs !ere !ell belo!
!hat !ould no! be deemed acceptable. (This is of course true for many other
industries !ith =legacy issues*). & number of accusations hae been made about
mar+eting practices used in that time.
a) The use of strident mar+eting campaigns stating that infant formula !as
better for babies than breast,mil+, despite all eidence to the contrary.
b) @anding out free samples to ne! born mothers, as !ell as to health
professionals.
5iing free samples to mothers of ne! born babies in hospitals is a particularly
ini;uitous practice, as if a mother stops nursing a baby for more than a fe! days,
she loses the ability to produce breast,mil+. In many deeloping countries infant
formula, li+e most Western consumer goods, is ery e?pensie compared to aerage
incomes. In other !ords, giing mothers free samples of infant formula in the
hygienic enironment of a hospital !ill cause her breast,mil+ to dry up. -nce she
returns home, she !ill hae no alternatie but to try and feed her baby on infant
formula, een though this could often be made !ith dirty !ater that might lead to
dysentery. It is !ell documented that many families in deeloping countries lac+
the income re;uired to purchase enough formula to ade;uate feed a baby, so that
the proision of free samples of infant formula could lead to babies suffering seere
4
malnutrition, and een death by staration. @o!eer, it is also documented that
instead of breast,mil+ some babies may receie co!*s mil+, goat*s mil+, plain tea,
sugar !ater, rice !ater or plain !ater that may also be detrimental to their
healthy deelopment.
That said, it is important to note the massie rise in the standards of liing !hich
has occurred in many deeloping countries oer the last thirty years, particularly in
"outh 'ast &sia. In countries such as Thailand, Tai!an, and "outh 1orea rapid
economic gro!th has meant that in urban areas at least clean !ater is no!
generally aailable and incomes are high enough to ma+e infant formula an
affordable item for most people. -ne aspect of this process of rapid deelopment
has been economic empo!erment for !omen, an increasing number of !hom are
entering professional and business life. In poor agricultural societies !here the
ast ma8ority of men and !omen !or+ on the land, and lie nearby, breastfeeding
is a relatiely easy option. -nce !omen hae prolonged commutes to !or+ in
nearby cities, !ith minimal proision of crKches and nurseries, leaing their babies
at home !ith relaties, to be fed on infant formula, is the only practical
alternatie. In Western 'urope maternity leae legislation economically empo!ers
!omen !ho !ish to stay at home and breastfeed their babies in the first si? months
to do so. In deeloping countries such legislation may not e?ist.
(ote. again it is important not to lose sight of the fact !e are considering (estl)*s
baby food mar+eting practices. Morphine can be necessary, useful and used safely,
but that does not e?cuse it being aggressiely mar+eted.
!". /istor& of 0ro$ing Concern o#er the Marketing of Breast-'ilk Substitutes
There !as gro!ing public concern about the mar+eting of infant formula in
deeloping countries from the early /AFEs on!ards. (ote. Baby Mil+ &ction dates
the campaign from the /A3Es !hen concerns !ere raised about the impact of
s!eetened condensed mil+ being promoted for =delicate infants*. In the >1 this
!as led by the deelopment charity War on Want. In /AF7 War on Want produced a
report, *he 5aby 6iller, alleging that the aggressie mar+eting campaigns of (estl)
and other companies producing breast,mil+ substitutes !as responsible for
significant infant death.
#ublic concern gre! in the second half of the /AFEs !hich led to many non,
goernmental organiGations ((5-s) adocating a boycott of (estl) and Wyeth
products. It also led to a >" "enate In;uiry into the sub8ect in /AFF. Finally, in
/AH/ /AFA t!o international organisations got together to deise an International
Code of Mar+eting of Breast,mil+ "ubstitutes. These !ere the >nited (ations
Children*s Fund (>(IC'F) and W@-, !hich conened an international meeting,
inoling goernment, health bodies, baby food companies and (5-s. The Code
!as adopted by the W@-*s 34
th
&ssembly in May /AH/. The preamble to the Code
states that.
73onsidering that when mothers do not breastfeed! or only do so partially!
there is a legitimate market for infant formula and for suitable ingredients
from which to prepare it8 that all these products should be made accessible to
those who need them through commercial or non-commercial distribution
systems! and they should not be marketed or distributed in ways which may
interfere with the protection and promotion of breastfeeding8
9ecognising further that inappropriate feeding practices lead to infant
malnutrition! morbidity and mortality in all countries! and that improper
practices in the marketing of breast-milk substitutes and related products can
contribute to these ma/or public health problems:.
The +ey points of the Code as established in /AH/ !ere.
5
a& 1o advertising of breast-milk substitutes.
b& 1o free samples or supplies are to be given to mothers.
c& 1o promotion of products through health care facilities.
d& 1o contact between company marketing personnel and mothers.
e& 1o gifts or personal samples to health workers.
f& 2nformation to health workers should be scientific and factual only.
g& ;ll information on artificial feeding! including the labels! should explain
the benefits of breastfeeding and the costs and hazards of artificial
feeding.
h& 0nsuitable products should not be promoted for babies.
i& 5abies should not be depicted on infant formula packaging.
/& <abels should be set out in local indigenous languages.
In /AH4 (estl) agreed to accept and adhere to the Code, and at that time many of
the arious (5- boycotts !ere endedsuspended. The implementation of the Code
in deeloping countries !as put in place by (estl) through the 1estl= 2nstructions,
!hich !ere deeloped in consultation !ith W@- and >(IC'F, though neer
approed by these bodies as (estl) implies. @o!eer, in /AH7 (5-s alleged that
(estl) and Wyeth !ere in breach of the Code*s spirit, if not its letter, by s!itching
from adertising to giing free samples to hospitals in deeloping countries. In
/AH7 the W@- Code !as tightened up to prohibit the giing of such free samples.
&t the same time the International (estl) Boycott Committee (I(BC)Baby Food
(et!or+ (IBF&(), the parent grouping of !hich Baby Mil+ &ction and other boycott
coordinating groups formed in the >1, announced a second the re,launch of the
boycott of (estl) and Wyeth products on the grounds that the company had bro+en
its underta+ing and !as continuing to iolate the International Code and
0esolutions in a systematic and institutionalised !ay, as demonstrated by
monitoring conducted by the International Baby Food &ction (et!or+ (IBF&(), to
!hich Baby Mil+ &ction belongs.!as untrust!orthy, a The boycott !hich continues
to this day. In /AA3 (estl) announced that it !ould not permit free samples to be
gien unless specifically re;uested by 5oernments for certain restricted social
!elfare cases.
!"1 /I234I(s
The prealence of @IBC&IDs in sub,"aharan &frica has brought for!ard a ne! ethical
;uestion concerning the supply of standard infant formula. &ccording to the
charity Medecins >ans 4rontieres @IBC&ID" currently infects more than 2.6 million
children !orld, !ide. In 2EE3 FEE,EEE children !ere ne!ly infected !ith the @IB
irus, AEL of these in sub,"aharan &frica. @alf of all children !ith @IB die before
they reach the age of t!o.
It is +no!n that an @IB infected mother has a 2EL chance of passing the irus onto
her baby through her breast,mil+, and it is estimated that in /AAE,2EEE /.Fm
infants in &frica !ere infected !ith @IB in this !ay. >p to December 2EEE it is
estimated that 3.H million children hae died from &IDs, !ith 3.4m of these being
infected by their mothers, !ith some /./,/.Fm infected solely through drin+ing
breast,mil+ infected !ith @IB. In sub,"aharan &frica it is belieed that AE out of
eery /,EEE pregnant !omen are @IB positie. -f these AE pregnancies, 2F,37
babies are e?pected to contract the @IB irus in utero, during labour, or through
breast,mil+. In this conte?t the proision of free infant formula could sae infant
lies on a substantial scale, rather than the opposite.
&ccording to an article in the "all >treet ?ournal (6
th
December 2EEE), in 2EEE the
t!o largest formula producers, (estl) and Wyeth, offered to gie free infant
formula in tightly controlled circumstances to @IB infected mothers in southern
&frica, including the use of generic pac+aging !ith no reference to either company.
This offer !as refused by the >nited (ations Childrens Fund (>(IC'F), calling it a
6
breach of the Code. Wyeth and (estl) !ere therefore inhibited from supplying free
infant formula on the grounds that >(IC'F !ould hae accused them of breaching
the W@- Code. >(IC'F*s Director Carol Bellamy told the "all >treet ?ournal
7"e don:t believe that 1estl= and the other ma/or formula makers have a
particular role to play in the ;2@s crisis. "hat they should do is comply with
the %"#$& code.:
&t same time >(IC'F*s sister organisation, >(&ID", !as critical of this decision. In
many sub,"aharan countries een a small portion of standard formula often costs
more than an aerage family*s !ee+ly income. @ence the proision of free formula
is crucial if infant formula is to play an important role in the preention of @IB
infection ia infected breast,mil+. >(&ID" Director #eter #iot !as ;uoted in the
?ournal as saying that >(IC'F.
7*hey:re having difficulty accepting that the world has changed:A.the 01 must
look beyond the fierce battles of the past in an effort to save lives.:
(ote. If you are going to refer to the Wall "treet %ournal article, it is recommended that to
gie some balance, reference should also be made to a follo!,up article in the British
Medical %ournal 7 %anuary 2EE/. The milk of human kindness: #ow to make a simple
morality tale out of a complex public health issue. -r the letter sent to the Wall "treet
%ournal by >(IC'F '?ecutie Director, Carol Bellamy, /4 December 2EEE, ;uoted in the BM%
!hich stated. "Bou fail to acknowledge that 0nicef is leading the way in addressing mother
to child transmission! and you fail to explain fully why 0nicef so strongly supports
breastfeeding." 9esearch showed! she said! that formula fed infants were four to six times
more likely to die of disease than breast fed infants! and "exclusive breastfeeding can save
lives! as many as '.( million a year. ; rush to promote formula feeding! she explained!
could lead to the spread of other infectious diseases. 0nicef.s view is that if formula is to
be used! it needs to be done in a targeted manner. *he organisation is currently piloting
pro/ects in '' countries to offer women #2C testing and counselling! offering formula to
those who then chose to use it. "
Baby Mil+ &ction !or+ed !ith >(IC'F on the @IB interention pro8ect in helping to design
labels for infant formula !hich gae re;uired information in a clear !ay to increase the
chance that the formula !ould be used safely.
7
In 2EE/ the World @ealth &ssembly adopted 0esolution 64.2, !hich calls for action.
7*o recognize and assess the available scientific evidence on the balance of
risk of #2C transmission through breastfeeding compared with the risk of not
breastfeeding! and the need for independent research in this connection8 to
strive to ensure ade)uate nutrition of infants of #2C-positive mothers8 to
increase accessibility to voluntary and confidential counselling and testing so
as to facilitate the provision of information and informed decision-making8
and to recognize that when replacement feeding is acceptable! feasible!
affordable! sustainable and safe! avoidance of all breastfeeding by #2C-
positive women is recommended8 otherwise! exclusive breastfeeding is
recommended during the first months of life8 and that those who choose other
options should be encouraged to use them free from commercial influences.:
In summary, !here replacement feeding is feasible this is recommended for @IB,
infected mothers. Where it is not, e?clusie breastfeeding is recommended.
(ote. This also ma+es the point that information for mothers should be =free from
commercial influences*. (estl) is in breach of this 0esolution as soon after it !as
adopted the company set up a (utrition Institute for "outhern &frica !ith the
stated purpose of promoting infant formula for use by @IB,infected mothers.
&t the 'uropean #arliament #ublic @earing into (estl) mar+eting of breast,mil+
substitutes held at the 'uropean #arliament in (oember 2EEE, >(IC'F stated.
7Many people have )uestioned the continued relevance of the 3ode in the
context of mother-to-child transmission of #2C through breastfeeding. <et me
assure you that there is an even greater need to ensure 3ode compliance in
areas of high #2C prevalence. *he 3ode protects artificially fed children as
well as those mothers who decide to breastfeed.
$ne of its aims! as specified in ;rticle '! is to ensure the proper use of breast-
milk substitutes when these are necessary. 2f incorrectly prepared! infant
formula can be lethal. $ver-dilution! the result of unsuitable availability of
formula! leads to malnutrition. 0nder-dilution can cause serious health
problems such as kidney failure. *his is without discussing whether sanitation
and access to clean water! fuel and ade)uate skills permit safe preparation.:
!"5 6ater 4#ailabilit&
The use of impure !ater in the preparation of infant formula, and the resultant
aderse health ris+s, plays a +ey role in the ethical issues surrounding breast,mil+
substitutes. It is !orth noting that according to the >( /./ bn of the !orld*s
inhabitants lac+ access to ade;uate clean !ater, defined as 6E litres per day for
drin+ing, !ashing, coo+ing, and sanitation. The >( stated that 6m people a year
die from !aterborne diseases, of !hich 2.2m people a year die from diarrhoeal
diseases, most of them infants, due to contaminated !ater. &t the %ohannesburg
5lobal "ummit on the 'nironment in 2EE2 a commitment !as made to hale the
proportion of the !orld*s population !ithout safe drin+ing !ater by 2E/6.
The >( stated that 3E countries, the ma8ority of them in &frica, account for HFL of
the people !ithout access to safe !ater. The >( also pointed out that there is
actually plenty of aailable !ater in the !orld, and the proision of ade;uate
drin+ing !ater for the entire !orld population !ould re;uire less than /L of the
!orld*s ground !ater. @o!eer, the problem is the !ay !ater is used. &bout FEL
of the !orld*s fresh !ater goes into irrigation of agricultural land, and in some
deeloping countries this figure rises to oer AEL. It is generally accepted that the
proision of clean !ater supplies normally inoles the deelopment of ade;uate
sanitation serices. It is no! recognised that these t!o goals play a crucial role in
8
economic deelopment. &ccording to the (5-, Water &id, these issues are also
materially lin+ed to raising the education leel, particularly for !omen. For
e?ample, a Water &id study in 'thiopia found that proiding access to fresh !ater
reduced the time spent collecting !ater, a tas+ traditionally allocated to !omen,
from si? hours to t!enty minutes per day.
9
!"7 ,he %e& Ethical Issues relating to Breast-Milk Substitutes
The aim of this CFB paper is to set out the ethical issues at sta+e, and not to reach
conclusions. The ;uestion of infant formula mar+eting is complicated, technical,
and the sub8ect of heated debate. This section !ill therefore attempt to clarify
!hat !e beliee are the +ey ethical issues relating to it.
a& >tatus of 2nfant 4ormula
-ne ;uestion !hich needs to be addressed is the moral status of infant
formula itself. Is it a bad thing in itself, li+e tobacco or gambling, or is it
more li+e alcohol, !here the problems arise from misuseM Many supporters
of IBF&( !ould probably argue that !hile theoretically infant formula may
not be a bad thing in itself, in practice it is a substitute for a ery good
thing, i.e. breast mil+.
b) 9ole of 2nfant 4ormula in 3hild @eath
It cannot be disputed that hundreds of thousands of young children die each
year in the deeloping !orld due to malnutrition or !ater,borne disease.
@o!eer, it may be important to distinguish bet!een baby deaths that
arise from the use, or misuse, of infant formula due to inappropriate
mar+eting by leading infant formula producers, and those that are due to
other causes. These might include ignorance on the part of the mother,
and the grossly inade;uate health care systems !hich e?ist in much of
southern &frica. &s described in section /.7 it is impossible to find pure
!ater in much of &frica. &lthough the >nited (ations has pledged to ma+e
clean !ater aailable to all of the !orld*s population, this is a long !ay
from being achieed.
c& >upplying 2nfant 4ormula in ;reas of "eak #ealthcare >ystems
In other !ords, ho! morally culpable are the infant formula producers if
they act as reasonable suppliers of infant formula to countries !ith grossly
inade;uate health care systems, such as those in southern &frica, !here
misuse of their products then occursM For the sa+e of argument, let us
assume that they are fully compliant !ith the International Code, but that
their products are still lin+ed to child death. If the misuse of standard
formula products arises from ignorance or misunderstanding in the conte?t
of inade;uate medical systems, is it fair to blame the companies for thisM
It could be argued that infant formula should be !ithdra!n entirely from
such countries. -n the other hand, such a !ithdra!al could lead to
increased infant malnutrition through replacement of infant formula by
een more inappropriate substitutes such as goats mil+, or sugar !ater.
The prealence of @IBC&IDs in southern &frica also needs to be ta+en into
account.
d& 3ompliance with the 2nternational 3ode
-ne of the +ey ethical issues surrounding infant formula relates to the
e?tent to !hich the formula manufacturers are complying !ith the
International Code. & large part of the debate relates to the ery different
interpretations of the Code made by (estl) on one hand and Baby Mil+
&ction, the World @ealth &ssembly and >(IC'F on the other. The
comple?ity of this debate can ma+e it hard to see the !ood for the trees.
While there has been a massie some improement in the mar+eting
standards used to promote infant formula in deeloping countries, the +ey
ethical ;uestion is !hether it is enough.
e& >ocial 9esponsibility 3onsiderations
&nother ethical issue concerns broader social responsibility considerations.
In other !ords are the infant formula producers sho!ing a narro! legalistic
10
=compliance* attitude to the Code, but ignoring broader ethical issuesM In
particular !hat should they do !hen mar+eting formula in deeloping
countries !ith inade;uate healthcare systems. "ome critics !ould argue
that it is the role of goernments to legislate or proide guidelines
appropriate to the social and deelopmental conte?t of the country
concerned, !here there e?ists a lac+ of capacity to implement and monitor
such legislation then, in this day and age, the company must e?ercise
diligence to!ards consumers !ith respect to the use of their products.
Indeed they should do so !ithout needing to be prompted by goernment,
other!ise company mission statements count for ery little.
)" Nestl Polic& on the Marketing of Infant *or'ula
)"! /istor&
Infant formula is one of (estl)*s oldest products, haing been inented by @enri
(estl) in /H7F. It no! accounts for less that 2L of total group turnoer, but it !as
the company*s principal product until the early /AEEs. This corporate history
probably e?plains !hy (estl) appears fiercely attached to maintaining its presence
in this area, and !hy the company feels obliged to argue its case so strongly. 5ien
the enormous negatie publicity that the sub8ect of =baby mil+* has generated for
(estl) oer the last thirty years, on a strict cost,benefit analysis it !ould probably
ma+e sense for the company to e?it the standard infant formula mar+et. @o!eer,
!e suspect that a sense of corporate history probably preents it from doing so.
(ote. (estl) also refers to its baby food business as one of its =main strategic
pillars*. The reason behind this, is that the company is basically a 8un+,food
company (indeed according to inestment ban+ >B" Warburg, nearly half of (estl)*s
profit is at ris+ if effectie regulations on unhealthy foods are introduced through
the World @ealth &ssembly N this !ould be higher but for (estl)*s inolement in
pet food, cosmetics and bottled !ater). The baby food business enables (estl) to
portray itself as a =nutrition* company and to gain the tacit endorsement of the
health care system !here its promotional materials appear.
)") Nestl -nderstanding of the 6/O Code
(estl)*s understanding of the W@- code is e?plicitly set out in a number of
company documents. "uch an understanding is +ey to the e?tent to !hich the
company is indeed complying !ith the Code as set out in the World @ealth
&ssembly (W@&) 0esolution 34.22 of May /AH/. The follo!ing are ;uotations from
the (estl) Document, 2nternational "#$ ;ction 9eport, dated &pril 2EE3.
7"#; resolutions are recommendations to all member states of the "#$.:
=*he 3ode calls upon governments to take action to give effect to the
principles and aim of this 3ode! as appropriate to their social and
legislative framework! including the adoption of national legislation!
regulations! or other suitable measures.:
= 99esolutions passed after the adoption of the "#$ 3ode have the same
status as the 3ode- they are recommendations to all of its member
governments.< W@- Director 5eneral, 5ro Brundtland, /AAH. 91either the
3ode nor any resolution has a real impact and a lasting meaning unless
countries implement them according to their national laws and practice.
Member states are sovereign8 they may! if they choose! implement "#$:s
recommendations to the letter! they may actually go beyond these
recommendations! or they may simply ignore them together.<*
=1estl= universally follows all countries: implementation of the "#$
3ode. $ur decision! two decades ago! to voluntarily and unilaterally
implement the "#$ 3ode as a minimum in all developing countries is due
to the fact that the economic! social! and sanitary conditions in most of
11
those countries differs substantially from the situation in developed
countries like the 0>; or +0.:
71estl= voluntarily and unilaterally implements the 3ode in more than '((
developing countries - we apply the 3ode to all 2nfant food products being
marketed or otherwise represented as a breast-milk substitute. *hat
means starter formula %--D months& and in the case of 1estl= it means
follow-on formula %D-'E months&. =
71estl= is in voluntary compliance with the "#$ 3ode in all developing
countries %more than '(- nations&. "e support governments: efforts to
translate "#$ resolutions into national languages. 1estl= has begun a
new monitoring process with governments around the world to ensure
compliance with the "#$ 3ode. ;n initial 9eport produced in 'FFF
contained official statements from (, governments representing over (-G
of 1estl=:s infant formula sales in developing countries. ;ll provide
evidence that 1estl= complies with the "#$ 3ode as is it is implemented
in that country.:
(estl)*s interpretation of the Code is based, in part upon a section !hich
says that.
7Hroducts other than bona fide breast-milk substitutes! including infant
formula! are covered by the 3ode only when they are marketed or
otherwise represented to be suitable Afor use as a partial or total
replacement of breast-milk.:
The company therefore beliees that the Code*s references to products used as
partial or total replacements for breast,mil+ are not intended to apply to
complementary foods unless these foods are actually mar+eted as breast,mil+
substitutes.
)"+ Recent (e#elop'ents in Code 0uidelines
In May 2EE/ the W@- changed re,stated its recommendation on breast feeding from
=recommended e?clusiely for the first four to si? months of life*, to
=recommended for the first si? months of life*. This !as in line !ith 0esolution
4F.6 adopted in /AA4 !hich called for complementary feeding to fostered from
about 7 months of age. >(IC'F !rote to (estl) in December /AAF setting out that
(estl)*s continued failure to change labels of complementary foods constituted a
breach of this 0esolution. During national demonstrations in the >1 iIn May 2EE3
(estl) announced.
72n line with our clear support for the new 9esolution! 1estl= has conse)uently
completed label changes on complementary foods to follow six month
recommendation. 1estl= is the only company manufacturing infant formula
and complementary foods to have taken this step! in spite of the risk that this
may put complementary foods at a commercial disadvantage vis-I-vis
competitors: products.:
Baby Mil+ &ction and >(IC'F hae proided monitoring eidence sho!ing that
(estl)*s claim to hae changed labels !as not fully implemented.
)". Nestl8s Polic& and Manage'ent Control of Infant *or'ula Marketing
The importance of infant formula mar+eting to (estl) is sho!n by the fact that the
company*s Chief '?ecutie, #eter Brabec+, !rote an introduction to a 2EE/ (estl)
paper called 2nfant 4eeding in the @eveloping "orld. In it he says.
$ur policy and practice in developing countries since 'FJ, has meant no
12
public promotion! including no advertising! no advertising leaflets! no
milk nurses! no samples to mothers! and a very restrictive policy on free
formula for evaluation by health professionals. "e leave communication
to mothers about infant formula in developing countries completely up to
health professionals.:
="e also carry out annual audits on "#$ 3ode compliance with a sample
of 1estl= companies! and we investigate any substantiated claims made by
those who believe we have broken the 3ode. Many of these we find to be
inaccurate! but in a company of over EE(!--- individuals! mistakes can be
made. 2f we find that the 3ode has been deliberately violated! we take
disciplinary action.:
7;s 3+$! 2 personally review any reports of 3ode violation discovered
either in our audits or in the developing world or through reports from
other organisations! and 2 make sure that the appropriate action is taken.:
(estl) has also introduced a system of -mbudsmen, i.e. senior managers outside of
infant nutrition to !hom staff can report concerns. In other !ords, the company
has put in place a system to alert @ead -ffice of possible Code iolations. These
people !or+ in areas li+e accounting or public affairs, so they hae no incentie to
coer up Code breaches.
(ote. &uditors can be seen in (estl)*s 2EE2 "ustainability 0eie! in front of
po!dered !hole mil+ ne?t to breastmil+ substitutes in the baby feeding section of a
shop N a breach of 0esolution 4A./6. (estl) has refused to indicate !hich countries
it has conducted audits on. It has commissioned one e?ternal audit, into actiities
in #a+istan, but auditors !here told they could not contact (5-s or a (estl)
!histle,blo!er and could only interie! doctors from a list proided by (estl).
Baby Mil+ &ction !rote to @ilary #arsons, @ead of Corporate &ffairs, (estl) (>1)
offering to proide documentary eidence to the auditors, but this offer !as not
passed on. The resulting audit !as a !hite !ash. Baby Mil+ &ction has !ritten to
(estl)*s ombudsman as+ing for a response to the many reported iolations !here
ans!ers had not been receied or responses !ere inade;uate. The ombudsman did
not reply. (estl) !histle,blo!er, "yed &amar 0aGa, says he !as threatened and
offered money to +eep ;uite !hen he raised his concerns about (estl) malpractice.
@e remains in e?ile from #a+istan and has not seen his family for 6 years.
)"1 %e& Ele'ents of Nestl8s Position on Infant *or'ula Sales
>nless (estl) is guilty of ma8or and systemic duplicity, there seems little reason to
doubt that the aboe statements illustrate the company*s sincere coniction that it
is doing its best to conform to its understanding of the Code.
(-T': (estl) is guilty of ma8or and systemic duplicity on this issue. (estl)*s
strategy of suggesting the issue is one of interpretation and only Baby Mil+ &ction
disagrees !ith (estl)*s interpretation is 8ust that N a strategy. Baby Mil+ &ction
goes bac+ to the Code and 0esolutions and see+s adice from >(IC'F*s $egal -fficer
in case of doubt.
The +ey elements of this, in the CFB*s opinion, are the follo!ing.
(estl) recognises the Code as consisting of adisory recommendations to
goernments. It is goernments that hae the responsibility to implement the Code
in their o!n countries through la! and medical standards in the light of their o!n
local conditions. (ote. (estl) ignores &rticle //.3 of the Code !hich states.
9Independently of any other measures ta+en for implementation of this Code,
manufacturers and distributors of products !ithin the scope of this Code should
regard themseles as responsible for monitoring their mar+eting practices according
13
to the principles and aim of this Code, and for ta+ing steps to ensure that their
conduct at eery leel conforms to them.<

(estl) beliees the Code set out minimum standards in all deeloping
countries. It does not beliee that it applies to deeloped countries, !here
the problem of impure !ater does not e?ist, and !here po!erful regulatory
agencies such as the Federal Food and Drug &gency (FD&) in the >" set their
o!n stringent standards. (estl)*s position is that it uniersally follo!s all
countries* implementation of the Code, follo!ing its decision more than
t!o decades ago, to oluntarily and unilaterally apply the W@- Code in
deeloping countries and regions. In deeloping countries and regions
!here there is no local code in place, or if the local legislation is less strict
or precise than the W@- Code, the Code is used as a minimum standard.
-ther!ise the local measures apply.
(estl) understands the Code as only applying to breast,mil+ substitutes.
This means starter formula (E,7 months) and in the case of (estl) it means
follo!,on formula (7,/2 months). In the company*s opinion it does not
apply to complementary foods such as fruit 8uices, infant cereals, and other
non,mil+ based !eaning products.
(estl) beliees that it follo!s the Code principles banning free supplies of
infant formula, !hich it understands to hae particular reference to nursing
mothers. It does beliee ho!eer that it is allo!ed to ma+e small samples
of infant formula aailable to medical professionals for ealuation
purposes.
(estl) accepts the Code ban on the public adertising of infant formula.
@o!eer, it beliees that the Code allo!s it to put nutritional information
about its infant formula on the side of formula pac+ets. The Code states
that the label should state ingredients used, compositionCanalysis of the
product, storage conditions, batch number of date before !hich the
product is to be consumed. The Code also allo!s =scientific and factual
information* to be disseminated to health professionals.
The company claims that all sales of its global infant formula since /AA2 hae been
in accordance !ith W@- guidelines. Company policy is that any breach of the
guidelines must be reported to the company Chief '?ecutie, and that there has
not been any significant breach for many years.
(ote. This is surprising. Is (estl) no! admitting that it !as iolating the
International Code and 0esolutions from /AH/ to /AA2M &t the time it claimed to be
abiding by the measures.
@o!eer, as sho!n in "ection 3 of this paper, IBF&( alleges that there hae been
hundreds of Code iolations by (estle in recent years. The CFB has carried out
limited database searches and not found recent reports in ne!spapers or ne!s
serices accusing (estl) of significant Code breaches. (The last definite breach
appears to hae occurred in #a+istan in /AA7, and !e understand that the company
carried out stringent disciplinary measures subse;uently, as !ell as bringing in
independent auditors to assess the situation, and ma+e public their conclusions).
+"9 Criticis's of Nestl b& Bab& Milk 4ction
+"! (escription of Bab& Milk 4ction
14
Baby Mil+ &ction is a non,profit organisation !hich is the >1 armmember of the
International Baby Food &ction (et!or+ (IBF&(). It describes its ob8ectie as being.
=*o save lives and to end the avoidable suffering caused by inappropriate
infant feeding. 5aby Milk ;ction works within a global network to strengthen
independent! transparent and effective controls on the marketing of the baby
feeding industry. *he global network is called 254;1! a network of over E--
citizens groups in more than '-- countries. ; marketing code was introduced
in 'FJ' to regulate the marketing of breast-milk substitutes. 3ompanies
continue to violate its provisions - see examples here. 4ind out how 5aby Milk
;ction works to stop them and how you can help.
In other !ords, Baby Mil+ &ction could be described as a campaigning organisation
!hich sees its role as fighting for !hat it sees as the undeniable good of
breastfeeding. There is an adersarial tone to much of its material, !ith a sense
that it is a small (5- trying to achiee its aims despite !hat it sees as obfuscation
by huge, rich companies such as (estl) and Wyeth.
IB*4N:S Se#en Principles
The right of infants eery!here to hae the highest leel of health.
The right of families, and in particular !omen and children, to hae enough
nutritious food.
The right of !omen to breastfeed and to ma+e informed choices about
infant feeding.
The right of !omen to full support for successful breastfeeding and for
sound infant feeding practices.
The right of all people to health serices !hich meet basic needs.
The right of health !or+ers and consumers to health care systems !hich are
free of commercial pressures.
The right of people to organise in international solidarity to secure changes
!hich protect and promote basic health.
+") 4cti#ities of Bab& Milk 4ction3 IB*4N
$i+e many (5-s Baby Mil+ &ction and IBF&( carry out a number of related
actiities. @o!eer, its ma8or function is the production of regular and detailed
monitoring reports on !hat it describes as =baby mil+* mar+eting throughout the
!orld based upon IBF&(*s global net!or+ of contacts. IBF&(*s most recent
monitoring report !as 5reaking the 9ules! >tretching the 9ules E--,! produced in
May E--,. It !as claimed that this report. =@ocuments how baby food companies
idealise their products! ignoring the negative health impact of artificial feeding:.
Baby Mil+ &ction also carries out political lobbying. It presented the eidence from
its 5reaking the 9ules report atto the @ouse of Commons on /3 May 2EE4. The
meeting !as hosted by $ynne %ones M# !ho has tabled an 'arly Day Motion (a
petition for M#s) calling for the >1 5oernment to support action to end baby food
mar+eting malpractice in the >1 and in other countries. Baby Mil+ &ction stated
that this proposal receied significant support across political parties.
IBF&( and Baby Mil+ &ction also proide e?pert !itnesses to argue its case on a
technical basis. For e?ample it sent a delegation in May 2EE4 to the 5enea
meeting of the World @ealth &ssembly discussing current concerns in infant and
15
young child nutrition. IBF&( e?perts presented eidence on bacterial
contamination of po!dered formula and the increased use of bogus health claims to
promote artificial feeding.
+"+ IB*4N8s Current Monitoring (ocu'ent
The 5reaking the 9ules! >tretching the 9ules E--, 0eport monitored and analysed
the promotional practices of /7 transnational baby food companies and /4 bottle
and teat companies bet!een %anuary 2EE2 and &pril 2EE4. The benchmar+
standards used for measuring mar+eting practices !ere the International Code of
Mar+eting of Breast,mil+ "ubstitutes and subse;uent, releant World @ealth
&ssembly (W@&) 0esolutions. The criteria used in producing this 0eport !ere to
analyse infant mar+eting on the basis of =defending breastfeeding and ensuring
that breast-milk substitutes are used safely! if necessary! on the basis of ade)uate
information and appropriate marketing:.
"ome 3,EEE complaints !ere receied from monitors in 7A countries around the
!orld. &fter legal chec+ing about 2,EEE iolations !ere reported in 5reaking the
9ules and many of these came !ith photos. Jeong %oo 1ean, IBF&(Os $egal &disor
said.
""e have K'E pictures of actual violations in the report. *here is no way
that the companies can deny that they were found in flagrant violation of
the 3ode and 9esolutions."
The main criticisms of the food companies in the 0eport !ere as follo!s.
.4unctional. claims. 3ompanies try to differentiate their formulas by
adding a string of additives and then claiming performance benefits for
these.
4ree and low-cost supplies continue.
+xclusive breastfeeding for D months continues to be undermined by most
companies.
2nformation to health professionals. 3ompanies violate the re)uirement
that this is restricted to scientific and factual matters.
#ealth facilities and health workers continue to be targeted.
>ponsorship of medical seminars! conferences and associations of medical
professionals is becoming more widespread.
+". IB*4N Criticis's of Nestl
The summary of 5reaking the 9ules identifies (estl) as controlling 4EL of the
global baby food mar+et. It goes on.
7*hat dominant position is unfortunately matched with its record as the worst
3ode offender. 2t was the company with the greatest number of reported
violations of nearly all the key provisions of the 2nternational 3ode. 1estl=
maintains it abides by the 3ode but that means it abides by its own in-house
72nstructions: which fall short of the 2nternational 3ode. +ven within its own
narrow interpretation of the 3ode! 1estl= violates several provisions by
promoting infant formula and follow-up formula and by disseminating
information materials which are more promotional than 7scientific and
factual: as re)uired by the 3ode. 2n countries where the 3ode is not enforced
like *hailand and ;rmenia! 1estl= and other companies shower gifts on health
workers and mothers.:
16
5reaking the 9ules has a detailed dossier on (estl) and other infant formula
companies. 0egarding (estl) it ma+es the follo!ing detailed allegations.
a& ;rticles (.' and (., of the 3ode prohibit advertising! promotion! and the
gift of free samples to mothers.
(eertheless, a (estl) distributor is accused of promoting (estl) (an by
the internet in &rgentina. -ther allegations include claims that. a "!iss
supermar+et magaGine promotes (estl) Beba 2 and has a picture of a happy
mother and child, and a parents* magaGine in $u?emburg adertises Beba
"ensitie !ith the claim that it is. =nearly lactose free and suitable for
infants !ho are sensitie to lactose*. In Thailand (estl) is accused of
giing out free samples of $actogen to mothers at home.
b& ;rticle (.L of the 3ode bans promotional devices at the point of sale.
(estl) is accused of haing special posters of (an in &rmenia, and of haing
sent out sales reps in China. It is accused of handing out samples of
$actogen and (an/ in shops in Thailand.
c& "#; 9esolution ,K.( %'FF,& urges and end to free or subsidised donations
to products to all parts of the health care system.
It is alleged that (estl) donates unsolicited (an / formula in China, and
gies free samples of (an "oya to mothers in &rgentine health facilities. It
proides free samples of $actogen / and (an/ to health facilities in
Thailand, and actiely promotes (an / and $actogen / to pregnant !omen
there.
d) 3ode ;rticle K.L prohibits financial or material inducement to health
workers.
It is alleged that (estl) gies free gifts of (estl) mouse pads and diaries to
health !or+ers in Colombia and Costa 0ica. The 0eport states that in
&rmenia (estl) gies free baby suits to hospitals !ith the !ords =I loe my
mum*, ne?t to a (estl) logo. In Indonesia it is accused of distributing
posters, diaries, calendars, stationery, and materials on infant care to
health facilities !hich are displayed in !aiting rooms and doctors* offices.
e) ;rticle F of the 3ode re)uires labels 1$* to discourage breastfeeding! and
to inform about the correct use of the product and the risk of misuse.
The 0eport accepts that in most deeloping countries (estl)*s formula
labels do comply !ith the Code*s re;uirements, but =in small print*.
@o!eer, it accuses the company of repeatedly iolating &rticle A by
ma+ing !hat it calls* idealising statements*. For e?ample, in China (estl)
(an / labels say. 73hoose )uality food! choose 1estl=:. The Finnish label
for (an claims that it can. 7be used from birth as an addition to breast-
milk! or to substitute it:. In "outh &frica, the $actogen / label is alleged
to imply the product has the same benefits as breast,mil+ by the claim that
it. =#as all the vitamins and minerals re)uired by an infant for growth and
development.
f) ;rticle ,.E of the 3ode prohibits information material to have text or
pictures which idealises the use of breast-milk substitutes. ;rticle K.E
only allows product information which is factual and scientific.
5reaking the 9ules notes that most (estl) materials are mar+ed =for the
medical profession*, but accuses them of failing to meet the re;uirements
of articles 4.2 and F.2. In &rgentina the company is accused of promoting
(an in professional 8ournals in idealistic terms, e.g. 7closest to mother:s
milk at lowest price:. & poster at a paediatric congress in &rgentina had
the slogan. 7*he most intelligent choice when it is necessary to replace
17
breast-milk8 so intelligent that it even prepares itself.* In &rmenia a
(estl) hospital leaflet is alleged to claim that (an is a fully adapted infant
formula, and is close to human mil+ in content and digestibility.
%g& "#; 9esolution (,.E %E--'& recommends exclusive breast feeding for six
months.
5reaking the 9ules !elcomes the fact that (estl) is the only infant formula
manufacturer to agree to change its labels in response to the aboe
recommendation. @o!eer, the 0eport alleges that although (estl)
claimed to be fully compliant !ith the recommendation by &pril 2EE3, in
fact there !ere seeral e?amples of it not doing so.
(estl) has not produced a formal response to the 5reaking the 9ules report,
although one is e?pected later in the year. @o!eer, they hae shared their
preliminary conclusions !ith us. The company notes that although the report is
dated 2EE4, many of the allegations are ery old, some going bac+ to the /AAEs.
(estl) has inestigated all 2EE allegations of Code iolation in the report. They
state that of these.
HH cases sho!ed no Code iolation, as they concerned complementary foods
!here the Code does not apply:
4E !ere based upon mista+en data:
4H !ere based upon insufficient data to ma+e an accurate assessment
possible. The company apparently inited IBF&( to supply more
information on these cases, but this did not arrie.
/F had some 8ustification, and referred to leaflets sent to healthcare
professionals in "outh &frica and Thailand. The company claims that it
immediately tightened up the information on these labels.
2 concerned infant formula in &rmenia, !here a poor translation from
0ussian had resulted in a technical code iolation:
/ !as a similar mis,translation in $ithuania.
(ote. IBF&( has receied and responded to detailed comments from (estl) and the
response is aailable. It is interesting that (estl) only raised ;uestions oer 3HL of
the iolations in the Brea+ing the 0ules report, suggesting that it accepts the
remaining 72L are iolations. (estl)*s assertions aboe do not stand up to scrutiny
as the full response demonstrates.
+"1 ,he Nature of the (ebate bet$een Nestl and Breast-Milk Ca'paigning 0roups
-ne of the difficulties that ma+e it hard for an independent obserer to come to
any conclusion about (estl) and infant formula mar+eting is the high leel of
emotion displayed by both parties. It seems fair to state that both (estl) and Baby
Mil+ &ction passionately feel that they are morally right, and hae a high degree of
suspicion about the other. Indeed, the CFB understands that for many years (estl)
e?ecuties refused to share a platform !ith Baby Mil+ &ction. &pparently, this
policy changed in 2EE/ and (estl) has since participated in many debates !ith Baby
Mil+ &ction.
We suspect that there may be a tendency for (estl) e?ecuties to dismiss any
accusation made by Baby Mil+ &ctionCIBF&( on the grounds that this is a pressure
group !hose !hole e?istence depends upon haing corporate targets such as (estl)
to attac+. -n the other hand some of Baby Mil+ &ction*s literature !ould seem to
18
feed such suspicions in ie! of its highly partisan language, !hich seems to suggest
that Baby Mil+ &ction regards (estl) as a ruthless multinational company !hich
see+s to ma?imise profits at the cost of infant lies, and is not aboe deceit to
coers its trac+s. &n e?ample of this rhetorical tone is sho!n by an e?tract from a
Baby Mil+ &ction leaflet belo!.
71estl=.s idealising leaflets in +gypt and Cietnam
"e exposed 1estl= leaflets in Cietnam and +gypt which promote 1estl= infant
formulas in an idealising way. "e also exposed a 1estl= advertisement in >outh
;frica which encouraged mothers to attend talks on the .1estl= @evelopmental
1utrition Hlan. given by the .1estl= 5aby-3are 4riends..
*he response below was sent to 5aby Milk ;ction four months after we wrote to
1estl=. 2t is likely that we have only received a response as members of the public
have also complained to 1estl=! prompted by our 3ampaign for +thical Marketing
action sheet.
0nfortunately the response from 1estl=.s >enior Holicy ;dvisor! 5everley Mirando!
demonstrates either ignorance or deliberate dishonesty about the provisions of the
3ode and 9esolutions. ;t present the company has no intention of stopping these
violations. Hlease keep up the pressure on 1estl= to abide by its responsibilities
by supporting our letter-writing campaigns and the 1estl= boycott.
5aby Milk ;ction has defeated 1estl= in a series of public debates. 2f 1estl=
attempts to speak at your college or organisation! feel free to invite 5aby Milk
;ction to come to debate with 1estl=. 2n the past 1estl= refused to even speak if
we were present in the room! but thanks to pressure from the boycott has backed
down from this position.
4or updates on the boycott see the 5oycott 1ews supplement to our 0pdate
newsletter. ;lso see the <atest 1ews section.
*he boycott has been launched by national groups in ;ustralia! 5ulgaria! 3anada!
3ameroon! 4inland! 4rance! Mermany! 2reland! 2taly! <uxembourg! Mauritius!
Mexico! 1orway! Hhilippines! >pain! >weden! >witzerland! *urkey! 06 and 0>;&.
*he boycott will continue until 1estl= abides by the 2nternational 3ode and
subse)uent "orld #ealth ;ssembly 9esolutions in policy and practice.*
+"5 Relations bet$een Nestl, and -N bodies like 6/O and -NICE*
This polarised and highly controersial debate does not 8ust occur bet!een (estl)
and Baby Mil+ &ctionCIBF&(. 0elations also appear strained bet!een the company
and >(IC'F. For e?ample, in /AAF (estl) Chief '?ecutie #eter Brabec+ fle! to
(e! Jor+ in an attempt to come to agreement !ith >(IC'F on W@- Code
interpretation. #ress reports state that >(IC'F Director Carol Bellamy !al+ed out
of the meeting half!ay through, and her deputy refused to discuss @IB, instead
haranguing Brabec+ oer (estl)*s faults. 0elations bet!een (estl) and >(IC'F
seem to hae been e?tremely poor eer since. (estl) sources suggest that the press
reports !ere e?aggerated.
7Mrs. 5ellamy did not voice any criticism of 1estl= at the meeting! but rather
listened! then was called out for a telephone call in mid-meeting. >he sent a
letter to Mr. 5rabeck afterwards closing the door to future dialogue! saying
that the differences between the organisations regarding "#$ 3ode
interpretation were too great to warrant further discussion. #owever! in spite
of these differences! the previous active conflict between 0123+4 and 1estl=
has been relatively dormant in the past L years.:
19
-n the other hand, (estl) has had a positie !or+ing relationship !ith the W@-
and F&- on food safety, helping to design and fund for the past /E years a food
safety education programme for health professionals in &sia. & senior (estl)
manager seres as Bice Chair of this. In addition on the obesity issue, #eter
Brabec+ !as one of t!o C'-*s to accept the then W@- Director 5eneral*s initation
to the first C'- roundtable !ith the food industry on obesity and (estle has had
constructie dialogue !ith W@- eer since. &lso the 'uropean Food Industry*s Tas+
Force, chaired by (estl), !as the first industry body to come out in support of the
W@- global "trategy on Diet, #hysical &ctiity and @ealth.
(ote. The Methodist Church !as directly inoled in the monitoring report Crac+ing
the Code, published in %anuary /AAF !hich found =systematic* iolations by (estl)
and other companies. (estl) also attac+ed the report as biased.
+"7 %e& points of Bab& Milk 4ction8s Nestl Criticis's
Baby Mil+ &ction*s criticisms of (estl) can be classified into t!o types. The first
are factual e?amples produced by IBF&( !here the company appears to be in
breach of basic Code principles through actions such as proiding free infant
formula samples to pregnant !omen or nursing mothers.
@o!eer, the second type is based upon Baby Mil+ &ction*s ery different
interpretation of the role, nature, and scope of the International Code compared to
(estl).
>tatus of 3ode. Whereas (estl) sees the Code as consisting of adisory
recommendations to goernments, Baby Mil+ &ction regards it as haing the
status of a global ruleboo+. Is the Code a global minimum standard, or are
formula manufacturers able to !or+ !ith local goernments to meet their
local needsM
(ote. Baby Mil+ &ction is mandated by &rticle //.4 of the International Code, !hich states.
1ongovernmental organisations! professional groups! institutions! and individuals
concerned should have the responsibility of drawing the attention of manufacturers or
distributors to activities which are incompatible with the principles and aim of this 3ode!
so that appropriate action can be taken. *he appropriate governmental authority should
also be informed. This does not state that the Code should be used as the reference in
some countries and not others, nor does any other 0esolution.
"imilarly, &rticle //.3 of the Code states. 2ndependently of any other measures taken for
implementation of this 3ode! manufacturers and distributors of products within the scope
of this 3ode should regard themselves as responsible for monitoring their marketing
practices according to the principles and aim of this 3ode! and for taking steps to ensure
that their conduct at every level conforms to them.
Meographical 9each of 3ode (estl) beliees the Code sets out minimum
standards in all deeloping countries. Baby Mil+ &ction argues that it
applies uniersally. What happens !hen local goernments implement
legal re;uirements different from the CodeM Is it desirable, or unnecessary
for the Code to be incorporated in each country*s legislationM
Baby Mil+ &ction and IBF&( !or+ to bring the Code and 0esolutions into legislation N it is
perhaps their main actiity. @o!eer, &rticle //.3 continues to apply. Its !ording is ery
clear independently of any other measures taken for implementation of this 3odeA
0esolution 34.22 under !hich the Code !as adopted describes it as a =minumum*
re;uirement to be implemented in its =entirety*.
20
<imitations on 3ode. (estl) argues that !hile the Code refers to =all
countries*, this is in the conte?t of the possibility of =infant malnutrition,
morbidity and mortality*. "ince the latter conditions do not arise in
deeloped countries, the Code only applies to deeloping countries. -f
course, deeloped countries such as the >1 tend to hae their o!n detailed
codes for mar+eting of infant formulas in hospitals.
(ote. (estl) has no basis for ma+ing this claim. In doing so, it is not at odds !ith Baby Mil+
&ction, it is at odds !ith the World @ealth &ssembly. The Code directs goernments to
>(IC'F for assistance in introducing the Code into legislation. >(IC'F employs a $egal
-fficer for this purpose. >(IC'F has made it clear in !riting to (estl ) that the Code
applies to all countries, not to (estl)*s o!n list of countries.
;pplication of 3ode to @eveloped 3ountries. (estl) argues that selling
infant formula in deeloped countries in !ays not compatible !ith the Code
is therefore acceptable. Baby Mil+ &ction on the other hand argues that
this sho!s that (estl) is in breach of it, and is particularly critical of infant
formula mar+eting in the >" and Canada. (5ien the po!ers of the FD& in
the >", and the tendency of the >" courts to ley large fines, it is arguable
that these countries can loo+ after themseles).
(ote. There !as a oluntary ban on adertising in the >" until (estl) entered the mar+et in
/AHH !ith its ta+eoer of Carnation. (estl) sued the &merica &cademy of #ediatrics and
the other baby food companies under anti,trust legislation and began adertising
unilaterally. (o! all companies adertise. The >" has supported the Code and 0esolutions
since /AA4 and &rticle //.3 applies there as much as any!here else.
@efinition of 5reast-milk >ubstitutes. In (estl)*s understanding the Code
only applies to breast,mil+ substitutes, such as starter infant ,formula (E,7
months). In Baby Mil+ &ction*s opinion it applies to all products that might
replace breast feeding, !hich includes not only formula but complementary
foods such as fruit 8uices, and infant cereals under certain circumstances.
(ote. (estl) repeatedly refers to the Code applying only to starter infant formula
(for e?ample, its =Charter* sets out its =Infant formula mar+eting policy for
deeloping countries). The "cope of the Code is clear. 9The Code applies to the
mar+eting, and practices related thereto, of the follo!ing products. breastmil+ substitutes,
including infant formula: other mil+ products, foods and beerages, including bottle,fed
complementary foods, !hen mar+eted or other!ise represented to be suitable, !ith or
!ithout modification, for use as a partial or total replacement of breast,mil+: feeding
bottles and teats. It also applies to their ;uality and aailability, and to information
concerning their use.<
@efinition of ;dvertising. There are also highly technical disputes bet!een
the t!o sides about the Code ban on the public adertising of infant
formula. (estl) argues that the Code allo!s it to put nutritional
information about its infant formula on the side of formula pac+ets,
!hereas Baby Mil+ &ction accuses it of promotional material =idealising*
breast,mil+ alternaties. There are e?tremely technical arguments about
the nature of material on infant formula pac+aging, i.e. is its role to adise
physicians, or is it trying to unduly influence ne! mothersM
(ote. This confuses different issues. This is not about a definition of adertising. The Code
is actually ;uite clear and addresses issues separately. The issue of information on labels is
separately and clearly defined in &rticle A of the Code. #romotional materials are different
again. The should be no promotion to the general public, under &rticle 6 of the Code.
Information to health !or+ers must be restricted to scientific and factual matters, under
&rticle F, and there are often concerns that (estl) materials do not comply. "ee+ing direct
21
and indirect contact !ith pregnant !omen and mothers of infants and young children is
banned under &rticle 6.
." *,SE. 0ood
."! Role and (escription of *,SE.0ood
The FT"'45ood "0I inde? series incorporates breast,mil+ substitutes as one of its
+ey ethical criteria. It therefore proides some independent assessment of this
contentious area.
FT"'45ood is a family of "0I or ethical stoc+ mar+et indices !hich !as launched in
%uly 2EE/. FT"' recognised the need for a partner to add "0I e?pertise to its o!n
s+ills in inde? construction, so the FT"'45ood inde? series !as therefore created in
association !ith 'I0I". The underlying concept !as to construct a broadly based
"0I inde? for a number of regional mar+ets. the >1, >": 'urope, and the !orld,
!ith the ob8ectie of producing a benchmar+ to measure "0I fund performance in
these regions. The follo!ing e?clusions !ere then used to filter out unacceptable
companies. tobacco producers: companies proiding strategic parts or serices or
manufacturing nuclear !eapons systems: manufacturers of !hole !eapons systems,
and o!ners or operators of nuclear po!er stations and those mining or processing
uranium. The basic philosophy underlying the inde? !as to include only companies
moing to!ards best practice in the areas of the enironment, human rights, and
sta+eholder relationships.
.") ,he Role of -NICE*
&gainst the bac+ground of the dispute oer the mar+eting of infant formula it is
important to note that the >nited (ations Children*s Fund (>(IC'F) agreed to be
associated !ith FT"'45ood in return for the right to nominate three members of
the &disory Committee. >(IC'F also gained the commitment of FT"' to pay it all
the net license income FT"' receied from its clients in the first t!ele months of
operation, as !ell as a 6Ep charge on each trading screen sho!ing the data. FT"'
International hoped that this !ould generate reenues estimated at P/m (Q7EE,EEE)
for donation to >(IC'F.
."+ *,SE.0ood8s Changed Criteria Relating to Infant *or'ula
From its inception in %uly 2EE/ the FT"'45ood inde? series e?cluded on ethical
grounds eight food and pharmaceutical companies producing breast,mil+ substitutes
on the grounds that they !ere in breach of the International Code of Mar+eting of
Breast,Mil+ "ubstitutes. These companies !ere. &bbot $abs: Bristol Myers ";uibb:
@einG: Mei8i Mil+: (estl): (oartis: (utrimco, and Wyeth.
@o!eer in March 2EE4 the FT"' 5roup announced that it !as lifting its blan+et ban
on such companies follo!ing an e?tensie process of public consultation.
FT"'45ood stated that from no! on it !ould use =measurable inclusion criteria.*
The announcement stated:
74*>+ will establish a small +xpert 3ommittee! comprising academics and
experts on the industry! which will review company reports to assess whether
they adhere to the 4*>+,Mood criteria and to make recommendations to the
4*>+,Mood Holicy 3ommittee as to the continuing eligibility of companies.:
&s at -ctober 2EE4 the CFB inspected list of the companies included in the
FT"'45ood, and it found that none of the eight !as included in that list, despite
the recent reision to FT"'45ood*s breast,mil+ substitute criteria. @o!eer, it is
possible that >(IC'F*s influence has preented FT"'45ood from doing so.
22
(ote. The reason (estl) and other companies are e?cluded is because they ery
clearly fail to comply !ith the inclusion criteria. For e?ample, companies hae to
hae a policy accepting that the Code and 0esolutions apply to all countries
(including the >" and Canada) and all breastmil+ substitutes, not 8ust infant
formula.
1" ,he Methodist Church Position
1"! /istor& of Methodist Church position on 'arketing of breast-'ilk substitutes
In /AA2 the Methodist Conference adopted Memorial /E/, 0nethical Marketing
Methods! !hich urging Methodists to inform themseles about the issues inoled
although the Conference declined to support a boycott of (estl) products. & ma8or
paper discussing the !hole sub8ect of breastfeeding !as brought to the /AAA
Conference (Conference &genda /A) called "hat:s 5est for 5abiesN The /AAA
Conference approed three related resolutions.
!;3! Conference receies the report and encourages local churches and
Methodist groups to study all the issues and to act accordingly.
!;3) Conference calls on @er Ma8esty*s 5oernment to incorporate into
legislation the proisions of the W@- Code and the subse;uent resolutions
of the World @ealth &ssembly, and monitor their application in the (@".
!;3+ Conference encourages Methodists in Britain to support the Baby Friendly
@ospital Initiatie, and further encourages Methodists in conersation !ith
partner Churches oerseas to support BF@I in many countries of the !orld.
1") Methodist Council <)=
The Methodist Council, the e?ecutie body of the Methodist Church, !as concerned
that the /AAA resolution =left the 3onference:s position uncertain:. It therefore
submitted a report to the 2EEE Methodist Conference called "hat:s 5est 4or
5abiesN (Methodist 3ouncil E). This report !as receied by the 2EEE Conference,
therefore becoming the definitie statement of the Methodist Church*s position on
the issue. This paper noted the follo!ing (the follo!ing numbers refer to the 2EEE
Conference &genda).
L. There is no conincing eidence !hich points to an accommodation,
understanding or agreement bet!een Baby Mil+ &ction (Baby Mil+ &ction)
and (estl) in the foreseeable future.
,. The British Methodist Church has no !ay independently of ad8udicating on
the ongoing disputes bet!een Baby Mil+ &ction and (estl). It remains
un!ise for the Church to be aligned une;uiocally !ith one side or other.
The church needs to be in a position !here it can e?ercise a critical role
to!ards both parties to the dispute, and e?press its an?ieties about the
behaiour of both.
6.E The irreconcilable conflict bet!een Baby Mil+ &ction and (estl) has seeral
dimensions to it.
5.1 The W@- International Code of Mar+eting of breast,mil+ substitutes is
designed to protect mothers and health !or+ers from commercial
pressures. The W@- has proo+ed many interpretations, not to mention
the relationship bet!een the Code and subse;uent resolutions of the World
@ealth &ssembly. -n the one side are those !ho insist that the Code must
be applied in eery conte?t, irrespectie of national la!. -n the other are
those !ho insist that the Code re;uires its claims to be incorporated by
each goernment into national legislation in realistic and achieable !ays
appropriate to their conte?t.
23
(.E The disputes about the sort of eidence !hich might constitute a breach of
the Code, and the means by !hich eidence is to be tested to assure its
reliability and truthfulness.
(.L The failure of international bodies to !or+ together to!ards a common
frame!or+ of understanding.
(., The confusion bet!een mista+es, inade;uacies of management action and
intentional malpractice measured against the proisions of the W@- Code.
1"+ Outco'e of )999 Conference
The 2EEE Conference.
+13! 0eceies the report.
+13) For the sa+e of clarity, the Conference records the follo!ing 8udgements.
2./ In the light of the Christian 5ospel, the health, nurture and deelopment of
ery young babies and their mothers merits the prayerful and practical
support of Methodists.
2.2 The Conference is not aligned !ith either side in the disputes bet!een
Baby Mil+ &ction and (estl), !hich hae been going on for more than 26
years: the Conference encourages Methodists, local churches and Methodist
groups to study all the issues and to act accordingly.
E.L The Conference endorses continuing constructie engagement by members
of the Conne?ional team !ith both (estl) and Baby Mil+ &ction.
5 Other Ethical Issues concerning Nestl
5"! Ethiopia
Many people !ere shoc+ed to read in the financial press in 2EE/ that (estl) !as
suing the goernment of 'thiopia, one of the poorest countries in the !orld, for
damages of P7m relating to nationalisation in the /AFEs. In December 2EE2 (estl)
C'- #eter Brabec+ announced that the dispute had been settled for a total sum of
P/.6, !hich !ould be distributed to humanitarian organisations for famine relief in
'thiopia.
(ote. &s an interesting footnote, on H May 2EE4, (estl) (>1) C'- &lastair "y+es
!rote to the national press denouncing a decision by Brea+through Breastcancer to
turn do!n a Q/ million cause,related mar+eting deal !ith (estl) on ethical
grounds. In the letter Mr. "y+es, claimed (estl) abided by the baby food mar+eting
re;uirements and !as a force for good in the !orld. &s an e?ample of its
humanitarian !or+ Mr. "y+es referred to the donation to 'thiopia, neglecting to
mention the -?fam campaign that prompted the company to donate the money
bac+ rather than fight for and +eep a larger sum.
5") Coffee Prices
In the /AAEs and early 2EEEs global coffee prices plummeted causing great
economic distress in particular to small coffee farmers. This !as due to a serious
oer supply caused among other things by e?pansion of large,scale coffee farm
operations in BraGil and Bietnam. In the late /AHEs unroasted coffee beans reached
P3.3E a lb, but by 2EE3 the aerage price receied by coffee farmers had fallen to
PE.7E a lb, !ell belo! the global aerage production cost of PE.HE lb. For seeral
years groups li+e Traidcraft hae promoted Fairtrade ground coffee brands such as
Caf) Direct !hich are produced on the basis of ensuring that their producers
receie a price !hich gies them a liing !age, and enables them to care for the
24
enironment. Caf) Direct has done !ell in the >1 ground mar+et, !ith a claimed
mar+et share approaching /EL.
@o!eer, the ast bul+ of global coffee production is used in instant coffee, !hich
is dominated by t!o companies. 1raft (Ma?!ell @ouse), and (estl) ((escafe),
although the >" food group "ara $ee has a significant presence in the ground coffee
mar+et. (estl) is the !orld*s single largest coffee buyer, !ith a global mar+et
share of /4L. In response to the global coffee crisis, arious organisations hae
announced that they !ould sell Fairtrade coffee. In 2EE2 the large caf) chain
"tarbuc+s announced that they !ould promote Fairtrade coffee. In May 2EE3 the
!orld*s largest coffee bro+ers, (eumann and Bolcafe announced an agreement !ith
the >",based 0ainforest &lliance !ith the aim of stimulating the production of
=sustainable coffee*, defined as coffee plantations !hich meet basic enironmental
and social re;uirements. &t the end of 2EE3 1raft announced plans to sell
sustainable coffee, but to date (estl) does not appear to hae done so.
-n the other hand, the company is a member of the "ustainable &griculture
Initiatie and has set up a number of sustainability pro8ects !or+ing !ith small
farmers in Central &merica and &frica. (estl) argues that the concentration on
=Fairtrade* coffee is misleading, as this is only a minute fraction of the total
mar+et. It beliees that its policy of buying more coffee directly from farmers, i.e.
bypassing coffee bro+ers, is more effectie in enabling more of the price to be
passed bac+ rather than being dierted to middle men. The groups* C'- #eter
Brabec+ has lobbyied for structural change in the mar+et place to ease commodity
price fluctuations. Further (estl) ma+es appro?imately half of all (escafe in the
deeloping !orld thus ensuring more of the added alue remains in those countries.
(ote. (estl) often ma+es the point about buying coffee directly from gro!ers, but buying
directly is not the same as paying a fair price. (estl) has opposed independent monitoring
of its procurement policies 8ust as it opposes independent monitoring of its baby food
mar+eting practices.
5"+ Cocoa Plantations
In 2EE2 serious and documented allegations emerged that some cocoa, the base
material for chocolate production, !as being produced in West &frica using slae
labour, often children. In -ctober 2EE3 (estl) put out a statement, 3oca "orking
Hractices! !hich stated that.
71estl= does not own cocoa farms or plantations in "est ;frica. 1evertheless
1estl= is committed to ensuring that coca is grown without the worst forms of
child or forced labour. ;s part of our commitment! we have partnered with
the global chocolate and cocoa industry and 1M$s in an international protocol
that lays out a series of action steps designed to ensure that cocoa is grown in
a responsible manner.:
5". Obesit&
In the >nited "tates the food industry seems to be increasingly targeted by la!suits
alleging health damage through obesity. "uch la!suits seem modelled on those
filed earlier against the tobacco industry. In the >1 there is increasing concern
that the >1 population, li+e those of many other deeloped countries, is copying >"
trends !here the ma8ority of the adult population is oer!eight, and a significant
proportion seriously obese. -besity is lin+ed to a ariety of health problems such
as heart disease and diabetes.
This problem is perhaps most serious !hen it inoles children. Children in the >1
eat less than half the recommended amount of fresh fruit and egetables each day
and the proportion of primary school children !ho are oer!eight doubled bet!een
/AH4 and /AAH to reach 26L. In turn this has been lin+ed to gro!ing diagnosis of
25
Type 2 (late onset) diabetes in children, something preiously normally e?perienced
in late middle age. Many health charities are concerned that confectionery
companies are partly to blame for this problem. (There !as a ma8or public
controersy in the >1 in May 2EE3 !hen the >1 chocolate company Cadbury*s 5et
&ctie mar+eting campaign encouraged children to get sports e;uipment for their
schools by saing chocolate !rappers. It !as estimated that children had to eat
/7E million bars of chocolate to get e;uipment !orth QAm). &t that time
Dr Wendy Doyle of the British Dietetic &ssociation called for the British 5oernment
to introduce regulations restricting food adertising aimed at children, as is the
case in "!eden. "he said.
7*hese big food companies have these huge budgets to promote all these
things to children. 2 am sure it is having an impact - the manufacturers
wouldn:t do it if it did not. 5ecause of the problem of obesity! the
Movernment has to take an active step to stop children being targeted by
advertising.:
(estl), li+e Cadbury, has a range of initiaties aimed at schools. It has supported
grass roots tennis for oer 4E years. More recently it has funded through 4Children
the creation of oer 7EE Ma+e "pace contemporary youth clubs and hae helped set
up sporting actiities through these clubs. It a!ards the (estl) "marties Boo+ #riGe,
for children under //. It sponsors the schools publication 1ey "+ills in Conte?t,
!hose section on =(utrition* does not !arn about the dangers of eating too much
chocolate or s!eets. -ther (estl) material states.
7*he good news is that sensible snacking can play a very important role in a
healthy diet and healthy lifestyle. 2n fact! some experts theorise that our
bodies were meant to eat this way. 3urrent research suggests that having
numerous smaller meals over the course of the day helps to keep your blood-
sugar levels on a more even keel.:
-n the other hand (estl) does state its commitment (1estl= and 1utrition, 2EE3)
to.
79esponsible advertising and marketing to children! and we have internal
marketing codes to formalise that commitment. "e adhere to voluntary
guidelines! such as the 2nternational 3hamber of 3ommerce 9ules on 3hildren
and Boung Heople and Marketing.*
In this conte?t it is !orth noting that (estl) is one of the !orld*s leading food
companies in terms of funding research and deelopment to design healthier foods.
The company has pioneered a range of products such as ="eltesse* that either hae
lo!er calories, or can assist in !eight reduction. It is also a pioneer of foods that
may hae positie effects on health, the latter sometimes being called =functional
foods*. & good e?ample !ould be =probiotics* i.e. yoghurts containing natural
bacteria that actually inhibit the gro!th of harmful bacteria in the stomach such as
#elibacter pyliori !hich are lin+ed to the deelopment of ulcers. -er the past 6
years (estl) has deeloped or reformulated oer FEE products globally to lo!er fat,
sugar and salt. In the >1 that has included the remoal of TF&s from confectionery
products, salt reduction in cereals and in soups and sauces.
(ote. (estl) targets schools in a ma8or !ay, not only !ith ending machines, but schemes
intended to encourage children to buy confectionery and cereals, many of !hich are high
salt and high sugar. For e?ample, it has a =bo? tops for education* scheme !here it
donates /E pence to the school in return for cereal tops.
5"1 0M *oods
There is a !ide gulf bet!een the >", !here 5M foods appear to be !idely
26
accepted, and 'urope !here they are regarded !ith great suspicion by the ma8ority
of consumers. Indeed, 5M foods !ere banned by the 'uropean Commission until
the >" goernment forced the '> to drop this ban under WT- trade rules. (estl)
has stated that it !ill use 5M foods !here permitted, and if customers !ant them.
(ote. 5reenpeace has publicised that despite promises to the contrary (estl) foods in
'urope and China (including baby foods) hae been found to contain 5M ingredients.
5"5 6ater Misuse
5lobalisation has led many multinational companies to significantly e?pand the
scale of their operations in deeloping countries. In the food industry, there are
gro!ing concerns that soft drin+ companies may be digging !ells that drain the
local !ater table. For e?ample, in %anuary 2EE4 Christian &id published a report
entitled 5ehind the Mask- the 9eal 4ace of 3>9. 5ehind the Mask accused Coca,
Cola of staring Indian illagers of !ater in the southern Indian state of 1erala,
!here !ells are failing to +eep up !ith the demand. This is particularly
deastating in a community that is mostly dependent upon agriculture. It stated
that illagers are demonstrating outside the company*s bottling plant in
#lachimada.
There is a similar controersy inoling (estl) in BraGil. It is alleged that a (estl)
plant is depleting an a;uifer in a historic spa to!n in that country. In -ctober 2EE4
a group of Catholic and #rotestant clergy isited the 'uropean "ocial Forum on
Water complaining about (estl). @o!eer production ceased on -ctober 3/
st
2EE4.
In addition e?tractions !ere belo! the limits set by the authorities. Further the
authorities conducted tests, !hich found e?tractions to be sustainable, and !ith no
proen lin+s bet!een (estl)*s operations and the allegedly declining !ater leel in
other springs in the area.
(ote. The latest ne!s from BraGil is that it is not yet clear if (estl) is stopping its
operation. In addition, (estl) attempted to go bac+ on the agreement it made !ith the
8udge that heard the case against the construction of its bottling plant and illegal de,
mineralisation of !ater. & public hearing !as held in the @ouse of 0epresentaties !here
(estl) indicated it did not !ish to close its bottling plant. It !as told it had to honour the
agreement made !ith the court. (estl) has since bought !ater par+s in neighbouring spa
to!ns. -ne of the springs in the spa to!n has already dried up.
There !ill be the opportunity to meet campaigners from BraGil. Contact Mi+e Brady of
Baby Mil+ &ction for details.
No#e'ber )99.
27