By Patti Rundall
Recently Channel 4’s Dispatches programme, Breastfeeding Uncovered, focused primarily on the lack of support for breastfeeding women in the UK which included a quick look at baby formula marketing.
The programme started by showing painful experiences which were disturbing to watch. It was easy to forget that the majority of women in the world can and do breastfeed with minimal problems. Yet the problems we saw were mostly avoidable and came down to bad advice or lack of appropriate support and the UK’s dismal bottle and formula-feeding culture.
The fact that we assume we need healthcare providers to attach a baby effectively and painlessly to the breast shows how much breastfeeding skill we have lost. Despite the Baby Friendly Initiative and our mother support networks run by local volunteers, or online, our national knowledge about something so basic and important is shocking. But it’s not only our culture. Let’s not forget the role of the baby feeding industry, who, on top of their marketing budgets, pour funds into what they call “education”, the training of UK health workers and parental “advice”, so much of which is misleading. Many key institutions, such as the Royal College of Paediatrics and Child Health and the British Society for Allergy and Clinical Immunology, or the Association of British Dieticians, take funding from formula manufacturers, forgetting that commercial meddling in public health and education carries a significant risk.
The quality of the partnerships or the long-term health outcomes for women, babies and families is rarely independently evaluated. Much of the inept care, misdiagnosis and implied product endorsement, the blanket warning against co-sleeping with your baby, the "hungry baby" and other myths such as that soreness and pain are inevitable in breastfeeding, can be traced, at least in part, to the baby food industry’s door. And this is not unintentional. Indeed, it’s at the heart of a global, centuries old strategy to grow a lucrative market by undermining and destroying breastfeeding. See the article in this Journal by Marta Busquets on the history of formula for more information.
“The US is an approximately $4billion market… I think there were three factors that fuelled our growth and one offset. So let’s begin with the offset. We continue to see breastfeeding rates in the US climb through 2014. Now we’ll be watching very closely to see whether the improvement in unemployment trends will cause this trend to abate somewhat. It’s our hope and expectation that will be the case…”
Kasper Jakobsen, Mead Johnson CEO, Feb, 2015
“We were having a discussion among executives from various areas including India and other executives from Kenya and a small team from Europe [about] the products that would be most penetrative in these marketing areas and it was duly decided that infant baby formula would be probably the most receptive. Mothers are very emotional… We wanted to use a nursing mother with the youngest possible baby...
The strategy was formed around the idea that mothers had better things to do with their time than nurse their babies. And also there was a cosmetic one that was in discussion too. And that was that we were appealing to the idea that if you nursed your babies that you might suffer from what is referred to as ‘bosom sag’ and that this would be obviated of course if you used these marvellous products... I don’t recall anyone ever suggesting that the water be boiled or anything.”
1989 interview with Harry, a retired advertising consultant about advertising project for Nestlé in the mid 1970s.
During the programme, the Dispatches team asked me to look at a range of Infant Formulas, Follow-on Formulas and so-called Growing up Milks that Kate Quigly, the presenter, had just bought. The packaging was covered in idealising images: teddy bears, shields, hearts and claims that were easy to shoot down. What I didn’t expect was Kate to say that she had believed the "specially formulated for your baby" claim – and that maybe the formula was actually better than her own breastmilk. The industry would never admit to making such a claim and I had forgotten how clever and misleading that one is. They are, after all, describing a product that can stay on the shelf for up to two years and is traded globally to millions of parents for babies who live in vastly different environments. The only thing that was "specially formulated" for Kate was the marketing message. This is a tricky thing to say on British TV with so many parents using these products and believing what’s said on the tin.
There were astonished reactions to my statement that none of these products except the infant formulas were necessary, nor are they recommended by the UK or the World Health Organisation (WHO), and that all the formulas for babies over 6 months (products that look almost identical to infant formula) had been invented by the baby food industry with the direct aim of getting round the advertising bans that apply to infant formula. Baby Milk Action and IBFAN (the International Baby Food Action Network) have campaigned against follow on formula since the early 1980s and have followed the bogus industry-funded science and political arguments at EU level. When Prof Michael Crawford at London Zoo analysed follow on formulas for us in 1984, he said they were more like rhinoceros milk than human milk! UK health visitors, alarmed at their composition, said they should be considered a "pudding". Baby Milk Action succeeded in getting the age of use raised from 4 months to 6 months for the UK and the 1986 World Health Assembly (WHA) Resolution said these products were not necessary. But the adoption of the Follow-up Formula Standard (Codex STAN- 156-1987 ) in 1987 ensured their global trade and unlimited misleading marketing ever since. While their composition improved in the EU the marketing got worse and sales boomed. It’s been an amazing success story for pure marketing hype.
Over the years, the WHO has issued several reinforcing warnings, but they issued guidance in 2016 saying that all formulas targeting babies 0-36 months function as breastmilk substitutes and are covered by the 1981 International Code of Marketing of Breast Milk Substitutes and subsequent relevant WHA Resolutions – a clear message that national controls should end this misleading marketing. An important new paper highlighting this issue has just been published by the WHO and UNICEF in November 2018.
So why don’t all governments strengthen their laws and stop this nonsense? What happened at this year’s WHA gives us a very current clue.
A front page, well-researched article in the New York Times, U.S. Opposition to Breast-Feeding Resolution Stuns World Health Officials, followed by 900 social media and 600 editorials, explained the story to millions of readers. The US Government had threatened Ecuador with losing its "most favoured nation status" - as well as US military protection - if they continued to support a Resolution calling for more breastfeeding support and an end to misleading marketing. The New York Times described the US action as "tantamount to blackmail." President Trump’s tweet that this was "fake news" ensured that the story went viral.
No one could believe that a Breastfeeding Resolution – and a mildly worded one at that - could evoke such a fierce response. I had been at the Assembly, knew the key delegates, and a few weeks earlier had been invited by Ecuador to speak about conflicts of interest. So, I knew something of Ecuador’s efforts to get consensus before the WHA and we all thought that this had been achieved. When we arrived at the Assembly and realised what was happening we advised delegates to call for a vote. I remembered that during the 1994 WHA, the USA and EU – supporting their industries – had objected to a Resolution calling for an end to donations and discounted sales of formula to health care systems. At the time, African delegates threatened to call for a roll call (a vote) and all sides withdrew their objections. Global consensus on WHO’s International marketing code was achieved for the first time.
President Trump may be just one person in the long history of opposition to the International Code by US Governments and the baby food industry since 1981, but perhaps by going just that bit too far he may have done us a favour in expanding awareness. Let’s see. At least the USA media has woken up and a new Resolution on breastfeeding has been introduced into the US Congress proposing legislative action in the US at the federal level.
Of course, these political changes extend way beyond infant feeding but we all have a responsibility to stand up to such pressure. We could start by reminding the US population that it was US citizens’ actions through the Nestlé Boycott and the 1978 US Senate Hearings, led by Senator Edward Kennedy that resulted in the adoption of the international marketing code in 1981.
Today, the USA, like the UK, is reducing the care for breastfeeding mothers. But, unlike the UK, the USA is also calling for the wholesale removal and re-evaluation of WHA Resolutions and public health safeguards that WHO, UNICEF, IBFAN and all our partners have helped integrate into food standards and laws over many years. How can one country, especially the one that hasn’t even ratified the Convention on the Rights of the Child (CRC), ignore democratic principles and throw its weight around in this way, forcing developing countries to welcome harmful products, lower safeguards and abandoning their indigenous food cultures? The long-term health implications are immense.
Any strengthening of legislation on nutrition, food safety or child health is on hold because of Brexit. Theoretically UK baby food marketing legislation could be strengthened if we leave, but the safety and human rights safeguards enshrined in EU legislation could be lost. We could be forced to accept imports of formulas made with hormone-laced milk or high in free sugars. Whatever happens, let’s not forget that the baby food industry will do what it can to expand its market, even if this means dismantling vital public health safeguards. Let’s not forget this as we try to protect UK babies, and all those for whom breastfeeding is a matter of survival.
Baby Milk Action continues to rely on its members and donations to ensure that it can continue its work. www.babymilkaction.org
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