Nestlé – the baby killer?
Niharika Lal writes on the evidence for the impact of Nestle’s corporate practices on infant health.
A great variety of factors can influence a mother’s decision of whether to breastfeed or not. Perhaps one of the more controversial factors is the influence of powdered milk-manufacturing companies and their advertising campaigns. The company that dominates this industry is Nestlé. It controls approximately 40% of the market and is by far the main supplier of powdered milk to the developing world. (1)
By using powdered milk instead of breastfeeding, the baby is denied its maternal antibodies, which are essential in building an immune system effective enough to ensure survival in developing countries. In addition, powdered milk is expensive, forcing women to over-dilute it in order to make supplies last longer. This, in turn, depletes the nutritional content of the resultant formula. Families are led into further poverty as the mothers’ own nutritious breast milk dries up, leaving them no choice but to buy powdered milk products. The reason behind this cascade of events is that women are led to believe that their own breast milk is inferior to powdered milk products.
WHO states that the death of around 1.5 million infants per year is due to being deprived of breastfeeding. This figure can increase up to 25 times in areas of unsanitary water, particularly developing countries. (2) In fact, 13% of all deaths of infants under the age of 5 worldwide could have been prevented if the infants had been exclusively breastfed in the first 6 months of their lives. Instead, babies receive over-diluted formula consisting of dirty water and providing insufficient nutrition. Taking into account the fact that the babies have poor immunity due to deprivation of maternal antibodies, it is not surprising that the main cause of death in bottle-fed infants is diarrhoea – infants who have not been breastfed are seven times more likely to suffer from it. (3)
This increase in infant mortality is at least partly due to the malpractice of companies like Nestlé, resulting in a global boycott being initiated in the USA in 1977 by Infant Formula Action Coalition (INFACT). By 1983, the boycott had spread to involve New Zealand, Canada, Australia, the UK, and parts of Western Europe. (4) However, this stopped in 1984 when WHO came up with international guidelines to help regulate the marketing of powdered milk, with which Nestlé was in agreement. These guidelines state how powdered milk products should be marketed, never disputing the fact that breastfeeding is always the best option for child nutrition. After many breaches of these guidelines, the boycott against Nestlé was reinstated and continues until present time. (5)
There have been over 2000 breaches of WHO guidelines in approximately 69 countries, Néstle being reportedly responsible for more of these violations than any other powdered milk company. (1) An example is the absence of adequate health warnings written on the milk products. These may be present in the incorrect language, or not displayed prominently. Nevertheless, the warning is insufficient to alert the customer to the inferiority of the product. In fact, the labels of Nestlé powders found in Egypt frequently use expressions such as “identical to breast milk” or “as in breast milk”. (2)
In 2006, a similar example occurred in Laos, where families were feeding their infants a Nestlé product called Sweetened Beverage Creamer. This is meant for coffee; however, the logo is of a bear cradling its baby. This product was being marketed to an illiterate population, using a logo which was very similar to the one on Nestlé infant formula. (6) A study was carried out to assess the impact that this particular product had on consumers, which found that 96% of consumers believed the product to contain milk, and 46% considered the product to be intended for babies due to the logo present on the packaging. (7)
A multi-site cross sectional survey carried out in West Africa published by the BMJ assessed the compliance of milk manufacturing companies with the WHO guidelines. It was discovered that 14% of hospitals had received free donations of powdered breast milk, and 12% had received free samples. This is in direct violation of the international guidelines. In addition to this, 44% of sales points were marketing breast milk substitutes, which is another violation as it may dissuade young mothers from breastfeeding. Around 40 of the powdered milk products investigated were in violation of the labelling guidelines – 11 of these products were Nestlé’s. Additionally, 66% of mothers had not been adequately educated about breastfeeding. (8) This indicates that, by not adhering to WHO’s international guidelines, companies such as Nestlé are able to mislead people in developing countries into thinking that their products are an option equal, if not superior, to breastfeeding. However, a point worth considering regarding this article in particular is the relatively small sample size – it took into account 106 mothers. Whether this sample group is representative of the whole of West Africa is questionable.
In order to battle the deterioration of infant health in the developing world as a direct result of bottle feeding, UNICEF and WHO have started a movement called the Baby-Friendly Hospital Initiative. This project, launched in 1991, targets hospitals in the developing world, encouraging them to comply with WHO international guidelines. Breastfeeding is encouraged, and the staff and young mothers at the hospital are educated about it, increasing the likelihood of babies receiving breast milk. (9)
This movement has been successful. In Gabon, located in west-central Africa, rates of neonatal diarrhoea have decreased by 15% in the first 2 years of implementation of the Baby-Friendly Hospital Initiative policies. There has also been an 8% decrease in overall infant mortality. Similarly, in Cuba, most hospitals have adopted the Initiative policies, resulting in breastfeeding rates increasing threefold from 25% to 72% in 6 years. In rural China, breastfeeding rates have increased from 29% to 68% in two years, and in urban areas, the rise has been from 10% to 48%. (9)
In attempt to lift the worldwide boycott of the company, Nestlé has acknowledged on its website the fact that breastfeeding is the best option for child nutrition. (10) In this sense, Nestlé is promoting breastfeeding and is aiding in educating the world about its health benefits; yet it continues to violate WHO guidelines. It is possible that the company is trying to redeem itself by what is written on its website, but is still continuing to violate the WHO international code, presumably hoping that it will not be widely publicised.
Whenever Nestlé has been confronted by these violations of the international guidelines, it has apparently refused to comment, or even denied the accusation (for which there is usually indisputable evidence). In 1997, a former employee of the company released internal documents which were evidence of its breaches of WHO guidelines. These offered proof that Nestlé had been marketing its products to mothers, supplying free samples of formula, and giving gifts to doctors in return for promotion of Nestlé products – all of which are in violation of the international marketing code. Nestlé denied accusations of malpractice. (11)
There have been numerous occasions when organisations such as Baby Milk Action have challenged Nestlé to debates, which could be seen as an opportunity for the company to admit its mistakes or defend itself publicly, but Nestlé has always declined, according to these organisations. Only recently has the company admitted that it was at fault in the 1970s for malpractice. Families who have lost infants due to not being breastfed as a result of unethical marketing have received no apology from Nestlé, nor have they received any compensation. (12)
Evidence strongly suggests that Nestlé has been violating WHO international code, showing disregard for the health of infants in the developing world. It seems that the boycott against the company will not be lifted in the near future, and organisations such as Baby Milk action will continue to campaign for Nestlé to abide by the rules of the marketing code. In the meanwhile, it is comforting to know that movements such as the Baby Friendly Hospital Initiative are having a positive effect on breastfeeding rates and infant mortality around the world.
Niharika Lal, 4th year medical student at the University of Dundee, UK.
n.lal@dundee.ac.uk
References
1 – Corporate Watch [Online]. Nestlé: corporate crimes. 1996 [cited 2008 June 1]; http://www.corporatewatch.org/?lid=240#babymilk
2 – Mike Brady. Baby Milk Action [Online]. [cited 2008 June 1]; http://www.babymilkaction.org/index.html. Citation on this website originates from WHO data: see the International code of marketing of breast-milk substitutes FAQs 2008 http://whqlibdoc.who.int/publications/2008/9789241594295_eng.pdf
3 – WHO [Online]. Key strategies for promoting breastfeeding. 2007 [cited 2008 June 1]; http://www.wpro.who.int/media_centre/fact_sheets/fs_20070801.htm
4 – Mike Brady. History of the Baby Milk Action campaign [cited 2008 Dec 2]; http://www.babymilkaction.org/pages/history.html
5 – Breastfeeding. The Nestlé boycott. 1998 [cited 2008 June 1]; http://www.breastfeeding.com/advocacy/advocacy_boycott.html
6 - INFACT Canada. Nestlé using deadly labels in south Asia. 2006 [cited 2008 June 1]; http://www.infactcanada.ca/action_alert_May16_2006.htm
7 - Barennes H, Andriatahina T, Latthaphasavang V, Anderson M, Srour LM. Misperceptions and misuse of Bear Brand coffee creamer as infant food: national cross sectional survey of consumers and paediatricians in Laos. BMJ [serial online] 2008 Sept 9 [cited 2008 Dec 2]; 337(1379); http://www.bmj.com/cgi/content/full/337/sep09_2/a1379?maxtoshow=&HITS=1
8 - Aguayo VM, Ross JS, Kanon S, Ouedraogo AN. Monitoring compliance with the International Code of Marketing of Breastmilk Substitutes in west Africa. BMJ [serial online] 2003 Jan 18 [cited 2008 June 1]; 326(7381):127; http://www.bmj.com/cgi/content/full/326/7381/127?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=breastfeeding+powdered+milk+africa&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
9 - UNICEF [Online]. The Baby-Friendly Hospital Initiative. [cited 2008 June 1]; http://www.unicef.org/programme/breastfeeding/baby.htm
10 – Nestlé. Infant and child nutrition. 2008 [cited 2008 June 1]; http://www.nestle.co.uk/Nutrition/InfantAndChildNutrition/
11 – Yamey G. Nestlé accused of breaking international code. BMJ [serial online] 2000 Feb 19 [cited 2008 Dec 2]; 320(468); http://www.bmj.com/cgi/content/full/320/7233/468/a
12 – Mike Brady, Baby Milk Action. Nestlé’s public relations machine exposed [cited 2008 June 1]; http://www.babymilkaction.org/boycott/prmachine05.html
See also this 2007 report “Milking it” in the Guardian