Informtional and educational materials for mothers

using such materials as a vehicle for product promotion. Although the Code allows information materials under the above conditions, the overriding principle is that health care facilities are not to be used for promoting products. Hardly any materials available for mothers comply with Article 4.2.

Front and back cover of a Mead Johnson booklet for mothers.

Chart 5 shows in which countries each company distributes informational or educational materials that violate the International Code.

Other companies that violate Article 4 of the International Code include Alter (Spain), Aponti (Germany), Boryung (Korea), Indofood (Indonesia), Milisan (Germany), Nam Yang (Korea) , Pompadour (Spain) and Sandoz (Spain).

Reference to product brand names

In Pakistan, a Meiji FM-T brochure advertises the infant formula on the front cover. Inside, the brochure offers mothers six simple indicators to determine whether or not their breastmilk is sufficient for their babies, such as "breast not full" and "baby is cranky".

This leaflet in the shape of an Enfalac tin is stapled to the inside of booklets distributed to mothers in Thailand. The booklet itself teaches how to diaper a baby. The Enfalac leaflet gives product information and is meant for health professionals.

In Germany, Nestlé advertises Beba infant formulas via a booklet distributed to mothers in health care facilities.

Milupa distributes a booklet in Hungary filled with packshots of all of its infant feeding products from formulas to teas to complementary foods and feeding bottles and teats. The cover design of the booklet is a repetitive pattern of feeding bottles, pacifiers and bowls of porridge. Nutricia/Cow & Gate distributes a leaflet in Hungary, available to mothers, picturing its whole range of infant formulas with packshots and product descriptions.

In the Philippines this Mead Johnson flyer on the topic of lactose intolerance uses the image of a baby sleeping on a pillow inside a pink O, the image associated in the Philippines with O-Lac, Mead Johnson’s lactose-free formula. A Mead Johnson "Baby Book" distributed to mothers in the Philippines includes a 2-page advertisement for the follow-up milk Enfapro within the first few pages. Throughout this booklet, Mead Johnson uses the images associated with its formulas such as the O-Lac baby in its pink O, and the Enfapro baby sitting in a rainbow or running accompanied by the slogan "start smart and alert".

Wyeth distributes booklets in Argentina, Bolivia, Nicaragua, Mexico and Venezuela which mention S-26. In a booklet distributed in Indonesia, Wyeth uses a drawing of a tin of SMA in the section showing how to prepare a milk feed.

Milupa booklet distributed in
Hungría.

Dumex booklets in Thailand, Indonesia and Malaysia advertise infant formula and follow up formulas with pack shots. Several booklets show the whole range of Dumex formulas and milks.

Dumex booklet in Thailand.

Wyeth uses the colourful building blocks and toys seen on the label of S-26 and Promil on the covers or inside pages of booklets distributed in Thailand and Malaysia. The booklets in Malaysia also make references to S-26 by illustrating the cover and each page with the word beta carotene. The booklets make no mention of beta carotene. It is a subliminal way of subtly advertising the infant formula which is promoted for containing this ingredient.

In Thailand, the covers of these Nestlé booklets
are designed to look like the label of Nan infant formula,
yet Nan is never mentioned by name.

In the Philippines, the back cover of a Wyeth booklet about the first six months is filled with a picture of the cartoon baby and slogan "just right" associated with its follow-up milk Promil. The obvious message is that once the baby completes six months, a formula will be necessary. Another Wyeth booklet about weaning uses the back cover as an advertisement for Promil.

Humana advertises eight formulas and two complementary foods with packshots in a booklet promoting a new product, Humana water for babies.

In Western Samoa, Abbott Ross representatives distributed three booklets intended for mothers. All three are obviously intended for use in North America and include a ‘Baby Line’ for calls about joining the’ Welcome Addition Club’ with a US telephone number. Booklet readers are encouraged to join and receive a free starter supply of Similac or Isomil and coupons for discounts on future purchases. Each booklet also includes a full-page advertisement for Similac and Isomil using pack shots showing the Abbott Ross bear on the label. The bear appears on each booklet cover in the text wherever bottle feeding is mentioned.

Two of the three Abbott Ross booklets are devoted entirely to bottle feeding with Abbott Ross formulas. The third book, entitled "Becoming a Parent" begins with a section on feeding the baby and how to make the decision between breastfeeding and bottle feeding. Breastfeeding is described as the ideal and natural way to feed during the first year. The encouraging words are dulled by the following misinformation which plants the seeds of anxiety: "After 3 or 4 weeks, her milk supply should be well established and their baby should be nursing well." Mothers reading this will wonder about the problems they will experience if it takes this long for the baby to begin nursing well.

The booklet also has a paragraph about how the father can help to give expressed milk or, "if formula-fed, fathers can help as often as they like with feedings" The final paragraph on the page is devoted to formula feeding, which, if chosen, should be done with Similac With Iron or Isomil. And, as these formulas are indicated for the full first year, the page ends with advice not to give cow’s milk during the first year. Abbott strategically places this advice to ensure a customer for at least one full year.

In Thailand, an Abbott Ross booklet distributed to mothers uses the bear logo on the front cover. The page about feeding shows a photograph of a mother breastfeeding and a father bottle feeding the newborn infant. Abbott Ross’s follow-up formula, Gain is advertised on the back cover.

In Bangladesh, Nestlé, Mead Johnson, Fasska, and Coberco Omefa distribute these prescription-sized information sheets about individual brands of infant formulas, each including a packshot. The Nestlé sheet for Lactogen states "Educational material for mothers for distribution by health professionals only. Presented with compliments of Nestlé."

Milupa booklets distributed in Croatia , Germany and Spain advertise infant formulas and a whole range of complementary foods.

Snow Brand distributes several different booklets on infant care in Thailand. A tin of Snow Brand baby milk is pictured among things that will be needed for the baby . The booklets devote much space to preparation of infant formulas and a picture of the tin is included here as well.

In Spain, Alter distributes a booklet for mothers advertising the whole line of Nutriben products with photos of each including infant formula, follow-up formula and complementary foods.

Idealising infant formula

In Colombia, the Abbott Ross booklet, "1-4 Meses"(1-4 Months) is meant to prepare the mother for what to expect of the baby during the first months. The section on infant feeding talks of formula as equal to breastfeeding ("La leche materna o la formula fortificada con hierro con que usted lo esta alimentando le esta dando toda la nutricion que necesita") (Mother’s milk or the iron-fortified formula that you are using now, is all your baby needs for nutrition).

This and another Abbott Ross booklet are placed in Colombia clinics for mothers to take from this Abbott Ross dispenser decorated with cartoon drawings matching those on the cover of the booklets. Matching plastic figurines are placed in front of the booklet dispenser.

A Nestlé booklet distributed in the Philippines entitled "Motherhood, a Special Post-Natal Experience" states "There is no need to be anxious abut bottle feeding since modern science has made infant formulas as similar to human milk as possible."

Wyeth distributes "Your Pre-natal and Post-natal Care Booklet" in the Philippines. The booklet includes a section on infant formulas entitled "Next best nutritionally to mother’s milk" It goes on for a full page to extol the virtues of formula and states that "all known vitamins necessary for the development and growth of your baby are provided by infant formulas." The booklet also informs mothers that "Wyeth infant formulas are designed to fulfil the nutritional needs of infants by providing all essential nutrients in their proper amounts in quantities closest to that of human milk."

More than one Mead Johnson "Baby Book" distributed in the Philippines gives information that could lead mothers to believe their milk is insufficient. Mothers are counselled to "avoid nursing baby in bed especially at night when one may fall asleep." Such advice is in complete opposition to that of lactation experts who encourage night feeding, especially for working mothers. This advice is followed by a full page on formula feeding introduced by a paragraph of reasons why breastfeeding may fail.

This colourful Nestlé leaflet entitled "Bient^ t Maman" (Future Mother) distributed widely in Gabon encourages breastfeeding, while simultaneously placing the idea of bottle feeding in the mind of the pregnant woman. The two pages devoted to breastfeeding are followed by a full page on preparing a formula feed, giving the impression that it is normal to replace or supplement breastfeeding with the bottle. The page begins with the advice "Si vous allaitez encore, donnez toujours le sein d’abord" (If you are still breastfeeding, always give the breast first.).

The same Nestlé leaflet advises mothers to clean their nipples with boiled water before and after breastfeeding. Curiously, a Nestlé booklet in the Philippines advises mothers that soaping breasts may lead to cracked nipples and they ought to be massaged with baby oil then cleaned with water. Both leaflets undermine breastfeeding by making it difficult and potentially painful.

Companies are stretching the rules by ...

distributing information materials through the health care system as a way of familiarising mothers with their company name. Companies achieve the result of promotion without ever mentioning a particular product.

In Thailand, Mead Johnson distributes more than 15 different booklets for mothers about birth, infant care and nutrition. The books comply substantially with Article 4.2, but many dwell on bottle feeding. Since the mothers receive the booklets in health care facilities, it gives the impression that facilities endorse the information.

Promotion in Health Care Facilities
Free samples and supplies | Posters, calendars and other displays | Gifts to healthworkers
Gift to mothers in healt care facilities | Products information to health professionals