How breastfeeding is undermined

• Promotion using free supplies
• Inappropriate language
• Using "humanitarian aid" to create markets
• Labels which undermine breastfeeding
• Promotion to mothers and pregnant women
• Promotion to health professionals
• Undermining implementation of the International Code

With support nearly all mothers are capable of breastfeeding. Yet in many countries breastfeeding rates are low and artificial infant feeding has become part of the culture. In this section we look at examples of company promotional methods in order to understand how the baby food industry undermines breastfeeding and encourages artificial infant feeding.

Promotion using free supplies

Free supplies were restricted by the International Code and were finally banned in all parts of the health care system by the World Health Assembly in 1994 (Resolution WHA47.5). Despite the ban companies continue to use free supplies as a means of promoting their products. Giving bottles to newborns interferes with lactation. If a mother stops producing milk she has to purchase the company's products once she leaves the hospital and it is no longer free. IBFAN has campaigned on this issue for many years and has raised awareness of the promotional nature of free supplies.

• In July 1996 Nestlé was reported to be providing free and low-cost supplies of infant formula to hospitals in Kunming Province of China. In a public statement Save the Children said:

"Nestlé has made Lactogen widely available in six hospitals in Kunming, where it has targeted health professionals with both free and discounted supplies of the formula. This helps to create an incentive for the health workers, not only to use the formula within the hospitals, but actively to encourage its use among mothers of new-born children. Lactogen has been displayed in some of the hospitals for sale. The report prepared by our China staff and local health workers alleged that there had been an increase in the consumption of Lactogen and that breastfeeding rates had fallen."

Companies that belong to the International Association of Infant food Manucaturers (IFM) pledged as far back as 1991 to work towards the goal of ending free and low-cost supplies. Yet IBFAN's monitoring report Breaking the Rules, Stretching the Rules 1998 shows there were instances of supplies of infant formula being given to health care facilities in 19 of the 31 countries surveyed. Donations of follow-up formula and complementary foods have also been taking place.

Monitoring conducted by the IBFAN group in Pakistan and published in the report Feeding Fiasco in March 1998 found widespread distribution of free supplies. A former company representative describes in the report how hospitals receive free supplies and doctors are "purchased by companies...after which the doctor or hospital is bound to recommend the company's formula."

Inappropriate language

Article 9.2 of the International Code requires that labels are in a language appropriate to the country where the products are sold.

IBFAN's monitoring finds many countries where this is not respected. One long-running case concerns Malawi in Central Africa. Both Nestlé and Wyeth were reported in Breaking the Rules 1994 for violating this provision of the Code in Malawi. Both claimed English was the appropriate language, although Nestlé had earlier said:"Due to cost restraints of small runs it has not been viable to change languages for specific export markets."

When checking the situation a few years later IBFAN received a letter from the Malawi Ministry of Health saying: "The Ministry discussed the need to include Chichewa. - [the national language] - with Nestlé ...in mid 1994...not received a reply...nothing has happened." Government statistics show that of those women who could read, 43% could not read English, the language on the label.

Sometimes companies include under-lid leaflets in other languages. This will only be read after buying the product. Even parents who choose to breastfeed should be able to understand the warnings on a breastmilk substitutes so that their choice is not undermined.

Using "humanitarian aid" to create markets

In emergency and relief situations it is important that babies are breastfed, if possible. Artificial feeding in these conditions is difficult and hazardous and can lead to increased infant mortality rates. The basic resources needed for artificial feeding, such as water, fuel and sufficient quantities of breastmilk substitutes are scarce in emergencies. Furthermore breastmilk substitutes donated as humanitarian aid often end up in the local market and can have a negative influence on feeding practices generally.

The baby food industry has used emergencies generally to promote its products and used "humanitarian aid" as a way of entering into the emerging markets of Europe and the former Soviet Union.

• Large quantities of baby milks were donated by the European Union to the countries of the former Soviet Union. The tins carried a company brand name, the EU logo and an inscription, "Gift from the European Union to the people of Russia." This gives the impression that the product appears to be endorsed by the EU.  

• A German baby food company, Humana, donated baby milks to health centres in Russian villages. The boxes carried a baby picture and a notice saying "like breast milk", both violations of the International Code.  

• Relief workers in Kazakhstan received so much free infant formula that they used it in their coffee!  

• Dr Anahit Demirchyan, Coordinator of the UNICEF Baby Friendly Hospital Initiative in Armenia, said that "The distribution of breastmilk substitutes as humanitarian aid almost destroyed our breastfeeding programmes."

IBFAN is actively working with aid and development organisations on issues surrounding infant feeding in emergencies.

See the resources sheet for information on the IBFAN publication Crucial Aspects of Infant Feeding in Emergency and Relief Situations.

This tin was distributed in Russia as aid from the European Union and purchased at an open market in Estonia. IBFAN supports generic labelling (that is, labels without brand names) of products when there is a genuine need for them.

Labels which undermine breastfeeding

Article 9.2 of the International Code requires labels to be in the appropriate language and to include specified text warning that breastfeeding is best for babies and that the products should only be used on the advice of a health professional. In addition there should be no pictures or text which might idealize the use of infant formula.

Article 9.1 says that labels should not discourage breastfeeding.

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