What does Nestlé's report show?
- Nestlé
concludes that it is doing nothing wrong despite
the many violations reported to it by governments,
IBFAN and others. In 1998 WHO called on companies
to "respond promptly to correct all the
violations that are reported."
- In
May 1999 Nestlé's Assistant Vice President,
Niels Christiansen, claimed that over 70 governments
had verified Nestlé's compliance and there
were question marks in only three cases. Nestlé
refused to provide further information about this
statement when asked by Baby Milk Action. Strangely,
in October '99 Chief Executive, Peter Brabeck,
said: "We now have 54 countries verifying
our compliance, with only one government writing
to say that we don't follow the Code."
- Nestlé
states that the countries represented in the book
account for "over half our infant formula
sales in developing countries". What
about the other countries where Nestlé
has operations? Why are critical responses from
countries such as Samoa and South Africa not included?
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- In
some cases it is bizarre that Nestlé suggests
that the statement "verifies Nestlé
compliance." For example, the letter
from the Ministry of Health in the Cook Islands
states: "I have not noticed any of their
products being sold here."
- Only
six of the statements refer to monitoring or something
similar conducted by the authority providing the
statement - and three of these note violations
were found or reported.
- A
further five statements suggest concern about
violations.
- A
quarter of the statements relate only to materials
or information Nestlé presented to the
government authority.
- Many
statements appear to be a standard form of words,
presumably suggested by Nestlé.
- Many
statements include expressions such as "to
the best of my knowledge..."
- Nestlé
claims that it conducts international audits.
Why hasn't it published the reports resulting
from these? Will Nestlé accept independent
auditing of its activities?
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The International Code and Resolutions
As early as
the 1930's health workers were concerned about infants
dying as a result of unsafe bottle feeding (ref.
1). This grew as a scientific link was made between
unsafe bottle feeding and diarrhoea, malnutrition and
death (ref. 2).
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Breastfeeding
rates declined rapidly
during the 1960's as baby food companies expanded
their activities into developing countries. For
example, in Singapore in 1951 over 80% of 3-month-old
babies were breastfed, by 1971 it was only 5% (ref. 3).
Explaining
the expansion at the time, Nestlé's Norris
Willat said: "The high birth rates permit
a rapid expansion in the domain of infant nutrition"
(ref. 4).
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Concern
about this unnecessary death and suffering led to
the launch of the Nestlé Boycott in 1977, hearings
in the US Senate in 1978 and the drafting of a marketing
code, commencing in 1979. The International
Code of Marketing of Breastmilk Substitutes was
adopted
by the World Health Assembly in 1981 as a "minimum
requirement" to be implemented in its "entirety"
by Member States. Companies were also called on to
ensure that their conduct at every level conforms
with the provisions of the International Code.
(See the Baby Milk Action briefing paper History
of the Campaign for further details). |
The International
Code basically bans the promotion of breastmilk substitutes
and gives the responsibility for advising parents to health
workers. Companies are limited to providing scientific
and factual information to health workers. The International
Code also sets labelling and quality requirements
and aims to protect those who use breastmilk substitutes
as well as those who breastfeed.
Using
India's law to protect infant health
The
Indian law empowers listed Non-Governmental Organisations
(NGOs) to file cases in the courts and the courts
appoint a government prosecutor if it is decided
there is a case to answer. Sanctions include confiscation
of violating materials and imprisonment of executives
- in some cases imprisonment is mandatory. Nestlé's
Managing Director in India faces a prison sentence
if convicted in a long-running court case concerning
labelling. Nestlé has reacted by taking the
Indian Government to court and is attempting to
have key parts of the law revoked. There is no reference
to India in Nestlé's book.
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Subsequent
Resolutions have been adopted to clarify interpretation
of the International Code and to address
changes in marketing practices and scientific knowledge.
Nestlé has refused to acknowledge the subsequent
Resolutions and claims that interpretation of the
International Code is
confusing.
It has introduced a "Charter" and instructions
to employees which are more limited than the International
Code and Resolutions. If national measures are
more limited, Nestlé says it will follow
these rather than the Code and Resolutions.
Baby
Milk Action works with partners in the International
Baby Food Action Network (IBFAN) to end the avoidable
suffering and death. Today IBFAN consists of over
150 groups in over 90 countries.
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Groups conduct
independent monitoring of the baby food industry against
the International Code and Resolutions and work for the
introduction of government measures which are independent,
transparent and enforceable.
Implementing the International Code
and Resolutions
IBFAN monitors baby food companies and reports violations
of the International Code and Resolutions to companies
and governments, as requested by Article
11.4 of the International Code. Nestlé
has repeatedly dismissed reports of violations. For example,
it described the IBFAN monitoring report Breaking the
Rules, Stretching the Rules 1998 as "biased
and misconceived." Nestlé also led the
attack on the report Cracking the Code, published
in 1997 following research commissioned by the Interagency
Group on Breastfeeding Monitoring (ref.
5). This found "systematic" violations
of the International Code and Resolutions. UNICEF
stated: "IBFAN's monitoring is vindicated by this
report." The research has since been peer reviewed
and was published by the British Medical Journal in 1998
(ref. 6).
 |
Nestlé
attacks independent monitoring, but sometimes by exposing
Nestlé's marketing practices we can bring about
change. This picture shows an advertisement for Nestlé
Nan infant formula on a distribution van in Yerevan,
Armenia in August 1997. Following a Baby
Milk Action campaign, Nestlé had the advertisement
removed. |
Implementing the International Code
and Resolutions
At the 1998
World Health Assembly, the Director of Family and Reproductive
Health made the following call on behalf of World Health
Organisation (WHO) (ref. 7):
"In
summary, Mr. Chairman, if we are serious about wanting
to improve the health, nutrition and well-being of our
children, all governments need to urgently reflect the
recommendations of the Code and subsequent resolutions
in their own laws and regulations and take suitable action
accordingly. NGOs must be supported to intensify their
monitoring efforts specially in view of the HIV epidemic.
"Infant-food
industry needs to be proactive and more responsible to
monitor its own marketing practices and respond promptly
to correct all the violations that are reported."
Nestlé
does not like to receive reports of violations in practice.
In 1997 Nestlé was asked to acknowledge the important
role of IBFAN's monitoring and reporting and stated (ref.
8):
"Monitoring
by third parties, using questionable definitions
and methodology, simply leads to confusion and controversy."
A member of
the public acted on Nestlé's "Charter"
which encourages people to report violations. After receiving
a fourth letter about separate violations, Nestlé
responded (ref. 9):
"In
view of the fact that I am now replying to your fourth
letter on this
issue, I do not think further dialogue will be to our
mutual benefit."
Television
satirist/investigator Mark Thomas attempted to present
specific violations to Nestlé (Mark Thomas Product,
Channel 4, 5th October 1999, see the website http://www.channel4.com/mark_thomas/
nestle1.html). Nestlé refused to be interviewed
and dismissed his genuine concerns as "your interpretation."
In its new
book Nestlé pointedly ignores WHO's call on it
to respond promptly to correct all the violations that
are reported. Instead it claims it is being more proactive
in monitoring its own activities. Its conclusion is, however,
that there are virtually no violations and those found
are generally due to others misinterpreting the Code.
The statements from government representatives do not
support this view. A detailed analysis forms an appendix
to this report. Next, we present an overview.
Nestlé's statements - what they
really say
Baby Milk Action
is pleased that Nestlé recognises the need to do
more to monitor its baby food marketing activities. The
letter from Kiribati contained in Nestlé's book
makes it clear why it is important to market breastmilk
substitutes responsibly:
"Breastmilk
substitutes are discouraged at all costs by the Ministry
of Health. The main reasons are: Breastfeeding is the
best food for a child (every mother is capable of providing
when managed well). It has been proven that children have
often fallen sick due to poor hygiene during the preparation."
The International
Code and Resolutions?
Company activities
should be monitored against the International Code
and the Resolutions which clarify it. Yet in only one
case (South Africa) does the statement reproduced by Nestlé
refer to the subsequent Resolutions, and this notes that
marketing activities are the target of "extensive
criticism by the defenders of breastfeeding"
and notes: "The Nutrition Directorate does
not have the capacity to monitor transgressions of the
Code..."
It is not clear
whether other government authorities intended to include
the Resolutions when referring to the International
Code. It is known, however, that Nestlé has
refused to acknowledge the importance of the subsequent
Resolutions and has repeatedly attacked them. Has it done
the same in its approaches to governments? The sample
request letter, reproduced in Nestlé's book, refers
only to the International Code. (It is also interesting
to note that the sample letter does not inform the authority
that Nestlé intends to publish any response and
distribute it around the world.)
Further information
is needed, but the cases of Bulgaria and Russia
give an interesting insight. In Bulgaria and Russia the
statements refer to a European Union Internal Directive
which is only a partial implementation of the International
Code. The Directive does not apply to Bulgaria and
Russia. Even if these countries join the European Union,
the Directive does not prevent them from fully implementing
the International Code and Resolutions (Georgia
did just this in September 1999). Has Nestlé mis-led
the governments about the status of the Directive in order
to obtain these statements?
Systematic
violations
IBFAN
conducts independent monitoring of baby food company
marketing practices against the International Code
and Resolutions. The report Breaking the Rules,
Stretching the Rules 1998 reports on monitoring
in 31 countries. Nestlé is again found to
be the largest source of violations using methods
that even violate its own weak "Charter".
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Responsibility
for monitoring
Baby Milk Action
and IBFAN encourage governments to fulfil their obligations
under Resolution
34.22 and Article
11.2 to implement the International Code and
Resolutions in legislation and to take action to monitor
these measures independently of companies.
IBFAN acts
on Article 11.4
and reports violations to governments and companies. The
report Breaking the Rules, Stretching the Rules 1998
included the results of monitoring from 31 countries.
Interestingly, Nestlé appears to have been unable
to obtain statements from 20 of the countries covered
by the IBFAN monitoring report. This perhaps indicates
the importance of IBFAN's work in alerting governments
to company malpractice.
Nestlé
and all companies have responsibility under Article
11.3 to "ensure that their conduct at every
level conforms" to the International Code
"independently of any other measures taken for implementation..."
Nestlé
has claimed elsewhere that it conducts international audits
of its companies. Why hasn't it published the audit reports?
Will it accept independent auditing of its activities?
The letter
from Norway sets out Nestlé's responsibility:
"The
agreement between the Norwegian Baby Food Industry and
the, at the time called, Health Directorate, was, as you
know, made in 1983. In Article 11a-11.1, which deals with
the execution and supervision of the voluntary agreement,
it is stated that 'manufacturers of products which are
covered by this code, the WHO Code, are themselves responsible
that their marketing practices conform with the Code."
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Nestlé
received the "Lot of Bottle" award from
the UK
Food Group
on World Food Day, October 1998, for shameful violation
of the International Code and Resolutions
in the Philippines. Nestlé's "Health
Educators" have been found promoting Nestogen
infant formula to new mothers in the community.
A "Health Educator" is shown at work above.
(Photo: IBFAN Philippines, 1997).
|
It appears
that Nestlé S.A. (Swiss Headquarters) does not
take this responsibility seriously. For example, in 1996
Dr. Imelda Ben travelled to Switzerland from the Philippines
for the Nestlé S.A. shareholder meeting. She informed
shareholders and the Board of Directors that the activities
of Nestlé Philippines were endangering infant health.
The letter from the Secretary of Health in the Philippines,
reproduced by Nestlé, although generally complimentary,
acknowledges that violations have been reported. Baby
Milk Action has also raised violations with Nestlé,
such as its practice of employing graduate nurses on contract
as "Health Educators" who have been found promoting
Nestogen infant formula to new mothers in the community.
Nestlé
has denied this outright. It wrote on 27th September 1999
that "Nestlé Philippines assures us that
we do not have such a practice." Why is Nestlé
accepting the assurance of Nestlé Philippines when
it has received repeated reports of violations? Even Nestlé
Philippines website refers to Nestlé's "health
education on nutrition for village mothers."
Direct and
indirect contact of marketing staff with pregnant women
and the mothers of infants and young children is banned
by Article
5.5 of the International Code (Article 6(e)
of the Philippine Code also bans direct contact for specific
products). Yet in September 1999, the marketing firm OgilvyOne
received three Asian Direct Marketing Awards for its work
with Nestlé Philippines. Dickie Sorian, OgilvyOne
Manila, told BusinessWorld:
"When
we designed Nestlé's infant nutrition program,
we made full use of direct marketing insights and breakthroughs
that are now reshaping the way we market brands as well
as the relationships between consumers and brand."
Baby Milk Action
has asked Nestlé S.A. (13th October 1999) if it
has conducted an audit of Nestlé Philippines and,
if so, to release the audit report. At the time of writing
we have not received a response.
What has government
monitoring found?
Only 6 letters
refer to monitoring or similar (e.g. "spot checks")
conducted by the authority writing the letter (Dominican
Republic, Egypt, Zimbabwe, Philippines, Germany and
Romania).
The Dominican
Republic found violations:
"The
majority [of violations] were related to advertising
activities of popular products, and have since been corrected."
This is Baby
Milk Action's aim - a monitoring system that is effective
in stopping violations.
The report
from Germany notes violations:
"A
number of Lander authorities reported that they had received
complaints from interested parties."
The reports
from Egypt, Zimbabwe and Romania are complimentary.
It is known, however, that Zimbabwe only agreed
to comment on Nestlé's activities judged against
the International Code and would not state it was
also abiding by the subsequent Resolutions. Nestlé
also opposed the implementation of the International
Code and Resolutions in legislation in Zimbabwe,
and threatened to close down its operations in the country
if a law was introduced. Dr. Timothy Stamps, Minister
of Health, described this as "an idle threat"
on the TV programme, Mark Thomas Product, 5th October
1999.
Other
statements also refer to violations...
- Colombia
refers to the need for "corrective
action."
- Jordan
refers to the need for "control and
follow-up."
- Kenya
refers to "consultations that have
been held... I am aware that matters have been
sorted out amicably."
- South
Africa
refers to "extensive criticism by defenders
of breastfeeding."
- Switzerland
states "Manufacturers have been requested
to limit donations of samples."
According
to Nestlé's Chief Executive, Peter Brabeck,
the countries in the book only amount to about
half of its market for infant formula in developing
countries. What about the others?
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Do the statements
really "verify Nestlé's compliance" with
the International Code and Resolutions?
Some of the
letters Nestlé has reproduced are very clearly
not "verifying that Nestlé complies with the
International Code."
For example,
the letter from the Cook Islands states:
"I
have discussed this matter with our Nutritionist and she
has provided me the following informations... 'At present,
I have not noticed any of their products being sold here.'"
As a monitoring
strategy, Nestlé's approach is fundamentally flawed
if it is prepared to present such a letter as proof that
its marketing practices comply with the requirements.
Dane's
"surprised" by Nestlé's spin
Baby
Milk Action asked Bente Koch of the Danish Veterinary
and Food Administration if she was aware that Nestlé
would use a letter from her in its new book: Nestlé
implementation of the WHO Code: Official Response
of Governments. The letter has also been published on
the Internet.
She
said: "We are very surprised. We had the
impression that Nestlé would use the letter
in connection with export of infant formulas to
countries outside the EU in order to inform about
the fact that Denmark had implemented the Commission's
Directives." Asked if the letter was "official
verification of Nestlé's compliance"
as Nestlé claims, she explained: "It
is the responsibility of the marketer or distributor
to ensure their marketing is in accordance with
Danish Regulations. We never certify that a producer
is marketing in accordance with the Danish Regulations.
We have only given a description of the system."
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The letter
from Denmark states:
"The
ongoing food control system is currently supervising that
the law is being respected."
This appears
to be a statement setting out the responsibility of the
food control system, not an endorsement of Nestlé's
activities. Our view has been confirmed by the author
of the letter (see box). STOP PRESS 23rd January 2000
- Nestlé
apologises to Denmark
Nestlé
has also received letters from a local authority informing
it that it has broken the Danish law in a direct mailing
to mothers as part of its "Parents Club". At
the time of writing, the Veterinary and Food Administration
is considering Nestlé's appeal.
The letter
from Oman thanks Nestlé for attending a
meeting and does not refer to its marketing policy or
practice:
"This
is to express our sincere gratitude and thanks for your
co-operation in attending the meeting on the Omani Code
for BMS at the Ministry of Health on Sunday 22nd November
1998 on behalf of Nestlé. We are happy to know
that you all have the same goals in improving the health
of mothers and children in Oman."
Many of the
letters refer only to materials or information presented
to the authors by Nestlé. Many only state the official
"has no knowledge" or is
"not aware of violations." For example,
the letter from Hong Kong states:
"To
the best of my knowledge, mothers are not being solicited
by Nestlé's representatives to use infant milk
formula with free sampling in all of our maternal and
child health centres and maternity homes."
This statement
is only of any use if there are no other verifiable reports
of free samples. In addition, the International Code
and Resolutions cover far more than free sampling.
The letter
from Rwanda states:
"I
have received the annual report from the Manager of Nestlé,
Great Lakes Region, concerning the Nestlé company's
activities in Rwanda. I have no particular comments regarding
the report, however I encourage Nestlé to continue
implementing the instructions of WHO Code."
Baby Milk Action
also encourage Nestlé to implement the instructions
of the International Code and Resolutions. This
does not mean we endorse its activities.
Missing statements
In May 1999
Nestlé claimed to have endorsements from over 70
countries with questions only from 3. In the report, which
is dated July 1999, the situation had changed - Nestlé
claims endorsements from 54 countries with questions from
only one unnamed country and states it has not received
any other responses.
Yet Nestlé
received a letter from Samoa (21st April 1999)
stating:
"...In
summary Nestlé marketing practices in Samoa at
the present time not only contravene the WHO Code of Marketing
of Breastmilk Substitutes and the subsequent WHA resolutions,
but also seriously undermine the current nutrition education
programme in Samoa which promotes exclusive breastfeeding
to about six months."
Nestlé
received a letter from the Department of Health, Western
Cape, South Africa (19th May 1999) stating: "There
are violations of WHA
39.28, WHA 47.5 and
WHA49.15."
Nestlé
received a letter from Ministry of Health, Gabon
(8th July 1997) relating to Nestlé's promotion
of Cerelac complementary food at health facilities.
It described Nestlé's promotional methods of providing
gifts and free samples and showing film shows as
"flagrant violations" of a Ministerial
Decision brought to Nestlé's attention in 1991,
and the International Code. Other countries are
known to have refused to sign Nestlé's "Certificates".
Recommendations
Nestlé's
irresponsible marketing of breastmilk substitutes contributes
to unnecessary suffering and death of infants around the
world. It is disturbing that Nestlé has obviously
spent a considerable amount of money on its new "monitoring"
strategy, but concluded it is doing nothing wrong. This
suggests that the strategy is more concerned with polishing
Nestlé's image than protecting infant health.
Baby Milk Action
suggests that Nestlé addresses the following specific
concerns to improve its "monitoring" strategy:
- While it
is welcome that Nestlé recognises that it needs
to do more to monitor its baby food marketing activities
it is necessary to monitor these against the International
Code of Marketing of Breastmilk Substitutes and
subsequent, relevant Resolutions of the World Health
Assembly. The subsequent Resolutions clarify interpretation
of the International Code and address changes in marketing
practices and scientific knowledge. Nestlé has
refused to accept the validity of the subsequent Resolutions
even though WHO has made it clear that they have equal
status to the International Code.
- Nestlé
must accept that the International Code was adopted
under World Health Assembly Resolution
34.22 as a "minimum" requirement to be
implemented in "its entirety", and that governments
may put in place additional measures if they find this
appropriate.
- The International
Code (Article
11.3) requires companies to take responsibility
for monitoring their own activities "independently
of any other measures taken for implementation."
Nestlé claims to conduct audits of its companies.
Its stated policy of "openness" should include
releasing these reports. If it has nothing to hide,
it should open itself up to independent, external audits
to enable verification of any reports it has produced.
- Nestlé's
report refers to a call on the baby food industry made
at last year's World Health Assembly, but does not present
that call fully. WHO said: "Infant food industry
needs to be proactive and more responsible to monitor
its own marketing practices and respond promptly
to correct all the violations that are reported."
(Director Family and Reproductive Health - WHA 1998
- emphasis added). Nestlé has attacked monitoring
reports such as Breaking the Rules, Stretching the
Rules 1998 (produced by the International Baby Food
Action Network) and Cracking the Code (produced
by the Interagency Group on Breastfeeding Monitoring
in 1997) instead of taking action to end the violations.
Nestlé has also failed to end violations as requested
by a number of governments (such as Malawi, which has
been asking Nestlé to include the national language
on labels since at least 1994). If it took action to
end all violations reported to it, its professed willingness
to abide by the International Code might have
more credibility.
- Nestlé
is marketing specialist breastmilk substitutes in the
UK at the present time and is expected to launch a wider
range in the near future. Nestlé pointedly failed
to give an undertaking to fully abide by the International
Code and Resolutions in the UK when asked by Baby
Milk Action and is breaking these measures. It should
stop seeking direct contact with mothers (for any infant
or young child product) in line with Article
5.5 of the International Code.
References
- Milk
and Murder - Address to the Rotary Club of Singapore
in 1939. Reproduced by the
International Organization of Consumers Unions, October
1986.
- Derrick
Jelliffe coined the term "Commerciogenic malnutrition"
in an article in Food Technology, vol. 25, no. 55, 1971,
following research in Jamaica (referenced in The
Politics of Breastfeeding by Gay Palmer, Pandora,
ISBN 0-86358-2200-6).
- Berg. A.; The Nutrition Factor,
Brookings Institute, Washington, DC, 1973 (referenced
in The Politics of Breastfeeding by Gay Palmer,
Pandora, ISBN 0-86358-2200-6).
- Willat, Norris; How Nestlé
adapts products to its markets, Business Abroad,
June 1970 (referenced in The Politics of Breastfeeding
by Gay Palmer, Pandora, ISBN 0-86358-2200-6).
- Cracking the Code.
Interagency Group on Breastfeeding Monitoring, January
1997.
- Violations
of the international code of marketing of breastmilk
substitutes: prevalence in four countries.
British Medical Journal Volume 316, 11 April 1998.
- Statement
on Infant and Young Child Nutrition by WHO Executive
Director of Family and Reproductive Health to the 1998
World Health Assembly.
- Letter
from Nestlé Vice President, G. A. Fookes, to
Baby Milk Action, 24th July 1997.
- Letter
from Nestlé (UK) Corporate Affairs Manager, Ralph
Claydon, to a concerned member of the public, 16th October
1998.
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Cover
story prompted by the ASA ruling (see below)
