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?
|
- 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?
|
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.
|
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.
|
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."
|
|
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)
