Global Policy Forum

By Jeremy Laurance

Western companies including Nestlé and Danone are accused today of breaching an internationally agreed code on the promotion of baby milk in the developing world, which is contributing to the deaths of thousands of children.

Every 30 seconds, campaigners claim, a baby dies from unsafe bottle feeding. Yet despite the marketing code and an international boycott of the companies involved over more than 20 years, the trade continues.

The latest evidence comes from a survey conducted in Togo and Burkina Faso in West Africa, where companies were found to be routinely flouting the code agreed by 118 countries in 1981. The code was drawn up to ensure that any woman who wished to breast feed would not be dissuaded by promotions undermining the message that breast is best.

One of the major problems facing health workers in the developing world is that breast feeding is seen as backward, and bottle feeding is regarded as more modern and sophisticated, a result of the successful marketing of breast milk substitutes. Breast feeding has long been known to be the safest way of raising infants, providing them with the nutrition they need and protecting them from infection at a crucial stage of development. Bottle feeding carries greater risks from contaminated water used to make up the feed and unsterilised equipment.

Researchers from Helen Keller International, a charity based in New York, found free samples of infant formula were given to health clinics for distribution to mothers, in contravention of the code. A mother who gives up breast feeding will not start again. Leaflets advertising the products failed to emphasise the advantages of breast feeding or explain how the bottle feeds were to be made up safely.

The breast milk substitutes and similar products including fruit juices and infant cereals were promoted with pictures and drawings idealising their use as the modern way to raise children. Forty products were identified which were in breach of the labelling standards set down in the code, 21 made by Danone, 11 by Nestlé and eight by other manufacturers.

The survey was conducted by Victor Aguayo and colleagues, and published in the British Medical Journal. The authors say urgent action is needed to ensure families get objective information on child feeding "at a time when it can mean the difference between life and death".

They add: "Infant mortality in Togo and Burkina Faso is among the highest in the world. Every year sub-optimal breast feeding is the underlying cause of an estimated 3,300 infant deaths in Togo (25 per cent of all-cause infant mortality) and over 6,200 infant deaths in Burkina Faso (11 per cent of all-cause infant mortality)."

In a statement, Nestlé said it was "strongly committed" to the promotion of breast feeding and honoured the international code in all developing countries where it operated. It added: "We believe that in many countries a better way of monitoring and enforcing the code is needed and we believe this is best done by encouraging and supporting governments to take on this responsibility as urged in the WHO code itself."

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