Tricks of the Infant Food Industry
By Naomi Baumslag, MD, MPH
If your lives were embittered as mine is, by seeing day after day this massacre of the innocents by unsuitable feeding, then I believe you would feel as I do that misguided propaganda on infant feeding should be regarded as murder. . . Anyone who, ignorantly or lightly, causes a baby to be fed on unsuitable milk, may be guilty of that child's death. —Dr. Cicely Williams, Milk and Murder, 1939
Baby in bottle; cover illustration of The Baby Killer
Cover image of The Baby Killer. Source: Andy Chetley, War on Want Report, United Kingdom, 1974. Photo courtesy: War on Want
The billion-dollar formula industry—two million dollars a day—is about money, not public health. Exclusive breastfeeding has been eroded and undermined despite its exceptional benefits for infants and mothers. Although scientific studies continue to attest to the superiority of breastmilk, bottle-feeding formula is becoming the norm. Aggressive formula marketing has deceived mothers into believing that formula is equivalent to breastmilk. Good lactating breasts have been removed from the mouths of infants and promoted only as sexual organs. The positive effect of breastfeeding on mothers' health has also been ignored. Throughout the world, scarce resources are used to buy formula when the money could be put to better uses.
Infant food companies influence government health policies and have made the medical profession their handmaiden. They use "science" to scare mothers, exploit women's working rights and men's desires to adapt to family realities. While they have stopped some promotion to mothers in the mass media, they have bought time and programs to undermine breastfeeding. They have taken baby faces off their formula tins only to put them on "follow up milks." They have grudgingly endorsed the WHO/UNICEF International Code of Marketing of Breastmilk Substitutes, but whittled it down, and still complain it's too restrictive. Through the World Trade Organization, they are amassing even more power. In spite of the Code, and in spite of the efforts of thousands of breastfeeding advocates, the infant formula market is thriving, formula companies are growing, and profits are mounting.
IT'S ALL ABOUT PROFITS
The chief aim of corporations is to maximize profits by expanding markets, increasing the use of products, inventing new products and extending the length of their use. Their greed appears insatiable as more and more babies suck rubber in vain search for the juice of life. Their main concern is profit, not public health. It's clear that breastfeeding is not good for the baby food industry. The baby food industry (which includes the production of bottles and nipples) is an eight-billion-dollar a year industry with an enormous profit margin and vicious intercompany competition. For every dollar wholesale received, only 16 cents go to research and development.
Corporations invest only to maximize their returns. Formula companies give money to doctors, nurses, medical students and departments of pediatrics for research, equipment, gifts, payments, conferences, travel and publications, with the goal of enlisting their endorsement and promotion of the products.
Money spent on promotion and lobbying means less for quality control, research and basic ingredients. WHO has recommended that docosahexaenoic acid (DHA), essential to infant brain development, be added to infant formula. Europe and Asia have done this but formula makers in the US have resisted. The FDA and Ross Pharmaceuticals (maker of Similac) say there is not enough scientific evidence to do so, but Ross also admits that it's too expensive. Ross's earnings from the WIC program (Women, Infants and Children Supplementation program) has decreased because of rebates and so profit loss may be a factor. Babies' health doesn't seem to have a high priority. Damage to the company's name is to be avoided at all costs so they do not lose the market, especially now as there is an increasing number of competitors selling baby foods, formula for pregnant women (at least ten such products are now available), bottles and nipples.
Most of the ingredients in infant formula are incredibly cheap. Powdered milk contributes to only one-sixth of the total cost. Soy protein isolate used in soy-based formula is even cheaper.
BEHIND THE SCENES
With restrictions to formula distribution, the corporations become more devious, lobbying governments, challenging the law and establishing clinics and hospitals as marketing agents and centers. When other promotion avenues fail, companies go directly to governments to meet their needs.
Breast milk substitutes are based on doctored cow's milk or highly processed soy protein. Nevertheless, the formula industry was able to persuade the FDA to classify formula as a food, not a drug, so that they would be subject to less stringent review. The FDA allows the use of soy protein isolate in soy formula even though it does not have Generally Recognized as Safe (GRAS) status.
Corporations influence the selection of delegates to international infant-feeding meetings, including those sponsored by WHO. They offer special deals for the purchase of breast milk substitutes for nutrition programs, famine relief and even for orphans, but require their logo to be used. Every opportunity to advertise their products is maximized.
There are financial incentives for governments to import infant foods. Governments get extra income through sales taxes and import duties. In Zimbabwe, income is generated for governments through the 17.5 percent sales tax on imported formula and a 10 percent import duty. Thus, the government shares in the profits when mothers abandon breastfeeding.
The infant food companies have special contacts in nutrition and child health divisions of various governments who are their advocates and look after their name and interests. They pay for delegates to attend international nutrition conferences to vote their line.
Formula companies and their agents even interfere with the production of breastfeeding educational materials. On one known occasion Nestlé wrote to the US Secretary of Health urging him to withdraw an innocuous HEW publication "Perspectives on Maternal-Infant-Feeding," which was in strong demand, as they feared its influence. The report was "unscientific," they claimed. However, as it had been reviewed by leading authorities in the field, their efforts came to nil. In Zimbabwe, a pro-breastfeeding publication "Baby Feeding," funded by UNICEF, was held up because of Nestlé's lobbying efforts. The Attorney General finally ordered that it be released for publication. We have no idea how many such publications have been successfully blocked.
When a breastfeeding group in Guatemala protested the use of baby pictures on Gerber baby foods, Gerber reacted with attempts to bribe the national breastfeeding committee. When that did not work, they threatened the government. If Guatemala did not allow Gerber to exercise their free trade rights, they said, they would take their business out of the country. Unfortunately, Gerber got its way.
National breastfeeding groups are continually thwarted by the formula makers which insist that their representatives be included in their workshops and conferences. These representatives then work to water down any recommendations that interfere with the sale of their products. The Australian Federal Bureau of Consumer Affairs and several formula companies have a marketing agreement that ostensibly includes the Code provisions, but the panel set up to receive and investigate complaints regarding the marketing of infant formula in Australia includes representatives of the companies being policed! The Philippines has a strong national Code that restricts formula marketing yet the government does nothing about the baby food companies' flagrant violations.
AIDS AND BREASTFEEDING
One of the most egregious examples of formula-promotion through spurious science is the current dogma that HIV-positive mothers should not breastfeed. Despite the incomplete and conflicting scientific evidence on the transmission of HIV through breastfeeding, the corporations have seized on the HIV-epidemic as an opportunity to push formula feeding to the third world. For the formula companies, AIDS is a window of opportunity that is exploited to the nth degree. In South Africa, the head of the health department in the Ministry of Health stated at La Leche League's 1998 national meeting that "we're in bed with the enemy" to solve the AIDS breastfeeding crisis.
Formula makers have used AIDS research presented at the AIDS International Meeting in Vancouver 1996, and cited on the front page of the New York Times, to pressure UNICEF to endorse formula for babies born to HIV-positive mothers. The industry endorsed this research even though it had not been published in a peer-reviewed journal. The author of the New York Times article interviewed six "breastfeeding experts" but never reported any of their views. He did, however, report the views of non-breastfeeding advocates such as Thad Jackson, an immunologist who formerly was a full-time employee of Nestlé and now works for them as a consultant. The report was very biased and accused WHO and UNICEF of dragging their feet and not looking out for third world infants. According to the Wall Street Journal, "UNICEF remains captive to a clutch of activists who have been leading boycotts and protests against the baby formula makers since the 1970s on the highly spurious grounds that the companies trying to supply better nutrition ‘exploit' the poor. . . If the toll of African AIDS babies continues to rise, the credibility of one of the most beloved UN agencies may sink." This statement was on the front page, not in the editorial section!
A recent study in Durban shows that there is no difference between the incidence of HIV in exclusively breastfed and exclusively formula-fed infants of HIV-positive mothers from birth till six months, but there are no lobbyists to herald this positive news. Furthermore, is clear that mixed feeding of infants of HIV-positive mothers has the worst possible outcome.
INTERFERENCE AND INFLUENCE
There are an untold number of examples of the infant food industry's interference and influence. When the International Nutrition Conference met in Geneva, the formula industry systematically infiltrated the meeting. The INC recommendations had to be formulated in secret and were delivered to the plenary session to the surprise of the baby food industry.
The Maternity Protection Convention, adopted by the International Labor Organization in 1952, calls for 12 weeks' maternity leave, cash benefits equal to two-thirds of previous earnings and breastfeeding breaks totalling at least one hour per day. At a 1999 International Labor Organization meeting in Geneva, the powerful transnational corporations lobbied for removal of the nursing clause. New Zealand, Australia, UK, USA, Canada, and other some European countries sided with the formula companies but Italy, Greece, Austria, Croatia, the Netherlands, Philippines, United Arab Emirates and all of Latin America and Africa, as well as non-governmental organizations including the International Confederation of Nurses opposed the recommended change. Although the vote was close, breastfeeding breaks remained. However the struggle is not yet over. As most of the world's women still breastfeed, weakening the Maternity Protection Convention (MPC) would make it harder for governments to promote breastfeeding in the work place, depriving women who want to breastfeed of their rights.
The latest gimmick by Nestlé is to seek endorsements from governments stating they are in compliance with the Code. Nestlé supplies "Certificates of Code Compliance" for government representatives to sign. This has already happened in Panama City and Nestlé is pressing other Latin American governments to sign.
The Western Cape Provincial government in South Africa is also under pressure but according to the International Baby Food Action Network (IBFAN), this strategy is backfiring as an increasing number of governments are using the opportunity to spell out Nestlé's shortcomings. The South African Department of Health asked Nestlé to change labels on some products because they suggest introducing complementary foods at 4-6 months rather than at 6 months as required by the WHO resolutions. The Ministry of Health also complained that Nestlé posters were in clinics and their brochures were freely available, resulting in the promotion of the company's image as well as its products.
"Formula Fix," an Australian IBFAN video, was banned for use in a training program in South Africa. The request came from a long time employee of the Ministry of Health nutrition section. Staff were instructed not to show the video at a breastfeeding workshop as Nestlé did not want their image affected while they were in negotiations with the Ministry of Health. It's now being used again.
Formula companies continue to violate the Code and are engaged in relentless efforts to water it down. Meanwhile, they produce publications for government and health professionals to refute allegations of code violations.
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