World Health Organisation rules on infant milk formula are still flouted, activists say

Despite a couple of decades of pressure, multinational manufacturers of baby milk formula – and Nestlé in particular – remain a focus of activist campaigning. Breastmilk advocates want the Swiss consumer goods company to restrict its marketing of formula milk in developing countries.

Thirty years ago, concerns over unethical advertising led consumer groups to boycott Nestlé. In the UK, where the boycott has found particular traction, 73 student unions and 102 businesses have banned Nestlé’s products from their premises.

Nestlé is not the only company in the sights of campaigners (most of whom convene under the 200-strong International Baby Food Action Network, IBFAN). Big players such as Bristol-Myers Squibb, Danone, Pfizer, Mead Johnson and Abbott Ross also feature on the hit-list.

In an attempt to create a much-needed framework, the World Health Organisation agreed an international code on the marketing of baby-milk substitutes in 1981. The code contains a host of provisions, ranging from a ban of public advertising and free samples to mothers through to the prohibition of low-cost supplies for healthcare facilities.

Welcomed at the time as a landmark by companies and campaigners, the latter have grown increasingly disillusioned with the WHO code.

Why? Companies flout it. A few years ago, IBFAN assessed how 12 baby food companies were implementing the code in 67 different countries. The list of violations ran to 150 pages.

“The marketing of infant formula … continues to be such a very lucrative business [and] companies deliberately ignore WHO recommendations so as to compete intensely with one another,” the Breaking the Rules report concludes.

The code suffers two main problems. The first centres on interpretation. Even the term “breastmilk substitute” is contentious. Companies prefer the term “infant formula”.

“There are big differences between what Nestlé is saying and what WHO and World Health Assembly are saying,” says Pattu Rundall, policy director at UK-based campaign group Baby Milk Action.

Subsequent World Health Assembly resolutions have gone some way to providing clarification. In late May, for example, the WHA passed a new resolution concerning the child marketing of junk foods. The proposal included a specific proviso to support breastfeeding in emergency situations.

The non-binding problem

Even if the interpretation issues are resolved, a second larger problem exists. The WHO code is non-binding. Where specific national legislation is not present (as it often is not), companies depend on their own internal compliance systems.

Nestlé, like all other large manufacturers, publicly states that it applies the code “voluntarily and unilaterally”. To that end, it has an internal quality assurance system that clarifies compliance policies and procedures. All its health staff are trained on the code every year. Furthermore, it carries out multiple internal and external audits on an annual basis.

Such actions have led to undeniable improvements over the last three decades. Yet allegations of non-compliance continue. The latest example is Nestlé’s Protect label. Critics allege that the logo misleads consumers as babies fed on formula are more likely to suffer infection or illness.

The company rejects the claim. Nestlé’s Gayle Crozier-Willi says: “The logo helps distinguish this formula from other less advanced milk products but does not claim in any manner that infant formula is superior or equal to breastmilk.”

Stalemates such as this are leading many to call for the mandatory application of the WHO code. Companies reject the idea as unworkable and unnecessarily bureaucratic.

This leaves campaigners with one of two options: complain through formal channels – a process that is slow, expensive and mired in lack of clarity – or take their fight to the streets and supermarket shelves. It is not difficult to guess which they prefer.

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