Holding Wyeth/Pfizer to account: SMA advertising ruled misleading, email marketing condemned and...
In a national billboard, print and online advertising campaign in March 2012, Wyeth (part of Pfizer) promoted its formula in a series of advertisements showing mothers with young children under headlines: "What’s the best milk after Kate’s?", "What’s the best milk after Lisa’s?" etc.
Following complaints by Baby Milk Action and other groups and individuals, the Advertising Standards Authority (ASA) has ruled the answer is NOT SMA formula.
In a ruling published on 19 September it warns Pfizer not to repeat the advertisements after finding: "the ads misleadingly implied that follow-on milk was the best alternative to breast milk" and "the ads misleading implied that SMA Follow-on milk was superior to other follow-on milks".
However, there is no requirement under the UK Advertising Code for companies to run corrections when they have misled the public and no fines.
On 28 November, the ASA upheld another complaint brought by Baby Milk Action, this time against an email campaign. The email headed "How is feeding going?" was aimed at mothers with four-week-old babies and played on fears about milk intake and possible problems with breastfeeding before asking "Thinking of bottle feeding?" and promoting SMA infant formula with a claim it contains a fat blend closer to breastmilk. The ASA ruling states:
"The ad must not appear again in its current form. We told SMA [sic] not to produce marketing communications for infant formula except in a scientific publication or, for the purposes of trade before the retail stage, a publication of which the intended readers were not the general public."
[SMA is the brand, the company was Pfizer].
This is a significant ruling and we are calling on Nestlé, which has now completed its purchase of Pfizer Nutrition/Wyeth to stop all infant formula marketing communications. (See page 20).
These rulings are welcome, but Wyeth continues to promote its formula to health workers with the claim "Drop for drop, no other formula comes close" safe in the knowledge that the ASA refuses to investigate advertising in health journals.
For further analysis, see Baby Milk Action’s briefing How the Advertising Standards Authority fails to protect babies and their families in the UK - click here to download.
...the SMA Baby Know How roadshow stopped
Pfizer/Wyeth cancelled its much promoted SMA Baby Know How roadshow in June 2012 after shopping centres pulled out of the event. The roadshow was to have run through June and July, including during National Breastfeeding Week.
The stated purpose was to launch new packaging for SMA formula, while enticing mothers with the offer of advice, free mother-and-baby photographs and other inducements.
Members of the public sent messages of protest to the shopping centres in support of a Baby Milk Action 'Stop Wyeth' campaign.
The first event at Lakeside shopping centre on 14 June was cancelled the day before, meaning a planned demonstration did not have to go ahead.
The second event at Bluewater scheduled for 21 June was cancelled on 16 June, though Wyeth continued to advertise it until announcing the roadshow as a whole was 'postponed' on 20 June after other shopping centres also pulled out.
Baby Milk Action is calling on the shopping centres to put in place policies to respect baby milk marketing requirements to prevent a repeat.
See our press release announcing the success of the 'Stop Wyeth' campaign for further details - click here.
No promotion - cheaper formula
The millions companies spend on advertising, gifts, courting health workers etc. is added to the price of formula, which is already overpriced.
See the calculation by Baby Milk Action and the No Promotion - Cheaper Formula petition, a campaign supported by Mumsnet and others, at:
http://www.change.org/petitions/baby-milk-companies-no-promotion-cheaper-formula
Latest trends: baby clubs, social media and health workers
Baby Milk Action’s Look What They’re Doing 2013 monitoring report exposes latest strategies for targeting mothers in the UK. Danone’s Facebook strategy to promote its Cow & Gate brand of formula, for example, invites mothers to "Ask, chat, share & laugh!"
It has content-specific advertising placed on sites and websearches relating to infant formula and childcare and attempts to supplant health workers and mother support groups as the source of information on childcare by offering "expert advice and support".
Leaflets on pregnancy are placed in health facilities and displayed alongside NHS leaflets on diabetes and giving up smoking. Outside there is the subtle Cow & Gate heart logo. Inside, pregnant women are encouraged to contact Danone’s Cow & Gate-branded "Careline", visit its websites and sign up for information - including on formula.
In May 2012, following a Baby Milk Action campaign, Danone promised to stop distributing materials intended to reach the public through health care facilities, not just in the UK, but around the world. This is an important victory, but perhaps shows how the other strategies are taking over. Danone’s main aim is to get mothers to use its own website, offering information, film clips, advice, free gifts and more. It claims 3,000 mothers are signing up every week. Mother support groups have to compete if they want to reach mothers with unbiased information.
Once on the list, the emails come. One for pregnant women nearing their delivery dates promotes the Cow & Gate starter kit: "Compete peace of mind for the first 48 hours". Mothers who opt out of receiving information on milks are sent a weaning mailing when their children are 3 months old, encouraging spoonfeeding pureés - undermining the recommendation to begin complementary foods at about 6 months.
Perhaps most worrying of all, health workers are actively working with Danone. For example, Community Practitioner magazine distributes the Cow & Gate-branded Feeding for Life supplement, which promotes a website linking to information on formulas. The Infant and Toddler forum for health workers and parents is a partner in the government’s Public Health Responsibility Deal - the website is owned by Danone, which sponsors events. Of course, all of this is paid for by premiums on the formula price. (See No promotion - Cheaper formula campaign page 18).
Danone free booklet undermines home-grown organic foods
This booklet boasts about Cow&Gate’s quality assurance. Someone asks if it is safe for children to eat home-grown organic vegetables. Stephan (from Cow&Gate) answers:
"Do you know if the soil on your vegetable patch contains heavy metals, or what pesticides may have been used in the past?
"No I don’t....there’s a thought...."
Campaigners in the Philippines are exposing a threat levelled at the economy by Nestlé and other transnational companies if baby milk marketing regulations successfully defended in 2007 are not replaced.
Nestlé and its partners are pushing for a new, weak law to be introduced, which will allow them to advertise milks for use from 6 months of age (with the same branding as milks for use from birth) and target mothers directly.
The Department of Trade and Industry has been lobbying legislators on the industry’s behalf, writing to Members of Congress: "The proposed ban on advertising for milk products jeopardizes multinationals’ plan to invest $400 million."
Meanwhile the Department of Health, WHO and UNICEF have said in joint statement that the draft bill: "aims to support multinational companies while damaging the Filipino society: families, the mothers and children."
Campaigners have organised events such as protests outside congress (above - click for large image). They point out that elections for congress take place in 2013 and they have been hearing politicians warned that investment in their constituencies will be cancelled if they do not back the bill.
Nestlé has formed the Infant & Pediatric Nutrition Association of the Philippines with formula companies Abbott Laboratories, Fonterra Brands, Mead Johnson Nutrition and Wyeth (which it now owns) to lobby against the existing marketing requirements - yet Nestlé and other companies cite anti-trust regulations when called on to mutually agree to stop violations of the international minimum standards adopted by the World Health Assembly.
If Nestlé’s law is passed it will no longer have to put clear notices on labels about the benefits or breastfeeding, as shown right.
The Department of Trade and Industry told Congress: "The benefits derived from the performance of the infant formula industry in terms of government revenues and employment opportunities cannot be overemphasized."
• In the Philippines the industry is arguing that no country regulates the marketing of products for children over 6 months of age, falsely claiming this goes beyond the Code and Resolutions. In fact many countries have laws covering products for children to two or three years of age. (See page 14 for recent additions to the list.)
Fiji's Marketing Controls - Foods for Infants and Young Children which was gazetted in May 2010 and was presented at the World Breastfeeding Conference by Ateca Kama, a Senior Nutritionist at the National Food and Nutrition Centre, Ministry of Health, covers products for children up to five years of age.
South Africa - scope to three years of age
South African health campaigners are celebrating the adoption of the Regulations Relating to Foodstuffs for Infants and Young Children. This covers the marketing of products for children up to three years of age and was gazetted on 6 December 2012, a great way to mark the start of the World Breastfeeding Conference in India. (See page 4).
Implementation of the International Code of Marketing of Breastmilk Substitutes, adopted by the World Health Assembly in 1981, was diverted in South Africa when in 1986 the industry agreed a voluntary code of conduct with the Department of Health. This was ineffective and the industry responded to calls for regulations by forming the Freedom of Commercial Speech Trust in 1997 to argue that it was against their constitutional rights to prohibit advertising of products (Update 21).
The first draft of the new regulations was produced in 2003 and it took nine years to bring them into force in the face of constant pressure from the industry. In 2003, Nestlé attempted to buy a photo-opportunity with Nelson Mandela by offering to present a £500,000 cheque to him for his Children’s Fund via film director and actor Richard Attenborough (Update 33). The Fund turned it down, telling the media (iAfrica) that it was not the first time, "given the Nestle debacle in relation to HIV/Aids infected mothers and their campaign on promoting formula milk as opposed to breast milk and the disadvantages they put out publicly regarding breast feeding, the Nelson Mandela Children’s Fund declined the donation." Nestlé took British MPs on an free trip to visit South Africa in 2008 and one, Tom Levitt from Buxton, where Nestlé bottles water, (who also accepted gifts of sports tickets from the company) took to defending the company publicly (Update 41, Update 43).
IBFAN has gathered evidence of agressive marketing practices throughout this time and more than once Baby Milk Action supporters have sent messages of support to the South African Government to counter industry lobbying. In the final consultation on the regulations just adopted, the industry again claimed they were unconstitutional, tried to limit them to products up to one year of age and opposed the ban on baby food company sponsorship. In parallel with this, the industry tried to recruit health workers to their cause, saying they would gain Continuing Professional Development points from company-sponsored events if the law allowed them. Now the Regulations are in force, the harm caused by aggressive marketing can start to be reversed.
Vietnam - scope to two years of age
In June 2012 the Vietnamese National Assembly voted overwhelmingly (90% in favour) for the new Advertising Law which prohibits the advertising of baby milks for children up to two years of age and complementary foods up to 6 months of age.
• The US Embassy in Hanoi wrote to the President of the Assembly and Government Ministers urging against a ban on advertising formula milk products for babies above the age of 12 months.
Left: This picture from Vietnam by Martien van Asseldank featured in the IBFAN Calendar 2012.
Kenya - scope to three years of age
Kenya's new Law, the Breastmilk Substitutes (Regulation and control) Act 2012, finally came into force on 26 October 2012. As in many other countries, this is a story of concerted action by civil society and UN bodies to encourage policy makers to take action, and delays as they were diverted towards voluntary codes by the industry. In the final stages, as the Law awaited the President’s signature, Kenya came under pressure to weaken the proposals from GAIN, the Global Alliance for Improved Nutrition, who in a lobby paper suggested that proceeding with the law would threaten "Kenya’s ability to meet its commitments as a Scaling Up Nutrition (SUN) country." (See page 25).
The following chronology is based on a presentation at the World Breastfeeding Conference (page 4).
1981: Kenya supports the adoption of the International Code of Marketing of Breastmilk Substitutes at the World Health Assembly.
1983: Civil society through the Breastfeeding Information Group (BIG) supports the Ministy of Health (MoH) to draft first Breastmilk Substitutes Bill. However, this becomes a voluntary standard under the Kenya Bureau of Standards
1984 - 2001: Attempts to translate the marketing requirements into law are unsuccessful.
2002: MoH is supported by UNICEF to train an Attorney General lawyer on the Code.
2003-2007: Several more unsuccessful attempts to progress with legislation.
2008: Small core team formed of MoH UNICEF, WHO, IBFAN (Kenya), University of Nairobi. Attorney General provides a new lawyer to redraft with new WHA recommendations
2010: Draft Bill submitted to cabinet by Minister for Public Health
• 10th August 2012: Draft Bill gazetted for public review (10 days)
• 29th August: First reading in Parliament
• 12th September: Second reading – debate
• 20th September: Committee of the full house, motion was passed with few amendments
• 26th October: His Excellency President Mwai Kibaki assented and published the law as The Breast milk Substitutes (Regulation and Control) Act 2012.
The law prohibits the promotion of designated products, which includes infant formula and follow-on formula (defined as milk for use up to two years of age, including milks for special medical purposes) and complementary food products (defined as products for infants from 6 - 36 months of age).
A National Committee on Infant and Young Child Feeding is established to oversee the law, which shall not include "a person who has a direct or indirect interest in the manufacturing, distribution, marketing, advertisement or promotion of a designated product or complementary food product". It also prohibits all forms of company samples, gifts, sponsorship, grants, conferences and courses to health workers. Sanctions include up to three years in prison.
Mike Brady reflects on what it means to say breastfeeding is a human right.
Human rights apply universally and it is the responsibility of governments to deliver and protect these rights.
The right to breastfeed is an interpretation of existing rights, such as the right to adequate food in the Universal Declaration of Human Rights, the International Covenant on Economic, Social and Cultural Rights, and the Convention on the Rights of the Child, amongst others.
Professor George Kent of the University of Hawaii wrote in a paper on Human Rights and Infant Nutrition prepared for the World Alliance for Breastfeeding Action Global Forum in 2002:
"The principles are based on the concept that mothers should not be legally obligated to breastfeed, but rather they should be supported in making their own informed choices as to how to feed their infants."
Protecting the right to breastfeed does not force mothers to continue breastfeeding if they want to stop. We have the right to free speech, but that does not mean we are forced to give an opinion on every subject under the sun; if we want to speak, that right is protected.
In the UK, 90% of women who stop breastfeeding before six weeks do so before they wish to (Bolling et al, 2007 cited in UNICEF, 2012 - full Infant Feeding Survey details available at http://www.ic.nhs.uk/pubs/ifs2005). If the Government had protected the right to breastfeed, might the situation have been different?
To protect breastfeeding and empower mothers, we need to provide an environment that makes breastfeeding possible. Many societies present obstacles to breastfeeding, rather than remove them. Maternity leave for working women needs to be sufficient, at least for the recommended period of 6 months exclusive breastfeeding (so those who wish to do so, can do so), and working conditions must be conducive to continued breastfeeding into the second year of life and beyond. Convention 183 (2000) of the International Labour Organisation states:
"A woman shall be provided with the right to one or more daily breaks or a daily reduction of hours of work to breastfeed her child... These breaks or the reduction of daily hours of work shall be counted as working time and remunerated accordingly."
Not all countries have ratified the Convention. The UK has not yet done so.
Mothers also need protection from aggressive marketing of breastmilk substitutes. Ensuring parents have the required information and support on breastfeeding as called for by the Convention of the Rights of the Child entails implementing the International Code of Marketing of Breastmilk Substitutes and subsequent, relevant Resolutions of the World Health Assembly, which also aims to protect mothers who use breastmilk substitutes, who also have a right to accurate, independent information.
The Committee on the Rights of the Child now routinely looks at how governments have implemented the International Code and Resolutions when assessing their progress in complying with the Convention. The Committee commented in 2008 on the UK: "it is concerned that implementation of the International Code of Marketing of Breastmilk Substitutes continues to be inadequate and that aggressive promotion of breastmilk substitutes remains common".
To promote breastfeeding and inspire mothers and their families may require investment in social marketing.
In the UK, the coalition government scrapped the Infant Feeding Coordinator posts at the Department of Health, even though these posts are called for in the Global Strategy on Infant and Young Child Feeding.
It is also short sighted if the intention is to save money. UNICEF UK issued a report this year on the unnecessary illness that could be prevented and costs saved if breastfeeding rates increased, if the mothers who stopped breastfeeding earlier than they wanted were able to continue for longer.
The theme of the World Breastfeeding Conference was "Mom-made, not man-made". Perhaps "Mum-made, not manufactured" works better in our culture and helps us to highlight that the European Union prioritises trade and growth over health.
So we see the Irish Government’s Enterprise Ireland and Danone announcing investment of Euro 50 million in a baby milk factory to boost the economy by exporting formula around the world. According to Enterprise Ireland "98% of the output from [the] Macroom [facility] will be exported and commercialized in more than 60 countries worldwide". This will inevitably displace breastfeeding in other countries as well as its own. To benefit its economy, the Irish Government could instead invest in mothers, the "real milk" producers, in a country where less than half (47%) of mothers are breastfeeding on discharge from maternity services (NPRS, 2008 cited by the Health Service Executive).
To support breastfeeding requires provision of health care services, a supportive environment and counselling services, particularly in countries where breastfeeding is not entrenched and visible.
As Prof. George Kent comments with regard to the right to adequate food :
"There is increasing recognition at the international level that good nutritional status is an outcome that depends not only on good food but also on good health services and good care. Health services consist of a broad range of measures for the prevention and control of disease, including the maintenance of a healthy environment."
In the UK we have the National Health Service, free at the point of use, and an increasing number of hospitals are entering the UNICEF Baby Friendly Initiative, which aims to ensure support is provided to pregnant women and mothers in hospital and in the community. However, there are growing concerns about the way health workers are being targeted in the UK and other countries by baby milk companies, including through funding training and other events. (See page 17).
Mother support groups provide counselling services in the UK and the Department of Health does provide a grant towards the National Breastfeeding Helpline operated by a coalition of them. This is one example of the Government acting on its human rights obligations. However, a coherent approach is needed as the failure to adequately regulate the baby food industry means companies encourage pregnant women and mothers to contact company-branded telephone "carelines" for support on infant feeding and to sign up to their mother and baby clubs for information. There is an intrinsic conflict of interest in baby milk companies with products to sell making direct and indirect contact with pregnant women and mothers, and this is prohibited by the Code. The fact this is a marketing strategy was demonstrated in Nov 2012 when Baby Milk Action won a case against Pfizer/Wyeth before the Advertising Standards Authority (ASA) over its illegal advertising of infant formula when ostensibly providing breastfeeding support. (See page 18).
A human rights approach requires action on many fronts. It helps us to think coherently and logically about what is required to protect and deliver the rights in question.
Further reading
Breastfeeding: A Human Rights Issue? Development, Vol. 44, No. 2 (June 2001), pp. 93-98. http://www2.hawaii.edu/~kent/breastfeedingrights.pdf
Global Obligations for the Right to Food, edited by Professor George Kent, with a chapter on Holding Corporations Accountable by Mike Brady.
We know how to improve breastfeeding rates, but is action being taken - or are our babies falling through the gaps?
Every year close to 136 million babies are born all over the world. Of them as many as 92 million are not able to experience the WHO’s recommended optimal feeding practices: beginning breastfeeding within one hour, being exclusively breastfed for the first six months, and timely and appropriate complementary feeding with continued breastfeeding after 6 months, up to 2 years. This is in spite of the risks to children’s health, development and survival and to their long-term health and prevention of non-communicable diseases.
In order to increase the rates of optimal feeding practices, WHO and UNICEF developed the Global Strategy for Infant and Young Child Feeding, which provides a framework for action to scale up breastfeeding and infant and young child feeding interventions. They also developed a tool to monitor these inputs. Based on these tools, the Breastfeeding Promotion Network of India/ International Baby Food Action Network (IBFAN), Asia, developed the World Breastfeeding Trends Initiative (WBTi), which measures inputs and generates national action.
The WBTi includes assessment, action, and advocacy. It is an innovative web tool giving universal access to this information, and leads to colour coding and objective scoring to make it easily understandable for the policy makers. It is the central strategy of the global Breastfeeding Initiative for Child Survival (gBICS), jointly launched by the IIBFAN and the World Alliance for Breastfeeding Action (WABA) in 2008.
WBTi indicators
MEASURING PROGRESS
The indicators for the 10 areas of action include:
• National Policy, Programme and Coordination
• Baby Friendly Hospital Initiative (Ten Steps to Successful Breastfeeding)
• Implementation of the International Code
• Maternity Protection
• Health and Nutrition Care Systems
• Mother Support and Community Outreach - Community-based Support for the Pregnant and Breastfeeding Mother
• Information Support
• Infant Feeding and HIV
• Infant Feeding During Emergencies
• Monitoring and Evaluation
HIGH FIVE
The indicators for five optimal IYCF practices include
• Initiation of Breastfeeding (within 1 hour)
• Exclusive Breastfeeding (for first 6 months)
• Median Duration of Breastfeeding
• Bottle-feeding (<6 months)
• Complementary Feeding (6-9 months)
The WBTi was earlier launched in 2004-05 in South Asia, and its success led to its introduction in other regions of Asia, Africa, the Arab world and Latin America in 2008, and in Oceania in 2010.
Introduced in 82 countries, the WBTi has led to 51 countries being assessed, ranked and colour-coded based on their scores (see below).
Five South Asian countries have done their 3rd assessment since 2004-05 and two countries in the Latin America and Caribbean region have completed their 2nd assessment since 2008-09. Many countries in Africa and Asia are in the process of conducting trend analysis with their 2nd assessment. (Work has also started in the UK.) This shows that the interest is growing to find the gaps and bridge them.
Extracted from Are our Babies Falling through the Gaps: The State of Policies and Programme Implementation of the Global Strategy for Infant and Young Child Feeding in 51 Countries:
http://www.worldbreastfeedingtrends.org
Andy Chetley (left) and Zef Ebrahim (right) who died in 2012 both played a huge role in establishing IBFAN and Baby Milk Action. We miss their wise advice enormously.
Save the Children’s Report: Superfood for Babies: How overcoming barriers to breastfeeding will save children’s lives, found systematic aggressive marketing by Nestle, Danone and other companies. It made several recommendations made including bringing FTSE4Good criteria into line with the International Code and Resolutions.
Click here for IBFAN statement on the report and a link to download it.
Breastfeeding saves lives. Millions of people who would have died during their fist year had they been fed on formula are alive today because they were breastfed. Many more lives could be saved if breastfeeding rates improved. A paper was prepared for the World Breastfeeding Conference calculating how much it would cost governments and donors to support all mothers to breastfeed optimally.
It is said that breastfeeding is free because breastmilk is produced naturally without manufacturing and transport costs and does not require bottles or sterilising equipment to deliver. The best food in the best packaging.
According to the WHO/Lancet Child Survival Series, improving breastfeeding rates could prevent 13% of under-5 deaths in the 42 countries where most of these occur. That is, improved breastfeeding (not even universal breastfeeding) could save 1.3 million lives every year as well as reduce illness and the associated health care costs, as well the cost in human suffering.Yet the goal of improving breastfeeding rates seems to lag behind the goals of providing vaccinations, safe water and adequate sanitation, which even combined would save fewer lives than breastfeeding. Is it because breastfeeding is "free" that it is undervalued?
Or is it the fact that baby milk companies offer employment and tax income to governments that sees them being subsidised, as in Ireland at present? (See page 19).
BPNI presented a discussion paper called Scaling Up Breastfeeding/Infant and Young Child Feeding Interventions: What will it Cost? This calculated the budget to enable 100% of mothers and babies to breastfeed in the first hour after birth and then optimally, covering all countries for all births in a 5-year period. The total cost of protecting, promoting and supporting breastfeeding US$ 4 billion, or about 20% of the cost of staging the Olympic Games. If provision was made to pay all mothers below the poverty line US$ 2/day for 6 months, this would add nearly US$ 52 billion to the five-year budget. "The cost of not acting is measured in needless suffering and death, lost workdays caring for children and health care costs - while companies count their profits and encourage governments to think of investment and tax."
Click here to download the discussion paper.
We, the participants from 82 countries coming from diverse groups including governments, breastfeeding organisations, health providers, people’s organisations and movements, international NGOs and individuals... recognize that protection, promotion and support of breastfeeding and optimal infant and young child feeding is a human rights issue and should be entrenched in the public policy and programmes as a necessary condition needing resources.
We call upon all concerned to take the following actions:
Full declaration available at:
http://www.worldbreastfeedingconference.org