Formula milk companies are continuing to use aggressive, clandestine and often illegal methods to target mothers in the poorest parts of the world to encourage them to choose powdered milk over breastfeeding, according to a Guardian/Save the Children investigation.
In some of the most deprived areas of the Philippines Nestlé and three other companies were offering doctors, midwives, and local health workers free trips to lavish conferences, meals, tickets to shows and the cinema and even gambling chips, earning their loyalty. This is a clear violation of the Philippine law. At the same time, powerful lobby groups have been working to curtail government legislation regulating formula marketing and promotion, in the Philippines and across the world. The World Health Organisation’s international code explicitly prevents formula companies directly targeting mothers and healthcare professionals, and restricts advertising. Formula promotion is a particular issue in poorer countries because there is a higher risk of pneumonia and diarrhoea for babies, and with a lack of access to healthcare mothers are less informed about the benefits of breastfeeding. This was drawn up in 1981 after widespread protest against Nestlé’s marketing of formula as better than breastmilk, despite evidence that formula feeding was linked to babies falling ill or dying from poorly sterilised bottles.
Yet despite the industry’s claims it has cleaned up its act, the practices that were globally condemned four decades ago are still evident today across the developing world. The report by Save the Children says companies are systematically violating the milk code, with devastating consequences for infant health and mortality. Leading formula companies spend £36 on marketing for every baby born worldwide. East Asia, with its growing economies and high birth rate, is a key target.
Representatives from Nestlé, Abbott, Mead Johnson and Wyeth (now owned by Nestlé) were described as a constant presence in hospitals in the Philippines, where only 34% of mothers exclusively breastfeed in the first six months. Here, they reportedly hand out “infant nutrition” pamphlets to mothers, which appear to be medical advice but in fact recommend specific formula brands and sometimes have money-off coupons. Hospital staff were also found to be recommending specific formula brands in lists of “essential purchases” handed to new mothers. Targeted advertising on Facebook and partnerships with influential “mummy bloggers” means mothers are being exposed to more unregulated formula promotion than ever before.
TV advertising campaigns for follow-on milk by brands such as Bonna – which portray the “Bonna kid” as one who is smarter and succeeds in life – convinced them, they said, that bottle feeding is not only as good for the baby’s health as breast milk but will bolster their IQ and future prospects. Store displays of formula were splashed with claims such as “clinically proven to give the IQ + EQ advantage”. For mothers living in poverty, such aspirational marketing is particularly seductive. The barrage of marketing, advertising on TV and social media, and persuasive free gifts ensures that misinformation is rife.
Jessica Icawat, 24, wept as she recalled the sacrifices she had made to give Trista, her two-year-old daughter, Nestogen, a formula made by Nestlé. Breastfeeding had been hard and she turned to formula because the local community consensus was it is “fine, the same as breast milk”. Stick thin, her cheek and collarbones sticking out, Icawat was visibly malnourished, as was Trista, whose swollen stomach stuck out beneath a faded pink Little Mermaid T-shirt. The average cost of Nestogen is 2,000 pesos (£28) a month but Icawat could afford to spend only 800 pesos. “I didn’t eat just so I could feed the baby,” she said. “There were some days when I didn’t eat anything. And Nestogen is expensive so I could not always give it to my baby when she was hungry, I only gave her half bottles, four times a day.”
“The milk formula companies now take a clandestine approach,” said Dr Amado Parawan, who has spent 20 years working with Save the Children in the Philippines to champion breastfeeding. “On the face of it they have improved. But really they are skirting around the milk code by doing visits and dinners for midwives and doctors outside of office hours, in the evenings.”
Julianne Bores, a GlaxoSmithKline representative who worked alongside formula representatives in hospitals since 2009, described a culture of financial dependency, where if doctors want to go to expensive medical conferences – held mostly in lavish hotels or abroad - they would always ask the milk companies for sponsorship, and were occasionally allowed to bring their spouses. Formula representatives would also pay for “rest and recreation activities” for doctors and their families, such as tickets to Cirque du Soleil, and meals at popular restaurants. Bores was also an observer of the “parenting” and “nutrition” forums for parents held in the hospital canteens by the formula representatives, where samples or branded freebies like umbrellas and feeding bottles would be distributed. All these practices are a violation of Philippine law.
midwife Grace Shelo Almarez admits that before she was given training, she was among the many wined and dined by Nestlé, Mead Johnson, and Wyeth and offered numerous trips to conferences. As recently as October Nestlé offered her a trip to Iloilo, which she declined. “In return for that, if a patient decided to use formula milk, I’d recommend their product and tell them ‘Nestlé is good’ or ‘you should use Nestogen’ and so on. They are very persuasive, they make it sound like their products are very good for the mothers and the babies.”
The Save the Children report shows how global pro-formula campaigning is. In Mexico, where just 31% of infants are exclusively breastfed for the first six months, 50% of mothers said they had been recommended formula by their doctor, while in Chile, 75% of doctors, nurses and midwives in hospitals reported visits from formula representatives.
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