Advertising Standards Authority finds against Nestlé
BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7181.417a (Published 13 February 1999) Cite this as: BMJ 1999;318:417
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I would like to respond to the March 6 letter of Dr. Syed
Fasahatullah Husseni of Karachi, Pakistan.
Dr. Fasahat, as a chief paediatrician in Karachi, will be no stranger
to the unethical marketing practices prevalent in Pakistan. A report
published in April 1998 revealed that not a single company marketing baby
foods or feeding products in Pakistan was abiding by the International
Code of Marketing of Breastmilk Substitutes. Nestlé was far and away the
largest source of violations.
Implementation of the International Code as enforceable national
legislation is one of the most important steps all governments, especially
that of Pakistan, can take to “help out pregnant and lactating mothers” by
protecting them from the propaganda these companies churn out in the name
of “information”.
Before casting stones at international organisations and activists,
perhaps Dr. Fasahat would like to comment on the role paediatricians and the Pakistan Paediatric Association have played in
delaying the proposed law being drafted by the Ministry of Health in this
regard and weakening it in favour of the baby food industry.
I can not speak for “most of the developing countries” as Dr. Fasahat
feels confident in doing, but I can say that while the women of Pakistan
face many problems, severe malnutrition is not one of them. Besides, even
moderately malnourished women can produce sufficient quantity of quality
milk to satisfy her child.
What, on the other hand, does Dr. Fasahat have to say about the fact
that in Pakistan only 24% of women can read and write, about 67 million
people do not have access to safe drinking water, nearly every tenth baby
dies before his/her first birthday and diarrhea and acute respiratory
infections cause more than half of infant deaths? Under these
circumstances, how appropriate is it for the baby food industry to promote
its expensive and inferior products?
Also, marketing restrictions on the baby milk industry will not cause
an increased use of raw cow or buffalo milk, as suggested by Dr. Fasahat.
Rather, the use of raw cow or buffalo milk for babies results from the
growing bottle feeding culture encouraged by irresponsible promotion by
the baby milk companies. Marketing restrictions do not make a product
unavailable for the very small segment of society for which it is
necessary, but protect the very large segment of society for which it is
not from commercial exploitation.
Competing interests: No competing interests
Dr. Fasatahullah Husseni (6th March 1999), while defending unethical
promotion of breast milk substitutes, has cited invalid arguments in
favour of his views. Unethical practices for promotion of breast-milk
substitutes by any company ought to be condemned, and this does not
justify sparing any one of them.
Dr. Fasatahullah Husseni states that international organizations and
activists are "waging a war against the use of breast-milk substitutes."
This is quite wrong. The war is not against their use where necessary, but
against their UNETHICAL ADVERTISEMENT TO THE DETRIMENT OF BREAST FEEDING.
Though we all know about nutrition support programs, wether
international organisations are "doing" nothing" to help out the pregnant
and lactating mothers is for these organisations to answer.
I agree that these mothers should be provided much greater
nutritional support but that does not mean that unethical promotion of BMS
is justified.The formula milk costs around Rs 2000/- per month for a 3-4
month old baby in Pakistan , which is one and a half times the monthly
earnings of the majority of families. If only one third of this amount is
spent on lactating mothers , their nutrition will become optimum.
It is scientifically incorrect that the 'quality of malnourished
mother`s milk is very poor.' Numerous scientific studies have proved that
the quality of these mother`s milk is never poor, although quantity may be
diminished only in severely
malnourished mothers. This quantity can be increased by improving their
nutrition , which is more feasible by promoting breast feeding, thus
saving large sums of money required for purchase of formula milk and this
saving will be enough to improve the nutrition of the mother as well as
the whole family.
It is also a wrong argument that the unethical promotion of breast
milk substitutes should be allowed because a minority of mothers are
severely malnourished .The correct approach will be to improve their
nutrition so that exclusive breast feeding done for 4-6 months,
supplemented with semi-solid weaning foods from around 6 months age, and
not by formula milk , becomes possible.
There is a consensus among the pediatricians of the developing
countries, shared also by the Pakistan Paediatric Association, that
feeding breast milk is the key to survival of infants, wether normal or of
low birth weight, and that malnutrition and infant mortality usually
result from bottle feeding of formula milk with associated diarrhoeal
disease.
His statement that 'excessive restriction on milk company has only
caused increased use of raw cow or buffalo`s milk' is completely
unsubstantiated and misleading. There is no advertisement or advocacy for
the use of raw cow or buffalo`s milk and it has never posed any threat to
breastfeeding.
The correct approach will be to strictly enforce the Code of
Marketing of Breast Milk Substitutes in every country alongwith vigorous
campaigns to improve the nutrition of pregnant and lactating mothers.
Competing interests: No competing interests
Dear Editor,
We are surprised and dismayed that as a chief paediatrician, Dr Syed
Fasahatullah Husseni of Karachi, Pakistan, makes three illogical and
unscientific statements in his letter of 6 March.
1) He claims that waging a war against breastmilk substitutes does
nothing to help pregnant and lactating mothers. False! Does Dr Syed
Fasahatullah not realise that breastfeeding encourages, amongst other
things, women’s self reliance through their power to nurture. Healthwise,
breastfeeding helps child spacing, provides protection against ovarian and
breast cancer and osteoporosis. Does he not realise that it is poor infant feeding
practices and their consequences that are one of the world’s major
problems and a serious obstacle to social and economic development? Apart
from all that, protecting breastfeeding is the best long term nutritional
assistance that can be provided for babies whose mothers are at the mercy
of commercial exploitation. Fighting indiscriminate marketing of
breastmilk substitutes and pushing for strong legislation against such
practices is a very positive act.
2) He states that (all?) mothers in most (?) developing countries
are severely malnourished and that they have poor quality breastmilk.
False! While much needs to be done to improve on the nutritional status
of women, it is not true that there is as high a degree of severe
malnutrition as he implies. Also, many studies have shown that even
malnourished mothers do provide high quality breastmilk. The answer is not
that these mothers switch to breastmilk substitutes but that they be
taught to improve their own food intake at a fraction of the cost of
Nestle infant formula.
3) He states that the developer should be allowed to promote a
product if it is necessary even for a very small segment of society.
Would Dr Syed Fasahatullah then also condone promotion of opium or
morphine?
If Dr Syed’s view were representative of the views of hospitals and
Pakistani paediatricians at large, it is no wonder that Pakistan lags
behind her neighbours in implementing the International Code of Marketing
of Breastmilk Substitutes. This is a great pity because Pakistan is one of
the countries in the world which needs the Code most.
Annelies Allain
International Code Documentation Centre
The Netherlands
Competing interests:
The International Code Documentation Center (ICDC) was set up by the International Baby Food
Action Network (IBFAN), to focus on the implementation of the International Code of Marketing of
Breastmilk Substitutes. IBFAN is a worldwide non-profit network of citizen groups who work to
promote, protect and support breastfeeding. IBFAN does not ask or accept any funding or
sponsorship from any infant food or related industry. I don’t receive a salary, as I am a volunteer but
my expenses are reimbursed
Competing interests: No competing interests
It is not uncommon in the developing countries that the unethical
practices are adopted for the promotion of the breast milk substitutes.
Singling out only one company is not justified. There is a great dilemma
in this context that whereas international organiztions and activist are
waging a war against the use of breast milk substitutes, but on the other
hand they are doing nothing in helping put pregnant and lactating mothers.
In most of the developing countries pregnant and lactating mothers
are severly malnorished. And the quality of their breast milk is very
poor. Resulting in either low birth babies or Infant who fail to thrive.
There should be a campain to help out these poor females by provinding
them some type of cheaper and easily accessable nutritional support.
Whereas promotion of breast milk is definately commendable but there
are real problem where breast milk substitute became inevitable. If
something is necessary even to a very small segment of society, it is
justified for the product developer to promote those products.
These exessive restriction on milk company has only caused in
increased use of raw cow or buffalo milk in infant which is more harmful
than the formula milk. These international policies needs to be reviewed
in the context of present state of infant nutrition in the developing
countries.
I do not have any competing interests
Competing interests: No competing interests
As part of our Campaign for Ethical Marketing we call on supporters
to write to companies asking them to stop specific violations of the
International Code of Marketing of Breastmilk Substitutes and subsequent,
relevant Resolutions of the World Health Assembly. Past cases are posted
on our web site http://www.gn.apc.org/babymilk/ with company responses.
There has been little we can do to stop Nestlé and other companies making
claims in their responses, other than expose them. But when Nestlé
made similar claims in its 1996 advertisement we were able to take action,
because advertisements are subject to regulation.
When the ASA Council ruled that Nestlé should not repeat the claims
as made in the advertisement, we wrote to Nestlé to ask if it will stop
making similar claims in letters, publications and meetings. Nestlé
responded to the ruling by appealing and continues to make its
claims. Even if the ASA does not hear the appeal, every day of delay is a
victory for Nestlé.
Competing interests: No competing interests
Need for a more pragmatic approach towards Breast Milk Substitutes.
Our attitude towards the Breast Milk Substitutes is becoming more and
more unrealistic to an extend that we are equating it with Morphine and
Opium.One has to evaluate its merits and demerits in the historical
perspective.
The production of Breast Milk Substitutes Started only after the
advent of industrial revolution. Industrialisation of any society always
involves a substantial number of female population in industrial and other
related urban jobs, and hence keep these female away from their babies for
extended hours. Problem of feeding these babies necessiated the production
of alternate safe nutritional products.
It is a fact that the consumtion of Breast Milk Substitutes are
directly related with the level of industrialisation and urbanisation of
any society. Today most of the developing world is undergoing the similar
transformation which the developed world has achieved. Every day a
millions of female workers are inducted in various type of urban jobs,
they do not have any alternative but to work for thier survival.
My attitude towards Breast Milk Substitutes changed when I
encountered several hundred cases of Breast Feeding failure in female
factory workers and domestic maid servant. In many instances working hours
of these females extend beyound even 12 hours continously.In these
circumstances what alternate they have but to resort to alternate
nutrition, in most cases unfortunately it is the raw diluted unpasturised
cow milk.
Breast Milk Substitute is a need of modren industrialised society
like polyester or plastic. Definately nobody can equate cotton with
polyester or formula milk with Breast Milk, but as we cannot give up
thousand of man made products just because they are inferior to the
natural products.Humankind cannot survives today without its inventions.
Excessive advocacy of breast milk can detriment the female economic
progress which is very vital for thier social improvement in the
developing world. A working female evantually became self reliant and
progressive and achieve a much better status in the society.Children of a
working females are mostly much better of nutritionallly then non working
females.
If the international activists beliefs that by impeding the economic
progress of females in the developing world they could bring down infant
mortality and improves the health of these nations its their view. But the
reality is that it were the breast milk substitutes which helped females
in developed world earliar in the century in improving their economic and
social status in the society. And today millions of infants of newly
emerging female work force badly need them.
In the end I must acknowledge that there is nothing better than the
breast milk and indiscrimate use of breast milk should be condemned. But
breast milk substitutes should be dealt as alternate nutrition not as a
misdeed of a user. One thing which is also needed is that the breast milk
substitue should be considered as essential commodity and should be
provided to every infant who needs it.In this context government and
international donors should be urged to subsidise these products and
developers of these product should bring down prices and make them more
affordable for the people who needs them.
I do not have any competing interests.
Competing interests: No competing interests