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Misperceptions and misuse of Bear Brand coffee creamer as infant food: national cross sectional survey of consumers and paediatricians in Laos

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1379 (Published 09 September 2008) Cite this as: BMJ 2008;337:a1379

Rapid Response:

Nestle's mommy bear does not breastfeed

Dear Editor,

Breastfeeding is the best intervention to save infants’ lives
especially in the developing world. Following our last response to Nestle
that you kindly published (1), we posted the BMJ publications regarding
the misuse of coffee creamer with the Bear Brand label in Laos to Mr
Brabeck, President of Nestle S.A (2-6).

We recently received the following response from Petraea Heynike,
Executive Vice President of Nestle which means that Nestle will continue
to use a teddy bear to promote milk products. This is, in our view, a persistent
marketing trick to promote the use of breast milk substitutes. “In the new
logo, we specifically selected a large glass which is not feasible for
infants to hold, as a way of distinguishing the brand from infant
products, and we have removed the baby bear.” Since other BMJ readers and
the international scientific community are seriously concerned (7), you
will find enclosed Nestle’s answer and our response sent to Nestle Vevey
on 6 May 2009. We recommend NO BEARS on milk products, especially “Mommy
Bears”, the current “Good Immune System for Unlimited Learning
Opportunities” 40 millions Thai Bath (1162599 USD) marketing campaign of
Nestle in Thailand. (8)

From Petraea Heynike, Executive Vice President of Nestle

Dear Drs Barennes and Srour,

As Head of Marketing for Nestle, S.A., Mr. Brabeck has asked me to
respond to your letter of March 22.

I share your concerns about feeding inappropriate foods to infants,
both professionally and personally as a mother.

In order to avoid any potential confusion about Bear Brand milk
products not marketed as breast milk substitutes being used as such, we
have taken the precautionary measures described in Mr. Stieger's past
correspondence.

In the new logo, we specifically selected a large glass which is not
feasible for infants to hold, as a way of distinguishing the brand from
infant products, and we have removed the baby bear. (The American Academy
of Pediatrics Developmental Milestones specify 18 months as the age when a
child can hold a regular cup or glass without help).

To test whether or not your assertion is correct that this logo with
a bear holding a glass could be interpreted by mothers as indicating that
the product is intended for infants (under 12 months of age), we will
conduct a consumer test of this logo with a professional marketing
research firm, and we will share the methodology and results with you when
they are ready.

Your letter of March 22 also raises other points that we believe are
not based in fact, such as your assertion that the logo would not be
permitted in Switzerland. These we would be happy to discuss.
We also hope that your concerns go beyond commercial milks, and the Nestle
Bear Brand. As you may know, many infants receive a range of inappropriate
liquids, the most common ones being rice water, sugar water, and whole
cow's milk. It is this wide-scale practice which must be stopped,
principally by promoting exclusive breastfeeding for the first six months
of life, by education on appropriate complementary foods, and by health
professionals recommending infant formula over inappropriate liquids, when
a mother doesn't breast feed.

Nestle firmly believes in the importance and value of breastfeeding
and appropriate complementary feeding. We are therefore open to work with
any serious organization which wishes to promote exclusive breast feeding
for the first six months, educate women on the proper complementary foods
for infants and young children, and to educate doctors to recommend infant
formula rather than cow's milk for infant feeding, when a substitute is
needed. To this end, we would like to arrange a personal meeting with you
to clarify the various issues you raise, and to discuss the broader issue
of how to improve infant feeding practices in Laos.

Our response sent to Nestle Vevey on 6 May 2009

Dear Ms. Petraea Heynike,

Thank you for your letter. Thank you for your concerns about
inadequate and inappropriate liquid feeding of infants in poor families.
Thank you for your concerns about milk products marketed with the Bear
Brand label. We are glad to know that the baby bear will be removed.

Despite all your nice declarations and willingness, our concerns
remain high regarding your proposition and the use of the Bear Brand in
the Asian region. We fear a remake of the African scandals of the 70ties.
We really encourage Nestle to adopt ethical behavior despite their huge
commercial interest in the Bear Brand. The large glass held by the Mother
Bear could be very confusing, as mothers are encouraged to introduce a cup
to infants at six months of age. Any bears on milk products may be
confused by parents, especially if they are unable to read the label. We
recommend NO BEARS on milk products.

Thank you for your plan for consumer testing of the logo. Will the
test include illiterate ethnic minority parents? Will you be interested in
an external evaluation that we or another independent team could do? What
is your plan if the research reveals label confusion?

The BEAR BRAND label continues to promote milk products in Lao.
You should not believe that our concerns with the BEAR BRAND are
restricted to Lao. It extends to nearby Thailand where very aggressive
BEAR BRAND campaigns are ongoing : “Meanwhile, Nestle' (Thai) Ltd, the
manufacturer and distributor of the Bear-branded powdered milk would also
help its retailers cope with the current economic situation by
strengthening their sales and merchandising capabilities through its Sales
Blitz campaign….Roland Stieger, Nestle’s executive business manager for
dairy and creamers, said that the current economic difficulties had
negative impacts on all local industries as well as the decision-making of
Thai consumers. To cope with the situation, the Bear brand has laid down
plans to stimulate the local powdered milk market and assist its retail
partners.” (8)

Will this Sales Blitz campaign use the Bear Brand logo of the mother
and baby bear? How long will the impact of this campaign last and how many
infants will die?
Due to huge commercial conflicts of interest, we do not believe that
Nestle is appropriate to be in charge of educating women of the third
world how to feed their infants. We strongly suggest another independent
solution. Nestle’s willingness and expressed interest could be appreciated
by their anonymous contribution to breastfeeding campaign promotions by
well-known independent organizations.

We welcome the opportunity to meet with Nestle representatives,
together with the Lao Ministry of Health to discuss these issues.

1. Srour LM,.Barennes H. Will Nestle's Bears Continue to Mislead
Parents and Threaten Infants Lives? BMJ 2009.
http://www.bmj.com/cgi/eletters/337/sep09_2/a1379#208354

2. Barennes H, Andriatahina T, Latthaphasavang V, Anderson M, Srour
L. Misperceptions and misuse of Bear Brand coffee creamer as infant food:
national cross sectional survey of consumers and paediatricians in Laos.
BMJ 2008.

3. Barennes H,.Srour LM. Nestle's violations of the international
code on the marketing of breast milk substitutes. BMJ 2009.
http://www.bmj.com/cgi/eletters/337/sep09_2/a1379#204311

4. Slesak, G, Douangdala, P, Inthalad, S, Onekeo, B, Somsavad, S,
Sisouphanh, B, Srour, L. M., and Barennes, H. Misuse of coffee creamer as
a breast milk substitute: a lethal case revealing high use in an ethnic
minority village in Northern Laos. BMJ.
http://www.bmj.com/cgi/eletters/337/sep09_2/a1379#207174.

5. Stiegler R. Nestle's works to ensure appropriate use of milk
products http://www.bmj.com/cgi/eletters/337/sep09_2/a1379. BMJ 2008.

6. Stiegler R. The latest step in a series of extraordinary labeling
measures. http://www.bmj.com/cgi/eletters/337/sep09_2/a1379.

7. IBFAN. The International Code of Marketing of Breast Milk
Substitutes. www.ibfan.org/english/resource/who/fullcode.html.

8. K. Rungfapaisarn. Nestle introduces online Mommy Bear community.
The Nation, May 14, 2009.
http://www.nationmultimedia.com/2009/05/13/business/business_30102553.php

Competing interests:
None declared

Competing interests: No competing interests

26 May 2009
Hubert Barennes
Research and training coordinator
Leila M Srour
Institut francophone pour la médecine tropicale, Vientiane Laos