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Putting Babies Before Profits The History of the Deadly Fight Against the Formula Industry

The Code seeks to protect all families and babies from the inappropriate and aggressive marketing of the breastmilk substitutes (BMS) industry. The industry’s nefarious marketing tactics mislead families, undermine breastfeeding, and endanger children’s health.

The BMS industry, throughout its history, has claimed millions of infant lives.

2021 is the 40th anniversary of the Code’s adoption; we have come a long way, but the BMS industry continues to violate the Code, using ever evolving approaches to sell their products. Everyone has a role to play in the fight to protect breastfeeding.

A Nestle ad from 1917 exemplifies the misleading, unethical marketing we still contend with: against all evidence, the ad claims that Nestle formula will prevent infant mortality.

1867: Nestlé claims that its founder, Henri Nestlé, invented the world's first artificial infant food in 1867. By 1873, 500,000 boxes of Nestlé's Milk Food were sold in Europe, the United States, Argentina, Mexico and the Dutch East Indies; markets continue to expand to this day. The industry is now worth $71 billion and growing – it is expected to reach $119 billion (nearly doubling) by 2025.

1939: Dr. Cicely Williams’ speech, “Milk and Murder,” raises the alarm on the deadly risks of artificial feeding to the Singapore Rotary Club. “Misguided propaganda on infant feeding should be punished as the most criminal form of sedition, and that those deaths should be regarded as murder.”

1968: Dr. Derrick Jelliffe coined the term “commerciogenic malnutrition” to describe the impact of industry marketing practices on infant health, including starvation caused by inappropriate promotion and use of infant formula and bottlefeeding in areas with low income and poor access to clean water.

1973: UK development journal the New Internationalist runs a cover story, The Baby Food Tragedy, calling attention to the formula industry and calling for an action campaign to halt unethical promotion of baby milks.

1974: London NGO War on Want publishes the Baby Killer report, an investigation of the promotion and sale of commercial powdered baby milks in the developing world, blowing the lid off the scandal. The report reveals that “babies are dying because their mothers bottle feed them with Western-style infant milk,” using three strategies: 1) creating a need where none existed; 2) convincing consumers the products were indispensable; and 3) linking products with desirable concepts, as well as providing free samples.

1974: At the same time, the 27th World Health Assembly (WHA) is noting declines in breastfeeding in many parts of the world, urging member countries to “review sales promotion activities on BMS to introduce appropriate remedial measures, including advertisement codes and legislation where necessary."

1975 –1976: Bern Third World Action Group (AgDW) translates "The Baby Killer" and publishes it in Switzerland under the title "Nestlé Kills Babies”. Nestlé sues AgDW for libel, which generates widespread publicity. The court rules in favor of Nestlé, but the corporation is warned to "modify its publicity methods fundamentally."

Still, new mothers everywhere are receiving promotional material for formula and companies are intentionally undermining mothers’ confidence in breastfeeding. Companies hired salesgirls in nurses uniforms and incentivized hospitals to hand out free samples and encourage mothers to use formula.

Meanwhile, babies around the world are becoming sick or dying from malnutrition, as families duped by industry marketing’s promises and misleading claims are forced to dilute formula or mix it with unclean water.

1977: Nestle boycott launches in the United States, prompted by concern over its aggressive marketing. The boycott spreads to Australia, Canada, New Zealand in 1978 and later to six countries across Europe by 1983.

1978: Prompted by public outrage, Senator Edward Kennedy holds a US Senate Hearing to cross question Nestlé about its marketing of breastmilk substitutes around the world. Representatives from the BMS industry refuse to take responsibility for their actions; Kennedy reaches out to WHO for a global response, and WHO /UNICEF are urged to begin to take legislative action.

1978: The 31st World Health Assembly recommended that Member States prevent malnutrition by supporting breastfeeding and "regulating inappropriate sales promotion of infant foods that can be used to replace breast milk".

1979: WHO and UNICEF organize a joint meeting on infant and young child feeding that calls for the development of an international code of marketing.

News coverage on the WHO and UNICEF meeting, which included public hearings on infant and young child feeding and BMS companies.

In the meeting’s wake, the International Baby Food Action Network (IBFAN) is founded, as a watchdog organization to protect families from commercial milk marketing practices and hold BMS corporations accountable.

An article published ahead of the Code's adoption.

1981 - After several drafts, the Code was officially adopted with a roll-call vote of 118-1.

After pushing for weaker recommendations rather than a binding regulation, the US was the only country to vote against the Code’s adoption. The US business sector had successfully lobbied the administration to believe that the Code would set a precedent in allowing UN agencies to interfere with business interests.

‘Without the NGOs, without their constant lobbying, reminding us of our duty as public health officers, even harassing us for months on end, without all that, there would have never been a Code. WHO would simply not have had the courage to get on with it.’ - Halfdan Mahler (Former WHO Director General)

Since 1981, nineteen WHA resolutions have been passed to keep up with BMS industry’s ever-evolving tactics to undermine breastfeeding. Read more about all nineteen. 

1982: Peru becomes the first country to adopt the International Code as national legislation.

After the passage of the Code, BMS companies continue to undermine breastfeeding and promote their products. IBFAN publishes a report showing Code violations remain prevalent - this 1983 article in the Times of London cites nearly 15 million ex\amples of Code violations.
1984: Nestle boycott is suspended for six months after Nestle agrees to abide by some provisions of the Code in developing countries.

1986: Resolution WHA39.28 discourages free samples and donations; in 1988, seven years later, IBFAN reports show that free and low-cost supplies continued to flood health care facilities in Asia and Latin America. Even today, emergencies like the COVID-19 pandemic are plagued with formula milk donations, trying to undermine breastfeeding.

1989: The Nestle is boycott reinstated after they refuse to end their provision of free and low-cost products to health facilities and abide by the Code. The boycott continues to this day, alongside continued monitoring by IBFAN.

1996: Resolution WHA49.15 Calls on Member States make sure that: 1) complementary foods aren’t marketed or used to undermine breastfeeding; 2) giving money to health professionals does not create conflicts of interest; and 3) Code monitoring is transparently carried out without influence from the industry. Spoiler: These objectives have still not been met.

Photos from Viet Nam show free gifts, stark violations of the Code, to newborn babies’ families at the hospital. 40 years after the Code's adoption, and 25 years after Resolution WHA49.15, we are still contending with conflicts of interest with health facilities and health professionals.

2001: Resolution WHA 54.2 Officially changes the recommendation from 4 to 6 months of exclusive breastfeeding, with safe and appropriate complementary foods, as well as continued breastfeeding for two years or beyond.

2008: Resolution WHA61.20 urges Member States to scale up efforts to monitor and enforce national measures, reduce the risk of intrinsic contamination, and investigate the safe use of donor milk through human milk banks for vulnerable infants, mindful of national laws and cultural and religious beliefs

2012: Resolution WHA65.6 urges member states to strengthen control of BMS marketing and better safeguard against potential conflicts of interest, and requests the Director General to clarify guidance on the inappropriate promotion of foods for infants and young children.

2014: Resolution WHA67.9 Developed the Infant and Young Child Nutrition (MIYCN) Plan, setting the global target rate of exclusive breastfeeding to at least 50% by 2025.

2016: Resolution WHA69.9 clarifies that follow-up milks and growing-up milks are also covered by the Code, and cautions against cross-promotion of breastmilk substitutes via the promotion of foods for infants and young children.

2015: The Network for Global Monitoring and Support for Implementation of the International Code of Marketing of Breast-milk Substitutes – AKA NetCode – is launched to support the monitoring and enforcement of the Code, providing standardized tools and guidance.

2016: The UN Human Rights Office recognizes that breastfeeding is a human right that should be protected. The Code, as well, is a human rights issue: babies have a right to health, nutrition, and optimal development under the Convention of Rights of the Child, while parents have a right to accurate information when it comes to feeding their children.

The economic argument for breastfeeding remains salient: this 2018 article exposes the high out-of-pocket costs - in addition to health costs - of formula feeding, especially for low-income families.

2020: As of April 2020, 136 (70%) of the 194 WHO Member States have enacted legal measures on the Code. Of these, only 25 countries have measures substantially aligned with the Code. A further 42 have measures which are moderately aligned; 69 have only included some the provisions and 58 have no legal measures at all.

2020: WHA73.26 requests the Director General to prepare a comprehensive report on commercial milk marketing’s digital media strategy. An article in the Bureau of Investigative Journalism, in collaboration with Alive & Thrive, illustrates these new and nefarious tactics.

The article reveals that multinational baby formula companies, such as Nestlé and Danone, are manipulating Indonesian mothers by hosting webinars with experts, parenting classes, and turning them into bloggers and brand ambassadors – in effect, unpaid and underregulated advertisers.

2020: Companies seize a new entry point, beginning to capitalize on COVID-19 fears, using health claims, misinformation, and donations to unethically expand the formula market. Tactics found in an Alive & Thrive study include harnessing the public sentiment of hope and solidarity, which was exacerbated by the digital marketing boom.

Read the article from Alive & Thrive and Women’s Media Center, revealing how corporations are exploiting the pandemic to prey on mothers in Viet Nam.

Today, only about 41% of infants globally are exclusively breastfed in their first six months, while in the past 15 years, global sales of formula have more than doubled.

In this photo, Cambodian officials are trained to spot violations of The Code at points-of-sale.

Each year, nearly 600,0000 children and 100,000 women die from inadequate breastfeeding. These deaths, together with cognitive and health system losses, costs the world a billion dollars a day. Find out how much your country is losing by not breastfeeding with Alive & Thrive’s Cost of Not Breastfeeding Tool.

The BMS industry puts its business before babies. Corporations refuse to bring their policy or practices into line with the International Code and its subsequent resolutions, as the industry reaches 71 billion dollars and is projected to reach 119 billion USD by 2025.

The industry continues to lobby against full implementation of the Code in national regulations and manipulate families with unethical marketing, violating the rights of children and negatively affecting families, communities, and nations.

The industry continues to lobby against full implementation of the Code in national regulations and manipulate families with unethical marketing, violating the rights of children and negatively affecting families, communities, and nations.

This photo, from an A&T investigation, documents widespread Code violations on various platforms in Viet Nam.

Everyone has a part to play in the fight to #ProtectBreastfeeding and put #BabiesBeforeProfits.

Citations:

IBFAN-ICDC. Code Monitoring Kit, 4th ed.; IBFAN-ICDC: Penang, Malaysia, 2019.

IBFAN-ICDC. Code and resolutions 2016 Edition.

Ching, C.; Zambrano, P.; Nguyen, T.T.; Tharaney, M.; Zafimanjaka, M.G.; Mathisen, R. Old Tricks, New Opportunities: How Companies Violate the International Code of Marketing of Breast-Milk Substitutes and Undermine Maternal and Child Health during the COVID-19 Pandemic. Int. J. Environ. Res. Public Health 2021, 18, 2381.https://doi.org/10.3390/ijerph18052381

WHO, UNICEF, and IBFAN. 2020. Marketing of Breast-milk Substitutes: National Implementation of the International Code. Status Report 2020. World Health Organization, 2020, apps.who.int/iris/bitstream/handle/10665/332185/9789240006034-eng.pdf

History of the Campaign, Baby Milk Action, 2011, archive.babymilkaction.org/pages/history.html.

Created By
Mackenzie Mayo
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