As you know, I’ve been talking a bit about violations of the WHO Code. I’ve started collecting some examples of everyday Code-breaking in Australia.
My last example was of Wyeth’s transgressions. Have you heard of Nutricia, a Dutch Numico subsidiary? Some examples of issues in Numico’s past include direct-to-mother promotional campaigns in China, hospital violations in Indonesia, violations in Russia, and concealment and lies about salmonella contamination of their infant formula products in the UK and France.
Nutricia’s Australian website proclaims:
“… at Nutricia Australia we have adopted one of the strictest interpretations of the code in the interest of mother and baby.”
This is false.
IBFAN gives a detailed summary of the World Health Organisation Code on the Marketing of Breastmilk Substitutes here. Note particularly these articles:
“There should be no advertising or other form of promotion to the general public of products within the scope of this Code.” Article 5.1
* Companies are banned from seeking contact with pregnant women and mothers and must not promote products covered by the Code to them or the general public in any way .[...] Advertising is a form of promotion as are: direct mail, leaflets and pamphlets, posters, product samples, free gifts, video shows and lectures.[...] Article 5.3 covers retail outlets. It clarifies the ban on promotion by citing the following examples:
* point of sale advertising
* giving of samples
* discount coupons, premiums, special sales, loss-leaders and tie-in sales.”
Here’s what dropped into my letterbox last week. The Woolworths discount promotions leaflet is on the left, and the Coles one is on the right.
Back to the Code, and moving on to the Labelling section.
“Labels should be designed to provide the necessary information about the appropriate use of the product, and so as not to discourage breastfeeding.” Article 9.1
[...] * No idealising text or pictures [...]
Article 9.2 also bans:
* pictures or text which may idealise the use of infant formula.”
(You might try to quibble that these particular strictures are meant to apply to product labelling, not advertising – but that’s because advertising is BANNED. I think it’s reasonable to analyse the violating ads further using the labelling restrictions as guides.)
So I looked a little more closely at the Wyeth promotion, and saw this:
This is idealising text designed purely to convince breastfeeding mothers of colicky infants to wean onto artificial infant milk. Typical infant colic (YMMV) peaks at around 6 weeks of age, remains till around 3 months, then subsides. While it lasts, it can often be ameliorated by manageable maternal dietary changes (such as elimination of cows milk protein), babywearing, and/or changes in breastfeeding (feeding for longer from one breast, to reduce the amount of foremilk a baby is getting).
The vast majority of nursing mothers of colicky babies want to breastfeed. But a crying baby makes you desperate. Cultural programming beats women with messages that their bodies are weak, deficient, inadequate and dangerous to babies. This is powerful, noxious stuff. The healthcare system is not designed to support women through infant feeding difficulties; only to lecture them about breastfeeding at the time their babies are born, then hammer them with “Well, you tried, give it up now dear” if anything goes wrong. Companies clobber them with ubiquitous toxic advertisements for “gentle” formula that has “comfort proteins” and “keeps little tummies happy”.
A week or two after weaning, by the time a mum realises that the colic hasn’t stopped (or perhaps has become much, much worse as a result of the foreign proteins filling the baby’s belly), their milk supply will have dropped to nearly zero – and have you tried finding information about relactation in the mainstream healthcare system lately? No. They end up on a rollercoaster of trying one artificial food after another, sometimes ending up on extensively hydrolysed or amino acid formulas.
The Medical Journal of Australia estimates the cost of these formulas to the taxpayer-funded Pharmaceutical Benefits Scheme
“The estimated cost to the PBS for amino acid formula for 2003″“2004 of $7 107 627 was 10 times that of hydrolysed formula ($757 570).”
This isn’t counting the “gap” formula costs to the parents, or the other health costs, outlined at promom.org - RSV, croup, otitis media, pneumonia, gastroenteritis, inflammatory bowel diseases, diabetes, breast cancer, and other diseases and cancers. Human suffering and infant deaths? Priceless.
Australia needs to stand up and be counted. Stop bludgeoning women with “shoulds”, then whipping the rug out from under them. Start supporting women and babies in real ways. Enforce the WHO Code, and criminalise violations. Train and fund healthcare workers and the ABA. Bring in paid maternity leave for all women, for at least three months, moving to six months. Fund breast pumps for women who do wish to work or have other separations, and enforce workplace support for lactation. Encourage societal attitudes that see women’s bodies as powerful and functional, not weak, shoddy and defective.
And above all, stop blaming mothers. Put the blame where it belongs. Lying lies and the lying liars who tell them.
[...] substitute, and this marketing is a clear breach of the WHO Code. These violations are occurring every day, by companies who claim to be supporting the Code. They are [...]
The “keeping little tummies happy” might have some justification:
There are two types of standard formulae: those with the protein mix of cows (casein – i.e. “curd” – dominant), and those with the protein mix more resembling human milk (whey dominant). Casein/curd is much tougher to digest (and has a poorer amino-acid mix) than whey, and “little tummies” – younger infants – should definitely be fed something whey-dominant, (preferably fresh from mum).
[brand names edited out] whey-dominant product, and something that makes mother’s less likely to give “little tummies” a casein-dominant product (such as [brand names edited]) does provide a positive benefit. Casein-dominant formulae can have advantages as a “half-way house” as the child gets older and moves to normal cow’s milk.
(I used to work in the field many many years ago, and left for ethical reasons. One of the “good” things about baby pictures on cans is that I indicates to non-english speakers that it’s for babies (rather than cornflour). I gave a case or two of product to an infant welfare sister because one of her mothers had been making her 3 month old child’s feed from CORNFLOUR because it was white, and filled the baby up! And I always said “I’d rather you give younger babies our competitor’s whey-dominant feed rather than our casein-dominant version”. The ethical reps from our competitor said the same thing. Bosses weren’t happy about that!)
I’ve edited the advertising regurgitation out of your post. Formula doesn’t have “health benefits”. It’s the fourth choice of infant feeding, when mother’s milk direct, expressed mother’s milk, and donor human milk are unavailable. It’s calories and a few synthetic vitamins, designed to (hopefully) keep a baby alive, not benefit its health.
“The “keeping little tummies happy” might have some justification:”
It’s an evidence-free health claim on a food product. Without TGA registration as a therapeutic good, and good hard evidence, it’s quite likely illegal as well as a WHO Code violation (idealisation).
“I gave a case or two of product to an infant welfare sister because one of her mothers had been making her 3 month old child’s feed from CORNFLOUR”
And what did you do to encourage real breastfeeding education and support, relactation education, and the establishment of solid, workable donor milk networks?
I don’t buy the industry’s phony “We’re so altruistic, handing out formula, and look, we’d rather you give our competitor’s formula than have a baby eat anything else, give me a cookie!” bullshit. No cookies for formula companies, not now, not ever. EVERY SINGLE ONE lies repeatedly and systematically, every single one violates the Code, every single one doesn’t care. All are unrepentant.
In other words, while I appreciate that you’ve said you left the industry for ethical reasons, I completely reject the frame you’re working in here. It’s a formula company frame, not a breastfeeding-centric frame.
Lauredhel
(1) I totally agree with (a) your very strong pro-breastfeeding stance (b) your opinion of the disgusting behaviour of the companies in developing nations without decent water or fuel to sterilize (c) your condemnation of the ads including photos and promotional slogans rather than just name, size and price. The supermarket is just as guilty here, and I’d like to know if there was any monetary incentive given for the pictures/slogans by the manufacturers, or if store managers had merely received insufficient training from head office. I didn’t think it necessary to repeat the points you put across so well.
(2) I was certainly NOT saying there are any health benefits of formula over human milk. I am NOT a fan of the industry. My “frame” is that of someone looking at how closely what goes into the guts of a population of children can emulate the ideal. Actually, I’d go further than you seem to in your post and advocate that wherever practicable, formulae are “over the counter” rather than “in-front of the counter” products.
(3) My comments on whey dominant v casein dominant are very much based on evidence. It’s not only a digestibility issue but also relates to amino acid profile: especially for histidine which neonates cannot synthesize and is, for them, an essential amino acid.
(4) I wasn’t clear enough, but thought you’d pick this up from my comment. I was actually giving you even MORE reason to be angry at the ad. In the happy tummies ad you reproduce, the product names are the wrong way around: the casein dominant formula is grammatically bound closer to the “happer tummies” than the demonstrably gentler whey-dominant product. Thus, the ad could promote the incorrect and harmful idea that tummies are happier because there is a longer time between feeds (when actually the tummies are having a hard time processing all the casein). Manufacturers gain an advantage by people choosing the tougher formula, because they don’t have to completely swap around the ratio of the two protein fractions. If the products had been mentioned in the correct order, ambiguity might have provided an “out”. If the ad had “than other brands”, there might have been an “out”. There was no inclusion I could see in your reproduction of the line “breastfeeding is best for your baby”. There was no “out”.
(5) The only pictures on cans I think are reasonable are schematics indicating age-related product-suitability for those with poor english literacy: e.g. a baby on back v sitting up v crawling. Apart from that, the cutesy-wutesy pictures are unjustifiable because they could be seen as “idealizing” formulae. I’d note that 25 years ago NO pictures were allowed on products. In that regard, we’ve taken a step or two backwards in recent times. The only improvement is the availability of single-bottle emergency sachets that avoid the temptation to “use up the rest of the can”.
(6) The formula manufacturers are no better and no worse than the rest of big pharma as far as creating inappropriate demand when a new drug is developed. Consider the “epidemic” of ADHD, parents pushing for medicalization of the terrible twos, and the prescription of and addiction to amphetamine like drugs. Consider that manufacturers want to advertise prescription drugs to the general public. Normal food companies that put promotional characters on junk food and leading to COMPLETELY imbalanced diets are guilty of damaging the health of entire generations too.
(7) The logistical problems and costs of providing a safe supply of pooled human milk (which is not tuned for the individual baby) are significant. Such spending takes resources away from other ways of promoting nursing by mothers: infant welfare sisters and lactation consultants are grossly under-resourced and there is not enough help for young mothers to get over lactation difficulties, and too little time available for many sisters in poor areas to help each mother. Girls are turfed out of hospital too early. An emphasis on weight gain rather than lean body mass is an issue. Believe it or not, one infant welfare sister was pushing my daughter to move to formula when things got a little (not a lot) tricky. I can’t blame the nurse: too many people to see, too little time.
(8) There are other issues harming rates of breast feeding: social attitudes and working conditions. Even parliamentarians are criticized for breastfeeding in the chamber. Little old ladies who should know better berate my daughter for breastfeeding in public! We’ll know we’ve got it right when bank tellers have kids in slings suckling ad libitum and no-one bats an eyelid. (Slings are more natural than cots too, and too few are as lucky as I was, able to have my baby on my chest at the office, even though suckling wasn’t an option by someone named David!)
(9) You are absolutely right in this post that any reasonable code is being violated. Your points in the later post (“Flimsy, wimpy, weak”) about the parliamentary report are pretty-much spot on.
Hi David, sorry it took me so long to respond to your comment. It sounds like we’re much closer in stance on this than it seemed to me from your first comment.
When you get down to brass tacks, I go way further than that. I support complete societal overhaul including prolonged, properly paid maternity leave and comprehensive breastfeeding support in ALL areas, to support breastfeeding rates similar to those in some Scandinavian countries. With optimal breastfeeding rates, and appropriate funding and support for milk banking, all babies without access to mother’s milk could have ready access to donor breastmilk. Synthetic formulas would only be necessary for babies with the very rare syndromes which involve complete mother’s milk intolerance.
Please don’t refer to women as “girls”. Ta.