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DURING THE LAST decade, nutrition experts the world over have noted a sharp decline in the popularity of breast feeding. On one level, this is a product of changes in lifestyle that have accompanied the urbanization of many places in the developing world. But beyond that, widespread substitution of infant bottle formulas for mother's milk has been a result of some very aggressive--and very profitable--marketing techniques employed by large multinational corporations (and copied by a few fly-by-night smaller operations) in order to tap the huge pool of potential consumers in the Third World.
To a large extent, the sales campaigns launched by the makers of infant products beginning in the early sixties--when the prospect of zero or negative population growth and declining profits in the industrialized West led to the search for new markets--has been very successful.
Unfortunately, this business success--one study found 90 per cent of Kingston, Jamaica mothers were bottle feeding their children--has been a nutritional disaster for infants in poor countries where the proper facilities and adequate understanding necessary for correct preparation of the formula do not exist. Often formulas marketed in the industrialized nations come in pre-mixed liquid form, but the vast majority of those sold overseas are powders which require the addition of water. In many underdeveloped areas, no clean water is available--so sewage -fouled and bacteria-infested water ends up being fed to babies. In addition, many poor mothers lack the pots and/or fuel necessary to boil and therefore sterilize the one bottle and nipple they own. Because the formula is so expensive, it is quite often diluted so that its nutritional content is far from adequate; and some families compose look-alike substitutes out of corn starch and water or tea once the formula runs out. There is no refrigeration to keep the milk from spoiling. Moreover, the instructions on the can are often in a different language from that spoken in the area where these products are sold, so proper preparation is very unlikely. The British charity organization War on Want found one Nigerian mother feeding her baby just water, thinking it was the bottle itself that provided nutrition.
THE RESULT of such problems has been an alarming increase in the incidence of disease and malnutrition among the very young. Babies fed with formula under inappropriate conditions are caught in a vicious, ultimately debilitating cycle--underweight babies are prone to infections causing diarrhea, and babies with diarrhea extract fewer nutrients from the food they eat, aggravating the malnutrition. Bottle formulas lack the immunilogical benefits of breast feeding, which are especially key in unsanitary conditions. Scientists believe that immunity probably comes from the initial dose of antibodies in the colostrum (the yellowish fluid that comes from the mother's breast a few days after birth). Without the antibodies, babies are prone to common intestinal infections when bottles are not sterilized.
The point is not that malnutrition does not exist among breast-fed babies, because it obviously does. But in impoverished areas where babies are breast-fed, a severe state of malnutrition does not commonly set in until around the second year, when the mother stops nursing. A branch of the World Health Organization has found that because of the decline of breast-feeding, deaths from malnutrition now peak in the third and fourth months. According to World Bank nutritionist Dr. Alan Berg, the past two decades have seen the average age of the onset of malnutrition drop from 18 to eight months in several of the countries he studies. This difference in age is critical because the first two years after birth is the most vulnerable period of brain development.
It is important to remember that even malnourished mothers can provide enough milk for their babies. Fat levels in their supply may vary, but lactose and protein levels remain steady. Only about five per cent of all mothers can't produce milk, a key fact in light of the widespread belief that bottle feeding is the best, or even the only way to provide a baby with a healthy diet. Admittedly, in rich countries, where facilities for appropriate preparation of formulas are usually available, and where many women work and are unable to afford the time for regular nursing, bottle feeding has proven to be an adequate substitute for breast milk. But in poor countries, where product misuse is likely (such as Chile, where a study of bottle feeding found an 80 percent contamination rate), use of formulas is clearly undersirable. Besides the nutritional dysfunctions, the drain on already struggling economies is staggering. Third World countries spend an estimated $1 billion a year on essentially unnecessary milk. In these cases, it seems obvious that corporations are merely creating a need for their own products.
THE WORST OFFENDER is the Swiss giant Nestle, manufacturer of Lactogen, Nan, and Cerelac formulas. The marketing practices of Nestle, which owns 81 plants in 27 Third World countries and sells formula to 100 Third World countries, exhibits some of the insidious techniques used to create a market for infant formula. Nestle employs some 5000 "milk nurses" (also called mothercraft advisers)--trained or untrained company representatives who travel to hospitals and sometimes villages, dressed in their white uniforms, to tell mothers about the advantages of bottle feeding. Some are paid on commission. Another common practice is the setting up of "milk banks", which offer formula at reduced prices to the poor for a limited time, after which they continue to purchase formula at prices they can't afford. Hospitals and clinics in Jamaica and elsewhere give out free samples. Mike Muller of New Scientist reported examples in the Philippines of free supplies being given to hospitals, equipment donated, entertainment provided for doctors, and clinics being furnished. Sales representatives are given access to maternity wards. Advertisements on radio, on billboards and on posters in hospitals appear throughout the developing world.
This type of marketing raises the issue of corporate responsibility. Does the company's responsibility end with the sale of a product, or extend through its use or even the effects of its use? The Interfaith Coalition for Corporate Responsibility (ICCR), a coalition of church groups affiliated with the World Council of Churches, has been raising the moral issues surrounding promotion of infant formulas to the poor and uneducated in corporate boardrooms for several years now. With the backing of the Ford Foundation, the Rockefeller Foundation, and the U.N. among others, the ICCR has introduced shareholder resolutions to such corporations as American Home Products (the biggest American formula exporter with over $60 million in annual sales overseas), Bristol Myers, Carnation, Abbott Labs and Borden. The resolutions generally have called for either a study of marketing practices and the set-up of a committee to correct abuses or the actual cessation of sales in areas too poor or underdeveloped to get any benefit from formula feeding.
THE RESPONSES OF the corporations have been varied. Probably the most common tack has been that taken by Bristol Myers. When this corporation issued a proxy statement in 1976 urging a vote against the resolution and claiming that "Infant formula products are neither intended, nor promoted, for private purchase where chronic poverty or ignorance could lead to product misuse or harmful effects," a group called the Sisters of the Precious Blood sued the corporation for allegedly violating the Securities and Exchange Commission law against making misstatements on proxy statements. Despite the fact that the nuns compiled over 1000 pages of first-hand documentation of the inaccuracy of the Bristol Myers claim, a U.S. district judge threw the case out of court because the nuns could not prove that the corporation did them "irreparable harm."
Other corporations have been more receptive to complaints about their marketing practices. In the summer of 1976, the Abbott Corporation set up an office to investigate bottle feeding abuses, and in March of the next year that firm took its milk nurses out of uniform. In February of last year, Borden, Inc. withdrew all promotion of its KLIM milk to infants.
Just last week, the Harvard Corporation voted in favor of a resolution before American Home Products stockholders proposing a committee to reexamine marketing policies and correct abuses where they exist, although that resolution is not likely to pass. Several countries have also taken action to prevent further nutritional harm. Malaysia has initiated a national breast feeding campaign. In Guinea-Bissau, bottles are available only by prescription. In Jamaica, mothercraft personnel are forbidden to enter hospitals.
Nestle, the biggest seller of infant products, with $300 million annually, remains to this day especially unapologetic for its practices. Nestle calls its own behavior in the Third World "exemplary." On July 4, 1977, the Infant Formula Action Coalition (INFACT) began promoting a boycott of all Nestle products, demanding that the dorporation discontinue promotion of its infant formula products. The boycott continues todau, and includes such products as Nestle's Quik, Nescafe, Nestle's Crunch, Nestea, Tasters' Choice, all Libby's products, all Stouffer's products, Wispride. Dee Park Mountain Spring Water and others. Harvard dining halls continue to serve Nestle's hot chocolate. Next time you go for a cup, think about it...
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