Methodist Annotated 1104

8/12/2019 Methodist Annotated 1104

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Briefing Paper on the Ethical Issues Concerning the Marketing of Breast -Milk Substitutes, and Other Ethical Issues Relating to Nestl

IntroductionThis briefing paper has been produced by the Central Finance Board of the MethodistChurch (CFB). It attempts to set out the ethical issues, not to reach conclusions. Whereany opinions appear to be gien they should not be ie!ed as representing CFB policy."imilarly, they should not be considered as representatie of the ie!s of the MethodistChurch in general or the #ublic $ife and "ocial %ustice team in particular.

The paper constitutes the initial stage of a consultation process designed to enable theMethodist Church through its %oint &disory Committee on the 'thics of Inestment (%&C'I)to assess the ethical suitability of estl as a potential inestment, and to adise theCentral Finance Board of the Methodist Church accordingly. The consultation !ill payparticular attention to estl*s performance !ith respect to the International Code ofMar+eting of Breastmil+ "ubstitutes. -ther aspects of estl*s business !ill also beconsidered in arriing at a conclusion.

ContentsThe structure of this paper is as follo!s

/. 0eie! of 1ey 'thical Issues Concerning BreastMil+ "ubstitutes2. estl #olicy on Infant Formula Mar+eting3. Criticisms 0aised by Baby Mil+ &ction4. FT"'45ood*s Criteria on Infant Formula Mar+eting6. The Methodist Church*s #osition on BreastMil+ "ubstitutes7. -ther 'thical Issues 0elating to estl

!" Re#ie$ of %e& Issues Relating to Breast-'ilk Substitutes!"! (efinitions

The ma8or ethical concern regarding estl relates to the mar+eting of breastmil+substitutes, as described in the International Code of BreastMil+ "ubstitutes.These concerns essentially refer to mil+based substitutes, although &rticle 2 of theCode states 9The Code applies to the mar+eting, and practices related thereto, ofthe follo!ing products breastmil+ substitutes, including infant formula: other mil+products, foods and beerages, including bottlefed complementary foods, !henmar+eted or other!ise represented to be suitable, !ith or !ithout modification,for use as a partial or total replacement of breastmil+: feeding bottles and teats.It also applies to their ;uality and aailability, and to information concerning theiruse.<

there is a dispute bet!een campaigning groups and manufacturers !hether theyalso apply to =complementary infant foods* such as fruit 8uices and infant cereal.Manufacturers such as estl deny that fruit 8uices and infant cereal are coered bythe Code, !hereas Baby Mil+ &ction insists that they are. estl disputes that=complementary infant foods* are coered by the Code, despite the fact that>IC'F has stated in !riting to estl that they are coered as set out in &rticle 2.In its monitoring IBF& includes complementary foods mar+eted as replacementsfor breastmil+ (e.g. for feeding during the 7 month period !hen e?clusiebreatfeeding is recommended). In addition >IC'F has clarified, in !riting, thatcompany representaties cannot use complementary foods to circument theprohibition on see+ing direct or indirect contact !ith pregnant !omen or mothersof infants and young children (children up to three years of age), specified in

&rticle 6.6 of the Code. >IC'F has stated the prohibition is absolute.Complementary foods are other!ise outside the scope of the Code and subse;uent,

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releant 0esolutions adopted by the World @ealth &ssembly, e?cept for the generalpoint in 0esolution 4A./6 (/AA7) that “that complementary foods are notmarketed for or used in ways that undermine exclusive and sustained breast-

feeding.” "o, for e?ample, estl*s practice of promoting po!dered !hole mil+ inthe infant feeding sections of pharmacies alongside more e?pensie infant formulais coered by this 0esolution.

The controersy relating to mil+based nutritional products described in thisbriefing paper refers e?clusiely to standard infant formula. It is important todistinguish bet!een standard formula and other nutritional supplements. Mil+based nutritional supplements are mostly used to feed indiiduals !ith impaireddigestie systems. These include premature babies, children, or adults !ithdiseases of the digestie system, people !ith @I&IDs, and the elderly !ho can nolonger eat ordinary food. &s such products are clearly life enhancing and are notcontroersial. ote that this definition is at odds !ith that used in theInternational Code of Mar+eting of Breastmil+ "ubstitutes, !hich coers allbreastmil+ substitutes and not 8ust =standard infant formula*. estl, in common

!ith other baby food companies, is increasingly =medicalising* infant feeding. Fore?ample, it has launched a =hypoallergenic* formula in the >1 mar+eted for use!ith infants at ris+ of allergy. The same claim cannot be made in the >" after legalaction !as ta+en against estl after infants fed on the formula suffered fromanaphylactic shoc+. estl*s promotion of formula for use in @I interentions andof breastmil+ fortifiers is something that continues to cause concern.

The !hole ;uestion of the production and sale of standard infant formula productsis, on the other hand, hugely controersial. Certain groups and indiiduals belieethat the benefits of breastfeeding are so great that sales of standard infant formulaproducts should be strongly discouraged, if not banned. ote this is not theposition of Baby Mil+ &ction and it is misleading to suggest other!ise. Baby Mil+&ction stresses that the International Code and subse;uent, releant 0esolutions

are intended to protect mothers !ho artificially feed their infants as !ell as toprotect breastfeeding. Much of Baby Mil+ &ction*s !or+ is aimed at improinglabelling and composition of baby foods. Infant formula is produced by 27companies, but the standard formula mar+et is dominated by three companies.estl is the largest, trading under the =estl idina* and =estl Beba* labels in'urope, and =estl an* in &frica. "econd largest is the >" pharmaceuticalcompany Wyeth (formerly +no!n as &merican @ome #roducts) !hich sells the ="M&*and =ursoy* brands, follo!ed by the Dutch company umico !hich trades underthe utricia label. It should be noted that both estl and Wyeth are also leadingproducers of other nutritional supplements.

!") Infant *or'ula in (e#eloped CountriesFrom the beginning of the t!entieth century until the /A7Es medical opinion in

deeloped countries such as the >1 faoured bottled infant formula oer breastfeeding. There !ere a number of reasons for this. It !as thought that boilingbottled feed made it more hygienic than breastmil+. &s a result of the 5reatDepression of the /A3Es, and !artime austerity in the /A4Es, many children in the>" and 'urope suffered from malnutrition. @ence goernments at that timethought it desirable for babies to gro! as rapidly as possible, so infant formula,!hich may hae a higher calorific alue than breastmil+, !as the preferred choiceof many doctors.

@o!eer since that time the consensus of medical opinion has s!ung round so thatbreastmil+ is no! regarded, !ithout doubt, as the best choice for young babies.There hae also been other ma8or changes in standard medical adice about thebest !ay to feed babies. >ntil the /AEs many doctors adocated =training* the

baby by limiting feeding to once eery four hours, but no! it is accepted thatbabies, particularly young ones, should be fed upon demand.

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It is generally accepted that in normal circumstances breastmil+ proides the idealnutrition for babies prior to !eaning. @o!eer, the primary reason for adocatingbreastfeeding lies in the fact that in the first si? months of life an infant*s immunesystem is not fully deeloped. The child*s mother*s mil+ contains her antibodies,!hich help the infant fight infection: if both the mother and baby are e?posed toan infection, the mother*s immune system automatically produces antibodies !hichprotect the baby. -biously standard mil+ formula cannot contain such custommade antibodies. It is for this reason that the World @ealth -rganiGationrecommended in 2EE/ that mothers should e?clusiely breast feed for the first si?months, but that they could then use breastmil+ substitutes until the baby !asfully !eaned at /H months 2 years. World @ealth &ssembly adopted a 0esolutionin /AA4 (4.6) calling for complementary feeding to be fostered from about 7months of age. & 2EE/ 0esolution (64.2) !as adopted restating this as a globalpublic health recommendation of 9e?clusie breastfeeding for si? months !ithcontinued breastfeeding for up to t!o years of age or beyond.< This !ording isused in the 5lobal "trategy on Infant and Joung Child Feeding adopted in 2EE2

under 0esolution 66.26

The benefits of breastfeeding as regards antibodies are un;uestioned. @o!eer,medical science suggests that there are a number of additional health benefits frombreastfeeding, particularly in terms of reduced ris+ of childhood diabetes andallergic diseases such as asthma. It is also claimed that breastfeeding helpsdeelop an emotional bond bet!een mother and child, !hich is beneficial for thelater psychological deelopment of the child. $astly, research indicates that aprolonged period of breastfeeding is also beneficial for the mother in terms of aslightly reduced ris+ of breast cancer.

@o!eer, apart from the important e?ception of antibodies in the first si? monthsof life, the medical benefits from breastfeeding compared to using infant formula

in deeloped countries are not particularly great. The campaign against standardformula baby mil+ is based upon the principle that =breast is best*. @o!eer, thisseems to ignore the social changes that hae ta+en place in 'urope and orth&merica oer the past thirty years. It might hae been possible for most Western!omen to breastfeed their ne!born babies eery fe! hours in the /A6Es, !hen theystayed at home. o!, it is simply impractical, if not impossible, for !omen !ho goout to !or+ to breastfeed their child e?clusiely. While a minority of !omen may!or+ in places !here crKches are readily aailable, for most !omen such an optionis not aailable. In such cases the use of standard formula mil+based feeds areessential, unless society decides that a !omen*s right to !or+ should bedo!nplayed, as it !as in deeloped countries in the /A6Es, and may be today insome deeloping nations. ote this s!eeps aside a great deal of research onhealth benefits of breastfeeding in industrialised countries, ignores the fact that

breastfeeding rates in countries such as or!ay are oer AEL at 4 months andnegates the 5oernments targets for increasing breastfeeding rates. It also typifiesthe campaign as =against standard formula baby mil+* !hen the ethical issue relatesto appropriate mar+eting not the aailability of the product.

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!"+ he se of Infant *or'ula in (e#eloping CountriesThe aboe issues are also applicable to the sales of infant formula in deelopingcountries. @o!eer, there are also ery real concerns !hich are specific todeeloping countries. In particular they relate to the mar+eting of infant formulain countries !here there is no general access to pure !ater. There is little disputethat standard infant formula is safe in deeloped countries !here high ;ualitydrin+ing !ater is aailable, and !here bottles and preparation e;uipment can beeffectiely sterilised and !here increased ris+ of illness can be treated (fore?ample, an artificiallyfed child in the >1 is up to /E times more li+ely to behospitalised !ith gastroenteritis than a breastfed child).d.

In deeloping countries these factors are often not present, so using impure !atercan easily lead to the baby deeloping stomach infections such as amoebicdysentery. In adults such infections are unpleasant, but the patient usuallyrecoers. @o!eer for a young child they can be fatal. It is alleged that during the/A7Es and /AEs !hen infant formula !as !idely used in deeloping countries, theuse of such products may hae resulted in the deaths of hundred of thousands, if

not millions, of babies each year. Baby Mil+ &ction claims that this is still the case.Its !ebsite alleges ;uotes >IC'F (press release %anuary /AA) that

"Marketing practices that undermine breastfeeding are potentiallyhazardous wherever they are pursued in the developing world! #$ %theorld #ealth $rganization& estimates that some '.( million children dieeach year because they are not ade)uately breastfed. *hese facts are notin dispute."

@o!eer, although the W@- has referred to infant death from malnutrition or!aterborne disease, it has neer made any official statement about infant deathbeing due to infant formula mar+eting, nor has Baby Mil+ &ction suggested that ithas. It should be recalled, ho!eer, than !hen Baby Mil+ &ction !as called on to

defend a boycott adertisement before the &dertising "tandards &uthority,including the use of the statistic, "+very day! more than ,! babies die becausetheyre not breastfed. *hats not con/ecture! its 0123+4 fact” it did so successfullyand one of the organisations sending supporting statements !as W@-..

It seems fair to state that the mar+eting standards of the leading infant formulacompanies in deeloping countries in the /A7Es and early /AEs !ere !ell belo!!hat !ould no! be deemed acceptable. (This is of course true for many otherindustries !ith =legacy issues*). & number of accusations hae been made aboutmar+eting practices used in that time

a) The use of strident mar+eting campaigns stating that infant formula !asbetter for babies than breastmil+, despite all eidence to the contrary.

b) @anding out free samples to ne! born mothers, as !ell as to healthprofessionals.

5iing free samples to mothers of ne! born babies in hospitals is a particularlyini;uitous practice, as if a mother stops nursing a baby for more than a fe! days,she loses the ability to produce breastmil+. In many deeloping countries infantformula, li+e most Western consumer goods, is ery e?pensie compared to aerageincomes. In other !ords, giing mothers free samples of infant formula in thehygienic enironment of a hospital !ill cause her breastmil+ to dry up. -nce shereturns home, she !ill hae no alternatie but to try and feed her baby on infantformula, een though this could often be made !ith dirty !ater that might lead todysentery. It is !ell documented that many families in deeloping countries lac+

the income re;uired to purchase enough formula to ade;uate feed a baby, so thatthe proision of free samples of infant formula could lead to babies suffering seere

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malnutrition, and een death by staration. @o!eer, it is also documented thatinstead of breastmil+ some babies may receie co!*s mil+, goat*s mil+, plain tea,sugar !ater, rice !ater or plain !ater that may also be detrimental to theirhealthy deelopment.

That said, it is important to note the massie rise in the standards of liing !hichhas occurred in many deeloping countries oer the last thirty years, particularly in"outh 'ast &sia. In countries such as Thailand, Tai!an, and "outh 1orea rapideconomic gro!th has meant that in urban areas at least clean !ater is no!generally aailable and incomes are high enough to ma+e infant formula anaffordable item for most people. -ne aspect of this process of rapid deelopmenthas been economic empo!erment for !omen, an increasing number of !hom areentering professional and business life. In poor agricultural societies !here theast ma8ority of men and !omen !or+ on the land, and lie nearby, breastfeedingis a relatiely easy option. -nce !omen hae prolonged commutes to !or+ innearby cities, !ith minimal proision of crKches and nurseries, leaing their babiesat home !ith relaties, to be fed on infant formula, is the only practical

alternatie. In Western 'urope maternity leae legislation economically empo!ers!omen !ho !ish to stay at home and breastfeed their babies in the first si? monthsto do so. In deeloping countries such legislation may not e?ist.

ote again it is important not to lose sight of the fact !e are considering estl*sbaby food mar+eting practices. Morphine can be necessary, useful and used safely,but that does not e?cuse it being aggressiely mar+eted.

!". /istor& of 0ro$ing Concern o#er the Marketing of Breast-'ilk SubstitutesThere !as gro!ing public concern about the mar+eting of infant formula indeeloping countries from the early /AEs on!ards. ote Baby Mil+ &ction datesthe campaign from the /A3Es !hen concerns !ere raised about the impact ofs!eetened condensed mil+ being promoted for =delicate infants*. In the >1 this

!as led by the deelopment charity War on Want. In /A7 War on Want produced areport, *he 5aby 6iller , alleging that the aggressie mar+eting campaigns of estland other companies producing breastmil+ substitutes !as responsible forsignificant infant death.

#ublic concern gre! in the second half of the /AEs !hich led to many nongoernmental organiGations (5-s) adocating a boycott of estl and Wyethproducts. It also led to a >" "enate In;uiry into the sub8ect in /A. Finally, in/AH/ /AA t!o international organisations got together to deise an InternationalCode of Mar+eting of Breastmil+ "ubstitutes. These !ere the >nited ationsChildren*s Fund (>IC'F) and W@-, !hich conened an international meeting,inoling goernment, health bodies, baby food companies and 5-s. The Code!as adopted by the W@-*s 34 th &ssembly in May /AH/. The preamble to the Code

states that

73onsidering that when mothers do not breastfeed! or only do so partially!there is a legitimate market for infant formula and for suitable ingredients

from which to prepare it8 that all these products should be made accessible tothose who need them through commercial or non-commercial distributionsystems! and they should not be marketed or distributed in ways which mayinterfere with the protection and promotion of breastfeeding8

9ecognising further that inappropriate feeding practices lead to infantmalnutrition! morbidity and mortality in all countries! and that improper

practices in the marketing of breast-milk substitutes and related products cancontribute to these ma/or public health problems:.

The +ey points of the Code as established in /AH/ !ere

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a& 1o advertising of breast-milk substitutes.b& 1o free samples or supplies are to be given to mothers.c& 1o promotion of products through health care facilities.d& 1o contact between company marketing personnel and mothers.e& 1o gifts or personal samples to health workers.

f& 2nformation to health workers should be scientific and factual only. g& ;ll information on artificial feeding! including the labels! should explain

the benefits of breastfeeding and the costs and hazards of artificial feeding.

h& 0nsuitable products should not be promoted for babies.i& 5abies should not be depicted on infant formula packaging.

/& <abels should be set out in local indigenous languages.

In /AH4 estl agreed to accept and adhere to the Code, and at that time many ofthe arious 5- boycotts !ere endedsuspended. The implementation of the Codein deeloping countries !as put in place by estl through the 1estl= 2nstructions,

!hich !ere deeloped in consultation !ith W@- and >IC'F, though neerapproed by these bodies as estl implies. @o!eer, in /AH7 5-s alleged thatestl and Wyeth !ere in breach of the Code*s spirit, if not its letter, by s!itchingfrom adertising to giing free samples to hospitals in deeloping countries. In/AH7 the W@- Code !as tightened up to prohibit the giing of such free samples.&t the same time the International estl Boycott Committee (IBC)Baby Foodet!or+ (IBF&), the parent grouping of !hich Baby Mil+ &ction and other boycottcoordinating groups formed in the >1, announced a second the relaunch of theboycott of estl and Wyeth products on the grounds that the company had bro+enits underta+ing and !as continuing to iolate the International Code and0esolutions in a systematic and institutionalised !ay, as demonstrated bymonitoring conducted by the International Baby Food &ction et!or+ (IBF&), to!hich Baby Mil+ &ction belongs.!as untrust!orthy, a The boycott !hich continues

to this day. In /AA3 estl announced that it !ould not permit free samples to begien unless specifically re;uested by 5oernments for certain restricted social!elfare cases.

!"1 /I234I(sThe prealence of @I&IDs in sub"aharan &frica has brought for!ard a ne! ethical;uestion concerning the supply of standard infant formula. &ccording to thecharity Medecins >ans 4rontieres @I&ID" currently infects more than 2.6 millionchildren !orld !ide. In 2EE3 EE,EEE children !ere ne!ly infected !ith the @Iirus, AEL of these in sub"aharan &frica. @alf of all children !ith @I die beforethey reach the age of t!o.

It is +no!n that an @I infected mother has a 2EL chance of passing the irus onto

her baby through her breastmil+, and it is estimated that in /AAE2EEE /.minfants in &frica !ere infected !ith @I in this !ay. >p to December 2EEE it isestimated that 3.H million children hae died from &IDs, !ith 3.4m of these beinginfected by their mothers, !ith some /.//.m infected solely through drin+ingbreastmil+ infected !ith @I. In sub"aharan &frica it is belieed that AE out ofeery /,EEE pregnant !omen are @I positie. -f these AE pregnancies, 237babies are e?pected to contract the @I irus in utero, during labour, or throughbreastmil+. In this conte?t the proision of free infant formula could sae infantlies on a substantial scale, rather than the opposite.

&ccording to an article in the all >treet ?ournal (6th December 2EEE), in 2EEE thet!o largest formula producers, estl and Wyeth, offered to gie free infantformula in tightly controlled circumstances to @I infected mothers in southern

&frica, including the use of generic pac+aging !ith no reference to either company.This offer !as refused by the >nited ations Childrens Fund (>IC'F), calling it a

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breach of the Code. Wyeth and estl !ere therefore inhibited from supplying freeinfant formula on the grounds that >IC'F !ould hae accused them of breachingthe W@- Code. >IC'F*s Director Carol Bellamy told the all >treet ?ournal

7e don:t believe that 1estl= and the other ma/or formula makers have a particular role to play in the ;2@s crisis. hat they should do is comply withthe %#$& code.:

&t same time >IC'F*s sister organisation, >&ID", !as critical of this decision. Inmany sub"aharan countries een a small portion of standard formula often costsmore than an aerage family*s !ee+ly income. @ence the proision of free formulais crucial if infant formula is to play an important role in the preention of @Iinfection ia infected breastmil+. >&ID" Director #eter #iot !as ;uoted in the

?ournal as saying that >IC'F

7*hey:re having difficulty accepting that the world has changed:A.the 01 mustlook beyond the fierce battles of the past in an effort to save lives.:

ote If you are going to refer to the Wall "treet %ournal article, it is recommended that togie some balance, reference should also be made to a follo!up article in the BritishMedical %ournal 7 %anuary 2EE/ “The milk of human kindness: #ow to make a simplemorality tale out of a complex public health issue.” -r the letter sent to the Wall "treet%ournal by >IC'F '?ecutie Director, Carol Bellamy, /4 December 2EEE, ;uoted in the BM%!hich stated "Bou fail to acknowledge that 0nicef is leading the way in addressing motherto child transmission! and you fail to explain fully why 0nicef so strongly supportsbreastfeeding." 9esearch showed! she said! that formula fed infants were four to six timesmore likely to die of disease than breast fed infants! and "exclusive breastfeeding can savelives! as many as '.( million a year. ; rush to promote formula feeding! she explained!could lead to the spread of other infectious diseases. 0nicefs view is that if formula is tobe used! it needs to be done in a targeted manner. *he organisation is currently piloting

pro/ects in '' countries to offer women #2C testing and counselling! offering formula tothose who then chose to use it. "

Baby Mil+ &ction !or+ed !ith >IC'F on the @I interention pro8ect in helping to designlabels for infant formula !hich gae re;uired information in a clear !ay to increase thechance that the formula !ould be used safely.

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In 2EE/ the World @ealth &ssembly adopted 0esolution 64.2, !hich calls for action

7*o recognize and assess the available scientific evidence on the balance ofrisk of #2C transmission through breastfeeding compared with the risk of notbreastfeeding! and the need for independent research in this connection8 tostrive to ensure ade)uate nutrition of infants of #2C-positive mothers8 toincrease accessibility to voluntary and confidential counselling and testing soas to facilitate the provision of information and informed decision-making8and to recognize that when replacement feeding is acceptable! feasible!affordable! sustainable and safe! avoidance of all breastfeeding by #2C-

positive women is recommended8 otherwise! exclusive breastfeeding isrecommended during the first months of life8 and that those who choose otheroptions should be encouraged to use them free from commercial influences.:

In summary, !here replacement feeding is feasible this is recommended for @Iinfected mothers. Where it is not, e?clusie breastfeeding is recommended.

ote This also ma+es the point that information for mothers should be =free fromcommercial influences*. estl is in breach of this 0esolution as soon after it !asadopted the company set up a utrition Institute for "outhern &frica !ith thestated purpose of promoting infant formula for use by @Iinfected mothers.

&t the 'uropean #arliament #ublic @earing into estl mar+eting of breastmil+substitutes held at the 'uropean #arliament in oember 2EEE, >IC'F stated

7Many people have )uestioned the continued relevance of the 3ode in thecontext of mother-to-child transmission of #2C through breastfeeding. <et meassure you that there is an even greater need to ensure 3ode compliance inareas of high #2C prevalence. *he 3ode protects artificially fed children aswell as those mothers who decide to breastfeed.

$ne of its aims! as specified in ;rticle '! is to ensure the proper use of breast-milk substitutes when these are necessary. 2f incorrectly prepared! infant

formula can be lethal. $ver-dilution! the result of unsuitable availability of formula! leads to malnutrition. 0nder-dilution can cause serious health problems such as kidney failure. *his is without discussing whether sanitationand access to clean water! fuel and ade)uate skills permit safe preparation.:

!"5 6ater 4#ailabilit&The use of impure !ater in the preparation of infant formula, and the resultantaderse health ris+s, plays a +ey role in the ethical issues surrounding breastmil+substitutes. It is !orth noting that according to the > /./ bn of the !orld*sinhabitants lac+ access to ade;uate clean !ater, defined as 6E litres per day for

drin+ing, !ashing, coo+ing, and sanitation. The > stated that 6m people a yeardie from !aterborne diseases, of !hich 2.2m people a year die from diarrhoealdiseases, most of them infants, due to contaminated !ater. &t the %ohannesburg5lobal "ummit on the 'nironment in 2EE2 a commitment !as made to hale theproportion of the !orld*s population !ithout safe drin+ing !ater by 2E/6.

The > stated that 3E countries, the ma8ority of them in &frica, account for HL ofthe people !ithout access to safe !ater. The > also pointed out that there isactually plenty of aailable !ater in the !orld, and the proision of ade;uatedrin+ing !ater for the entire !orld population !ould re;uire less than /L of the!orld*s ground !ater. @o!eer, the problem is the !ay !ater is used. &bout ELof the !orld*s fresh !ater goes into irrigation of agricultural land, and in somedeeloping countries this figure rises to oer AEL. It is generally accepted that the

proision of clean !ater supplies normally inoles the deelopment of ade;uatesanitation serices. It is no! recognised that these t!o goals play a crucial role in

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http://www.ibfan.org/english/resource/who/whares542.html

http://www.ibfan.org/english/resource/who/whares542.html



economic deelopment. &ccording to the 5-, Water &id, these issues are alsomaterially lin+ed to raising the education leel, particularly for !omen. Fore?ample, a Water &id study in 'thiopia found that proiding access to fresh !aterreduced the time spent collecting !ater, a tas+ traditionally allocated to !omen,from si? hours to t!enty minutes per day.

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!"7 he %e& Ethical Issues relating to Breast-Milk SubstitutesThe aim of this CFB paper is to set out the ethical issues at sta+e, and not to reachconclusions. The ;uestion of infant formula mar+eting is complicated, technical,and the sub8ect of heated debate. This section !ill therefore attempt to clarify!hat !e beliee are the +ey ethical issues relating to it

a& >tatus of 2nfant 4ormula-ne ;uestion !hich needs to be addressed is the moral status of infantformula itself. Is it a bad thing in itself, li+e tobacco or gambling, or is itmore li+e alcohol, !here the problems arise from misuse Many supportersof IBF& !ould probably argue that !hile theoretically infant formula maynot be a bad thing in itself, in practice it is a substitute for a ery goodthing, i.e. breast mil+.

b) 9ole of 2nfant 4ormula in 3hild @eathIt cannot be disputed that hundreds of thousands of young children die each

year in the deeloping !orld due to malnutrition or !aterborne disease.@o!eer, it may be important to distinguish bet!een baby deaths thatarise from the use, or misuse, of infant formula due to inappropriatemar+eting by leading infant formula producers, and those that are due toother causes. These might include ignorance on the part of the mother,and the grossly inade;uate health care systems !hich e?ist in much ofsouthern &frica. &s described in section /.7 it is impossible to find pure!ater in much of &frica. &lthough the >nited ations has pledged to ma+eclean !ater aailable to all of the !orld*s population, this is a long !ayfrom being achieed.

c& >upplying 2nfant 4ormula in ;reas of eak #ealthcare >ystemsIn other !ords, ho! morally culpable are the infant formula producers if

they act as reasonable suppliers of infant formula to countries !ith grosslyinade;uate health care systems, such as those in southern &frica, !heremisuse of their products then occurs For the sa+e of argument, let usassume that they are fully compliant !ith the International Code, but thattheir products are still lin+ed to child death. If the misuse of standardformula products arises from ignorance or misunderstanding in the conte?tof inade;uate medical systems, is it fair to blame the companies for thisIt could be argued that infant formula should be !ithdra!n entirely fromsuch countries. -n the other hand, such a !ithdra!al could lead toincreased infant malnutrition through replacement of infant formula byeen more inappropriate substitutes such as goats mil+, or sugar !ater.The prealence of @I&IDs in southern &frica also needs to be ta+en intoaccount.

d& 3ompliance with the 2nternational 3ode-ne of the +ey ethical issues surrounding infant formula relates to thee?tent to !hich the formula manufacturers are complying !ith theInternational Code. & large part of the debate relates to the ery differentinterpretations of the Code made by estl on one hand and Baby Mil+&ction, the World @ealth &ssembly and >IC'F on the other. Thecomple?ity of this debate can ma+e it hard to see the !ood for the trees.While there has been a massie some improement in the mar+etingstandards used to promote infant formula in deeloping countries, the +eyethical ;uestion is !hether it is enough.

e& >ocial 9esponsibility 3onsiderations

&nother ethical issue concerns broader social responsibility considerations.In other !ords are the infant formula producers sho!ing a narro! legalistic

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=compliance* attitude to the Code, but ignoring broader ethical issues Inparticular !hat should they do !hen mar+eting formula in deelopingcountries !ith inade;uate healthcare systems. "ome critics !ould arguethat it is the role of goernments to legislate or proide guidelinesappropriate to the social and deelopmental conte?t of the countryconcerned, !here there e?ists a lac+ of capacity to implement and monitorsuch legislation then, in this day and age, the company must e?ercisediligence to!ards consumers !ith respect to the use of their products.Indeed they should do so !ithout needing to be prompted by goernment,other!ise company mission statements count for ery little.

)" Nestl Polic& on the Marketing of Infant *or'ula)"! /istor&

Infant formula is one of estl*s oldest products, haing been inented by @enriestl in /H7. It no! accounts for less that 2L of total group turnoer, but it !asthe company*s principal product until the early /AEEs. This corporate historyprobably e?plains !hy estl appears fiercely attached to maintaining its presence

in this area, and !hy the company feels obliged to argue its case so strongly. 5ienthe enormous negatie publicity that the sub8ect of =baby mil+* has generated forestl oer the last thirty years, on a strict costbenefit analysis it !ould probablyma+e sense for the company to e?it the standard infant formula mar+et. @o!eer,!e suspect that a sense of corporate history probably preents it from doing so.ote estl also refers to its baby food business as one of its =main strategicpillars*. The reason behind this, is that the company is basically a 8un+foodcompany (indeed according to inestment ban+ >B" Warburg, nearly half of estl*sprofit is at ris+ if effectie regulations on unhealthy foods are introduced throughthe World @ealth &ssembly N this !ould be higher but for estl*s inolement inpet food, cosmetics and bottled !ater). The baby food business enables estl toportray itself as a =nutrition* company and to gain the tacit endorsement of thehealth care system !here its promotional materials appear.

)") Nestl nderstanding of the 6/O Codeestl*s understanding of the W@- code is e?plicitly set out in a number ofcompany documents. "uch an understanding is +ey to the e?tent to !hich thecompany is indeed complying !ith the Code as set out in the World @ealth&ssembly (W@&) 0esolution 34.22 of May /AH/. The follo!ing are ;uotations fromthe estl Document, 2nternational #$ ;ction 9eport, dated &pril 2EE3

• 7#; resolutions are recommendations to all member states of the #$.:

• =*he 3ode calls upon governments to take action to give effect to the

principles and aim of this 3ode! as appropriate to their social andlegislative framework! including the adoption of national legislation!

regulations! or other suitable measures.:

• = 99esolutions passed after the adoption of the #$ 3ode have the same

status as the 3ode- they are recommendations to all of its member governments.< W@- Director 5eneral, 5ro Brundtland, /AAH. 91either the3ode nor any resolution has a real impact and a lasting meaning unlesscountries implement them according to their national laws and practice.Member states are sovereign8 they may! if they choose! implement #$:srecommendations to the letter! they may actually go beyond theserecommendations! or they may simply ignore them together .<*

• =1estl= universally follows all countries: implementation of the #$

3ode. $ur decision! two decades ago! to voluntarily and unilaterallyimplement the #$ 3ode as a minimum in all developing countries is dueto the fact that the economic! social! and sanitary conditions in most of

11



those countries differs substantially from the situation in developedcountries like the 0>; or +0.:

• 71estl= voluntarily and unilaterally implements the 3ode in more than '((

developing countries - we apply the 3ode to all 2nfant food products beingmarketed or otherwise represented as a breast-milk substitute. *hatmeans starter formula %-D months& and in the case of 1estl= it means

follow-on formula %D-'E months&. =

• 71estl= is in voluntary compliance with the #$ 3ode in all developing

countries %more than '( nations&. e support governments: efforts totranslate #$ resolutions into national languages. 1estl= has begun anew monitoring process with governments around the world to ensurecompliance with the #$ 3ode. ;n initial 9eport produced in 'FFFcontained official statements from (, governments representing over (Gof 1estl=:s infant formula sales in developing countries. ;ll provideevidence that 1estl= complies with the #$ 3ode as is it is implemented

in that country.:

estl*s interpretation of the Code is based, in part upon a section !hichsays that

7Hroducts other than bona fide breast-milk substitutes! including infant formula! are covered by the 3ode only when they are “marketed orotherwise represented to be suitable Afor use as a partial or totalreplacement of breast-milk.”:

The company therefore beliees that the Code*s references to products used aspartial or total replacements for breastmil+ are not intended to apply tocomplementary foods unless these foods are actually mar+eted as breastmil+

substitutes.

)"+ Recent (e#elop'ents in Code 0uidelinesIn May 2EE/ the W@- changed restated its recommendation on breast feeding from=recommended e?clusiely for the first four to si? months of life*, to=recommended for the first si? months of life*. This !as in line !ith 0esolution4.6 adopted in /AA4 !hich called for complementary feeding to fostered fromabout 7 months of age. >IC'F !rote to estl in December /AA setting out thatestl*s continued failure to change labels of complementary foods constituted abreach of this 0esolution. During national demonstrations in the >1 i In May 2EE3estl announced

72n line with our clear support for the new 9esolution! 1estl= has conse)uently

completed label changes on complementary foods to follow six monthrecommendation. 1estl= is the only company manufacturing infant formulaand complementary foods to have taken this step! in spite of the risk that thismay put complementary foods at a commercial disadvantage vis-I-viscompetitors: products.:

Baby Mil+ &ction and >IC'F hae proided monitoring eidence sho!ing thatestl*s claim to hae changed labels !as not fully implemented.

)". Nestl8s Polic& and Manage'ent Control of Infant *or'ula MarketingThe importance of infant formula mar+eting to estl is sho!n by the fact that thecompany*s Chief '?ecutie, #eter Brabec+, !rote an introduction to a 2EE/ estlpaper called 2nfant 4eeding in the @eveloping orld . In it he says

• ‘ $ur policy and practice in developing countries since 'FJ, has meant no

12



public promotion! including no advertising! no advertising leaflets! no“milk nurses”! no samples to mothers! and a very restrictive policy on free

formula for evaluation by health professionals. e leave communicationto mothers about infant formula in developing countries completely up tohealth professionals.:

• =e also carry out annual audits on #$ 3ode compliance with a sample

of 1estl= companies! and we investigate any substantiated claims made bythose who believe we have broken the 3ode. Many of these we find to beinaccurate! but in a company of over EE(! individuals! mistakes can bemade. 2f we find that the 3ode has been deliberately violated! we takedisciplinary action.:

• 7;s 3+$! 2 personally review any reports of 3ode violation discovered

either in our audits or in the developing world or through reports fromother organisations! and 2 make sure that the appropriate action is taken.:

estl has also introduced a system of -mbudsmen, i.e. senior managers outside ofinfant nutrition to !hom staff can report concerns. In other !ords, the companyhas put in place a system to alert @ead -ffice of possible Code iolations. Thesepeople !or+ in areas li+e accounting or public affairs, so they hae no incentie tocoer up Code breaches.

ote &uditors can be seen in estl*s 2EE2 "ustainability 0eie! in front ofpo!dered !hole mil+ ne?t to breastmil+ substitutes in the baby feeding section of ashop N a breach of 0esolution 4A./6. estl has refused to indicate !hich countriesit has conducted audits on. It has commissioned one e?ternal audit, into actiitiesin #a+istan, but auditors !here told they could not contact 5-s or a estl!histleblo!er and could only interie! doctors from a list proided by estl.Baby Mil+ &ction !rote to @ilary #arsons, @ead of Corporate &ffairs, estl (>1)

offering to proide documentary eidence to the auditors, but this offer !as notpassed on. The resulting audit !as a !hite !ash. Baby Mil+ &ction has !ritten toestl*s ombudsman as+ing for a response to the many reported iolations !hereans!ers had not been receied or responses !ere inade;uate. The ombudsman didnot reply. estl !histleblo!er, "yed &amar 0aGa, says he !as threatened andoffered money to +eep ;uite !hen he raised his concerns about estl malpractice.@e remains in e?ile from #a+istan and has not seen his family for 6 years.

)"1 %e& Ele'ents of Nestl8s Position on Infant *or'ula Sales>nless estl is guilty of ma8or and systemic duplicity, there seems little reason todoubt that the aboe statements illustrate the company*s sincere coniction that itis doing its best to conform to its understanding of the Code.

-T': estl is guilty of ma8or and systemic duplicity on this issue. estl*sstrategy of suggesting the issue is one of interpretation and only Baby Mil+ &ctiondisagrees !ith estl*s interpretation is 8ust that N a strategy. Baby Mil+ &ctiongoes bac+ to the Code and 0esolutions and see+s adice from >IC'F*s $egal -fficerin case of doubt.

The +ey elements of this, in the CFB*s opinion, are the follo!ing

estl recognises the Code as consisting of adisory recommendations togoernments. It is goernments that hae the responsibility to implement the Codein their o!n countries through la! and medical standards in the light of their o!nlocal conditions. ote estl ignores &rticle //.3 of the Code !hich states9Independently of any other measures ta+en for implementation of this Code,manufacturers and distributors of products !ithin the scope of this Code shouldregard themseles as responsible for monitoring their mar+eting practices according

13



to the principles and aim of this Code, and for ta+ing steps to ensure that theirconduct at eery leel conforms to them.<

•

• estl beliees the Code set out minimum standards in all deelopingcountries. It does not beliee that it applies to deeloped countries, !herethe problem of impure !ater does not e?ist, and !here po!erful regulatoryagencies such as the Federal Food and Drug &gency (FD&) in the >" set theiro!n stringent standards. estl*s position is that it uniersally follo!s allcountries* implementation of the Code, follo!ing its decision more thant!o decades ago, to oluntarily and unilaterally apply the W@- Code indeeloping countries and regions. In deeloping countries and regions!here there is no local code in place, or if the local legislation is less strictor precise than the W@- Code, the Code is used as a minimum standard.-ther!ise the local measures apply.

• estl understands the Code as only applying to breastmil+ substitutes.This means starter formula (E7 months) and in the case of estl it meansfollo!on formula (7/2 months). In the company*s opinion it does notapply to complementary foods such as fruit 8uices, infant cereals, and othernonmil+ based !eaning products.

• estl beliees that it follo!s the Code principles banning free supplies ofinfant formula, !hich it understands to hae particular reference to nursingmothers. It does beliee ho!eer that it is allo!ed to ma+e small samplesof infant formula aailable to medical professionals for ealuationpurposes.

• estl accepts the Code ban on the public adertising of infant formula.@o!eer, it beliees that the Code allo!s it to put nutritional informationabout its infant formula on the side of formula pac+ets. The Code statesthat the label should state ingredients used, compositionanalysis of theproduct, storage conditions, batch number of date before !hich theproduct is to be consumed. The Code also allo!s =scientific and factualinformation* to be disseminated to health professionals.

The company claims that all sales of its global infant formula since /AA2 hae beenin accordance !ith W@- guidelines. Company policy is that any breach of theguidelines must be reported to the company Chief '?ecutie, and that there hasnot been any significant breach for many years.

ote This is surprising. Is estl no! admitting that it !as iolating theInternational Code and 0esolutions from /AH/ to /AA2 &t the time it claimed to beabiding by the measures.

@o!eer, as sho!n in "ection 3 of this paper, IBF& alleges that there hae beenhundreds of Code iolations by estle in recent years. The CFB has carried outlimited database searches and not found recent reports in ne!spapers or ne!sserices accusing estl of significant Code breaches. (The last definite breachappears to hae occurred in #a+istan in /AA7, and !e understand that the companycarried out stringent disciplinary measures subse;uently, as !ell as bringing inindependent auditors to assess the situation, and ma+e public their conclusions).

+"9 Criticis's of Nestl b& Bab& Milk 4ction+"! (escription of Bab& Milk 4ction

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Baby Mil+ &ction is a nonprofit organisation !hich is the >1 armmember of theInternational Baby Food &ction et!or+ (IBF&). It describes its ob8ectie as being

=*o save lives and to end the avoidable suffering caused by inappropriateinfant feeding. 5aby Milk ;ction works within a global network to strengthenindependent! transparent and effective controls on the marketing of the baby

feeding industry. *he global network is called 254;1! a network of over Ecitizens groups in more than ' countries. ; marketing code was introducedin 'FJ' to regulate the marketing of breast-milk substitutes. 3ompaniescontinue to violate its provisions - see examples here. 4ind out how 5aby Milk

;ction works to stop them and how you can help.

In other !ords, Baby Mil+ &ction could be described as a campaigning organisation!hich sees its role as fighting for !hat it sees as the undeniable good ofbreastfeeding. There is an adersarial tone to much of its material, !ith a sensethat it is a small 5- trying to achiee its aims despite !hat it sees as obfuscationby huge, rich companies such as estl and Wyeth.

IB*4N:S Se#en Principles

• The right of infants eery!here to hae the highest leel of health.

• The right of families, and in particular !omen and children, to hae enoughnutritious food.

• The right of !omen to breastfeed and to ma+e informed choices aboutinfant feeding.

• The right of !omen to full support for successful breastfeeding and forsound infant feeding practices.

• The right of all people to health serices !hich meet basic needs.

• The right of health !or+ers and consumers to health care systems !hich arefree of commercial pressures.

• The right of people to organise in international solidarity to secure changes!hich protect and promote basic health.

+") 4cti#ities of Bab& Milk 4ction3 IB*4N$i+e many 5-s Baby Mil+ &ction and IBF& carry out a number of relatedactiities. @o!eer, its ma8or function is the production of regular and detailedmonitoring reports on !hat it describes as =baby mil+* mar+eting throughout the

!orld based upon IBF&*s global net!or+ of contacts. IBF&*s most recentmonitoring report !as 5reaking the 9ules! >tretching the 9ules E,! produced inMay E,. It !as claimed that this report =@ocuments how baby food companiesidealise their products! ignoring the negative health impact of artificial feeding:.

Baby Mil+ &ction also carries out political lobbying. It presented the eidence fromits 5reaking the 9ules report atto the @ouse of Commons on /3 May 2EE4. Themeeting !as hosted by $ynne %ones M# !ho has tabled an 'arly Day Motion (apetition for M#s) calling for the >1 5oernment to support action to end baby foodmar+eting malpractice in the >1 and in other countries. Baby Mil+ &ction statedthat this proposal receied significant support across political parties.

IBF& and Baby Mil+ &ction also proide e?pert !itnesses to argue its case on a

technical basis. For e?ample it sent a delegation in May 2EE4 to the 5eneameeting of the World @ealth &ssembly discussing current concerns in infant and

15

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young child nutrition. IBF& e?perts presented eidence on bacterialcontamination of po!dered formula and the increased use of bogus health claims topromote artificial feeding.

+"+ IB*4N8s Current Monitoring (ocu'entThe 5reaking the 9ules! >tretching the 9ules E, 0eport monitored and analysedthe promotional practices of /7 transnational baby food companies and /4 bottleand teat companies bet!een %anuary 2EE2 and &pril 2EE4. The benchmar+standards used for measuring mar+eting practices !ere the International Code of Mar+eting of Breastmil+ "ubstitutes and subse;uent, releant World @ealth&ssembly (W@&) 0esolutions. The criteria used in producing this 0eport !ere toanalyse infant mar+eting on the basis of =defending breastfeeding and ensuringthat breast-milk substitutes are used safely! if necessary! on the basis of ade)uateinformation and appropriate marketing:.

"ome 3,EEE complaints !ere receied from monitors in 7A countries around the!orld. &fter legal chec+ing about 2,EEE iolations !ere reported in 5reaking the

9ules and many of these came !ith photos. Jeong %oo 1ean, IBF&Os $egal &disorsaid

"e have K'E pictures of actual violations in the report. *here is no waythat the companies can deny that they were found in flagrant violation ofthe 3ode and 9esolutions."

The main criticisms of the food companies in the 0eport !ere as follo!s

• 4unctional claims. 3ompanies try to differentiate their formulas by

adding a string of additives and then claiming performance benefits forthese.

• 4ree and low-cost supplies continue.

• +xclusive breastfeeding for D months continues to be undermined by most

companies.

• 2nformation to health professionals. 3ompanies violate the re)uirement

that this is restricted to scientific and factual matters.

• #ealth facilities and health workers continue to be targeted.

• >ponsorship of medical seminars! conferences and associations of medical

professionals is becoming more widespread.

+". IB*4N Criticis's of NestlThe summary of 5reaking the 9ules identifies estl as controlling 4EL of theglobal baby food mar+et. It goes on

7*hat dominant position is unfortunately matched with its record as the worst3ode offender. 2t was the company with the greatest number of reportedviolations of nearly all the key provisions of the 2nternational 3ode. 1estl=maintains it abides by the 3ode but that means it abides by its own in-house72nstructions: which fall short of the 2nternational 3ode. +ven within its ownnarrow interpretation of the 3ode! 1estl= violates several provisions by

promoting infant formula and follow-up formula and by disseminatinginformation materials which are more promotional than 7scientific and

factual: as re)uired by the 3ode. 2n countries where the 3ode is not enforced

like *hailand and ;rmenia! 1estl= and other companies shower gifts on healthworkers and mothers.:

16



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5reaking the 9ules has a detailed dossier on estl and other infant formulacompanies. 0egarding estl it ma+es the follo!ing detailed allegations

a& ;rticles (.' and (., of the 3ode prohibit advertising! promotion! and the gift of free samples to mothers.

eertheless, a estl distributor is accused of promoting estl an bythe internet in &rgentina. -ther allegations include claims that a "!isssupermar+et magaGine promotes estl Beba 2 and has a picture of a happymother and child, and a parents* magaGine in $u?emburg adertises Beba"ensitie !ith the claim that it is =nearly lactose free and suitable forinfants !ho are sensitie to lactose*. In Thailand estl is accused ofgiing out free samples of $actogen to mothers at home.

b& ;rticle (.L of the 3ode bans promotional devices at the point of sale.estl is accused of haing special posters of an in &rmenia, and of haingsent out sales reps in China. It is accused of handing out samples of

$actogen and an/ in shops in Thailand.

c& #; 9esolution ,K.( %'FF,& urges and end to free or subsidised donationsto products to all parts of the health care system.It is alleged that estl donates unsolicited an / formula in China, andgies free samples of an "oya to mothers in &rgentine health facilities. Itproides free samples of $actogen / and an/ to health facilities inThailand, and actiely promotes an / and $actogen / to pregnant !omenthere.

d) 3ode ;rticle K.L prohibits financial or material inducement to healthworkers.It is alleged that estl gies free gifts of estl mouse pads and diaries to

health !or+ers in Colombia and Costa 0ica. The 0eport states that in&rmenia estl gies free baby suits to hospitals !ith the !ords =I loe mymum*, ne?t to a estl logo. In Indonesia it is accused of distributingposters, diaries, calendars, stationery, and materials on infant care tohealth facilities !hich are displayed in !aiting rooms and doctors* offices.

e) ;rticle F of the 3ode re)uires labels 1$* to discourage breastfeeding! andto inform about the correct use of the product and the risk of misuse.The 0eport accepts that in most deeloping countries estl*s formulalabels do comply !ith the Code*s re;uirements, but =in small print*.@o!eer, it accuses the company of repeatedly iolating &rticle A byma+ing !hat it calls* idealising statements*. For e?ample, in China estlan / labels say 73hoose )uality food! choose 1estl=:. The Finnish label

for an claims that it can 7be used from birth as an addition to breast-milk! or to substitute it:. In "outh &frica, the $actogen / label is allegedto imply the product has the same benefits as breastmil+ by the claim thatit =#as all the vitamins and minerals re)uired by an infant for growth anddevelopment.

f) ;rticle ,.E of the 3ode prohibits information material to have text or pictures which idealises the use of breast-milk substitutes. ;rticle K.Eonly allows product information which is factual and scientific.5reaking the 9ules notes that most estl materials are mar+ed =for themedical profession*, but accuses them of failing to meet the re;uirementsof articles 4.2 and .2. In &rgentina the company is accused of promotingan in professional 8ournals in idealistic terms, e.g. 7closest to mother:s

milk at lowest price:. & poster at a paediatric congress in &rgentina hadthe slogan 7*he most intelligent choice when it is necessary to replace

17



breast-milk8 so intelligent that it even prepares itself .* In &rmenia aestl hospital leaflet is alleged to claim that an is a fully adapted infantformula, and is close to human mil+ in content and digestibility.

%g& #; 9esolution (,.E %E'& recommends exclusive breast feeding for sixmonths.5reaking the 9ules !elcomes the fact that estl is the only infant formulamanufacturer to agree to change its labels in response to the aboerecommendation. @o!eer, the 0eport alleges that although estlclaimed to be fully compliant !ith the recommendation by &pril 2EE3, infact there !ere seeral e?amples of it not doing so.

estl has not produced a formal response to the 5reaking the 9ules report,although one is e?pected later in the year. @o!eer, they hae shared theirpreliminary conclusions !ith us. The company notes that although the report isdated 2EE4, many of the allegations are ery old, some going bac+ to the /AAEs.estl has inestigated all 2EE allegations of Code iolation in the report. They

state that of these

• HH cases sho!ed no Code iolation, as they concerned complementary foods!here the Code does not apply:

• 4E !ere based upon mista+en data:

• 4H !ere based upon insufficient data to ma+e an accurate assessmentpossible. The company apparently inited IBF& to supply moreinformation on these cases, but this did not arrie.

• / had some 8ustification, and referred to leaflets sent to healthcareprofessionals in "outh &frica and Thailand. The company claims that it

immediately tightened up the information on these labels.

• 2 concerned infant formula in &rmenia, !here a poor translation from0ussian had resulted in a technical code iolation:

• / !as a similar mistranslation in $ithuania.

ote IBF& has receied and responded to detailed comments from estl and theresponse is aailable. It is interesting that estl only raised ;uestions oer 3HL ofthe iolations in the Brea+ing the 0ules report, suggesting that it accepts theremaining 72L are iolations. estl*s assertions aboe do not stand up to scrutinyas the full response demonstrates.

+"1 he Nature of the (ebate bet$een Nestl and Breast-Milk Ca'paigning 0roups-ne of the difficulties that ma+e it hard for an independent obserer to come toany conclusion about estl and infant formula mar+eting is the high leel ofemotion displayed by both parties. It seems fair to state that both estl and BabyMil+ &ction passionately feel that they are morally right, and hae a high degree ofsuspicion about the other. Indeed, the CFB understands that for many years estle?ecuties refused to share a platform !ith Baby Mil+ &ction. &pparently, thispolicy changed in 2EE/ and estl has since participated in many debates !ith BabyMil+ &ction.

We suspect that there may be a tendency for estl e?ecuties to dismiss anyaccusation made by Baby Mil+ &ctionIBF& on the grounds that this is a pressure

group !hose !hole e?istence depends upon haing corporate targets such as estlto attac+. -n the other hand some of Baby Mil+ &ction*s literature !ould seem to

18



feed such suspicions in ie! of its highly partisan language, !hich seems to suggestthat Baby Mil+ &ction regards estl as a ruthless multinational company !hichsee+s to ma?imise profits at the cost of infant lies, and is not aboe deceit tocoers its trac+s. &n e?ample of this rhetorical tone is sho!n by an e?tract from aBaby Mil+ &ction leaflet belo!

7 1estl=s idealising leaflets in +gypt and Cietnam

e exposed 1estl= leaflets in Cietnam and +gypt which promote 1estl= infant formulas in an idealising way. e also exposed a 1estl= advertisement in >outh ;frica which encouraged mothers to attend talks on the 1estl= @evelopmental1utrition Hlan given by the 1estl= 5aby-3are 4riends.

*he response below was sent to 5aby Milk ;ction four months after we wrote to1estl=. 2t is likely that we have only received a response as members of the publichave also complained to 1estl=! prompted by our 3ampaign for +thical Marketingaction sheet.

0nfortunately the response from 1estl=s >enior Holicy ;dvisor! 5everley Mirando!demonstrates either ignorance or deliberate dishonesty about the provisions of the3ode and 9esolutions. ;t present the company has no intention of stopping theseviolations. Hlease keep up the pressure on 1estl= to abide by its responsibilitiesby supporting our letter-writing campaigns and the 1estl= boycott.

5aby Milk ;ction has defeated 1estl= in a series of public debates. 2f 1estl=attempts to speak at your college or organisation! feel free to invite 5aby Milk

;ction to come to debate with 1estl=. 2n the past 1estl= refused to even speak ifwe were present in the room! but thanks to pressure from the boycott has backeddown from this position.

4or updates on the boycott see the 5oycott 1ews supplement to our 0pdate newsletter. ;lso see the <atest 1ews section.

*he boycott has been launched by national groups in ;ustralia! 5ulgaria! 3anada!3ameroon! 4inland! 4rance! ermany ! 2reland ! 2taly ! <uxembourg! Mauritius!Mexico! 1orway! Hhilippines! >pain! >weden! >witzerland! *urkey! 06 and 0>;&.

*he boycott will continue until 1estl= abides by the 2nternational 3ode andsubse)uent orld #ealth ;ssembly 9esolutions in policy and practice.*

+"5 Relations bet$een Nestl, and N bodies like 6/O and NICE*This polarised and highly controersial debate does not 8ust occur bet!een estland Baby Mil+ &ctionIBF&. 0elations also appear strained bet!een the company

and >IC'F. For e?ample, in /AA estl Chief '?ecutie #eter Brabec+ fle! toe! Jor+ in an attempt to come to agreement !ith >IC'F on W@- Codeinterpretation. #ress reports state that >IC'F Director Carol Bellamy !al+ed outof the meeting half!ay through, and her deputy refused to discuss @I, insteadharanguing Brabec+ oer estl*s faults. 0elations bet!een estl and >IC'Fseem to hae been e?tremely poor eer since. estl sources suggest that the pressreports !ere e?aggerated

7Mrs. 5ellamy did not voice any criticism of 1estl= at the meeting! but ratherlistened! then was called out for a telephone call in mid-meeting. >he sent aletter to Mr. 5rabeck afterwards closing the door to future dialogue! sayingthat the differences between the organisations regarding #$ 3odeinterpretation were too great to warrant further discussion. #owever! in spite

of these differences! the previous active conflict between 0123+4 and 1estl=has been relatively dormant in the past L years.:

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http://www.nafia.nu/

http://www.ibfan.org/english/issue/code01.html



-n the other hand, estl has had a positie !or+ing relationship !ith the W@-and F&- on food safety, helping to design and fund for the past /E years a foodsafety education programme for health professionals in &sia. & senior estlmanager seres as ice Chair of this. In addition on the obesity issue, #eterBrabec+ !as one of t!o C'-*s to accept the then W@- Director 5eneral*s initationto the first C'- roundtable !ith the food industry on obesity and estle has hadconstructie dialogue !ith W@- eer since. &lso the 'uropean Food Industry*s Tas+Force, chaired by estl, !as the first industry body to come out in support of theW@- global "trategy on Diet, #hysical &ctiity and @ealth.

ote The Methodist Church !as directly inoled in the monitoring report Crac+ingthe Code, published in %anuary /AA !hich found =systematic* iolations by estland other companies. estl also attac+ed the report as biased.

+"7 %e& points of Bab& Milk 4ction8s Nestl Criticis'sBaby Mil+ &ction*s criticisms of estl can be classified into t!o types. The first

are factual e?amples produced by IBF& !here the company appears to be inbreach of basic Code principles through actions such as proiding free infantformula samples to pregnant !omen or nursing mothers.

@o!eer, the second type is based upon Baby Mil+ &ction*s ery differentinterpretation of the role, nature, and scope of the International Code compared toestl.

• >tatus of 3ode. Whereas estl sees the Code as consisting of adisoryrecommendations to goernments, Baby Mil+ &ction regards it as haing thestatus of a global ruleboo+. Is the Code a global minimum standard, or areformula manufacturers able to !or+ !ith local goernments to meet theirlocal needs

ote Baby Mil+ &ction is mandated by &rticle //.4 of the International Code, !hich states“1ongovernmental organisations! professional groups! institutions! and individualsconcerned should have the responsibility of drawing the attention of manufacturers ordistributors to activities which are incompatible with the principles and aim of this 3ode!so that appropriate action can be taken. *he appropriate governmental authority shouldalso be informed.” This does not state that the Code should be used as the reference insome countries and not others, nor does any other 0esolution.

"imilarly, &rticle //.3 of the Code states “2ndependently of any other measures taken forimplementation of this 3ode! manufacturers and distributors of products within the scopeof this 3ode should regard themselves as responsible for monitoring their marketing

practices according to the principles and aim of this 3ode! and for taking steps to ensure

that their conduct at every level conforms to them.”

• eographical 9each of 3ode estl beliees the Code sets out minimumstandards in all deeloping countries. Baby Mil+ &ction argues that itapplies uniersally. What happens !hen local goernments implementlegal re;uirements different from the Code Is it desirable, or unnecessaryfor the Code to be incorporated in each country*s legislation

Baby Mil+ &ction and IBF& !or+ to bring the Code and 0esolutions into legislation N it isperhaps their main actiity. @o!eer, &rticle //.3 continues to apply. Its !ording is eryclear “independently of any other measures taken for implementation of this 3odeA”0esolution 34.22 under !hich the Code !as adopted describes it as a =minumum*

re;uirement to be implemented in its =entirety*.

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• <imitations on 3ode. estl argues that !hile the Code refers to =allcountries*, this is in the conte?t of the possibility of =infant malnutrition,morbidity and mortality*. "ince the latter conditions do not arise indeeloped countries, the Code only applies to deeloping countries. -fcourse, deeloped countries such as the >1 tend to hae their o!n detailedcodes for mar+eting of infant formulas in hospitals.

ote estl has no basis for ma+ing this claim. In doing so, it is not at odds !ith Baby Mil+&ction, it is at odds !ith the World @ealth &ssembly. The Code directs goernments to>IC'F for assistance in introducing the Code into legislation. >IC'F employs a $egal-fficer for this purpose. >IC'F has made it clear in !riting to estl that the Codeapplies to all countries, not to estl*s o!n list of countries.

• ;pplication of 3ode to @eveloped 3ountries. estl argues that sellinginfant formula in deeloped countries in !ays not compatible !ith the Codeis therefore acceptable. Baby Mil+ &ction on the other hand argues thatthis sho!s that estl is in breach of it, and is particularly critical of infantformula mar+eting in the >" and Canada. (5ien the po!ers of the FD& in

the >", and the tendency of the >" courts to ley large fines, it is arguablethat these countries can loo+ after themseles).

ote There !as a oluntary ban on adertising in the >" until estl entered the mar+et in/AHH !ith its ta+eoer of Carnation. estl sued the &merica &cademy of #ediatrics andthe other baby food companies under antitrust legislation and began adertisingunilaterally. o! all companies adertise. The >" has supported the Code and 0esolutionssince /AA4 and &rticle //.3 applies there as much as any!here else.

• @efinition of 5reast-milk >ubstitutes. In estl*s understanding the Codeonly applies to breastmil+ substitutes, such as starter infant formula (E7months). In Baby Mil+ &ction*s opinion it applies to all products that mightreplace breast feeding, !hich includes not only formula but complementary

foods such as fruit 8uices, and infant cereals under certain circumstances.

ote estl repeatedly refers to the Code applying only to starter infant formula(for e?ample, its =Charter* sets out its =Infant formula mar+eting policy fordeeloping countries). The "cope of the Code is clear 9The Code applies to themar+eting, and practices related thereto, of the follo!ing products breastmil+ substitutes,including infant formula: other mil+ products, foods and beerages, including bottlefedcomplementary foods, !hen mar+eted or other!ise represented to be suitable, !ith or!ithout modification, for use as a partial or total replacement of breastmil+: feedingbottles and teats. It also applies to their ;uality and aailability, and to informationconcerning their use.<

• @efinition of ;dvertising. There are also highly technical disputes bet!eenthe t!o sides about the Code ban on the public adertising of infantformula. estl argues that the Code allo!s it to put nutritionalinformation about its infant formula on the side of formula pac+ets,!hereas Baby Mil+ &ction accuses it of promotional material =idealising*breastmil+ alternaties. There are e?tremely technical arguments aboutthe nature of material on infant formula pac+aging, i.e. is its role to adisephysicians, or is it trying to unduly influence ne! mothers

ote This confuses different issues. This is not about a definition of adertising. The Codeis actually ;uite clear and addresses issues separately. The issue of information on labels isseparately and clearly defined in &rticle A of the Code. #romotional materials are differentagain. The should be no promotion to the general public, under &rticle 6 of the Code.

Information to health !or+ers must be restricted to scientific and factual matters, under&rticle , and there are often concerns that estl materials do not comply. "ee+ing direct

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and indirect contact !ith pregnant !omen and mothers of infants and young children isbanned under &rticle 6.

." *SE. 0ood

."! Role and (escription of *SE.0oodThe FT"'45ood "0I inde? series incorporates breastmil+ substitutes as one of its+ey ethical criteria. It therefore proides some independent assessment of thiscontentious area.

FT"'45ood is a family of "0I or ethical stoc+ mar+et indices !hich !as launched in%uly 2EE/. FT"' recognised the need for a partner to add "0I e?pertise to its o!ns+ills in inde? construction, so the FT"'45ood inde? series !as therefore created inassociation !ith 'I0I". The underlying concept !as to construct a broadly based"0I inde? for a number of regional mar+ets the >1, >": 'urope, and the !orld,!ith the ob8ectie of producing a benchmar+ to measure "0I fund performance in

these regions. The follo!ing e?clusions !ere then used to filter out unacceptablecompanies tobacco producers: companies proiding strategic parts or serices ormanufacturing nuclear !eapons systems: manufacturers of !hole !eapons systems,and o!ners or operators of nuclear po!er stations and those mining or processinguranium. The basic philosophy underlying the inde? !as to include only companiesmoing to!ards best practice in the areas of the enironment, human rights, andsta+eholder relationships.

.") he Role of NICE*&gainst the bac+ground of the dispute oer the mar+eting of infant formula it isimportant to note that the >nited ations Children*s Fund (>IC'F) agreed to beassociated !ith FT"'45ood in return for the right to nominate three members ofthe &disory Committee. >IC'F also gained the commitment of FT"' to pay it all

the net license income FT"' receied from its clients in the first t!ele months ofoperation, as !ell as a 6Ep charge on each trading screen sho!ing the data. FT"'International hoped that this !ould generate reenues estimated at P/m (Q7EE,EEE)for donation to >IC'F.

."+ *SE.0ood8s Changed Criteria Relating to Infant *or'ulaFrom its inception in %uly 2EE/ the FT"'45ood inde? series e?cluded on ethicalgrounds eight food and pharmaceutical companies producing breastmil+ substituteson the grounds that they !ere in breach of the International Code of Mar+eting ofBreastMil+ "ubstitutes. These companies !ere &bbot $abs: Bristol Myers ";uibb:@einG: Mei8i Mil+: estl: oartis: utrimco, and Wyeth.

@o!eer in March 2EE4 the FT"' 5roup announced that it !as lifting its blan+et ban

on such companies follo!ing an e?tensie process of public consultation.FT"'45ood stated that from no! on it !ould use =measurable inclusion criteria.*The announcement stated:

74*>+ will establish a small +xpert 3ommittee! comprising academics andexperts on the industry! which will review company reports to assess whetherthey adhere to the 4*>+,ood criteria and to make recommendations to the4*>+,ood Holicy 3ommittee as to the continuing eligibility of companies.:

&s at -ctober 2EE4 the CFB inspected list of the companies included in theFT"'45ood, and it found that none of the eight !as included in that list, despitethe recent reision to FT"'45ood*s breastmil+ substitute criteria. @o!eer, it ispossible that >IC'F*s influence has preented FT"'45ood from doing so.

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ote The reason estl and other companies are e?cluded is because they eryclearly fail to comply !ith the inclusion criteria. For e?ample, companies hae tohae a policy accepting that the Code and 0esolutions apply to all countries(including the >" and Canada) and all breastmil+ substitutes, not 8ust infantformula.

1" he Methodist Church Position1"! /istor& of Methodist Church position on 'arketing of breast-'ilk substitutes

In /AA2 the Methodist Conference adopted Memorial /E/, 0nethical MarketingMethods! !hich urging Methodists to inform themseles about the issues inoledalthough the Conference declined to support a boycott of estl products. & ma8orpaper discussing the !hole sub8ect of breastfeeding !as brought to the /AAAConference (Conference &genda /A) called hat:s 5est for 5abiesN The /AAAConference approed three related resolutions

!;3! Conference receies the report and encourages local churches andMethodist groups to study all the issues and to act accordingly.

!;3) Conference calls on @er Ma8esty*s 5oernment to incorporate intolegislation the proisions of the W@- Code and the subse;uent resolutionsof the World @ealth &ssembly, and monitor their application in the @".

!;3+ Conference encourages Methodists in Britain to support the Baby Friendly@ospital Initiatie, and further encourages Methodists in conersation !ithpartner Churches oerseas to support BF@I in many countries of the !orld.

1") Methodist Council <)=The Methodist Council, the e?ecutie body of the Methodist Church, !as concernedthat the /AAA resolution =left the 3onference:s position uncertain:. It thereforesubmitted a report to the 2EEE Methodist Conference called hat:s 5est 4or5abiesN (Methodist 3ouncil E). This report !as receied by the 2EEE Conference,therefore becoming the definitie statement of the Methodist Church*s position on

the issue. This paper noted the follo!ing (the follo!ing numbers refer to the 2EEEConference &genda)

L. There is no conincing eidence !hich points to an accommodation,understanding or agreement bet!een Baby Mil+ &ction (Baby Mil+ &ction)and estl in the foreseeable future.

,. The British Methodist Church has no !ay independently of ad8udicating onthe ongoing disputes bet!een Baby Mil+ &ction and estl. It remainsun!ise for the Church to be aligned une;uiocally !ith one side or other.

The church needs to be in a position !here it can e?ercise a critical roleto!ards both parties to the dispute, and e?press its an?ieties about the

behaiour of both.

6.E The irreconcilable conflict bet!een Baby Mil+ &ction and estl has seeraldimensions to it.

5.1 The W@- International Code of Mar+eting of breastmil+ substitutes isdesigned to protect mothers and health !or+ers from commercialpressures. The W@- has proo+ed many interpretations, not to mentionthe relationship bet!een the Code and subse;uent resolutions of the World@ealth &ssembly. -n the one side are those !ho insist that the Code mustbe applied in eery conte?t, irrespectie of national la!. -n the other arethose !ho insist that the Code re;uires its claims to be incorporated byeach goernment into national legislation in realistic and achieable !ays

appropriate to their conte?t.

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(.E The disputes about the sort of eidence !hich might constitute a breach ofthe Code, and the means by !hich eidence is to be tested to assure itsreliability and truthfulness.

(.L The failure of international bodies to !or+ together to!ards a commonframe!or+ of understanding.

(., The confusion bet!een mista+es, inade;uacies of management action andintentional malpractice measured against the proisions of the W@- Code.

1"+ Outco'e of )999 ConferenceThe 2EEE Conference+13! 0eceies the report.

+13) For the sa+e of clarity, the Conference records the follo!ing 8udgements

2./ In the light of the Christian 5ospel, the health, nurture and deelopment ofery young babies and their mothers merits the prayerful and practicalsupport of Methodists.

2.2 The Conference is not aligned !ith either side in the disputes bet!eenBaby Mil+ &ction and estl, !hich hae been going on for more than 26years: the Conference encourages Methodists, local churches and Methodistgroups to study all the issues and to act accordingly.

E.L The Conference endorses continuing constructie engagement by membersof the Conne?ional team !ith both estl and Baby Mil+ &ction.

5 Other Ethical Issues concerning Nestl

5"! EthiopiaMany people !ere shoc+ed to read in the financial press in 2EE/ that estl !assuing the goernment of 'thiopia, one of the poorest countries in the !orld, fordamages of P7m relating to nationalisation in the /AEs. In December 2EE2 estlC'- #eter Brabec+ announced that the dispute had been settled for a total sum ofP/.6, !hich !ould be distributed to humanitarian organisations for famine relief in'thiopia.

ote &s an interesting footnote, on H May 2EE4, estl (>1) C'- &lastair "y+es!rote to the national press denouncing a decision by Brea+through Breastcancer toturn do!n a Q/ million causerelated mar+eting deal !ith estl on ethicalgrounds. In the letter Mr. "y+es, claimed estl abided by the baby food mar+etingre;uirements and !as a force for good in the !orld. &s an e?ample of its

humanitarian !or+ Mr. "y+es referred to the donation to 'thiopia, neglecting tomention the -?fam campaign that prompted the company to donate the moneybac+ rather than fight for and +eep a larger sum.

5") Coffee PricesIn the /AAEs and early 2EEEs global coffee prices plummeted causing greateconomic distress in particular to small coffee farmers. This !as due to a seriousoer supply caused among other things by e?pansion of largescale coffee farmoperations in BraGil and ietnam. In the late /AHEs unroasted coffee beans reachedP3.3E a lb, but by 2EE3 the aerage price receied by coffee farmers had fallen toPE.7E a lb, !ell belo! the global aerage production cost of PE.HE lb. For seeralyears groups li+e Traidcraft hae promoted Fairtrade ground coffee brands such asCaf Direct !hich are produced on the basis of ensuring that their producers

receie a price !hich gies them a liing !age, and enables them to care for the

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enironment. Caf Direct has done !ell in the >1 ground mar+et, !ith a claimedmar+et share approaching /EL.

@o!eer, the ast bul+ of global coffee production is used in instant coffee, !hichis dominated by t!o companies 1raft (Ma?!ell @ouse), and estl (escafe),although the >" food group "ara $ee has a significant presence in the ground coffeemar+et. estl is the !orld*s single largest coffee buyer, !ith a global mar+etshare of /4L. In response to the global coffee crisis, arious organisations haeannounced that they !ould sell Fairtrade coffee. In 2EE2 the large caf chain"tarbuc+s announced that they !ould promote Fairtrade coffee. In May 2EE3 the!orld*s largest coffee bro+ers, eumann and olcafe announced an agreement !iththe >"based 0ainforest &lliance !ith the aim of stimulating the production of=sustainable coffee*, defined as coffee plantations !hich meet basic enironmentaland social re;uirements. &t the end of 2EE3 1raft announced plans to sellsustainable coffee, but to date estl does not appear to hae done so.

-n the other hand, the company is a member of the "ustainable &griculture

Initiatie and has set up a number of sustainability pro8ects !or+ing !ith smallfarmers in Central &merica and &frica. estl argues that the concentration on=Fairtrade* coffee is misleading, as this is only a minute fraction of the totalmar+et. It beliees that its policy of buying more coffee directly from farmers, i.e.bypassing coffee bro+ers, is more effectie in enabling more of the price to bepassed bac+ rather than being dierted to middle men. The groups* C'- #eterBrabec+ has lobbyied for structural change in the mar+et place to ease commodityprice fluctuations. Further estl ma+es appro?imately half of all escafe in thedeeloping !orld thus ensuring more of the added alue remains in those countries.

ote estl often ma+es the point about buying coffee directly from gro!ers, but buyingdirectly is not the same as paying a fair price. estl has opposed independent monitoringof its procurement policies 8ust as it opposes independent monitoring of its baby food

mar+eting practices.

5"+ Cocoa PlantationsIn 2EE2 serious and documented allegations emerged that some cocoa, the basematerial for chocolate production, !as being produced in West &frica using slaelabour, often children. In -ctober 2EE3 estl put out a statement, 3oca orkingHractices! !hich stated that

71estl= does not own cocoa farms or plantations in est ;frica. 1evertheless1estl= is committed to ensuring that coca is grown without the worst forms ofchild or forced labour. ;s part of our commitment! we have partnered withthe global chocolate and cocoa industry and 1$s in an international protocolthat lays out a series of action steps designed to ensure that cocoa is grown in

a responsible manner.:

5". Obesit&In the >nited "tates the food industry seems to be increasingly targeted by la!suitsalleging health damage through obesity. "uch la!suits seem modelled on thosefiled earlier against the tobacco industry. In the >1 there is increasing concernthat the >1 population, li+e those of many other deeloped countries, is copying >"trends !here the ma8ority of the adult population is oer!eight, and a significantproportion seriously obese. -besity is lin+ed to a ariety of health problems suchas heart disease and diabetes.

This problem is perhaps most serious !hen it inoles children. Children in the >1eat less than half the recommended amount of fresh fruit and egetables each dayand the proportion of primary school children !ho are oer!eight doubled bet!een/AH4 and /AAH to reach 26L. In turn this has been lin+ed to gro!ing diagnosis of

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Type 2 (late onset) diabetes in children, something preiously normally e?periencedin late middle age. Many health charities are concerned that confectionerycompanies are partly to blame for this problem. (There !as a ma8or publiccontroersy in the >1 in May 2EE3 !hen the >1 chocolate company Cadbury*s 5et&ctie mar+eting campaign encouraged children to get sports e;uipment for theirschools by saing chocolate !rappers. It !as estimated that children had to eat/7E million bars of chocolate to get e;uipment !orth QAm). &t that timeDr Wendy Doyle of the British Dietetic &ssociation called for the British 5oernmentto introduce regulations restricting food adertising aimed at children, as is thecase in "!eden. "he said

7*hese big food companies have these huge budgets to promote all thesethings to children. 2 am sure it is having an impact - the manufacturerswouldn:t do it if it did not. 5ecause of the problem of obesity! theovernment has to take an active step to stop children being targeted byadvertising.:

estl, li+e Cadbury, has a range of initiaties aimed at schools. It has supportedgrass roots tennis for oer 4E years. More recently it has funded through 4Childrenthe creation of oer 7EE Ma+e "pace contemporary youth clubs and hae helped setup sporting actiities through these clubs. It a!ards the estl "marties Boo+ #riGe,for children under //. It sponsors the schools publication 1ey "+ills in Conte?t,!hose section on =utrition* does not !arn about the dangers of eating too muchchocolate or s!eets. -ther estl material states

7*he good news is that sensible snacking can play a very important role in ahealthy diet and healthy lifestyle. 2n fact! some experts theorise that ourbodies were meant to eat this way. 3urrent research suggests that havingnumerous smaller meals over the course of the day helps to keep your blood-sugar levels on a more even keel.:

-n the other hand estl does state its commitment ( 1estl= and 1utrition, 2EE3)to

79esponsible advertising and marketing to children! and we have internalmarketing codes to formalise that commitment. e adhere to voluntary

guidelines! such as the 2nternational 3hamber of 3ommerce 9ules on 3hildrenand Boung Heople and Marketing.*

In this conte?t it is !orth noting that estl is one of the !orld*s leading foodcompanies in terms of funding research and deelopment to design healthier foods.The company has pioneered a range of products such as ="eltesse* that either haelo!er calories, or can assist in !eight reduction. It is also a pioneer of foods that

may hae positie effects on health, the latter sometimes being called =functionalfoods*. & good e?ample !ould be =probiotics* i.e. yoghurts containing naturalbacteria that actually inhibit the gro!th of harmful bacteria in the stomach such as#elibacter pyliori !hich are lin+ed to the deelopment of ulcers. -er the past 6years estl has deeloped or reformulated oer EE products globally to lo!er fat,sugar and salt. In the >1 that has included the remoal of TF&s from confectioneryproducts, salt reduction in cereals and in soups and sauces.

ote estl targets schools in a ma8or !ay, not only !ith ending machines, but schemesintended to encourage children to buy confectionery and cereals, many of !hich are highsalt and high sugar. For e?ample, it has a =bo? tops for education* scheme !here itdonates /E pence to the school in return for cereal tops.

5"1 0M *oodsThere is a !ide gulf bet!een the >", !here 5M foods appear to be !idely

26



accepted, and 'urope !here they are regarded !ith great suspicion by the ma8orityof consumers. Indeed, 5M foods !ere banned by the 'uropean Commission untilthe >" goernment forced the '> to drop this ban under WT- trade rules. estlhas stated that it !ill use 5M foods !here permitted, and if customers !ant them.

ote 5reenpeace has publicised that despite promises to the contrary estl foods in'urope and China (including baby foods) hae been found to contain 5M ingredients.

5"5 6ater Misuse5lobalisation has led many multinational companies to significantly e?pand thescale of their operations in deeloping countries. In the food industry, there aregro!ing concerns that soft drin+ companies may be digging !ells that drain thelocal !ater table. For e?ample, in %anuary 2EE4 Christian &id published a reportentitled 5ehind the Mask- the 9eal 4ace of 3>9. 5ehind the Mask accused CocaCola of staring Indian illagers of !ater in the southern Indian state of 1erala,!here !ells are failing to +eep up !ith the demand. This is particularlydeastating in a community that is mostly dependent upon agriculture. It stated

that illagers are demonstrating outside the company*s bottling plant in#lachimada.

There is a similar controersy inoling estl in BraGil. It is alleged that a estlplant is depleting an a;uifer in a historic spa to!n in that country. In -ctober 2EE4a group of Catholic and #rotestant clergy isited the 'uropean "ocial Forum onWater complaining about estl. @o!eer production ceased on -ctober 3/st 2EE4.In addition e?tractions !ere belo! the limits set by the authorities. Further theauthorities conducted tests, !hich found e?tractions to be sustainable, and !ith noproen lin+s bet!een estl*s operations and the allegedly declining !ater leel inother springs in the area.

ote The latest ne!s from BraGil is that it is not yet clear if estl is stopping its

operation. In addition, estl attempted to go bac+ on the agreement it made !ith the8udge that heard the case against the construction of its bottling plant and illegal demineralisation of !ater. & public hearing !as held in the @ouse of 0epresentaties !hereestl indicated it did not !ish to close its bottling plant. It !as told it had to honour theagreement made !ith the court. estl has since bought !ater par+s in neighbouring spato!ns. -ne of the springs in the spa to!n has already dried up.

There !ill be the opportunity to meet campaigners from BraGil. Contact Mi+e Brady ofBaby Mil+ &ction for details.

No#e'ber )99.

Documents

Methodist Annotated 1104