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This miracle product, human breast milk, was around long before any notion of a market system. But today, because of that system, millions of women — especially those in underdeveloped nations who can scarcely afford it — are passing up the obvious benefits of breast milk for the bottled alternative, powdered infant formula, with disastrous consequences.
Twenty years ago in Chile, 95% of all mothers breast fed their babies beyond the first year. Now the practice has been virtually abandoned. But a recent study there shows that babies fed from a bottle during the first three months of their lives are three times more likely to die than those who are breast fed. Far from an isolated occurrence, this problem has been documented in many other poorer nations. The United Nations Protein Advisory Group declared, “In many instances, placing an infant on a bottle is tantamount to signing the death certificate of the child.”
Why are these babies dying? Why are women changing from the life-giving milk produced within their own bodies to expensive infant bottle formulas — a switch causing their children to suffer malnutrition, increased infection, retarded development, and often death? The answer lies in who the producers of infant formulas are, their motivations and their priorities.
The producers of breast milk are mothers. Few would disagree that a mother’s first priority is the health and well-being of her child. She wants to provide that which will make the child strong and healthy. The producers of powdered infant formulas, on the other hand, are multinational agribusiness corporations. These giants are primarily concerned with the growth and expansion on which their own survival is based. The corporate economy’s desire to expand requires new unexploited markets for the creation of new customers.
With the stabilization of birth rates in many industrialized countries, sales of infant formula products have slowed dramatically. Articles in business magazines described this crisis as “The Baby Bust”’ and “Bad News in Babyland.” To maintain and increase their sales, the companies sought markets where the population was still booming. Developing countries in Asia, Latin America, and Africa, with rapidly increasing birth rates, fit the bill. A recent annual report from one infant milk producer, Nestles Corporation, states, “Generally sales developed satisfactorily: although the continued decline in birth rate, particularly in countries with a high standard of living, retarded the market . . . In the developing countries our own products continue to sell well thanks to the growth of population and improved living standards.” There had been only one problem: the people didn’t have any need for the product. What was industry’s response? Create one! A massive sales campaign now appeals to caring parents’ desires to give their child the best available. It encourages poor mothers to abandon breast feeding for a more expensive and ultimately less healthful alternative. As one consumers group put it: “Where the need for growth in earnings conflicts with the welfare of newborn babies, multinational business seems to put its own health first.”
Claiming that they benefit underdeveloped countries by introducing a high quality nutritional product, these companies fail to recognize existing economic and social conditions which make proper use of the formula nearly impossible.
The head of the UCLA School of Public Health’s division of population, family, and international health, Dr. Derrick Jelliffe, says, “The pediatric nutritionist is left increasingly frustrated by the well-financed steam-roller marketing techniques of the food industry to sell totally unaffordable and inappropriate infant foods in impoverished countries while mouthing sanctimonious platitudes about their world role in improving child nutrition.” He coined the term “commerciogenic malnutrition” to describe the malnutrition caused by such ill considered promotion.
Why are these foods “unaffordable and inappropriate”? In most underdeveloped countries with low per capita incomes, powdered infant formula for a three-month-old baby can cost from 20 to 40% of a family’s income, as compared to, say, 2% in Great Britain. By the time the infant reaches six months, his feeding costs can consume up to 60% of an average income in many countries, or nearly 80% in extremely poor countries such as Guatemala. Not included in these figures are the added costs of bottles, nipples, cooking utensils, and fuel for sterilization, or for those nearly inevitable medical bills for bottle fed babies.
To the poor, uneducated mother, an obvious solution is stretching the formula by diluting it with more water than is specified on the package, the label of which she probably cannot read. A study conducted in Barbados in 1969 showed that 82% of the mothers were “stretching” the formula. They were making a 4-day can last between 5 days and 3 weeks. Young infants can drink only a certain amount of liquid a day, and so cannot get sufficient protein or calories with the diluted formula. The baby rapidly loses weight and its health deteriorates to a severely malnourished state called Marasmus. Marasmus is defined as “the result of chronic malnutrition arising from a simple insufficiency of food, and thus from a shortage of calories.” Mostly found among infants of less than one year, Marasmus is almost always associated with infantile diarrhea. While human milk is highly protective against both malnutrition and diarrhea, with improper use of bottle formulas, the two react synergistically. Underweight babies are prone to infections that create diarrhea and the baby suffering with constant diarrhea is unable to absorb enough nutrients from what food it gets. In some African hospitals, such babies are kept aside in beds labeled “Lactogen Syndrome.” Lactogen is a powdered infant formula product marketed by Nestles Corporation in many poorer countries.
Marasmus is often found together with Kwashiorkor — another form of malnutrition. For general purposes, both are lumped under the term PCM or Protein Calorie Malnutrition. Kwashiorkor is a nutritional disease associated with extreme protein deficiency combined with excessive intake of carbohydrates. This leads to the bloated, listless appearance among older children seen in so many hunger photographs. Because they can’t afford sufficient bottle formula, mothers often substitute cornstarch mixed with water or simply sugar water, believing that the milk-like appearance or simply the bottle itself can provide adequate nutrition. While the biologically normal continuation of breast feeding can’t supply the total nutrient intake needs of children one year and older, it helps supplement the transitional or weaning diet and therefore prevents Kwashiorkor. Yet the incidence of infant malnutrition in the underdeveloped nations is increasing. “It has been estimated that there are about 10 to 20 million young children with severe syndromes of Kwashiorkor or Marasmus at any one time — most of whom will die without treatment.” Can poor people afford either the product or its consequences?
Formula feeding also requires appropriate sanitary facilities and a supply of clean water. Directions in Nestles “Mother Book,” distributed by the company in Malawi, begin: “Wash your hands thoroughly with soap each time you have to prepare a meal for baby.” But even in the capital city of Malawi, only 34% of the homes have any type of washing facilities. The vast majority of West African families have no indoor cooking area but instead prepare meals outside on their “3-stone kitchen,” which supports one pot above an open wood fire. Even if the mother can read, of what relevance to her is the glossy picture of an aluminum saucepan on a modern electric stove with the instructions: “Place bottle and lid in a saucepan of water with sufficient water to cover them. Bring to the boil and allow to boil for ten minutes.” The result? Frequently, bottles don’t get sterilized. One study showed that 80% of all bottles examined contained high bacterial contamination. The resulting infection ties in with the vicious cycle of disease and protein calorie malnutrition. The mortality rate for infants suffering from Marasmus or Kwashiorkor is high, but those who do survive often suffer permanently retarded brain growth and intellectual development. Due to the present trend toward bottle feeding from birth, malnutrition now strikes children at an increasingly early age. Because the first six months are most crucial for growth of brain cells, the proportion of children with possible mental deficiencies is growing. It is estimated that 75-80% of the underdeveloped world population are unable to use baby formula safely. Here a choice of bottle over breast feeding is clearly a choice between life and death.
In order to so dramatically influence a mother’s child feeding practices, the infant formula companies have powerfully effective promotion campaigns. Not only do these companies have polished advertising schemes, they carry more economic clout than the governments of most poorer countries. Nestles, the largest seller of commercial baby milks in the world, recorded total annual sales in 1971 exceeding the gross national product of Uganda and Tunisia combined. Such companies can afford to flood the media with ads featuring pictures of plump, healthy babies clutching bottles and with captions such as:
Give him KLIM and watch him grow. KLIM is full of goodness to build strong bodies, bones and teeth. Give your baby the best full cream powdered milk — give him KLIM. KLIM is good for your baby and your growing children too.
A poor mother in Sierra Leone would never be exposed to an advertisement for breast milk such as the fictitious one at the beginning of this article. There’s a much greater likelihood, however, that she would hear at least one of the 15 thirty-second advertisements for Nestle’s Lactogen aired over local radio stations daily:
Bring up your baby with love and Lactogen. Now Lactogen better food cos it don get more protein and iron, all the important things that go make pikin strong and well . . . Lactogen and love.
While Nestles and other companies claim to direct advertising only at those who can afford to use the product properly, use of this common Krio dialect suggests otherwise.
Worse than a heroin addiction, once “hooked” on these products, the mother cannot return to breast feeding because her own milk dries up, and as the baby grows, the cost of the “fix” increases.
In addition to blaring radio ads, many other “hard sell” promotional tactics are used by the corporations. Those that sell infant formula in the poorer countries include such well known multinationals as Abott (Murine Eye Wash, feminine hygiene products), American Home Products (Woolite, Black Flag Insecticide, Chef Boy-Ar-Dee Foods, Brach’s Candles), Bristol-Myers (Bufferin, Ban, Vitalis, Windex, Excedrin), Nestles (Libby fruit and vegetables), and Cow and Gate (a British company).
Many of these companies seek out hospitals and the health care profession as prime targets for sophisticated advertising strategies. One method is to give out free samples to new mothers while still in the hospital. For the company, this represents an investment which they hope will be returned when mothers continue using the product after leaving the hospital. Companies also employ fully trained nurses as “milk nurses” to visit women at home and describe the benefits of bottle feeding. Calling them “mothercraft advisors,” Nestles employs nearly 5,000 such people, often tempting them with commissions on top of their salaries. “Milk Banks” located in hospitals and clinics sell commercial formulas at discount prices to those who can prove their poverty. Worse than a heroin addiction, once “hooked” on these products, the mother cannot return to breast feeding because her own milk dries up, and as the baby grows, the cost of the “fix” increases. These promotional practices effectively legitimize and encourage bottle feeding by direct association with the medical profession. While contributing to malnutrition and disease among infants, milk companies divert nurses trained at public expense from basic full-time health care work.
Should industry be responsible for the misuse of its products? Nestles says: “We make a product available on the market but the onus cannot be on us to stop mothers from taking such a product into consideration.” Dr. James Farquhar, a consultant pediatrician who has worked and traveled extensively in poorer countries, sees the situation differently:
“It is clear to all but those who will not see that informed, adequate, and relatively safe bottle feeding must follow or at least accompany but never precede literacy, education, infection, free water supplies, sanitation, and a standard of living which permits the purchase of enough baby foods, equipment, and means of sterilization.”
Certainly this does not mean that multinational infant food corporations are solely responsible for death and disease among infants. Other pressures have laid the groundwork for exploitation. We must also recognize that the social and economic costs go far beyond the tragedy of malnourished children.
An increasing pattern in developing countries is the steady migration from rural to urban homes. People forced off their land by inequitable land distribution or foreign corporate ownership go to the cities for jobs and for a new, more westernized, lifestyle. Market outlets for infant formula are much easier to establish in cities, and the cultural vacuum of newly urbanized communities breaks traditional patterns, tending to make people more inclined to new trends. One such trend is the new image of the breast as a cosmetic “sex symbol” rather than a source of infant nutrition. Women taking jobs outside the home are rarely given the opportunity or incentive to continue breast feeding while at work. All of these factors add up to an ideal situation for the milk companies.
A further response to the pressures of a modernizing society can be the failure of lactation. This is most frequently caused by psychological uncertainty and distress but may also be influenced by the simple suggestion that a woman’s milk supply may not be adequate. Milk company promotional literature can have just such an effect by stating: “When mother’s milk is not enough,” or “It may happen that you do not have enough milk to feed your baby. In this case the meal must be supplemented by bottle feeding.” Medical studies indicate that, at most, 5% of the population has a physical problem inhibiting breast feeding. And the problems that arise from a mixture of breast and bottle feeding are described by La Leche League International, an organization devoted to helping women breast feed successfully:
The supplementary formula is one of the greatest deterrents to establishing a good milk supply, and frequent nursing is one of the greatest helps. You see, the milk supply is regulated by what the baby takes. The more he nurses, the more milk there will be. If he’s given a bottle as well, he’ll gradually take less and less from the breast and the supply will diminish.
If this goes far enough, the woman’s breast milk will stop flowing completely and she will be dependent on use of the bottle formula. Again, the cycle of disease and malnutrition.
The abandonment of breast feeding represents serious, long term social and economic costs. In societies based on subsistence agriculture, the use of bottle formula creates a need for cash to purchase the milk, disrupting the self-sufficient work patterns of the people. Women, who traditionally grow the food, are forced to take paying jobs or begin raising primary cash crops. Removed from their food production role, these women become wage slaves, dependent on an income to buy most of the food for their families. Beyond individual costs, the decline of breast feeding can be calculated as a loss to the natural resources of the country. Alan Berg, a nutritionist, notes that in Kenya “the estimated $11.5 million annual loss in breast milk is equivalent to two thirds of the national health budget, or one fifth of the average annual economic aid.” He calculates that “losses to the developing countries more likely are in the billions.” In an article for Science Magazine (May 1975), Dr. Jelliffe stated, “Human milk should be recognized as a natural resource in economic, agronomic, and nutritional planning.”
What about the responsibility of the medical profession? Aren’t they letting the bottle milk corporations literally get away with murder? Graduates of western professional training, for the most part, and members of the highest socio-economic brackets, doctors often set a poor example by bottle feeding their own children. The real crime, though is in carrying this endorsement to people who cannot afford to use the formula safely. A Chilean doctor tells of his western-oriented medical education:
It was like a chemistry class or perhaps cookery. We used to spend all our time mixing up different kinds of artificial formulas in the laboratory. Our teachers were far more interested in this than breast feeding.
This man’s training was obviously not geared to the needs of people he would be treating. Perhaps doctors should instead heed the words of Oliver Wendell Holmes: “The breasts were more skillful at compounding a feeding mixture than the hemispheres of the most learned professor’s brain.”
Dim as all this may seem, progress is being made. Jamaica is one example of a developing country making big steps in reversing the breast-to-bottle trend. Medical students are now being taught to recognize malnutrition due to bottle feeding. Public hospitals refuse to allow the promotional activities of milk nurses, and the government is sponsoring free clinics to teach the importance of breast feeding. Directions on a tin of DAWN milk powder, produced by a nationalized company in Zambia, are a startling reminder of the difference between people vs. profit-oriented products. It reads:
The best food for your baby is mother’s milk. It is better than this or any other kind of artificial food. Don’t feed your children artificially unless you are sure that you have the money to buy enough milk. By the time your child is four months old, he will need five pounds of milk powder each month. Are you sure you have enough money to buy this?
This shows impressive progress, particularly in a country where at one time mothers put empty cans and feeding bottles on their dead babies’ graves, still believing them to be the child’s most valuable possessions. However, Jamaica and Zambia are definitely in the minority among underdeveloped countries. Very few have followed Papua New Guinea’s example of making infant formula promotion illegal. A further step that none have taken would allow for the dispensing of bottle formula with prescription only. This would provide the crucial test as to how many women actually need such products.
The baby food industry is extremely image conscious. Publicity in home markets linking baby formula usage with malnourishment and death is bound to have an impact.
Small governments cannot battle the multinational mammoths alone. It is essential that external pressure be exerted as well. The baby food industry is extremely image conscious. Publicity in home markets linking baby formula usage with malnourishment and death is bound to have an impact. For U.S. based corporations, pressure from shareholders resolutions has brought some concessions from Borden and Abbott on their promotional strategies. Until recently, Bristol Myers has refused to accept any responsibility. Upon realizing that they owned stock in the company, a Catholic Teaching Order — Sisters of the Precious Blood — sued the corporation concerning mis-statements on infant formula promotion in proxy material. Despite extensive documentation to support the case against Bristol Myers, the judge dismissed it, saying that to rule on the accuracy of the company’s statements “would be an exercise in semantics.” Since then, the sisters have reached a more satisfactory settlement with Bristol Myers out of court by threatening to appeal.
Controlling more than one third of all the infant formula in the world market, Switzerland based Nestles has been least responsible in recognizing the tragic consequences of its products. Nestles sued a Swiss citizens group for $5 million in damages, charging that accusations in a pamphlet the group produced were defamatory. The pamphlet, entitled, “Nestles Kills Babies,” stated that Nestles’ efforts were unethical and immoral, that its marketing techniques resulted in infant death, and that its representatives posed as medical personnel. With mounting evidence supporting these statements, Nestles, at the last minute, decided to drop all charges against the group and press only the charge that the title was defamatory. Because the group couldn’t prove intentional murder on the part of Nestles, they lost the case and were fined a token $300. However, they considered it a significant victory in the struggle. In passing sentence, the judge stated, “This is no acquittal of Nestle” and in his opinion said:
Hence, the need ensues for the Nestle company to fundamentally rethink its advertising practices in developing countries as concerns bottle feeding, for its advertising practice up to now can transform a life-saving product into one that is dangerous and life-destroying. If the complainant (Nestle) in the future wants to be spared the accusation of immoral and unethical conduct, it will have to change its advertising practices.
There is now an international boycott of Nestles’ products and it is gaining strength. Apparently feeling its impact, David E. Guerrant, president of Nestles — U.S., attempted to defend his company in a letter to one of the primary organizers of the boycott, The Third World Institute of Minneapolis. Mr. Guerrant has his own interpretation of the judge’s opinion:
The company was vindicated last year when a Swiss court found the members of the Third World Work Group guilty of defamation. The Swiss court held that statements which attributed responsibility to Nestle for infant deaths were false and were intended to severely damage Nestle’s business reputation.
In the final paragraph of his letter, Mr. Guerrant accused the Third World Institute of “inciting well-intentioned citizens to act on the basis of biased, false and misleading information.”
The company’s sensitivity to its public image is a useful leverage point in the struggle to stop infant formula death and malnutrition. While few own stock in a corporation selling such products, most people are potential consumers. To become known to these consumers as the promoter of a “dangerous and life-destroying product” is very threatening to those who market baby products. Beyond the economic pressure of the boycott is its educational value. Knowledge of the issues behind the Nestles boycott leads to a greater understanding of multinational involvement in the developing world.
What Can You Do?
Groups representing a wide variety of interests have joined together in the Infant Formula Action Coalition (INFACT) and on July 9, 1977 launched a nationwide boycott of all Nestle products. Similar actions have been underway for some time in western Europe, home of Switzerland-based Nestle — the largest infant-formula distributor in poorer nations. Specific demands behind the boycott, aimed at immediately stopping all promotion of infant formula, are:
End direct advertising of formula to consumers.
End distribution of free supplies to hospitals, clinics, and homes of newborns.
End the use of company “milk nurses.”
End promotion to the health professions and through health care institutions.
Organize Locally For “Infant Day” April 13, 1978
Infant Formula Action Day is a day for people across the country to join in united action to help infants in developing countries, the potential victims of bottle disease. Activities are now being planned by groups and individuals to raise awareness about the issue and put pressure on companies which promote infant formula. Keep in touch with INFACT for more information.
Join The Campaign
Active groups in more than a dozen cities are working to spread the Nestle boycott. To find out how to link up with the campaign where you live, write or call:
Interfaith Center on Corporate Responsibility
National Council of Churches
475 Riverside Drive
New York, N.Y. 10027
Third World Institute of the Newman Center
1701 University Avenue
Minneapolis, Minnesota 55414
1499 Protrero Ave.
San Francisco, California 94110
Agricultural Resources Center
P.O. Box 646
Chapel Hill, N.C. 27514
Libby, McNeill & Libby products
Other Products Include:
Nestle’s milk flavorings
Cross & Blackwell products
Swiss Knight Cheese
Deer Park Mountain Spring water
Boycott Nestle products. Inform your local grocer, restaurant, or food service of the issue and ask them not to stock Nestle products.
Get endorsements for the Nestle Boycott and infant formula education work from your local church, union, political party, health group, hunger organization, business affiliation, or government body. Forward endorsements to National INFACT, the companies, and to appropriate members of Congress [National Infact, 1701 University Ave., S.E., Minneapolis, Minnesota 55414].
Write to the Nestle Company informing them that you “boycotted another Nestle product today,” and explain why.
Nestle Company, Inc.
100 Bloomingdale Road
White Plains, New York 10605
Show “Bottle Babies,” a documentary film on the issue. To arrange for a local showing, contact:
Washington CAIC (Clergy and Laity Concerned)
1322 18th St., N.W.
Washington, D.C. 20036
Write letters-to-the-editor of your local newspapers informing them of the issue and urging support of the Boycott.
Educate your friends and relatives about the issue.
Investigate stockholdings of local institutions — churches, universities, foundations.
Send a letter to your congresspersons in Washington, D.C. Inform them that you are supporting the Nestle boycott. At the same time tell them that you want them to support investigation into, and government control of, corporate sales practices in the infant formula market.