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Exporting Infant Malnutrition
by Leah Margulies
‘Science for the People’ Vol. 9, No. 4, July-August 1977, p. 9–12
An economy based on consumption needs consumers. When the market is saturated at home, the solution—look abroad for new and untapped markets. This is exactly what has happened in the infant formula industry. With too few mouths to feed at home, the major manufacturers of baby foods have stepped up their promotion tactics over the last few years in Third World countries where population rates are still rapidly increasing. Massive sales campaigns presently encourage poor women around the world to abandon breast feeding for bottle feeding—a more expensive, complex, and less healthful method. The result: increasing infant malnutrition and mortality. There could be no more dramatic illustration of corporations, hungry for profit, manufacturing a need that wasn’t there.
Infant Formula—A Poor Substitute
First of all, what kind of product is infant formula? It is a highly processed food which, in the finer products, is patterned after breast milk in fat content, protein and sugar source, although it does not have either the antibodies or the digestibility of the real thing. Sometimes the product is sold premixed but more often, especially in poor countries, it is sold as a powder that requires measured amounts of pure water for proper reconstitution. Clean bottles and nipples are also necessary.
Breast milk, on the other hand, has been described as the “original convenience food” in a pamphlet produced by the War on Want, a British advocacy group. Besides supplying the proper quantities of protein, fat, etc., it protects the infant from disease by providing antibodies important to the development of the immunization system.
For poor women in underdeveloped countries, who don’t have refrigeration, access to pure water, easy measuring arrangements and the ability to read the instructions, infant formula is a dangerous convenience. They cannot use it properly. An investigation by the War on Want discovered a Nigerian mother who fed her baby mostly water—but with a bottle and nipple she had seen advertised on a billboard in town. It was not made clear to her that it’s what’s inside that counts. Other mothers have been known to fill bottles with mixtures of water and cornstarch in an attempt to imitate the appearance of the product.
This says nothing of the expense of infant formula to poor families. For many, the cost of feeding one child exclusively on formula can cost thirty percent or more of a family’s income. Many mothers, then, dilute the powder to make it last longer. Several studies in the Caribbean, for example, showed that many women were stretching a four days’ supply to last three weeks. Another study in Barbados also found that eighty-two percent of mothers surveyed were diluting the powder. What results is increased infant malnutrition and mortality at earlier and earlier ages among Third World children.
Earlier and More Severe Damage
There is plenty of evidence linking formula feeding with increased rates of infant mortality and malnutrition among children of poor countries. In a hospital survey in Sierra Leone, 713 of 717 children admitted for malnutrition had been bottle fed. In Chile in 1973, three times as many deaths occurred among infants who were bottle fed before three months old than among wholly breast-fed infants. A research team inspecting feeding bottles there discovered a bacterial-contamination rate of eighty percent. In some African hospitals, babies suffering from malnutrition are in beds marked “Lactogen Syndrome” after Lactogen, a baby formula made by Nestle.
Furthermore, physicians and nutritionists working in Third World countries report that babies are suffering from chronic diarrhea and other symptoms of extreme malnutrition much earlier than in the past. When breast feeding was widespread, malnutrition did not become severe until after weaning, usually in the second year of life. Now the average age of children suffering from malnutrition in some parts of the world is eight months. One dangerous result of this earlier malnutrition is often damage to the child’s mental development. The earlier the malnutrition occurs and the longer it lasts, the greater the chances that the child’s brain will be impaired.
Insidious Marketing by Multinationals
The corporations that sell infant formula abroad in the Third World run the gamut from prestigious American, Swiss, British and Japanese multinational corporations like Abbott, American Home Products / ‘ Bristol-Meyers, Nestle and Cow and Gate—to local fly-by-night manufacturers trying to cash in. Sophisticated companies with resources and capital at their disposal are promoting their products to unsophisticated consumers who take what they see quite literally. When a Third World woman sees a fat, healthy baby nursing from a bottle on the wall of her health clinic, she believes it to be an endorsement.
Other influences are at work. She may have recently entered her country’s burgeoning workforce and moved to a city where she is exposed to the synthetic images of glamor that characterize women in Western-style ads. She may be learning to be self-conscious about her body and breast feeding is not part of that self-image to which she is aspiring. Bottle feeding is in vogue. A consumer is born.
In the past few years there has been documentation of insidious marketing and promotional techniques employed by companies aggressively competing to expand their share in a fast-growing and, thus far, unsaturated market. Companies advertise on billboards, on radio, and even on TV. Because of the lack of strict controls on advertising in many Third World countries, claims are made about the advantages of bottle feeding which would not be allowed in Western countries. In hospitals throughout the Third World posters advertising a particular product are common. Some companies, primarily Nestle, have milk banks in hospitals where they sell formula to mothers at discount prices.
Some companies give hospitals prescription blanks, printed up to look like hospital stationery with a list of the company’s products underneath for the doctor to use when recommending one of these products. Some companies sponsor crawling contests and hire clowns and magicians to entertain parents and then advise them of the advantages of bottle feeding.
Most formula manufacturers hire nurses to promote their products through hospitals, doctors and maternity and postnatal clinics where they distribute free samples and speak to women individually. These milk nurses constitute what American companies call the “mothercraft personnel.” These women may not actually be trained nurses. Or, they may be trained nurses lured by the higher salaries and fringe benefits, among them the use of a car, which American companies offer. These nurses often visit women in their homes and even make home deliveries of formula. They rarely tell mothers of the costs of bottle feeding.
Milk nurses are apparently influential in persuading women to bottle feed their infants: “Ninety-five percent of the [Nigerian] mothers who combined breast and bottle feeding said they had been advised to do so by medical personnel, mainly midwives and nurses. Milk company representatives who give talks on feeding appear to be identified as hospital and clinic staff.”
Growing Public Concern …
Despite the fact that a handful of pediatricians have been voicing their concern for “bottle illness” for the past fifteen years, little was publicized until the Protein Advisory Group of the UN system issued two declarations concerning the issue. By 1974, the World Health Assembly (the governing body of the World Health Organization, WHO) unanimously adopted a resolution which identified misleading sales practices as a cause of declining breast feeding and urged nations to review and regulate the marketing of infant formula.
However, the problem only gained widespread interest when War on Want, a British charity organization, published the first major expose of the issue entitled “The Baby Killer” by the English journalist, Mike Muller. In April 1974, a Swiss group, the Arbeitsgrouppee Dritte Welt, translated the booklet into German and retitled it “Nestle Kills Babies.” Nestle is the second largest food company in the world, with subsidiaries in twenty-eight countries, and is the largest seller of baby foods in the Third World. Nestle brought a libel suit against the group and last spring a judge ruled in favor of Nestle on a technicality. It could not be proved, he said, that Nestle deliberately set out to kill babies—as the pamphlet’s title indicated. But, the judge declared while announcing his decision, “This is no acquittal.”
In the United States, the Interfaith Center on Corporate Responsibility (ICCR), an ecumenical agency which plans the corporate-responsibility actions for approximately fifteen Protestant denominations and over 135 Roman Catholic orders, has put pressures on American baby formula companies who, along with Nestle, dominate the market. For two years, shareholder resolutions have been filed which have asked management to disclose sales and marketing practices. One company, Bristol-Meyers, the makers ofEnfamil, is now being sued by an ICCR member, the Sisters of the Precious Blood, for allegedly misleading shareholders m the company’s 1976 proxy statement on the issue.
… And Token Response
In response to criticism, the major manufacturers of infant formula have banded together in an attempt to regulate themselves. Last year, Abbott Laboratories, makers of Similac, joined with American Home Products, Nestle and eight other companies in the International Council of Infant Food Industries in order to create an industry-wide Code of Marketing Ethics. Bristol-Meyers had refused to join, claiming the code might violate anti-monopoly laws. However, after months of negotiations, the remaining companies were not able to decide which “ethics” they will adhere to. There are now three separate codes, each with slightly different guidelines.
The codes are essentially more similar than different—especially in their shortcomings. All three codes fail to include any means of enforcement other than by the companies’ own management. Equally important is that the codes, while appearing to keep the industry ethical, actually legitimize current unethical practices. For example, the codes continue to allow mothercraft personnel to distribute free samples and to wear nurses’ uniforms, albeit with the company’s insignia. Critics believe, however, that any commercial personnel who have a role in educating mothers need to be organized and trained by recognized local institutions and health authorities and must function to satisfy local needs. Trained nurses can perform their health care function only if the element of sales promotion is removed from their job description.
Despite the obvious weaknesses of these codes, companies use them to divert criticism. Having a code appears responsible and humane. In fact, it only lets the companies off the hook. Infant formulas can be sold under carefully controlled and supervised conditions and still be misused because existing social and economic conditions make proper usage virtually impossible.
Third World Self-Determination
Some Third World governments are taking actions to protect their people. In Jamaica, the government has placed limitations on the import of baby milk products. The Malaysian authorities have initiated a nationwide breast feeding campaign. There are stricter controls on radio advertising in many countries and many hospitals are refusing to allow formula manufacturers to display posters. On the grassroots level there appears to be a determination among health workers to protect children from the dangers of bottle feeding. But, these are small gains seen against the backdrop of the power of the giant corporations’ abilities to promote their products, even indirectly.
There is, moreover, a recognition on the part of Third World nutritionists of the need for a substitute for breast milk—for the less than five percent of women who cannot breast feed for physiological reasons and for the small but growing numbers who must work away from home. But, such substitutes must be designed to suit conditions in Third World countries—the less refrigeration and cooking needed, the better. Zambian nutritionists have developed an infant-weaning food made from local foodstuff. it is sold with strong warnings against its use by anyone who does not have the necessary clean water. Each can also strongly recommends breast feeding. Because it is locally made, this substitute is much cheaper than imported formulas.
Beyond the human tragedy involved, the sale of infant formula in the Third World is a perfect example of how the multinational corporations export inappropriate lifestyles and products to countries ill prepared to resist the penetration. They don’t help countries decide their real priorities. They are all too ready to define what other countries need based on Western values, especially if it’s good for profits.
Third World countries are beginning to act. In Western Europe the marketing of infant formula in the Third World has become a major humanitarian issue. In this country, various groups are beginning to act around this issue. (See box.) It will clearly take the coordinated efforts of individual governments, health care personnel and concerned groups to reverse the destructive marketing techniques that have wreaked such devastation on the infants of the Third World.
A List of References
The Baby Killer, by Mike Muller, War on Want, London, 1974.
“Formula for Malnutrition,” by Consumers Union, CJC Brief, Corporate Information Center, Room 566, 475 Riverside Drive, New York, NY 10027.
Baby Formula Abuse Action Group of Philadelphia, PO Box 12913, Commerce Station, Philadelphia, PA 19108.
Earthwork, 1499 Potrero Avenue, San Francisco, CA 94110, (415) 648-2094.
Food Action Center, 1028 Connecticut Avenue NW, Washington, DC 20036, (202) 466-3726. Food Day, 1757 S. Street. NW, Washington, DC, 20009, (202) 332-4250.
Infant Nutrition Group, 8th Day Center for Peace & Justice, 22 East Van Buren Street, Chicago, IL 60605. Interfaith Center for Corporate Responsibility, 475 Riverside Drive, New York, NY 10027.
Northern California Interfaith Committee on Corporate Responsibility, 870 Market Street, San Francisco, CA 94102, (415) 397-0484.
Southern California Interfaith Hunger Coalition, 1716 N. Wilton Place, Los Angeles, CA 90028, (213) 466-6504.
To get the film, Bottle Babies, contact: American Baptist Films, Valley Forge, PA 19481, (215) 768-2307. $20. Order several months in advance.
Tricontinental Films, 333 Sixth Avenue, New York, NY 10014, (212) 989-3330. $30 plus $5 shipping; $300 to buy. Order a month in advance.
National Council of Churches, Audio Visuals, 476 Riverside Drive, New York, NY 10027. $95 to buy. Church affiliation needed.
This article is reprinted from HealthRight, a quarterly publication of the Women’s Health Forum in New York. Subscriptions are $5 a year, and their address is 175 Fifth Avenue, New York, NY 10010.