STRETCHING THE RULES
As the International Code of Marketing of Breastm ilk Substitutes and, increasingly, national laws based on the Code are closing the front door of hospitals and clinics to formula companies, these companies are desperately trying to keep their foot in the door. Access to the health care system is the best channel to reach pregnant women and mothers of newborn babies. Not only is a woman especially vulnerable in those stages, but she has also placed her trust in the medical establishment. Whatever is taught or given her by her doctor must be the best for h er baby. Naturally, that is whst all mothers want: the best.
Extending the market
New products and new practices have already been introduced in many countries and will rapidly spread to others. Special milks for mothers and young children are a logical extension of the market whch initially included only regular infant formula. Over the years, that market was extended to include follow-up formulas and then a whole range of special formulas for pre-mature, low-birth-weight, lactose intolorant babies, or other babies deemed in need of another formula. Extending the market to mothers and toddlers does not only vastly increase the potential number of consumers, but also provides ample opportunity for companies to keep using the hospital and the old techniques used when formula promotion was in its heyday.
Now, as before the International Code was adopted, Nestle, Mead Johnson and Snow Brand openly sponsor ante-natal classes and give each mother a bag of goodies covered with their company name. The only difference is that now the sample in the bag is not infant formula, but a formula for the mother. In this way, companies continue to communicate a commercial message to the mother at the crucial time when she is making the decision about how to feed her baby. The care system is implicated as pormoting both company and products. Breastfeeding again comes out a poor cousin.
New products not within the scope of the International Code give companies another way to compete with breastfeeding. The Code clearly outlaws direct contact between company marketing personnel and mothers. Companies now do so under the guise of promoting these new products, which are not within the scope.
|Gone are the days
when maternities would innocently hand over the addresses
of mothers attending ante-natal classes. Today, companies
build their own mailing lists by asking mothers to enroll
in their mothers clubs or inviting them to seminars
on parenting. Direct mail is then timed for sensitive
moments in the babys life: the growth spurt at
three months, the mothers questions about
complementary feeding at four, five or six months, the
first birthday and so on.
In Malaysia, some 200 pregnant women were invited to a five-star hotel for a Nestle MOM fashion show. When the local breastfeeding mothers group complained that the Code prohibited such direct contact between the company and mothers-to-be, Nestle replied that it was not hosting as "Nestle", but that this was a MOM event and that MOM is not a product covered by the scope of the Code.
Nestlé MOM gift bag given to mothers attending antenatal classes in Malaysis
Formula for mothers
First came infant formula, then follow-up formula, and now, a formula for pregnant and lactating women. Milk for mothers is a very clever invention because it allows companies to ride on the breastfeeding wave and link the goodness of breastfeeding to a new product. At the same time, it gives the same companies that make infant and follow-up formulas another opportunity to remind mothers, doctors and hospitals of their company names. At least 10 major companies are currently aggressively promoting formulas for pregnant women and lactating mothers. Colourful brochures, advertising on TV, in magazines and newspapers, sponsored ante-natal classes, samples and seminars all contribute to the creation of a brand-new market.
|A market filled with brands: MOM (Nestle), Formance(Abbott Ross), Lactomil (Wyeth), Mama Care and Ma Ma Sustagen (Mead Johnson), Mama Plus (Dumex), Frisomum, (Friesland/Dutch Baby), Protifar (Nutricia). All the big baby food producers are present. Snow Brand was a bit late to jump on the bandwagon with Maternity. Relative newcomers are Novalac (United Pharmaceuticals) and Anmum from the New Zealand Dairy Board (NZDB). The NZDB does not make infant formula but must have been inspired by other companies' follow-on milks because it Created ANMUM 1 and ANMUM 2.||
The Anmum milks are heavily promoted in Singapore, Malaysia, Taiwan, Hong Kong and the Philippines but not in the NZDB's home country, New Zealand.
Nestle has been busy promoting Nestle MOM in Latin America as well as in Asia. A glossy 25-page booklet was sent to doctors in Brazil and six Brazilian hospitals reported promotion for MOM. Abbott gives colourful Formance monographs to health professionals in Bolivia, Colombia, Mexico and Peru. Abbott also advertises Formance with brochures in Kuwaiti hospitals, newspaper ads and direct mail in Malaysia. Mead Johnson's formula for mothers, Mama Care, is promoted in hospitals in Mexico and the Philippines. Anmum and Mama Care have started active "mothers' clubs". The Anmum Club offers seminars, inexpensive videos, diaper bags and kitchenware often in return for Anmum tin foils. Wyeth advertises Lactomil on posters placed in Malaysian maternity hospitals. Filipino mothers waiting for immunisation of their babies are given a MOM cup with MOM formula.
everywhere: by mail, at
ante-natal sessions, doctors offices, maternity
clothing shops, pharmacies and in Malaysia
even at McDonald's where baskets of free
Novalac samples were on offer.
Do breastfeeding mothers need such formulas? No! A balanced diet of local foods will usually supply all the 14 vitamins and 12 minerals Formance promises the mother. During pregnancy, the body naturally prepares for the baby and for lactation by storing up additional nutrients and energy. Mothers need to know that they are perfectly capable of selecting a healthy diet for themselves and for their infants. Those who are very malnourished cannot afford to buy Anmum, MOM or any other formula. What they need is more nutritious local food at a fraction of the cost of these glamorous formulas for mothers. Very inexpensive supplements of folate, iron and vitamin A in tablet form are also available.
Yes. The essential prominent promotional message for this product is that mothers need it in order for breastfeeding to be successful. For example, an advertisement for Abbott Rosss Formance proclaims in large print "Promotes the production of breastmilk." Formance brochures state it will improve both the quality and the quantity of breastmilk. The slogan on the cover of an Anmum 2 brochure from the NZDB states "Breastfeeding mothers have special nutritional needs different from pregnant women." The inside of the brochure tells mothers that Anmum 2 improves the quality of breastmilk. Such messages undermine years of breastfeeding promotion designed to show women that breastfeeding comes naturally and every woman can do it. By making breastfeeding more complicated, a busy mother might easily say, instead of drinking that new formula myself, I might as well buy formula for the baby.
Moreover, In trying to convince women to buy the products, companies exploit the known advantages of breastfeeding and play on the mother's fears, especially her very natural fear that there could be something wrong with the baby or with her milk. Mama Plus brochures say: What's good for mum is better for baby. Frisomum makes the proper growth and development of your baby possible. A prescription slip for Nestle MOM says: Trust MOM to know what is best for baby. Dumex Mama Plus in a leaflet for mothers mentions recent studies which confirm an increased risk of congenital birth defects because of inadequate intake of folic acid. Taurine is essential for the normal development of the foetus' brain, nerves and eyes, it says..... All you seem to need to avoid such risks is two glasses of Mama Plus in either chocolate or vanilla flavour.
Mead Johnson advertises on a fake cover of Newsweek it donates to Filipino hospitals
|Anmum 2 says
it helps to ensure that babies receive the best possible
start in life. The main slogan for Abbott Rosss
Formance is: "because all women deserve to
have healthy babies." Wyeth's Lactomil
posters advise both pregnant and nursing women through
colourful photos how much they would need to consume of
expensive-looking foods to satisfy their essential
requirements in protein, iron, calcium, folic acid and
zinc... concluding: "to make sure you get all the
added nutrients you need... supplement with NEW! Lactomil:
because baby's health begins with mother".
Formulas for mothers do not violate the letter of the International Code because they did not exist when the Code was drafted. They do stretch the spirit of the Code by seriously undermining breastfeeding.
Follow-up formula now has its own follow up. The results of the IBFAN Monitoring Project show that so-called 1-2-3 milks, or milks marketed specifically for children from one to three years of age, are being heavily promoted in different countries around the world. While the content and analysis differ very little from that of follow-up milk, 1-2-3 milk is marketed as though it is an entirely different product. This product appears to be part of the continuing effort by milk companies to stay one step ahead of policy makers.
As with milks for mothers, companies use this product to reach mothers in the health care system, to obtain names and addresses of women of child-bearing age and to advertise with impunity. For example, an advertisement for Dutch Lady 1-2-3 in Malaysia includes a coupon asking mothers to fill in their name, address and current brand of formula they are using. 1-2-3 milks are advertised throughout the health care system via posters, calendars, leaflets, clocks and gifts and also by leaflets given in supermarkets. The milks are also promoted with free samples that come by direct mail or through the health care system and through free childrens club memberships and newsletters.
|Company names and brand
names are reinforced
in the mothers mind by repeated images such as
Nestles four-foot Neslac Ninja Turtle growth
chart that hangs on clinic walls in Pakistan.
Mead Johnson gives mothers samples of its milk for toddlers, Enfagrow, and free gifts such as the towel in the picture. The towel depicts three stages of growththe silhouette of a baby, a toddler and a child. Above the silhouette of the baby is the word Enfa , whereby the company cleverly omits the rest of the brand name Enfalac, an infant formula which may neither be advertised under the International Code nor Malaysias national Code.
SPONSORSHIP: ARE THERE
The ethical question of how the funding of travel, conferences, journals and scholarships affects prescribing behaviour is not directly addressed by the International Code. In fact the Code can be read to allow such funding provided contributions are disclosed and do not constitute inducements to promote products within the scope of the Code. Disclosure has to be only to the institution to which a health worker is affiliated which appears to exempt all private practitioners. As to when financial or material contributions become "inducements" is open to interpretation.
WHA49.15, adopted in 1996, goes one step further by wanting to ensure that financial support does not create conflicts of interest for professionals working in infant and young child health.
Companies are either breaking or stretching these rules by spending vast amounts of money on sponsorship.
Main | Introduction | Executive
Summary | Promotion through
the Health Care System | Promotion to the
Labelling | Feeding Bottles and Teats | Appendix | This Inform...