BTR - SUMMARY

EXECUTIVE SUMMARY

Breaking the Rules 98 reports on violations of the WHO/UNICEF International Code of Marketing of Breastmilk Substitutes and relevant WHA Resolutions revealed during a 31-country survey carried out between January and September 1997.

The survey results show that in nearly every participating country, the main producers of infant formula and other breastmilk substitutes do not comply with the requirements set out by the World Health Assembly. The most significant trend is the industry’s continued focus on the health care system. Companies have always used the health care system as a way to promote infant formula. As the Code, national legislation and the Baby Friendly Hospital Initiative threaten to cut that point of entry, new products have been devised to keep the channel open. After all maternity units are the most direct avenue to mothers and babies and health care professionals are the best authority to recommend new products. A recruitment ad placed recently ( 29 Sept. 1997) by Wyeth in a Malaysian newspaper describes the job of a "nutitional representative" as:

to promote, sell, educate and create demand for the usage of the company’s products through regular and aggressive coverage of all health care professionals.

The results also indicate that it is exclusive and continued breastfeeding that are most threatened by marketing practices. On the surface, it would appear that companies have jumped on the bandwagon to promote breastfeeding by diligently including a "breast is best" message on nearly all of their materials. The underlying messages, however, are that breastmilk needs to be supplemented, i.e. while it is good for newborns, it will not be enough on its own for very long; that follow up formulas are necessary at four or six months, implying that breastfeeding should stop; that working women need substitutes; that fathers need to take part in feeding; and that babies need herbal drinks, special water and early complementary foods. Mothers are bombarded with these messages in materials produced by the companies that manufacture and sell infant formulas, follow-up formulas, other infant foods, feeding bottles and teats.

Mothers, health workers and hospitals still receive free samples and supplies from numerous companies, but headed by the four major ones: Abbott Ross, Mead Johnson, Nestle and Wyeth.

Companies are still using posters, clocks, calendars, and gifts to mothers and health workers as a way of promoting products, primarily within the health care system. Products are promoted directly by brand name, or indirectly through association of the company with images of healthy, happy babies or breastfeeding.

Company-produced information for mothers like booklets, growth charts, posters and other printed matter still advertise brand names of products or fail to comply with Article 4 of the Code. Even those companies that do comply (i.e. produce materials that include a statement on breastfeeding and the required warnings about the dangers of artificial feeding) still obtain promotional value by associating their name with infant health. For example, Mead Johnson distributes no fewer than 15 different booklets for pregnant women or new mothers in hospitals in Thailand.

Very few companies still dare to advertise infant formula directly to the public. The focus has now shifted to the promotion of follow-up formulas, complementary foods, milk for one year olds and toddlers, and formula milks for mothers. The trend is to extend the market by expanding the product range to cover pregnant women and pre-school children. The new products also provide companies with another way to compile mailing lists creating potential for direct marketing to mothers for at least 3 years after the baby’s birth.

Although the labels of infant formula have improved, none are perfect aside from those required to conform to a national standard. The expansion of the product range has also allowed greater cross-brand similarities so that one label easily reminds the consumer of another for a different age group.