Firstly, what are the problems with baby milk substitutes?
There is much research and information now that shows a mother's own breast milk is the healthiest for her baby. A few mothers may have problems breastfeeding, and so there is a small need for a reliable substitute. But generally breast milk is the way to go, and there are groups who have long been advocating the promotion of "breast is best'' .

Of course, when a company has a good product, it wants to keep its market share, and increase consumer use of it. The problem is that Nestle seems to be redefining its potential customers, not just those who need the milk substitute, but those who may find it more convenient. No problem there, it seems, mothers should have a choice.
There are problems though.

Because milk substitute needs to be made up with water, wherever there is water of dubious quality there will be risks of introducing water borne disease to babies, who are otherwise not directly ingesting water. So in places with poor hygiene and poor water supply, which is often the case in the hospitals and living areas of developing countries, there can be major health risks with the use of milk substitutes.

Dr Raj Anand, in New Internationalist (1) states that there is a 14 times higher chance of babies dying from diarrhoea when on milk substitutes, over those fed on breast milk.

Another part of the WHO code is that in non-English speaking countries, labels noting the use of the product and whether it is useable as a milk substitute or just a supplement (that breast milk must be given as well), must be in the local language. In India, where the government has legislated that product must display a notice in English and Hindi to the effect that "breastmilk is best.", Dr Anand cites an example of a tin of lactogen with no Hindi notice. (1)
Where women aren't able to understand the information about the use of the product, they can make a decision that could be disastrous for their child.

WHO and UNESCO recommend that babies be exclusively breastfed for the first four months and up to 6 months if possible. They state that the most common reason for women to stop breastfeeding early is because they think they do not produce enough milk, or that it is of poor quality. (2) In most cases neither of these is true. One can imagine that where the mother has been an essential contributor to the family income (the case in many communities in both industrialised and developing countries), the sooner she can get back to work, the better. So to bundle the baby up with one of the younger family members, and a bottle, means she can be at work earlier, and can work longer without interruption. (I certainly don't countenance this but it is often a fact of life).

Women may see the use of these products as a very convenient way of coping with a new child, and the possible loss of a job. The World Alliance for Breastfeeding has produced a document on the problems for working women with infants, including comment on the right to breastfeed in public places. (3)
Once the mother uses less breast milk, the breast produces less, and can completely stop production quite quickly, if the milk is not used. So a mother who uses a milk substitute regularly runs the risk of not being able to return to using her own milk.

The WHO International Code on Marketing of Breast Milk Substitutes (4) was introduced because hospitals and health care workers (especially those in developing countries) were receiving free samples, and subsidised product, as well as free gifts and other incentives, which could easily predispose them to advocating breastmilk substitutes where breastmilk itself would be a much better and healthier choice. Health workers would have a much easier time if they were able to put babies on breastmilk substitutes while in hospitals, with little cost to the hospital. Of course, when the mother and child left hospital, they would no longer have access to free or cheap product, and would have to start purchasing it, because the mother's milk would have stopped.

"The concern now strongly felt by many, including Save the Children and UNICEF, is that the babymilk manufacturers are behaving in ways which undermine the consensus and circumvent and violate the Code despite public claims to the contrary. Their interests are clear, however, as the global babyfoods market is enormous and growing."
Mike Aaronson, Director-General of Save the Children UK to New Internationalist. (5)

Full article

Latest

Nestle is reported to have indulged in violations of the Code in Pakistan, by a former employee. Nestle counter that he is trying to blackmail them

BMJ 1998 Editorial

BMJ 1998 Article

British Medical Journal

- The British Medical Journal, April 11 1998 has an editorial and a full article on reported violations of the code by baby milk manufacturers, showing that such violations are still occurring in certain countries. The study looks at one city in Poland, Thailand, Bangladesh and South Africa. The report seems to vindicate a report in late 1996 by the International Baby Food Action Network, whcih was condemned by the Baby Milk Manufacturers Association.

BMJ Feb 1999

The British Medical Journal continues to report on alleged evidence of WHO Code breeches.

In Feb 1999 it reports that a former Nestle employee released documents allegedly showing more breeches.

BMJ ASA

BMA - Sponsorship

A further article in September 1999 discusses the ethicla dillema for the Royal College of Paediatrics and Child Health in its continuing acceptance of Nestle sponsorship, which it chose to not disclose.

Interesting responses can be found at the end of all of these articles.

If you are interested in breastfeeding issues, the following site has many articles, including some that look at the complex issue that arises for mothers with HIV and the opportunities this gives for the suppliers of milk formula.

Breastfeeding site

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