Nearly 40 years after Nestlé found itself in the centre of a controversy over the marketing of infant formula milk to mothers in the developing world, the food and pharmaceutical industry is again locked in a public relations battle with campaigners opposed to the promotion of breast milk substitutes.
Doctors in Australia have called on the government to ban the advertising of baby formula milk after the country's health ministry scrapped an independent panel that oversaw the marketing practices of firms that produce it.
Susan Moloney, president of the paediatric and child-health division of the Royal Australasian College of Physicians, told the Sydney Morning Herald in March the ban should cover marketing practices like free sampling, gifts to health workers, and in-store promotion of formula milk for babies less than a year old.
"We're very concerned that if there's no independent oversight, then we need legislation to block advertising of infant formula," she said.
If implemented, the ban would meet the World Health Organisation (WHO) international code of marketing of breast milk substitutes, which calls for a worldwide ban on advertising baby formula milk. It was endorsed by 118 countries in 1981 following a worldwide campaign against formula milk marketing sparked by a stinging news feature report in the British press accusing Nestlé of endandering the lives of newborns in developing countries by encouraging mothers to feed them formula milk.
But there are those who are wary of such a move. "Any ban on the marketing of a legitimate product will set a bad precedent for freedom of ethical information distribution, especially one widely recognised by doctors as an alternative to breast milk," said Clara Shek, Managing Director, Ogilvy PR Hong Kong told PRWeek.
According to the Australian Breastfeeding Association (ABA), only 39 per cent of Australian babies were exclusively breastfed up to three months and breastfeeding rates in the country were falling below the national health recommendations. "It's not about saying no to formula, but giving parents information without subjecting them to marketing hype," says ABA chief executive Rachel Fuller.
Campaigners on the offensive
Shek believes the the proposed action is prompted by ‘fear’. "Many research studies have shown mothers are well aware of the benefits of breastfeeding, but still choose not to do so. Would additional knowledge of infant formula advertising sway them further? Or, are there deeper reasons behind the drop in breastfeeding rates?" she asks. Indeed, breastfeeding rates are also linked to factors such as working conditions, maternity leave, lactation deficiency, infant care support, and education. But that has not stopped civil society activists from relaunching an offensive on formula milk producers. Save the Children has called on manufacturers like Danone and Nestlé to do more to promote breast-feeding after a report it released in 2013 accused them of breaking the international code. The UK-based charity said its research showed evidence of infant formula companies targeting maternal health workers in places like China and Pakistan and also demanded larger warnings on product labels.
"The findings suggest that the code is being violated in significant ways by companies in Pakistan, which try to influence mothers through interpersonal communication, advertisements and endorsement by health professionals," said the report, Super Food for Babies.
The International Baby Food Action Network (IBFAN), a coalition of 270 civil society organisations has accused firms of targeting mothers through "mother and baby clubs", making health and nutrition claims for formula, sponsoring health conferences and playing on the psychology of parents by promoting milk brands as 'growth' or 'brain development' essentials.
It has released a 237-page report listing specific code violations by individual formula milk manufacturers. This includes the use of mobile apps as tools for direct marketing; playing up attributes such as ‘intelligence’, ‘growth’ and ‘health’ and product benefits; and distribution of milk samples, gifts and promotional material to medical staff. The report, Breaking the Rules, Stretching the Rules 2014, says baby milk companies are targeting China's lucrative $12.4 billion infant formula market which is expected to double in the next three years.
Infant formula is an engineered food designed to mimic human milk. The industry itself is not easy to define. It is a mix of food and pharmaceuticals. This is evident when one looks at the players. The sector has historically been dominated by the likes of food majors such as Nestlé and Danone, as well as pharmaceutical companies like Abbott, Bristol Myers Squibb and Glaxo Smith Kline.
The industry is going through a phase of consolidation with large multinationals merging with smaller local players. Recent major deals include Nestlé buying Pfizer's infant nutrition unit for $11.9 billion in 2012 (Pfizer having itself bought Wyeth) and Danone buying Numico for $17.3 billion in 2007.
The exception is China, where the market is fragmented with a large number of local players. In December last year, China's food and drug watchdog launched revised regulations aimed at holding local infant formula producers to a higher standard. This follows a sharp rise in the demand for international formula milk brands.
The new rules raise requirements for infant formula producers in nine specific areas, including product safety control, formula product inspection, manufacturing process and product recall. Under new regulations, infant formula producers must register product formula, packages and labels with provincial food and drug administrations.
Authorities have been striving to restore consumer confidence in Chinese dairy products, the reputation of which was undermined by the melamine milk scandal in 2008, which caused the deaths of at least six babies and left another 300,000 ill.
The IBFAN report is an attempt to 'name and shame' companies that violate the international code. It alludes to a scandal that broke out in China in September 2013 in which Dumex was accused of paying 'bribes' to over 116 doctors and nurses in 85 medical institutions in return for preventing babies from being breastfed. The exposé, which was carried out by the state-run CCTV was a PR disaster for Danone.
Bribery and lobbying
At an estimated $400 million, India's baby food market is a fraction of China's, but it is growing rapidly and expected to hit $700 million by 2015. With 25 million babies born each year, India has become the fastest growing infant nutrition market in the world.
Manufacturers there have also come under fire for alleged code violation. In January 2014, Dairy Reporter broke a story that accused Danone-acquired Nutricia of bribing doctors across the country. "E-marketing websites are increasingly becoming the latest tool for aggressive promotion," observed the Breastfeeding Protection Network of India’s (BPNI) in a 2013 newsletter.
Some of the most intense public relation battles between campaigners and baby food makers have taken place in the Philippines where regulation require manufacturers to put bold labels on milk brands that clearly state the protective effects of breastfeeding. In 2012 the Philippine Department of Trade and Industry urged members of Congress to pass a draft bill that was aimed at relaxing these rules. Campaigners claimed this was done at the behest of the industry.
Nestlé has borne the brunt of their criticism. It accounts for 28 per cent of the global infant formula market that is worth about $58 billion. As industry leader, it is often a target for censure. "Not for nothing is Nestlé one of the four most boycotted companies on the planet," said Baby Milk Action's campaign coordinator, Mike Brady. Nestlé now employs a team of communications experts to monitor allegations of code violations and consumer complaints in the press and social media.
All global milk food brands claim they abide by the WHO code, which advocates exclusive breastfeeding for babies under six months. Nestlé, for instance, lists in detail the steps it takes to ensure its marketing practices are in compliance and regularly invites NGOs and child health campaigners for dialogue.
An industry source told PRWeek that Nestlé does not permit its marketing agencies to show infants or mothers in its promotion materials. Firms like Danone, Friesland and Abbott sponsor 'nutrition' programmes for mothers and health workers where breast-feeding is promoted.
These MNCs present themselves as 'partners' supporting national health programmes, not the 'profiteers' campaigners often portray them as. Infant formula, they say, is a vital substitute to ensure the healthy development and growth of a child who, for medical or other reasons, is unable to be breastfed.
Abbott has developed a business code in over 36 languages and all its employees are trained to abide by it. These include rules on communication practices for sales staff when promoting products to healthcare professionals. The firm says it audits its marketing and sales practices to ensure compliance with the WHO code.
Caught in the crossfire
There are no clear winners in this PR battle, although milk food companies have had to fight on the defensive. According to the WHO, only 37 countries have passed laws reflecting all the recommendations of the code. It has found that only 38 per cent of babies around the world are exclusively breastfed.
The issue is hotly debated because it concerns child health. In the developing world, where infant mortality rates are high, mothers often have to be educated about how to feed their babies. This is where baby food companies and their critics come into conflict. While the former claims mothers have the right to make informed choices, the latter argues product marketing is misleading.
Governments are often caught in the middle. They have to strike a balance between protecting freedom of choice and improving infant healthcare.