Republican News · Thursday 23 January 2003

Corporations exacerbate child mortality in Africa

When it comes to deciding between people's welfare and benefits, there is only one choice for corporation CEOs: money. That is one of the conclusions that can be drawn from a report published by science magazine the British Medical Journal, which has found that some corporations - Danone and Nestlé among them - have not complied with the International Code of Marketing of Breastmilk Substitutes in West Africa. They are still promoting their substitute products while failing to inform of the advantages of breastfeeding.

This is the second big scandal involving Nestlé in the last month, as during the Christmas period it became known that the food corporation was pressuring famine-stricken Somalia to repay a 30-year-old debt. International public opinion forced the company to backtrack.

This latest report found that 40 commercial breast milk substitutes violated the labelling standards of the Code of Marketing of Breastmilk Substitutes: 21 were manufactured by Danone, 11 by Nestlé, and eight by other national and international manufacturers.

In 1981, the World Health Assembly adopted the International Code of Marketing of Breastmilk Substitutes as a minimum international standard to ensure the proper use of these products. The code is based on adequate information and appropriate marketing and distribution practices. By 1996, all 181 member states had affirmed their support to the adoption of national legislation or other suitable measures to give effect to the principles of the code.

The Code states that manufacturers should not use healthcare systems to provide mothers with free samples of their products, to disseminate promotional materials containing incomplete and biased information, or to promote the use of breastmilk substitutes among health professionals and mothers of young infants. Manufacturers must not use distribution points to promote their products. They must stop using the news media to idealise the use of breastmilk substitutes. Lastly, they must label their products according to the directives of the code.

The study in the British Medical Journal found that manufacturers of breastmilk substitutes are using national healthcare systems in Togo and Burkina Faso to promote their products and to distribute free samples to mothers (violation of article 6.7). Health systems are also being used to distribute free samples to health providers for purposes other than professional research or evaluation (violation of article 7.4) and to distribute material inducements to promote products within the scope of the code (violation of article 7.3). The presence of such promotional gifts in the professional environment, observed in audits endorsed by breastmilk manufacturers themselves, conveys a message of health providers' endorsement of breastmilk substitutes.

The report detailed promotional materials for pregnant women and mothers that idealise the use of breastmilk substitutes. There was no clear information on the superiority of breast feeding, the negative effects on breastfeeding of introducing breast milk substitutes, or the difficulty of reversing the decision not to breastfeed (violations of articles 4.2 and 4.3) further showing that manufacturers are using national healthcare systems to market their products.

The report states that the situation requires urgent policy action to ensure that families are provided with objective and consistent information on child feeding (article 4.1) at a time when appropriate counselling can make the difference between life and death. Data show that infant mortality in Togo and Burkina Faso is among the highest in the world and that a considerable proportion of those infant deaths is attributable to sub optimal breastfeeding.

Every year, sub optimal breastfeeding is the underlying cause of an estimated 3,300 infant deaths in Togo (25% of all cause infant mortality) and over 6,200 infant deaths in Burkina Faso (11% of all cause infant mortality).

It is also relevant to point out that one of the main causes of child mortality in Africa is water borne disease. The use of breastmilk substitutes increases this risk, as often polluted water is used for the mix or utensils used are not properly sterilised before use.