The infant formula industry uses guerrilla tactics …

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Without meaningful and targeted interventions to protect, promote and support breastfeeding, many countries, especially in Africa, are on the path of decreasing breastfeeding with increasing levels of malnutrition, more pronounced childhood obesity and its health problems associated with noncommunicable diseases.

Chantell Witten

Chantell Witten is a lecturer at Free State University and is President of the Child Health Priorities Association and South African Civil Society Nutrition Officer for Women’s, Adolescent and Children’s Health (SACSoWACH).

Despite numerous policies, interventions and efforts to promote breastfeeding uptake, South Africa, like many other countries, falls short of the global target of 50% exclusively infants under six months of age. breastfed. The opposition to breast milk is infant formula, and when mothers cannot afford enough infant formula, other fluids that substitute and substitute for breast milk are sugar water, sweet teas, and cereals. for diluted bottle-fed infants.

Considering the widely known benefits of breast milk, why is formula feeding so desired?

One can look to the glamorous and attractive infant formula advertisements of beautiful bouncy babies with big eyes and happy mothers. Then there are the smart, scientific-looking medical professionals who endorse this “clinically approved infant formula” for children or maybe the appeal is in the status that infant feeding signals. All of these above-the-line marketing strategies are in play.

But there are other, more devious ways that infant formula manufacturers are using to secure their long-term market base.

The first misrepresentation is that infant formula is like breast milk. As a society, we have to accept that selling more infant formula means less breastfeeding. And less breastfeeding means more poor health, in all settings, in developed and developing countries. Without meaningful and targeted interventions to protect, promote and support breastfeeding, many countries, especially in Africa, are on the path of decreasing breastfeeding with increasing levels of malnutrition, more pronounced childhood obesity and its health problems associated with noncommunicable diseases.

The infant formula industry has affected low and middle income countries to expand the market.

In South Africa, one in four infants under six months of age have never received breast milk (25%), while one in three receives exclusively breast milk (32%), most of the 43% is mixed-fed, receiving breast milk and other foods, mainly infant formula. This means that 68% of infants under six months of age, who should only be given breast milk as recommended by the national health ministry and global health organizations, receive sub-optimal infant nutrition.

While many health researchers have focused on the obstacles and challenges facing breastfeeding mothers, the true depth and hold of power of the infant formula industry needs to be analyzed from a strategic marketing perspective.

It’s a war to destroy breastfeeding.

The formulas industry is dominated by a small number of extremely powerful multinational companies with the resources to deploy the best global marketing expertise. Like all businesses, the infant formula industry is governed by the fiduciary imperative to seek profits above all other concerns, including the health of children. This mix of fiscal power, sophisticated marketing and determination is causing serious damage to public health, children’s nutrition, and the future health of adults.

The manufacturers of infant formula have positioned themselves as credible and useful partners in infant feeding that many mothers have turned to in times of breastfeeding difficulties. The website of one of the companies with the largest market share in South Africa says “your trusted partner, guiding you and your baby through your journey of the critical first 1,000 days, from design on your baby’s second birthday. We look forward to sharing this exciting journey with you.

You would be forgiven for viewing him as a trusted healthcare professional interested in the well-being of your child. It’s easy to forget that this is a business primarily interested in making a profit.

So how has the infant formula industry become so personalized and trustworthy?

It has relied and still relies on people of influence, especially health professionals. For starters, infant formula manufacturers only distributed infant formula through doctors. Later, infant formula became part of the health system when mothers and babies were separated and babies were cared for by a nurse in a nursery who fed the babies formula.

Baby-Friendly Hospital Initiative

This became the norm until 1991, when the World Health Organization and Unicef ​​launched the Baby-Friendly Hospital Initiative (IFHB) to protect and support breastfeeding. The “10 BFHI Steps” included initiating breastfeeding within one hour of birth, not having prelactated feeding to interrupt breastfeeding, babies living together with their mothers, and banning infant formula. unless clinically indicated.

South Africa opened its first BFHI accredited hospital in 1994. Mowbray Maternity Hospital in Cape Town has retained its BFHI status and to date over 80% of all public health facilities with maternity services apply. the BFHI principles.

Why is it that despite this enormous effort, South Africa still struggles with low breastfeeding rates?

In 2012, South Africa published Infant and Young Child Feeding Regulations, R991 which prohibit the advertising and promotion of infant formula in any form and on all media platforms. But since then, infant formula companies have embarked on different strategies to promote and market their product.

Under the pretext of promoting and supporting optimal infant feeding, this includes the sponsorship of educational opportunities such as continuing professional development activities for health and paramedical professionals, sponsorship of specifically related conferences and symposia. infant and young child nutrition, funding students and researchers through industry. affiliated entities like the Nestlé Nutrition Institute Africa and sponsorship of lecturer positions to specifically teach infant and child nutrition.

Without proper monitoring and reporting, infant formula manufacturers continue to push the boundaries and test the strength of R991. The most recent Mom and child events funded by Nestlé are just a few of the many violations committed by the infant formula company. Nestlé’s Baby & Me website and its “Start Strong, Stay Strong” program continue to provide parents with information on feeding infants and children who violate R991.

In 2018, Nestlé South Africa commemorated World Breastfeeding Week by installing a branded breastfeeding station at Baragwanath Taxi Rank in Soweto. While many breastfeeding women praised the safe space offered by the breastfeeding station, they also expected to receive free products. After complaints from civil society, the provincial health ministry quickly shut down the breastfeeding station in violation of R991.

In 2017, Nestlé offered to sponsor the Preemie & Me conference, dedicated to the care of premature babies. The organizers, ignoring the conflict of interest and the provisions of R991, initially accepted Nestlé funding but had to decline after prominent guest speakers Dr Nils. Bergman and Dr Jack Newman have threatened to step down after Nestlé “accidentally” aired a Nestlé-branded program bearing the names of the guest speakers. This caused a great deal of consternation and anger among the speakers and the wider children’s health fraternity. Nestlé offered no apologies to the conference organizers or speakers.

Nestlé has not only funded a number of leading South African academics, researchers and professional associations, but now a leading South African scholar sits on Nestlé’s board of directors. Surely this signals a serious conflict of interest for the director and chairman of the Alliance of African Universities Research Center of Excellence on Sustainable Food Systems at the University of Pretoria?

This “sorry, not sorry” modus operandi is a registered trademark of Nestlé. After 40 years of International Code of Marketing of Breastmilk Substitutes and nearly 10 years of South Africa’s R991 regulation, it is fortunate that the food justice fraternity in South Africa has adopted R991 and recently successfully challenged Nestlé to disengage from the infant nutrition space.

But more needs to be done.

If the national health ministry is to assert that South Africa is a breastfeeding country with zero tolerance for R991 violations, then the ministry should seriously consider strategic litigation. Following the precedent of the Health promotion tax on sugary drinks (known as the ‘sugar tax’), based on the astronomical cost of infant morbidity and mortality due to inappropriate infant feeding practices, South Africa should seriously consider a tax on infant formulas. In doing so, South Africa would send a strong message to the infant formula industry that children’s lives are more important than profits and that children deserve the protection afforded them in our Bill of Rights and Constitution. . SM / MC


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