Case Study - Nestl - Public controversy over the marketing of breast-milk substitutes

The debate over the marketing of breast-milk substitute in developing countries entered the public sphere in 1973 with the publication of The Baby Food Tragedy an interview with two child nutrition experts by The New Internationalist. However, the controversy did not boil over until the publication in 1974 of a pamphlet, The Baby Killer, by the British organisation War on Want. This pamphlet was widely distributed and translated. In particular, a German left-wing student organisation, Arbeitsgruppe Dritte Welt (Third World Working Group), published the same year a translated and altered version under the name Nestl ttet Babies (Nestl kills babies). Nestl sued the organisation for libel. Although it won the court case in 1976, the publicity around it contributed to making the pamphlet known in the United States and elsewhere. At the same time, Nestl continued to review its marketing practices in developing countries. In 1974 and 1975, Nestl revised the contents of its educational and informational materials to strengthen the emphasis on the importance of breastfeeding and to remove advertising or promotional material. By 1976, Nestl was phasing out infant formula mass media advertising, and by 1978, this was withdrawn in all developing countries. In addition, the International Council of Infant Food Industries (ICIFI) was created by Nestl and seven other infant formula manufacturers in 1975. A code of ethics was adopted to guide companies marketing and advertising practices. However, scientific evidence was pointing out to a more complex issue. Dana Raphael, Director of the Human Lactation Center of Connecticut, was one of the first scientists to hold infant formula manufacturers responsible for high infant mortality rates in developing countries. Yet, in 1976 after a two-year study which observed how infants were fed in 11 different cultural settings around the world, she found that in the cultures studied a decline in breastfeeding was not a major part of the problem. In some, breastfeeding was still universally practiced. Most importantly, the study showed that mixed feeding was common: infants were breastfed but were also given other, and inappropriate, foods from a very early age. A WHO/UNICEF two-year Collaborative Study on Breastfeeding revealed the same patterns in 1979. The Nestl Boycott On 4 July 1977, the newly formed Infant Formula Action Coalition (INFACT) started a consumer boycott against Nestl and demanded the end of infant formula promotion. They also lobbied U.S. Senator Edward Kennedy, chair of the Subcommittee on Health and Scientific Research of the Committee of Human Resources, to hold Public Hearings on the infant formula issue. The Public Hearings took place in May 1978. In July, Kennedy met with representatives from the industry, including Nestl, to determine what to do next. At the request of the Infant Council of Infant Food Industries, and with a support letter from Nestl, Kennedy asked the director general of the World Health Organisation (WHO) to sponsor an international conference to discuss the issue and come up with an international recommendation for marketing infant formula in developing countries. In 1979, Nestl developed internal guidelines limiting advertising and sales promotions, curbing free samples and supplies, spelling out the content of informational materials and ending all financial incentives for health professionals to sell

formula. In the same year, WHO and UNICEF held a meeting on Infant and Young Child Feeding. The International Code of Marketing on Breast-milk Substitutes In May 1981, the World Health Assembly (WHA) adopted the International Code of Marketing of Breast-milk Substitutes. Nestl announced its unilateral implementation of the WHO Code in developing countries in March 1982. It was the first company to implement the Code across its entire operations in developing countries, through the Nestl Instructions on the implementation of the WHO International Code of Marketing of Breast-milk Substitutes. In May, an independent audit commission, the Nestl Infant Formula Audit Commission (or Muskie Commission because it was chaired by former Secretary of State Senator Edmund Muskie) was charged by Nestl with the responsibility for ensuring compliance by the companys field offices with code provisions and the companys own instructions. By October 1982, consultations with the Muskie Commission led to a thorough revision of Nestl Instructions. That year, the Methodist Church voted against joining the Boycott and The Washington Post withdrew its editorial support for the Boycott. In January 1983, the American Federation of Teachers withdrew its support for the Boycott. Support for the Boycott waned quickly in the course of 1983. In 1984, following talks between the WHO, UNICEF, Nestl and Muskie Commission, the activist groups end the boycott. However, at the end of 1988 two new activist organizations, Action for Corporate Accountability (ACA) in the U.S. and Baby Milk Action (BMA) in the U.K., re-launched the Nestl Boycott. One issue remained for these activist groups: infants who have to be fed on breast-milk substitutes and for whom free supplies were permitted by the Code. The boycott received very limited attention in the U.S. and disappeared in 1990. In the U.K., the boycott continued with the backing of the Church of England. Latest developments By 1989, Nestl had published a Plan of Action for Infant and Young Child Feeding where it committed to end all free and low priced supplies of infant formula in developing countries except for the limited number of infants who need it. In 1994, activists published a report entitled Breaking the Rules on alleged violations of the WHO Code by manufacturers. Nestl investigates and responds to each allegation. In the same year, the Church of England suspends its support to the boycott. In 1996, Nestl stopped providing health care facilities with free supply of infant formula in most parts of the world. In 2001, the World Health Assembly adopted resolution 54.2, which states that exclusive breastfeeding should be recommended for the first 6 months of life. Nestl has unilaterally taken the decision to market infant cereals in developing countries from 6 months of age. In 2004, Nestl refined its internal Nestl Instructions and developed and implemented a global management system to ensure compliance with the WHO Code across all Nestls operations. This includes Nestl Policy and Instructions, Nestl WHO Code Management System, an Internal Ombudsman procedure as well as internal and external audits.