Full Breaking the Rules, Stretching the Rules 2004 report

AfricaIBFAN Africa and national monitors from:Ghana, Kenya, Malawi, South Africa, Tanzania,and Zimbabwe.

AsiaWHO Collaborating Center for Child Health(China); BFHI Hong Kong Association; BK.PP-ASI / YASIA (Indonesia); Breastfeeding SupportNetwork of Japan; JIMFACT (Japan); PersatuanPenggalak Penyusuan Susu Ibu Malaysia; PerakConsumers Association (Malaysia); ThaiBreastfeeding Alliance (Thailand).

Middle-EastBreastfeeding Friends (United Arab Emirates).

CaribbeanThe Informative Breastfeeding Service (Trinidadand Tobago), Fundashon Lechi Mama Kòrsou(Curaçao, Netherlands Antilles).

EuropeIBFAN Europe and the following nationalgroups: “Confidence” Health (Armenia);Breastfeeding Advancement Group (Bosniaand Herzegovina); Women and Mothers againstViolence (Bulgaria); Imetystuki ry (Finland);Claritas (Georgia); Aktionsgruppe Baby-nahrung (Germany); Geneva Infant FeedingAssociation (Switzerland); Italian CodeMonitoring Coalition (Italy); LKEVAB(Latvia); Lithuanian Breastfeeding SupportSociety; Initiativ Liewensufank (Luxembourg);Center for Family, Motherhood & ChildhoodSupport (Macedonia); Stichting Baby Voeding(Netherlands); Center for Children Care (Serbiaand Montenegro); Baby Feeding Law Group(United Kingdom).

Latin AmericaIBFAN Latin America and national IBFANgroups from Argentina; Colombia, CostaRica; Dominican Republic; Mexico, Peru andUruguay.

ICDC is also grateful to its donors and to theUNICEF offices which facilitated national trainingand monitoring surveys.

The editors would like to thank the countlessindependent monitors from 69 countries whoreported more than 3,000 Code violations toICDC during the monitoring period.

ACKNOWLEDGEMENTS

International Baby Food Action Network

Breaking the Rules

2004Stretching the Rules

Evidence of Violations ofthe International Code of Marketing

of Breastmilk Substitutes andsubsequent Resolutions

Breaking the Rules, Stretching the Rules 2004Breaking the Rules, Stretching the Rules 2004Breaking the Rules, Stretching the Rules 2004Breaking the Rules, Stretching the Rules 2004Breaking the Rules, Stretching the Rules 2004Evidence of Violations of the InternationalCode of Marketing of Breastmilk Substitutesand subsequent Resolutions.

The report was compiled and edited by Yeong Joo Kean andAnnelies Allain of the International Code Documentation Centre(ICDC) with contributions from Karyn Chua, Raja Abdul Razak,Jean Pierre Allain, Tracey Wagner-Rizvi, Sita LetchmiSinnathamby and R. Komala.

Breaking the Rules 2004 is based on results of worldwidecontinuous monitoring between January 2002 to April 2004,using the Standard IBFAN Monitoring tool, SIM.

The SIM database collection centres were managed by LauraArcara, Dr. Fernando Vallone, Shanti Kelly and Raja Abdul Razak.IBFAN/ICDC also acknowledges contributions from Lida Lhotska,Mike Brady and HHT Tarimo.

© ICDC May 2004

Any part of this publication may be reproducedprovided it is not taken out of context andthe source is fully acknowledged.

ISBN 983-9075-10-1

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IBFAN S/BPO Box 19, 10700 Penang, MalaysiaTel: +60 4 890 5799Fax: +60 4 890 7291Email: [email protected]

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Executive Summary. .............................................................................4Introduction. .........................................................................................6International Code Summary. ............................................................8

Code violations by baby food company(in alphabetical order)

Abbott-Ross ............................................................................................10Danone ....................................................................................................16Dumex ....................................................................................................18Friesland .................................................................................................22Gerber .....................................................................................................25Heinz.......................................................................................................28Hipp ........................................................................................................31Humana...................................................................................................35Mead Johnson .........................................................................................37Meiji .......................................................................................................44Milupa ....................................................................................................47Morinaga ................................................................................................51Nestlé ......................................................................................................53Nutricia ...................................................................................................68Snow .......................................................................................................75Wyeth ......................................................................................................77

Summary of violations by bottle and teat companies ............................84

Stretching the Rules ...............................................................................89

Contents

Breaking the Rules, Stretching the Rules 20044

very three years, IBFAN publishes a report on compliance with theInternational Code of Marketing of Breastmilk Substitutes and relevant World

Executive Summary

Health Assembly Resolutions. The 2004 report, “Breaking the Rules – Stretchingthe Rules”, is organised by company in alphabetical order and follows differentCode themes within the write-up of each company. This summary highlights themarketing trends over the past three or four years.

Health facilities still come out to be the preferred avenue for companies toreach mothers. This is especially so in countries which have not implementedthe Code or where measures are inadequate. Countries with strong measureswhich are properly enforced are better at keeping company promotion out ofhealth facilities. The scourge of supplies (donations of formula) and samplesremain a major problem area with companies competing to receive equal andsometimes exclusive treatment by hospitals. Distribution and display ofcompany materials is widespread and as in the case of supplies and samples,these are more prevalent in countries where purchasing power is high likeUAE, Singapore and Hong Kong.

Closely intertwined with promotion in health facilities is the pursuit of healthprofessionals by companies. One country – Thailand – sticks out withcompanies vying to entice doctors and nurses with innovative gifts in varietiesand numbers not seen elsewhere. Mothers too are deluged with gifts duringtheir stay in hospital and when they return for check-ups. This happens becausethe voluntary code in Thailand has expired and with no other instrument inplace to provide a level playing field, companies compete ruthlessly to expandtheir market share. All of this comes at a price to the health care system, not tomention the health of infants.

The problem of promotion in health facilities is compounded by the factthat the Code is weak in certain areas. Companies exploit these weaknessesby pushing at the boundaries of what is allowed. One striking example isinformational materials for health professionals. Since information to mothersis restricted, companies adeptly mark materials as ‘information for healthprofessionals’, list the required statements and warnings in small print whilethe text is addressed to mothers. Such attractive company materials are oftensupplied in bulk to health facilities, testimony to the fact that mothers areintended as the captive audience. One company, Nestlé, even states on itsmaterials that the item is intended for health professionals for distribution tomothers!

Claims which ride on “closeness to breastmilk” abound in advertisements,leaflets and the so-called scientific and factual information for healthprofessionals. The one dominant theme over this period was the emphasison fatty acids such as DHA/ARA, naturally found in breastmilk, butimitated (derived from fungi, algae or fish oil) and added to formula topurportedly make babies smarter. Eleven out of the 16 international companiesincluded in this report jumped on the bandwagon of selling ‘intelligencein a bottle’. All are cashing in on the emotional desires of parents to havesmart children.

E

The Strategy pinpoints themain problems affectinginfant and young childfeeding and identifies imple-mentation and monitoring ofthe International Code andsubsequent resolutions as akey area requiring action.

“Manufacturers and distribu-tors of industrially processedfoods for infants and youngchildren... should ensurethat... (these products) meetapplicable Codex Alimentariusstandards... They should(also) ensure that theirconduct at every level con-forms to the Code, subse-quent relevant Health Assem-bly resolutions, and nationalmeasures that have beenadopted to give effect toboth.”

“Virtually all motherscan breastfeed pro-vided they haveaccurate information,and support withintheir families andcommunities andfrom the health caresystem”

Dr. Lee Jong-WookDirector General of WHO in hiscall on governments to promote,

protect and support breastfeedingat the launch of the Global

Strategy on Infant and YoungChild Feeding

23 March 2004

Article 44 of the Global Strategysets out the responsibility ofcompanies:

5IBFAN -- International Baby Food Action Network

In many parts of the world, parents are willing to pay extra for the IQ promise. Itis estimated that infant formula supplemented with fatty acids cost parents anadditional US$200 a year as these products are priced 15 to 30% more thanstandard formula. There are no independent long term studies to substantiate thebenefits of added DHA/ARA to formula. Only recently have regulating agenciesstarted to act. In April 2004, Canada’s Food Inspection Agency ordered MeadJohnson to stop claims about the effect of DHA & ARA in its Enfamil products.It is expected that other governments will take similar action. Apart from theIQ springboard, companies also harp on how other added ingredients bring aproduct ‘closer to breastmilk’ and boost baby’s immunity to disease, promotehealthy growth, etc. All these misleading claims are promotional in nature andprohibited by the Code.

The issues of conflicts of interest and medical ethics come to head whendoctors, nurses, midwives and their professional associations receivehandouts ranging from gifts of little consequence to big grants from industry.The impact on professional integrity is far-reaching. Monitoring reveals anincreasing number of health professionals becoming addicted to companydonations and sponsorship. China with its 19 million new babies annuallywill be the next unsuspecting target of companies in this respect. The fact thatthe country has more than half of the world’s Baby Friendly health facilitieswill have little meaning unless the national law based on the Code is properlyimplemented and enforced.

Although prevalent, Internet advertising did not out-strip other forms ofpromotion as was initially feared. In a positive development, some companieshave actually removed blatantly promotional content from their web-site, andothers have restricted their web-pages to health professionals.

Where labelling is concerned, long and tough battles will need to be waged atthe Codex Alimentarius Commission before health, functional and nutritionclaims which idealise products become things of the past. Several forcedrecalls of products contaminated with the deadly Enterobacter sakazakii,indicate the need for labels to warn that no formula is sterile. Labelling sawgreater compliance when Nestlé took a long awaited lead in labelling itscomplementary foods from “six months”; implementing the globalrecommendation for six months exclusive breastfeeding. The company, however,needs to prove its sincerity in upholding the WHO recommendation by applyingit to all countries and by keeping its Blue Bear complementary food mascot out ofhealth facilities.

Other companies, meanwhile, behave as if the several World Health AssemblyResolutions on “six months” do not exist. This ‘head in the sand’ approachgenerally applies to the interpretation of the scope of the Code with manycompanies sticking to the indefensible stand that the Code applies only toinfant formula, not to “other products which are marketed or represented asbreastmilk substitutes”. This narrow interpretation accounts for a sizeable chunkof violations reported.

Feeding bottles and teats. Unlike the past reports, Breaking the Rules 2004gives only illustrations of violations involving feeding bottles and teats anddoes not give a company by company account. This in no way deflects fromthe severity of the violations by manufacturers of feeding bottles and teats. Atable summarises the performance of 14 major companies vis-à-vis the relevantCode provisions.

The final “Stretching the Rules” section features some practices which discouragebreastfeeding but do not directly violate the Code. Mostly, these practices involve‘formula for mothers’ or ‘growing-up milks’.

How does DHA- ARAget into formula?

“Infant formula is currentlya commodity market, withall products being almostidentical and marketerscompeting intensely todifferentiate their products.Even if Formulaid (theblend of fatty acids, DHA-ARA) has NO benefit, wethink it would be widelyincorporated into formula,as a marketing tool and toallow companies to promotetheir formula as ‘closest tohuman milk’.”

Note: The company which wrotethe above in early 2002 is Martek,the main supplier of oils and otheradditives to most formula makers.Martek’s sales went up 183% in 9months. It took independent re-searchers 2 more years to establishthat the added fatty acids have nodefinite benefits.


Introductionreaking the Rules, Stretching the Rules 2004 is based on evidence collectedbetween Jan 2002 to April 2004. The ‘Rules’ are the benchmark standard

“Those who makeclaims about infantformula that inten-tionally underminewomen’s confidencein breastfeeding, arenot to be regarded asclever entrepreneursjust doing their job,but as human rightsviolators of the worstkind.”

Stephen LewisDeputy Executive Director

UNICEFApril 1999

provisions of the International Code of Marketing of Breastmilk Substitutes andrelated World Health Assembly resolutions.

Contrary to other years, monitoring was not organised by region, nor did it resultfrom a worldwide training of coordinators from selected countries as was thecase in 2001. Breaking the Rules 2004 (BTR) is the first major outcome of SIM,the Standard IBFAN Monitoring tool which aims at popularising monitoring,yet maintaining standard questionnaires so that groups and individuals use thesame protocol to report evidence from wherever they are. Reporting is flexible. Itcan be electronic with digital forms and digital pictures or it can be manual withhandwritten notes and actual specimen. With SIM, everyone can be a monitor.Results were first checked, translated and collated by four collection centres inEurope, Latin America and Asia. They were then merged into one large databaseand underwent thorough legal and factual checking by ICDC, before being sortedby company and by type of violation. In total, more than 3000 reports were receivedfrom 69 countries, some only with very sparse information, others with hundredsof entries each.*

During the period under review, a few countries wanted to do monitoring as anational exercise. Training with SIM was provided by IBFAN-ICDC underthe auspices of national governments and/or UNICEF field offices. Althoughthe results were primarily meant for national reports, they obviously fed easilyinto the BTR collection. This was the case for Indonesia, China and Thailand.(See the separate “Look what they’re doing” reports). IBFAN Latin Americaheld a short training course for volunteer monitors and has published a 20page “Look what they’re doing in Latin America” report in Spanish. IBFANEurope used seed grants to motivate some groups to do monitoring whileIBFAN Africa coordinated its own monitoring. All shared their results forthis worldwide report.

SIM is not designed to obtain statistical information nor is it meant to providefull information on any one company or any one region. In fact, reports covered atotal of 176 companies but many were found to be subsidiaries of transnationalsor local distributors. To provide continuity and the possibility of assessing progress,it was decided to continue in this BTR with the same list of the 16 largest companiesas in previous reports.

The progress in digital technology meant that many monitors were able to send inscanned pictures and digital photographs. There was such a wealth of images thatonly about one third could be reproduced and even then they had to be shrunk tofit. For each violation reported, there are at least ten others that went unnoticed.Private deals, pay-offs and agreements escape the public eye completely. And for

B

* All data were reviewed and double-checked. Entries not sufficiently substantiated by evidencewere rejected. All efforts were made to verify the accuracy of this report but any errors remain theresponsibility of the editors.


each violation reported, one can be sure there are thousands more of the samebecause companies mass-produce their materials and labels. In other words thecontents represent the proverbial ‘tip of the iceberg’.

BACKGROUND

The International Code was adopted in 1981 as a “minimum” standard to helpprotect and promote breastfeeding in all countries. Its preamble explains that“the marketing of breastmilk substitutes requires special treatment which makesusual marketing practices unsuitable for these products”. The Code, summarizedoverleaf, spells out which marketing practices should be discontinued. Since itsadoption, the Code has been re-affirmed by the World Health Assembly (WHA)on at least 15 occasions and new Resolutions with the same legal status as theCode have been adopted to clarify certain provisions and to attempt to keep upwith changing products and practices. One of the aims of Breaking the Rules isto inform the WHA of the status of compliance with its recommendations and ofthe new trends in marketing.

Scientific evidence from hundreds of studies over the past twenty years confirmsthat breastfeeding — and especially exclusive breastfeeding during the first sixmonths — is the optimal way to nourish and nurture infants. Breastmilk containsall the essential nutrients as well as antibodies that counter infection. No infantformula made of cow’s milk, soy or other ingredients can ever equal this naturalway of feeding. Human milk decreases risks for a large number of acute andchronic diseases including diarrhoea and respiratory infection. Breastfeedingprovides all necessary nutrients and liquids for six months, it supplies half thebaby’s nutritional requirements between six and 12 months and up to one thirdbetween 12 and 24 months. Even in the most affluent conditions, where water isclean and mothers are highly educated, an artificially fed infant is more likely tosuffer from respiratory illnesses, gastrointestinal infections, and allergies. Therisk of HIV infection through breastfeeding certainly exists, but it has beenestablished that not breastfeeding can lead to a six-fold increase in infant mortalitydue to infectious diseases.

IBFAN is often asked whether it is not frustrating to do Code monitoring andkeep on finding violations? Yes it is, but without watchdogs the Code would bea mere piece of paper. The network also knows that it does make a difference, abig difference. IBFAN’s evidence is being used by international organisationsand ethical investment companies and manufacturers are increasingly beingchallenged about their social responsibility and observance of human rights. Wherethere are no laws, or where laws are not enforced, independent monitoring is theonly way of putting pressure on companies to behave, the only way of teachingconsumers about new tactics, of informing health professionals about the latestpropaganda. If there were no independent monitoring, companies would not needto look over their shoulders and promotion would be much worse.

In addition to reporting, monitoring also allows action. Over the past year alone,monitoring has led to at least one conviction in court, (Wyeth in the UK was fined£60,000 for illegal advertising) to a change in a big commercial campaign (Gerberin Trinidad and Tobago) and to the suspension of another (Nutricia in China), toa retraction of claims (Mead Johnson in Canada) and to apologies (Mead Johnsonin Malaysia) as well as to revisions in company materials (Nestlé in China andGhana). Each one of these was started by one individual saying: “Hey, this is notright” and, through IBFAN, knowing that she can rely on others for support andhelp to build sufficient pressure for change. Governments as far apart as Brazil,India and Iran have demonstrated that strong laws can change labels, thatadvertising can be stopped and that companies will obey the rule of the land ifthere is political will to enforce it. IBFAN is committed to continue checking whois “Breaking the Rules”.

Children who are notexclusively breastfed for 6months are more at risk forthe following diseases,illnesses, and conditions:

About 40% more likely todevelop type 1 diabetes.About 25% more likely tobecome overweight orobese.About 60% more likely tosuffer from recurrent earinfections.About 30% more likely tosuffer from leukemia.About 100% more likely tosuffer from diarrhoea.About 250% more likely tobe hospitalized for respira-tory infections like asthmaand pneumonia.

These statistics wereremoved from messages andads designed to show therisks of NOT breastfeedingduring the NationalBreastfeeding AwarenessCampaign by the USDepartment of Health.

The percentages and the tworeferences to the risks ofleukemia and diabetes wereremoved, NOT because therewas insufficient scientificevidence but because ofenormous pressure by MeadJohnson and Abbott-Ross, thetwo largest American formulamakers.

It might make mothers feelguilty, said the companies. Ifit is the truth, said healthprofessionals, we cannotwithhold information fromour patients. If we want toencourage people to wearseatbelts, we do also givethem information about whatmight happen if you don’t, sowhy not with breastfeeding.


The Code covers the marketing ofall breastmilk substitutes (Article 2).These include:

infant formula (including so-called‘special’ baby milks such as ‘hypo-allergenic’ formula, preterm milksand others);follow-up milks;complementary foods such ascereals, teas and juices, waterand other baby foods marketedfor use before the baby is sixmonths old.

The Code also covers feedingbottles and teats. (Articles 2, 3 andWHA 54.2 [2001]).

Informational and educationalmaterials dealing with the feedingof infants and intended to reachhealth professionals, pregnantwomen and mothers of infants andyoung children, should include clearinformation on all the followingpoints:a) the benefits and superiority of

breastfeeding;b) maternal nutrition and the

preparation for and maintenanceof breastfeeding;

c) the negative effect on breast-feeding of introducing partialbottle feeding;

There should be no advertising or otherform of promotion to the general publicof products within the scope of theCode. There should be no point-of-saleadvertising, giving of samples or anyother promotional device to inducesales directly to the consumer at theretail level, such as special displays,discount coupons, premiums, specialsales, loss-leaders and tie-in sales.Marketing personnel should not seekdirect or indirect contact with pregnantwomen or with mothers of infants andyoung children (Article 5).

Manufacturers and distributors shouldnot distribute to pregnant women ormothers of infants and young childrenany gifts of articles or utensils, which maypromote the use of breastmilksubstitutes or bottle feeding. No financialor material inducements to promoteproducts within the scope of the Codeshould be offered to health workers ormembers of their families. Financialsupport for professionals working ininfant and young child health should notcreate conflicts of interest (Articles 5.4,7.3, WHA 49.15 [1996]).

Facilities of health care systems shouldnot be used to promote infant formulaor other products within the scope ofthe Code. Nor should they be used forthe display of products, or placards orposters concerning such products, or forthe distribution of material bearing thebrand name of products covered by theCode (Articles 6.2, 6.3, 4.3).

Information provided to healthprofessionals by manufacturers anddistributors regarding products coveredby the Code should be restricted to

SCOPE

PROVISION OF CLEARINFORMATION NO PROMOTION

TO THE PUBLIC

NO GIFTS TO MOTHERSOR HEALTH WORKERS

NO PROMOTION TOHEALTH CARE FACILITIES

NO PROMOTION TOHEALTH WORKERS

The International Code was adopted by the World Health Assembly on 21 May 1981. It is intendedto be adopted as a minimum requirement by all governments and aims to protect infant health bypreventing inappropriate marketing of breastmilk substitutes.

d) the diff iculty of reversing thedecision not to breastfeed; and

e) where needed, the proper use ofinfant formula.

When such materials contain infor-mation about the use of infant formula,they should include:a) the social and financial implications

of its use;b) the health hazards of inappropriate

foods or feeding methods;c) the health hazards of unnecessary or

improper use of infant formula andother breastmilk substitutes.

Such materials should not use picturesor text, which may idealise the use ofbreastmilk substitutes (Articles 4.2and 7.2).

WHO The Interna& Subsequent World Hea

‘Inappropriate feeding practices lead to infant malnutrition, morbidity and mortality inall countries, and improper practices in the marketing of breastmilk substitutes andrelated products can contribute to these major public health problems.’

SUMMARY

CODE PREAMBLE


Neither manufacturers nor healthworkers should give pregnant women ormothers of infants and young children,samples of products covered by theCode. Free or low-cost supplies ofbreastmilk substitutes should not begiven to any part of the health caresystem which includes maternity wards,hospitals, nurseries and child careinstitutions. Donated supplies in supportof emergency relief operations should onlybe given for infants who have to be fedon breastmilk substitutes and shouldcontinue for as long as the infantsconcerned need them.

Supplies should not be used as a salesinducement (Articles 5.2, 7.4). Note:Articles 6.6 and 6.7 of the Code havebeen superseded by WHA Resolutions39.28 (1986), WHA 45.34 (1992) andWHA 47.5 (1994).

It is important that infants be exclusivelybreastfed for six months and only receivesafe and appropriate complementaryfoods thereafter. Every effort should bemade to use locally available foods. Any

Labels should provide the necessaryinformation about the appropriate useof the product, and should notdiscourage breastfeeding. Infant formulamanufacturers should ensure that eachcontainer has a clear, conspicuous andeasily readable message in anappropriate language, which includes allthe following points:

a) the words “Important Notice” ortheir equivalent;

b) a statement about the superiority ofbreastfeeding;

c) a statement that the product shouldonly be used on the advice of a healthworker as to the need for its useand the proper method of use; and

d) instructions for appropriatepreparation, and a warning of thehealth hazards of inappropriatepreparation.

Neither the container nor the labelshould have pictures of infants, or otherpictures or text which may idealise theuse of infant formula. The terms

‘humanised’, ‘maternalised’ or similarterms should not be used (Articles9.1, 9.2).

Monitoring the application of theInternational Code and subsequentResolutions should be carried out ina transparent, independent manner,free from commercial influence(WHA 49.15 [1996]).

Independently of any other measurestaken for implementation of theCode, manufacturers and distributorsof products covered by the Codeshould regard themselves asresponsible for monitoring theirmarketing practices according to theprinciples and aim of the Code.Manufacturers should take steps toensure that their conduct at everylevel conforms to all provisions above(Article 11. 3).

NO FREE SAMPLESOR SUPPLIES

NO PROMOTIONOF COMPLEMENTARYFOODS BEFORE THEY

ARE NEEDED

ADEQUATE LABELS:CLEAR INFORMATION,

NO PROMOTION,NO BABY PICTURES COMPANIES MUST

COMPLY WITH THE

INTERNATIONAL CODE

CODEX STANDARDS

The Codex Alimentarius Com-mission must continue to improvethe quality standards of processedfoods for infants and young childrenand to promote their safe and properuse at an appropriate age, includingthrough adequate labell ing,consistent with the InternationalCode, resolution WHA 54.2, andother relevant resolutions of theHealth Assembly (WHA 55.25[2002]).

scientific and factual matters, and shouldnot imply or create a belief that bottlefeeding is equivalent or superior tobreastfeeding. Samples of productscovered by the Code, or equipment orutensils for their preparation or use,should not be provided to healthworkers except where necessary forprofessional evaluation or research at theinstitutional level (Articles 7.2, 7.4, WHA49.15 [1996]).

food or drink given before complemen-tary feeding is nutritionally required mayinterfere with the initiation ormaintenance of breastfeeding andtherefore should not be promoted foruse by infants during this period.Complementary foods should not bemarketed in ways that undermineexclusive and sustained breastfeeding.Breastfeeding should continue for up totwo years and beyond. (Code Preamble;WHA Resolution 39.28 [1986], WHA45.34 [1992] and WHA 47.5 [1994],WHA 49.15 [1996], WHA 54.2 [2001]).

For the full text, see:www.ibfan.org/English/resource/

who/fullcode.html

a tional Codea lth Assembly Resolutions

UNICEF

10 International Baby Food Action Network -- IBFAN

Miles D. WhiteChairman of the Board and CEOAbbott Laboratories100 Abbott Park Road,Abbott Park, Illinois 60064-3500, USATel: +1 847 937 6100Fax: +1 847 937 1511URL: www.abbott.com

Only in Brazil has the law forced RoscoBear off labels.

eadquartered in suburban Chicago, Abbott Laboratories producespharmaceuticals, nutritionals and medical products. Abbott Ross

Abbott -Ross

Hmarkets its products in 130 countries.

In 2002, Abbott achieved record sales of $17.7 billion and net earningsof $3.2 billion. The Medical Products Group, which includesdiagnostics, hospital products and nutritionals, reached $8 billion insales. There has been speculation that Abbott Laboratories would spin-off its nutritional products business in favour of more concentration onhospital products. An analyst with J.P Morgan says “But the hospitalproducts business isn’t nearly as profitable as the nutritionalsbusiness”. The high profitability of the infant food business and intensecompetition from Mead Johnson are the main reason for Abbott’saggressive marketing campaigns.

Abbott successfully uses ‘image transfer’ by riding on anotherorganisation’s good reputation. For example, in 2004, in the Gulfcountries, Abbott bought UNICEF diaries and inserted its companyname, mission statement and addresses on the inside front cover and theAbbott logo on the last page with the slogan “Improving Lives”. Thissame strategy was used for a well-known breastfeeding book publishedin 2002 by the American Academy of Pediatrics (AAP); Abbott bought300,000 copies and added the Rosco bear to the cover. Mothers anddoctors who receive a free copy, get a double message. Does it promotebreastfeeding or Similac? The chairman of the AAP breastfeedingcommittee called it “Thievery”. But AAP makes a profit and agreed tosell Abbott another 300,000 copies in 2003. Abbott has continouslynurtured close ties with the AAP by giving grants for its awards anddonating at least $500,000 towards AAP’s operating budget. Thecompany also contributes to the $1 million renewable grant to the AAPby several formula manufacturers. Little wonder that AAP came to thecompanies’ aid when they felt a 2003 US government campaign topromote breastfeeding was too hard-hitting on the risks of formulafeeding. The campaign has now been watered down.

In the US, where breastfeeding rates are increasing, Abbott and otherformula manufacturers have launched their latest marketing tool to get alarger share of the $3 billion market: the addition of fatty acids, DHAand AHA into formula products. Abbott’s claim, however, that its Isomiland Similac products bolster IQ and eyesight are based on short termclinical trials that merely show short term benefits and no benefits whencompared to breastfed children. Abbott’s Isomil soy formula has beenwithdrawn from the market in New Zealand following widespreadconcern over long term risks to child health.

In China, company representatives visit mothers and offer samplesof infant formula, give infant feeding information by telephone andsend promotional materials directly to mothers.

Promotion to the public

Article 5.1 of the Code prohibits advertising and all other forms ofpromotion of products under the scope of the Code.

Article 5.2 and 5.4 of the Code prohibit companies from giving samplesand gifts to mothers.

FORMULA:Similac, Similac Advance, SimilacAdvance Excel, Similac AdvanceFollow-On, Similac ExcellenceFollow-On, Similac Advance WithIron, Similac LF, Similac Gain, Gain,Gain Advance, Gain IQ, Gain Plus,Premilac 1, Premilac 2, Neosure,Isomil, Isomil Follow-Up.

COMPLEMENTARY FOODS:Abbott Extra Cereals, Similac Cereals.

Products include:

Logos & Icons:The Rosco Bear and his comfortblanket promote most Abbott Rossinfant and follow-up formula.



Abbott uses parents clubs and coupons to collect ad-dresses and particulars of babies, to direct targetedpromotional mailings.

ABBOTT-ROSS

Parents in Singapore canfill in coupons in Similacads in a newspaper andMotherhood magazine toreceive a free 400g tin. Theads compare the productwith breastmilk and makeclaims about brain devel-opment. One ad has theheading “The smart for-mula for smart babies”.

In Singapore, Rosco Bearinvites pregnant women tosign up or recommend afriend to the company’s“Join Our Club” pro-gramme using an entryform in a booklet aboutSimilac Advance Follow-On, Gain IQ Follow-Upand Isomil Soy ProteinFollow-Up formulas.

A sign-up coupon for Abbott’s IQ Club is handed outat an International Baby/Children Products Expo inHong Kong. IQ Club members receive a free gift, in-formation on infant feeding, discounts on clothes andtoys, and invitations to health talks.

Samples, CDsand pouches topromote brandrecognition andensure mother’sloyalty.

In Thailand company repre-sentatives visit or call moth-ers at home, give samplesand gifts and recommendSimilac infant formula.Promotional materials aremailed directly to mothers.

Babies wearing graduationcaps, the mention of braindevelopment and the bigletters “IQ” suggest theproduct will increase “in-telligence quotient”. InSingapore, tiny words re-veal this IQ refers to “In-testinal Quality”.

vance materials the “I” in “IQ” contains the word “eye”,suggesting the product will improve vision as well asintelligence. Also in Malaysia, Gain Plus, a growing upmilk, has the same ‘eye’ in IQ.

IQIntelligenceIntelligenceIntelligenceIntelligenceIntelligence?

or Eyeor Eyeor Eyeor Eyeor Eye?IntestinalIntestinalIntestinalIntestinalIntestinal?

Abbott’s IQ stands for any of these

depending on where you buy the product

is it

Not so in Hong Kong andMalaysia where in Gain Ad-

munological defence. The largeletters IQ and the smart baby im-ply the baby will be more intelli-gent. There is no conclusive evi-

“IQ: most nutritious, baby totally brilliant.” A leaf-let in Hong Kong links Gain Advance with braindevelopment and claims it will strengthen baby’s im-

dence to back this upbut the promotion isvery effective interms of sales.

Coupons in ads for Gain IQin Singapore’s Motherhoodmagazine can be redeemedfor a 450g tin. The ads pro-mote Gain IQ as a growing-up milk but the packshot callsit a follow-on formula.


International Baby Food Action Network -- IBFAN12

ABBOTT-ROSS

An insert in a Similac Advance leaflet in Singaporeoffers samples and a toy – the “Similac sensory bear”– to enhance the development of baby’s senses.

An advertisement in a Thai newspaper features healthybabies with packshots of Similac Advance, Gain Ad-vance, Similac LF and Isomil.

An advertisement inThailand for Similac Ad-vance compares theproduct with breastmilk.Words like “good immu-nity”, “clever”, “gooddigestion” and “comfort-able tummy” idealise itsuse. An advertorial withthe same heading rein-forces the ad’s messages.

In Curaçao, a display card in a pharmacy showspackshots of Similac and five other Abbott brandsand describes the situations for which they are rec-ommended, under the heading: “Formulas for all yourpatients’ feeding needs.”

A graph in the centre of the ad showsequivalence with breastmilk – definitely nottrue and not allowed by the Code.

Promotion at point-of-sale

Article 5.3 of the Code bans promotional devices at theretail level.

Shelf-talkers, posters and leaflets promote Premilacinfant and follow-up formulas in shops in China. Com-pany representatives promote Premilac in someshops.

Abbott gives discounts and giftswith purchases of Gain in Colom-bia, and discounts on Similac Ad-vance in Peru.

Special shop displays promote Similac in the Domini-can Republic and Gain in Vietnam, where a large card-board teddy bear wearing a graduation cap claimsadded DHA enhances brain development.

Promotion in health facilities

Samples and suppliesWHA Resolution 47.5 (1994) urges an to end to free or

subsidised donations of products to all parts of the healthcare system.

Article 7.4 allows samples to health workers only forresearch purposes. Health workers may not pass on samples.

Abbott gives unsolicited donations to health facili-ties, (Similac in Indonesia and Curaçao, Similac,Similac Advance and Isomil in the Dominican Re-public, Similac and Similac Advance in Peru and theUnited Arab Emirates, Similac Advance and GainAdvance in Thailand). Health workers often pass onfree supplies as samples to mothers.

Health facility staff and company reps give motherssamples of Similac, Similac Advance or Isomil inChina, Malaysia and the Dominican Republic. In thelatter country, they visit health facilities sometimestwice weekly to give samples and flyers. After cae-sarean delivery, mothers receive samples of Similac.

Mothers of low birthweight babies in Thailand aregiven Neosure samples upon discharge.

Abbott distributes Similac disposable infant nipplesto health facilities in the UAE.

Gifts to health workersArticle 7.3 provides that there should be no financial or

material inducement to promote products.

Abbott wins favour with health workers through giftslike:

calendars in China;clothing and bottles of whisky in the Dominican Re-public;jackets and prescription pads in Perunotepads, pens and deodorant pads in Thailand.

Abbot offers afree tin of SimilacExcellence Fol-low-on to moth-ers in Singaporewho are impres-sed with the pro-duct’s claim to be“even closer tobreastmilk”.

Members in Abbott’s Parents Club in Thailand re-ceive a free parent-baby journal, samples, invitationsto seminars, other activities and counseling on mater-nal and child nutrition.

Telephonedeodorant padsbearing brandnames likeSimilac Advanceand Gain.


Breaking the Rules, Stretching the Rules 2004 ABBOTT-ROSS

Other gifts and materialsArticle 6.2 bans the promotion of products within the

health care system.Article 6.3 prohibits the display of products, placards and

posters or the distribution of company materials unlessrequested or approved by government.

Similac leaflets with baby pictures and packshots aredisplayed in health facilities in Lithuania.

Nurses in Thailand are re-cruited to get mothers to com-plete sign-up sheets. Abbottuses the information to mailmusic CDs, cassette tapes andsamples of Similac Advance tomothers.

Labelling

Article 9 of the Code requires labels to NOT discouragebreastfeeding and to inform about the correct use of the pro-duct, the risk of misuse and abide by a number of other points.

Similac labels in Indonesia claim the formula is pat-terned after breastmilk, and Isomil labels fail to in-dicate that the product is for babies with specific di-etary needs.

A bottle and teat and the company’s teddy bear mas-cot appear on Similac labels in Kenya.

Labels of Similac and Isomil in Indonesia, Isomil125g samples in Malaysia (below) and Similac inKenya and the Dominican Republic are in English onlyand not the local languages as required by the Code.

Abbott gives health work-ers in the UAE notepadsshowing a Gain packshotand two babies.

In New Zealand where Isomil is now withdrawn fromthe market, the label used to say “First choice ofDoctors”. The New Zealand Commerce Commissionfound Abbott guilty of false claims over that state-ment.

In health facilities in many countries, Similac Ad-vance is portrayed as the formula of the future withthis beautiful starry-eyed baby looking into space.In Malaysia, thesame “New Era”baby promotes Iso-mil Plus, a growingup milk. Rosco Bearand his comfortblanket promote allAbbott formulae.

In paediatric clinics and maternity wards in Thailand,Abbott displays items featuring Rosco Bear to pro-mote Similac and Gain.

Similac posters are displayed in health facilities inIndonesia.

Abbott products and promotional materials and post-ers are displayed in health facilities in China.

Mothers in Thailand receive gift packs, pouches andpromotional materials (Similac Advance and GainAdvance) in health facilities, sometimes while stillin the labour room!

In Zimbabwe, Isomil tins lack important statementsrequired by the Code and the national law.

In Indonesia, Abbottsupplies health facilitieswith cot cards bearingthe company name andRosco Bear.

Tear-off prescription pads given to health workersin Yemen make it easy to undermine breastfeeding.

Health workers tickthe picture of the for-mula and g ive thesheet to mothers, whopurchase the recom-mended formula inpharmacies.



ABBOTT-ROSS

Bottle feeding is idealised by attractive pictures ofinfants in a Lithuanian leaflet for Similac Advanceand in Puerto Rico by a picture of a mother bottlefeeding a baby in a Similac booklet.

An Abbott-Ross handbook on breastfeeding inCuraçao intended for health care workers clearly ad-dresses mothers. The text refers to 3-4 weeks ofbreastfeeding and mentions Similac and Isomil twelvetimes. Four out of its 27 pages are devoted tobreastfeeding problems, but not a word about prob-lems caused by bottle feeding.

A leaflet in Singapore designed as a baby’s letter toMummy draws comparisons between breastmilk and

“Mummy, my future isin your hands... sochoose the rightformula.”

Similac Advanceand recommendsstarting solidfoods at four tosix months of age.

A booklet in Singapore promoting Similac AdvanceFollow-On, Gain IQ Follow-Up and Isomil Soy Pro-tein Follow-Up recommends solid foods from fourmonths.

Leaflets in China promoting Similac Advance, Gain,Gain Advance and Premilac 1 and 2 make claimsabout the products such as “strengthens baby’s im-munity”, “No indigestion with formula made byAbbott”, “optimum mental and psychomotor devel-opment, strong bones, enhanced immune function”and “well-tolerated formula”.

In the UAE, an infant feeding booklet promotesSimilac Gain and gives incorrect advice, such as togive the baby water between feeds, orange juice fromthree months and other fruit juices and solids fromfour months.

Cover of booklet

Inside pages

Leaflets in China, Hong Kong, Lithuania, Puerto Rico,Singapore, UAE and Uruguay compare Similac,Similac Advance, Similac Advance Excel, Gain Ad-vance with breastmilk.

Front and back views of leaflet

In this leaflet from the UAE titled “Similac – clinicalperformance like a breastfed infant”, Similac Ad-vance and Similac Advance Excel come out on topwhen measured against two unnamed brands, withcontent and infant development comparable tobreastmilk.

Article 4.2 requires all information material to advocatefor breastfeeding and not contain pictures or text whichidealises the use of breastmilk substitutes.

For health professionals, Article 7.2 of the Code only allowsproduct information which is factual and scientific.

Misleading text and pictureswhich violate the Code

A leaflet in Lithuania advertises the Abbott formulaline, as well asSimilac cereals,using a happybaby’s pictureand packshots.The cereals arerecommendedfor use from fourand five months.

A“Child Care Handbook by American Abbott” inChina gives incorrect information about breastfeeding.Mothers are told to feed for 10 minutes on eachbreast and advised to wash their nipples with hotwater. The information given on artificial feeding

Abbott productsranging fromFormance milk formothers to Similac,Gain, Pediasure andGrow, encircle ahappy baby on theback cover.

does not com-ply with Article4.2 of the Code.



A series of cardsdistributed in ahealth facility inChina showsRosco Bear

with the gold shield for a bet-ter immune defence system.The cards give child develop-

ment information on one side and a baby data formon the other. The series starts from 0-1 month untilthe baby is 15 months old.

ABBOTT-ROSS

Gold shield T-PAN protection in Premilac 1 & 2.

Chinese pro-motional ma-terials use agold shield tos y m b o l i s eresistence to infectionsand immunity to dis-ease, claimed by the T-PAN content in itsproducts.

A baby warrior holds a similarshield in this leaflet on SimilacAdvance.

A discount price list for a range of products includingSimilac Advance is clipped to a leaflet promotingthe product in China.

The Similac Welcome Addition website displays thewhole range of Similac products and promotionalmessages:“No matter the need, trust the makers ofSimilac to have the right formula product for baby”and “... Similac – the name doctors and mothers havetrusted for generations”.

A leaflet in Uruguayidealises the use of Abbottbreastmilk substitutes withphrases like “adequatecogni t ive and v i sualdevelopment”, “minimumcolic”, and “best nutri-tional profile”.

A leaflet in China proclaims:“Babies fed formula byAbbott grow as healthy as those fed by breastmilk.”

A booklet in Puerto Rico titled “Infant formulas arenot all the same” goes so far as to say Similac is equalto or slightly better than breastmilk.

Abbott’s Thai website contains product informationand tips on infant feeding which feign to encouragebreastfeeding but contain messages that undermine thepractice. For example, awrite-up on “Nucleotide(TPAN)”, shows ahealthy baby encircledby a TPAN banner, andfavourably compares ba-bies fed formulas withadded nucleotides tobreastfed babies.

“T-PAN” is superimposed over a teddy bear head to associate it withAbbott’s Rosco Bear.

The cover of a VCD in Hong Kong called Tender lov-ing story of breastfeeding says about Abbott products:“helps raise immunity”, “achieved by Abbott T-PAN”and “closest to the level of breastmilk” .


he Danone Group was consolidated in 1994 and is now said tobe the sixth largest food manufacturer in the world. It is ‘big’Danone T

in yoghurts and biscuits and dominates the mineral water market inseveral countries. A long chain of acquisitions and mergers led to theGroup controlling a great number of older companies. In 1973Danone - Gervais (Gallia, Bledina) merged with BSN-Evian(Jacquemaire, Fali) and became the leading baby food producer inFrance. Diépal, Nutripharm, Liga and Vitabis all belong to theDanone Group. Danone markets infant feeding products in otherEuropean countries, in Russia, Francophone Africa and in the MiddleEast.

Little monitoring was done in those regions and this is reflected inthe outcome below. Lack of evidence during this period (2001- 2004),does not imply the company is “clean”. In France, an October 2001national monitoring report placed Danone as the worst advertiser,well above Nestlé. These two companies together produced 72 % ofall ads for babyfood in France (with 45% by Danone and 27% byNestle). In terms of booklets and leaflets, Danone dominated againwith 38% while Nestlé took 29%.

The British Medical Journal in January 2003 reported on Codemonitoring in Togo and Burkina Faso (West Africa) where it wasfound that of the 40 commercial breastmilk substitutes that violatedlabelling provisions of the Code, 21 were manufactured by Danone.

Danone has recently been criticised for its involvement in the EUfunded CHOPIN project. This seeks to develop an infant formulawhich would not pre-dispose the baby to obesity later in life. One ofthe CHOPIN trial calls for 200 formula-fed and 50 breastfed infantsin 5 EU countries. In Belgium and Germany the researchers couldnot find enough formula-fed babies! Bledina is experimenting onthese babies with new formulations of baby milks (www.childhood-obesity.org). Eighty percent of the Programme is publicly funded(EU) while Danone funds less than 20% but clearly seesopportunities for future marketing.


Article 5.1 of the Code prohibits advertising and all other forms of promotionof products under the scope of the Code.

Franck RiboudPresident and CEODanone Groupe7 rue de Téhéran, F-75008 ParisTel: +33 1 44 352020Fax: +33 1 42 256716URL: www.danonegroup.com

FORMULA:Blédilait, Alma-Blédilait, Gallia,Actimel, Nursie.

COMPLEMENTARY FOODS:Blédine, Blédina cereals(8 varieties),Blédina infant juice, Blédine jarredbaby food, Blédisoup, Gallia instantcereals, Phosphatine(10 varieties),Zywiec Zdroj bottled water.

Products include:

The Blédina website“Pas à pas, bébé granditavec Blédina” (step bystep, baby grows up withBlédina) features a mes-sage from a “Doctor inNutrition” who says that“If you chose to bottlefeed your baby, you knowthat the composition of

Blédina website features packshots and a baby bottlefeeding (see next page).

This “Bledina, Second Mother” poster isnow a vintage collector’s item but onewonders if Bledina’s attitude to breast-feeding has changed very much since itpublished this poster around 1920.

(see 2004 website)


Breaking the Rules, Stretching the Rules 2004 DANONE

infant formula isclose to mother’smilk”. A movieclip on the websiteshows a busymother bottle feed-ing her baby.

On the same website, Blédina implies equivalencebetween its products and breastfeeding: “during thefirst four months breastmilk and babymilk are theonly foods adapted to the baby’s young and imma-ture digestive system. They satisfy his nutritionneeds perfectly...”. A separate paragraph acknowl-edges that breastfeeding is the best way to nourishthe baby...but immediately warns the mother thatshe has to feed herself with utmost care to havequality milk - no coffee, alcohol or other stimu-lants and “to keep beautiful breasts, mother mustwear a special bra day and night” and finally:“Weaning is the transition from breastmilk tobabymilk...”

WHA Resolution 54.2 (2001) advises exclusivebreastfeeding for 6 months which means that therecommended age for use of complementary foods cannotbe under 6 months.

In Burkina Faso, Blédine jarred baby food, Blédisoup,Blédina juice and Gallia instant cereals are all rec-ommended from 4 months and mostly by feedingbottle.

In Costa Rica, a Danone Actimel leaflet found at apaediatrics congress claims that the product has the“efficiency of fermented milks or acidolactic bacte-ria in fermented milks for prevention and treatmentof infant diarrhea”. It is recommended for infantsfrom three months.

This Blédina chart recommendseverything for baby exceptbreastmilk.

Also in the UAE, Blédinadistributes a leaflet “For aHealthy Growth” to healthworkers showing pack-shots of the Nursie rangeof 6 formulas for ages 0-6months and cereals for agesfrom 4 months.

Check boxes below each pro-duct make it easy for the doctorto tick and pass to the mother.



Article 6.3 prohibits the display of products, placards andposters or the distribution of company materials.

WHA Resolution 47.5 (1994) urges an end to free orsubsidised donations of products to all parts of the healthcare system.

Labelling

Article 9 of the Code requires labels to NOT discouragebreastfeeding and to inform about the correct use of theproduct and the risk of misuse.

In France, the label on Blédina infant juice claimsthat the product “contains water, to hydrate” and rec-ommends that the product be used for babies fromfour months. The label also advises that the productbe used “day to day to ensure the nutritional balanceof the baby”, wrongly implying that breastmilk is in-sufficient for that purpose during baby’s first months.

A Blédina leaflet in a United Arab Emirates (UAE)hospital shows a chart recommending Blédina prod-ucts for low-birth-weight, acute diarrhoea, minor di-

gestive disorders and ...from birth! There is no men-tion at all about breast-feeding. Flipside showsBlédina products withpackshots: Nursie formulafor 0-6 months and cerealsfrom the fourth month.

In Togo, one health facility displayed a large calen-dar with pictures of mothers and their infants, a teddybear, and the legend “Danone Baby Food”

Ready-to-feed Nursie bottlesfor newborns are donated tomaternities in the UAE.

Zywiec Zdroj, a mineral water in Poland controlledby Danone shows a happy, healthy mother and baby,implying the water is to be used for bottle feeding.


These promotional symbols are used onlabels and repeated in booklets, postersand on T-shirts.

he Dumex brand was created in 1946 by the East Asiatic Company(EAC), a Danish multinational founded in 1897 for the export ofDumex T

pharmaceutical products to Asia. EAC started marketing baby foods inAsia in 1953 under its Nutrition Division. Operations were laterconsolidated under the International Nutrition Company Ltd., a whollyowned subsidiary of EAC. Dumex products can be found in more than20 countries throughout Europe and Asia.

EAC Nutrition is headquartered in Singapore and its products aremanufactured in China, Denmark and New Zealand. They are soldprimarily in Asia, the Caribbean and Eastern Europe.

The company recorded net sales of USD 1 billion in 2002. It says it has“nourished” over 20 million babies in its market areas and that itsbrands are highly recommended by medical professionals. It recognizesthat breastmilk is best for babies, but the company will provide“complete nutrition” during the baby’s first year of life “if breastfeedingis not possible for mothers”.

The International Code forbids all sampling, but Dumex representativesgive out plenty. A particularly bad case was found in Cambodia in2001 where small plastic sachets with just enough formula for one feedwere given to new mothers to introduce them to the product. The

Company representatives give free samples of Dumex 2 to mothersin shops and at home in Thailand.Promotional materials are mailed to Thai mothers.Dumex 1 is advertised on TV in China.In China, Dumex uses banned promotional tactics in shops: specialoffers, tie-in sales, gifts of free toys with purchases, posters, shelftalkers and leaflets.An ad in Singapore’s Motherhood magazine promotes NutraKidsas “Two-step weaning foods for babies from 4 and from 6 months”and includes a contact number for enquiries.



Article 5.2 and 5.4 of the Code prohibit companies from giving samplesand gifts to mothers.

Mark A. WilsonPresident and CEOThe East Asiatic Company(Dumex Division)2 Enterprise Rd, Singapore 629814Tel: (65) 6265-4566Fax: (65) 6265-7169Email: [email protected]: www.youngnutrition.net

www.eac.com.sg

FORMULA:Dumex 1, Dumex 2, Mamex, Mamil.

COMPLEMENTARY FOODS:NutraKids (formerly Protimex).

Products include:

sachets had no instructions on howto use the product but a stickerwith the Dumex brandname wasprominent. Mothers in poverty-stricken Cambodia are notexpected to be able to buy a lot offormula, so small sachets mab beenough to tempt some of them. Incountries with higher purchasingpower, mothers receive full-sizesamples.

Logos & Icons:Like other manufacturers, Dumexhas adopted recurring symbols toillustrate and promote its products.Its rattles and feeding cup havecome to signify brands.


Breaking the Rules, Stretching the Rules 2004 DUMEX

An advertisement in the Moth-erhood magazine in Singa-pore announces a change ofbrand names from Protimexto Nutrakids, recommendedfor use from four months. Acoupon offers a free sampleof Nutrakids. The weakvoluntary Code in Singa-pore allows this, the International Code does not.

Promotion in health facilities, suppliesand promotion to health workers


Article 7.3 provides that there should be no financial ormaterial inducement, to promote products within the scope ofthe Code.

Article 7.4 allows samples to health workers but only forresearch purposes. Health workers may not pass on anysamples.

Dumex donates unsolicited supplies of formula tohealth facilities in Thailand. Dumex and other com-panies arrange with health facilities to take turns pro-viding free supplies.

Health facilities in Thai-land display items thatfeature the Dumex com-pany and brand name.

Company representatives in Thailand give mothersin health facilities promotional materials such as leaf-lets, music tapes and gift packs containing productsamples, nappies, feeding bottles and booklets on in-fant feeding.

Health workers in a Thai hospital give mothers a leaf-let which says Dumex 1 has nutrients that are impor-tant for brain development and the immune system.

Dumex uses health workers in Thailand to give moth-ers a form to fill out, enabling the company to sendpromotional materials later on.

Thai Mothers receive free samples of Dumex 1 and 2from company reps and health workers throughout theirstay in health facilities and at postpartum check-ups.

Dumex gives health workersin Thailand a booklet called“Secret tricks to help yourchild become clever”.

In a Thai hospital leafletspromote Dumex 2 for ba-bies from 6 months to 3years.

Cambodian health workersare given T-shirts by Dumex. T-

shirt

mod

elle

d by

IBFA

N st

aff

Dumex reps in Thailand visit workplaces to dispenseinformation about infant feeding and recommend spe-cific brands to mothers.

A poster-sized calendar in an Internet café in PhnomPenh and in many retail outlets promotes Dumex prod-ucts, including follow-on formula, with packshots andclaims such as: ‘improved formulation’ with OFA(Omega fatty acids), beta caro-tene and taurine.

In Thailand, Dumex gives health workers diaries,newspaper racks, notepaper holders, handbags, pensand notepads bearing the brand name Dumex.



DUMEX

In a Cambodian hospital, a Dumex height measurementwall chart features the company name together withthe rattle and feeding cup found on Dumex labels.

Calendars in a Cambodian health facility show im-ages of Dumex products with the slogan “Expert inInfant & Child Nutrition”.

In China, mothers in health facilities are given cardsannouncing a Dumex child care hotline.

A leaflet found in health careunits in China announces “newformulation, new package forDumex infant formula” andclaims it is closer to breastmilk,promotes good mental healthand strengthens resistance todiseases. Clipped to the leaf-let is a free delivery hotline,an application forDumex’s BabyClub and a com-pany represen-tative’s card.

In a hospital in Singapore, discharge bags given tomothers contain a cardboard photo frame whichdoubles as immunization schedule. A tearaway sec-tion invites mothers to fill in a card to receive a “spe-cial baby gift” and informationregarding

benefits”.Wo r l d

“Dumex

In China, Dumex 1 labels recommend complemen-tary feeding from four months. Dumex 2 labels con-tain promotional text such as “Better Basis, GreaterFuture”, “Promote Resistance against Diseases” and“Raise Winners of Tomorrow”.

Dumex labels in Cambodia are written in Thai, Malayor English but not Khmer.

NutraKids cereals in Malaysia and Singapore are la-belled for use from four months.

Labelling


WHA Resolution 54.2 (2001) advises exclusivebreastfeeding for 6 months which means that the recommendedage for use of complementary foods cannot be under 6 months.

A 48-page booklet in a ‘discharge pack’ of a hospitalin Singapore contains guidelines “to stimulate yourbaby’s mental development during the first year” andpictures for visual stimulation from the Dumex 1 and2 labels (rattle and feeding cup) and Mamex andMamil labels (toy and book).

In China Dumex distributes calendars, posters, weightand height charts for infants, leaflets and stickers bear-ing the Dumex name. These items are displayed on

health facility walls, windows,shelves and notice boards.

In Saudi Arabia, Dumex distributesto doctors, formula tin-shaped tran-

sistor radios la-belled as Pro-timex (now knownas NutraKids) onone side and MamaPlus on the other.

20


Breaking the Rules, Stretching the Rules 2004 DUMEX

In Hong Kong, a booklet Dumex – A guide to infantfeeding suggests that solids be introduced from threemonths and shows a mother spoon-feeding her baby.It claims that Dumex is specially formulated to pro-vide suitable nutrients for the different stages of de-velopment and features a feeding schedule for breast-fed and bottle fed babies. Included are promotionalprices, special offers and a Dumex hotline service.

A booklet in Singapore entitled Fine Weaning recom-mends breastfeeding for four months. The Dumex 1rattle and Dumex 2cup appear on alter-nate pages. TheDumex name be-neath three childrenwith a graduationcap suggests thecompany’s productswill make childrenintelligent.

A Chinese handbook for ex-pectant mothers advertises afull range of Dumex productsincluding Dumex 1 andDumex 2. There is a columnfor mothers to fill in and returnto the company, facilitating di-rect marketing. The picture ofthe children with a graduationcap (shown above) is on theinside back cover.

‘Add value for life’ is the heading of a leaflet in Thai-land which advertises Dumex 1 and 2 and claims theaddition of nucleotides promotes immunity, growthand brain development and that the amount of betacarotene in the formula is the same as in breastmilk,enhancing immunity.

A card and a leaflet in China show packshots and an-nounce Dumex follow-upformula is now fortifiedwith AA and DHA. In Thailand, a leaflet promoting Mamex claims the

nutrients for brain development in Mamex are simi-lar to breastmilk; a table shows that Mamex is clos-est to breastmilk compared to other brands.




A booklet for healthworkers in Thailandtitled ‘3N of braindevelopment’ showspicture of a motherand sister bottlefeeding a baby,idealising bottlefeeding.

In Thailand a Health guidebook for mother and childpromotes Dumex 1 and 2 assimilar to breastmilk, with“best nutrition for highestbrain development”. Threebabies symbolise the Dumex“3N” slogan (Nature, Nurtureand Nutrition).

A shelf talker in a supermarket in Malaysia announcesa free pack of NutraKids infant cereal with every

A leaflet promoting —“Win theweaning blues”— found at acounter at a Disney on Ice Showin Malaysia promotes Nutrakidscereal, marketed for use from fourmonths, with packshots and a babypicture.

purchase oftwo packs.

An advertisement in a Ma-laysian newspaper and amagazine in Singaporeshow packshots and babypictures. A toll-free “Nutri-line” is also given. Theproduct claims to produce“fitter...brighter babies”.


Friesland riesland Coberco Dairy Foods increased its production in 2001by buying up Nutricia’s division of flavoured milks and coffeeFriesland Coberco Dairy Foods F

whiteners. Its 2003 turnover was 4.6 billion euros, but net profitdecreased by 33% to 56 million euro. Moreover, Dutch trade unionsthreatened court action in March 2004 because the company has beenunder-paying its pensioners.

Faced with losses in Europe, Friesland focuses on the profitablemarkets in South East Asia by intense brand positioning in Vietnamand Malaysia (Dutch Lady), in Indonesia (Frisian Flag) and inThailand (Foremost). An international brand design consultancycompany is creating new ‘brand architecture’ and packaging. Thenew labels on infant foods now use a common ‘Triple Care’ icon.The product designs are currently being rolled out across Asia.Promotional efforts and new label designs in The Netherlands andGreece in 2002 paid off with market shares of respectively 14.7%and 17.3%.

In 1997, Coberco (acquired by Friesland in 2000) lost a lawsuit inBangladesh where it promoted My Boy Eldosoy and My BoyEldoplus in violation of the International Code and the BangladeshLaw. The IBFAN group in Bangladesh reported that the Cobercodistributor admitted to the charge and quietly paid its fine.

An IBFAN campaign starting in 1984-1985 managed to change theMalaysian subsidiary’s name from “Dutch Baby Milk Industries”into Dutch Lady. The company’s infant formula brand, however,remained “Dutch Baby” and delivery vans continued to advertise theformula to the public in violation of the International Code. IBFANreported on this regularly in its “Breaking the Rules” publicationsfrom as early as1985 and asrecent as 2001. By 2004,however, the companyfinally appears to havetaken note of the protests.The last “Dutch Baby”van is gone.

J.G.M. PriemP.O. Box 124,7940 AC Meppel, The NetherlandsTel: +31 522 276 276Fax: +31 522 276 444Email: [email protected]: www.fcdf.com

Products include:FORMULA

Friso, Frisolac, Frisolac H, Frisomel,Frisomel Advance, Frisopep, Frisosoy,Frisovom, Dutch Baby, Dutch Lady,My Boy Eldosoy, My Boy Eldoplus.

COMPLEMENTARY FOODS

Frisocrem.

Logos & Icons:Formula labels promote bottlefeeding with a soft-toy teddy bearand bottle. Frisomel follow-on milkand Frisocrem cereal labels show abunny. The catch phrase linking theFriso range of products is: “FrisoTriple Care – Development,Digestion and Resistance.”


Article 5.1 of the Code prohibits advertisingand all other forms of promotion of productsunder the scope of the Code.

Friesland collects information for directpromotion by asking parents inSingapore to complete a coupon in anadvertisement for free samples ofFrisomel and Frisogrow. The heading“Frisocare” and the “Friso Triple Care”logo promote the products as being goodfor mental and physical development.


Breaking the Rules, Stretching the Rules 2004 FRIESLAND

A leaflet in a China supermarketcompares Frisolac H with breast-milk and claims it promotes intel-ligence, health and digestion.

In this advertisement inSingapore’s Motherhoodmagazine, parents can win aFrisomel ‘walking bunny’ orcash prizes of up to S$888 (anauspicious number in Chinesecommunities) with every pur-chase of 900g Frisomel fol-low-on milk at chain stores.

A chain store in Hong Kong ad-vertises a special price forFrisomel Advance follow-upformula.

Toy bears are givenwith purchases ofDutch Lady 2 follow-on milk in supermarketsin Vietnam. Promo-tional leaflets are alsodistributed in stores.

Unsolicited supplies of Frisian Flag infant formulain 200g boxes are delivered to health facilities in In-donesia and distributed to mothers.

In a health facility inRussia, a poster entitled“Child Feeding, What?When?” promotes sixtypes of formulas belowa picture of a mother andbaby.

A large Friesland teddy bear pic-ture is stuck above a washing sinkin a Moscow hospital.


Back of flyerFront of flyer

To entice sales in Hong Kong, Friesland distributesflyers offering free delivery of Frisosoy and Frisovompurchases. A list of phone numbers for placing ordersare printed on the flipside of the flyers.

Newspaper Advertisem

ent

Friesland gives health workers in Thailand gifts suchas notepads, pens, magnets and tissue boxes bearingthe company name and/or the Frisolac brand name.

Article 7.3. No financial or material inducements for healthworkers.

Article 6. No product promotion in health care system.

Posters and leaflets bearing theFrisolac brand name, packshotsand the “Friso Triple Care” logo aredisplayed in Thai health facilities.

Health facilities in In-donesia display cotcards with the FrisianFlag company nameand logo.

A Friesland baby at birth.


WHA Resolution 47.5 (1994). No donations or subsidisedsupplies in any part of the health care system.

Article 5. No samples or gifts to mothers.

Taking turns with seven other companies, Frieslandprovides unsolicited donations of Frisolac 1 andFrisolac 2 to health facilities in Thailand, which arepassed on to mothers as samples.

Samples to mothers in Thailand come in pretty pouches.



A 2003 monitoring report byVietnam’s Ministry of Healthsays Friesland displays post-ers and leaflets about itsproducts inhealth facili-ties, such asthe one pro-moting DutchLady 1 and 2.

FRIESLAND

In Malaysia, the company placed an ad in The Starnewspaper to recruit nutritional reps whose responsi-bilities include “regular visits to medical institutionsto promote infant related products”.

In Indonesia, Frisian Flag infantformula labels encourage mixedfeeding and advise that babies needfoods other than breastmilk fromfour months.



Article 7.2 Only factual and scientific info to healthprofessionals.

In China, promotional materials compare Frieslandformulas with breastmilk.

In a brochure in Thailand entitled Alternativeway for mother who loves and cares for baby, a

A leaflet in Thailand claims that with Frisolac 1,“Baby will have no constipation and will be healthy”,and that Frisolac 2 “gives full energy for good devel-opment”. A hotline number is also provided.

“Your baby’s first weaning guide”, a leaflet inSingapore, recommends complementary feeding fromfour months. The cover picture suggests that it allowsfathers to share feeding responsibilities. Packshots andtext promote Frisocrem:“Being a nutritiously forti-fied instant milk based cereal, its convenience is in-disputable.”F r i e s l a n d ’sbear and rab-bit mascotsand “FrisoTriple Care”logo promotetrust and com-pany loyalty.

Frisosoy is compared with breastmilk in a leaflet inThailand.

In this leaflet inChina, a loving gazebetween mother andbaby idealises the useof Frisolac H.

An ad in a magazine onfood allergies in theNetherlands promotesFriso 1 and Friso 2 as“the complete solutionfor allergies”.

happi ly playing mother and baby ideal iseFriesland cereals and infant and follow-up for-mulas.

In Russia, Frisolac, Frisopep, Frisovom andFrisosoy labels all show the toy bear together with alarge, shiny feedingbottle, idealising the useof formula and discour-aging breastfeeding.(Note: bottles are allowed forillustrating methods of prepa-ration, usually with graphicson the back of the tin).

Article 9 of the Code requires labelsto NOT discourage breastfeeding and toinform about the correct use of theproduct, the risk of misuse and abide bya number of other points.

Labelling

In a leaflet inS i n g a p o r e ,F r i e s l a n d ’ s“Friso TripleCare” logo, bearand rabbit mas-cots present Fri-somel follow-onas a trustable so-lution. The leaflet cautions, “Look again! If you thinkyou have chosen the best milk for your child”, anduses pseudo-scientific language and a flow chart toidealise the functions of additives in the product.


n 1994, the Gerber Products company merged with Sandoz andthen became part of Novartis, a Swiss giant in pharmaceuticals,Gerber I

veterinary products and a leading producer of genetically modifiedseeds. Gerber, however, keeps its own profile, particularly with itsfamous baby face which appears on all its labels often together withthe slogan: “Shouldn’t your baby be a Gerber baby?”

Gerber controls between 60% to 90% of the US and Central Americababy food markets. Its biggest rival in Europe and Southeast Asia isHeinz. Gerber has recently launched into China in a very aggressiveway. Like elsewhere, the baby face is very prominent.

The Gerber baby face has also meant trouble. When Guatemalabanned baby pictures on labels and refused to register new Gerberproducts in 1993, the case went to the Supreme Court. Guatemalawas brave but had to buckle under in the face of the combined cloutof company lawyers and US government pressure. Brazil, however,is a bigger fish and Gerber wisely chose not to challenge its strictlabelling laws but to sacrifice its baby face at the prospect of breakinginto the huge new market, dominated by Nestlé. Both companies nowabide by Brazil’s strict labelling laws and dutifully put on theircomplementary food labels: “Breastfeeding must be maintained afterintroducing new foods into the child’s diet, until 2 years or beyond.This product must not be used for feeding infants during the first 6months of life, except upon advice of a doctor or nutritionist”.

Gerber is pushing product exposure through creative new ways suchas contracting the Brazilian Outback restaurant chain to give freeGerber jars and juices to travelling babies while their parents enjoy asteak and a break.

With rising opposition to genetically modified ingredients, Gerberannounced in 1999 that it would eliminate GM ingredients from allits products worldwide. Greenpeace and other campaigners rejoicedbut in 2001, Greenpeace test results showed that Gerber usedgenetically engineered soya in its baby food products in thePhilippines. The irony is obvious: how can a subsidiary ofNovartis which spends millions on promoting GM seeds as safe,turn around and ask farmers to deliver non-GM ingredients for itsown baby food?



Daniel VasellaCEO, NovartisLichtstrasse 35, CH-4002Basel, SwitzerlandTel: +41 61 324 1111Fax: +41 61 324 8001URL: www.novartis.com

COMPLEMENTARY FOODS:Gerber vegetable, fruit, meat or fishpurees, Gerber cereals, Gerber juices,Gerber bottled water.

GERBER FEEDING BOTTLES AND TEATS.

Products include:

Logos & Icons:Gerber’s website has a story of thewoman whose face as a baby becamean icon for the company in 1928 andthe official trademark in 1931.

“The logo is the essence of who weare,” said a vice president forGerber North America. “It is theepitome of a happy, healthy baby andthe symbol of trust we have withparents. It’s everything to ourcompany.”

Advertising expert, Professor JimTwitchell agrees: “There could bebetter baby foods, but if you own theconcept of the beautiful baby, thenyou’re golden. And that’s what Gerberowns, and it just made mincemeat outof all its competitors, and I think itwas primarily because of what was onthat label”.

Gerber’s 75th anniversary was advertised as the “Forever Young”campaign in Trinidad’s Guardian newspaper, on the radio andin leaflets. Two main promotions were announced: anyone whobuys two or three Gerber products can win prizes such as babyclothes and can also enter the Anniversary Sweepstakes forUS$1,000 in cash or hampers. Gerber feeding plans and car stick-



GERBER

ers were freelyhanded out.

An advertisement in a parents’ magazine in CostaRica promotes Gerber’s fortified food products foruse after three months and states: “Around the fourth

month your babywill recogniseyour voice…withtime he will learnhow to relate invarious ways…thanks to goodfeeding”.

Also in Costa Rica,Gerber gives out pocketdiaries that say on thecover: “The only thingwe cannot give ismother’s love … All therest, Gerber gives ....”

The Gerber website promotes its baby foods, Gerberbaby water and other products with baby pictures,packshots and slogans: “Shouldn’t your baby be aGerber baby?” and “Join the Gerber Family”.



In pharmacies in Costa Rica, Gerber displays postersinviting mothers to enter a lucky draw when they buyGerber products. Winners receive monthly pocketmoney for varying periods of time.

In a leaflet in the same Beijing supermarket, Gerberasks: “Smart mother - have you prepared well?Are you ready?”The leafletrecommendsGerber pureesafter threemonths, juicesfrom two monthsand Gerberspring water forbottle feeding.

A leaflet in a Beijing supermarket offers gifts withpurchases of Gerber products during the company’s75th anniversary celebrations. A form, to be filled inand sent to Gerber facilitates future contact.

Front of leaflet Flipside of leaflet

Gerber distributes a leaflet Feeding plan – GerberSteps in Dominican Republic supermarkets that pro-motes First Step products for use from 4 months.

Gerber uses tie-in sales at a supermarket in the Do-minican Republic to promote their fruit purees.

In Mexico Gerber offers up to 30% discount on itsproducts.

Note: The “ForeverYoung” campaignwas suspended andthen modified aftercomplaints by TIBS ofTrinidad and Tobago— an IBFAN group.

A leaflet in aShanghai super-market promotesGerber vegetablepurees as “1st and“2nd Foods” with-out specific agerecommendations.The baby is wearing a maternity wristband, suggest-ing the product may be suitable from birth.

A Gerber cereal adver-tisement in a Vene-zuelan magazine asks “Do you need a crèche?” andannounces a competition to win a place in a crèchewith the purchase of Gerber foods.


Breaking the Rules, Stretching the Rules 2004 GERBER

A “First Step” leaflet in a Mexican supermarket pro-motes Gerber vegetable/meat/fruit purees from fourmonths: “According to modern infant nutrition prac-tices, it is possible to introduce complementary foodsas soon as your baby needs additional calories, fol-lowing his physical development rather than his chro-nological age.” The leaflet features a crawling babywith packshots of purees and rice cereals.

Labelling

WHA Resolution 54.2 (2001) advises exclusive breast-feeding for 6 months which means that the recommended agefor use of complementary foods cannot be under 6 months.

In a UAE supermarket display of the range of Gerberproducts, brandname and logo areshown on all sides.This picture topsthe display andalso appears as anadvertisement in alocal newspaper.

Shelf talkers and special displayspromote Gerber products in Indonesian supermarkets.

Gerber puts up special displays inUruguay shops to encourage sales.

Gifts are offered with Gerber purchasesin Peru, Malaysia and Thailand.

Gerber items are also displayed in health facilities inThailand and the Dominican Republic.


Article 6.2 bans the promotion of products within the healthcare system.

All of Gerber’s labels (except in Brazil) violate theCode because of the baby face logo and because itsFirst Foods are recommended from four months. InBrazil, Gerber follows the law and its labels say: notbefore six months.

Gerber Oatmeal labels in the United States say “theAmerican Academy of Paediatrics(AAP) recommendssupplementing baby’s diet with iron beginning at 4 to6 months” and that the product supplies the ironneeded by infants. This implies endorsement by theAAP, which in fact recommends exclusivebreastfeeding for six months.

Gerber spring water labels in Costa Rica encour-ages early complementary feeding, saying the prod-uct is ideal for preparing porridges, juices and cere-als, which Gerber markets for use from three months.


In China Gerber productsand posters are put in hospital display windows.

Also in Mexicoa free jar ofGerber pearpuree is givenwith the pur-chase of one setof products - Gerber’s special offer in Mexico includes teats

for newborns and complementary foods.

one jar each of apple, carrots, and rice cereal plustwo teats for newborns - all of which are marked “FirstStep” without a recommended age of use.

A Gerber publication in adoctor’s office in Costa Ricabears the company logo oneach page and features twohappy babies on the frontcover. The back cover listsGerber contacts.

This ad in The Star newspa-per in Malaysia invites par-ents to fill in a coupon(which gives the companyaddresses for direct promo-tion) to receive a free sampleof Gerber Rice Cereal. Thead promises a reduced pricefor two Gerber Rice cere-als and encourages mothersto go for early complemen-tary feeding; mothers areleft to decide when it’s “hightime”. The age recom-mendation onseveral smallpackshots isnot readable.

In a Singapore Motherhood advertisement, Gerber says:“From 4-6 months, a milkdiet alone is insufficient”.


einz was established in 1869 and manufactured bottledhorseradish, ketchup and pickles. The introduction of babyHeinz H

foods 65 years ago saved Heinz during the depression.Approximately 60% of Heinz’s total sales come from outside theUnited States, making it the most international U.S.-based foodcompany. 2003 sales were over USD 8 billion with a net income ofUSD 560 million.

Heinz carries some infant formula and a full range of baby foodsfrom 4 months to adult table food, from iron-fortified baby cereal tospecially prepared vegetables, fruits and meats for infants, toddlermeals, desserts and juices.

Heinz bought Farley’s baby foods in 1994 and Earth’s Best organicbaby foods in 1998.

While Heinz is most known for its own jarred baby foods, it alsosells formula and other baby foods under the Plasmon, Dieterba,Nipiol, Wattie’s, Farex and Farley’s brand names in variouscountries. Camera feeding bottles claim to belong to the “HeinzBaby Corporation”. Heinz denies any link to Camera.

William R. JohnsonPresident and CEOH.J. Heinz CompanyP O Box 57, PittsburgPA 15230-0057, USAURL: www.heinz.com

www.heinzbaby.com

FORMULA:Nurture Starter, Nurture Plus,Nurture Follow-on, Farley’sfollow-on.

COMPLEMENTARY FOODS:Farley’s, Farex, Heinz cereals, pureesand jarred foods, Heinz infant juices,Heinz All-in-One Cereal andPlasmon.

Products include:

Logos & Icons:Heinz categorises its baby food in linewith the age of intended consumers,e.g. baby cereals, cereal with formula(infant cereals plus 35% infantformula), beginner foods, strainedfoods and juices, junior foods andtoddler foods. Its products are intro-duced in stages. Stage 1 begins at 4months; labels always feature a baby.Its fruit juice bottle doubles as afeeding bottle.



A magazine advertisement inChina introduces Heinz’s eightnew purees, cereals and juices byfeaturing each product in its ownbaby cradle.

A leaflet in China advertises“Heinz Baby Expert On Line”, aradio programme on infant andcomplementary feeding. Heinzproducts are recommended for usefrom four months. The leafletforms a prepaid aerogramme, en-ticing mothers to submit their nameand address to Heinz for directmarketing.

A plaque on a Chinese leaflet titled‘Mother trusts Heinz, Baby lovesHeinz’ states that Heinz is “recom-mended by Chinese Child Nutritionand Health Research Centre” and thatits products are guaranteed by the au-thorities. An insert pulls out to revealHeinz infant cereals and purees, somerecommended from four months.




Article 5.3 of the Code bans promotionaldevices at the retail level.

“Love which feeds” is the theme of a magazine adfor Heinz purees in the Dominican Republic that alsomakes health claims about the product.

An advertisement in the Malay-sian magazine Parenthood seeksentries for “The Heinz-Farley’sRusks Baby Debut Contest”.Parents win a Heinz hamper iftheir baby’s photo and captionare selected for publication.For Heinz, it is a way to col-lect addresses for future directpromotion.

Another ad for Farley’sRusks in the same magazinefeatures a coupon that moth-ers can submit for a free in-formation leaflet.

HEINZ

A UK magazine ad recommendsFarley’s for use from 4 monthsand shows a cute teddy bear un-der the heading ‘Heinz. TheNew Name Behind Farley’s’.

In China, an im-munisation recordbooklet contains apage that showcasesHeinz cereals withpackshots.

This supermarket shelf-talker in Co-lombia has the slogan “Dreams be-gin with Heinz … the love that feeds”and shows a baby, a graduation cap,crayons and a black board, implyingHeinz produces an intelligent child.

A series of ads for Farley’s Fol-low-on in magazines in the UKoffer a free sachet bycalling the “tinytumscareline”. Mothersand babies idealise theuse of the productwhich is claimed to“improve baby’s im-mune system”.

An ad titled ‘Infant Nutrition-ist’ in a scientific journal inChina promotes Heinz cere-als and purees for use fromfour months and shows ababy with a bib inscribedwith the letter “A” for excel-

lence. Scientific symbols of calcium, zinc and ironclaim that the cereals are fortified – how much of thiswill be absorbed by the baby is another question. An ad in an Indian magazine promotes six varieties

of Farex cereals, with pictures of babies and toddlersand recommends the product from four months.

An advertisement in Mother-hood magazine in Singaporeasks “Isn’t it time to give yourchild all the important nutrientseveryday?” and makes nutritionand health claims about the Heinz products shown.

Heinz lists events and displays packshots of its cere-als and jarred foods, one of which is recommendedfor use from four months, in anad in a scientific journal inChina titled ‘Heinz, Authorityon Infant Nutrition’.

A TV advertisement in China says Heinz infant cere-als contain “various nutrients for baby’s growth”, add-ing that “baby’s healthy growth is your wish”. The adis accompanied by a jingle from a famous Chinesepop song, “Kissing my baby”.

This ad for Heinz All-in-One Ce-real with Infant Formula at www.heinzbaby.com does not mentionbreastfeeding as the best. It claimsthat it “meets 100% of your baby’sdaily iron needs” and contains 35%infant formula. “Trust Heinz to giveyour baby the very best”.



HEINZ

Heinz offers a free bib with every purchase of twotins of Heinz purees in Colombia.

Shelf talkers draw attention to reduced prices on HeinzBaby Juices and on Farley’s Follow-on in the UK.

Heinz baby cerealis sold at a discountat a chain store inSingapore. Redee-ming a coupon en-ters customers inthe store’s monthly Lucky Draw for a $100 prize.

Labelling


Heinz product labels in many countries idealise theiruse with pictures of babies and attractive images.

In New Zealand Wattie’s gives health workers infopacks that promoteHeinz Nurture in-fant and follow-onformulas, using theslogan “NurturingNew Zealand Ba-bies for over 20years”.

A shelf talker in a Beijing supermarket asks custom-ers to “collect stars ….to get gifts” with purchases of

Heinz cereals, pureesand juices. Pamphletslist the gifts available(baby sleeping bag,backpack, householditems, toy train).

Shelf talker

Leaflets in Shanghai super-markets offer points forHeinz purchases to be col-lected and redeemed forfeeding cups, towels, toysand baby furniture.

Soon-to-expire Heinzproducts are sold at dis-count prices in a super-market in Gambia.

In China Heinz in-fant feeding book-lets promote thecompany’s fullproduct range,recommendingmany products foruse from fourmonths. The booklets are supplied in bulk to healthfacilities and made available to mothers with new-born babies, such as this one.

Heinz displaysposters, leafletsand products inhealth facilitiesin China.

Heinz labels recommend products from too young anage: as of four months for most products in most coun-tries. In Mexico and Uruguay, Heinz puree labels donot state any recommended age.

The brand nameNurture of the Heinz infant formula range in NewZealand idealises the use of infant formula.

In New Zealand, Wattie’s “Guide to Baby FeedingCard” and “Gettingstarted on solids”advise that comple-mentary feeding be-gin at four monthsusing Farex andWattie’s products.



Heinz often hands out gifts tohealth workers in China.

In a UAE hospital, Farley distributes leaflets on wean-ing: “4-6 months....time to start weaning”. A full rangeof Farley’s products illustrates the message.

In a health facility in Trinidadand Tobago a leaflet titled‘Heinz’s Infant & Toddler Nutrition FAQ’ promotesHeinz foods for use from four months.


ipp is a family-owned company located in southern Germany. Itwas founded in 1932 and has established a strong reputation in theHipp H

organic baby food market. Hipp has factories and subsidiaries in severalEuropean countries. It markets mainly in Europe (very aggressively inEastern Europe) and is now expanding into Asia (Pakistan, Uzbekistan,Taiwan, Japan and China).

In Germany, Hipp gives out videos projecting idyllic unpollutedlandscapes and Mr. Hipp among apple trees. The company claims itsorganically grown ingredients will help prevent allergies. Hipp hasreceived praise from environmentalists for guaranteeing organicingredients at affordable prices. Recently the Swedish probioticspecialist BioGaia signed an agreement with Hipp. However, Hippcontinues to produce non-organic foods under the Bebivita label whichdoes not reveal its connection with Hipp. The company has also beencriticised for its heavy-handed entry in the Costa Rica jungles wherefarmers use unsustainable slash and burn techniques in their rush togrow organic bananas for Hipp.

Article 7.3 of the Code provides that there should be no financial ormaterial inducement to health workers to promote products. Not manybaby food companies nowadays dare give bonusses to doctors based onthe number of product prescriptions. It was highly disturbing, therefore,to learn that in Armenia, Hipp pays a commission to doctors for eachHipp product mothers buy on prescription.

Hipp received the 1999 Shaming Award from the UK Food Group, forthe misguided labelling of its infant teas, purees and juices whichencourage an early end to exclusive breastfeeding. The FoodCommission (UK) found in 2000 that Hipp biscuits have more sugar(21%) than a jam doughnut (19%) even though the biscuits are labeled“sugar-reduced”.


Article 5.1 of the Code prohibits advertising and allother forms of promotion of products under the scopeof the Code.

Mr. Klaus HippGeneral ManagerHiPP GmbH & Co.Georg-Hipp-Straße 785276 Pfaffenhofen, GermanyTel: 0 8441 - 7 570Fax: 08441 - 7 574 02Email: [email protected]: www.hipp.de

FORMULA:Hipp Pre, Hipp 1 and 2, Hipp HA,Hipp NE.

COMPLEMENTARY FOODS:Hipp purees, juices, cereals, readymeals, biscuits, mineral water,“goodnight meals”, muesli and teas,Bebivita.

Products include:

Logos & Icons:Hipp uses its company name withthe three hearts as brand name.The company prides itself on arange of organic baby foodspromoted with a “Bio” logo.

Hipp baby foods use Western babies to adver-tise in a magazine in China. This ad is entitled‘Babies’ tender stomachs need nature’s care’.

An advertisement forHipp juices in a mother’smagazine in Taiwan anda leaflet for Hipp jarfoods and juices bothfeature the “Bio” logo,the slogan “Very Or-ganic, Very Tasty”, and

a baby eating Hipp products. A cut-outcoupon in the ad offers free gifts.

magazine advertisement leaflet



Free samples of Hipp Pre infantformula are given to mothers byshopkeepers in Lithuania.

HIPP

Mothers in Latvia receive cou-pons for Hipp products and giftpacks containing promotionalmaterials and free samples ofHipp baby drinks, recommendedfor use from one week of age.

Hipp posters, pro-motional leafletsand brochures inshops in Armeniahave pictures ofbabies.

An ad in the UK magazineBaby & You, displays theHipp Organic product lineand offers a sample and a‘money-off coupon’ by call-ing a local hot-line. In answerto the heading, the advertise-ment says: “All ingredientsare grown naturally… theapples are grown in sunny or-chards far away from all pol-luting influences.”



Hipp donates unsolicited supplies of its infant for-mula to health facilities in Armenia and of Hipp teasand Hipp juices in Latvia. Samples are then given tomothers.

Health workers in Lithuania give mothers free samplesof Hipp Camomile Baby Tea recommended for usefrom the first week.

Unsolicited free supplies of Hipp follow-on formulawere placed in doctors’ waiting rooms in Germany,as many as 20 packs at a time.

An ad entitled ‘For your baby, the most natural is thebest’ in Eltern magazine in Luxembourg asks “After

the breastfeeding period of6 months, what can you of-fer to your baby?”, imply-ing that breastfeedingshould cease after sixmonths and that babiesshould progress to Hipp 2as the natural option.

An ad for Hipp infant teasin Mothers’ Journal inLithuania encourages bottlefeeding with a cartoon babydrinking from a bottle andholding a teddy bear. Theheading reads “Be Healthyand Big - With love, Hipp”.

An ad in a scientific jour-nal in the UK uses thepopularity of organic prod-ucts to promote Hipp or-ganic infant and follow-upmilks. The ad compares theproducts to breastmilk:“formulated to be as nutri-tionally close to breastmilkas possible”.

A leaflet in Hong Kong says Hipp baby teas can begiven 1 week after birth and Hipp fruit and vegetablepurees 9 weeks after birth.

Cover of leafletFlipside of leaflet

In the UK, Hipp usesshelf talkers to adver-tise a discount – fourjars for the price ofthree.

Hipp car stickers in Arme-nia, Lithuania and Russiasay “Baby with us”.


Breaking the Rules, Stretching the Rules 2004 HIPP

Hipp distributes promotional materials such asbooklets and calendars for display at health fa-cilities in Armenia, promoting Hipp products foruse from as early as the first week of life. Carstickers and pens with the Hipp name and logoare given to health workers.

Feeding bottles in a pack-age which advertises Hippformulas are included in agift pack for mothers in hos-pitals in Germany, togetherwith a booklet from Hipp.

In Georgia Hipp gives writing pads to health workersand Hipp booklets on infant feeding to health work-ers and the public. They contain statements such as:“Use Hipp Pre for infants when mother’s milk is notenough.”

Doctors in Armeniaearn a commission

Article 7.3 provides that there should be no financial ormaterial inducement, to promote products within the scope ofthe Code.

Article 7.4 allows samples to health workers but only forresearch purposes. Health workers may not pass on anysamples.

In Latvia and Lithuania, Hippgives health facilities clocks,cups, writing pads, sweets andmagazines showing the “Hipp

Bio” logo andHipp ball-pointpens.

on prescriptions for Hipp products; all they need todo is fill in their name, workplace and signature onspecial Hipp prescription forms.

Hipp baby tea labels in Lithuania show a bottle andrecommend use of the product from the first week.

In Armenia Hipp juice labels recommend use fromthree months; porridges, vegetable, fruit and meatpurees from four months.

The label of Hipp Pre in Lithuania states that theproduct is “…good for supplementing whenbreastfeeding”.

Labelling


Misleading text and pictures whichviolate the Code

Article 4.2 requires all informationmaterial to advocate for breastfeedingand not contain pictures or text whichidealises the use of breastmilk substitutes.

33

In Latvia, Hipp distributespromotional materials tomothers. Among themare a booklet and adaisy-shapedleaflet whichadvertise a fullrange of pro-ducts under theHipp Bio range.

In Germany Hippinfant meal labelsrecommend theproduct for use“after five monthsinstead of a bottlemeal”.

Hipp infant formula labels in Switzerland underminemothers’ confidence in breastfeeding with statementssuch as “If you can’t breastfeed or if you can’t do itany longer, you can use Hipp1 from the first bottle”.

The label recom-mends the use of fol-low-up formula afterfour months.The la-bels of Hipp 1 and 2look alike and canconfuse mothers.

Breastfeeding posterwith HiPP logo found

on wall of paedi-atric polyclinicin Armenia.



HIPP

The booklet from Armenia isdetailed below:

Hipp distributed leaflets andbooklets about their prod-ucts to health workers at aPerinatal Conference in Ger-many, including a leaflet

Hipp Pre and Hipp 1 areclaimed to be adapted tomother’s milk in terms ofprotein, fat and carbohydratecontent.

The booklet promotesHipp infant formula, teas,porridges, cereals and pu-ree products, includingHipp Hypo Allergenic 1and 2, Hipp Pre, Hipp 1and 2.

Hipp juices are recom-mended to vary the baby’sdiet, adding that this is “es-pecially important if you arebreastfeeding”.

Hipp vegetables and fruitsare said to be necessary inthe child’s diet “from 9weeks”.

Hipp Goodnight por-ridges and cereals andHipp Meat purees arerecommended from fourmonths.

that claims there is nodifference betweenbreastfed and Hipp HA-fed babies at the age ofsix months and anotherthat describes Hipp NEas a special formula forthe “first days of life”. Itclaims Hipp NE is mod-elled on colostrum andtargeted at breastfed ba-bies as a supplement dur-ing their first days to pre-

A leaflet in Serbiashows packshots ofHipp formulas, cere-als, juices, purees andinfant water.

In many parts of Europe, Hippwidely distibutes a booklet oninfant feeding that introducesits product line. The book isavailable under various titles,in different languages and withslight variations, but all pro-mote Hipp products withpackshots and idealising pic-tures and recommend comple-mentary feeding from tooyoung an age.

Another booklet showing the same picture of a happymother and child on the cover, recommends comple-mentary feeding from three to four months,breastfeeding or bottle feeding only once a day at sixto seven months and no breastfeeding at all after eightmonths. The booklet dedicates four pages to HippBio organic products. Similar booklets are seen inGeorgia, Latvia, Romania and Lithuania.

A Hipp booklet in Rus-sian found in Armenia of-fers “Recommendationsfor feeding in case of al-lergy”. The booklet con-

vent hypoglycemia and dehydration.

tains misinformation and confusing statements. Onpages 3 and 6, it states that allergy-prone infantsshould be exclusively breastfed while on page 8, itimplies that exclusive feeding with Hipp Hypo-al-lergenic 1 is just as good. Pages 4 and 5 promotebottle feeding, again implying the equivalence withbreastmilk. It also promotes Hipp complementaryfoods as of four months.

Pages 4 & 5 of the booklet


umana, Germany’s second biggest producer of milkproducts, has an annual turnover of €2.53 billion. It sellsHumana H

products under the Humana and Miltina brands. The companyhas long been criticised because of its misleading companyand brand name.

In November 2003, two babies died and fifteen babies fellseriously sick as result of an outbreak of thiamine (Vitamin B1)deficiency in Israel associated with the use of Humana’s koshersoy-based infant formula Remedia Super Soy 1. Despite the labels’claim, Israeli Health Ministry officials found less than 10% of therequired amount of vitamin B1 in the formula. It had been left outbecause Humana ‘thought’ there was enough thiamine in soy! Itsabsence or insufficiency leads to encephalopathy, a serious form ofbrain disease in the newborn. Long-term effects may resemble beri-beri infection.

After dragging its feet, the company admitted a mistake was madein the production process. Dr. Chessa Lutter of PAHO/WHO said“the Remedia deaths serve as a powerful reminder that formula isnever as safe as manufacturers would have us believe … Unlessthere is an easily identifiable cluster of sick infants like in Israel,the fact that formula is responsible for their symptoms is likely togo unnoticed.” Remedia broke its relations with Humana inFebruary 2004. Russia, Georgia and Azerbaijan banned Humanaproducts.


Article 5.1 of the Code prohibits advertising andall other forms of promotion of products under thescope of the Code.

Albert Grosse FrieHumana Milchwerke Westfalen eGBielefelder Strasse 6632046 Herford, GermanyTel: +49 5221 1810Fax: +49 5221 181300

FORMULA:Humana 0, Humana 1 and Humana 2,Humana 0-HA, HA1, HA2,Pre Humana and Humana 0-VLB.

COMPLEMENTARY FOODS

AND OTHER PRODUCTS:Amorosa, Humana SL, HA Brei cereal.

Products include:

An ad for Humana 2 in a Serbian magazineshows seven babies looking up to theHumana name.

A sponsored article in The Resonancenewspaper in Georgia, about an interviewwith a paediatrician discussing infant feeding and allergies, describesHumana products as a close substitute to mothers milk when en-countering digestive problems.

Advertisements in theGerman magazineBaby present babiesand Humana as “milkspecialists”, the slo-gan that also appearson product labels,and show packshotsof various Humanainfant and follow-onformulas.

Inadequate quality control is not theonly shortcoming that Humana needsto change. Its cow’s milk basedformula is called “Humana”,misleading consumers into believingit is “humanised”. The terms“humanised”, “maternalised” orsimilar ones are banned by the Code.Sri Lanka blacklisted Humana forthis reason some 15 years ago.



HUMANA

Humana displays posters inGeorgia and Serbia featuringbaby pictures, and promotes itsproducts in pharmacies, marketsand grocery shops.

A coupon for free samples isincluded in a German maga-zine ad for Humana HA1,HA2 and HA Brei cereal rec-ommended for use from fourmonths. Packshots show thesimilarity in design betweenthe formula, follow-up for-mula and cereal labels, caus-ing potential confusion.

Labelling


A leaflet about pre-term babies features pictures ofinfants, an “SOS” phone number and a coupon forfree samples of Humana formula. It says: “Ifbreastfeeding is not possible, pre-term formulais available to cover the special nutritionalneeds of preemies.”

At a perinatal con-ference in Berlin,Humana distributedmaterials to be passedon to mothers, includ-ing a leaflet entitled‘For babies whocouldn’t wait’, pro-moting Humana 0,Humana 0-HA andHumana 0-VLB forlow birthweight orpre-term babies.


Article 6.2 bans the promotion ofproducts within the health care system..

A booklet in Georgia entitled‘For love of the child’ promotesHumana products and urgespaedia t r ic ians to recom-mend Humana 0, Humana0-HA and Pre Humanaspecial formulas.

Humana’s Amorosa mineralwater label in Italy states inEnglish that it is “recom-mended for the preparation ofbaby food” and in Italian thatit is a “food for newborns”.

On formula labels in Georgia and Serbia, Humanaclaims to be the “Milk Specialist”. The labels are pri-

marily in Germanwith stickers bear-ing only partialtranslation into thelocal language.

An advertisementin Germany’s El-tern (Parents) ma-gazine announcesthe addition ofprebiotics to Hu-mana follow-onformulas and saysthe company was“inspired as usualby breastmilk”.Another ad says Humana makes its products as close to

breastmilk as possible. Both adsare placed next to articles relatedto infant feeding.

Packages containing baby foods and pens with theHumana brand name were given to health professio-nals at a lecture organised bythe company in Georgia. Thegifts win health workers’favour and samples will bepassed on to mothers.

Health facility waiting roomsin Serbia display posters,leaflets, calendars and penswith the Humana companyand brand name.

A leaflet in Germany promoting Humana 0-VLBspecial formula says it is “conceived for the specialneeds of pre-term low birthweight babies”, but doesnot mention the superiority of breastmilk.

A Humana booklet on breastfeeding promotes prod-ucts and discourages breastfeeding, saying it “…ex-cludes the father”.

Poster


Peter R. DolanChairman and CEOBristol-Myers Squibb Company345 Park Avenue, New York,NY 10154-0037, USATel: +1 212-546-4000URL: www.meadjohnson.com

www.enfamil.com, www.bms.com

ead Johnson, a subsidiary of Bristol-Myers Squibb claims to bethe world leader in infant formulas with its Enfamil family of

MeadJohnson

Mformulas. Worldwide sales reached $721 million in 2003.

The company is very proud of its Enfamil Lipil infant formula launchedin January 2002 and said to be the first to contain DHA and ARA in theUS. However, in January 2003, Mead Johnson recalled 505 cases of theproduct distributed to hospitals, stores and clinics in the US due tocontamination by Enterobacter sakazakii. In March 2004, PregestimilHA was recalled in Canada because of an error in scoop size which couldlead to over-concentration and hence to diarrhoea and dehydration.

The claims about Enfamil Lipil (and Enfalac A+ and Enfapro Premium)containing DHA & ARA are deceptive. Mead Johnson says theyimprove eyesight and intelligence... These long chain fatty acids arenaturally present in breastmilk in perfect amounts; absorption rates fromcommercially manufactured fatty acids may not match at all. Canada’sFood Inspection Agency (FIA) investigated the truth of these claimsand in April 2004, the FIA asked Mead Johnson to terminate the claimsforthwith! Prosobee, the soy formula was withdrawn from the NewZealand market several years ago, following widespread concern overlong-term risks of its use.

Intense competition with rival Abbott resulted in increased advertisingspending. Among the promotions is a sweepstakes offering 20 collegescholarships, each worth $25,000 to be won weekly from January 2004until May 2004. Parents are to see their paediatrician to enrol in thesweepstakes. The lucrative baby formula market in the US, worth over$486 million to Mead Johnson, prompted the company to stall a federalbreastfeeding ad campaign end 2003. The campaign emphasised therisks of not breastfeeding (different from the usual trumpeting of theadvantages of breastfeeding). Mead Johnson and Abbott-Ross joinedforces to pressure the government to drop or dilute the campaign. Closeties with the American Academy of Pediatrics (AAP) in the form ofannual grants and sponsorship is believed to be behind AAP’s supportfor the industry stand (see Introduction for deletions in the campaign).

Bristol-Myers Squibb committed $115 million for a 5 year ‘Secure theFuture’ programme which was supposed to aid millions of Africanwomen and children in need of AIDS medication. The Washington Postreported that 77% of the money went to US-based charities and medicalresearch institutions mostly in order to silence criticism of theprogramme. Only a few thousand AIDS victims are said to be reachedby the PR effort which may, incidentally, have helped prepare theground for Mead Johnson formulas.


Article 5.1 of the Code prohibits advertising andall other forms of promotion of products under thescope of the Code.

FORMULA:Alacta, Alacta NF, Enfamil 1 + 2,Enfamil A+, Enfamil AR, EnfaCare,Enfamil Lipil, Enfamil Lipil with Iron,Enfamil Premium, Enfamil LactoFree,Enfamil Prematuros, Enfamil Soya,Enfalac, Enfalac A+, Enfalac HA,Enfapro, Enfapro 2, Enfapro Premium 2,Prosobee, Progestimil, O-Lac andNutramigen.

Products include:

Logos & Icons:Since 2001, Mead Johnson has beenworking with design experts “toupgrade and reposition” its “Enfa”products so that they will be easilyrecognisable throughout the world. Likeits previous sketches of babies, the newbrand design encompasses infantformula, cereals and toddler food.

An advertisement for Enfapro in a Mexi-can magazine encourages mothers to buy theproduct by saying “Your baby is wortheverything”.

In some markets, Peter Rabbit, Beatrix Potter’sfamous children’s character, is still used as agraphic and idealises bottle feeding.

New designerlabelling focusseson Enfa and the

blue bow.



MEAD JOHNSON

An advertisement in CostaRica claims “Intelligence –You can see it in his eyes”and says that “the magnifi-cent thing of breastmilk isthe marvellous thing ofEnfapro Premium 2”.

A Mead Johnsonwebpage in Fin-land shows a babyhappily workingon a computer, toprove the intelli-gence of MeadJohnson babies.

An advertisement in a Chi-nese magazine claims thatwith Mead Johnson’s Enfa-pro A+ babies’ eyesight andintelligence improve.

The www.enfamil.com website advises “if you chooseto feed your baby formula, use Enfamil LIPIL withIron” and in much smaller print “if you choose tobreastfeed, your baby receives DHA & ARA frombreastmilk”.

Mead Johnson’s Mama to Mama newsletter in Ma-laysia and Singapore regularly publishes letters frommothers. One of them stated she used Enfapro (fol-low-up formula) from birth with results which “ex-ceeded all expectations” and that she “found moth-ering to be much easier and fuss-free withEnfapro”. Following com-plaints, Mead John-son hastened toapologize andblame the terriblemistake on a “typo-graphical error”...

Mead Johnson reps in Thailand talk to pregnant fac-tory workers and mothers and encourage them to drinkEnfaMama, distribute the “Smart System” guide oninfant care and gift sets with samples of Enfalac A.

A leaflet in the USpromotes EnfamilLipil as the onlyformula “that hasLIPIL, a blend ofnatural nutrientsthat may helpoptimise eye andbrain development” and says it is “a blend of DHA &ARA: Nutrients found in breastmilk”. It offers sav-ings of up to $4 by sending contact information andthe baby’s birth date.

The WebMD site advertises the “Enfamil Family Be-ginnings” Club with pictures of cute babies and in-

duces visitorsto join with of-fers of retaildiscounts, nu-trition advice,online and tele-phone support.

Mothers who enrol in the Mead Johnson Mother’sClub in Hong Kong receive a gift pack with pictures

of the entire productrange, a set of cardsspecially designedfor babies and the‘Mead Johnson’sThree Steps tostimulate intelli-gence’ booklet.

Mead Johnson adver-tises discounts forEnfapro A+ in theMing Pao newspaper inHong Kong.

An Enfapro Premium 2ad in a parents magazine inMexico claims the producthas DHA & ARA levelssimilar to breastmilk andshows a picture of a baby’shand on a mouse pad.

A leaflet in Hong Kong advertises a ‘train’ of MeadJohnson formulas starting from Enfamil A+,

Enfapro, Enfagrowand ending with Enfa-kid. It also contains anentry form for the MJMother’s Club.

A product that changesblurred to sharp ...


Breaking the Rules, Stretching the Rules 2004 MEAD JOHNSON

In the Dominican Republic, the company promotesAlacta, offers discounts in pharmacies and uses spe-cial displays to promote Enfamil.

Mead Johnson reps in Thailandgive out samples of Enfapro tomothers in shops, hold specialsales and offer discounts onEnfalac, Enfalac A+, Enfaproand EnfaMama.

Also in China the com-pany uses posters, shelf-talkers, special displaysand offers of gifts withpurchases of its products.

Discounts and special sales inChinese shops promoteEnfamil and Enfapro.

In China the company mailspromotional materials tomothers at home; shops alsodistribute such materials.

Company pro-moters in Chinause leaflets topraise the bene-fits of EnfamilA+; they alsoannounce child-care seminars sponsored by Mead Johnson.


Article 5.3 of the Code banspromotional devices at the retaillevel.

In Mexico a promotional letter inside a magazine says“in case you cannot breastfeed your baby for any rea-son, ask your paediatrician about Mead Johnson prod-ucts that contain DHA and ARA”

Enfapro is regularly advertised on TV in Hong Kong.

A Mead Johnson gift pack for new mothers in Malay-sia contains a‘see-and-touch’ flipbook and promotesthe range of Enfa products.

Vietnam is one of the first countries to advertise thenew Enfa range icon above shops and in the media.

Clever cartoon ads in Malaysian newspapers enticethe public to check out Mead Johnson’s website whichpromotes all the Mead Johnson products. It offers freesamples onrequest.

In Hong Kong, Enfamil displayed in health facili-ties, says that its DHA & ARA levels are similar tobreastmilk, while information about Enfamil AR,Prosobee and O-Lac claim that their fatty acid contentaids development of brain, eyes and nervous system.

Mead Johnson cot tags were found in an Argentinehealth facility with the slogan“Mead Johnson – Worldleader in nutrition – is with your baby from birth”.

In a Chinese hospital a Mead Johnson flyer offers aquiz program with prizes of toys or formula for thefirst 100 parents who answer questions about TVprogrammes correctly.



Article 7.3 provides that there should be no financial ormaterial inducements to promote products.

Mead Johnson gives fridge magnets with a toll-freenumber to health workers at medical symposiums inArgentina.

Mead Johnson gives out growth charts, prescriptionpads, calendars and folders with the Enfamil and

Mead Johnson sponsors at leastone neonatology announcementboard. It says: “Courtesy ofMead Johnson, where goodhealth is born”.



MEAD JOHNSON

Mead Johnson distrib-utes pens with the Enfa-mil logo and an Enfa-mil questionnaire todoctors at a paediatriccongress in Argentina.The prize for correct an-swers to the question “What is the solution to theseproblems?” is a set of product samples.

Enfamil questionnaire

Thedesignsalsopromotebrandnames.

Mead Johnson baby posters.

endars, clocks, hand-phones, stationery, post-ers, educational toys anddesigns and bags. Manyof them carry brandnames like Alacta-NF,Enfalac HA, EnfalacA+ and Enfapro.

Mead Johnson distributes many gifts to health work-ers and health facilities in Thailand, among them cal-


Mead Johnson’s Enfaclock found in a Viet-nam hospital.

In Peru company reps visit mothers at health fa-cilities to promote and give samples of EnfamilPremium and Pregestimil via the health workers.

Mead Johnson donates supplies to many health fa-cilities in Thailand. Mothers receive Enfalac A+samples and other Mead Johnson gifts from healthworkers.

Mead Johnson donates unsolicited supplies ofEnfamil and EnfaCare to health facilities in the Do-minican Republic.

In Indonesia Mead Johnson provides unsolicited sup-plies of Enfamil, Enfalac and O-Lac to health fa-cilities. Health workers give mothers free samples ofEnfamil, Enfapro and Enfalac A+ as going-homegifts. Mead Johnson posters are displayed in healthfacilities, usually with the company logo and Enfamil,Enfapro brand names.

Article 5.2 and 5.4 of the Code prohibit companies fromgiving samples and gifts to mothers.

Enfamil 2 brands in health facilities in Peru. BabyID tags with the company logo are provided and usedin hospitals. Mead Johnson prescription pads bear theslogan “The first thing a newborn consumes is love,next our foods”.

An ad in the Argentine Paediatric Journal claims theEnfamil range is“a complete rangeof paediatric com-plements of vita-mins and iron soyou can be surethat the little onegets all he needs”.

In Peru the company sends unsolicited supplies ofEnfalac, Enfamil and Progestimil to health facili-ties. One health facility aspiring to be BFHI certifiedis still receiving unsolic-ited supplies of EnfamilPremium.



An ad in the Thai Medical Times claims Enfalac isthe only formula that research shows can increase MDI(Mental Development Index) scores 7% higher thanthose in babies not on Enfalac.

Mead Johnson hands out gift bags to mothers at healthfacilities in Thailand which include the ‘Smart Sys-tem: birth – 6 months’booklet, Smart SystemProgramme Guide, regis-tration form for Smart Sys-tem and stimulation devel-opment materials, and a200gm box of Enfapro.

In the Maldives the company distributes calendars,pens, educational materials and free samples to healthworkers.

When mothers or nurses order Enfalac in Malaysianhospitals, the product gets delivered with a gift packcontaining samples of EnfaMama, a towel with thecompany logo,nappies, babybooks and leaf-lets promot-ing the entireEnfa range.

Mead Johnson’s Enfamil label in Indonesia encour-ages mixed-feeding by recommending it to be used tocomplement breastmilk for infants under 12 months.It also recommends complementary food for babiesabove 4 months.

MEAD JOHNSON

In China, health education boards in hospitals bearthe Mead Johnson logo. Company reps distribute freesamples of Enfamil to mothers; calendars with theEnfamil and Enfapro brands, note pads and pens tohealth workers.

Health facilities in the Dominican Republic displayproducts with the Enfamil brand and mothers receivefree samples of Enfamil from health workers andcompany reps.

Company reps and health workers distribute gift packswith samples of Enfalac, Enfalac A+ or Enfapro tomothers in health facilities in Thailand. Mothers arerequired to give their particulars to the companyto facilitate future contact.

Enfamil Prematuros in Peru competes withbreastmilk by claiming it is a complete formulawhich promotes good visual and mental devel-opment.

In Mexico the label forEnfamil AR statesthat the product is de-signed specially for in-fants wi th phys i -ological reflux prob-lems, whereas breast-feeding is the bestmethod to deal withthis problem.

Labelling


WHA Resolution 54.2 (2001) advises exclusivebreastfeeding for 6 months which means that therecommended age for use of complementary foods cannotbe under 6 months.

In Trinidad and Tobago free samples of EnfamilLactoFree are given tomothers at health facilities.Book marks from “EnfamilFamily of Formulas” listthe “101 ways to praise achild” and show 6 MeadJohnson formula products.

In Puerto Rico and the Dominican Republic theEnfamil Lipil label idealises the product by claim-ing that the DHA and ARA composition is closest tothat of breastmilk.



Leaflets full ofbaby picturesin China pro-mote Enfamil,Enfamil A+and Enfalac

for infants, Enfapro and Enfagrow for toddlers,Junior Sustagen for older children, and MaMaSustagen for mothers.

MEAD JOHNSON

In Argentina the company distributes a booklet: “Re-gurgitation affects some 50% of all babies” and a CDto paediatric students in teaching hospitals. The textmisleadingly suggests that 50% of babies suffer fromregurgitation and that Enfamil A.R. can help reducethe occurrence, while ignoring the fact that breastfedbabies have less regurgitation and that it is a normalevent. An ad with similar wording appears in the Ar-gentine paediatric journal. These ads are neither “sci-entific nor factual”.

The following Mead John-son booklets were distrib-uted at a Paediatric Con-gress in Argentina:

Enfamil is recommendedfor pathological problemsthat can be resolved bybreastfeeding.

Pregestimil label in Indonesia is in English only.

An Enfamil 1 label insert in China advertises otherEnfa products starting from EnfaMama to Enfapro,Enfagrow and Enfakid accompanied by pictures ofbabies.

Enfamil Nutramigen: portrayed as a solution to(cow’s) milk protein allergies.

Lactose-free Enfamil: “provides essential nutri-ents similar to those of breastmilk and routine for-mulas”

Enfamil Soya: gives incorrect information onweaning and diarrhoea and does not mentionbreastfeeding at all.


For health professionals, Article 7.2 of the Code only allowsproduct information which is

factual and scientific.



Breaking the Rules, Stretching the Rules 2004 MEAD JOHNSON

A leaflet in a Mexican health facility promotes MeadJohnson’s infant formulas as “Closer than ever” tomother’s milk.

In Thailand an Enfalac HA leaflet says it is the “lat-est technology ... with hypo-allergenic formula, theonly formula that gives valuable nutrients close tobreastmilk”.

Booklets entitled Enfalac A.R.: Nutrition for regurgi-tation claim the product contains essential fatty acidssimilar to breastmilk.

In Thailand a leaflet showing a baby claimsLCPUFA+s content in formula increases baby’s vi-sion and IQ, like breastmilk.

Another Mead Johnson leaflet in Thailand claimsEnfalac A, Enfalac A+ and Enfapro contain nutri-ents for good physical growth, brain development andimmunity and that the whey casein protein ratio isthe same as in breastmilk.

Company promoters in China recommend EnfaMamato pregnant mothers, distributing leaflets called NewMother’s Health for 280 Days which also promoteEnfamil and Enfamil A+ as “similar to mother’smilk”.

A baby care bookletin a Hong Kong hos-pital has pictures ofEnfamil A+ andEnfapro on almostevery page.

A flyer in Hong Kong entitledHow to switch milk advertisesEnfamil A+ for newborns andEnfapro for 6 months andabove. A similar leaflet pro-motes Enfapro 2 describingthe wonders of its DHAcontent.

A leaflet in HongKong promotes Pro-sobee, O-Lac andEnfamil A.R. whileanother promotesEnfamil A+ as theonly infant formulawith ingredients that

fit FAO/WHO recommendations on DHA & ARAand match those found in breastmilk.

Mead Johnson leaflets in Mexico claim that “MeadJohnson’s new formula is the only one with DHA andARA levels similar to breastmilk and the only one thathas clinically proven significant improvements inmental and visual development of babies.”

Early stimulation for babies from 0-6 months

“Lets helpthem to be asbrilliant asthey can be”.

Mead Johnson:“Always ready”(Argentina).

Any truth inDHA addedbenefits?

A Mead Johnson ad inSingapore, “With ARA andDHA in Enfapro A+, it isnot just toys that catchyour child’s eye”.


ith annual sales of 732,368 billion Yen (USD 6.7 billion) in2002, Meiji founded in 1917, is one of the largest JapaneseMeiji W

manufacturers. The company’s main business is dairy products, babyfoods, and pharmaceuticals. It claims to make unceasing efforts tobring its infant formula “as near as possible to the functions ofmother’s milk.”

Meiji’s products include formula, complementary foods, beveragesand snacks matched to baby’s age. It supplies infant formula mainlyin Japan, China, Thailand, Taiwan, Malaysia and Pakistan.

In August 2002, in Japan, the company mislabelled Meiji Step, itsfollow-on milk, with standard directions for Hohoemi infant formula,causing young babies to suffer diarrhoea and vomiting fromconsuming the wrong milk for their age. The public outrage reflectedin the media resulted in a downturn in sales.

Meiji has engaged in a joint venture in Thailand with the CP Group,and in China it has established a joint venture with a state-runenterprise.

Shigetaro AsanoPresident and CEOMeiji Dairies Corporation1-2-10, Shinsuna, Koto-kuTokyo 136-8908, JapanTel: 81 (3) 5653-0300URL: http://www.meinyu.co.jp/english/

FORMULA:Meiji FM-T, Meiji FP-T, MeijiHohoemi, Meiji Step, Meiji FU, MeijiSoft Curd.

Products include:

Logos & Icons:Meiji is one of several companiesusing its name as a brand name formost of its products.

A leaflet about the stages ofpregnancy, distributed by To-kyo health authorities, containsan ad for Meiji Hohoemi.Cartoon characters are on

labels and in ads.

In China, Meiji has added a baby bear to its logoand promotes its products by offering door signsfor paediatrician’s offices and the like.

In Thailand Meiji mails free samples of Meiji FM-T to mothers.


Article 5.1 of the Code prohibitsadvertising and all other forms ofpromotion of products under thescope of the Code.

Meiji advertises Meiji Step for babies nine months and older, in aJapanese magazine, with the heading: ‘We want to nurture babiesand mothers across nations.’

The Japanese Hohoemi website catalogue compares Hohoemi in-fant formula with breastmilk (“Getting gentler, getting closer tobreastmilk”) and promotes Meiji baby water for use from 2 months.

Baby waterInfant formula


Breaking the Rules, Stretching the Rules 2004 MEIJI



In China, shelf-talkersin stores promote MeijiFM-T and Meiji FU.

Meiji towels are of-fered as gifts withpurchases of MeijiFM-T in a Chinasupermarket.

Leaflets in shops and midwives’ stations in Ja-pan offer gifts to mothers when they purchaseMeiji Hohoemi formula and submit a form withtheir personal par-ticulars, enabling fu-ture direct contact.

Mothers in Japan can collectstickers with purchases ofMeiji’s follow-up formulas toexchange for a storybook featur-ing their baby’s name as the hero.A similar scheme is used forother Meiji products also.




Article 6.3 prohibits the display of products, placards andposters or the distribution of company materials unlessrequested or approved by government.

Meiji gives health facilities in Thailand unsolicitedsupplies of Meiji FM-T and Meiji FU to pass on tomothers as samples. Meiji takes turns with seven othermilk companies supplying formula to some health fa-cilities. Meiji products and items are displayed in nurs-eries, nurses’ stations and maternity wards.

Company reps give mothers inThai health facilities gift sets thatinclude a Meiji FM-T sample,baby clothes, mittens and Meijipromotional materials.

Gifts such as incubator cov-ers, bags, diaries and calen-dars with the Meiji logo andbrand names are given tohealth workers in Thailand.

Meiji FM-T and Meiji FU leaflets are given tomothers outside health facilities in China. Theycontain promotional images and slogans like:“Brain Gold” and “Clever mum’s choice” and“Raise an intelligent baby – Choose Meiji”. Oneleaflet claims Meiji products are “suited to Ori-ental mothers and babies’ nutritional needs”.“Breastfeeding is best” is superimposed overMeiji FM-T packshots in all the leaflets in anattempt to disguise the promotion.



MEIJI

A catalogue available at a midwife station in a Tokyohealth facility advertises the entire line of Meiji for-mula, baby foods and several brands of feeding bottlesand teats.

Meiji gives health workers in Thailand mother book-lets that recommend exclusive breastfeeding for onlythree months and complementary foods from fourmonths. They also recommend formula if a mothercannot breastfeed due to work or insufficient or nomilk. Text promotes Meiji FM-T and Meiji FU as“…complete formulas with nutritious value for gooddevelopment of children at every age”.

Meiji representatives in Japan give health workers abooklet entitled ‘Maternity Textbook’ to give to moth-ers. It contains promotional material about MeijiHohoemi, including a comparison with breastmilk.

A large poster promoting Meiji FM-T from birth andclaiming it is “Almost a Breastmilk” is found in anEgyptian hospital.

A large 2003 calendar with packshots on every page,leaflets and other materials promoting Meiji FM-T,Meiji FU and Mamilac milk for mothers are com-monly on display in clinicsand hospitals in Japan.

Mothers in HongKong health facili-ties receive card-shaped advertise-ments promotingMeiji FU with adrawing of a tod-dler wearing a

graduation cap and packshots with a cute koala bearon the labels. The text says, “Brighter brain andbrighter eyes” and promotes DHA as “Brain Gold”.

At a conferencein Thailand,Meiji promotesits products inbooths anddisplays.

Meiji ad in a Japanese magazine boasts about Meiji’s80 years of study of breastmilk and pledges to con-tinue producing nutritious and safe milk.


ilupa was founded in 1921 as a family business in a small town inGermany. In 1995 it was bought by Nutricia and became aMilupa M

partner in NUMICO (Nutricia, Milupa, Cow & Gate). Its marketing andlabelling remain independent and hence it is reported here as a separatecompany.

Milupa claims to be the leader in breastmilk composition research byfirst introducing taurine in 1986, then in 1993 LCPs (long chain poly-unsaturated fatty acids) into infant formulas. After engineering anothergeneration of LCPs in 2001, Milupa went into prebiotics like so manyother companies, forever seeking a way of commercial production ofnatural ingredients in breastmilk so as to exploit it in marketing.

In May 2002, the company’s Step 1 baby meal rice cereal was mistakenlyfilled with Milupa Oatmeal Cereal where gluten content may have adverse


Article 5.1 of the Code prohibits advertisingand all other forms of promotion of productsunder the scope of the Code.

Dr. Rainer SiewertMilupa GmbHBahnstrasse 14-30D - 61381 Friedrichsdorf, GermanyTel: 06172 / 99-0Fax: 06172 / 99-1595URL: www.milupa.de

FORMULA:Aptamil Start, Aptamil Pre, Aptamil,Aptamil HA, Milumil, HN25, Conformil.

COMPLEMENTARY FOODS:Milupa Cereal, Milubrei, Miluvit,Miluris, Kinder Grieb, FenchelMilutee, Milupa Infant Foods andMilupa 7 Cereals.

Products include:

Logos & Icons:Joining the battle of additives, “LCPMilupan - for healthy development” isthe logo and slogan used to describeand promote LCP fatty acids added toMilupa formula products. Its comple-mentary foods are marketed from fourmonths and its juices and teas from asearly as the eighth day of life.

A label of Milupa OatmealCereal in Canada tells us theproduct belongs to Nutricia butis distributed by Wyeth, whichin Canada belongs to Nestlé.

GLOBALISATION IN A NUTSHELLeffect on those sensitive to gluten.This incident caused the recall of theproduct in Canada. Then in Septem-ber of the same year, Milupa’s HN25special formula was recalled in HongKong due to contamination byEnterobacter sakazakii.

Milupa has no strong single set of icons topromote its products. It has dabbled with acartoon range of sun, moon and stars in the MiddleEast; its car stickers show a bear, and Milupababies come and go on hospital posters.

Milupa cereals are advertised in the Daily Enquirer newspaper inthe Philippines, showing packshots beneath a picture of a motherfeeding her baby cereal. The ad claims: “[Milupa cereals] providea full range of vitamins and the most important minerals. Two serv-ings of Milupa cereals contain at least 50% of the daily require-ments of these micro-nutrients.” It provides an address, telephoneand fax numbers and email for more information.

Milupa’s German website contains promotion for all Milupa prod-ucts, including infant and follow-up formula, and has a baby nutri-tion advice section for new mothers.

Leaflets at an International Baby/Children Products Expo in HongKong contain a “Milupa MothersClub” entry form that gives Milupainformation for direct promotion.The leaflet shows packshots ofMilupa cereals and recommendstheir use from four months. In viola-tion of WHA 47.5, it comparesMilupa cereals to traditional por-ridge in terms of nutritional value,preparation and taste, and saysMilupa “wins” on all three counts.

Front

Over

leaf



MILUPA

Milupa gives out samples of Milupa cereals, recom-mended for babies below six months, at a roadsidestand in Latvia.

A father feeding a baby with a Milupa bottle, sug-gesting relief for mother, idealises the use of Milupainfant formula in ads in both Germany and Lithuania.

In Lithuania, the ad forAptamil 3 and Milumil3 (both recommendedfor use from eightmonths) in a Tavo Vaikasmagazine is titled ‘Theday with daddy’.

The ad for Milumil 2, Milumil HA2 (for use fromfour months) and Milumil 3 (for use from eightmonths) in the German Wo Bekomme Ich Mein Baby

magazine also says: “Be-cause Milumil is so easy toprepare, Daddy will behappy to substitute forMama.” It promises that“…your child always getsexact nutrients that it needsfor healthy growth”.

In Serbia, a cute baby picture is used to promote vari-ous Milupa products in My Baby and Mama maga-zines and in leaflets and posters in Belgrade andZrenjanin pharmacies and health facilities.

The same baby advertises Aptamil2 and Milumil 2 follow-up formulasrecommended from four monthson posters in Bosnian clinics.

... and here it promotesAptamil, Milubrei, Miluvit, KinderGrieb all marketed for use from fourmonths, and an assortment of otherproducts for older babies...

... and here, it promotes FenchelMilutee, an infant tea recom-mended for use from the secondweek of life and claimed to preventcolic. The photo insert of thisMilupa baby is also used as aposter in health facil ities,reinforcing brand recognition.

An ad for Miluvit, Milumil 2, Milubrei and Aptamil2 in My Baby magazine in Serbia (left) includes pack-shots and a phone number for nutrition advice. Simi-lar images appear on heightcharts (right) in health facilities.

Milupa exploits breastfeeding in Germany to adver-tise Aptamil 2 from four months and Aptamil 3 fromeight months in the magazine Baby. The same pictureis used on a leaflet for Aptamil Pre and AptamilHA1 given out at a perinatal conference in Berlin.

Below the heading “Naturally, we can’t compete with this packaging…”, the ad (above left) says: “ … and breastfeeding is still best for thebaby, but when nature does not cooperate, breastmilk-like Aptamil inthe blue package will help.” The leaflet (above right) compares the LCPingredients added to Aptamil Pre and Aptamil HA1 with breastmilk.

As recently as 2004, the en-tire range of Milupa formu-las are promoted in Eltern(Parents) magazine in Ger-many with claims thatprebiotics make Aptamil“very close to the original”.

A leaflet inside a maternity wear and baby productscatalogue in the UK invites mothers to join Milupa’smailing list: “…you can expect to receive another pre-cious little bundle – over £50 worth of money-off cou-pons” Other benefits include: a personalised websiteto guide mothers through pregnancy and early par-enthood, a dedicated careline with mums, midwivesand health care professionals offering advice, regularmailings, free samples and monthly competitions.Completed sign-up formsgive Milupa information fordirect marketing.

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Leaflet from Berlin conference


Breaking the Rules, Stretching the Rules 2004 MILUPA

A leaflet on Aptamil andMilumil distributed at a peri-natal conference in Germanyshows packshots and com-

“Little man. Big business. Noproblem.” An ad for Conformilin Baby magazine in Germanysays the product can stop loosestools and constipation.

pares the products to breastmilk, saying they are“adapted to breast-milk” and “approach breastmilk”.


Article 5.3 of the Code bans pro-motional devices at the retail level.

A booklet in a shop in Serbia pro-motes Milubrei and Miluvitproducts, most for use from fourmonths.

In Serbia, Milupa sets up specialdisplays in shops to promoteMilumil and Aptamil and uses tie-in sales and promotional leaflets toboost sales of Milubrei.

Leaflets given tomothers at a phar-macy in Belgrade,Serbia, advertiseAptamil 2 for use from four monthsand offer a free “Milubox” with eachpurchase.

An advertisement for Aptamil First in the CommonPractitioner scientific journal in the UK comparesthe Aptamil range with breastmilk, makes claimsabout LCPs and says “Aptamil is now Britain’s fast-est growing infant milk”.

In Switzerland, health workers give mothers gift boxesthat contain samples of Aptamil HA and Aptamil Pre,Milactin tea for mothers and breast pads.


Article 6.2 - No product promotion in health care system.Article 7.3 provides that there

should be no financial or materialinducement, to promote productswithin the scope of the Code.

Milupa gives health workers inHong Kong towels embroideredwith Aptamil 1, Aptamil 2 andAptamil 3 and the Milupa logo.

Milupa prescription pads in health facilities in Ghanaand in Sudan advertise Aptamil 1 and Aptamil 2,other formulas and Milupacereals for infants from fourmonths. Check boxes makeprescriptions easy.

The reverse of the leaflet fromSudan suggests strict four-hourlybottle feeds from Day 1.

Prescription pad from Ghana

Prescription pad from Sudan

An advertisement in the Archives of Disease in Child-hood says that “…when a baby is not breastfed,healthcare professionals advise mums to choose aninfant milk that contains LCPs”, suggesting infant for-mula with LCPs is an alternative to breastmilk. Theadvertisement mentions no brand name but displaysMilupa’s name and logo.

In Serbia, items bearing thenames Milumil, Milubrei,Miluvit and Fenchel Miluteeare displayed in health facil-ity waiting rooms.

In the UAE, Milupa gives health facilities toys andhealth workers bright red plastic bags with “Milupa”in bold on both sides.

A height chart in a Zrenjanin,Serbia, health facility showspackshots of products, includingMilumil 2 and Miluvit, both mar-keted for use from four months.



In health centres in Sudan, colorful brochures adver-tise Milupa cereals from four months with claimsabout iron fortification to “prevent anaemia, fre-quently seen during the weaning period”.

Doctors in Sudan receive blocks of tear-off sheetsabout HN25 as a solution for diarrhoea to give tomothers as “a service of Milupa”.

A fancy Milupa booklet given out by hospitals in theUAE advocates mixing Miluris (as of four months)into breastmilk or formula as a smooth start in wean-ing. It also promotes Milupa teas as of zero months,jarred foods after four months and soluble rusks to bedisolved in breastmilk or formula.

MILUPA

The inside of Aptamil Pre boxes in Latvia advertisesAptamil 1.

In Tanzania, Milupa 7 Cereals labels recommend usefrom four months and claim: “The recipe containspre-biotics which are naturally occurring nutrientssimilar to those found in breastmilk.”

Milutee (infant tea) labels inSerbia recommend it for use asof one week. The label shows ababy picture and is mostly inGerman, with only partial trans-lation on a sticker.

Aptamil 1 and Milumil 1 labels in Lithuania have noimportant notices, no mention of the superiority ofbreastfeeding, and no statement that the productshould be used only on the advice of a health worker,yet space is found for graphics to attract mothers.

A glossy Milupabrochure for doc-tors in the Sudancalls Aptamil“the first invest-ment for a child’sfuture” and pro-motes “An Apta-mil for EveryStep”:AptamilStart, Aptamil 1and 2.

Labelling


WHA Resolution 54.2 (2001)advises exclusive breastfeeding for 6months which means that the recom-mended age for use of complementaryfoods cannot be under 6 months.

A leaflet in Ghana comparesthe protein, fat and carbohy-drate content of breastmilk,cow’s milk and Aptamil 1 ina bar graph to show Aptamil1 has a “special compositionclose to breastmilk”. It makesother claims comparingAptamil 1 with breastmilk.

A leaflet in Macedonia promotes Milumil 1, Milumil2 and Milubrei cereal, saying the products “removeproblems in children who eat too fast” and the richcontent of complex carbohydrates will make “chil-

In Ghana, a Milupa poster for its wheat & fruits ce-real shows a baby with a bunch of fruits on its headand has the caption “Milupa cereals as natural asnature intended”. The product is recommended foruse from 4 months.



dren relaxed andcalm through thenight”.


Morinaga


Article 5.3 of the Code bans promotionaldevices at the retail level.

Akira OnoChairman and CEOMorinaga Milk Industry Co., Ltd.33-1 Shiba 5-chome, Minato-kuTokyo 108-8384, JapanTel: +81 3 3798 0152Fax: +81 3 3798 0107URL: www.morinagamilk.co.jp

FORMULA:Hagukumi, Chirumiru Ayumi,Morinaga 1, Morinaga 2, MorinagaBF, Morinaga BMT, Morinaga NL33,Chilmil.

OTHER PRODUCTS:Morinaga Bottled Baby Water.

Products include:

Logos & Icons:Morinaga’s logo, in some countriesstill a cow’s head, is now supposed tochange into a cherub holding theletter “M”, except in Japan where thelogo consists of a simple but stylised“M” associated with the company’swide range of food products.

Morinaga uses posters, shelf-talkers and leaflets to promote its productsin China. Promoters are sent to shops and discounts are common.

Kalbe Farma, Morinaga’s distributor in Indo-nesia, uses special displays and shelf-talkers,gives samples and offers discounts to promotesales at shopping complexes, where represen-tatives promote Chil Mil follow-up formulathrough direct contact and leaflets.

A leaflet about Morinaga 1, 2 and 3 insupermarkets in China shows the samebaby elephant used on the formula la-bels. The leaflet compares Morinagaformulas to mother’s milk.

In China, Morinaga uses cartoon drawings ofelephants on its labels and promotional materials.

In Japan a leaflet announces a lucky draw for45,600 customers of Morinaga powdered milksor baby foods. Prizes include gift cards of up to100,000 yen for 300 winners and a small can ofpowdered milk for 12,000 others.

stablished in 1917 as Nippon Rennyu, the company was reorganisedas Morinaga Milk Industry Company in 1949. Morinaga producesE

mainly dairy products and beverages. It also manufactures agriculturalequipment and pharmaceuticals, but food and dairy products accountedfor 94% of the company’s revenues in 2002.

Morinaga manufactures formula under a 1994 joint venture agreementwith Mitsui and Harbin Dairy in China. A chemical license agreement inIndonesia appears to continue but is now with Kalbe Farma since SariHusada was bought up by Nutricia.

Morinaga Nutritional Foods Deutschland manufactures probioticcultures (such as Bifido bacteria and Lactobacillus bacteria), Lactulose(isomerized lactose = prebiotic), Lactoferrin (multi-functional dairyprotein) and protein hydrolysates. Many of these go into infantformulas.

In an effort to build a stronger brand, anew corporate image has been forged in2003 with the creation of a strange-looking ‘cherub’.

Sponsorship in Japan of TV pro-grammes and commercials with thenew logo started in April 2003.



MORINAGA

Morinaga donates unsolicited supplies of MorinagaBMT to health facilities in Indonesia and health work-ers give them to mothers as free samples.

In Indonesian health facilities, company representa-tives obtain mothers’ contact information throughmidwives and call mothers directly to promoteMorinaga BMT and other company products.

Morinaga promotional materials are distributed inhealth facilities in China and Indonesia.

Morinaga gives baby cots with the company nameprinted on it to health facilities in Indonesia.




Labelling

Article 9 of the Code requires labels toNOT discourage breastfeeding and toinform about the correct use of theproduct and the risk of misuse.

Morinaga’s Hagukumi infant for-mula labels in Japan have a cartoondrawing of a baby and idealise theproduct by comparing it tobreastmilk.

The Morinaga BF label in China states that “the prod-uct is like healthy breastmilk”.

In Indonesia the Chil Mil label shows a baby with abottle and claims the product contains DHA and vita-mins for brain development and growth.

A leaflet for Morinaga Baby Water in Japan en-courages bottle feeding, recommending that it be used

In Japan a Morinaga leaflet creates fears and con-fusion in mothers’ minds, warning: “If you feed cowmilk, which contains less iron, instead of breastmilkor powdered milk, the risk of iron anaemia will in-crease … It might stunt your baby’s physical andmental development.” It also says: “If you arebreastfeeding, it is recommended to continuebreastfeeding and start feeding follow-up milkaround nine months because iron intake is likely tobe deficient around this period.”

to prepare infant formula. Itsays Baby Water “does notbreak down the mineral bal-ance of formula milk and istherefore ideal for preparingformula”.




A cartoon baby appeals:“Mom, make our milk with

‘Baby Water’, please!”

An advertisement in a maternity and child healthmonthly newsletter for health workers in Japan, pro-motes Hagukumi formula by stating “A lot of thingswe learned from breastmilk”.

In Japan, a maternity health handbook contains anadvertisement for Morinaga’s Hagukumi togetherwith a packshot and the formula’s website at:

A leaflet in Japan comparesMorinaga’s ChirumiruAyumi follow-up formula(for use from nine months)with breastmilk, saying thatlike breastmilk, it containslactoferrin to help build re-sistance to disease.

www.hagukumi.ne.jp


estlé claims to be the world's largest and most diversified foodcompany, marketing its products in almost every country in theN

world. It has grown in the Americas and in Europe, mainly by buying upsmaller food companies, by joint ventures and take-overs. In 1985 Nestléacquired Carnation to win a share of the lucrative US baby food market.Later it bought the Wyeth division of baby foods in Canada.

In Asia, there are fewer companies to take over but Nestlé expects to growfaster on its own steam. At a press meeting in 2003, Nestlé pointed to the2.4 billion consumers in China and India combined and said it counted onChina to become the company's biggest market. Indonesia with 220million people is a big third in Nestlé's planning.

In terms of product development, Nestlé was quick to have seen thepotential growth of 'functional' foods compared to ‘normal’ foods.“Functional food”, Nestlé researchers say, “provides a specific health orperformance benefit over that of consuming a normal healthy diet” (sic).Its market grows at about 9% per year, versus 2% for ‘normal’ food.Instead of creating new brands, Nestlé has been adding a claimed healthbenefit to existing products and portrays those benefits through brandedactive ingredients or ‘logos’ such as “Prebio 1” or “Omega Plus”,“Comfort Proteins” and “Bifidus”.

In consumer reports, shareholder publications and in reports to the WHO,Nestlé claims to abide by the International Code. Evidence in this reportonce again shows otherwise. The consumer Boycott of Nestlé productscontinues in some 20 countries aiming to force the company to fulfill itspledge to comply with the Code. As a first step, Boycott organisers haveasked Nestlé to accept that the Code and Resolutions are minimumrequirements for all countries. The company refuses to do so.

In 1999 the UK Advertising Standards Authority ruled against Nestlé'sclaim that it markets infant formula 'ethically and responsibly'. In 2000the company refused to attend a European Parliament hearing into itsmarketing of baby foods. In January 2004, the UK Trading StandardsOffice asked retailers to stop displaying and selling US parentingmagazines containing advertisements for infant formula, includingNestlé brands.

Nestle's interpretation of the Code restricts the scope to infant formulaand follow-on formula by the same brand name. Even under this verylimited interpretation, Nestle ‘breaks the rules’ as demonstrated byevidence in this report. See Section 1.

Where national measures are inadequate or have expired, as is thecase in Armenia and Thailand, Nestle and other companies are quick toreturn to aggressive and competitive marketing tactics, including freeformula supplies to hospitals, samples for mothers, media advertising andseducing health workers with gifts. They only abide by the Codegrudgingly when forced.

In September 2001, Nestlé claimed it supported the WHO recommen-dation of exclusive breastfeeding for six months and would “changelabels of complementary foods, including infant cereals and jarred babyfoods currently marketed between 4 and 6 months” in more than 150“developing countries.”

Nestlé

Peter Brabeck-LetmatheCEONestlé S.A.Avenue Nestlé 55CH-1800 Vevey, SwitzerlandTel: +41 21 9242111Fax: +41 21 924 2813Website: www.nestle.com

FORMULA:Aletemil, Alfaré, AL110, CarnationAlsoy, Carnation Follow-up Soy,Alprem, Aletemil HA, Bear Brand,Beba, Beba HA, Beba Pre, BebaSensitive, Carnation Good Start,Carnation Follow-Up, Lactogen,Guigoz, Nan, Nan AR, Nan HA, NanSoya, Pre Nan, Nestogen, Nidal,Nidina and Pelargon.

COMPLEMENTARY FOODS:Alete, Alete HA Brei, Baby Menu,Cerelac, Nestlé Cereal, Nestlé CHE,Nestlé Legumes, Nestlé Bubur Susu,Nestlé Rice, Nestum, Nestlé PrimaInfanzia.

Products include:

Another new icon, Blue Bear, hasinvaded hospitals and shops aroundthe world. Blue Bear is conspicuouson all promotion for complementaryfoods and has become an instantlyrecognisable mascot even without thecompany name.

Violations by Nestle have been divided into two sections:Formulas and Complementary foods.

Logos & Icons:Nestlé’s trademark family of birdshave been fattened up and have nowbecome an icon on formula labelsand gift items.



NESTLÉ

Nestle and six months exclusive breastfeedingHealth campaigners have long been concerned about the promotion of products which encourage early weaning. In1994, the World Health Assembly passed a Resolution calling for action on "fostering appropriate complementaryfeeding practices from the age of about six months … emphasizing continued breastfeeding … and frequent feed-ing with safe and adequate amounts of local foods." This means that complementary foods should not be promotedfor use before the age of six months and that local foods can be an adequate complement to sustained breastfeeding.Because there was little action, in 1996 the World Health Assembly repeated its call and urged that "complementaryfoods are not marketed for or used in ways that undermine exclusive and sustained breastfeeding". Finally, in 2001the Assembly issued another recommendation on "six months" and only then Nestlé, as the market leader, an-nounced that it would comply.In April 2003 the company announced that it had "completed label changes on complementary foods to follow thesix-month recommendation". During their general monitoring, IBFAN observers have checked the age recommen-dations of all companies and provide evidence that the change promised by Nestlé finally occurred in many coun-tries but not in all. See Section 2 for continuing violations.It is hoped that Nestlé will abandon its double standard and apply the change in all countries, reflecting the univer-sality of the Code and subsequent Resolutions. Other companies would have to follow suit if Nestlé continues adecisive leadership role.However, at the end of 2003, Nestlé gave a large grant to the American Academy of Pediatrics (AAP) to pay for thecost of sending the AAP 2004 Pediatric Nutrition Handbook for free to over 50,000 doctors. The Handbook re-verses AAP's 2000 endorsement of "six months exclusive breastfeeding" by going back to the old “4 to 6 months.”The Handbook mentions “4 to 6 months” several times but has only one footnote to say that the AAP Section onBreastfeeding favours the 6-month recommendation. Double standards once again?

Section 1 – Promotion of formulas


Article 5.1 of the Code prohibits advertising and allother forms of promotion of products under the scope ofthe Code.

Article 5.2 and 5.4 of the Code prohibit companiesfrom giving samples and gifts to mothers.

In Argentina, a Nestlédistributor uses the Internet(www.etoledo.com.ar) topromote sales of Nan 1 and2, Nidina and Nestlécereals. The text includesan idealising statementwhich claims Nan 2 is a“maternalised milk”.

Nestlé gives free samples of Nan 1 in Bulgaria.

A magazine ad in Lithuania pro-moting Nan 2 shows an infanthand reaching for support from anadult.

In Switzerland, an advertisementBaby Nutrition from Nestlé in asupermarket magazine promotesBeba 2 and other products andstates that parents can be assured

“…that their child gets, at any step of his development,the nutrition precisely correspondent to his needs.From milk formulas to the delicious little completemenus…”. There is a picture of a happy mother andchild.

A parent’s magazine in Luxembourg advertises BebaSensitive special formula with the claim that “Bebais nearly lactose free and suitable for infants whoare sensitive to lactose” andthe product gives “the safefeeling to make the rightchoice.”

A French magazine ad says“Nidal Bifidus 2 thanksmothers for being themodel” thereby equatingits formula to mother’smilk.

Nestlé maintains a US web site: verybestbaby.comIt promotes Good Start formula with the slogan “It’sthe Good Start that will last a lifetime.”

The baby formulas section claims its Good Start“Comfort Proteins” are gentle on a baby’s tummy andare “patterned after breastmilk” containing the “rec-ommended levels of fat, carbohydrates, vitamins andminerals for baby’s first year.”

Breaking the Rules, Stretching the Rules 2004 NESTLÉ


The section on “Choosing a Formula For Your Baby”idealises bottle feeding by suggesting that “bottlefeeding offers another opportunity for you and otherfamily members to comfort your baby”. The sectionends with a promotional message “When choosing aroutine formula for your newborn, consider iron-for-tified Nestlé Good Start Supreme DHA & ARA”

Nan 2 is promoted asRoyal feeding in aclever ad in Kinderenmagazine, Netherlands.“Royal feeding” inDutch “Vorstvoeding”is only one letter awayfrom Borstvoeding(breastfeeding). The adappeared one monthafter the birth of aprincess in the RoyalDutch family. N.B.–Like in other EU countries,the Dutch law is weaker than theInternational Code and allows for advertising in publications specialisingin babycare. The International Code does NOT permit this. Nestlé’s ownInstructions forbid promotion of follow-up formula when the brand nameis the same as the infant formula name.

In an amazing flyer obtained on a city bus inGaborone, Botswana, Nestle violates every articleof the Code by showing that it does not!

In Thailand, Nestlé gives out samples like Lactogen1 and Nan 1 to mothers at home. Samples of BearBrand follow-up formula are given to mothers in anintroduction scheme where mothers are asked to pro-vide their friends’ contact information to Nestlé.

* Upon complaint, Nestlé claims that these leaflets were used to“educate their distributors and salespeople in South Africa.”



Nestlé sends sales reps to shops and supermarkets inFuzhou, Nanjing and Wuhan in China to promote Nanand Lactogen.

Fortnightly, Nestlé representatives leave promotionalmaterials on Nan products at a pharmacy in SanCristobal in the Dominican Republic. Employees re-ceive free samples for themselves and to pass on tocustomers.

In Indonesia, Nestlé promotes Lactogen and Nanthrough salespeople in pharmacies in Gowa andSidoardjo. It also offers discounts to customers buy-ing Nan 1 in shops in Surabaya.

In Thailand, Nestlé gives out samples of products likeLactogen 1 and Nan 1 to mothers in shops.

In Armenia, thereare special displaysof Nan. Posters ofthe blue bear logohave the slogan“Start with thebest.”

In Indonesia, a dis-play of Nan productsis prominently set upnear the entrance of ashop in Solo.

Nestle promotesNan HA 1 andNan 1 by organi-sing special salesin Taiwan.

In Malaysia, Nan2 sold out quicklywhen promoted asa special offer.

A supermarket maga-zine in Switzerlandpromotes a range ofNestlé formulas andcomplementary foodssuch as Beba 2 andBeba 2 HA and jarredfoods all recom-mended as suitable from four months.

The ad says “you don’t need to bea successor to the throne to be fedin a princely way.” “Nestle. For alllittle princes and princesses.”



NESTLÉ

Gifts to health workers

Article 7.3 provides that there should be no financial ormaterial inducement, to promote products.

In Colombia, Costa Rica and the Dominican Repub-lic, gifts such as mouse pads, diaries, clocks, prescrip-tion pads and stationeries, all with the Nestlé nameand logo, are distributed to health workers.

In Germany, Nestlé provides health workers with in-formation records used for the transfer of newbornsduring emergencies. The Alete brand logo appearsat the bottom of the sheet with the slogan “All thebest for your child”.

Promotion in health facilities:samples and supplies


In Thailand,

Nestle provides health facilities with free supplies ofLactogen 1, Nan 1, Nan HA and Bear Brand fol-low-up milk.

it recommends the use of its products by distributingpromotional materials and samples, offers services andgifts such as special classes on infant feeding andvideo tapes on pre-natal care such as “Guide for ex-pectant mother” to promote company loyalty amongwomen at a time when they are making infant feedingdecisions.

it persuades pregnant women and mothers to fill informs with their contact information and expected de-livery date so that specific product promotion can bemailed out at appropriate stages. Health facilities areasked to distribute samples and sign-up sheets tomothers.

In the Chinese provinces Fujian, Nanjing and Jiangsu,Nestlé donates unsolicited infant formula Nan 1 tohospitals including Baby Friendly ones.

In Argentina, mothers receive free samples of NanSoya in health facilities.

In Armenia, two 450 g tins ofAlfaré hypo-allergenic for-mula marked “sample for profes-sional evaluation” are routinelygiven to each patient in a resusci-tation unit. Doctors fill up requestforms but no evaluation is con-ducted.

In the Dominican Republic, Nestlé representativesprovide free infant formula for display in clinics whichthe paediatricians will then prescribe to mothers. Inone clinic, mothers received Nan 1 infant formulafrom nursing staff in the perinatal room and also Lac-togen, Nestogen and Nestlé Cereals elsewhere.

In Peru, Nestlé offers supplies of Nan.

In Indonesia, Nestlé is reported to have donated sup-plies of Nan 1 and Lactogen 1, either:

unsolicitedor upon request of health workersor as a sale without collecting paymentor at a hefty discount.

New mother with Lactogen 1 sample inIndonesia

The company alsodistributes samplesof Nan 1 andLactogen 1 tomothers throughIndonesian mid-wives. Nestlé repsthen call on newmothers at home toenquire whetherthey are still givingtheir babies Nestléproducts.

it actively promotes Nan 1 and Lactogen 1 to preg-nant women and mothers in health facilities; mothersare given samples purportedly to ‘help them savemoney.’

it distributesLactogen 1and Nan 1and gift packsthroughobstetricians,paediatricians,nurses andgeneralhealthworkers who passthem on to mothers.



In Armenia,

Nestlédistributes“Love my mom”baby suits to poly-clinics andmaternities.

Promotional leaf-lets on Nan aredistributed to poly-clinics and then passedon to mothers.

Nestlé distributes prescriptionforms to doctors in clinics inArmenia. The prescriptionsare given to mothers to taketo pharmacies where they pur-chase whatever Nestlé prod-uct is prescribed. Doctorsthen get a commission, report-edly about 10% of the sale.

A similar scheme is said to beoperating in Bulgaria wherethe commission is said to be 7%.

The NestléBlue Bearmascot ispositioned insuch a waythat theslogan reads“I love myNestlé mom”

Doctors fill in their name,

their clinic and the brand

to get a commission

Nestlé desk calendar implying medicalendorsement

In Serbia and Montenegro, Nestlé distributes table cal-endars as gifts to health workers.

Nestlé wall clocks are displayed in a South Africanhealth facility.

Nestlé in Nigeria givesout notepads to healthworkers. Each pagereminds them of theNestlé name and logowith a caption promotingthe company as “...theexperts in nutrition.”

In Indonesia,Nestlé distrib-utes posters,diaries, calen-dars, stationeryand materialson infant careand nutrition tohealth facilitieswhich are displayed in waiting rooms, nurseries anddoctors’ offices. Many of these materials contain pro-motional pictures and text for products such as Nanand Lactogen. Nestlé also provides gifts for distri-bution to mothers. Gifts vary depending on which classmothers are warded in.

Nestlé distributes many gifts to health workers in Thai-land which feature the company name with and with-out the logo of the ‘fattened birds’ – organisers, book-lets and growth charts, pregnancy cycle cards, candles,paper holders, toys, bags and pens.

Gifts tohealthworkers inThailand

In the UAE, Nestlé distributes every year expensivedesk and pocket diaries to health workers.

The inside pages of the 2004 diaries promote Nan 1, Nan 2,Cerelac and Neslac in the UAE

Nestlé apron worn by a health worker in Venezuela

In Venezuela, Nestlé distributes aprons with the com-pany name and logo to nurses and other workers inpaediatric wards.



NESTLÉ

Labelling


In most developing countries, Nestlé’s formula labelscomply with the Code to a large extent although theyuse small print for the required warnings. Several, how-ever, do violate Article 9 by comparing the product tobreastmilk and by using idealising statements such as:

In China, Nan 1 labels say“Choose quality food, chooseNestlé” and claim that theproduct is close to breastmilk.Nan 1 is idealised by the claimthat its low phosphorous contenthelps calcium absorption andpromotes the growth of Bifidusbacteria.

The Nan label in Finland claims that it “can be usedfrom birth as an addition to breastmilk or to substi-tute it” and that the “amino acid composition of theproduct has been renewed…able to reduce the amountof protein which is now closer to the protein level ofbreastmilk”.

In Mexico, Nestlé’s Nan 2 label and in Peru Nan 1claim the product have “new improved protein effi-ciency from start.”

In South Africa, the Lactogen 1 label suggests theproduct has the same benefits as breastmilk with theclaim that it "has all vitamins and minerals requiredby an infant for growth and development."

The Pelargon label in Tanzania promotes its higheracidic content as being able to aid digestion.

Nestlé occasionally fails to comply with the local lan-guage requirement on infant formula labels. In somecases, there is inaccurate translation. For example:

In Armenia,

the Alfaré label has instructions in 13 languages andtranslation is inconsistent. For example the statement:“Semi-elemental formula with low osmotic activity”in Russian reads as “semi-elemental formula with lowasthmatic activity” in Armenian.

Translation is also inconsistent on the Nestogen la-bel. In Russian, there is a statement that breastmilk isthe ideal nutrition for a“newborn”, meaning a babybelow one month, while in Armenian breastmilk issaid to be ideal for a “baby”.

Labels on Pre Nan, Nan Hypoallergenic 1, andPelargon in South Africa are only in English with-out the local languages as required by the Code.

Nan and Nestogenproducts in Armeniaand Georgia carry im-ages of a large feedingbottle on the label, thuspromoting the culture ofbottle-feeding. (bottleson labels are only al-lowed for illustrating themethod of preparation).

Nestle’s Nan 1 label in Zimbabwe which originatesfrom South Africa is not in the two main local lan-guages which are chiShona and isiNdebele.

Booklets and brochures for doctors proclaim thatbreastmilk is best for babies and the warnings aboutthe hazards of bottle feeding are there– in tiny print! – so legally, Nestlécomplies with the Code. In practice,promotion dominates by far.




Most Nestlé materials are marked “for the medical pro-fession” but they fail to meet the criteria set down underArticles 4.2 and & 7.2 The following are examples ofmaterials which fail to meet the mark and are often sup-plied in bulk and thus made freely available to mothers.

Argentina

Advertisements in professionaljournals and leaflets promoteNan as “the most complete,balanced and safe range of in-fant formulas” and “… clos-est to mother’s milk, at lowestprice”, “nutritive and naturalas your love” and “the mosteconomic starter formula”.

A Nan 2 promotion “Nutritionallysuperior to cow’s milk” whileNan HA says “Infant formulawhich prevents allergy”.



Armenia

A leaflet found in a paediatric hospital claims Nan isa fully adapted infant formula and is close to humanmilk in content and digestibility.

Nan leaflets – Nan: New with improved quality ofproteins and Nestlé Nan Acidophilic - distributed tohealth workers at a Nestlé conference make broadclaims comparing the product with breastmilk andcompare the growth of the breastfed child with onewho is fed new Nan. There are statements whichclaim that Nan promotes formation of bones, braindevelopment and visual acuity.

At a paediatric congress, a Nestlé poster and an ad-vertisement in a scientific journal both claim (liquid)Nan is “The most intelligent choice when it is neces-sary to replace breastmilk; so intelligent that it evenprepares itself.”

Promotion for health workers in Armenia

“My first CD” with songs from TheBeatles and sounds of laughter of littlebabies. This CD was distributed at theArgentinean Paediatrics Congress.Inside the case is a coupon to requestinfo about Nestle’s products forbabies.

Huge packshots dominatethe congress.

A Nestlé Nutrition booklet in Russian promotes thefull range of Nestlé infant formula, Nestogen, Nan,Alsoy, Alprem and Alfaré with a summary of microand macronutrients added to the products making themcloser to breastmilk, closer to nature and fully replac-ing breastmilk.

Warnings on back page in small print

Botswana

An 8-page book-let found in aBotswanan hos-pital proclaimsthat “Growingup is ThirstyWork” and pro-motes Lactogen1 “for the hungryfull term infant”and Lactogen 2 as “specifically adapted to the needsof infants on complementary food” and “high inbioavailable iron.”

A leaflet 37ºC in the shade claims that by usingPelargon “diarrhoea and its side effects are coun-teracted” but fails to explain the risks involved inartificial feeding where water is unsafe.

Another Chinese leaflet with a similar picture asks“Why the Nan baby’s bottom is not red?” Two of thebabies suffer red bottoms but the one fed on Nan doesnot, implying that Nan 2 with Bifidus can preventsore bottoms.

An advertisement in a professional journal promotesLactogen 1 and Lactogen 2by showing a colourfulsketch of children playingaccompanied by the slogan“Look! More and MoreLactogen Babies GrowHealthily and Happily”. Theadvertisement claims thatLactogen is the leadingbrand in China and usesadvanced technology in itsmanufacture. (see page 60)

China

A leaflet in a Chinese mater-nity ward, Nan healthy baby,the future will be evenbrighter claims that Nan 1 isthe only formula that is lowin phosphorus and closest tobreastmilk. The background issimilar to a Nan label.



NESTLÉ

Dominican Republic

A Nan leaflet in the waiting room of a paediatric clinicsays that “the best infant formulas have a composi-tion qualitatively and quantitatively adapted to hu-man milk”; “New Nan – optimum calcium phospho-rus ratio … in quantities closer to human milk”

A booklet “Nucleotides in infant nutrition” given tomothers in clinics states that “Nan 1 starter formulahas added nutrients to cover the needs of the new-born, among them nucleotides”. The booklet promotesNan 1 as equivalent to breastmilk.

Nan 1 booklet Importance of adequate protein inges-tion found in clinics bears the message - “Breastmilk:high quality protein; Nan 1: the appropriate alterna-tive”. There are tables comparing Nan 1 composi-tion to that of breastmilk. It claims that the stool pat-terns of babies fed on Nan 1 are similar to those fedon breastmilk.

A magazine advertisement for Nidina follow-up for-mula says “Give him all the protection he needs” anduses a baby picture to promote the use of Nidina asof four months.

Too little, too late – pursuant to complaints made to Nestlé China on thematerials marked on this page and on page 59, the company agreed toeither withdraw or amend the materials.

A Lactogen leafletstarts with the slo-gan “the naturalsmell of milk andDHA content makesyour baby healthyand smarter.” Thesame slogan alsoappears on a Nanleaflet. Nestlé denies it portrays bottle feeding asequivalent to breastfeeding and explains instead thatDHA oxidises easily and can develop a fish off-tasteand that Nestlé’s manufacturingprocess ensures the natural taste ofmilk is preserved.

Georgia

A Nan leaflet found in a doctor’s office claims thatits protein, carbohydrate, amino acid and mineral com-ponents are close to mother’s milk.

Germany

Booklets distributed to health workers at a perinatalconference in Berlin have many phrases discourag-ing breastfeeding or equating Nestlé products tobreastmilk. For example –

- a booklet titled Allergen-Low Infant Nutritionwith Alete displays a healthy infant on the frontpage with the motto “All the best for your child”.

- booklet for parents has advertisements forAletemil HA 1 & 2 and has the Alete slogan“All the best for your child”. There is a state-ment claiming that “Babies need allergen-lownutrition to prevent allergies. If there is notenough breastmilk, Aletemil HA is … the provenalternative from birth.”

- A booklet for parents – “Intensive care unit forinfants – advice for parents” advertises AleteHA Brei and features the Alete slogan “All thebest for your child”. Complementary feeding issuggested to start as early as four months.

- A daily nutrition booklet meant for parents rec-ommends the use of Alete complementary foodsfrom the fifth month and baby teas from the sec-ond week of life.

- A Beba booklet claims that it can solve infantcolic with its low lactose content.

Leaflets promoting Nestogen infant formula featur-ing a packshot of the product and a huge bottle andteat are found in health facilities,shops and pharmacies.

In Finland, a brochure aimed athealth care professionals comparesNan baby formula to breastmilk.

- A Beba Pre booklet uses phrases like “… his-tory of life-saving Nestlé products” to catch theattention and confidence of the reader. Text like“Beba Pre contains nucleotides modelled onbreastmilk” attempts to equate bottle feedingwith breastfeeding.

- A Beba Pre leaflet titled“Nestlé Beba Pre evennearer to the natural model”equates Beba to breastmilk.It also claims to containproteins “even closer now tomother’s milk.”

In Ghana, Nestlé reps persuade health workers of ababy-friendly hospital to accept Lactogen 1 and 2promotional leaflets on the grounds that HIV+ moth-ers, orphans, mentally sick or caesarean mothers

A Nan leaflet proclaims that“raising an intelligent child is nolonger an impossible dream”with Nan 1 and Nan 2 and thatthe Bifidus in Nan makes “ex-cellent baby”.



A leaflet found in a super-market in Arkhangelsk, Rus-sia promotes Nestogen andidealises the use of formulawith a large bottle printed onthe front and back of the leaf-let. Packshots of five otherproducts are shown – Nan,Alprem, AL110, Alsoy andAlfaré.

A six-page brochure–Nan 1 – The New Standard:Closer to the reference – inGhana is portrayed as sci-entific and factual informa-tion for health profession-als. It promotes Nan as hav-ing “a protein contentequivalent to the mean den-sity of mature breastmilkand an increased proteinquality closer to the nutrient composition of humanmilk.”

A booklet titled I amBreastfeeding my Baby is en-dorsed with the statementthat it is “Educational mate-rials for mothers for distri-bution by health profession-als only. Presented with com-pliments of Nestlé.” It con-tains misleading informationon breastfeeding and wasstopped from circulation by Ghanaian authorities inJune 2003 after complaints by health workers. InMarch 2004, the booklet, purportedly revised, is backin circulation but still has misleading information par-ticularly on positioning and attachment.

would need it. Thefront of the leafletshows packshots ofLactogen 1 and 2,while under Lacto-gen 1 it says “theright choice” andunder Lactogen 2,“Two feeds of Lactogen 2 a day provides the dailyprotection needs of the infant”.

A poster displayed in a pharmacy in South Africa –“The Lactogen range, the specialty range and intro-ducing the range of Nan” – shows a row of Lactogenand Nan products.

When closed, leaflet seems topromote breastfeeding ...

When opened, a differentstory unfolds!

Thailand

A Nan 1 brochure claims to have “new improved pro-tein efficiency” and starts with the statement that“breastmilk is best” with a page showing the face of ababy next to another page showing the mother’s breast.The leaflet opens up to symbolically separate the babyfrom the breast with a picture of Nan 1 and the state-ment that “Nan 1 is closer now than ever ...”

A Nan 1 brochure found in a Thai hospital claims theproduct “gives valuable nutrients which have com-plete benefits for baby from birth to one year.” It alsoequates the product with breastmilk by claiming that“the amino acid profile of Nan 1 is close to breastmilkand is suitable for the best growth”. The brochureuses the picture of a lovely healthy baby with the cap-tion “add value with quality protein…”.

A brochure Protect your baby from allergy shows apicture of a healthy looking baby with a happy fam-ily. The brochure states that if a mother is not able tobreastfeed, the risk of allergy in the baby will increaseand the alternative would be to use Nan HA formulawhich is similar to breastmilk.

Another Serbian brochure entitledNan 2 Follow-Up for Older Infantsshows a beautiful picture of a baby’shand clutching an adult’s finger to-gether with the Blue Bear mascoton a label of Nan 2. It couldsymbolise bonding. It also equatesbottle feeding to breastfeeding bystating that “Nan is the first choiceat the right moment”.

A Nan booklet found in a doctor’soffice in Serbia promotes its lac-tose-free formula by implying medi-cal endorsement of the product witha nurse’s cap and a stethoscope‘worn’ by a Nan tin.



NESTLÉ

Other brochures found in a hospital promote Nan HAunder different slogans such as “Protect your belovedbaby from allergy”, “Nan HA: for baby…there’s norisk involved.” All claim to decrease the risk of aller-gies in a child because of small molecules of proteinswhich ease digestion and absorption like breastmilk.A statement boldly equates Nan HA to breastmilk bystating that “If mother cannot breastfeed, risk of al-lergy will be increased. The other choice ishypoallergenic formula (HA) which is similar tobreastmilk.”

A leaflet given out at a perinatal conference offersfree membership of Nestlé’s Dear Mom Club whichcomes with the promise of programmes for motherand child and free gifts.

A selection of the many information materials for health professionalsinThailand – they are not restricted to scientific and factual matters.

A leaflet on Nan HA, Nan 1 and Nan 2 with a healthybaby picture idealises the use of the products with thecaption “Complete nutrition for healthy growth anddevelopment”.

A Nan 2 brochure, part of a set called Full of Lovefrom Mother’s Breast claims that it contains BifidusBL which promotes body resistance and prevents in-fection the same way as in breastfed children. An-other brochure in this set promotes Nan HA as simi-lar to breastmilk with a statement “Breastfed babyand/or Nan HA fed baby can reduce the incidence ofskin allergy”. It idealises Nan HA with a picture of ahealthy baby.

A leaflet on Nestlé Carnation Follow-up formula inTrinidad and Tobago claims that the product is a “nu-tritionally complete baby formula specially formu-lated for babies 4 months of age and older to ensureactive babies’ needs for calcium” and although“starter formulas are adequate for the first year,…Follow-up provides extra nutrition insurance”.“Priced to save parents up to 20% compared toEnfamil (Mead Johnson) and Similac (Abbott-Ross)”,it “helps promote the continued use of an iron-forti-fied formula throughout the first year of life”.

Nestlé promotes Lactogen 1by distributing a four-pagecard leaflet in health facilitiesin Vietnam. This leaflet haspackshots of Lactogen 1 with

Numerous copies of a leaflet found in a waiting roomof a community health centre in Trinidad andTobago describe the “unique characteristics” ofNestlé’s soy-based Carnation Alsoy - “nutritionallycomplete”and Carnation Follow-up Soy - “slightlysweeter taste than soy starter which increases com-pliance in infants”. Carnation Good Start is “de-signed to keep the osmolality similar to breastmilk”producing “stool consistency similar to breastfedinfants”and Carnation Follow-up is “ enriched withvitamins and minerals for healthy growth and devel-opment.”

Contrary to what the pictureshows, women in the Middle Eastdo not sleep in their head-dress.Guigoz claims credit for thepeaceful scene of both mother andbaby sound asleep (and far apart).

In the UAE, a brochurefor Guigoz 1 and Guigoz2 for the medical profes-sion specifically targetsmothers in the MiddleEast with claims that theimproved formula ad-dresses mother’s worriesregarding a list of com-mon ailments including“fever, coughs and colds,colic” and “baby not de-veloping normally:weight, walking and talk-ing, etc., baby not sleeping well”.

‘rays’ emanatingfrom a can andarching towardsthe baby’s brain,bones and bodyimplying theproduct is bene-ficial to the baby’sgrowth and deve-lopment.

63


IBFAN -- International Baby Food Action Network

In September 2001, Nestlé announced its support forResolution WHA 54.2 (2001) which recommendsexclusive breastfeeding for six months. The companypromised to change its labels in more than 150developing countries although the Code andsubsequent resolutions apply universally. Nestlé’sinitiative, however was welcomed as it showedgoodwill and leadership over other companies whichso far have ignored the need for label change.This section shows, unfortunately, that Nestlé was slowto fulfill its promises. Monitors in a dozen countriesstill found many labels and ads with the four-monthrecommendations which undermine exclusivebreastfeeding. The evidence recorded here is basedonly on reports after Nestlé’s April 2003 announcementthat it had “completed the change.”For reasons of space, we are not reporting on thegreat number of pre-April 2003 violations ofcomplementary foods promoted as breastmilksubstitutes.

• Another magazine advertisement shows a toddler anda whole range of eight Nestlé foods: three are rec-ommended from four months and a partially hiddenone is labelled from three months. (June 2003)

• In China, label changestook effect mid-2003. Evenso, in August 2003, anadvertisement in a scien-tific journal shows 15 veryyoung babies (below sixmonths) competing in aglobal baby competitionand with the winner beinga baby fed on cereals underthe Nestlé Nutrition Plan.

In Hong Kong

• Blue Bearstickers withpackshots of“Infant CerealRice” and“Infant CerealMilk” bothlabelled foruse from fourmonthsonwards aredistributed at the HongKong Baby Products Expo (Aug. 2003).

• In shops in Botswana, Nestum cereals labelled fromfour months are sold at a discount and advertised inweekly special sales flyers as newspaper inserts, hand-outs in stores, to homes and on the streets. (Aug 2003).By Jan. 2004, Nestlé cereals in Botswana were stilllabelled at four months.

• In Argentina, Nestlé promotessales of formula and comple-mentary food through(www.etoledo.com.ar). Nestlépurees are promoted as suitablefor use as of four months andNestlé cereals do not have anyage recommendation. (30 Oct 2003)

• Coupons with an attached application form to jointhe Nestlé Caring BB World are found in Hong Kong.Upon submission of the form, a free bib bearing thename of the baby is given as a gift. Cereals in HongKong are marketed for use at four months (Aug.2003).

Section 2 – Complementary foods promotedas breastmilk substitutes

In Bulgaria• An advertisement in a

magazine shows a happycouple with their baby on abeach with a pack shot ofBaby Menu recommendedfor use from four months(April 2003).


Article 5.1 of the Code prohibits advertising and all otherforms of promotion of products under the scope of the Code.


Upon complaint, Nestlé China argues that it is allowed to ad-vertise to health professionals (companies are only allowed toprovide factual and scientific information) but agrees neverthe-less not to continue with the ad.



NESTLÉ

contains a discount booklet with eight couponsworth a total of €4. (April 2003)

• In pharmacies in Milan, Italy, Nestlé aggressively pro-motes their Nestlé Prima Infanzia products throughthe use of special displays, piles of promotional ma-terials which encourage the use of the products as offour months, special occasion leaflets, special sales,discounts and shelf-talkers. (June 2003)

• A Lithuanian magazine adoffers a free pair of NestléBlue Bear socks in ex-change for a Blue Bear cutout from Nestlé cerealboxes. Some of the prod-ucts are recommendedfrom four months onwards.(April 2003)

In Malaysia,

• Free sample of Nestlé Rice Cereal recommends theproducts as suitable for use as of four months of age.(Nov. 2003)

• Shelf talkers promote NestléRice Cereal in supermarketswith the slogan “Nestlé BabyCereal, weaning babies forgenerations.” Label indicatesfour months. (April 2003)

In Serbia,

• An advertisement in a Serbian magazine recommendsweaning with Nestlé Rice Cereals from four months.(July 2003)

• A 24-page booklet deliv-ered to Italian homes presentsNestlé ready-to-use comple-mentary foods many of whichare recommended from fourmonths (April 2003).

• A community service bill-board in Indonesia remindsmothers to send their babiesto the community healthcentre and at the same time,advertises Nestlé milk por-ridge at four months withthe slogan “Growing Mo-ments, Nestlé Moments”.(April 2003)

• Nestlé set up a stall at a Baby/Children Products Expoin Hong Kong to give out coupons which indicate thatproducts are sold at special prices at the exhibition.When mothers fill in forms attached to the couponsthey may select to receive samples of Nestlé Cerealrecommended for use from four months or Neslacgrowing up milk. (Aug. 2003)

• A leaflet in Hong Kong entitled The Nestlé NutritionPlan promotes “The New Improved Formulation ofNestlé Infant Cereals” from “Stage 1” (from fourmonths) “so that your baby always gets the rightnutrition at the right moment of development”. TheBlue Bear mascot is featured with a bowl of cereal.(July 2003)

• In Italy, Nestlé sends outgift boxes of Nestlé Cerealsor Nestlé Prima Infanziapurees by mail to mothers.

“Dear Mom” letter emphasisingthe need to start baby oncomplementary foods, either

cereals or purees,as of four months.The letter fails tomention theimportance andbenefits of exclu-sive and sustainedbreastfeeding.The gift pack also

These gift boxes contain a

• A magazine advertisement for cereals with the sameslogan induces mothers to submit their particularson coupons which entitle them to receive free bibsfrom Nestlé. (July 2003)

• A leaflet headed“Nestlé: Why com-promise whenit’s the question ofbaby’s growth?”found in a Serbianshop advertisescomplementary foodsfrom four monthswith packshots of jarredfoods and a picture ofthe Blue Bear carrying asign with a big ‘4’ onred background.(July 2003)

65



• A Nestum Blue Bear leaflet fromTrinidad and Tobago talks aboutintroducing cereals from sixmonths but one of the packshotlabels has a four-month recom-mendation. (Nov. 2003)

• Nestlé CHEcereals in Chinaare recom-mended for fourmonths andshow a largebaby picture onlabel. (May2003)

• Nestlé’s infant juice labels in Switzerland recommendthe product for babies from four months. There is aspecial coupon on the label for collection of “bearpoints” in exchange for special offers. (July 2003)

• In Malawi, the Nestum label carries the age recom-mendation of four months. (July 2003)

• In Serbia where cereals arelabelled for four months, apharmacy gives out BlueBear car stickers to mothers.

before complementary foods are necessary. Nestlé’sBlue Bear features on different types of puree. Nestlénon-milk cereal label advises that “milk feeding,preferably with breastmilk should continue as longas possible” but recommends the product for babiesfrom four months. (April 2003)



Labelling

WHA Resolution 54.2 (2001) advises exclusivebreastfeeding for 6 months which means that the recommendedage for use of complementary foods cannot be under 6 months.

• In the Dominican Republic, mothers receive freesamples of Nestlé Cereals in health facilities(July 2003).

• In Indonesia, Nestlé put upa signboard for a maternityin Indonesia which fea-tures the names of Nestléand the Cerelac brand atthe entrance of a health fa-cility (April 2003).

• A prescription pad in a UnitedArab Emirates hospital showspack shots with check boxes andrecommends cereals and othercomplementary foods from fourmonths (Nov. 2003).

• Nestlé Prima Infanzia puree label in Italy recom-mends it for babies from the age of four months,

• Similarly, Nestléfruit puréelabel inIndonesia ispacked in acardboardcarton withmainlyFrench andEnglish texts. Worse, thecardboard packaging recommends use from sixmonths but the bottles inside the packaging havelabels which recommend four months. (Aug. 2003)

• In Vietnam,Nestlé fruitpurées arelabelled assuitable foruse fromfour months.Text on thecarton is inFrench buta sticker inVietnamese pasted over the bottle’s label showsonly the composition of the product.(Oct. 2003)

“four months” on its way out ...

The Blue Bear mascot for Nestlé’s complementary foods is quickly finding its way into neonatal,maternity and paediatric wards to promote brand recognition and tempt parents to introduce

complementary foods early. Several ads address new mothers.

Blue Bear comes in

Promotion in healthcare facilities

International Baby Food Action Network -- IBFAN

• Free 15gm sachets of infant cereals rec-ommended for use from four months areat the reception of a clinic in Malaysia.There is no limit to the amount that canbe taken by patients. Nestlé representa-tives also visit antenatal classes and dis-tribute door gifts comprising samplesand pamphlets of Nestlé Cereals.

• Nestlé distributes large Cerelac calendars to health facilitiesin the UAE and Russia where Blue Bear features as acommon denominator. Various packshots promote products.Cerelac is described as "a spoonful of love.”

• In Malaysia, Nestlé distrib-utes stacks of notepads tohealth facilities withcompany name and BlueBear mascot in variousposes.

UAE hospitalsreceive three-dimensionalembossed BlueBear calendars.

• Nestlé gives out ball-point pens with theNestlé name and the Blue Bear mascot tohealth workers in Armenia. The BlueBear icon promotes Nestlé’scereal products.

The ubiquitous Blue Bear in a variety of posesadorn boards like this in Chinese hospitals

• Many maternityand paediatrichospitals inChina havenotice boards oninfant care andfeeding. Thosesponsored byNestlé sportconspicuousBlue Bears.

Breaking the Rules, Stretching the Rules 2004NESTLÉ

66

• Unsuspecting healthprofessionals in Chinawere glad to use sheetafter sheet of BlueBear stickers onpaediatric doors andneonatal walls totallyunaware that thesedecorations wereclever advertise-ments for comple-mentary foodswhich their littlepatients would notneed for at least sixmonths or never.(WHO recommendshome-made comple-mentary foods out oflocal ingredients).

Blue Bear stickers coverthe entire glass door to aneonatal ward.

• A leaflet WhenLife’s Appetite isOn the Rise, foundin a doctor’s officein Serbia, featuresa child’s impres-sion of BlueBear. An ‘actual’Blue Bear ispictured on thefront while onthe back page isa feeding table advisingcomplementary feeding from four months.

• A leaflet in a Macedonian doctor’s office showsa range of Nestlé cereals recommended for useat four months. Other products on the leaflet in-cludes fruit juices and purées.

• A leaflet distributed at a paediatric confer-ence in Lithuania promotes the use of allNestlé products except for infant formula.Many Blue Bear cereals, purées and juicesare recommended from four months.

• Found in a doctors cabi-net in Georgia, a guidefor mothers shows pic-tures of an infant beingspoon-fed and a motherbottle-feeding her baby.Blue Bear wearing a bibreminds her of Nestlé ce-reals. The text discour-ages breastfeeding

“If you can’t breastfeedyour baby, use specialisedinfant feeding products,which are very close tobreastmilk.”

• A card “An Invitation to all New Mothers” found in aSingaporean clinic offers mothers to enrol in Nestlé’s InfantNutrition Plan; it requires contact information of mother andbaby’s birth details.

It promises a free sample upon enrolment andpromotes Nestlé products including fourcereals recommended forfour months.

• Nestlé gives mothers anintroductory copy ofNestlé Baby Newsmagazine in maternitiesin Switzerland and sendsupdates and promotionsby mail. The magazineadvertises its websitewhich shows a banner ofNestlé baby services andBlue Bear links toNestlé’s website.Nestlé Baby News website (top)


IBFAN -- International Baby Food Action Network 67


Nutricia

Jan BenninkChairman and CEORoyal NUMICO N.V.Rokkeveenseweg 492712 PJ ZoetermeerThe NetherlandsTel: +31 79 353 9000Fax: +31 79 353 9620Website: www.numico.com

FORMULA:NUTRICIA–Nutrilon, Nutrilon Premium,Nutrilon LF, Nutrilon Soya, Nutrilon AR,Nenatal, Nutriben, Nutricia Soya,Nutriprem, Bebelac, Bebelac EC,Kissing My Baby, Malish, Malutka,Nutricia Infacare, Vital Infantil, KAS1000, L-K Infantil, Bago Prematura.

COW & GATE–Cow & Gate Premium,Cow & Gate Follow-On, Cow & GateStep-Up, Cow & Gate Next Step, Cow &Gate 2 Plus, Omneo Comfort.

SARI HUSADA–SGM, Vitalac.

COMPLEMENTARY FOODS:Cow & Gate jar foods, Cereal Nutricia,Crème Nutricia, Nutrix, Bambix, SGM.

Products include:

utricia, the largest Dutch baby food manufacturer, belongs to theRoyal NUMICO holding company (1998) coined after Nutricia,N

the mother company, Milupa, a German baby food manufacturer(bought in 1995) and Cow & Gate, acquired by Nutricia in 1981. Therange of Bebelac products (formerly by Lyempf) are now marketedunder the Nutricia label. This report looks at all companies underNUMICO, except for Milupa which is analysed separately as it sticksto its own brand names and promotional schemes.

Debt burdened NUMICO has been undergoing a restructuring drive,after an expensive adventure into the North American vitaminbusiness. Divestment activities saw the sale (at a huge loss) of itsnutritional supplements subsidiaries, GNC (US), and Vitamex(Sweden). NUMICO now intends to once again focus on baby foodand clinical nutrition in order to become a “high-growth, high-margin specialised nutrition company”. It offloaded Nutricia India,described as a ‘low-margin start-up dairy and baby food operation’which saw losses in the first half of 2003 and also discontinuedMococa dairy production in Brazil.

Hoping to save costs on its baby food production in Western Europe,NUMICO plans to reduce its plants from 16 to 9 by 2005. Thecompany wants to take advantage of Poland’s entry into theEuropean Union by tripling production at its Polish plant. NutriciaPolska already exports 30% of its production to non-EU countriesbut will now increase exports into the EU.

Net sales in the baby food sector increased by 5.6% in 2003 to€1,016 million. The market grew especially in the UK, Ireland andBelgium. The growth outside Europe was even stronger, some 12%with Russia, Turkey and Indonesia being the top buyers. Most of thegrowth, production-wise, was in formula (7%) while cereals andjarred food only increased by 3%. In 2003, Nutricia Belgium wasforced to recall over 100,000 bottles of Olvarit baby food whenshards of glass were found in a bottle.

In February 2004, IBFAN was alerted to a commercial campaign byNutricia in China. The campaign, due to start in March, intended togive away 50,000 CDs with famous children’s songs in order toentice mothers to buy Nutricia baby formula. Nutricia’s Director inChina said: (with these CDs)… “we have gold in our hands”.IBFAN-ICDC launched a protest as the scheme was a clear violationof the Code as well as the Chinese law. Nutricia promised to modifythe campaign “to comply with Code” and at the time BTR goes topress, the CD campaign remains suspended.

NUMICO claims to abide by the International Code and has issued“Guiding Principles for the Marketing of Infant Formula”.Unfortunately these Principles only govern the marketing of “starterinfant formula”. This is clearly in contradiction of the scope of theCode which encompasses “all breastmilk substitutes”. The GuidingPrinciples also fall short of other minimum requirements set by theCode and fails to pay any attention to subsequent World HealthAssembly Resolutions which enjoy the same status as the Code.

Logos & Icons:

69



NUTRICIA

In Botswana, a store flyer distributed to homes, shops,motorists and pedestrians and as newspaper insertsoffers discounts for Nutricia Infacare products.


Article 5.1 of the Code prohibits advertising and all otherforms of promotion of products under the scope of theCode.

Article 5.2 and 5.4 of the Code prohibit companies

In Indonesia, company representative in shops claimNutrilon can provide the same nutrients as breastmilk,help the baby gain weight and promote the increaseof brain cells.

Ghana: Poster with two adorable babies shows Cow & Gate brand name andthe Nutricia logo to promote brand recognition. The company also offers“Buy 3 get 1 free” promotions for Cow & Gate Cereals for four-month oldinfants.

An ad for Crème Nutricia in thedaily Star newspaper in Malay-sia: “Perfect balance”.

Nutricia gives out leaflets in shops in Curaçao aboutformula products Nenatal, Nutrilon 1 and 2, Omneo,Nutrilon Lactose Free, Nutrilon Soya 1 and SoyaPlus 2. Other leaflets contain information on 3 dif-ferent types of Nutricia cereals: Cereal Nutricia,Crème Nutricia and Nutrix; all recommended from4 months.

In China, a magazine ad-vertisement – “Are yousure your baby will be ex-cellent?” – shows 3 rab-bits on a race track with 1rabbit way ahead imply-ing that excellence is dueto added DHA and fruc-tose, reasons for mother tochoose Kissing My Baby,by Nutricia.

An advertisement in a Chi-nese magazine shows ababy and the slogan “Kiss-ing my baby, giving moreconfidence” and packshots of Kissing My BabyFollow-up formula. Atthe bottom of the ad is aform to join the ‘KissingMy Baby’ club.

Also in Curaçao, Nutricia offers new mothers a free“Happy Baby Box” which they can obtain by pre-senting and stamping theirbaby’s birth certificate atthe distributor’s office.The box contains a pack-age of Nutrilon Follow-on (6-12 months), CerealNutricia (four months)Crème Nutricia (fourmonths) and gifts, such asa toy bear and a spoonbearing the Nutricia name.

In Indonesia, Sari Husada promotes its SGM 1 for-mula with special displays and shelf-talkers in super-markets.

The Parenthood magazine inMalaysia advertises CrèmeNutricia recommended for4-8 months.

Also in Indonesia, Nutricia setsup special displays at strategicplaces in supermarkets forproducts such as Bebelac,Nutrilon, Nutrilon Premiumand offers gifts with purchases.

In Ghana, special placards for Cow & Gate Cereals,recommended for infants as of 4 months are seen inmany shops.

Cow & Gate Follow-on is advertised on the HongKong TVB Jade Channel.

In China, Nutricia encourages sales of its productswith tie-in sales and offers towels with purchases.

Mothers in Indonesia in-tending to return to work re-ceive samples of NutrilonPremium 1, Crème Nutri-cia recommended from 4months and leaflets onNutricia Baby Club.



NUTRICIA



Article 7.4 allows samples to health workers only forresearch purposes. Health workers may not pass on samples.

Cow & Gate Step-Up andNext Step formulas (3 for 2promotion) are advertised in asupermarket in-house maga-zine (UK).

A shelf talker in aUK shop offers“New lower price”.

In the UK: fourCow & Gatebaby jar foodsfor the price ofthree. The jarsare labelledfrom 4 months.

This advertisement in the UKpromotes a new range ofdrinks which “introducesyour baby to new fruits andflavours, helping them to ex-pand their repertoire oftastes from an early age.Suitable for babies from 4months…”.

Temporary discountsare promotional andfollow-on milks arebreastmilk substitutes.

In the Netherlands,Nutricia took advantageof the birth of a Dutchprincess to offer specialgifts: all babies born onthe same date (7 Dec2003) received a giftpack including comple-mentary food for 8month-olds. Purchase of 10 Nutricia products (ex-cluding infant formula) allowed for a free gift ofroyal orange baby slippers.

This may not be a violation of the weaker Dutch lawbut it contravenes the International Code

Buy Nutricia baby foodand redeem gifts shownin the giraffe! (Malay-sian supermarket flyer).

Early weaning advo-cated on this leaflet formothers in Serbia:“Bebelac cereals for thefirst non-milk feeding at4 months.”

Bebelac poster inSerbian shop promotesformula. An ad with thesame picture is seen ina magazine in Bosnia &Herzegovina.

Health facilities in the Dominican Republic displayitems, which carry the Nutrilon, Nutricia Soya andNutriben brand names, in waiting rooms, paediatricwards and on office shelves.

Cow & Gate takes outadvertorials in the UK Baby& You magazine which pur-port to give weaning advicebut actually promote its newrange of baby drinks pro-moted from 4 months.

The UK parent’s website – www.ukparents.co.uk –contains a link to www.readymilk.co.uk/uk2shop.htm- which advertises pre-made Cow & Gate Premiumformula in sterilised disposable bottles with the head-ing “Making feeding easy – Ready Milk”.

Another advertorial in the UK Mother & Baby maga-zine appears as a Q&A from a mother but actuallypromotes Cow & Gate’s Omneo Comfort which isclaimed to be “specially formulated for babies withsensitive digestive systems.” The article shows a packshot of the product and asks the reader to enter into adraw to win ‘comfort packs’ – which includes a babysleeping bag and cuddle robe.

A tie-in-sale in the UK encourages mothers to buythree Cow & Gate formulas (including Premium 1and 2 Plus) and get one free.

Buy four – get one free!

71



NUTRICIA

Gift for mothers in Curaçao:baby passports have theNutricia company logo and theslogan “Nutricia Baby Feed-ing Specialists”. The state-ment on the importance ofbreastfeeding is included in aseparate sheet which willeasily fall out of the booklet.

Nutricia distributes many gifts to health workers suchas calendars, wall clocks, posters, pens, pencil cases,notebooks and growth charts bearing brand namessuch as Bebelac 1 together with the company logo.Most of these items are put up on walls or desks wherethere are seen by the public.

Nutricia delivers Christmas hampers asgifts to a clinic in Curaçao. The com-pany also supplies the clinic and a hos-pital in Curaçao with free formula.

In Argentina, Nutricia Bago provides unsolicited sup-plies of Kas 1000, L-K Infantil and Nutrilon Soyato health facilities. Health workers pass them on themothers as free samples.

Nutricia distributes unsolicited supplies of Nutrilonto health facilities in the Dominican Republic whichare subsequently distributed to mothers. Nutricia pre-sents gifts of calendars, and blocks of notepads tohealth workers, all of which contains either theBebelac 1 or Nutrilon brand names and the companyname and logo.

In Indonesia:

Company representatives visit mothers at health fa-cilities once or twice a month to promote Nutriciaproducts such as Bebelac.

Nutrilon 1 free sup-plies to this maternityclinic are passed on tomothers after delivery.

In one clinic, mothers are given free samples ofBebelac 1 on discharge. Company representativeslater telephone mothers to ask whether they are stillusing Bebelac.

Baby cot tags andpatient number cardsare supplied byNutricia to healthfacilities and beareither the Bebelac orthe Nutrilon brandname.

Health facilities displayclocks, calendars,posters and otherinformation advertisingNutricia products inwaiting rooms and onhealth workers’ desks.

Baby mattresses stamped with theNutricia name are also given.

A Bebelac healthrecord card

A leaflet – “Diarrhoea in infants” –found at a clinic in Curaçao (Carib-bean) claims that “Nutricia InfantFormulae are complete: they closelyresemble breastmilk, not only com-position, but also in absorptioncharacteristics.”

A maternityclinic inCuraçaodistributesCrème Nutriciabrochures which promote rice porridgefrom 4 months. The same facility givesout Nutricia bookmarks with colourfulpack shots of 7 different brands ofNutricia formulas.

Nutricia donates unsolicited supplies of Bebelac,Bebelac 1, Crème Nutricia, Nutrilon and NutrilonPremium 1 to health facilities. In some cases, sup-plies are provided at special discounts or invoices areissued but are not followed up with payment collec-tions. Elsewhere, Nutricia obligingly supply healthfacilities with Bebelacand Nutrilon upon re-ceiving requests fromthe facilities.



NUTRICIA

In Mexico, a poster in ahealth facility shows apicture of a baby andstates “Bebelac, the num-ber one for your baby”.

In Serbia, health facilitiesdisplay posters featuringthe Bebelac brand.

A Nutricia Infacare poster which says “That specialcloseness” is displayed in South African health fa-cilities in reception areas.

Nutricia provideshealth professionalsin the UAE withBebelac andNutrilon prescrip-tion pads. Theseshow pack shotsand brand nameswith little checkboxes for the doctor

Health workers in Serbia receive gifts such as deskcalendars, pens, diaries and notepads featuring theBebelac or Bebelac EC brand names.

A brochure on Bebelac 1 inUAE claims the product has “aunique vegetable fat mix for su-perior infant development” andthat “early supplementation ofvegetable fats can determinethe infant’s IQ level.”

to tick. The flipside of the pads contain morepromotion and claims such as “Nutricia Prebiotics”produces a “bifidogenic effect similar to that ofbreastmilk”.

Sari Husada frequently do-nates gifts such as baby cottags, baby feeding schedules,beddings, briefcases, informa-tion materials, leaflets, immu-nisation tables, growth charts,wall clocks, water dispensers,posters, notebooks and stick-ers to health workers. Theseitems carry brand names offormulas such as Vitalac 1 or

Sari Husada also provides health facilities with unso-licited supplies of SGM, SGM 1 and Vitalac 1. Theseare then passed on to mothers. What brand of for-mula mothers receive depends on the ward class theyare in. Mothers in first class wards receive more ex-pensive brands.

In Peru, Bago Sancor donates unsolicited suppliesof Bago Prematura and Sancor Bebe to health fa-cilities, including BFHI accredited ones, and moth-ers receive free tins of Sancor Bebe from healthworkers.

In one health facil-ity, a NutriciaParents’Guide onEntertaining andEducating YoungChildren advertisesCrème Nutriciastarting from 4months as “theperfect balance”(back cover).

In Malaysia, Nutriciaprovides unsolicitedsupplies of Bebelac 1and Bebelac EC to pri-vate clinics which thendistribute them as freesamples.

A desktop calendar given tohealth workers in the UAEshows a father cradling ababy and five pack shots ofthe Bebelac range of formu-las with a different colourscheme for each month rep-resenting the

shades of the five differentBebelac labels.

Health facilities displayproducts such as Nutri-lon and Nenatal inwards, health worker’soffices and, ironically, inbreastfeeding rooms formothers.

2 or SGM. One finds them in waiting rooms, exami-nation rooms and in front of delivery rooms.

73



NUTRICIA

Labelling

Article 9 of the Code requires labels to NOT discouragebreastfeeding and to inform about the correct use of the pro-



Highlights of text and picturesin company materials which

violate the Code

In Argentina, the labels of Nutrilon Soya, NutrilonPremium, Kas 1000 and L-K Infantil and VitalInfantil 1 do not have a warning about health haz-

The label of Crema Nutricia in Costa Rica indicatesit is suitable for infants from 4 months.

The Bebelac 1 label in the Dominican Republic andMexico discourages exclusive breastfeeding with astatement that the product should be given “whenbreastfeeding is not possible or is insufficient”

Sari Husada’s SGM 1 label in Indonesia recommendscomplementary feeding as of 4 months and promotesthe use of its SNM porridge.

The label on Cow & Gate’s Omneo Comfort in SouthAfrica compares the product with breastmilk: “Stools ofan infant fed with breastmilk are soft and lighter incolour” and “when using Omneo Comfort, if changingfrom another formula, you may find that baby’s stoolbecome softer and lighter”. The text is only in English.

Labels on Infacare 1 in SouthAfrica and Tanzania claim it is a“…scientifically constitutedpowdered infant formula. It isbased on analysis of breastmilkto support your baby’s healthygrowth”. The text is only in En-glish, not, as required, in the lo-cal languages.

The label of Bebelacinfant juice in Serbiarecommends the prod-uct for use from 4months.

In Italy, the Nutrilon AR la-bel shows a large feedingbottle and does not havea warning on the healthhazards of inappropriatepreparation.

A Nutrilon bookleton prebiotics inArgentina makesNutrilon out to besimilar to breast-milk and claims that“prebiotics stimulatethe growth of theintestinal flora, predominantly bifidusbacteria, promoting normal stool consistency”.

Labels on Malish andMalutka in Georgia andMalish in Armenia do notcontain the importantnotice that breastfeeding isbest nor a warning on thehealth hazards of inappro-priate preparation.

In Indonesia, Vitalac’s label does not contain a warn-ing about the health hazards of inappropriate prepa-ration of the formula and that it should only be usedon a health worker’s advice.

duct, the risk of misuse and abide by anumber of other points.

The Vital Infantil 2 follow-up for-mula label discourages continuedbreastfeeding by suggesting that asof 6 months, babies no longer getbreastmilk so require a special tran-sition milk food “ like this one …”

ards of inappropriate prepa-ration and the statement thatthe product should be usedonly on the advice of a healthworker.

Nutrilon Soya infant formula advises on its label inthe Dominican Republic that complementary foodsshould be introduced as of 4 months. Nutrilon 2 inIndonesia does the same.

In Luxembourg, theBambix non-milk cerealdisplays a picture of ababy and recommendsthe product for “1st age”babies. On the backpanel, it says it is “idealfor bottle-feeding fromfour months.”



NUTRICIA

“Nurturing a healthy littlebaby” is how this Nutricialeaflet from Hong Kongpromotes Cow & GateFollow-On 2.

Nutricia distributes Nutrilon Omneo leaflets at a sci-entific congress in Costa Rica which shows picturesof babies and the promotional message “…stools ofoptimal consistence, similar to those of breastfed in-fants” and claims it is a “balanced food in case ofgastrointestinal troubles”.

A Nutrilon booklet in a Dominican Republic healthfacility says “In many cases, it is recommended toreplace breastfeeding with bottle feeding, following

An Indonesian leaflet onBebelac 1 claims it is asgood as breastmilk and thatbabies fed on the productwill be healthy and bright.

A Cow & Gate ad in the Com-munity Practitioner in theUK invites health profession-als to contact them.

Ad in the same journal promotesCow & Gate Premium as “nu-tritionally complete” with a“unique calcium : phosphorousratio for healthy bones for life”...“the first choice to promotehealthy growth when notbreastfeeding”.

The bulletin of the ArgentinePerinatal Association shows awell known doctor with threepack shots of Vital Infantil 1and claims the products to be“the safest formula that pro-vides essential nutrients, eas-ily digestible fats, etc…” .

Nutricia gives out mouse padsto health workers in Argentinacontaining a Nutricia Bagologo and the text “Doctor, yousee? Both in infant nutritionas when you work on yourcomputer, I am your bestsupport”.

Another ad on theback of the same pub-lication says “VitalInfantil 1: the for-mula with a strongimpact on infant feed-ing from birth”. TheVital bear breaks through a barrier and proclaims that“if baby takes this milk, he will also be strong…”

Also, a Nutriben leaflet in the Dominican Republicclaims the formula is similar to breastmilk in terms ofits lipids profile, calorie distribution, carotene andtaurine content.

“Complete balance beginshere” – an ad in the Indone-sian Ayahbunda magazine pro-motes Crème Nutricia begin-ning from 4 months.

A Nutricia calendar in an In-donesian health facility pro-motes products for infants,pregnant or lactating moth-

An Infacare ad in Indiasays“Now I can tickle mybaby’s taste buds withsome great nutrition”.

ers. A picture of a happy infant accompanies the slo-gan “Always there at every step of a mother’s andbaby’s life”.

In Ghana, Cow & Gate pre-scription pads recommendsfour cereal products fromfour months. Free samplesof cereals are given tohealth workers.

Cow & Gate company representatives give freesamples of cereals to Ghanaian health workers

In Hong Kong, Nutri-cia invites mothers tojoin the Cow & Gatebaby club and receivegifts.

a weekly progression” withoutstating specifically in what situ-ation this is required.

A booklet on Vital Infantil 1,

sorbed fats, similar to those in breastmilk”.

showing the same doctor andthe text “We know you carefor all kids as if they wereyour own” claims “goodnessof easily digested and ab-


ounded in 1925, Snow Brand is one of Japan’s major baby milkcompanies. It produces a wide range of products, from dairy toSnow F

alcoholic beverages and livestock feed. Snow does biotech research andis reported to have cloned a calf from its mother’s milk.

Snow uses its company name as a brand name on most of its products,promoting brand recognition every time the company name is used. Itintroduced the Smart Baby and Smart Kid brands to capitalise onparents’ desire for smart children.

Snow has been involved in a record number of Japan’s food scandals. In2000, thousands suffered food poisoning from Snow Brand milk whichcaused a huge public outcry and was Japan’s worst contamination casefor over 30 years. In 2001 Snow was discovered to have purchased 13.8tonnes of Australian beef, repackaged it as Japanese beef and thenclaimed compensation from the Japanese government for having excessbeef that could not be sold. In 2002 the company admitted fiddling withthe expiry dates on 760 tonnes of frozen butter. No wonder that manysupermarkets pulled all Snow products from their shelves.

In an attempt to regain consumer confidence, Snow is said to havejoined forces with Nestlé Japan to produce baby foods. In 2002, Snowwas still in financial trouble and reported to seek additional loans fromthe Norinchukin Bank. By 2003, the market was ‘up’ again. SnowBrand bought Bean Stalk from a pharmaceutical company and wasdoing well selling Bean Stalk Pocar baby isotonic drinks. Clevermarketing convinces mothers that their babies need such re-hydrationdrinks to replace electrolytes lost during perspiration!

Kohei NishiPresident and CEOSnow Brand13 Honshio-cho, Shinjuku-kuTokyo 160-8575, JapanTel: +81 3 3226 2158Fax: +81 3 3226 2150URL: www.snowbrand.co.jp

FORMULA:Snow Brand A1, Snow Brand F,Snow Brand F2, Snow Brand F Plus,Snow Brand P7L Beta, Smart Baby 1,Smart Baby 2.

Products include:

Logos & Icons:Snow products and materials bear thesame Snow logo. Bunny and Bearicons appear on labels of someproducts and promotional materials.


WHA Resolution 47.5 (1994) urges an end to free or subsidised donationsof products to all parts of the health care system.

Article 7.4 allows samples to health workers but only for research purposes.Health workers may not pass on any samples.

Snow gives health workers in Thai-land gifts such as clocks, calendars,pens and notepads featuring the SnowBrand company and brand name.

Article 6.3 prohibits the display of products,placards and posters or the distribution ofcompany materials unless requested orapproved by government.

Health facilities in Thailand dis-play Snow Brand posters andother promotional materials.

Wall poster clock

In Thailand Snow donates sup-plies of Snow Brand P7L Betato health facilities, both on requestand unsolicited.



SNOW

Company representatives inThailand give health workersSnow Brand F and SnowBrand P7L Beta samples thatare passed on to mothers.

Snow gives health workers inThailand sign-up sheets to dis-tribute among mothers, en-abling the company to contactthem directly with futurepromotions.

Snow seeks direct contact withmothers at health facilities in Thai-land to recommend Snow Brandproducts and to give samples and

Snow gives cash grants tohealth facilities in Thailandand pushes its products andpromotional materials at pro-fessional meetings.

Article 7.3 provides that thereshould be no financial or materialinducement, to promote productswithin the scope of the Code.

Promotional materials in Thailand contain messagesthat undermine breastfeeding like “when formulais necessary”, “when a mother cannot breastfeed”and advice on supplementing breastfeeding withbottle feeding.

Promotional materials inThailand compare Snowproducts to breastmilk, suchas this booklet that claims thecomposition of Snow BrandP7L Beta is based on re-search on the breastmilk ofJapanese mothers. Anotherbooklet compares its ratio ofomega 3 and 6 with that ofbreastmilk.

Several brochures inThailand claim SnowBrand P7L Beta encour-ages good bowel move-ments with the addition ofoligosaccharide. This ex-ample tells mothers“Don’t let your baby getconstipation” and showsa packshot of SnowBrand P7L Beta.

Bad advice in a booklet entitled Hello Baby in Thai-land claims that weight gain slows when baby is onemonth old and mothers should know that their milk isnot enough and start giving formula.

A leaflet in Hong Kong features on the front page thecartoon teddy bears from Snow’s Smart Baby 1 la-

gifts. Typicalgift pouchescontain a tinof SnowBrand P7LBeta, a baby’s

bonnet, and a booklet titled 7 in-teresting topics for your belovedchild, reinforcing the “7” in thebrand name.

In Hong Kong a discount on Snow’sSmart Baby 2 is advertised in thelocal Ming Pao newspaper.

In Thailand Snow provides shopswith baby gloves and baby socksto give out when customers buySnow products.

bel and the slo-gan “Especiallyfor newborn”. Italso shows apackshot and amother and babyand outlines theproduct’s nutri-ent composition.


Article 5.3 of the Code bans promotional devices atthe retail level.






yeth started as a small drugstore around 1860 in Philadelphia,USA. As Wyeth Laboratories, it later became the first toWyeth W

‘advance manufacture’ frequently prescribed medicines in bulk. In1931, American Home Products (AHP) bought the rights to Wyeth,which had been bequeathed to Harvard University.

SMA is said to be the first commercial ‘infant formula’, produced in1921. By 1933, Wyeth introduced Beta-carotene in formula (branddesigners returned to the carrot-image in the next century) In 1961, thecompany launched its whey-dominant infant formula, S-26, claiming itwas close to breastmilk. Promil started in 1981, as the first ‘follow-upmilk’ (6 months – 1 year) in North America. It was followed byProgress (1 year to 4 years) in 1993.

While S-26 was doing well in export markets, competition was tough inthe US where Mead-Johnson and Abbott Ross control 86% of thenational market. To undercut the two giants, Wyeth went into “storebrands”. These are formulas produced for large supermarket chains whoapply their own label and sell the formula for up to 40% less than theestablished Enfamil and Similac brands.

Wyeth produces and markets formulas in more than 100 countries. Itssubsidiary in the UK was renamed SMA Nutrition, mixing company andbrand names. All of Wyeth’s major brands: SMA, S-26, Promil andProgress tout a “Gold” line with claims that added fatty acids promotebrain development, immunity and growth. They also use the catchphrase: “Never so close to breastmilk”.

Like most of the other large companies, Wyeth has cashed in on thepresumed benefits of adding LCPUFAs (long chain polyunsaturatedfatty acids) to its formulas. A prominent feature of its promotion arepictures of babies (and carrots) wearing a mortarboard, signifyingintelligence and academic excellence following intake of DHA and AA,the fatty acids Wyeth has added to its formulas. Recent studies haveshown that these claims are bogus and Mead Johnson has already beenforced to withdraw them in Canada.

In August 2001, Wyeth recalled SMA Gold and White formulas in theUK after a severe case of infant botulism was linked to contaminatedSMA Gold. While the recall was widely publicized in the UK andIreland, the same batch of formula had also been distributed in SriLanka, Thailand, Ghana and Nigeria and it is not clear whether thepublic in those countries was alerted. Then, in December 2002, Wyethrecalled 1 million tins of both milk and soy-based formulas expiring in2005, after FDA found Enterobacter Sakazakii in samples it tested.Another 500,000 tins of the same batch (all destined for US storebrands) had not yet left the factory in Vermont, USA.

In July 2003, SMA Nutrition, the UK subsidiary of Wyeth, was foundguilty by the Birmingham Magistrates Court on six separate counts ofillegal advertising and ordered to pay £60,000 in fines and costs. Inarriving at a guilty verdict on all six summonses, the judge said that thecompany has deliberately “crossed the line” in an effort to advertisedirectly to a vulnerable section of society. The initial charges werebrought by the Trading Standards Department of Birmingham Cityfollowing complaints by mothers who felt that SMA’s advertising brokethe UK Law as well as the International Code.

Robert EssnerChairman, President and CEOWyeth (American Home Products)P O Box 8616, PhiladelphiaPA 19101, USATel: +1 610 902 4100Fax: +1 610 688 6228URL: www.wyeth.com

FORMULA:S-26, S-26 Gold, S-26 Promil, S-26Promil Gold, S-26 HA, SMA, SMA 1,SMA White, SMA Gold, SMA Wysoy,Infasoy, Promil, Promil Gold,Progress, Progress Gold. StoreBrands: Baby basics, CVS, Home Best,Healthy Baby, Kozy Kids, Hill CountryFare, HEB, Little Ones, Parent’sChoice, Safeway Select, Walgreen’s.

Products include:

Logos & Icons:Wyeth promotion in Asia and SouthAfrica uses cartoon carrots, wearingbaby booties and gloves, and croppingup in advertisements, printed materials,on clocks and signboards. The carrotsseem to have taken over from Wyeth’scartoon babies which used to dominateadvertisements.

Added fatty-acids areprojected as health benefits.





In Argentina, Wyeth advertises S-26 via the radio.

Posters, shelf-talkers and leaflets promote Wyeth prod-ucts in shops in China.The“Wyeth Golden Star” is acontest for babies who have been fed S-26 for morethan 6 months.

Front of contest leaflet.

Flipside of contest leaflet.

In China, company reps visit shops to promote S-26.

Baby nappies, napkins, toy bricks and picture booksare given with purchases of S-26 in China.

In Botswana, store flyers advertising discounts for S-26are put into newspapers and distributed as junk mail.

Discounts on products areadvertised in a Hong Kongnewspaper.

A Promil Gold leaflet inHong Kong offers a free giftwith every purchase and in-cludes a portion to sign upfor membership withWyeth’s baby club to receivefurther promotions.

In China, Wyeth mails promotional materials andnewsletters tomothers. A Chi-nese leaflet pro-motes S-26 withthe slogan “Wyethbaby, great fu-ture” and showsa picture of ababy.

A Mexican website promotes SMA Gold and PromilGold. It advises that breastfeeding or formula feed-ing provide all that baby needs in the first months oflife (equating their formula to breastfeeding).

Special displays in Indonesian shops promote S-26and S-26 Gold. Sales reps encourage mothers to tryS-26 or S-26 Gold by claiming their added DHA &AA content makes the products similar to breastmilk.Mothers can give their address to receive more ‘in-formation’ materials.

WYETH

In Mexico, promotional trays for SMA Gold, PromilGold and Progress Gold bears the slogan “Feedingthe hopes of the future”. SMA Gold infantformula is representedmerely by the word“Gold” following Wy-eth’s narrow interpreta-tion that the Code appliesonly to infant formula.

An advertisement in Singa-pore’s Motherhood magazine“Win! Wyeth Promil Gold andProgress Gold milk powderworth $1190.40” asks moth-ers to submit coupons to beamong 48 readers to win a tinof each product.

An advertisement forPromil Gold in theMotherhood magazinein Singapore shows ababy correctly fittingshapes into their corre-sponding holes, and

claims the product is “Enriched with preformed AA,DHA, natural carotenoids, nucleotides & seleniumthat help mental and physical development”. Wyethidealises the formula by saying “your dream of a fu-ture scientist in the family may not be just a dream”.

Wyeth runs advertisementson Chinese TV showing ayoung girl putting S-26 in hermother’s shopping cart, withthe commentary “the reasonwhy a bright 4-year old girlcan speak 4 foreign lan-guages,… (is that she) drinksS-26 for 3 years and 9months”.



In Peru, Wyeth gives dis-

In the UK, shelf-talkersannounce discountedprices offered for SMAGold and SMA Pro-gress.

S-26 Gold is displayed inpharmacy shop windowswith price discount offersin Uruguay.

counts to customers who purchase S-26 infant formula.

An advertisement in the UKmagazine Baby & Youshows three cute babies ofdifferent races and thephrase “SMA Progress is asindividual as they are” andmakes the c la im “SMAProgress is the only onewith the optimum balance ofiron and Vitamin C”.

Wyeth holds special sales for its S-26, S-26 Promiland S-26 Promil Gold in Thai department stores.

A supermarket flyer in HongKong advertises Promil Goldwith a $5 discount if purchasedtogether with Huggies diapers.

In Mexico, Wyeth distributesleaflets to mothers in shops,

promoting SMA Gold as“Closer to mother’smilk” and “the mostnatural after mother’smilk” recommended“when your baby is 6months old. Congratu-lations!”



Article 6.3 prohibits the display of products, placards andposters or the distribution of company materials unlessrequested or approved by government.

S-26 promotional materi-als are displayed in ma-ternity wards and on no-tice boards and shelves inhealth facilities in China.

A large South African advertisement announces newpackaging of 6 brands of Wyeth baby foods by show-ing a child reading a Wyeth newspaper: “HOT NEWS!Wyeth Nutritionals’ babies just got a face-lift”. Apackshot panel displayed next to it claims that theproducts “help ensure growth, promote health and

aid physical,mental andemotional de-velopment andwell-being” .Leaflets in adietitian’s of-fice use thesame picture. St

icke

rs

Leaflets

WYETH

In Argentina, Wyeth donated baby scale covers with adrawing of Wyeth’s cartoon baby, as well as cot cov-ers with a big S-26 logo in the middle.

Cot cover

Baby

sca

le c

over

S-26 key chainsgiven to health work-ers in Argentinacome with fridgemagnets proclaiming“Look how easy andfast you can prepareS-26 Gold” and showa mother bottle-feed-ing an infant. Themagnet is put up for display in the health facility.



Company reps visit mothers at health facilities inThailand to distribute samples of S-26.

A bookmark found in a HongKong health facility shows apackshot of S-26 and a babywearing a graduation cap.

Posters advertising a range of Wyeth products aredisplayed in South African health facilities.

Health workers in Indonesiagive samples of Promil follow-up formula to breastfeedingmothers even though their ba-bies are only 3 months old.

Wyeth posters, booklets on baby care, immunisationcards and other materials can be found in health fa-cilities in Malaysia.

Wyeth distributes note andprescription pads withmixing instructions forS-26 to health workers inTrinidad and Tobago.

UK health facilities display booklets promoting SMAProgress.

In China, Wyeth donates display shelves and calen-dars with the S-26 brand and the company logo tohealth facilities.

In Thailand, company repsvisit mothers in health facili-ties to gather addresses and torecommend the use of theirproducts.

A table toilet paper dispenser ina Thai health facility is made toresemble a can of S-26.

In Uruguay, an S-26 Gold ad-vertisement in a scientific jour-nal claims the product “con-tains long-chain polyunsatu-rated fatty acids, the same asbreastmilk”.

Clocks and other items with theWyeth logo and brand namesare displayed on nursescounters, in paediatricians’ of-fices, waiting rooms and maternity wards in Thailand.

The company distributes calendars and stationery withthe company name and logo or the S-26 brand nameor both to health workers in Thailand.

In Colombia, health facilities get a discount on S-26formula when ordered together with other products.

In Peru health workers receive S-26 calendars andnotepads with the Promil brand name.

Company reps give out product brochures to mothersat Thai health facilities. Sometimes, gift packs con-taining a tin of S-26 and brochures are given.

Prod

uct b

roch

ure

Gift packs

In South Africa, Wyeth distributed the“WyethNutritionals Reassurance Beyond Nutrition” folderto participants at the Sensitive Midwifery Symposium.The inside cover has an advertisement for a wide rangeof Wyeth infant formula products.

In the UAE, Wyeth giveswatches with the company logoto health workers.

Wyeth donates cot tags, posters and other items withtheir name and logo to health facilities in Peru; otheritems are displayed in obstetric stations and paediat-ric emergency areas.

Health workers in the Dominican Republic and Perugive free samples of S-26 Gold and SMA to mothers.

In Uruguay, Wyeth gives healthworkers prescription pads withpictures of a mother and herbaby, of S-26 Gold and a babyholding a tin of S-26 Gold.

WYETH



WHA Resolution 47.5 (1994) urgesan end to free or subsidised donationsof products to all parts of the healthcare system.

Many health facilities receive unsolicited free sup-plies of S-26 and S-26 Gold from Wyeth in Peru.

In Indonesia, Wyeth sometimes invoices health facili-ties for supplies of S-26, but does not collect payment.Wyeth also gives unsolicited free supplies of S-26 tohealth facilities. In one hospital first class patientsreceive a gift pack which includes a sample of S-26infant formula. Some health facilities receive suppliesof S-26 at discounted prices.

In the Dominican Republic, Wyeth donates unsolic-ited supplies of SMA to health facilities.

Labelling

Article 9 of the Code requires labels to NOT discouragebreastfeeding and to inform about the correct use of the pro-duct, the risk of misuse and abide by a number of other points.

The label of S-26 in Indonesia claims that it containsimportant nutrients vital for optimal growth and de-velopment, but does not mention the benefits ofbreastfeeding nor the need to consult a health worker.

S-26 and SMA White labels in Kenya are in Englishonly. The latter say “More satisfying for hungrierbabies” implying breastmilk is insufficient. The samemessage appears on labels in the Gambia.

SMA Gold labels inKenya are in Englishonly and say “Noweven closer to breast-milk”.

In Malawi, labels of SMA are not written in the na-tional language and omit the statement that the prod-uct should only be used on the advice of a healthworker.

SMA-Wysoy’s label in Kenya shows a picture of afeeding bottle and teat.

A range of Wyeth Nutritionals products in South Af-rica including S-26 1, S-26 Gold, S-26 Promil, SMA1 and Infasoy 1 carry statements like “Breastfeedingfor babies is best from birth to 6 months” or“Breastfeeding for babies is best from 6-12” whichmay confuse mothers and others.

In Mexico, a freesample of Wyeth’sPromil Gold hasan insert under thelid showing a babyand slogans like -‘Now the future ofyour baby can beas brilliant asgold” and “ Forbabies that devourthe world”.

Labels of S-26 in Tanzaniaclaim it is “closer to humanmilk in its nutritional valueswhen compared to other formu-las…” and contain confusingage recommendations.

In Tanzania, the SMA Goldlabel states that it is “…even

closer to breastmilk”, claims that “…the balance ofmilk proteins are similar to that found in breastmilk”and advertises other SMA products.




An advertisement in “Com-munity Practitioner” in theUK shows packshots of SMAGold and SMA Whiteagainst a backdrop of a poolof milk with drops of ‘nucle-otide’ falling into it. The ac-companying text reads “al-ways looking for ways tobring our infant formulacloser to breastmilk”.

WYETH

Wyeth regularly donates unsolic-ited supplies of S-26, S-26 Goldand Promil Gold to health facili-ties in Thailand. The companytakes turns with other milk com-

panies to provide free supplies to health facilities.



The My baby book in the Dominican Republic says“Your doctor recommends a Wyeth formula (S-26 orSMA). Wyeth provides essential nutrients closest tothose of mother’s milk”.

WYETH

In Singapore, a leaflet en-titled “Promil Gold - 7IQ points advantage”promotes the IQ advan-tage of the product overother foods and milks. Itclaims to be Singapore’sfirst follow-on formulafortified with both AA &DHA.

A leaflet in Hong Kong claims “breakthrough in in-fant formula”,showing a graph comparing breastmilk,S-26 and one Brand A+. S-26 appears most similarto breastmilk.

The Wyeth Golden Baby, high achievement in the fu-ture leaflet given out at the International Baby/Chil-dren Products Expo in Hong Kong claims PromilGold contributes to a child’s intelligence. It urgesmothers to change to Promil Gold at 6 months to“supplement nutritional deficiencies of older infants”after weaning.

Another S-26 Manual for health professionals in theDominican Republic claims that “S-26 for prematurebabies has a higher nutritional concentration thanordinary formulas or mature breastmilk” and is “justlike human milk and contains whey-predominant pro-tein” with “LCPUFA levels similar to breastmilk”.

A pamphlet in China promotes Promil Gold andProgress Gold with a picture of a graduate carrot withblocks of DHA and AA. Infant formula is indirectlypromoted by the figure “1”.

In Hong Kong, theleaflet How to preventallergies to milk pro-tein for your baby pro-motes S-26 HA “aspreventing genetic al-lergic reaction to milkprotein” and “nearerin resemblance tobreastmilk”.

The same baby pic-ture is found on fansgiven to health work-ers, bearing the “Al-pha” protein logosidentified with S-26Gold.

The Handbook for complete development in all di-rections from birth - 6 months was distributed at theThai Perinatal Society Conference. It contains claimsthat formula with added carotene, Omega 9 and othernutrients will promote immunity levels and brain de-velopment similar to that of a breastfed baby.

Brochures promote S-26 Gold in health facilitiesin Hong Kong with the slogan “Never closer tobreastmilk as now” and a baby’s face with a ‘goldenkiss’ on its cheek.

Wyeth brochure compares S-26 Gold with breastmilk


Breaking the Rules, Stretching the Rules 2004 WYETH

In Thailand, the S-26 range leaflets given to healthworkers bear claims that the products have “completenutrients closest to breastmilk” or have “biofactorsfor 3-dimensional development” and “the best com-plete thing that a mother could give her baby” .

The brochure The best start, start here in Thailandpromotes Wyeth’s S-26 Gold and S-26 Promil Goldwith DHA & AA content levels closest to breastmilk.

Wyeth brochures andleaflets in Thailand usethe intelligence themeto idealise its (DHA-AAenriched) products.

In Trinidad and Tobago, pregnant women who comefor a check-up are given a packet with a booklet ofhelpful tips for parents-to-be. The envelope and in-troductory letter show packshots of SMA’s range offormulas.

A leaflet in Peru given to mothers during their visit tohealth facilities contains information on the stages ofthe baby’s growth and says “S-26 closest to mother’smilk”.

In the UK, the Taking Good Care of Mums and Ba-bies leaflet draws a similarity with breastfeeding bysaying “giving your bottle fed baby a milk that’s clos-est to breastmilk is just one way to get a good start inlife – so at SMA Nutrition we give you more”.

Front of flyer

Flipside of flyer

A metro station billboard in Hong Kong promotesPromil Gold with the slogan “Wyeth with the bestnutrition, in exchange for the best development”. Thead prompted protests by breastfeeding advocates. Ithas since been removed.

Bottle & TeatCompanies

CODE VIOLATIONS BY COMPANY

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85



FEEDING BOTTLES & TEATS


Article 5.1 of the Code prohibits advertising and allother forms of promotion of products under the scope ofthe Code.

Advertising, a practice forbidden by Article 5 of theCode forms the bulk of violations. Advertisements offeeding bottles and teats are usually found in parentingmagazines, promotional leaflets and through websites.In shops, special displays are common. Most of thesematerials contain idealising text which claim the prod-ucts have characteristics similar to the mother’s breastor nipple. Invariably, the text is misleading and in-tended to discourage breastfeeding.

Feeding Bottles & Teats

A selection of pictures below illustrates.

This Avent Naturally ad isfound in magazines in manycountries, including Italy,Lithuania, Mexico, Singaporeand the UK. The slogan “thebottle that helps you tobreastfeed longer” isaccompanied by textclaiming that Avent designsits feeding bottle to be “asclose to nature as possible”.

Avent ads in parentingmagazines in theDominican Republic,Germany, Serbia andTrinidad & Tobagocompares the “naturalshape” of mother’sbreast to the productand says it “mimics amom”.

Avent,Babelito andChiccoadvertise onArgentinianwebsites.

Babelito, which produces difficult toclean feeding bottles (right), paints amural (top) to promote its products on apharmacy wall in Uruguay.

A Camera ad in a mothers’magazine in Thailand makesa sweeping claim that theproduct “is safe for baby”,ignoring the risks associatedwith bottle feeding.

An Argentinian ad in a storemagazine announces it takesbabies “from breast to teat,through Chicco”.

Feeding bottles and teatscome under the scope of theInternational Code of Mar-keting of Breastmilk Sub-stitutes. Manufacturersare allowed to sellbut may not advertiseor promote theirproducts in any way.Their labels may not discourage breastfeeding. Moni-toring has again revealed that manufacturers and dis-tributors of these products consistently violate the Code.They are either unaware of their obligations or chooseto ignore that the Code applies to their marketing prac-tices as much as to those of manufacturers and distribu-tors of baby foods. Promotion of feeding bottles under-mine efforts by governments and NGOs to protect, pro-mote and support breastfeeding. Since these companiesignore their social and moral responsibilities, the situa-tion can only be corrected by government regulationand through concerted action by consumers.




Curity ad in a parentingmagazine in Mexico claimsit is “recommended by theMexican PaediatricAssociation”, implyingmedical endorsement.

Height measuresadvertising Curitybottles to Mexicancrèches.

(R) Dr. Brown’s NaturalFlow feeding bottle adentices mothers with theslogan “Your babydeserves the best!” inMotherhood magazine(Singapore)

(L) An ad in Baby andYou magazine (UK)announces: “There usedto be more questionsthan answers… Nowthere is a feeding bottlethat provides one simpleanswer - The Dr. Brown’sNatural Flow”.

A HonduranEvenflo billboardadvertises feedingbottles byshowing a pictureof daddy bottlefeeding his babyand the slogan“with love for thebaby”.

Johnson & Johnson havediscontinued their own lineof feeding bottles but theironline store,www.Babycenter.com(accessible throughJohnson & Johnson’swebsite) hosts andpromotes several brandsof feeding bottles andteats.

Huki manages to findseven similaritiesbetween its rubber teatand a human breast inthis Indonesian ad.

This Mexican leaflet says “for bestgrowth, Gerber is more than youimagine”. In Costa Rica, an ad inpocket diaries given to mothershighlights the convenience of theproduct by saying “you can feed himeven though you are not with him”,and in the Dominican Republic, aGerber ad promotes its teatsbecause baby “will enjoy his food”.

The caption above baby’s hand in a Mister Baby adin Italy says “I want it exactly like this”.

In Italy, a Mister Baby’s adcomparing breastfeeding with aconventional teat and theMister Baby variety shows poorattachment to the breast andover-simplifies the complexmovements inside the mouththat makes breastfeeding sodifferent from bottle feeding.

A blatant promotional ad forMister Baby from amother’s magazine inTaiwan.

“No more crying babies!” shoutsthis Singaporean advertisementin the Motherhood magazine to“parents who really care.”

A Nuk ad for its feedingbottles and teats in aJapanese magazine reminds“Mothers, please startthinking about regular teeth before a baby’s first tooth comesout” and claims products are modelled “on mother’s nippleswhere a baby has to use its chin and tongue” and “its uniqueshape is …the result of .. research on how a baby trains its noseto breathe...”

87




Manufacturers, distributors and retailers occasionallyoffer gifts and special discounts to induce sales.

Other types of promotion


Article 5.4 of the Code prohibit companies from givingsamples and gifts to mothers.

To boost sales, manufacturers and distributors areincreasingly joining forces with parenting magazinesto offer gifts of bottles and teats to subscribers. Thistype of promotion is similar to sampling.

Other methods of promotion are through specialdisplays and baby clubs.

Cute gurgling babies are used by NUKto hard-sell bottles and teats inArmenia. An advertisement in the Io e il miobambino magazine advertises NUK bottles as “ Nuk a naturalphilosophy … the best alternative to mother’s breast.” Theadvertisement shows a mother bottle-feeding her baby andportrays NUK teats as equivalent to mother’s nipples.

An interesting juxtaposition of the pseudo with the real thing.This time a two-page spread from Pigeon in Japan shows howsatisfied and happy baby can be even when its not mummy.

The breast as an icon? Thishard-cover Pigeon book inJapan uses cartoons to discussbreastfeeding, but containserroneous and misleadinginformation.

The baby in this Pigeonmagazine ad in Indonesia says“My friend won’t make mechoke”. An illustration drawssimilarity between the Pigeonteat and mother’s nipple.

Tommee Tippee ad in theUK talks about “a teat soclose to the real thing, itcould be mummy”. Indeed.

“Bottoms up!” - Tolly Joy inSingapore borrows the famousphrase among drinkers to sellfeeding bottles.

“Perfect for the new mom” discount given by anonline baby store for Avent products.

The Parenting magazine inMexico offers a Curitybottle as a gift with a one-year subscription to themagazine.

A Pigeon ad in Parents Guidemagazine in Indonesia offers thefirst 20 subscribers Pigeon giftpacks which include feedingbottles. Other subscribers will getup to 35% discount on Pigeonproducts.

NUK Baby Clubapplication forms

were distributed atan expo in Hong

Kong.

Snoopy, thefamouscartooncharacterpushes NUK inSerbia.




There are also reports of samples of bottles and teatsbeing given to health care facilities by Huki in Indone-sia and Pur in Thailand. These are then given as gifts tomothers.

Labels

Article 9.1 of the Code requires labels to NOT discouragebreastfeeding and to inform about the correct use of the pro-duct, the risk of misuse and abide by a number of otherpoints.

The Code requires that labels should be designed to pro-vide the necessary information about the appropriate useof the products, so as not to discourage breastfeeding .Monitoring reveals that information on labels of mostfeeding bottles and teats contain claims of similarity withmother’s nipple or breast and have misleading informa-tion or statements which idealise bottle feeding.

Avent/Cannon (UK)

Babelito (Argentina) ? ?Camera (Taiwan)

Chicco (Italy)

Curity (USA) ?Evenflo (USA) ?Gerber (USA) ?Huki (Indonesia)

Japlo (Malaysia) ?Johnson & Johnson (USA) ?Mister Baby (Italy) ? ?Nuk (Germany) ?Pigeon (Japan)

Tommee Tippee (USA) ?

Nopromotion

to thepublic

Nopromotion

in healthcarefacilities

AdequatelabelsCompanies

COMPLIANCE

WITH THE CODE

PartialComplianceSubstantialViolation

? ComplianceUnknownNotApplicable

dd

Promotion in Health Facilities

Space constraints mean many violations are excludedfrom this report. The chart below summarises the per-formance of 14 companies in relation to applicable Codeprovisions based on data collected from January 2002to March 2004.

Promotion in health facilitiesArticle 6.2 bans the promotion of products within the

health care system.

Pigeon actively promotes its products in health facilities in theUAE by offering gifts and booklets which contain bad breast-feeding advice. For example it starts by asking “how to know ifbreastmilk is sufficient” and advises weighing before and afternursing. It worries mothers by saying that dried breastmilk maycause bacteria and mould! ‘Change your Pigeon breastpad every3-4 hours’. It stresses the need for breastpumps because oflikely abnormalities of the baby’s mouth or the mother’s nipple,flat breasts, inverted nipples, baby can’t suck properly, breasttoo hard, etc.

Code compliance by selectedfeeding bottle companies

Huge boxes of these packshave been given to a hospitalin UAE to be distributed in maternity and paediatric wards.

Chicco labels in Indonesia havea picture of a baby and offeran extra teat for everypurchase. The label claims itsdesign and function are similarto a mother’s breast and willpromote the growth anddevelopment of the baby’s jawand teeth. It claims to preventchoking, vomiting andindigestion.

In Malaysia, Doctor Baby claims itsteats are shaped like mother’snipple and are non-carcinogenic.

The label of this Pigeon teatshows how similar it is tomom’s nipple so that “baby canswitch from breastmilk toinfant formula smoothly.”

Label of Pigeon feedingbottle and teat inIndonesia features twocute cartoon babies andclaims to have an anti-choke regulator.

Evenflo label in Mexicoclaims its feeding bottleand teat is “just likeMom”, “natural ...like you”

The Rules


90

STRETCHING THE RULES


Products such as ‘formula for mothers’ and growingup milks (GUMs) are not within the scope of the Code.Nevertheless, the aggressive promotional tactics usedfor such products serve to undermine breastfeeding.IBFAN monitors reported on these and other prac-tices which are not banned by the Code but whichgive rise to conflicts of interest and clash with mes-sages which promote breastfeeding.

Stretching the Rules

For years New Zealand Milk Ltd. only sold Anmumformula for pregnant and lactating mothers in South-east Asia and the Middle East. Since this was not abreastmilk substitute, its marketing was not regulatedby the Code. Because of this, Anmum gained accessinto health facilities where it became popular withboth health workers and mothers. After entrenchingthe brand in hospitals and clinics, in 2003, the com-pany introduced an infant and follow-up formula rangecalled Anmum Infacare in Malaysia. Promotion ofAnmum formulas for mothers now also promotes in-fant formula because it has the same name.

Mead Johnson (Enfa range), Wyeth (S-26 range), Hippand others all exploit the value of similar brand namesby selling a product to mom during pregnancy andthus promoting the sale of baby foods once the babyis born.

Familiarity boost salesThe marketing of formula for pregnant women andbreastfeeding mothers give baby food companies directaccess to mothers and gives them an excuse to be presentin health facilities. The Code prohibits such access formarketing conventional baby foods such as formula andother breastmilk substitutes. Moreover, formula formothers is unnecessary and undermines their confidence.

Growing-up milks or 1-2-3 milks (GUMs) were also in-vented to bypass the restrictions of the Code especiallyin terms of advertising and promotion in clinics andhospitals.

Both formula for mothers and GUMs use brand namesand designs or pictures and logos which are identical orvery similar to those of products covered by the Code.The promotion of the one links the mind of the con-sumer to the other, creating brand awareness and ex-tending brand loyalty into another range of products.

The name and thepackaging of SGM 3, aGUM manufactured bySari Husada (Nutricia) inIndonesia, is very similarto that of the company’sinfant formula andfollow-up formula.

An advertisement –“Baby’s needsincrease as hegrows” – in theAyahbunda magazinein Indonesia pro-motes Nutrilon 3Step-up as a foodthat claims to meetthe nutritional needsof a child 1-5 yearsold. Implicitly, thisadvertisement alsopromotes Nutrilon 1and 2.

Nutricia also markets Bebelac 3 or Delilac which are GUMs butlook very much like Bebelac infant formulas. The similarity is

intentional, and very profitable too!

‘similar ... very similar...

same brand name!

Formula for mothers ... and for baby

91

Breaking the Rules, Stretching the Rules 2004 STRETCHING THE RULES


In Thailand, a MeadJohnson ad shows amother using earphonesto allow her foetus tolisten to classical music.Simultaneously the adshows how MeadJohnson’s formula flowsto her foetus’ brain. Asimilar ad in Malaysia says“Beethoven can stimulate yourdeveloping baby’s brain fromthe outside. Now, EnfaMamacan help develop his brain fromthe inside.

Cashing in on the goodness ofbreastmilk and parental love

Some ads even resort to psychobabble by comparingtheir products with mother’s love. Claims like “goodas your love” are used with reckless abandon.

In an attempt to outdo each other, milk companies areclaiming that their GUMs (growing up milks) containproperties similar to breastmilk which are required to“help develop brain and visual acuity”. Anotherrecurring claim is increased immunity against sicknessand disease provided by GUMs. For example, anadvertisement in Ayahbunda magazine in Indonesiapromotes Morinaga’s Chil Kid for children one yearand older with a picture of a toddler saying, “Mom …mom, now I don’t easily fall sick.” The labelresembles Chil Mil follow-up formula.

Exploiting women’s fears andaspirations

For example, Abbott promotes Formance for mothersor mothers-to-be in China with a leaflet proclaiming“Before delivery, nurture the foetus; after delivery,boost milk production” and claims that it improvesupon the quantity and quality of mother’s milk. Suchmessages undermine mothers’ natural ability tobreastfeed.

Companies are aware of every pregnant woman’sdesire: comfortable pregnancy, safe childbirth andhealthy, intelligent babies. More than happy to fill thiswish, companies flood the market with expensiveformulas that promise everything from smart foetuses(milk for pregnant women), to superior breastmilk(milk for breastfeeding mothers), to blue-ribbon babies(growing-up milk). The aggressive promotion of suchproducts deliberately hides the fact that a balancedand sustainable diet of local foods, available at afraction of the cost, will supply the nutrients requiredfor a healthy pregnancy and successful breastfeeding.

A wall poster for Formance seeninside a pre-natal clinic in Chinagives mothers the impression thatthe product is necessary for a safeand healthy pregnancy

In Hong Kong, Wyethinsinuates that S-26 Mama,an unnecessary product, willnurture an intelligent child inthe womb.

Capitalising on thesame intelligencetheme, promotion inSingapore andVietnam claim thatAnmum hasimportant nutrientsthat support thegrowth anddevelopment ofbaby's brain duringthe early stages ofpregnancy.

Similarly, a shelf talker in a Malaysian supermarket advertisesAnmum as “healthy for baby's brain development.” Illustrationprojects the image of a pregnant woman envisioning the healthygrowth of the baby from foetus to full grown baby.

Testing the limits ofdecency: as if the previousads were not aggressiveenough, this one (inThailand) goes further toshow a foetus holding acan of Anmum like aprized possesion.


92



For mothers who were not ‘captured’ by productpromises early enough, milk companies have createdother clever schemes to get them hooked on GUMS.These programmes emphasise growth and develop-ment urging mothers to ‘catch up’ and join the com-pany bandwagon.

Hipp advertorial in German magazine. Note the similarity indesign of labels of growing-up milk (centre) and formula (right)

Baby clubs: entry to Direct MarketingHospitals used to give companies lists of new mothers’addresses as a routine. They now know better. So thecompanies had to find a new way to get mothers’particulars. Most have set up baby clubs, parentingclubs and online networks as a way of reaching out tomothers everywhere. Advertisements and coupons inhospitals extend invitations to mothers to sign up withsuch clubs and networks in their early stages ofpregnancy. Through this, companies are able to gatherpersonal data about mothers (and babies) and can thusdirectly promote the entire range of products, startingwith milk for mothers, followed by breastmilksubstitutes and then GUMs. The Code forbidscompany personnel from contacting mothers butthrough the clubs, the companies argue, that motherscontact them.

To boost credibility (and sales), companies team upwith the media and promote their products via spon-sored advertorials on maternal and child nutrition.Often written by health professionals or the company’sin-house nutrition team, these advertorials directly orindirectly endorse a particular product or brand .

Expert advice from company-friendlyprofessionals

A bewildering array of claims – these ads attempt to emotionallylink the product with intelligence and parental love

The “Asian MomNetwork” is anattempt by MeadJohnson to reachmothers throughcyberspace.Applicants willreceive a freesample.

Half of the leaflet is a “response card” allowing for the mother’scontact information and the baby’s current formula brand to besent to the company for more ‘information’ and free samples ofFrisogrow

Similar ...

Very similar ...

Gift packs for mothers who enrolled in Mead Johnson's Mother'sClub at an expo in Hong Kong. Inside the pack is a “MeadJohnson A+ 3 steps to stimulate intelligence" booklet and apack of educational cards. Indirectly, these promote Enfamil’sA+ formula.

93

Breaking the Rules, Stretching the Rules 2004 STRETCHING THE RULES


SponsorshipAlmost all companies involved in the baby foodbusiness sponsor seminars, conferences or trainingsessions for health workers or sponsor individualhealth workers' attendance at such events. Althoughthe Code allows for such funding (provided it isdisclosed to the relevant parties), the acceptance offinancial incentives from milk companies will conveyconflicting messages. What is more disturbing (but notsurprising) is that companies use these functions topromote their products in the name of scientificinformation. Participants at these events often receivegifts, a practice prohibited by the Code.

This advertorial in a parentingsection of a Malaysiannewspaper has an accom-panying advertisement for a“Super Discount Saver"which offers a 40 sendiscount for each jar ofGerber "World's No. 1 BabyJar Food". The advertorialtalks about the differentGerber foods required fordifferent stages of baby'sgrowth and method ofpreparation. It also asksreaders to take advantage ofthe discount offer to try outall the different flavors ofGerber jar foods.

Other practices worth notingDepending on how stringent the Code or themarketing law of a particular country is, AbbottRoss will either market Gain Plus as a follow-upformula or as a growing-up milk.

And in Thailand.

Nestlé makes its presencefelt in a paediatricconference in Argentina.

Abbott sponsorship ofa perinatologyconference in Thailand.

Productpromotion fromWyeth and MeadJohnson pervadethe exhibitionarea of the sameperinatologyconference inThailand.

What better way forNutricia to imprint itsname with healthprofessionals inIndonesia thanconducting a coursefor them?With an excellentlunch, of course.

Same brand, same company, different ages...How can mothers not be confused?

In Malaysia,Gain Plus –1to 3 years.

In the UAE,Gain Plus –18 months

In Hong Kong,Gain Plus – 6months


94



A Nestlé calendar which advertises Nido GUM in theDominican Republic promotes the culture of bottlefeeding by showing a picture of a young girl busyfeeding her doll.

Friesland distributes breastfeeding posters to healthfacilities with the slogans “The best beginning forlife” and “More than just a mother’s love” showingits own company name and logo as well as that of

IDAI, the Indone-sian PaediatricSociety. The IDAIcollaboration istantamount tomedical endorse-ment of Frieslandproducts and sendsconflicting mes-sages to mothers.

Companies which necessarily compete with breast-feeding because they produce substitutes, must not beallowed to advertise their names or logos under the pre-text of promoting breastfeeding.

The ultimate conflict of interest

Feeding Bottles and TeatsLike manufacturers and distributors of baby foods, bottleand teat companies are finding that it pays to fund healthworkers for conferences and research. Although theseare allowed by the Code subject to disclosure, the ethi-cal issue of conflicts of interest remains unresolved andhealth workers who are mindful of their responsibilitiesto promote and protect breastfeeding should be carefulnot to involve themselves with companies which areCode violators.

Abbott Ross demonstrates the tricky art of adaptive reuse. Thetactic to advertise a breastmilk substitute by promoting a GUM isevident – the same ad used to advertise Similac Advance infantformula in one country is reactivated to promote Isomil Plusgrowing-up milk in another. Why reinvent the wheel when youcan rehash? The baby does the marketing.

Nestlé starts them young!

This poster from a UAEmaternity associatesbreastfeeding withNestlé’s name andlogo.

Strange bedfellows – a signboardacknowledging Avent and Playtexsponsorship of a breastfeedingconvention in the USA

An Avent leaflet found inside a breastfeeding bookpromoting Avent’s sponsorship of a competitionfor the best breastfeeding study and the bestbreastfeeding promotion project.

IBFAN continuously compiles violations and welcomes your input.Have you noticed any company practices lately which violate the International Code or subsequent

resolutions? Or which discourage breastfeeding? If so, help us collect the information by photocopying andcompleting the form below and sending it to –

IBFAN-ICDC, P.O Box 19, 10700 Penang, Malaysia. E-mail: [email protected]

1Type of product: A. Infant formula, B. Follow-up formula, C. Complementary food, D. Bottle & Teat, E. Other (please specify)

The above information is necessary to enable IBFAN-ICDC to double-check the information youhave given, if necessary. Your identity will be kept confidential.

Description of Code violation (please answer all questions, especially the when, where, who, what and how)

1. Short Description .................................................................................................................................(Include heading or slogan found on company materials.)

2. When was the violation observed? (dd/mm/yyyy) ..............................................................................

3. Where? (place, city and country) ........................................................................................................(For newspapers and periodicals, please indicate the name and date of publication.)

4. Who is violating the Code and how?

If specimen or picture is attached, tick here

5. Observation / Details (Please use another sheet of paper if necessary):

• This form may be returned to IBFAN/ICDC by post or via email as a Word, PDF or JPEG file. An electronic version ofthis form can be obtained from IBFAN/ICDC at [email protected] or can be downloaded from the IBFAN website atwww.ibfan.org

• Where possible, include actual specimen, photographs or scanned images of Code violations with your form.• Samples should be identified and matched to the correct forms, especially when you do more than one report.

Name .............................................................................

Address .........................................................................

E-mail ...........................................................................

Which IBFAN group, if any:

.......................................................

.......................................................

Company Brand Type of product1 Type of violation2

MONITORING THE CODE

2Type of violation: A. Advertisement, B. Commercial promotion in health facility, C. Company contact with mothers,D. Donation of products to health facilities, E. Free sample, F. Gift to health worker, G. Gift to mother, H. Inadequate labelling,I. Promotion in shops, J. Sponsorship, K. Other (please explain, use another sheet of paper if necessary)

YOU can be a monitor and help

protect infant health!!!

Thank you!

Together we are strong.

IBFAN–ICDCP.O. Box 19

10700 Penang, MalaysiaFax: +60-4-8907291

Email: [email protected] Web: www.ibfan.org

The International Baby Food Action Network (IBFAN) is acoalition of voluntary organisations in both developing andindustrialised nations, working for better child health andnutrition through the promotion of breastfeeding and theelimination of irresponsible marketing of artificial infantfoods.

IBFAN was launched in October 1979 and the networknow counts over 200 citizen groups in 95 countries aroundthe world. The network helped to develop the WHO/UNICEF International Code of Marketing of BreastmilkSubstitutes and is committed to seeing marketing practiceseverywhere change accordingly. IBFAN has successfullyused boycotts and adverse publicity to press companies intomore ethical behaviour. It also helps to promote andsupport breastfeeding in other ways.

About IBFAN

The International Code Documentation Centre (ICDC) wasset up in 1985 to keep track of Code implementationworldwide. ICDC publishes The State of the Code byCountry and The State of the Code by Company every twoto three years. Since 1991, ICDC has been giving trainingcourses on Code implementation to assist governments indrafting appropriate legislation and other measures toprotect breastfeeding. ICDC collects, analyses and evalu-ates national laws and draft laws. ICDC also conducts Codemonitoring courses and maintains a database on Codeviolations worldwide.

About ICDC

Documents

Full Breaking the Rules, Stretching the Rules 2004 report