Great success for the discussion evening 'Nestlé in Pakistan: The Baby Formula Scandal exposed' during the International Film Festival and Forum on Human Rights 2015

On February 27, 2015, during the International Film Festival and Forum on Human Rights (FIFDH) held in Geneva, the movie Tigers was screened within the framework of a discussion evening entitled 'Nestlé in Pakistan : The Baby Formula Scandal exposed' organized in collaboration with IBFAN-GIFA.

The feature film Tigers is based on the true story of a former Nestlé salesman, Mr Syed Aamir Raza. He blew the whistle after the shock realization of the impact of his employer’s activities on children’s health. That decision had terrible consequences on its private life and he had then to seek asylum in Canada, where he spent long years away from its family before they could finally be reunited in exile.

Mr Aamir Raza attended the screening and took part in the debate that followed, together with Ms Yasmine Motarjemi (former corporate food safety manager at Nestlé and whistleblower) and Mr Mike Brady (Baby Milk Action/IBFAN UK). The co-author of the movie, Mr Andy Paterson, was also present and answered some questions about the preparation of the movie. The debate was moderated by Mr Alain Maillard, chief editor for Edito, and led to a very fruitful discussion with the public. 

Related links:

• Article on the event in the newspaper Le Courrier - February 27, 2015 (in French)
• Webcast of the debate

Sweden at the CRC: Significant Decrease of the Rate of Exclusive Breastfeeding

On January 13^th and 14^th, 2015, the Committee on the Rights of the Child considered the fifth periodic report of Sweden on the situation of the implementation of the Convention on the Rights of theChild (CRC) in the country. The Swedish delegation was led by Mrs. Pernilla Baralt, State secretary at the Ministry of Health and Social Affairs.

On this occasion, IBFAN submitted an alternative report to inform the CRC Committee on the situation of infant and young child feeding in Sweden.

General overview of breastfeeding in Sweden

The report pointed out the lack of tracking of key breastfeeding indicators (especially related to early initiation of breastfeeding and to continued breastfeeding at the age of 2 years). It also emphasized the significant decrease of the rate of exclusive breastfeeding until 6 months that happened between 2000 (33.4%) and 2012 (14.5%).

Regarding the promotion of optimal breastfeeding practices, it is of serious concern that the official Swedish publications, such as the ones accessible from the National Food Agency portale, are not in line with the official recommendations on infant and young child feeding issued by the World Health Organization. In addition, the protection of breastfeeding is still insufficient in Sweden. The International Code of Marketing of Breastmilk Substitutes and the relevant subsequent World Health Assembly resolutions have been only partially implemented through national legislation and although a voluntary policy on the marketing of breastmilk substitutes has been adopted, it is not enough to ensure that parents and caregivers are not facing undue commercial pressure from the baby food industry.

In addition, the quality of the training courses of health professionals on optimal breastfeeding practices, considered as ‘too basic’ in a 2008 report, should be put into question and improved, and the consistency of information provided to mothers in maternity wards of the country should be regularly monitored.

Finally, mother-to-child HIV transmission rate should be monitored and information on the implementation of any specific policy on infant feeding in emergencies should be provided.

Discussion on infant and young children feeding

The Committee raised concern about the lack of implementation of the International Code into national legislation and about the issues related to the marketing of infant formula in the country. It noted that the rate of exclusive breastfeeding is very low and asked if there is an explanation about it. The Committee further emphasized the link between suboptimal breastfeeding practices and the growing trend of obesity and overweight within the Swedish population. It then requested the delegation to provide clarification on the activities that are lead by the government with aim to promote breastfeeding.

The delegation answered that in Sweden, the cultural environment is generally favourable to breastfeeding. It also noted that the decrease of the rate of exclusive breastfeeding is not so important for children born since 2011 and that in 2009, a national breastfeeding committee has been formed in order to promote, protect and support breastfeeding. Besides, it highlighted that a 2013-2016 Strategic Plan for Coordination on Breastfeeding Health has been adopted and is structured around 5 main objectives (1/development of a national knowledge on breastfeeding, 2/ training on breastfeeding aimed at health professionals, 3/ information of health professionals and policy-makers about the WHO recommendations on breastfeeding, that have been translated in Swedish 4/ official recommendations on breastfeeding should be consistent with the WHO recommendations and 5/ the EU directive on infant formulae and follow-up formulae should be implemented through national legislation and monitored).

The Committee thanked the delegation for its clarifications. It however insisted on several unanswered questions: Is there a Swedish comprehensive database tracking the breastfeeding indicators (especially the early initiation of breastfeeding and the continued breastfeeding until the age of 2 years)? Is the International Code fully implemented and monitored? What explains the decrease of the rate of exclusive breastfeeding considering the very high rate of institutional deliveries? Which measures are take to tackle the obvious lack of adequate training of health professionals regarding breastfeeding? Is there any plan implemented to protect and support breastfeeding in emergencies?

Concluding Observations

In its Concluding Observations, the Committee did not make any recommendation directly or indirectly related to infant and young child feeding. A general recommendation related to health and health services called for strengthening “efforts to improve the health status of children from disadvantaged and marginalized groups and allocate sufficient financial, human and technical resources to ensure their right to health without discrimination” (§ 41).

Written contribution to the Committee on the Rights of the Child / 2014 Day of General Discussion / Digital Media and Children’s Rights

Breastfeeding protection, an essential component of the child’s right to health

Breastfeeding is recognized as a crucial intervention to provide infants and young children a healthy start in life.[1] It is the single most effective intervention for saving lives:  if applied globally, optimal breastfeeding can annually prevent about 830.000 deaths of children under 5 years. Unfortunately, out of 135 million babies born every year, almost 83 million are not enabled to follow optimal breastfeeding practices.[2]

Enshrined in the article 24 of the Convention on the Rights of the Child on the right of the child to the enjoyment of the ‘highest attainable standard of health’, breastfeeding should be protected against marketing practices that could undermine it. Therefore, the Committee has integrated the 1981 International Code of Marketing of Breastmilk Substitutes (the Code), to date completed and extended by fifteen subsequent relevant WHA resolutions forming an integral part of it, in the CRC General Comment No. 15 (2013), which specifies that besides the States’ obligation to implement and enforce the Code (para 44), baby food companies have the direct obligation to comply with it in all contexts (para 81).

However, the misconduct of baby food companies continues to be a key cause for poor breastfeeding practices, as these companies reap profits from promotion of their products which directly compete with breastfeeding. Recently, the report Breaking the Rules 2014, published by IBFAN’s International Code Documentation Centre, presented more than 800 Code violations by 27 companies in some 81 countries.

Digital media: a new marketing avenue for baby food companies

Since democratization of new technologies and Internet access, a new avenue has opened up for companies to advertise their products on digital media, including social media such as Facebook and YouTube. Mobile and web-based technologies using ‘behavioural targeting’ offer them new opportunities to interact directly with mothers, despite the fact that the article 5 of the Code prohibits baby food companies to seek direct or indirect contact with pregnant women and mothers of infants and young children, regardless of the mean used for making that contact.

Popular bloggers, especially mothers, are roped in to endorse products and thus influence their huge following. Advancing their electronic marketing even further, companies are developing mobile software applications (known as ‘apps’) that millions can download onto their mobile phones, tablets, laptops and PCs. Companies use these apps as direct promotional tools. Several apps are designed to ‘help’ pregnant women and new mothers. Special offers, discounts, contests, product launches and campaign announcements are now available to tech-savvy young mothers and their families.

Creating a corporate culture among parents through websites, social media and apps

Websites facilitate baby food companies’ contact with mothers by offering them gifts (such as a trip to Singapore), free samples and discount prices (such as a ‘Ramadan special package’, offered by Hero[3] on its Egyptian online shop).

Encouraging mothers to spread the word about their products, companies’ websites also foster their participation through a wide range of social activities, such as, for example, photo contests for babies, invitations to baby fairs or mothers blogs.

Thousands of mothers[4] are linked to companies through their Facebook, Twitter or Pinterest pages, where offers of free gifts, promotions and ads violating the Code are regularly posted. Some of these pages even offer ‘live chats’ or ‘carelines’ through which mothers can talk directly to company personnel to get nutritional advice on infant and young child feeding.

Besides, many other companies have developed a phone app for monitoring the feeding routines of infants and for providing advice, such as the one developed by HiPP[5] in Norway. In Slovenia, Novalac[6] even offers parents a local language smart phone ‘baby app’ which allows the company to offer promotions and special deals to parents.

‘Mothers clubs’, or how companies disguise marketing under ‘parents advice’

A new trend for companies is to promote virtual platforms called ‘Nutriclub’, ‘Moms club’ or even ‘Baby club’, connecting with pregnant women and offering mothers one-on-one support, parenting advice, information about pregnancy and child development, together with information on their products. When joining a ‘club’, mothers are offered gifts, promotional offers and invitations to try products. For example, parents who sign up to Wattie’s[7] club are offered the chance to win about USD 520 of free gifts.

Video clips and viral marketing, advanced marketing tools for selling baby foods

Baby food companies are regularly publishing attractive video clips on their websites and social media, but also on TV and as ads on other websites. These video clips are systematically ‘shared’ on YouTube, allowing them to be spread over social media by users. For example, a cute cartoon video clip, recently published by Nestlé, has been viewed over a million times within a month.

These video clips often claim that industrial baby foods have positive effects on babies’ health and contribute to their optimal cognitive development. For example, in a Dumex[8] video clip run on the company’s website and on TV, mothers share their opinion on the good effect of Dumex baby formula to assist the baby’s immune system. Similarly, in Hong Kong, Nestlé’s video clip for infant formula claims that the product promotes ‘gut health, digestion, absorption’. There is overt comparison with breastmilk via the DHA and ARA components which, contrary to systematic reviews of the evidence, are claimed to ‘help baby’s brain and visual development.’

Campaigning on the first 1000 days: the hijack of breastfeeding promotion by companies

The 1000 days between a woman’s pregnancy and her child’s 2^nd birthday is a critical period for long term development. UNICEF and WHO have launched a global campaign for health and development through adequate nutrition during this critical ‘1000 days window of opportunity’. Baby food companies sensed a marketing opportunity and launched their own ‘first 1000 days’, campaigns. Both Nestlé and Danone, baby food leading companies, have co-opted the slogan of the first 1000 days.

Nestlé launched its own first 1000 days advertising campaign called ‘Start Healthy, Stay Healthy’ in order to associate itself with the UN message. Under its campaign, the company reaches out to the public through its website and social media and calls on visitors to join the company in promoting the World Breastfeeding Week 2014 while claiming to support breastfeeding. Apart from targeting mothers, Nestlé sponsors courses organised by professional organisations and even organised ‘scientific conferences’ for doctors in India, despite the explicit prohibition of such events by the Indian Infant Milk Substitutes Act. In Malaysia, the company has pushed the boundaries even further and launched a ‘1500 days’ campaign.

For its part, Danone registered the domain name http://www.first1000days.ie/  under its Nutricia subsidiary. In China, Dumex’s 1000 Days programme, with emphasis on child’s immunity, offers a service tailored for mothers and aimed at providing advice from pregnancy through various stages of early childhood. A book on this 1,000 day programme is distributed free when mothers register on the Dumex website. In Ireland, Danone’s front company Cow & Gate followed the Dumex example by launching the First 1000 Days campaign, using a celebrity couple as ambassadors. Incentives like free recipe books are offered to tempt potential customers.

How to protect child’s right to health against corporate violations of the Code through the use of digital media

In order to protect breastfeeding and thus, the right of the child to the enjoyment of the highest attainable standard of health, States parties should be urged to:

1. Fully implement the International Code of Marketing of Breastmilk Substitutes and its relevant subsequent WHA resolutions, especially WHA63.23, into their national legislation

It is crucial for Member States to fully implement the Code as it regulates marketing practices of baby food companies to protect the right to health of infants and young children, including against malevolent marketing practices that take place online. More specifically, article 5 of the Code prohibits manufacturers and distributors from providing mothers with free samples of their products, whether directly or indirectly. The provision also forbids promotion tools to induce sales direcly to the consumer at the retail level, such as special displays, discount coupons, as we can find on companies websites, their online shops and social media. Finally, the Code states that the marketing personnel should not seek direct or indirect contact of any kind with mothers of infants or young children. 

Resolution WHA63.23 calls upon the development of legislative, regulatory and effective measures to control the marketing of breastmilk subtitutes in order to give effect to the Code.

2. Ensure effective monitoring of the Code and implement deterrent sanctions against violations

According to the Code, monitoring the application of the Code lies with governments acting individually and collectively through WHO (article 11). Resolution WHA61.20 urges States to scale up efforts to monitor and enforce national measures and to avoid conflicts of interest. 

To meet their obligations, States should therefore be urged to implement deterrent sanctions for Code violations into their legislation. 

3. Launch modern and attractive digital campaigns on breastfeeding promotion and support 

Governments should promote and support optimal breastfeeding practices through modern and attractive media campaigns. Using the same digital media devices than baby food companies, States parties would be able to counter the damages induced by the aggressive marketing practices of the private sector. By maintaining catchy and helpful websites, promoting social media pages and spreading innovative videos through the Web, governments will be able to disseminate the adequate information to a wider public and create a popular trend towards optimal breastfeeding practices. 

4. Implement their Extraterritorial Obligations into legislation

According to the CRC General Comment No. 15 (2013), baby food companies have a direct obligation to comply with the Code in all contexts and thus, to respect to right of the child to the enjoyment of the highest attainable standard of health.

Pursuant to international human rights law, States have the duty to ensure that companies based in their territory do not infringe the human rights of people their countries, but also in other countries where the companies operate.[9] Therefore, the States should be urged to implement legislation aimed at holding home-based companies, including baby food companies, accountable for their human rights violations abroad.

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[1] UNICEF, Pneumonia and diarrhoea : How to tackle the deadliest diseases for world’s poorest children. June 2012. http://www.unicef.org/media/files/UNICEF_P_D_complete_0604.pdf.

[2] Bhutta et al., What works? Interventions for maternal and child undernutrition and survival, The Lancet, 2008, 371 (9610) : 417-440.  http://www.who.int/nutrition/topics/Lancetseries_Undernutrition3.pdf.

Save the Children, Superfood for babies: How overcoming barriers to breastfeeding will save children’s lives, 2013. http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/SUPERFOOD%20FOR%20BABIES%20ASIA%20LOW%20RES%282%29.PDF.

[3] Hero is a Swiss company.

[4] For example, by May 2013, the Danone Facebook page had received some 53,000 ‘likes’, thus multiplying Danone’s Code violating record.

[5] HiPP is a German company.

[6] Novalac is a French company.

[7] Wattie’s is a brand owned by Heinz, a US company.

[8] Dumex is the Asian subsidiary of Danone, a French company.

[9] Principle 25  (c) (d) (e), Maastricht Principles on Extraterritorial Obligations of States in the area of Economic, Social and Cultural Rights. Available at: http://www.fian.org/fileadmin/media/publications/2012.02.29_-_Maastricht_Principles_on_Extraterritorial_Obligations.pdf

Low Breastfeeding Rates in Jordan (CRC)

On the 26^th of May 2014, the Committee on the Rights of the Child considered the combined fourth to fifth periodic reports of Jordan on the situation of the implementation of the Convention on the Rights of the Child (CRC) in the country.

IBFAN presented an alternative report to inform the CRC Committee on Jordan’s situation on the issue of infant and young child feeding.

General overview of breastfeeding in Jordan

In Jordan, the rate of early initiation of breastfeeding is low (38.8%) what, compared to the very high rate of institutional delivery (almost 99%), questions the quality of the training provided to health professionals. Furthermore, almost four children out of five are not exclusively breastfed until 6 months of age, while more than 45% of the infants under 1 month of age are fed with infant formula and some 24% of the children of 4-5 months of age are weaned prematurely. These data should be assessed in close conjunction with the high stunting rate of the children under 5 years of age are stunted (8%). The country has implemented most, but not all, of the provisions of the International Code of Marketing of Breastmilk Substitutes as legally enforceable measures.

A general lack of data on “baby-friendly” hospitals also has been observed. Similarly, a lack of data on HIV/AIDS and infant feeding has been noted. This is especially concerning given that the latter infection is still stigmatized and the population does not receive adequate and comprehensive information about it.

Besides, the alternative report emphasized that not all working women are benefiting from maternity protection and many women still experience occupational segregation.

Finally, it has been highlighted that, despite a national policy and training programme on infant and young child feeding in emergencies, support to optimal breastfeeding practices in refugees’ camps is not ensured and refugee women often face difficulties to access to health care facilities.

Discussion on infant and young child feeding

The CRC Committee pointed out that the rate of exclusive breastfeeding is low and asked if there was any national campaign to encourage mothers to breastfeed for a longer period. 

The delegation of Jordan answered that Jordan has implemented a law prohibiting the marketing of breastmilk substitutes. It stated that awareness-raising campaigns to promote breastfeeding have been launched and information on the best way to incorporate breastfeeding within the family routine has been disseminated.  The delegation also explained that there is a national guidance for medical professionals on the circumstances in which powdered milk should be recommended.

In addition, the delegation also explained that Jordan has the lowest rate of HIV/AIDS in the Arab region and that the national HIV/AIDS strategy includes reintegration measures for infected persons and awareness-raising campaigns on the transmission of the virus.

Concluding Observations

In its Concluding Observations, the CRC Committee recommended Jordan to strengthen its mechanisms for data collection (para 8 (b)). Regarding health issues, it urged the country to “ensure equal access to quality health services by all children, through the adoption of measures aimed at prioritizing children in the most disadvantaged and marginalized situations, especially child refugees, and by addressing child malnutrition and infectious diseases” (para 44). The Committee also emphasized the necessity to “improve access to quality, age-appropriate HIV/AIDS, sexual and reproductive health information and services” (para 48).

However, the Committee issued no direct recommendations related to infant and young child feeding. 

Germany, Breastfeeding and Attachment Disorders between Mother and Child

Germany presented its consolidated 3^rd and 4^th periodic report on the situation of the implementation of the Convention on the Rights of the Child (CRC) in the country.

IBFAN presented an alternative report and an annex to inform the CRC Committee on Germany’s situation on the issue of infant and young child feeding.

General overview of breastfeeding in German

The alternative report insists on the lack of up-to-date information concerning breastfeeding practices. Indeed, there is only one national  survey with data on breastfeeding practices and this data go back to 2005, assessing that initiation of breastfeeding was of 81.5% and that children were exclusively breastfed during a mean duration of 4 to 6 months, while WHO recommends exclusive breastfeeding to 6 months. The report highlights that in the most vulnerable social classes, breastfeeding is less practiced. Another discrepancy in practices has also been found between the different Länder. Regarding the implementation of the International Code, Germany has adopted the EU Directive 2006/141/EC on infant formulae and follow-on formulae, which is weaker than the Code. However, even this legislation is neither monitored nor enforced. The marketing of breastmilk substitutes is aggressive and “gifts”, among other things, are provided to patients by doctors and nurses. Hipp provides, for example, a special programme that gives the attendants credits for their obligatory continued education. In addition, Germany faces another issue related to conflicts of interest: some scientists are paid by baby food industry to carry out studies on breastfeeding. As demonstrated in the literature, such business interests may seriously affect the results of these studies and thus influence the reliability of the data and ultimately lead to distortion of policy decisions. Finally, only 78 out of about 800 hospitals complied with the requirements of the WHO/UNICEF Baby-friendly Hospital Initiative (BFHI). Furthermore, due to economic pressure on hospitals to work profitably and more workload for less staff, baby-friendly hospitals face difficulties to keep up their standards. The national health insurance does not consider their services as a quality standard and therefore, does not get any extra payment and support.

Discussion on infant and young child feeding

The CRC Committee asked if Germany implemented the International Code. The issue of maternity protection rules, especially maternity leave, has also been discussed, as well as the  existence of any potential barriers to breastfeeding in public. The Committee then raised its concern about the increasing rate of attachment disorders between the mothers and their children in Germany, stressing the importance of breastfeeding to build attachment in the early stage of life. The German delegation did not address in their response any of these issues.

A wide range of other topics related to the rights of the child were tackled during the session: the impact of the business sector on children’s rights, children with disabilities, children from ethnical and social minorities, birth registration, corporal punishment, help lines for children, juvenile justice, education, harmful practices on children, children in institutions and baby-boxes.

CRC Committee's Concluding Observations

In its Concluding Observations, the CRC Committee recommended Germany to establish a comprehensive data collection system (para 16), to respect children’s rights in relation to the business sector (para 23), to raise awareness about healthy eating habits (para 57) and to promote breastfeeding while informing the public on the risks of formula feeding (para 63).

In the first instance, the CRC Committee requested the State Party to “establish a comprehensive and integrated data collection system on children covering all Länder and the entire period of childhood up to the age of 18, and to introduce indicators on children’s rights on which progress in the realization of those rights could be analysed and assessed.

Further, the Committee recalled its 2013 General Comment N° 16 on State obligations regarding the impact of the business sector on children’s rights, that specifically calls on States “to implement and enforce internationally agreed standards concerning children’s rights, health and business including the [...] International Code of Marketing of Breast-milk Substitutes and relevant subsequent World Health Assembly resolutions”. In the section Children's right and the business sector, the Committee recommended Germany to “(a) Establish a clear regulatory framework for the industries operating in the State party to ensure that their activities do not negatively affect human rights or endanger environmental and other standards, especially those relating to children’s rights; (b) Take into consideration the best interests of the child when adopting budgetary measures such as subsidies for business affecting children rights; (c) Examine and adapt its legislative framework (civil, criminal and administrative) to ensure the legal accountability of business enterprises and their subsidiaries operating in or managed from the State party’s territory, regarding violations of child and human rights.”

The CRC 2013 General Comment N°15 on the right of the child to the enjoyment of the highest attainable standard of health (art. 24) explicitly recognises the importance of breastfeeding for the achievement of the right of the child to health. It urges States, in the effort of diminishing infant and child mortality, to devote particular attention to neonatal mortality and suggests, inter alia, to “pay particular attention to ensuring full protection and promotion of breastfeeding practices”. Moreover, “exclusive breastfeeding for infants up to 6 months should be protected and promoted and breastfeeding should continue together with appropriate complementary foods preferably until two years of age as feasible. States’ obligations in this area are defined in the “protect, promote and support framework”, adopted unanimously by the World Health Assembly in its 2002 Global Strategy for Infant and Young Child Feeding". Regarding Health and health services, Germany is urged to pay attention to the General Comment N° 15 and to “undertake advocacy and awareness-raising programmes targeting schools and families, emphasizing the importance of physical exercise, healthy eating habits and lifestyles, as well as take all necessary efforts to address the existing disparities in health outcomes. Special attention should be paid to children and young people in vulnerable situations, especially those from socially disadvantaged or migration backgrounds”. The Committee furthermore recommended the State Party to “take every necessary legislative and structural measure to ensure that every child within the State party has access to breastfeeding through the control of infant formula which will promote better bonding between infants and mother."

Last but not least, as the Committee noted with concern that breastfeeding rates were declining in Germany, it recommended the government to “strengthen its efforts to promote exclusive and continued breastfeeding by providing access to materials, and educating and raising awareness of the public on the importance of breastfeeding and the risks of formula feeding. The Committee urges the State party to strictly enforce the International Code of Marketing of Breast-milk Substitutes.”