New state nutrition programmes in Córdoba province and the city of Buenos Aires are being implemented with companies that produce baby formula. Soledad Barruti investigates what lies behind these deals for Mu.
On 21st May 1981, a global agreement still considered unique more than 35 years later was signed at the World Health Organisation (WHO) headquarters in Geneva. On that day, 118 countries agreed that it was necessary to preserve humanity from the free market, deceitful advertising, and conflicts of interest that had achieved something sinister: convincing a significant chunk of the population that the food and pharmaceutical industries together had overtaken biology and produced a milk for babies that was better than human milk.
Thanks to a string of doctors convinced by these businesses – and who then in turn convinced their patients – in just one generation the number of breastfeeding mothers slumped in countries as diverse as the US and Peru. It’s calculated that a million babies died in Africa where the brands used guerrilla marketing techniques, including false nurses who instructed women who had just given birth that this innovative foodstuff – provided for free – would cause their baby to grow up to be larger, more energetic, and more intelligent.
Months later these very same babies experienced commerciogenic malnutrition: neurogenic problems, blindness, and rickets – even heart failure. Many of them survived, because they were luckier, because they lived in urban areas with secure water sources to prepare the milk, or because their families could afford to keep buying the formula to feed them. But they experienced a string of illnesses, including gastrointestinal problems, allergies, and asthma.
Soon after, evidence emerged that nobody discusses today: babies fed with formula are the least healthy in an increasingly sick system. Public health expenditure falls when breastfeeding increases because it reduces the number of premature deaths and all of the most frequent symptoms that fill the emergency wards: gastroenteritis, bronchospasm, and otitis.
Breastfeeding also has an impact on women’s health, as those who don’t breastfeed have a higher risk of suffering breast and uterus cancer and osteoporosis. Family expenditures are also incomparable, because breastfeeding is free – commercially speaking of course, because the time and dedication of women to do this and their removal from the workforce isn’t taken into consideration nor is duly compensated with licensed pay for a long enough time.
Breast milk is safe and nutritious, empowering to women, democratic and equalising, and it is likely because of this that so much engineering is expended to eliminate its use.
And so, 35 years ago in Geneva, there was this document: The International Code of Marketing of Breast-milk Substitutes. A set of standards to which foods that could impede or obstruct breastfeeding must conform to. It is prohibited to advertise infant formulas, follow-on milks, flours, cereals, or dairy products for babies by any means, including feeding bottles and dummies. Free samples or equipment from the clinic also cannot be given out – the exchange with medical professionals should be purely scientific.
Of course the document does not prohibit the baby formula itself. But it establishes that it is the only alternative when breastfeeding is impossible because of illness or if the mother does not want to breastfeed, and is a product similar to a medicine to deal with specific situations that the WHO calculates affect no more than 5% of the population.
The Code recognised three things: the perfection of human milk, the inferiority of substitutes, and the vulnerability of people to the fierce combination that is direct and subliminal advertising, using experts and money. This gave way to an expression of the era that would grow proportionally to the cunning of the industry: activism to protect the business that deceives it. Because even though the WHO asked governments to introduce laws that would penalise violations of the Code, few countries did.
The majority, like Argentina, met them halfway: they adhere to it, but don’t have penalties for not complying. This of course led to boundaries being pushed, from a supermarket shelf dedicated to substitutes one day, to clinics supported by laboratories the next. And to what is happening now: governments fervently trying to be associated with companies, to push forward their models, raise funds and improve their image, but jeopardising previous achievements and the health of babies, especially those of the poor.
In the 64 early childhood centres of Buenos Aires there are 9,000 boys and girls of impoverished families, aged between 45 days and four years. They come from marginalised areas of the capital and arrive there, under the care of teachers and carers, for an average of eight hours.
The programme depends on the City’s Ministry for Human Development and was inaugurated in 2009 to bring under the State umbrella a diverse group of soup kitchens, picnic areas, and nursery schools that were run by different NGOs. Today it is also a place where parents can receive information about nutrition, raising their children, and sexuality. However, in the last few months the early childhood centres have become a site of a conflict born out of the movement of money and the clash of modern interests known as Corporate Social Responsibility.
Through a little window opened by Minister Guadalupe Tagliaferri, entered the most controversial agreement with a brand dedicated to the sale of child nutritional products and breastmilk substitutes: Nutricia Bagó. From 2017, this private company for ‘advanced medical nutrition’ will be training the professionals in charge of the childhood centres “with regard to the care for the development and correct and healthy nutrition of the first 1,000 days of life”. That is, from the pregnancy to the first two years.
The news set the activist world alight. Doctors, lactation consultants, members of different scientific communities and officials expressed the same thing: “This is a government violation of the Substitute Code. A company producing infant formula cannot give recommendations about feeding infants. Even though they do not talk about formula directly and state that breastfeeding is irreplaceable, subliminal advertising exists, and that’s why the Code is specific about these questions.”
In total seven high level sources were consulted, all of whom immediately asked to remain off the record. Why? Because the scientific communities to which they belonged or the ministries where they worked do not issue statements publicly. Even a month after the signature had been released (not the full agreement as that remains confidential within the Development Ministry) the institutions seem to be protecting their private relationships and their funding, shutting their members off in a dark de facto silence.
An official of the Federal Social Development Ministry, part of the department of Carolina Stanley, who occupied Tagliaferri’s position in the city until the start of this year, assured that the agreement was circulated as a possibility during the previous administration, but anticipating what the response would be they did not want to sign it. What is it exactly that they feared? That this collection of meetings and postal exchanges that is now occupying the time of the Ministry would erupt in a scandal.
Nutricia Bagó did speak to Mu. “We didn’t receive a letter or a formal consult which told us that we had violated the code. We are searching to understand what is going on and we have proactively met with Fagran (Argentine Federation of Licensed Nutritionists), AADYN (Argentine Association of Dieticians and Nutritionists), Fundalam (Lactation and Maternity Foundation), SAP (Argentine Society of Paediatrics); because these institutions are the ones which we have been working with for years and they wanted to know about the agreement.”
And what is the agreement?
“It is an agreement of mutual collaboration,” claims Nutricia. “What we do is develop training workshops about diet, portion control, encouraging breastfeeding, and healthy sleep to professionals of the early childhood centres. There will not be brand logos or products. We will not do the training directly but via a very well-known foundation called Fundasamin.”
Fundasamin is a foundation dedicated to spreading information, organising congresses, and giving workshops for neonatology, obstetrics and nursing professionals, among others. It is made up of doctors and nurses and receives support and funding from businesses involved in producing infant formula such as Mead Johnson, Abbot, and Nutricia Bagó. The alliance is so fluid that one of its members, the coordinator of teachers Carmen Vecchiarelli, appears as part of the Advisory Council of the Association of Infant Nutrition Companies: the chamber which brings together the substitute producers and which until recently was presided by Juan Tonelli, the partner of Vice President Gabriela Michetti.
Fundasamin confirmed that they had carried out joint workshops with Nutricia and worked together at other opportunities. But for this project the foundation said that: “we only have an invitation to participate in injury and healthy sleeping training, not diet.”
The city government preferred not to respond to basic questions such as “is the company or the foundation going to carry out the training?”
Whichever it is, for the experts of the code, it doesn’t matter. Fernando Vallone, who was during a number of years the local coordinator of IBFAN (the International Network of Groups for Infant Diet) the international organisation which gathers and denounces violations of the Code in the world, says that: “whether the training is funded by Nutricia directly or through Fundasimin it doesn’t change that fact that it is an enormous step backwards which wastes many years of effort to form a single message about the adequate diet for a baby.
“It’s like using a fox to take care of the chicken house.”
“It is sad that the government believes that it should resort to the private sector to provide advice when there are consultants throughout its health system, and on top of that it is alarming that it gives this task to a company that manufactures and markets infant formulas,” Enrique Abeyá Gilardón wrote in his blog.
As a doctor, breastfeeding expert, and member of the homonymous commission of the National Health Ministry, he summarises a concern currently shared by experts around the world: with breastfeeding in slow recovery, will it be the governments who ruin it again?
George Kent is a professor at the University of Hawaii, as well as an expert in proper nutrition, food policy, and human rights. He is currently working on a book that brings together evidence to support the theory that governments are becoming partners of industry, and as such, active promoters of infant formula. “One way is by allowing agreements that are prohibited,” he says. Another, perhaps the next step, is the purchase and delivery of formula by the State. That happens in the United States, and began to happen in recent months in Chile. ”
Chile, the country that made the most progress in the region to promote breastfeeding, last month inaugurated a free Nutrilón delivery programme. “I believe that, as so often, this country is the guinea pig for a plan designed for the region,” says Chilean paediatrician magister in Human Nutrition Cecilia Castillo. “They are trade agreements that come from Washington; it is the only explanation.”
Without going any further, in Argentina the free delivery of children’s formula, without medical prescription – and in practice nothing more than a diagnosis of poverty – is what the Ministry of Development of the Province of Córdoba began to do through the programme ‘More Milk, More Proteins’.
Divided into two categories, the programme is a cause for celebration and indignation. On the one hand, the delivery of fortified milk to 100,000 children of school age and up to 11 years, using a notebook to monitor their health, was received. But on the other, no one could explain the benefits of extending the plan to new born children of vulnerable families, who will receive a can or two of Nidin formula (Nestlé) per month for up to one year.
“How will children be able to escape social exclusion? With education. How are they going to receive what they are taught if they do not have the proper food?” This is how Governor Juan Schiaretti put it in his presentation. Everyone agrees, except that child formula is, according to scientific consensus, the opposite of the best possible food for infants.
“There are many things to look at,” says Cecilia Karplus, a member of the Lactation Commission of the National Health Ministry and The League of Milk. “Holding or discouraging breastfeeding in the first month is what will determine if it will be successful. Some 95% of women begin breastfeeding, but only 30% continue it exclusively to six months, in most cases because they did not have adequate support, or they directly had commercial interference. Entering vulnerable places with formula is to disrupt the babies’ only survival strategy. ”
Africa, 1970? Something like that.
“If the formula they give them is not enough, what are they going to feed those babies with?” Says Karplus. “With milk in sachets that is indigestible until they pass one year? With mate? How do you ensure that an indigent family has access to safe water to prepare it?”
The programme in which the province invested $68.6m for the first four months (of which $11.3m went to the purchase of 96,000 cans of formula), does not provide funds for advice on breastfeeding. “But if the province invested those same resources in consultants who made intensive support visits – twice a week – to the homes of those same women who are now receiving formula, they would save a hundred thousand dollars,” says Karplus.
“There is an ethical dilemma that has to do with whether governments should give free formula to mothers who, beyond a specific medical problem, say they cannot breastfeed, but do not have the money to afford it,” says Kent. “It is a very serious matter, but to which we must put other questions. For example, if many of these women are opting for the formula because they understand it as something more valuable. And if we are doing enough to get the right message and create the necessary conditions, including labour laws, to ensure adequate food.
“Otherwise what exists is a violation of a human right that few take into account: that of the dyad that allows mother and child to have no interference.”
Translated by Katie McGhee, Zack Marzouk & B.M. Bresnahan.