UK

MEDIA BRIEFING

A Generation On:
Baby milk marketing still
putting childrens lives at risk
Almost 1.4 million children are still dying every
year because they are not getting enough of their
mothers milk. Aggressive marketing by companies
is one of the reasons babies are not breastfed.
World leaders have committed to cutting infant
mortality by two-thirds by 2015.The protection,
promotion and support of breastfeeding could
make the single biggest contribution to
childrens survival.1
Its over 25 years since the introduction of the
International Code of Marketing of Breast Milk
Substitutes in 1981.2 And were a whole generation
on from the start of the international campaign
and boycott to stop companies such as Nestl
promoting alternatives to breast milk.Yet,
manufacturers are still flouting the Code by
heavily promoting manufactured baby milk and
food.We think thats appalling.
Globally, improving breastfeeding rates could
save the lives of nearly 3,800 children a day. In

Bangladesh, for example, improving breastfeeding

rates could cut child mortality by one third.3
Meanwhile, in the UK, in 2006/07, for every pound
spent by the government to promote breastfeeding,4
over 10 was spent by leading manufacturers to
promote baby milk and foods.While funding for
companies advertising campaigns grew by a
whopping 37 per cent during that year,5 UK
government spending on breastfeeding promotion
has steadily gone down since 2004/05.6 Sadly,
despite recent improvements, breastfeeding rates
in the UK remain among the lowest in Europe.7
Save the Children UK is calling on manufacturers
to put babies health before profit by complying
with the Code, which was adopted at the World
Health Assembly (WHA).We are also calling on
the World Health Organization (WHO) and
UNICEF to take on a stronger role in monitoring
Code compliance and to support governments
to strengthen legislation on the marketing of
breast milk substitutes.

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How breastfeeding saves lives

Breastfeeding:
has positive effects on the health of mothers
and children, whether they are rich or poor
reduces the risk of acute infections such as
diarrhoea, chest, ear and urinary tract
infections, flu, and meningitis
protects against chronic conditions in the
child such as allergies and type I diabetes
prevents cardiovascular diseases, including
high blood pressure and obesity later in life
promotes child development and is associated
with higher IQ scores in low-birth-weight
babies.
Breastfeeding is unparalleled in providing the
ideal food for infants.The optimal way to feed a
baby is exclusive breastfeeding for the first six

months followed by breastfeeding combined with

complementary foods until the child is two years
old.8 In the case of mothers infected with HIV,
the WHO recommends that they abstain from
breastfeeding only if replacement feeding that is
acceptable, feasible, affordable, sustainable and
safe is readily available. Otherwise, exclusive
breastfeeding is still recommended for the first
six months.9 Recent research from South Africa
has shown that babies of HIV-positive mothers
who received formula or animal milk in addition
to breast milk were twice as likely to be infected
with the HIV virus as infants who received
breast milk only.The study also found that infants
of HIV-positive mothers were more likely to
survive if they were exclusively breastfed than
if they were given breast milk and formula.10

Marketing baby milk and food

The UK

Despite all the impressive health benefits of

breastfeeding, public awareness campaigns
promoting breastfeeding have lagged well behind
marketing campaigns for manufactured baby milk
and food. Sadly, a small minority of the 129 million
babies born in the world each year receive optimal
breastfeeding, and many are not breastfed at all.11
While commercial promotion of substitutes is
not solely responsible for this, there is scientific
evidence linking aggressive marketing with reduced
breastfeeding and knock-on effects on childrens
survival.12

The UK baby food market is dominated by three

companies Heinz, SMA (Wyeth) and Nutricia
(Numico).14 Jointly they account for about 84 per
cent of all retail sales of baby food in the UK.15 It is
a highly profitable business, totalling 329 million in
sales in 2004/05 and set to grow by 20 per cent by
2010.16 It is estimated that it costs UK parents
about 650 to bottle-feed a baby for one year.17
The three top UK baby milk manufacturers spent
7.6 million on marketing campaigns in the UK
in 2006/07.This is over ten times what the UK
government spent on promoting breastfeeding
in the same year.18

The international Code does not ban the sale

of baby milk, but addresses how it is marketed.
It aims to ensure that mothers receive accurate and
unbiased information in order to make an informed
decision.13 However, companies invest millions in
the promotion of formula milk products. Selling
baby milk is a lucrative business.The more babies
are born and the more mothers decide to give up
breastfeeding, the more money there is to be made.

In 2006, the UK government launched a new

scheme, Healthy Start, replacing the Welfare Food
scheme. Healthy Start provides teenage mothers
and families on benefits with children under 4
with weekly vouchers to swap for fresh milk, fruit,
vegetables, vitamins, as well as baby milk.The aim
of the scheme is to encourage healthier eating,
including breastfeeding, which was inadvertently
undermined by the Welfare Food scheme.

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Opportunistically, however, some leading companies

tried to exploit Healthy Start to market their
products and gain access to parents.
For instance, Cow & Gate (Numico) launched a
marketing campaign targeting national newspapers
to coincide with the launch of Healthy Start in early
December 2006.Their advertisements promoted
the whole portfolio of products, including infant
formula, which is illegal under UK law, claiming that
its baby milk is the closest to breast milk.They
also publicized their national helpline for callers to
get information about Healthy Start vouchers.19
Following complaints from public pressure groups,
the Department of Health took action to clamp
down on Cow & Gates advertising spree. Heinz

also took their chances in order to promote

Farleys formula to health workers claiming it was
the only brand to offer 900g baby milk tins for less
than the price of a Healthy Start voucher (see
figure 1).Their strap line read: Farleys Baby Milks,
Best Formula, Best Price and a graph suggested that
their formula is close to breast milk and better than
competing brands. Both companies were violating
the Code.
In March 2007, marketing claims conventionally
used by all companies to promote baby milk,
including that it is as close as possible to breast
milk (Aptamil), that prebiotics support natural
defences or that it helps brain and eye
development, were deemed illegal by the UK

Figure 1. A leaflet promoting Farleys

formula baby milk to health workers
3

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Trading Standards.20 Companies are now required

to re-design their labels and scrap promotional
campaigns in accordance with the revised guidelines.
Research in the UK by Save the Children21
uncovered that:
All companies still openly market certain ranges
of baby food and drink (eg, flavoured water
and juices) to babies from four months, if not
younger, contravening WHO guidance, which
recommends exclusive breastfeeding until
six months.
Retailers ranging from supermarkets to groceries
and pharmacies undercut each other through
multiples promotions and everyday low pricing.
These retailers account for almost threequarters of all sales of breast milk substitutes
in the UK22 and also violate the Code.
Brands increasingly rely on below-the-line
(indirect) advertising directed at new mothers

because direct advertising of infant formula is

unlawful in the UK. Educational materials on
childrens nutrition and growth, telephone
support lines and, increasingly, websites are
being used to reach out to mothers, pregnant
women and potential mums to advertise the
full portfolio of products and establish brand
loyalty often even before their babies are born.23
Mothers are also offered substantial vouchers
(up to 90 from Cow & Gate) as an inducement
for signing up to companies mums clubs.These
tactics are clearly prohibited by the Code and
WHA resolutions.
Companies aim to enhance their products
credibility and sales by forging links with health
professionals and doctors.They do this by
offering incentives such as prize draws and VIP
trips, and create conflicts of interest through
support of educational activities, departments
or organisations, and funding research.

Unethical marketing to mothers

UK
Research published in the UK24 demonstrates
the power of companies promotion of infant
formula. It reported that 60 per cent of pregnant
or breastfeeding women in the UK had seen or
heard infant formula advertisements, even though
advertising infant formula to the public has been
banned for ten years in the UK. Advertising led
almost a third of these women to believe that
infant formula was as good, or even better, than
breast milk. One in five mothers also reported
giving follow-on formula to babies of less than
three months, even though it was intended for
babies of six months. Up to three-quarters of
babies born in the UK are either exclusively or
partly artificially fed before they are six months
old.25 However, nine in ten mothers who stop
breastfeeding within six weeks of birth say that
they would have liked to continue for longer.26

Botswana
Research in Botswana,27 supported by Save
the Children, has revealed that violations of
the Code by baby food companies are still
common. Baby milk and food are indiscriminately
advertised in the public domain; product labels
are not written in the appropriate local language,
posing a serious health hazard for babies; and
companies still distribute information materials
to public health centres and hospitals in open
violation of the Code. More than a third of
all young mothers and pregnant women in
the capital, Gaborone, have seen or heard
advertisements for infant formulas and food
targeted at babies of less than six months.28
Almost 30 per cent of mothers also reported
having been advised by either health
professionals or peers and family to use infant
formula, usually of a specific brand (most
commonly Nestls NAN) or other food and
drinks for their babies under six months.29

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Save the Children findings in Bangladesh

Child malnutrition and infant mortality rates are
extremely high in Bangladesh. Save the Children
estimates that child mortality could be cut by
almost a third, saving the lives of 314 children
every day, if breastfeeding rates were improved.30
However, the total value of baby milk and food
imports in Bangladesh is almost 16 million
per year.31 This is 100 times more than the
government of Bangladesh can afford to invest
in supporting the Bangladesh Breastfeeding
Foundation and other service providers
responsible for the countrys breastfeeding
promotion.32
Hazeras story
Hazera is 21 years old and lives in Dhaka.When
she gave birth to her son she tried to breastfeed
him but found it difficult. I couldnt get the baby
to suck because there was no milk, she said.
There were 40 new mothers on her ward, and
just one nurse, so she didnt get much help from
hospital staff. Her mother-in-law and husband put
pressure on her to feed the baby. Her husband
rushed to the local pharmacy to buy a tin of

What needs to change?

Thirty years into the Nestl boycott and over
25 years on from the signing of the International
Code of Marketing of Breast milk Substitutes, the
aspirations of the Code still remain elusive in many
countries and mothers are still widely exposed
to marketing messages promoting and idealizing
artificial feeding. At best, the Code provides a
benchmark for best practice, and at worst it is a
symbol of the failure of voluntary self-enforcement
by companies to ensure childrens rights are
upheld.33 Millions of lives are lost because babies
are not adequately breastfed.We cannot afford to
wait another generation before this is fixed. Save
the Children is calling on baby food companies,
governments, the WHO and UNICEF to put their
full weight behind the Code.

Hazera in hospital with her newborn baby son. It

takes her husband three days to earn what it costs
to buy one tin of milk formula.

formula.The pharmacist advised him which brand

to buy and told him how to prepare each feed as
he couldnt read the label on the tin.The formula
cost 350 taka (2.78). It takes Hazeras husband
three days to earn that amount.They dont know
how they will be able to afford to continue
bottle-feeding their baby unless they switch to
a cheaper alternative, such as dried cows milk.

Baby food companies

In 2003, the ethical investment index FTSE4Good
developed criteria to determine whether or not
baby food companies should be included in the
index.34 Before then, all baby food manufacturers
were automatically excluded from the index
because of evidence of Code violations. In order
to qualify for entry on the FTSE4Good index,
baby milk companies do not have to demonstrate
full Code compliance, only that they have put
management systems in place to reach, eventually,
Code compliance. In 2006, one company, Novartis,
through its baby food division Gerber, became the
first company to meet the FTSE4Good breast milk
substitutes marketing criteria and to make it onto
the index. Gerber dominates US baby food sales
with 82 per cent of the market and it has the lead
5

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position in Mexico, Latin America and Poland.Their

entry onto the FTSE4Good index was therefore a
remarkable step forward, which acted as a catalyst
for some of the other industrys heavyweights that
had previously failed to engage with FTSE.

but have thus far failed to comply with their criteria.

With Gerber now out of the game, the race is on
for the next company to make it on the index.
Recommendations
Save the Children urges all manufacturers to
put children before profits and to comply with
the Code.
Companies (see Table 1) must develop policies in
line with the Code and put in place management
systems that will have an immediate impact on
marketing practice and lead to a dramatic
reduction in Code violations.
The FTSE4Good Breast Milk Substitutes Criteria
currently fall short of the Code as they do not
include follow-on milks, aimed at children above
six months. Save the Children is calling for this
shortcoming to be urgently addressed.

In April 2007 Gerber was taken over by Nestl,

a FTSE4Good non-complier. It is anticipated that
this, and other recent acquisitions, will contribute
to a record boost in sales and profits in Nestls
nutrition division.35 However, as Gerber is not
a listed company in its own right, we are back
to square one with no longer any breast milk
substitutes manufacturers on the FTSE4Good
index.The question now is, can Gerber, a bold
company which had positioned itself towards
Code compliance, influence Nestl, the industrys
colossus, to rectify its unethical ways? In the
30th year of the international boycott, Save the
Children calls on Nestl to take on this challenge.

Governments

Save the Children has ranked the worlds major

manufacturers of breast milk substitutes (see
Table 1) according to their level of engagement
with FTSE for inclusion on the FTSE4Good index.
Companies at the bottom have opted out of the
FTSE4Good process altogether, whereas the ones
near the top are engaging in negotiations with FTSE

The main responsibility for implementing and

monitoring the Code is on national governments.
Since 1981, 139 countries out of the 193 that
adopted the Code have taken some measure to
implement it, supported by the International Baby
Food Action Network and UNICEF. Countries,
including Brazil, India and Sri Lanka, have translated
most of the Code and resolutions into national law.

Table 1:Worlds major breast-milk substitutes companies ranked by engagement with

FTSE on the FTSE4Good Breast Milk Substitutes Criteria
Ranking

Company

Numico (Netherlands)

eg, Nutricia, Milupa, Cow & Gate

Danone (France)

eg, Bledina

Abbott Laboratories (USA)

eg, Similac, Isomil

Wyeth (USA)

eg, SMA

Nestl (Switzerland)

eg, NAN, Nidina, Gerber

Heinz (USA)

eg, Farleys, Mothers Own

Meiji Diaries (Japan)

eg, Meiji FP-T

Bristol Myers Squibb (USA)

eg, Enfamil

Source: Responsible Investment Unit, FTSE Group

Examples of brands

Key
~ Mixed engagement
No engagement

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Most countries, including the UK, Bangladesh and

Botswana, have either implemented some provisions
of the Code as law, implemented the Code as a
voluntary measure, or currently have laws in
draft form.36
In 2006 the European Commission revised its
legislation on the marketing and composition of
breast milk substitutes, partly in line with the Code.
This year, the UK will review legislation on the
marketing of breast milk substitutes to bring it in
line with the new EC regulations.This offers an
invaluable window of opportunity for tightening
UK law closing the loopholes that breast milk
substitutes manufacturers have exploited since
the law was introduced in 1995.
In those countries where the Code has been upheld
and fully incorporated into law, like Brazil, for
instance, violations have stopped and breastfeeding
rates gradually improved. In Brazil, the Code and
subsequent WHA resolutions have been embedded
into regulation since 1988 and are monitored by the
governments health inspectorate (ANVISA) and
IBFAN.This has contributed to breastfeeding rates
rising by 4 per cent a year.37 In addition to strong
legislation governments must therefore monitor
compliance on a regular basis and take action on
practices in breach of the law.
Recommendations
Save the Children calls on the UK government
to go further than the new EU Directive in
tightening its legislation to ensure that mothers
and babies in the UK are protected in the
manner recommended by the World Health
Assembly from commercial promotion of
breast milk substitutes.
Save the Children also calls on the UK
government to reverse the decrease in funding
allocated to the promotion of breastfeeding.
The government of Bangladesh must strengthen
the enforcement of its national code by ensuring
that all manufacturers are registered with the
legal authorities, and that they are adequately
sanctioned for violating the Code.

World Health Organization and

UNICEF
Save the Children believes that the World Health
Organization (WHO) should take on a stronger
role in enforcing the Code and in making violations
publicly unacceptable and consigned to history,
and that UNICEF should promote more rigorous
monitoring of its implementation.
Recommendations
The WHO must help governments strengthen
legislation on the marketing of baby milk
substitutes and food, and monitor their
implementation. It must be bolder in getting
companies to comply with the Code.
UNICEF must ensure that compliance with
the Code becomes a measure of progress
on countries implementation of the UN
Convention on the Rights of the Child.

Notes
G Jones et al and the Bellagio Child Survival Study Group
(2003) How many child deaths can we prevent this year?, The
Lancet,Vol 362, July 2003
1

The International Code of Marketing of Breast milk Substitutes

was adopted at the World Health Assembly (WHA) in 1981.
Since then a number of WHA resolutions have been adopted
updating and adding to the original Code.The Code and
subsequent WHA Resolutions must be considered together.

Research by Save the Children UK based on G Jones et al, ibid

In 2006/07 the UK government allocated a total of 729,011

for breastfeeding promotion including developing educational
materials, PR materials for breastfeeding campaigns, developing
and updating websites, conferences and supporting the work of
the National Network of Breastfeeding Co-ordinators.

In 2005/06 major baby milk and food manufacturers spent a

total of 5,582,089 on advertising their products in the UK
compared to a total of 7,626,847 in 2006/07. Source: Nielsen
Research Multimedia System

UK government spending on breastfeeding promotion has

decreased from 747,000 in 2004/05 to 743,000 in 2005/06
and 729,011 in 2006/07. Source: Department of Health answer
to PQ tabled by Annette Brooke MP on 26/03/07

Department of Health, Infant Feeding Survey 2005, preliminary

results released in May 2006.

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WHO (2006) The International Code of Marketing of Breast

milk Substitutes: frequently asked questions www.who.int/
child-adolescenthealth/New_Publications/NUTRITION/
ISBN_92_4_159429_2.pdf

Ibid

Mother-to-child transmission of HIV-1 infection during

exclusive breastfeeding in the first six months of life: an
intervention cohort study, Hoosen M Coovadia, Nigel C Rollins,
Ruth M Bland, Kirsty Little, Anna Coutsoudis, Michael L Bennish,
Marie-Louise Newell, The Lancet 2007; 369: 110716

10

11

http://www.unicef.org/programme/breastfeeding/challenge.htm

12

WHO (1998) Evidence for the 10 Steps to Successful Breastfeeding

The Code and subsequent WHA resolutions cover advertising

or any other form of promotion of infant formulas, follow-on
milks, feeding bottles or teats. Complementary foods, such as
cereals and baby food in small jars, should not be promoted for
use below the age of six months.

13

14

Including Cow & Gate and Milupa.

Mintel International group Limited (2005) Mintel Premier

Summary Report, November 2005
15

16

Ibid

Save the Children UK (August 2006) Code-watch research,

unpublished

17

23

Ibid

National Childbirth Trust and UNICEF (September 2005)

Follow-on Milk Advertising Survey,
www.nct.org.u/media/pressrealease?prid=43

24

Department of Health (2000) Infant-feeding Survey UK

www.dh.gov.uk/assetRoot/04/05/97/63/04059763.pdf

25

26

Ibid

Interagency Group on Breastfeeding Monitoring, UNICEF UK,

Ministry of Health Botswana and UNICEF Botswana,
Monitoring of Compliance with the International Code of
Marketing of Breast Milk Substitutes and subsequent World
Health Assembly Resolutions in Gaborone, Botswana
(November 2005)

27

28

Ibid

29

Ibid

Research by Save the Children UK based on G Jones et al and

the Bellagio Child Survival Study Group (2003) op cit
30

Prof M Q K Talukder (2002) Benefits, protection, promotion

and support of breastfeeding, unpublished

31

Research by Bangladesh Breastfeeding Foundation and Save

the Children UK, unpublished

32

A Holder and D Doane, Why Corporate Social Responsibility is

Failing Children, Save the Children UK and Corporate

33

18

Nielsen Media Research (March 2007) unpublished research

Responsibility Coalition, March 2007

19

Daily Star advert from 11 December 2006.

34

New Trading Standards guidelines in line with UK legislation

on the marketing of breast milk substitutes were issued in
March 2007.

20

To mark the 25th anniversary of the Code, Save the Children

involved its supporters in a monitoring exercise to provide a
snapshot of ongoing violations of the Code.This was done in
partnership with Baby Milk Action in the UK and with the
International Baby Food Action Network (IBFAN), the World
Alliance for Breastfeeding Action (WABA) and UNICEF globally.
Activists around the world were engaged in spotting violations
during World Breastfeeding Week from 17 August 2006.
For more information on reported violations refer to
http://worldbreastfeedingweek.org/

21

22

http://www.ftse.com/Indices/FTSE4GOOD_Index_Series/
Downloads/Breast_milk_substitute.pdf
FTSE4Good criteria, however, fall short of the International
Code in that they do not include follow-on milks, aimed at
children above six months.
Statement by Richard Laube, Head of Nestl Nutrition, to
shareholders at the Annual General Meeting on 19th April
2007,Geneva.

35

International Baby Food Action Network (2006) The State of

the Code by Country, www.ibfan.org/site2005/abm/paginas/

36

articles/arch_art/298-11.pdf
M F Rea, Rethinking Breastfeeding in Brazil: How we reached
10 months of duration. Cadernos de Saude Publica 2003; 19
suppl.1:37-45

37

Mintel Premier Summary Report, Mintel International group

Limited, November 2005

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