In a media brief entitled Exposing the Market Offenders: Unethical Marketing Practices of Baby Food Companies that Harm Babies' Health, the industry watchdog states: "37 years after the adoption of the International Code of Marketing of Breastmilk Substitutes, baby food companies continue to pay lip service and claim to be staunch breastfeeding supporters.
"But their actions prove otherwise, as violations of the Code still happen frequently to undermine breastfeeding."
Monitoring the manufacturers
The IBFAN Asia is referring to findings presented in its recently published Report on the Monitoring of the Code in 11 Countries of Asia, which details the alleged inappropriate marketing of infant nutrition products and feeding bottles in Bhutan, China, India, Indonesia, Maldives, Mongolia, Nepal, Philippines, South Korea, Sri Lanka and Thailand.
The organisation notes that economic and population growth had made APAC one of the world's fastest-growing regional infant nutrition markets, adding that ever-aggressive marketing of breastmilk substitutes and feeding bottles and teats" is a "major factor undermining efforts to improve breastfeeding rates" in the region.
Along with the Breastfeeding Promotion Network of India (BPNI), the IBFAN Asia supported monitoring in the aforementioned 11 countries, coordinating with its International Code Documentation Centre (ICDC) to carry out the exercise.
Monitors in each country were coached by the IBFAN Asia and IBFAN-ICDC to conduct a one-year monitoring project starting in October 2017, focusing on labelling, as well as online promotional activities.
Following this, the monitors produced individual country reports, which were then compiled into a single regional report that highlighted trends among companies that were said to "violate and circumvent" the International Code (a collective term referring to the International Code of Marketing of Breastmilk Substitutes and relevant World Health Assembly resolutions).
Naming and shaming
The IBFAN Asia says manufacturers' use of claims on labels to "mislead the public", as well as the blurring of lines between selling and promoting infant nutrition products online, are "especially blatant".
It adds: "These health and nutritional claims have become prime marketing tools. Presented as complex scientific formulations, they appear in the form of trademark logos, mascots, or benefit icons to create a premium market. Often, companies also compare these additives with properties in breastmilk."
The report names Danone (China, Mongolia, Nepal and Thailand), Nestlé (India and Sri Lanka), Pasteur (South Korea) Wyeth (China, Indonesia and Thailand) among the examples of companies guilty of the aforementioned offences.
More specifically, Danone's Aptamil Profutura line in China is said to be missing the required statement that the product should only be used if advised by a healthcare professional, while the company's Nutricia Farex Stage 1 infant formula in Mongolia has been flagged for its health claims of "tailored nutrition that supports growth, development and immunity at all stages".
In reference to Nestlé's NAN ExcellaPRO 1 formula, the report alleges that the company "uses trademarks to disguise idealised phrases as part of their brand name", adding that despite being trademarked, NAN ExcellaPRO 1 is "nonetheless an idealisation of the product".
In Sri Lanka, Nestlé's NAN 1 Starter Infant Formula is highlighted on similar charges: "The fat bird mother feeding its babies is idealising as it conveys ideas on feeding that is maternalised and nurturing.
"The cradling hands carrying the Bifidus sign on the front corresponds with the statement 'naturally active probiotic culture that may help reinforce body's immunity' on the back."
Pasteur's New WithMom Stage 1 formula in South Korea is also mentioned for its claims that it benefits bowel health, which results in "golden-coloured stool", as well as for the brand name WithMom being an "idealisation" in itself.
Wyeth's S-26 Promil 1 formula carries the tagline 'Nutrissentials', which the report's authors say is "wordplay (that) suggests idealisation of 'nutritious essentials'.
The report also scrutinises the company’s S-26 SMA Gold Stage 1 formula, which is sold in Thailand: "Graphic icons on the front of the package lay down the groundwork — a book icon that suggests intelligence and mental development, and a shield representing (the) immune system.
"On the back, there is a brain-shaped picture dotted with a number of fancy-named nutrients such as alpha-lactabumin, lutein, omega-3 and omega-6. At the bottom of the box, there are more icons with explicit claims such as 'iron is a crucial substance in haemoglobin' and 'vitamin A is good for vision'."
Vigilance against violations
Apart from detailing the perceived offences and offenders in APAC’s infant nutrition sector, the report also includes suggestions to strengthen implementation of the International Code and reduce instances of inappropriate marketing.
The IBFAN Asia says that despite eight of the 11 countries having adopted all or most of the International Code's provisions as part of their respective national legislations, "violations continue as monitoring and enforcement mechanisms are not effectively in place, or the law is outdated as marketing tactics and scientific findings have evolved".
The report suggests that "countries should enlist necessary support (e.g., UNICEF) on how to deal with industry with the aim of protecting public health, and take active steps to implement, monitor and enforce the existing measures".
It goes on to say that advocacy should include making sure that legislators and policymakers understand and recognise their obligations under the International Code, as well as relevant national laws — that is, to "promote and protect breastfeeding, and to eliminate inappropriate marketing practices".
All relevant government agencies should also be "authorised to monitor and enforce national measures that give effect to the International Code", with sanctions or warnings considered 'effective means' to underline the seriousness of government protection of breastfeeding.
The report adds that where government resources are insufficient, civil society can offer necessary support in the form of community-based monitoring, and naming and shaming infant nutrition companies.
"Protecting the health of infants and young children requires a concerted effort that is ever-ongoing — 37 years after the Code was adopted, the old battle goes on in the new world, and protecting the health of children from aggressive, misleading and inappropriate marketing should be a public health priority and human rights obligation of governments, without delay."
