Milking the African market

Nutrition reduced to powdermanufacturers of breast milk substitutes are grossly violating an international code while selling their products in West Africa. So says a study published in the British Medical Journal. The study has been conducted by Victor M Aguayo of Helen Keller Worldwide, a us-based research organisation; Jay S Ross from the Academy for Educational Development, usa; Souleyman Kanon of the International Baby Food Action Network, an association of 90 citizens' groups in over 150 countries; and Andre N Ouedraogo of the World Health Organization, Switzerland.

In 1982, the World Health Assembly adopted the International Code of Marketing of Breastmilk Substitutes. As per the code, manufacturers have to mention the following on the product labels: health benefits of breastfeeding, instructions for the appropriate preparation or storage of formula milk and a warning against the health hazards of inappropriate use.

The researchers examined whether the companies were complying with the code. The study was carried out in Togo (a country without a legislation regarding the marketing of the substitutes) and Burkina Faso (which has the regulation). Along with examining the products available in the regions, the researchers interviewed staff members of 43 health facilities and 66 sales outlets and distribution points, 186 health providers and 105 mothers.

Among other things, it was found that 40 products, including those of companies like Nestl and Danone, violated the code. Staff members of five health facilities had received promotional gifts from the manufacturers. Most health providers had never heard of the code, and 66 mothers had not received any counselling on breastfeeding. Moreover, levels of code violations were the same in Burkina Faso and Togo.

The study has fuelled the debate over the moral issues concerning breast milk supplements. "How do we proceed when all the evidence suggests that many manufacturers continue to view the international code as a covenant more to be honoured in the breach than in the substance?" says Carol Bellamy, executive director of United Nations Children's Fund (unicef).

The manufacturers deny the allegations. A spokesperson of Danone said that only three of the company's 21 products named in the study were covered by the code. Francois-Xavier Perroud, Nestl's spokesperson, warned that the company would take all the "necessary steps" if it found any errors in the findings of the study. He added that the products identified in the study appeared to be food supplements such as cereals, and not breast milk substitutes.