This is also true for women who, for medical or other reasons, cannot breastfeed. The WHO estimates that 600,000 women die each year from complications related to pregnancy and childbirth. Infant formula is often used as the best alternative to breast-milk for the babies left without a mother.

Fact: More infant formula is sold in Belgium, which has a population of 10 million, than in the whole of sub-Saharan Africa, which has a population of over 650 million.

However, the vast majority of mothers in developing countries do not have the means to buy infant formula and feed their babies inferior traditional substitutes for breast-milk, including whole cow's milk, rice water, cornstarch water, or cassava flour and water. These substitutes can be dangerous because they lack the required nutritional content and balance.

Breastfeeding and water

The breast versus bottle controversy has unfortunately obscured the true picture of infant feeding in developing countries. The vast majority of women breastfeed, and at the same time give their babies the above-mentioned traditional foods, or just plain water. In fact many of the countries with the lowest exclusive breastfeeding rates are also those with the lowest formula use.

It has been estimated that in parts of South Africa, 90% of women breastfeed, but only 10% do so exclusively in the first month. This rate of exclusive breastfeeding drops further to 2% by the fourth month, with plain water being the most common additional substance used. Very few women use infant formula.

This typical pattern is a major reason, together with socio-economic factors, why infant mortality is actually highest in countries with the highest breastfeeding rates. Also, serious levels of diarrhoea and malnutrition actually become most pronounced during the second 6 months of life because of low quality and unhygienic complementary (weaning) foods. This crucial fact is also obscured when the infant nutrition issue is portrayed as "breast vs. bottle".

Use of infant formula

The fact that more infant formula is sold in Belgium, which has a population of 10 million, than in the whole of sub-Saharan Africa, covering a population of over 650 million, puts the sale and use of this product in developing countries into context. Even within sub-Saharan Africa, the sale of formula is highly concentrated in more affluent urban areas, including the approximately 10 million South Africans who have a middle or upper class standard of living. The sale of infant formula is low in Africa and is not growing, primarily because the ability to purchase it is low. The majority of women resort to traditional foods to supplement or substitute breast-milk.

It may seem paradoxical to some, but the developing countries that have the highest use of infant formula also have the lowest rates of infant mortality. This is obviously not a cause and effect relationship - what the two statistics show is that as a country develops economically and as more women enter into paid employment, infant health and nutrition improves and the use of infant formula increases.

Fact: The overwhelming majority of babies - both breastfed and non-breastfed - by tradition are given water (alone or mixed with local foods) from the first months of life. This is the real reason why teaching exclusive breastfeeding for the first 6 months of life is so important.

Nestlé's marketing

In order to reach mothers who do need infant formula, while not promoting it to those who do not, Nestlé leaves the recommendation of breast-milk substitutes to health professionals and does not promote infant formula to the public in developing countries at all. This commitment to a ban on promotional activities means: no advertising, no in-store promotions, no sampling programmes, no price incentives, no "milk nurses" and no educational materials mentioning infant formula.