Should all mothers be encouraged to breastfeed exclusively for the first 6 months?

Are babies more "at risk" if bottle-fed?

What is the reason for the decline in breastfeeding?

Does Nestlé discourage breastfeeding?

Does WHO say that 1.5 million babies die annually because of bottle-feeding?

Is Infant formula dangerous because it is often mixed with dirty water?

What about mothers in developing countries who are illiterate and cannot read the preparation instructions?

Does the WHO Code cover complementary foods?

Were Follow-up milks created by the infant food industry to contravene the Code?

Why do the Nestlé Instructions for the implementation of the WHO Code of Marketing of Breast-milk Substitutes apply only to developing countries? And what is its relationship with national (local) codes?

Does Nestlé lobby governments of developing countries to ensure that they put weak national codes in place?

Does Nestlé provide free supplies of infant formula to hospitals in developing countries, in violation of the WHO Code and several subsequent WHA Resolutions?

What is Nestlé's position regarding the age of marketing of its complementary (weaning) foods?

Does Nestlé sponsor seminars and symposia for doctors and nurses, in violation of the WHO Code?

Does Nestlé give expensive gifts to health workers?

Does Nestlé give samples to health workers?

Does Nestlé print its labels in local languages?

Is Nestlé using the HIV/AIDS tragedy as a cover to market its infant formula?

How does Nestle monitor its own practises?

Doesn't the WHO Code go against the business interests of Nestlé, and limit what you can do in marketing infant formula?

Does Nestlé promote Infant Formula to mothers in developing countries?

Why is infant formula sold in developing countries?

Yes, breast milk is the ideal food for healthy growth and development of babies. In 2001 the World Health Organization (WHO) changed its recommended duration of exclusive breastfeeding from 4 to 6 months to 6 months, therefore breastfeeding should be encouraged and promoted accordingly.
 
However, not all mothers are able to feed their babies on breast milk alone for 6 months, or, for various reasons, they choose not to.
 
Infant formula is the best nutritional alternative for those babies who are not breastfed. However, most women in developing countries do not buy infant formula. They feed their babies inferior traditional substitutes like whole cow's milk, tea, rice water, cornstarch water or cassava flour and water. Such substitutes can be dangerous because they lack the required nutritional content and/or balance.
 
At about 6 months, breast milk alone does not fulfil the nutritional need of the growing baby. Thus complementary foods need to be introduced, preferably together with continued breastfeeding. Every baby has different needs, that is why mothers are advised to consult a health professional to discuss the appropriate time to start with complementary foods.
 
Every mother has the right to choose what she feels is best for herself and her baby on the basis of objective information and advice from a qualified health professional.

Firstly, infant formula is not the same as bottle-feeding. e.g. in Sub-Saharan Africa when a feeding bottle is used, it most likely does not contain infant formula but rather plain water, cornstarch water or other traditional food mixtures. Infant formula can be fed by bottle, cup or cup and spoon.

If the mother is healthy, it is likely that the baby will be healthy and breastfeeding will be successful. Mothers should first and foremost be encouraged and supported to breast feed their baby. However, there are cases when babies are "at risk" (e.g. low birth weight, premature or when the mother has died) and may need supplements to compensate for this. These babies are more "at risk," than healthy, breast-fed babies. In cases like those it is unlikely that bottle-feeding has caused the risk. Both the risk and the need for a breast-milk substitute are possibly due to the baby's disadvantage at birth. Infant formula can be a life-saving product, if prepared and used correctly.

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.

Of the total Nestlé sales, Infant Formula represents approx. 1%. Only about 5% of this is consumed in Sub-Saharan Africa. In fact more Infant Formula is sold in Belgium, with a population of 10 million, than in the whole of Sub-Saharan Africa covering a population of more than 650 million.

Actually the global rate of exclusive breastfeeding increased 18% (from 39% to 46%) between 1989 and 1999, according to UNICEF. This is a welcome development, however it is very difficult to make a general statement as the situation varies dramatically from country to country. e.g. the reported exclusive BF rate in Liberia is 73% while in Kenya reaches only 5% (1).

Many factors could have an impact on exclusive breastfeeding patterns and they are all linked to economical, social and cultural circumstances. e.g. it has been estimated that in parts of South Africa, 90 % of women breastfeed, however only 10% do so exclusively in the first months. This rate of exclusive breastfeeding drops further to 2% by the fourth month, with plain water being the most common additional substance used and very small number of women using infant formula.

Other Factors, which have an impact on breastfeeding, include the rapid urbanisation in developing countries, which has led to social and cultural changes, include an increasing number of women entering into paid employment.

(1) The State of the World's Children 2003; UNICEF: New York, USA; 2002

Nestlé has always emphasised the superiority of breastfeeding. As far back as 1869, Henry Nestlé, the Company's own founder said:

"During the first few months, the mother's milk will always be the most natural nutriment, and every mother, able to do so, should herself suckle her child."

Nestlé also supports the promotion of breastfeeding. A little-known fact is that Nestlé is one of the largest private producers of breastfeeding promotional material in the world. Nestlé is also the largest private distributor of the WHO Code of Marketing of Breast-milk Substitutes in the world, having distributed tens of thousands of copies to educate both our staff and the health systems we deal with.

The fact that the lives of 1.5 million babies could be saved if exclusive breastfeeding was successfully promoted and maintained is often distorted to suggest the fault lies with the use of infant formula. The distorted use of this statement is expressed through campaign slogans like: "A baby dies every 30 seconds from unsafe bottle feeding" or "The World Health Organization (WHO) estimates that 1.5 million infants die as a result of diarrhea every year because they are not breastfed. Despite this, companies continue to promote artificial feeding in ways that undermine breastfeeding..."
 
This statistic is often attributed to the World Health Organization. In fact, the WHO has clarified that it has never made such a statement either in relation to infant formula or to bottle-feeding in general.
 
"... WHO has made no statement quantifying the impact on either morbidity or mortality of infants being fed on bona fide infant formula, i.e. breast-milk substitutes manufactured in accordance with the relevant standards of the Codex Alimentarius. In contrast, WHO has estimated that [this] number of infant deaths... that could be averted annually through effective breastfeeding promotion, and this irrespective of the breast-milk substitutes used to feed them or, for that matter, the feeding utensils employed for this purpose".
(WHO, 19 November 1992).
 
The challenge is to educate and encourage mothers to exclusively breast feed their baby during the first 6 months of life, and breastfeed along with the introduction of complementary food, for as long as possible. Because infant mortality is actually highest after 6 months of age efforts to improve complementary feeding practices are equally important.
 
The use of misleading statements should be stopped. Instead, the tackling of the root problem and proactive educational efforts about proper infant feeding are needed, as part of a global and structured solution that offers the most hope in improving infant health and reducing infant mortality in developing countries and regions.

Unfortunately, lack of clean water is a reality in many developing countries. The vast majority of women in developing countries breastfeed, and at the same time give their baby additional traditional foods, or just plain water. If for some reason a baby is not breastfed he or she needs a breast-milk substitute. Until everyone has a safe water supply, the only solution is to teach mothers the importance of boiling water and how to prepare infant formula correctly. All Nestlé's infant formula labels provide clear preparation instructions; these instructions are provided in the appropriate and clear language and also in a pictorial way.

Unfortunately, most poor mothers who need to use a breast-milk substitute cannot afford infant formula and therefore have to feed their babies with a potentially harmful substitute. The challenge is to find a way to make appropriate substitutes available to those babies who really need it.

The WHO Code states that it is the responsibility of health workers to advise mothers on infant feeding - first and foremost by encouraging and protecting breastfeeding, secondly by informing the mother about appropriate alternatives (advantages and disadvantages) which include instructions on how to prepare infant formula correctly. Thus Nestlé does not have any direct contact with mothers or pregnant women with respect to infant formula. The only way Nestlé "talks" directly to a mother is through the labels. The WHO Code stipulates what important information should be carried on each infant formula product. Nestlé infant formula labels are totally in line with the WHO recommendations and national regulations. e.g. All labels state: "breastfeeding is best for your baby" and include preparation instructions in the relevant local languages and also pictorially. Twenty years ago, when Nestlé developed the present concept of infant formula labels, WHO and UNICEF were consulted.

Complementary foods, such as infant cereals or fruit and vegetable purée are not breast milk substitutes.

This is clarified in the WHO International Code publication, contained in the integrated explanatory statement (Annex 3) by the Chairman of the WHO Executive Board, read to the delegates of the World Health Assembly in 1981, upon which the delegates voted. The explanation reflects the intent of the drafters. 150 representatives of governments, NGO's including IBFAN, infant food manufacturers and nutrition experts were involved in the drafting process together with WHO and UNICEF.

This important clarification on the scope of the code thus was part of the approval by the WHO Member States and has not been changed since 1981.

Nestlé complementary foods are not marketed or presented as breast-milk substitutes.

Modern follow-up formulas were developed in the 1960s at the request of the medical profession, because the nutritional needs of older babies are different from those of new-borns. However, the concept of starter and follow-up formula dates back to the beginning of the twentieth century.
 
In May 2000, WHO once again made clear that follow-on formula does not fall within the scope of the code, reiterating what was said in 1992 (Document WAH45/1992/REC/1). However, governments can of course decide otherwise:
 
"As WHO has already observed, on the assumption that follow-up formula is not marketed or otherwise represented to be suitable as a breast-milk substitute, strictly speaking it does not fall within the scope of the International Code. However, WHO has also made clear that, taking into account the intent and spirit of the Code, there would appear to be grounds for the competent authorities in countries to conclude otherwise in the light of the way follow-up formula is perceived and used in individual circumstances"
Source: World Health Organisation, Nutrition for Health and Development, Geneva, Switzerland, May 2000
 
According to Nestlé's instructions, we apply the Code to starter formula and also to follow-on formula, which is intended for use from 6 months onward if the brands of follow-on and starter formulas are the same (like NAN1 and NAN2)
 
To our knowledge Nestlé is the only infant formula manufacturer that extends the Code application beyond infant formula.

The WHO Code was adopted by the WHO Member States as a recommendation to governments, who are required to implement the Code as appropriate to their social and legislative framework.

Nestlé universally follows all countries' implementation of the WHO Code.

Our decision, more than two decades ago, to voluntarily and unilaterally apply the WHO Code in all developing countries and regions (more than 155) is due to the fact that the economic, social and hygienic circumstances in most of those countries differs substantially from the situation in developed countries like the US or the EU countries. In countries where there is no local code in place, or if the local legislation is less strict or precise, we implement the WHO Code. Otherwise, the local code applies.
 
The Nestlé Instructions, issued in 1982, were reviewed and refined in 1984 in consultation with WHO, UNICEF and the International Nestlé Boycott Committee. As a result the International Nestlé Boycott was terminated, as there was a clear agreement by both INBC and Nestlé that our policies were in line with the Code.

No, it is not in Nestlé's interest to have weak national codes in place; we apply the WHO Code and the Nestlé instructions if the national code is less strict than the WHO Code itself.
 
A strong national legislation, that includes monitoring procedures, provides clarity and an even playing field for all infant formula manufacturers.. Therefore, Nestlé encourages governments to adopt strict codes with effective government sponsored monitoring. The WHO Code itself also recommends this.

The WHO Code says "Donations or low-price sales to institutions or organizations ... may be made. Such supplies should only be used or distributed for infants who have to be fed on breast-milk substitutes..." (Article 6.6)

Nestlé does not provide mothers in developing countries with free samples of infant formula. The situation with medical facilities is similar, except for rare social welfare cases.

A 1994 WHA Resolution recommended to governments a total ban on free supplies to hospitals. Nestlé agrees with this recommendation in principle as it aims to reinforce the primacy of breastfeeding.

However, Nestlé also agrees with the way many governments have implemented this resolution, allowing donations e.g. for orphans, multiple births, hospitalised babies with no access to mothers milk and disaster relief.

Nestlé's policy regarding donations or low-price sales of infant formula was thus reinforced in 1994 to reflect the WHA Resolution; we therefore do not give free supplies of infant formula for healthy newborn babies apart from exceptional cases in response to an official written request.

Nestlé fully supports the May 2001 WHA Resolution 54.2, which changed the recommended duration of exclusive breastfeeding from 4 - 6 month to 6 months, thereafter introducing complementary foods while recommending continued breast feeding for as long as possible. Thus we implement this resolution in the same way as we implement the WHO Code and we have completed label changes on complementary foods to follow the 6-months recommendation. In addition, to reflect the WHO mandated "Expert Consultation on the Optimum Duration of Exclusive Breastfeeding", we also advise mothers to consult their health professional on the appropriate age for the introduction of complementary food, since the needs of each baby varies.

Nestlé is the only company manufacturing infant formula and complementary foods to have taken this step.

Meetings and symposia designed to further knowledge about infant nutrition are an example of essential cooperation between industry and the medical profession. Sponsorship of these meetings, as well as support for individuals, is fully disclosed in accordance with Article 7.5 of the WHO Code.

No. According to our Instructions, financial or material inducement to promote infant formula is not allowed.
Inexpensive items of professional utility, like measuring tapes, weighing-scales, thermometers or tongue depressors, or culturally appropriate small items are allowed. The Nestlé Instructions, issued in 1982, including a "List of materials of professional utility which may be distributed to individual health workers" (Annex 4), were reviewed and refined in 1984 in consultation with WHO, UNICEF and the International Nestlé Boycott Committee.

In accordance with the WHO Code, Nestlé provides samples (maximum two cans, once only) for professional evaluation when a new product or formulation is introduced, or to introduce a product range to a newly qualified doctor. We also allow samples for approved clinical trials or research. Samples must bear the mention "sample for professional evaluation" and sample distribution records must be kept.

Yes, we do print labels in local languages. It is important to mention that in some countries there are many local languages being used. We therefore comply with national requirements with respect to the appropriate language and additionally ensure that, subject to governmental approval, the "primary common language" is used, either on it's own or together with other languages widely spoken. e.g. in South Africa label are printed in Sesotho, Zulu, Afrikaans and English. On infant and follow-on formulae our label's preparation instructions are also shown in pictorial form.

This is not at all the case. First and most importantly, Nestlé fully supports the UNAIDS/WHO/UNICEF Collaborative Policy Statement on HIV and Infant Feeding, which states that HIV (the virus that causes AIDS) can be transmitted by breastfeeding. The Statement refers to studies, which indicate that between 25%- 33% of infants born to HIV-positive mothers are also infected, and more than one third of these babies are infected through breastfeeding. Nestlé supports the Statement's recommendations that:

• Breastfeeding should continue to be protected, promoted and supported,
• Women who are aware of their HIV status should be given the best available information on breastfeeding; the risk of HIV transmission through breastfeeding; the risks and advantages of other methods of infant feeding,
• Women should be empowered to make informed decisions about infant feeding, and supported in carrying them out. This support should include efforts to promote clean water and sanitation to minimize health risks when a breast-milk substitute is used.

The Statement recognizes that if infants born to HIV-positive women can be ensured uninterrupted access to nutritionally adequate, safely prepared breast-milk substitutes, they are at less risk of illness or death if they are not breast-fed.

Nestlé believes that governments, NGOs, the international health community and the infant food industry should work together to ensure that safe alternatives to breastfeeding, and the necessary educational back-up, are made available to all mothers at risk. These measures must pay particular attention to mothers in poor communities, where the risks of incorrect feeding are highest.

Nestlé is also Funding Corporate Sponsor of the International Red Cross and Red Crescent Societies' Africa Health Initiative 2010. Our contribution focuses initially on an educational project of young people in Nigeria seeking to prevent the transmission of HIV/AIDS.

As an infant foods manufacturer we have a clear responsibility to monitor our own practices. We take this responsibility very seriously, and have put various procedures in place to do our best to ensure our compliance with National regulations and the WHO Code, which include:

• Detailed instructions on WHO Code implementation,
• Education and training of our staff,
• Regular audits on a worldwide basis of our marketing practices relating to infant formula,
• If requested providing our assistance to health authorities towards promotion of breastfeeding, and raising Code awareness;
• Seeking governments' opinion of our Code compliance;
• Implementing an internal WHO Code Ombudsman System (in 2002) allowing any Nestlé employee to raise concerns about Code compliance in a confidential way, outside of line management.

We are continuously looking for further improvements to ensure Code compliance.

We certainly agree that breastfeeding is the ideal way to feed a baby, and that breastfeeding practices need to be encouraged, promoted and protected. We also believe that infant formula is a product that could be lifesaving for babies not being breastfed, however infant formula is also a product that deserves special treatment in terms of marketing, e.g. in situations where sanitary conditions could result in its misuse. We therefore strongly support the objectives of the WHO Code.
 
Also from a purely business perspective, it is important that newborn babies get the best possible start in life and grow into healthy and strong adults - in this context it is worth to note that 98% of Nestlé's products are not intended for infants. What is also important is that all infant food manufacturers are held to the same high standards, which is why we favour strong enforcement of the WHO Code done by Governments.
 
The WHO Code will only truly succeed if governments enforce it and monitor its compliance.

In order to reach developing world mothers who do need infant formula, while not promoting it to those who do not, Nestlé leaves the recommendation of appropriate breast milk substitutes to health professionals and for almost 20 years has stopped all promotion of infant formula to the public. This commitment to a ban on promotional activities means: no advertising, no store promotions, no price incentives, no 'milk nurses' and no educational materials mentioning infant formula.

Infant formula is the only product recommended by the UN's food standards body as an appropriate substitute for breast-milk.

For working mothers in the developing world who can afford it, infant formula can be a vital product, as the mothers are commonly obliged to return to work when their baby is a few months old, and often forced to be away from their babies from sunrise to sunset. This is also true for women who, for medical or other reasons, cannot breastfeed, as well as the orphans of the over 600,000 women who annually die in childbirth.

However, the vast majority of mothers in developing countries do not have the means to buy infant formula and feed their babies inferior (and dangerous) traditional substitutes for breast-milk, including whole cow's milk, rice water and corn starch and water. These are commonly used by both breastfeeding and non-breastfeeding mothers.