Beginning of a public controversy over the marketing of breast-milk substitutes

The debate over the marketing of breast-milk substitute in developing countries entered the public sphere in 1973 with the publication of “The Baby Food Tragedy” – an interview with two child nutrition experts – by The New Internationalist.

However, the controversy did not boil over until the publication in 1974 of a pamphlet, “The Baby Killer”, by the British organisation War on Want. This pamphlet was widely distributed and translated. In particular, a German left-wing student organisation, Arbeitsgruppe Dritte Welt (Third World Working Group), published the same year a translated and altered version under the name “Nestlé tötet Babies” (Nestlé kills babies).

Nestlé sued the organisation for libel.  Although it won the court case in 1976, the publicity around it contributed to making the pamphlet known in the United States and elsewhere.

At the same time, Nestlé continued to review its marketing practices in developing countries. In 1974 and 1975, Nestlé revised the contents of its educational and informational materials to strengthen the emphasis on the importance of breastfeeding and to remove advertising or promotional material. By 1976, Nestlé was phasing out infant formula mass media advertising, and by 1978, this was withdrawn in all developing countries.

In addition, the International Council of Infant Food Industries (ICIFI) was created by Nestlé and seven other infant formula manufacturers in 1975. A code of ethics was adopted to guide companies’ marketing and advertising practices.

However, scientific evidence was pointing out to a more complex issue. Dana Raphael, Director of the Human Lactation Center of Connecticut, was one of the first scientists to hold infant formula manufacturers responsible for high infant mortality rates in developing countries. Yet, in 1976 after a two-year study which observed how infants were fed in 11 different cultural settings around the world, she found that in the cultures studied a decline in breastfeeding was not a major part of the problem. In some, breastfeeding was still universally practiced. Most importantly, the study showed that mixed feeding was common: infants were breastfed but were also given other, and inappropriate, foods from a very early age. A WHO/UNICEF two-year Collaborative Study on Breastfeeding revealed the same patterns in 1979.

The Nestlé Boycott

On 4 July 1977, the newly formed Infant Formula Action Coalition (INFACT) started a consumer boycott against Nestlé and demanded the end of infant formula promotion. They also lobbied U.S. Senator Edward Kennedy, chair of the Subcommittee on Health and Scientific Research of the Committee of Human Resources, to hold Public Hearings on the infant formula issue.

The Public Hearings took place in May 1978. In July, Kennedy met with representatives from the industry, including Nestlé, to determine what to do next. At the request of the Infant Council of Infant Food Industries, and with a support letter from Nestlé, Kennedy asked the director general of the World Health Organisation (WHO) to sponsor an international conference to discuss the issue and come up with an international recommendation for marketing infant formula in developing countries.

In 1979, Nestlé developed internal guidelines limiting advertising and sales promotions, curbing free samples and supplies, spelling out the content of informational materials and ending all financial incentives for health professionals to sell formula. In the same year, WHO and UNICEF held a meeting on Infant and Young Child Feeding.