Mother of two, Irshad Khan, sits in her servant’s quarters with a child clinging to her breast. As natural as that may be, according to UNICEF, she is one of only 16 percent of women in this traditionally Islamic nation today who have chosen to breast-feed exclusively for the first three months after birth.
While Islamic teaching requires mothers to breast-feed their children until the age of two, Khan told IRIN: “I fed both my children this way and wouldn’t have it any other.” It’s convenient because she doesn’t have to get up in the middle of the night to prepare milk, spend hours sterilising bottles, nor does it cost her a single rupee, she adds. Despite Khan’s desire to breast-feed, most women in Pakistan are opting for an easier solution.
This is fuelling a long-standing debate between multinational Nestle and consumer rights advocates in Pakistan over what critics charge are unfair and misleading advertising practices by the conglomerate.
The Network for Consumer Protection [NCP], an NGO based in the capital, Islamabad, blames milk-powder makers for discouraging mothers to breast-feed. Nestle has been targeted as one of the main culprits. The NCP, a leading advocate of a worldwide breast-feeding campaign, claims Nestle is not adhering to World Health Organisation (WHO) codes when promoting its product to health professionals in Pakistan.
“Our main grievance is that they are not abiding by the international code of marketing of breast-milk substitutes as they claim that they do,” Tracey Wagner Rizvi, who heads the NGO’s breast-feeding campaign, told IRIN. “We have evidence that they are violating the code by giving gifts and bribes to doctors, giving them air-conditioning units, so that doctors promote the milk substitute rather than breast milk,” Rizvi said.
Nestle dominates the milk-substitute market in developing countries, and particularly in Pakistan. The milk-powder manufacturer is adamant that it is sticking to the WHO code. Nestle’s deputy director for Pakistan, Shahid Siddique, denies the allegations, telling IRIN: “We have heard of these allegations, we have investigated them, and we have found these to be untrue. In fact, there are certain gifts which are allowed under the code, and we have always confined ourselves to giving these sorts of gifts, which are professional in nature, to the doctors.” Nestle argues that its medical delegates who introduce their product to doctors do not have sales targets to reach.
“There is no doubt that breast-feeding is best for keeping the baby healthy,” UNICEF’s Nutrition Project Officer in Pakistan, Saba Mebrahtu, told IRIN. “There is evidence that shows that bottle-feeding, especially in developing countries, is the leading cause of diarrhoea.” The water mixed with baby-milk powder could be unsafe, and it was often impossible in unsanitary conditions to keep bottles and teats sterile, she said. This can lead to infection causing diarrhoea, the biggest killer of children worldwide, according to UNICEF. “Both UNICEF and the WHO recommend breast-feeding,” Mebrahtu added. In Pakistan, between four to five million babies are born every year, and 10 percent die before their first birthday, half of them from diarrhoea. Critics also argue that baby-milk powder, costing US $4 a tin, is very expensive for a developing country such as Pakistan.
The row over the breast-milk substitutes started in the late seventies. In the early 1980s, a code was issued by the WHO, essentially banning all advertising of baby-milk powder. The WHO recognised that breast-feeding reduced the incidence of infectious diseases, especially gastrointestinal infections. In March 2001, a conference called by the WHO in Geneva recommended that breast-feeding be used exclusively worldwide for up to six months, followed by complementary bottle feeding.
WHO’s member states are expected to adopt the above recommendations in May 2001, in a bid to clear up some of the debate. But the problems won’t stop there. Manufacturers are still insisting on recommending between four and six months, and leaving it open for the mothers to decide whether to stop breast- feeding. Although flatly denied by manufactures, the NCP argues that companies have adopted this approach in an effort to gain additional sales from this two-month period. Indeed, the stakes for such allegations are high. The International Baby Food Action Network (IBFAN) has calculated that the industry can make at least US $1 billion worldwide from the infant foods currently promoted for use between the ages of four and six months.
When the new code was issued, WHO stated that governments should adopt and implement their own rules and regulations accordingly. The NCP says that although the Pakistani government has made some progress in moving forward on implementing a code, a lot more needs to be done. Pakistan’s health ministry is working on the 12th draft of its own version of the code, but this is being contested by the milk-powder industry. The industry also claims that it offers a product to mothers who need to use their formula for medical reasons, such as those who are unable to produce sufficient milk themselves.
The NCP believes Nestle can adopt more subtle marketing techniques when advertising milk powder. Rizvi said that in the Islamic state of Iran, generic labelling is used, and it is very difficult for women to get hold of milk powder. The government has direct control over the distribution of formula milk, enabling it to keep close tabs on the amount of milk needed and distributed. Mothers require a certificate from their doctor stating they actually need formula milk in order to buy it, she said.
How this debate will be resolved has yet to be determined, but The NCP maintains that tighter controls, such as those applied in Iran, are needed if the lives of innocent children in Pakistan are to be saved.