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Why babies must come before business

In its annual report 'The Progress of Nations' Unicef ranks countries according to their progress on human rights, health and welfare. The Right Reverend Barrington Ward unleashed an attack on the sale of formula milk for the feeding of babies
Not all miracles stand up to scientific scrutiny, but breast milk is one that does. It is without doubt one of the world's great life-savers. Science has taken a long time to recognise what mothers and midwives always knew: breast-feeding is best for babies, and there is no substitute of equal value.

Breast milk contains all the nutrients vital for nourishment, as well as growth factors believed to help in tissue development and antibodies to fend off infections. It is always at the right temperature, requires no mixing, sterilisation or equipment, and is safe regardless of the quality and availability of water. Its composition changes from feeding to feeding, and even within feedings, and the amount is triggered by the mother's hormonal response to the needs of the baby. Breast-feeding encourages bonding between mother and baby, and discourages conception.

The World Health Organisation and Unicef recommend that babies be fed breast milk only - nothing else, not even water - for about the first six months of life. World-wide, reduction of formula feeding and improved breast-feeding practices could save an estimated 1.5 million children a year.

So why are only about 44 per cent of infants in the developing world (even fewer in industrialised countries) exclusively breast-fed? One factor has to be the relentless promotion of breast milk substitutes. It is no accident that breast-feeding levels are high in countries such as Burundi and Rwanda, where there is little marketing. I am now firmly persuaded that the promotion regularly practised by the infant formula companies is unethical, and flouts the International Code of Marketing of Breastmilk Substitutes, which they signed. In fact, they helped draft the code, which seeks to protect breast-feeding as "an unequalled way of providing ideal food for the healthy growth and development of infants". (A report on the code breakers was made between August and October 1996 in Bangladesh, Poland, South Africa and Thailand.)

The results showed that the formula companies have been distributing marketing literature promoting formula over breast milk, and giving away formula to maternity hospitals and mothers - from one in 12 mothers surveyed in Poland, to one in four in Thailand.

Free samples, especially those handed out by health professionals, are an insidious form of promotion. A mother can easily switch from breast to bottle, but from bottle to breast is another story. After being fed with formula, even for just a few days, the baby, used to an artificial teat, is fussy about accepting the breast. Meanwhile, the mother's milk production has declined.

Now the worried mother has a cranky and hungry baby on her hands, and she is convinced she must give up the breast and use formula for the duration. Rarely are such problems explained to women when "gifts" of baby formula are thrust into their hands. And when a doctor or nurse provides the "gift", it carries an implicit stamp of approval.

The industry has complained that the study is biased and unscientific. This is rubbish. Independent co-ordinators supervised the study in each country, and the many organisations that sponsored it would not have gone through this exercise without assurances that rigorous research protocols would be observed.

The Church of England suspended its support of a boycott of companies promoting formula, as an act of good faith while the study was being undertaken. The multinationals' criticism of the study adds up to this: they are simply not about to acknowledge their own unethical practices in countries that offer promising market potential.

THE MOVE towards infant formula became epidemic in the industrialised countries after the Second World War and is spreading in rapidly urbanising parts of the developing world. Despite their claims, though, industry has never developed a product on a par with breast milk. In fact, the best that science has done in this area is to prove that women's bodies know better than any manufacturer what to feed their babies.

Of course, the impact of inappropriate infant feeding is immeasurably greater in developing countries. Lack of safe water for mixing the formula, and contamination of feeding-bottles, are the main reasons why formula- fed babies die; another is that families cannot afford adequate supplies of formula, so they dilute it too much.

Compared with babies who are exclusively breast-fed, those fed formula have 10 times the risk of incurring bacterial infections requiring hospitalisation, four times the risk of meningitis and three to four times the risk of middle ear infections and gastroenteritis.

Not surprisingly, the industry has challenged in national courts some of the new laws that have been enacted to prevent such abuses. Their arguments can verge on the ludicrous: in India, Nestle argued that it could not meet the law's requirement that a notice about the superiority of breast-milk appear in a panel at the centre of formula tins - because you cannot pinpoint the centre on a cylindrical tin!