Written by Laura Davies
How many babies would you say a company would have to kill before people would stop buying their products? If your answer is anything over one, I’m concerned for you, but you’re not wrong. Now, I can’t say Nestlé has directly killed hundreds of thousands of babies. What I can say, is that a study by the National Bureau of Economic Research estimates that in 1981 alone, the mortality resulting from Nestlé’s marketing of infant formula in low-income countries was 66,000, and they’ve been promoting it non-stop since the 1970s.
Today estimates range from 800,000 to 1.5 million child deaths a year as a result of bottle feeding in unsuitable conditions. Otherwise known as the locations where Nestlé has pushed their formula with fake nurses, misleading ads and slogans like “Lactogen is the very best milk for your baby.” You know, unlike the sterile, convenient and free breastmilk mothers were already using.
The Hunt for New Markets
The post-World War II baby boom was a dream for infant formula companies. More babies meant more customers, breastfeeding rates had dropped by half, and sales peaked in 1957. However, this kind of growth couldn’t last forever, and the 1960s saw a falling birth rate and a return to breastfeeding. With record profits to maintain and shareholders to satisfy, formula companies needed more babies and more mothers who needed formula.
The obvious answer was to look for new customers in lower-income countries, but there was a problem. Only between 1 and 5% of women were unable to breastfeed, so very few required infant formula. This was made even trickier by the fact that low wages meant bottle-feeding their babies would use up around 40% of their income.
When presented with these issues, it’d be nice to think that most companies would give up. Not only was there no need for the product, convincing mothers to buy it for their babies would probably mean there’d be no money left for them to feed themselves. This pesky moral dilemma didn’t stand in the way for Nestlé though. Where a new market could be found, profit could be made. So, in the 1970’s formula, lies and ad campaigns flooded into Africa, Asia and South America.
Racism, Fear and Anxiety
Breaking into the markets was easy. All Nestlé had to do was follow these simple steps. Create a need, convince customers that their product is required to achieve “the good life”, link their product to desirable and unobtainable concepts, and most importantly, provide a free sample.
Creating a positive image of infant formula was easy. Billboards were erected, ads were run in papers and posters were plastered around hospitals with images of a healthy, chubby baby sitting next to a tub of powdered formula. Racism played a huge part in the strategy. The babies were almost always white with the implication being that all the fashionable, western women were bottle-feeding their babies, so you should too.
The real challenge lay in creating the need. How could they, as an infant milk company, sabotage the breastfeeding efforts of millions of women in multiple countries? The answer was fear. Nestlé knew that stress and anxiety could reduce if not stop lactation altogether and if they could do that, they’d have their customers locked in.
So how do you scare a bunch of new mothers enough to prevent them from being able to feed their babies? Some attempts were subtle, implying breastfeeding would lead to your breasts sagging, prevent you from working, and make you look poor and uncivilised. Others ditched all attempts at subtlety.
Nestlé advertised Lactogen in Africa for use “when breast milk fails” and one of their most famous ads featured the claim, “Don’t wait too long to wean your baby. If you do the little one is likely to be weak and anaemic.” Borden KLIM produced a radio jingle that went “The child is going to die because the mother’s breast has given out. Mama o Mama the child cries. If you want your child to get well, give it KLIM milk”. This fear acted as a “confidence trick” inhibiting the let-down reflex and causing women’s milk supplies to dry up.
The Free Sample Trap
While this ability to manipulate demand for their products was a neat ploy, Nestlé went one step further and decided to mess with the physiology directly. You see, another handy feature of breast milk is that it stops being produced pretty quickly when it’s no longer needed. Nestlé realised that if you could interrupt the first days of a new mother breastfeeding their baby, they’d find it incredibly difficult to restart their milk supply and essentially be hooked on the product. All Nestlé needed was to get them to try a free sample.
To do this, they had to get into hospitals and delivery centres and capture their customers in the first few hours after birth. Doctors and physicians were targeted. Nestlé sent gifts, note pads, and pens. Anything the doctor would use in front of patients that would indicate their endorsement of the product. Doctors with newborns were supplied with a year’s supply of free formula so other mothers would be convinced of its superiority. Hospitals too were flooded with free samples so that formula could be used straight away in the event of any issues. Captive physicians were also quick to recommend it even in the absence of breastfeeding problems.
One stubborn Doctor who refused to recommend formula to his patients was even sent a cake on New Year. I’m not sure why anyone at Nestlé thought a cake would be a sufficient enticement to convince a doctor to recommend a product that would triple the mortality rate of his patients but they tried it anyway.
Another, less obvious and more insidious strategy is the role formula companies took in hospital design. By providing free architectural services the companies could manipulate the layout of maternity units to physically separate newborns from their mothers and make breastfeeding more difficult. Infant formula company Abbot Laboratories helps design 200 maternity departments a year in the US alone. If you’ve ever wondered why the nursery seems a long walk from the mother’s room, check who designed it and you might get your answer.
Milk Nurses
As if all this wasn’t enough, Nestlé had one more trick up their sleeve. Milk Nurses. They’d dress up their sales team in medical uniforms and send them into hospitals to ambush new mothers there. These were largely untrained women and they’d set up shop on maternity wards to give free samples and gifts to the new mums.
At one time, Nestlé had 5,000 of these so-called ‘mothercraft advisors’ distributed around hospitals in low-income countries. The mothers they advised had no clue they weren’t medical professionals and so accepted their recommendations in the same way they would a doctor. Their goal was to get the free samples into babies like a heroin dealer providing the first hit. This would prevent early breastfeeding and therefore cause milk supplies to dry up. When mothers left the hospitals, the formula was no longer free, breastfeeding was no longer an option and they’d be hooked into spending half the family income to feed their baby.
It was such an effective strategy that competing companies started using it too and didn’t stop even after it was banned. Milk nurses, who were often paid commission on top of their wage, found ways around it. In Singapore, Dumex nurses would wait outside hospitals and give mothers free samples on their way home. In Jamaica, Bristol Myers nurses would sneak into maternity centres, copy the names and addresses of new parents and visit them at home and in the Philippines they’d walk around the public housing projects looking for baby clothes on the washing lines and knock on the door.
Bottle Baby Disease
While directing shady advertising practices at new mums is already pretty morally corrupt, it’s the impact of the strategy where the real tragedy lies. It’s true that there was nothing technically wrong with the formula, and millions of babies living in high-income countries thrived on it. The women being targeted by Nestlé in the 70s, however, were not in a position to benefit from the product. In fact, they were in a position where the use of the product carried a significant risk of death to their baby through what the doctors who witnessed it would call “Bottle Baby Disease”.
You see, formula works great when it’s prepared with clean, boiled water and given in a sterilised bottle. The West African mothers being sent home with a formula-dependent baby were cooking in a three-stone kitchen. That’s a campfire which uses three stones to support a cooking pot. There’s no way they’d be lighting a fire, boiling a pot, and sterilising a bottle every time their baby needed a feed. One study found that 80% of the bottles they examined had high levels of bacterial contamination.
There was also the added issue of a lack of access to clean water. Many of the communities targeted by Nestlé relied on dirty surface water that housed harmful bacteria. Mixing it with the milk powder did nothing to make it any safer.
Another issue was price. Nestlé had no business hooking mothers who couldn’t afford it on to formula. The obvious consequence is that mothers wouldn’t be able to afford enough tins to get through the month so would try to “stretch the powder” by diluting it with extra water. One 1969 study in Barbados found that 82% of mothers were stretching a 4-day supply of formula to last anywhere from 5 days to 3 weeks. Babies drinking the diluted bottles often fell into a chronic malnourished state known as Marasmus. In some African hospitals, it was nicknamed Lactogen syndrome, after Nestlé’s Lactogen powdered infant formula.
In other cases, mothers would add corn starch or sugar water to make the formula last longer. This led to another form of malnourishment known as Kwashiorkor. A nutritional disease resulting from a combination of protein deficiency and excess consumption of carbohydrates. This is the condition responsible for the shockingly bloated stomachs seen in many cases of hunger and famine.
A study in Sao Paulo found that 32% of bottle-fed babies ended up suffering from malnourishment and had to be hospitalised. Unfortunately, malnourishment isn’t an easy thing to reverse. Those who recover often suffer permanent effects as they’ve been starved during a crucial period of brain growth. Many, however, never recover.
Once a baby becomes underweight, they become more vulnerable to infections and diarrhoea, this, in turn, reduces the baby’s ability to absorb nutrients and can ultimately result in their death. A bottle-fed baby living in unhygienic conditions is 25 times more likely to die of diarrhoea and 4 times more likely to die of pneumonia than a breastfed baby and a baby dies every 30 seconds as a result of unsafe bottle feeding.
Of course, Nestlé argued that it was a misuse of their product and not the product itself causing these deaths. But, they made it very difficult for mothers to use it correctly. Labels and instructions were nearly always written in English and very rarely in the language of the country where they were being sold. Plus, many of their customers were illiterate and the small line drawings on the tin were rarely detailed enough. They couldn’t get across the very real consequences of skipping sterilisation or stretching the powder.
When you consider that they were marketing their formula in Jamaica where the average income was only $7 a week, Malawi where even in the capital city only 34% had access to handwashing facilities and that UNICEF estimated the cost to formula feed a baby in Africa at 50% to 140% of the average income, it seems obvious that profits were being put before people.
The Baby Killer
Profits were soaring, but so was the infant mortality rate. New Internationalist were first to shed light on Nestlé’s immoral practices in their August 1973 issue “The Baby Food Tragedy” and A War on Want investigation entitled “The Baby Killer” was published a year later in 1974. Each of these pieces highlighted the tragedies that were taking place as a result of Nestlé forcing its way into the low-income markets.
The company felt wrongfully attacked and in 1975 two representatives were sent to the paediatric ward at University hospital in Nairobi, Kenya. They were looking for a clear defence against what they believed to be unsubstantiated defamations. However, as they entered the ward, full of infants who were exclusively Nestlé fed since birth, one of the babies collapsed. The doctor they’d come to see tried desperately to save the child but it died, right in front of the two Nestlé representatives. They left without a word. Sadly so did the mother, who still carried a tin of Nestlé formula in her bag.
Despite this harrowing event Nestlé still felt they had a leg to stand on when “The Baby Killer” article emerged again. This time translated by the “Third World Action Group” based in Switzerland who’d changed the title to “Nestlé Kills Babies”. As with the original, the article rightly claimed that Nestlé staff were posing as medical personnel and that their marketing practices were leading to infant deaths.
Nestlé originally attempted to sue for $5 million in damages but, as the case progressed, they realised the group was uncovering a large amount of damaging evidence. So, at the last minute, they withdrew all complaints except that of the title “Nestlé Kills Babies”. Unfortunately, the judge had to side with the formula company as the group couldn’t prove that they had intentionally gone out and killed any babies. Fortunately, it was clear to the judge that the marketing practices were unethical so, the group were only fined a token sum of $400 instead of £5 million. Nestlé was warned that the result wasn’t an acquittal of them and they must modify their publicity methods.
The Code
By 1977, public disapproval had grown to the point of protests and INFACT (Infant Formula Action Coalition) launched a boycott against Nestlé and all of its products. A boycott that continues to this day. Unfortunately, this wasn’t enough to make Nestlé change their ways. So in 1978, Senator Edward Kennedy took the marketing of baby formula to the Senate. This prompted the WHO (World Health Organisation) and the United Nations Children’s fund to step up and create what would become The International Code of Marketing of Breast Milk Substitutes in 1981 or “The Code”.
The code prohibits formula companies from promoting products in hospitals, giving free samples, giving gifts to medical professionals, giving misleading information, promoting products designed for babies under 6 months old and using misleading images or text. The label must also be written in a language that could be understood by the parent and must include a prominent health warning.
Has Nestlé Changed?
The Code, while comprehensive, was ultimately voluntary. So did Nestlé choose to meet it? Initially, they agreed and even stated on their website that they would follow both the letter and the spirit of the code. Unfortunately, they still haven’t managed it.
The 2014 film Tigers tells the story of, Syed Amir Raza Hussain, a former pharmaceutical salesman who worked for Nestlé, visiting hospitals in Pakistan between 1994 and 1997. He resigned when he saw a baby die of diarrhoea and dehydration as a result of being bottle-fed with the product he was there to sell. Unfortunately, his attempt to blow the whistle and end their practices with his report “Milking Profits” resulted in bribes and threats and he ended up having to flee the country and leave his young family behind.
Several other investigations have since taken place and exposed multiple instances where Nestlé’s practices were failing to meet the standards they claimed to follow. Multiple products were discovered with labels written in a non-native language and some labels had instructions in an appropriate language but warnings written only in English.
Other countries found issues with the ingredients themselves. For example, Nestlé’s product labels in Brazil and Hong Kong advise against giving sucrose to babies but their South African milks contain it. Other Nestlé formulas claim to be healthy as they don’t contain vanilla flavouring but then their milk powders in China and South Africa contain vanillin compounds.
Nestlé has also gotten around the ban on advertising for under 6-month-olds by introducing stage 2 and follow on milks. These are milks designed for older children but have been deemed unnecessary by medical professionals. Instead of providing a vital supplement to a child’s diet, what they actually do is allow Nestlé to advertise their products, with almost identical packaging to their first infant formulas, worldwide.
Private Doctors in Bangladesh have also claimed to still be receiving monthly visits from Nestlé representatives. This is a country where, according to Save the Children, 314 infant deaths could be prevented every day if breastfeeding rates improved. That’s a cut in infant mortality of almost a third.
Overall they now stick to approximately 57% of the code, picking and choosing the bits they like. Of course, the wording on their website has now been changed to “raising awareness throughout our value chain on the importance of the International Code of Marketing of Breast-Milk Substitutes” to cover their backs. 57% might not sound too bad until you realise that the other 43% of things they’re actively deciding to do are things they know, and have personally witnessed, kill babies.
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