I'm pleased to present a guest post today by Caroline, an expat living in Madagascar, about what formula marketing is like in a country where the WHO Code has been adopted. I was particularly interested in hearing about this because of the recent discussion about whether or not Nestle abides by the Code in countries where it has to.
Madagascar is one of the 32 countries in which the International Code of the Marketing of Breastmilk Substitutes (the "Code") is law. The two main infant formula brands that are marketed here in Madagascar are Nestlé and Blédina. I would say that they each occupy about 45+ percent of the market, although perhaps Blédina, a French brand, has a slightly higher market share (the other 10 percent occupied by France Lait and other smaller brands).
Both Nestlé and Blédina ostensibly adhere to the Code. Blédina states on its website that it supports the Code's recommendation of exclusive breastfeeding for six months, and is committed to adhere to this recommendation (i) in accordance with the application clauses found in local regulations or (ii) as it stands, in the absence of regulations. As the Code is law in Madagascar, both Nestlé and Blédina have taken steps to abide by the letter of the Code (or at least their interpretation of it) here.
Here is a typical supermarket aisle for infant formula.
Note that there are no special promotions of the stuff and it is not on a special display. There is also no billboard advertising of infant formula (stage 1 or 2) that I have ever seen here. Also of note: all the puréed food in jars is labelled as being for babies 6 months and up.
The exact same jars are labelled as being for babies age 4 months and up in France and elsewhere in Europe!
However, sometimes mistakes are made. A few weeks ago, I was in the store that also happens to be the official distributor for Nestlé here in Tananarive and what do I see? This display.
In it are all the Nestlé products available in the store, including KitKat, some breakfast cereal, infant cereal, and Guigoz Stage 1 and 2 infant formulas. Around the display is a yellow ribbon with the Nestlé logo and "Pour une croissance saine" written all around the ribbon. Ironically, I also saw a billboard behind the cashier's desk, marked "for employee use only" with clear instructions from Nestlé as to what constitutes a violation of the Code. So clearly, the store was making an effort. I asked to speak to the store manager and told him that I appreciated his store's efforts to adhere to the Code and that the ribbon constituted point of sale advertising of infant formula and was therefore in violation of the Code. He said he would take it up with Nestlé and apparently he did because Nestlé called me a week later. We discussed the issue and they removed the ribbon.
But Nestlé and Blédina don't need to advertise their infant formulas directly. They have much more insidious ways of advertising their products. This Blédina sign hangs outside virtually every pharmacy in Tana. It doesn't say anything about infant formula. There is even a disclaimer in tiny letters underneath stating "Ces produits ne sont pas des substituts de lait maternel" (translation: these products are not breastmilk substitutes).
All Blédina has to say is that this sign is meant to advertise Blédina's complimentary food: cereal and purées for example, and is not intended to advertise formula. The disclaimer in tiny letters is their proof. And yet, all most people need to see is the Blédina sign to think infant formula.
Take a look at this calendar produced by Nestlé and sitting on a cashier's desk at a store
It's just a photo of some building blocks along with the statement "Nourishing children in Africa for healthy growth." Wow. Now that's good. Nestlé can deny that it advertises formula at all because nothing in the ad says anything about what IS being advertised.
And then there are the ads of products that Blédina and Nestlé will argue do not fall within the scope of the Code. Here is a photo of a billboard ad for Blédina's "lait de croissance" - literally, growth milk, intended for children age one and up.
As far as Blédina is concerned, we are no longer talking about infant formula or any breastmilk substitute, as this milk is for toddlers. Yet the World Health Organization recommends breastfeeding for a minimum of two years, so how can this milk NOT be a breastmilk susbtitute?
Nestlé advertises its Nido powdered milk extensively. Nido is not infant formula. Yet, as shown recently on my blog, shops will systematically place it alongside the infant formula. And since it is much cheaper than infant formula, Malagasy people will buy it instead, thinking that it is formula. Nestlé has refused to put a label on Nido to indicate that Nido is not intended for babies under one year of age, stating that since Nido is not a breastmilk substitute, Nestlé has no obligation under the Code with respect to Nido.
Then there is a problem with baby bottles. The pharmacy closest to our home has these displays of their Avent products.
Note that the Code only covers bottles and teats, so Avent has conveniently placed the most emphasis on its associated products: bottle sterilizers, bottle warmers, diaper bags, breast pumps and breastmilk storage containers. I explained to the pharmacist in this pharmacy that their Avent display sign promotes bottles and is therefore in violation of the Code. He was surprised. He thought the Code only covered formula and that's it.
Which brings me to the last point. Even though the Code is law in Madagascar, so many people who ought to know better really don't have a clue about the Code or what it covers. Malagasy women generally breastfeed for two years. The percent who breastfeed exclusively for six months was around 67 percent in 2004. The main reasons for not breastfeeding exclusively are (1) having to work and (2) misinformation and ignorance. Under misinformation and ignorance, we have the women who are too poor to even consider buying formula but who try to feed their baby other things (rice water, for example). And there are women who are moving out of poverty and into the middle class who see prominent displays of bottles in the pharmacy, who see the Blédina signs everywhere, who see the healthy white toddler in the billboard ad and who decide that infant formula must be a good idea.
So even in a country where the WHO Code is law, formula and bottle companies still manage to promote their products and convince women to breastfeed less.
Caroline is a lawyer, writer, teacher and lactivist. She lives in Tananarive, Madagascar with her husband, 5-year old daughter and 1-year old son. Caroline writes about lactivism, intactivism, cultural aspects of parenting, green parenting, bilingualism and multilingualism, alternative and foreign education systems, and anything else relevant to globetrotter parents on her blog, The Globetrotter Parent.
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