Cover image courtesy of Mark Zatta.
–by Patrick Quinn–
Source: Zatta, M. (2013). Nestle: Baby Formula Case Study [Photograph]
Most people know Nestlé for their chocolate. However, the company started in 1867 by making infant formula for babies whose mothers were unable to breastfeed. Over the next century, Nestlé began marketing its formula throughout the third world with dire consequences. This paper will look at the strategies Nestle used in promoting its infant formula and how such promotions resulted in malnutrition, disease, and death throughout the Third World. I will also look at three reports from the 1970’s – The Baby Food Tragedy by New Internationalist, War on Want’s “Baby Killer”’ pamphlet, and an analysis of the 1975 documentary Bottle Babies – which revealed Nestlé’s harmful practices, the international response, and the role Western superiority played in progressing Nestlé’s objectives.
Humans have been supplementing infant’s food for millennia. According to Stevens, Patrick and Pickler, “The use of animal’s milk for infant feeding is noted as far back as 2000 BC” (2009). Until the 19th century, humans have been using various types of animal’s milk as an alternative or supplement to human milk. As science and technology advanced, so did formulas. In 1760 Jean Charles Des-Esartz analyzed and published the chemical composition of human milk. Following Des-Esartz’s publication, scientists began reformulating animal milk to mimic that of humans. Advancements in food preservation in the 19th century allowed for the commercial production of baby formula (Stevens, et al. 2009). This opened the door for Henri Nestlé to develop his farine lactée infant formula in 1867. Nestlé (n.d) created his formula to be used as “a safe, easily digestible breast-milk substitute for infants”. According to the Nestlé website, their baby formula gives mothers who are unable to breastfeed a healthy alternative for their children. However, Nestlé (n.d.) also contends “[They are] a strong supporter of breastfeeding and believes that breastfeeding provides the best exclusive nutrition for babies in the first six months of life”. In this way Nestlé is not promoting their product as superior to breastfeeding. They that it should only be used as a backup if the mother is unable to feed herself. Henri Nestlé even wrote in 1867, “During the first months, the mother’s milk will always be the most naturally nutritious, and every mother, able to do so, should herself suckle her children” (Nestle, n.d.). However, throughout the 20th century, Nestlé overpromoted their formula throughout the developing world causing irreparable physical and mental harm to the people living in these areas. Nestlé continued to aggressively market their formula in these countries for nearly a hundred years.
By the 1930s a connection between the use of baby formula and malnutrition formed. Dr. Cecily Williams became the first doctor to observe this connection and denounced the promotion of formula as a substitute to breastfeeding (Brady, 2012; Fitzpatrick, 2010). However, Nestlé continued their aggressive promotion of formula over the course of the next four decades, which resulted in a significant decrease in the number of mothers who breastfed throughout the world. In the 1970s three different reports – New Internationalist’s Baby Food Tragedy issue in 1973, War on Want’s “Baby Killer” by Mike Muller in 1974, and the Bottle Babies documentary in 1975 – exposed the effects Nestlé’s marketing strategy had on countries throughout Africa and the rest of the developing world. These reports caused global outrage and an international boycott of Nestlé products.
It is important to note that formula/bottle feeding is not inherently dangerous. As Mike Muller (1974) notes, “In optimum conditions, with proper preparation and hygiene, they can be perfectly adequate infant food” (pg. 2). The problem, however, is the promotional practices employed by Nestlé in Africa and the rest of the developing world, which encouraged formula use in non-optimum conditions. It is equally important to understand that Nestlé was not the only company employing these strategies. In fact, Nestlé used market competition to justify their tactics; As a Nestlé representative explained, “And if we don’t come along with our product, we’re out. We’re out of that hospital because someone else is going to supply it” (Muller, Pg. 12). I am focusing on Nestlé for several reasons, however. Mainly because “[They are] the market leader in sales of breast-milk substitutes and controls nearly 30 per cent of the baby food market” (Fitzpatrick, 2010). Furthermore, in 1981 – The year the World Health Organization adopted the International Code of Marketing of Breast-milk Substitutes – Nestlé’s market share in the Third World was 60% (Beauchamp, 1993). For this reason, they share the majority of the blame, and were the main target of the reports and boycott mentioned above. Looking at the substance of these reports will give an insight into the depth of these marketing strategies, the negative consequences they caused, and the underlying theme of Western superiority that prompted mothers in the developing world to abandon breastfeeding for formula. These reports will also provide a context for the international Nestlé boycott, and the subsequent International Code of Marketing of Breast-Milk Substitutes created by the World Health Organization (WHO) in 1981.
As concern spread over baby formula and increased malnutrition in the Third World, it became increasingly clear the promotional practices of companies such as Nestlé was causing it. In 1968 Dr. D.B. Jelliffe coined the term ‘commerciogenic malnutrition’. That is, “the malnutrition caused by the ill-considered promotion of infant foods in developing countries” (Muller, Pg. 10). Shortly after Dr. Jelliffe named this phenomenon, The New Internationalist addressed commerciogenic malnutrition in their August 1973 issue The Baby Food Tragedy. One of the articles “Action Now on Baby Foods” highlights the effect baby formula has had in Zambia. The article argues mothers were persuaded by the misconception that formula would be best for their babies. Unfortunately, the way the formula and bottles were used, ultimately resulted in the baby’s death; “She was not to know that her own breast milk was better, cheaper and safer than anything she could buy in a tin” (Action now on baby foods, 1973). Part of what perpetuated this problem, New Internationalist (1973) argued, is the cost of formula feeding. A significant portion of Zambian families’ income is required to purchase feeding formula every week. Because most families in Zambia cannot afford the weekly expenditures, mothers would dilute the formula to make it last longer. This is problematic because the diluted formula prevented the babies from receiving the proper nutrients needed, which, ultimately, resulted in malnourishment. In turn, malnourishment lowers a person’s resistance to disease, which the babies in Zambia were more susceptible to due to the combination of unsterilized bottles and a lack of antibodies to fight disease that breastmilk provides. A cycle emerged as diluted food caused malnourishment, which resulted in the inability to fight disease. Disease further prevented the babies from benefiting from the diluted formula, malnourishment continued, resulting in weight loss and, eventually, death (Action now on baby foods, 1973). New Internationalist noted that even if the baby survives, malnutrition will continue to plague it throughout its life: “For the wrong food in the wrong quantities in the vital early months of life can and does inflict irreparable damage on both body and brain” (1973). The effects are inescapable under such conditions in the developing world.
In 1982 New Internationalist did a follow up after the adoption of the WHO’s International Code of Marketing of Breast-Milk Substitutes focusing on the industries’ role in this problem. In their April 1982 article, “Babies Mean Business”, Edward Baer analyzes the way Nestlé and other companies created consumers within Africa and other countries throughout the developing world. According Baer (1981), the companies did this by “[creating] a need where none existed, [convincing] consumers that [their] products are indispensable for the ‘good life’”, and “[linking] products with the most desirable and unattainable concepts; and then give a sample…free” (1982). Nestlé took advantage of this system by promoting “the view that breastfeeding is complicated and prone to failure” (Baer, 1982). Nestlé’s advertisements – such as their slogan for Lactogen, “when breast milk fails” – instilled fear and anxiety in mothers about their inability to breastfeed, which can have the physiological effect of actually stopping lactation, forcing the mother to continue to buy formula. Furthermore, Nestlé focused on societal concerns of mothers centered around Western cultural superiority. Such superiority focused on the ideals of Western beauty, in that breastfeeding will cause breasts to sag (a societal change from the West where breasts became sexualized); Breastfeeding is time consuming and mothers will not have the time to work; And snob appeal (if you breastfeed, then you are a peasant). Racism was also a factor in their ad campaigns by playing on the assumption of White superiority – I.e. white women do not breastfeed, therefore you should not either (Baer, 1982). Each of these tactics were meant to instill fear in mothers about breastfeeding and get them hooked on formula.
War on Want
Following the initial New Internationalist magazine in 1973, Mike Muller from The War on Want dug deeper into the accusations raised in his 1974 report, “The Baby Killer”. According to Muller, the newly developed urban areas were the target of these promotions. As modernization became a priority in these areas, mothers began to turn away from breastfeeding in order to adopt the more “modern” form of bottle-feeding Nestlé was promoting. The zeal of these communities highlights one of the main problems with development. As Western products became available in these countries, the new urban class were forced to adopt them in order to maintain their new “modern” lifestyles and to separate themselves from the peasant-like conditions of the rural areas. Development also brought about social changes for the women in the newly urbanized areas of Africa. As women in these areas began working for wages, they had less time to breastfeed. Nestlé’s promotion of formula as an easier, quicker way of feeding appealed to these women. In Nigeria, formula ads played on the cultural concept of “power and strength”; E.g. “bottle feeding was seen to hasten physical development” (Muller, Pg. 5). Muller argues this is dangerous in still developing areas whose residents lack the basic necessities required for safe formula use.
Muller (1974) contrasts Nestlé’s instructions – presumed to be used with “modern” appliances – with the standard home kitchen in developing Africa. Instructions, such as “wash your hands thoroughly with soap each time you have to prepare a meal for baby” does not properly apply to places like Malawi where “Sixty-six percent of households in Malawi’s capital have no washing facilities at all”, and “sixty percent have no indoor kitchen” (Muller, Pg. 7). This led to another problem in the preparation of formula: The “three stone kitchen”. Muller (1974) explained the three stoned kitchen is the only way to prepare food in these communities and often times meals are prepared using the same pot. This type of situation makes it difficult for mothers to properly boil water to sterilize the bottle, and without cold, running water easily accessible there is no way to cool down the bottle afterward. The lack of a standard Western-style Kitchen contributes to the susceptibility of a child to contract diseases. Furthermore, Muller notes that although Nestlé provides instructions on how to use their formula in the native languages where it is sold, “Most Third World mothers, however, are illiterate, even in their native languages” (Pg. 7). This illiteracy contributes to a lack of nutritional knowledge by mothers.
Muller also expands on the way Nestlé’s promotional strategies created consumers in Africa that was mentioned earlier by Bauer. According to Muller, “A survey conducted by Dr. David Morley in a rural Nigerian village found less than 1% of mothers with serious breastfeeding problems” (Pg. 6). In this way, Nestlé created a need among a majority of women, when a very limited number actually needed their product. Nestlé also used “milk nurses” to promote their products in hospitals, where sales women would dress in nurse uniforms to provide nutritional advice and instructions to new mothers. Although, this was intended to be educational, the sales pitches often implied their product could provide the additional nutrients children need before breastfeeding stopped. Furthermore, the formula companies would target doctors and nurses to promote their products. Nestlé would sponsor conferences for doctors in order to inform them about the nutritional benefits of their formula, which the doctors could pass on to the wealthier mothers who would come to see them about bottle feeding. For the poorer, and likely illiterate, mothers who rely on clinics, Nestlé would provide free promotional posters to hang in the waiting rooms that would portray, a happy, healthy baby feeding from a bottle. This was a problem because, “Whether it is intended to or not, much of the promotional, or educational material used by the milk companies, will, to the illiterate, appear to endorse bottle feeding” (Muller, Pg. 9). Nestlé would further promote their products by giving free samples and bottles to new mothers in order to get them “hooked” (Muller, 1974). This becomes problematic because once the sample is out, the mother may stop lactating and will not be able to breastfeed.
“The Baby Killer” report highlighted the various strategies Nestlé used to promote their formula throughout the Third World and the negative consequences that resulted from such promotion. Throughout the report Muller makes abundantly clear the use of Western solutions to Third World situations exacerbated many of the problems in developing nations. “The Baby Killer” gave the most in-depth analysis of Nestlé’s tactics, causing global outrage that resulted in an international boycott of Nestlé products that lasted for seven years and the creation of the WHO’s International Code of Marketing of Breast-Milk Substitutes.
A year after Muller’s report, in 1975, Peter Krieg directed the documentary, Bottle Babies. Howard Z. Lorber and Margo Cornelius provide a review of the documentary that analyzes the films success in showing Africa’s underdevelopment and “how human values have become distorted in a dialectic between engendered desire and multinational commercial exploitation” (1982) by focusing on Nestlé’s promotion of their formula. Lorber and Cornelius’s analysis explains the way colonialism has affected African’s desire to be like the West, which Nestlé has successfully exploited:
“They are prompted to be “modern” by using formula. This prompting is part of an old and complex process in which, psychologically and culturally, the dominant class in a social formation sets the rules and the values by which the “good life” is judged” (Lorber & Cornelius, 1982).
In this way, Lorber and Cornelius make clear how colonialism forced indigenous peoples to adopt Western means of living in order to become “civilized” and “modern”. Nestlé takes advantage of this supposed “superiority” to market their baby formulas as the “modern” way of feeding. They are showing the mothers the best way to raise their babies is by bottle feeding them in order to achieve Western “superiority”. By imposing their formulas on developing nations, Nestlé is reinforcing the practices of colonialism through a form of corporate imperialism, with just as dire of consequences. In effect, “Krieg’s film implicitly but not explicitly demonstrates the underdevelopment process as a series of events that continually reduce the Third World nations’ ability to become economically and politically independent” (Lorber & Cornelius, 1982).
The Nestlé Boycott and World Health Organization’s Code
In 1977, three years after “The Baby Killer” was published, Infant Formula Action Coalition (INFACT) launched a consumer boycott of Nestlé products in the United States. The boycott quickly spread and by 1978 Australia, Canada, and New Zealand joined. As the campaign against Nestlé spread, world governments, the United Nations (UN) and WHO began addressing the lack of policy regarding the promotion of baby formula. In 1978 Senator Edward Kennedy began holding senate hearings in the United States focusing on the marketing of baby formula in developing countries. The following year WHO and the United Nations Children’s Fund (UNICEF) hosted a meeting to create an international code of marketing for baby formula, which eventually became the International Code of Marketing of Breast-Milk Substitutes, adopted by WHO in 1981 (Baby milk action, n.d.).
The WHO’s code provided guidelines to help promote breastfeeding and prevent the dangerous marketing strategies used by formula companies. The code also established “the right of every child and every pregnant and lactating woman to be adequately nourished” (World Health Organization, 1981), and focused on governments’ role in properly educating and informing families of proper infant and child feeding. In addressing the marketing techniques used by formula companies, the code prohibited the distribution of free samples, the use of “sales nurses” employed by formula companies in promoting their products in hospitals or from making personal visits to mothers, and banned the sponsored trips Nestlé provided for doctors to inform them about their products. The code also required health care systems to encourage breastfeeding and prohibited them from promoting the use of infant formulas or displaying formula products in hospitals or clinics. Finally, the code set a standard for the quality and labeling of formula products (World Health Organization, 1981). After initial resistance to the code, Nestlé agreed to oblige by it in 1984 after “130 countries had passed legislation or formulated policies to restrict advertising” (Brady, Pg. 529). Six months after Nestlé accepted the terms of the code the international boycott ended (Baby Milk Action, n.d.).
The adoptions of WHO’s International Code of Marketing of Breast-milk Substitutes proved the success of the International Nestlé Boycott. However, as the code states in the Introduction, “it would adopt the code in the form of a recommendation rather than as a regulation” (1981). This caveat allowed Nestlé to continue their unethical practices. In 1987, the International Baby Foods Action Network (IBFAN), the organization created to monitor the code’s application, found “companies flooding health facilities with free and low-cost supplies and violating other provisions of the International Code” (Baby Milk Action, n.d.). Following this report, a second boycott was launched in 1988. Then, “In 1991 Baby Milk Action sent a report to the Nestlé Infant Formula Audit Committee detailing 114 cases in which Nestlé had allegedly violated the code” (British Medical Journal, Pg. 1563).
Dr. Cecily Williams’s first public denouncement of baby formula in the 1930s was the first criticism of its connection to malnourishment. This opened the door for Dr. Jelliffe to research the effects of “commerciogenic malnutrition” in the 1960s, and the investigative reporting by The New Internationalist, War on Want, and Peter Krieg in the 1970s. These reports highlighted the physical and emotional benefits of breastfeeding, and how the formula industries, such as Nestlé’s, promotion of baby formula perpetuated the trend of malnourishment and poverty throughout the developing world. In effect, these promotions relied on the historical contexts of colonialism and development, to convince mothers in the Third World their product would make them socially superior – like the West. The reports from the 1970s helped to unify the world against the unjust practices of the baby food industry, and ultimately resulted in the WHO’s International Code of Marketing of Breast-milk Substitutes in order to regulate the promotion of baby formula. However, this code has not ended Nestlé’s promotion of their formula. As Brady (2012) makes clear, the baby formula companies invest millions lobbying governments around the world to weaken regulations of the laws that enforce the WHO’s code, and “In 2010, 500 violations were documented in 46 countries” (Pg. 530). The fight against malnutrition continues, as companies like Nestlé continue to profit off of developing nations at the cost of infants’ lives.
This post may have been edited by admin for clarity and length.
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