An investigation by the
Bureau of Investigative Journalism for
The Independent found that Danone has been marketing its formula milk product Aptamil in Turkey by suggesting mothers with six-month old babies might not be providing enough of their own milk to meet their children’s needs. The episode has echoes of the baby milk controversies of the 1970s, which led to the international boycott of Nestlé, and illustrates the importance of emerging markets to Western multinationals. The campaign boosted infant formula sales in Turkey by at least 15 per cent and may have led to mothers moving their infants on to formula unnecessarily.
Danone says it based its advice on WHO guidance, and claims that both the WHO and the UN agency Unicef endorsed the campaign. But the WHO has demanded that Danone stop using its name and logo while Unicef has denied endorsing the company’s actions.
“Danone’s campaign is misleading,” said Dr Colin Michie, chairman of the British Royal College of Paediatrics and Child Health’s nutrition committee. “There is not enough evidence to support its approach.” He added: “Mothers who follow Danone’s advice could end up moving their babies on to formula milk unnecessarily.”
Danone insisted that the campaign was aimed at discouraging “inappropriate” substitutions for milk such as rice flour, rather than “competing with breast milk”.
“Turkish Unicef and the WHO, together with other partners (the Ministry of Health, TV stations, supermarkets, Paediatric Association) supported this campaign, with the WHO allowing its logo to be used on printed materials,” it told the Bureau. The campaign had increased mothers’ estimation of the amount of breast milk fed to their babies by 63 per cent, it added.
Danone – best known in the UK for Actimel and Activia and Cow & Gate formula milk – began its Turkish marketing campaign in 2010.
The company identified the infant nutrition market in Turkey – with a population of 73 million, a relatively high birth rate and salaries on the rise – as one with major potential. But traditionally Turkey had high rates of breastfeeding – and no tradition of using formula milk.
In 2009 Numil, Danone’s baby nutrition arm in Turkey, enlisted 577 paediatricians to measure the breast-milk production of mothers of children aged six months. The doctors used breast pumps or weighed the babies before and after feeding to get their results.
They found the mothers were producing an average of 290ml per day, although the findings have not been peer reviewed. The company then attempted to calculate a figure for the amount of breast milk a mother should be providing their child.
Numil took a WHO bulletin, which referred to an independent research paper on the energy children need to get from complementary food after six months of age. The paper was not designed to prove how much breast milk a child needs, and the resulting figure is not recognised as a recommendation for a breastfeeding child by international authorities.
Danone then launched a marketing campaign to promote the 500ml figure – which it inaccurately claimed was a WHO recommendation – with the slogan, “Half a litre every day”.
The message was promoted on TV, online and in supermarkets. One television ad stated: “Your baby needs at least 500ml milk per day. If your breast milk is not enough, give Aptamil formula to support your baby’s immune system.”
Supplementing with formula can reduce breast-milk flow. Unicef says there are several ways mothers can increase their breast-milk supply, such as expressing milk between feeds.
At the same time, Danone publicised an online test it had developed so mothers could check if they were providing 500ml. The test asks mothers questions about the frequency and duration of breastfeeding. Thousands of women have filled it in – and according to Danone, most have so far been given the result that they are not providing 500ml. The advice to those who are deemed to be providing less than 500ml is to use formula.
But experts have questioned both the 500ml figure and recommending it to parents. Dr Helen Crawley, director of First Steps Nutrition Trust, said estimates of how much milk meets infant requirements are needed in case a child has to be fed with expressed breast milk or formula.
“This is not the same as making a recommendation to mothers about volumes of breast milk,” she said. “The relatively high exclusive breastfeeding rates in Turkey may be undermined by any campaign which suggests a volume that may sound unachievable.”
Dr Gonca Yilmaz, director of one of the biggest paediatric units in Turkey, also condemned the campaign. “The health benefits of breast milk are enormous and mothers must not be pressured into buying formula based on inaccurate advice,” she said.
Both the WHO and Unicef have denied endorsing the campaign. The WHO said Danone did not have permission to use its logo and has written to the company asking it to remove its name within 14 days.
Dr Ayman Abulaban, the Unicef representative for Turkey, has also written to the company. “The Unicef Turkey office has not endorsed this campaign,” he wrote. “We kindly ask you to remove the Unicef name from your campaign materials.”
The Turkish Ministry of Health was not available for comment, but in a statement to Danone it said: “We are pleased that Numil is supporting the ministry in the promotion of correct infant feeding patterns, to encourage and increase breastfeeding rates as well as reduce inappropriate feeding.”
Sour milk: The Neslé scandal
Boycotts of Nestlé breast milk substitutes spread from Minneapolis to Europe in the late 1970s and early 1980s. They were triggered by the Swiss firm’s alleged “aggressive marketing” of instant formula in the Third World.
Campaigners claimed the products led to the suffering and deaths of children because parents mixed the powder with water that was often contaminated.
In 1981, the World Health Organisation approved the International Code of Marketing of Breast Milk Substitutes, to protect breastfeeding and to ensure breast milk substitutes were used safely where they were necessary.
Nestlé has always denied the allegations.
