Milking a cash cow

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Formula companies and US embassy try to block advertising law that seeks to promote breastfeeding in Vietnam

 
A store that sells baby formula is located next door to a maternity hospital in Ho Chi Minh City

It took Paul Finnis almost five months to get an official apology from a European formula milk maker.

Finnis, who directs the British NGO Saigon Children's Charity in Ho Chi Minh City, was livid when his partner received an unsolicited phone call from a company salesman. He said there was only one place the salesman could have got personal information about his partner - the HCMC hospital she'd been to and the only way he could have got it was through "nefarious means."

The company said it was sorry for "the use of private medical information for sales calls."

"This is a serious allegation and as such we took the time to investigate fully in Vietnam, as well as review activities in all countries where we operate," the company wrote in its May letter to Finnis, who authorized Vietweek to publish its content. "The practice in question has been stopped with immediate effect in Vietnam."

Several would-be mothers told Vietweek that they had been bombarded by calls from salespeople from different formula companies. The salespeople all said they wanted to "consult" the mothers on nutrition for their babies, but the mothers said they knew that they were just trying to get more clients for their formula products.

The aggressive marketing of formula milk is common across Asia and Vietnam is no exception. Health advocates have for long chided Vietnam for weak laws "full of loopholes" and poor enforcement that have created fertile ground for formula companies to market their products freely, if not somewhat disreputably.

Formula companies, mostly multinationals, were none too happy when Vietnamese lawmakers began to address the problem.

US formula firms were so worried about a proposed Vietnamese ban on advertising breastmilk substitutes that they requested their government to intervene.

In an official letter to Vietnamese lawmakers dated June 13th, the US embassy in Hanoi said: "Several US companies have contacted the US Embassy regarding their serious concerns about this proposed prohibition on advertising of formula milk products, which could have a significant negative impact on their business in Vietnam."

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"We share their concerns," said the letter, which was addressed to house speaker Nguyen Sinh Hung and several other senior legislators.

"We ask that the National Assembly fully consider the implications of any changes to the draft [law] and engage in a full decision with affected stakeholders before making any such changes."

The letter was obtained and released by the International Code Documentation Center, a Malaysia-based non-profit that seeks to eliminate the irresponsible marketing of baby foods.

The National Assembly resisted the pressure, approving on June 21 a law prohibiting the advertising of formula products for children under two years of age "” a stronger version of an earlier law that set the age limit at one year. The new law takes effect next January.

"This law and the Maritime Law were the two bills that got the highest rate of approval from deputies," Le Nhu Tien, vice chair for the parliamentary Committee for Culture, Education, Youth, and Children, told Vietweek.

Tien, an outspoken proponent of the ad restrictions, was supposed to be among the recipients of the letter from the US embassy, but he said it had not reached him "somehow." But he confirmed that his colleagues had received it.

Tien, who helped draft the law, said the ban was the "best decision" the lawmakers could make to promote the public good. The United Nations also said passing the law fully complies with the Convention on the Rights of the Child and international standards.

The US embassy declined to comment on its letter, citing policy on official or diplomatic correspondence. But spokesman Chris Hodges said the embassy is "closely watching" the implications the law may have on trade and US companies in Vietnam.

Health advocates said the reaction of the formula companies was quite predictable.

"We are not surprised at all by the companies' resistance to the passing of this law," said David Clark, a UNICEF legal nutrition advisor in New York.

Clark cited a report by Euromonitor International, an industry analysis company, that the baby food industry sees government regulation as a "growing constraint."

Breastmilk substitutes are a very profitable product, with global sales of baby food projected to grow by 37 percent (US$11.5 billion) to $42.7 billion from 2008 to 2013, said the report.

Almost two-thirds of this growth ($7.5 billion) will come from the Asia-Pacific region, it added.

The US embassy letter did not spell out the names of the formula companies. Vietweek's pointed question to several US formula makers about whether they asked the embassy to intervene elicited a direct reply from only one of them.

"We have not"¦ contacted the US Embassy regarding the new Vietnam law restricting advertising for formulas 0-24 months," said Trupti Wagh, a Pfizer spokesperson.

Christopher Perille, a Mead Johnson spokesman, said while it endorses breastmilk as the superior form of infant nutrition, the company recognizes that "there are infants who are not breastfed for a variety of personal and medical reasons."

US puts profit before health

The International Code on Marketing of Breastmilk Substitutes, sponsored by the World Health Organization (WHO) and UNICEF, is not legally binding. It is up to individual countries to implement the code by enacting their own laws. Vietnam did so in 1994.

While many countries, from Europe to Brazil to the Philippines, have introduced legislation and other measures to encourage mothers to breastfeed, they have come under huge industry pressure, according to the International Code Documentation Center.

For instance, a diplomatic cable released by anti-secrecy group WikiLeaks revealed that the US embassy had in December 2005 lobbied against a breastfeeding campaign in the Philippines and blocked revisions in the Philippine Milk Code's Implementing Rules and Regulations on the advertising of milk formula for infants.

 "It is dead wrong for the US government to ignore the International Code and protect greedy corporations who are to blame for so much unnecessary infant morbidity and mortality," the International Code Documentation Center said in a press release last month commenting on the US embassy letter.

Brainwashed

Most Vietnamese mothers Vietweek spoke to said they do not produce enough breastmilk. Others said they believed breastmilk by itself is not ideal or sufficient nutrition for infants.

Health experts have sought to allay such fears.

"It is in their minds but it does have serious repercussions on actual milk production," said Annelies Allain of the International Code Documentation Center.

She cited the WHO as saying that 98 percent of mothers have enough breastmilk. They will understand this provided their self-confidence is boosted rather than undermined by advertising, negative stories from relatives and neighbors and even doctors.

Vietnamese mothers do not buy this argument.

"We don't have good nutrition as our peers do in the West," said Nguyen Thi Quy Hien, who is five months pregnant.

"So I think I will choose some breastmilk substitutes for my baby to make up for my lack of nutrition," said Hien, a secondary school teacher in District 4.

While experts have expressed sympathy with would-be mothers like Hien, they also warned against misconceptions propagated by baby formula ads that would have consumers believing that substitutes are healthier than breastmilk.

 "I am not evangelically opposed to "˜formula' milk - and I can see where it can be useful - but I feel that there is too much information about this available and not enough about the relative advantages of breastfeeding," said Finnis, the NGO director.

"But I also have a concern, especially here in Vietnam where many mothers cannot afford to pay for formula, that they can easily end up feeling as though they are doing too little for their baby if they decide to breastfeed only."

Nemat Hajeebhoy, Vietnam country director for the Alive & Thrive Initiative, a Washington-based non-profit organization that seeks to improve health and nutrition and reduce stunting, said the incorrect assumption that mothers do not produce enough milk was the most cited cause of insufficient breastfeeding.

"Biologically speaking there is no research to support this," she said. "Unless the mother is really severely nutritionally deprived, there is little or no reason they shouldn't produce enough milk."

BABIES SUFFER

Last May, UNICEF warned of a major decline in breastfeeding rates across East Asia, with the rate of Vietnamese mothers exclusively breastfeeding for the first six months declining to around 15 percent from nearly 20 percent last year.

Evidence has clearly shown that exclusive breastfeeding for the first six months of a baby's life not only improves their future growth and educational achievements, but also significantly reduces national health costs and helps prevent chronic malnutrition, it said.

According to the General Nutrition Survey, one in every three children in Vietnam is stunted and health experts have said one of the major factors responsible is insufficient exclusive breastfeeding.

Meanwhile, in its country report analyzing the baby food market in Vietnam, Euromonitor International confirmed that Abbott Vietnam continued to occupy the leading position in 2010 with a value share of 24 percent.

"The company was also very active in its advertising, which also contributed greatly to its dominant position." the report, released in October 2011, said.

In its 2011 annual report, Abbott said: "Growing populations and increasing personal incomes are driving demand for Abbott nutritional products in markets such as China, Southeast Asia and Latin America."

Mead Johnson also said in its annual report last year that the Asia and Latin America markets represented 66 percent of net sales. The company said it saw "solid results" in Southeast Asia in the first quarter of this year, especially Vietnam and Thailand. 

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By An Dien, Thanh Nien News (The story can be found in the August 3rd issue of our print edition, Vietweek)
Jon Dillingham contributed to this report

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