Milking parents for their children's worth

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Relentless marketing is a surefire formula for success, but children might pay the price for missing out on breastfeeding.

Children are at the receiving end as aggressive marketing of formula milk drowns out voices calling for mothers to exclusively breastfeed their children for at least six months, international experts say.

They are calling for increased intervention from the Vietnamese government to prevent Vietnamese parents from being led astray by the constant bombardment of advertisements by multinationals.

Parents should retain faith that breastfeeding would provide the best start for their kids, they add.

A story published on September 20 by Associated Press (AP) said marketing by formula companies Vietnam had fewer mothers adequately breastfeeding their kids.

A UNICEF study in 2006 found only one out of every six mothers exclusively breastfed their babies. The figure included women who stored milk for use in bottles as exclusive breast-feeders.

According to the World Health Organization, exclusive breastfeeding during the first six months of life provides critical nutrients and protection from disease, while continued breastfeeding after six months, for up to two years of age or beyond, is the optimal approach.

International guidelines and Vietnamese law recognize breast milk as superior to formula for an infant's health. Last month the Vietnamese government also launched a nationwide campaign to improve public awareness of breastfeeding for their kids.


"The respective authorities need to be active in their work to protect Vietnamese parents from false information through advertising - that is one of the main sources of confusion at the moment"

Dr. Marjatta Tolvanen-Ojutkangas, UNICEF Chief of Child Survival and Development Program

But the campaign has several hurdles to overcome including the relatively limited resources of the Vietnamese government and the success that multinational companies selling formula milk have already had in changing the mindset of the mother.

"The relentless marketing of baby food companies rides on the notion that breastfeeding is incompatible with work and modern lifestyles. Their marketing shows formula feeding to be elitist, scientific and exploits the desire of parents to have brighter, healthier and bigger children," said Yeong Joo Kean, an attorney with the International Code Documentation Center, a Malaysia-based nonprofit that seeks to eliminate the irresponsible marketing of baby foods.

“The big marketing budgets and clever promotional tactics of baby food companies outweigh any breastfeeding promotion efforts that a few officials in the [Vietnam] Maternal and Child Department can manage,” she said.

While Yeong Joo Kean said the fanfare marketing of formula companies downplays the inherent risks involved in artificial feeding for the health and well-being of children, a senior UNICEF official wanted action taken against it.

"The respective authorities need to be active in their work to protect Vietnamese parents from false information through advertising - that is one of the main sources of confusion at the moment," said Dr. Marjatta Tolvanen-Ojutkangas, UNICEF Chief of Child Survival and Development Program.

"There is no truth, for example, to stating that the formula includes colostrums. The first 'milk' after birth that is full of protective antigens for the baby that by the very nature of reproduction can only be in mother's milk in mammals," she said.

She also said the notion promoted by advertisements that using formula milk will make your child taller and smarter is not true either.

In fact there is some evidence to the contrary. Formula companies gloss over another major side-effect of their products, according to Tolvanen-Ojutkangas.

"There is evidence to show that formula-fed children are more likely to suffer from childhood obesity - which is indeed a growing concern among Vietnamese children, and increased use of formula contributes to that trend, but no company says so."

Both Tolvanen-Ojutkangas and Kean urged Vietnamese mothers to take advantage of changes in modern life - more working women with money to spend - instead of blaming them for not breastfeeding their children.

"Many mothers do have more money to buy formula but that has nothing to do with what is the best for her child - they have the right to be breastfed, because that provides the best start for life," Tolvanen-Ojutkangas said.

"Let the increased family income be used for good food for the mother so she can even better breastfeed, or for any other family need - but not to fatten the company accounts."

As long as mothers get the right message about breastfeeding, they can continue to breastfeed despite the heavy workload, according to Kean.

"Mothers, whether working or not are now just not getting the right messages about infant feeding because of the incessant propaganda they receive," she said.

Illegal and unsavory

The AP story reported that "dozens of interviews with mothers, doctors, health officials and shopkeepers suggest that formula companies pay doctors to peddle their products, promote it for infants under age one and approach mothers and health care workers at health facilities - all of which are against the [Vietnamese] law."

It also cited a former official at a clinic in the southern province of Dong Nai, around 35 kilometers to the northeast of Ho Chi Minh City, that the clinic received "a small commission for each can" from an exclusive deal with Dutch Lady, a brand of Friesland Foods, based in Meppel, the Netherlands.

In a statement sent to Thanh Nien Weekly, the company denied the claim.

"We do donate chairs, benches to several hospital and clinics with [a] logo [that] promote[s] breastfeeding," it said.

"We have the Dutch Lady logo at general clinics. A number of visitors at those clinics are pregnant women, and they are exposed to our Mama product, which is not against Vietnamese law."

Vietnamese law bans advertising formula products for children under age one.

Nursery schools in Hanoi and HCMC are adorned with the logos of Mead Johnson and US-based Abbott, which have provided benches, playground equipment and other gifts, AP reported.

At the City Nursery School in District 3, a major nursery school in HCMC, Abbott has also held outdoor activities for the kids twice a year, school vice principal Nguyen Thi Xinh told Thanh Nien Weekly.

The firm had also conducted medical check-ups and done IQ tests for children at the school, Xinh said. The papers recording the results of the check-ups or the tests were printed with Abbott logos, she said. Backpacks given to the children also carried the Abbott logo, Xinh said.

Among the parents of around 700 children at the school, 10 percent were planning to have more children, Xinh said.

Corruption and greed

Several Hanoi shopkeepers also said that formula companies pay doctors commissions for promoting sales, AP reported. The customers bring labels or plastic caps from formula tins back to their doctors to document sales, it said.

Vietnam's low-paid doctors are easy targets for formula companies, which offer them "formidable benefits," AP quoted Dr. To Minh Huong, deputy director of Hanoi's main maternity hospital, as saying.

But Yeong Joo Kean from International Code Documentation Center shrugged off poverty as the cause for this corrupt practice.

"I don't think poverty is the cause. It is the greed. The doctors who work with companies don't stop even when they are rich," she said.

Nguyen Thi Ngoc Anh, a teacher in Tan Binh District, told Thanh Nien Weekly that she had been approached by a salesman of a formula brand at a private clinic in District 1 run by a doctor from a maternity facility in HCMC.

"The salesman was allowed to approach me only upon the agreement of the doctor," Anh said.

There is a conflict of interest when health professionals receive commissions to promote company products, Kean said, and the damage this causes goes far beyond what is usually imagined.

"It is a conflict of the worst sort because here the health of the most vulnerable segment of society - infants and young children - is affected."

Government intervention

Both Tolvanen-Ojutkangas from UNICEF and Kean said the Vietnamese government has to play a crucial role in protecting its people from false information through advertising.

The International Code of Marketing of Breast-Milk Substitutes, sponsored by the World Health Organization 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.

But Kean said it does not take a genius to know where the loopholes lie in a Vietnam's decree on marketing and usage of nutrition products for young children.

The decree can be easily strengthened and there is expertise available to do so, she said.

"I also think that the gatekeepers of the Vietnamese Decree - the Food Administration people - who approve all the promotional materials on baby foods, need to have a paradigm shift in their mindset," Kean said.

"Presently, they are rather too business friendly and not that friendly for babies."

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