Official pronouncements about promoting breast-feeding have remained just that rhetoric, as formula milk companies have a heyday
A man scans the labels of formula products at a supermarket in Ho Chi Minh City
The target is ambitious to have 50 percent of newborns exclusively breastfed by 2015.
But there is no evidence of any headway made toward meeting it. The number of Vietnamese babies who are exclusively breastfed during the first six months of life – “the most crucial period” - stands at less than 20 percent, according to the United Nations Children's Fund (UNICEF). It estimates the average rate of exclusive breastfeeding for Asia at 42 percent.
"Exclusive breastfeeding rates have increased in most regions in the world, but this is not the case for Vietnam," said Roger Mathisen, Nutrition Specialist for UNICEF Vietnam.
Vietnamese mothers blame their failure to exclusively breastfeed babies on inadequate maternity leave, which is just four months. They say the need to get back to work forces them to wean the babies away from breast milk early on. Others admit they are not completely confident they will have enough breast milk for their babies or do not know how to breastfeed properly. Then there are those who say breast milk by itself is not ideal or sufficient nutrition for infants.
The blame for a cornucopia of confusion and misinformation that still surrounds exclusive breast-feeding in Vietnam has been laid at the door of aggressive marketing campaigns run by formula milk companies who stand to make huge profits.
Formula sales in Vietnam jumped 39 percent in 2008, according to a study by The Nielsen Company, a US-based market researcher. Another survey found that the industry spent more than US$10 million on advertising in that year, placing it among Vietnam's top five advertisers.
The World Breastfeeding Week, launched July 29 in Vietnam by the World Health Organization (WHO) and UNICEF, focused on the role of health workers and facilities in promoting breastfeeding. Health experts said this focus was necessary to fight the relentless marketing by formula milk companies.
Vietnam's Decree 21 on trading and use of nutrition products for young children prohibits formula salesmen from approaching health workers or mothers at healthcare facilities. But Thanh Nien Weekly found in talks with mothers and health officials that the companies have cleverly circumvented the regulation.
Pham Lam Thanh Truc, an employee of the Nha Rong Insurance Joint Stock Company in Ho Chi Minh City, told Thanh Nien Weekly she was called by salesmen of Abbott and Mead Johnson both before and after giving birth.
"I received three calls from Abbott salesmen last month. They encouraged me to use their products for my two-month baby," Truc said.
Another mother, 33-year-old Vo Huong Quynh, said she had also been bombarded by calls from Abbott salesmen.
"They knew my name, my baby's name and my date of delivery. They must have got my information from the hospital I delivered or the private clinic of a doctor in District 5 since they were the only two places I went to before giving birth," said Quynh, a lecturer at the HCMC University of Education.
The companies denied they were breaking any law. One of them declined to comment on allegations by mothers that they were approached by the company's salespersons.
"We can say that [our] marketing and sales employees receive excellent training to assure that their activities are fully compliant with relevant Vietnamese laws and regulations," said Gail Wood, a spokesperson for Mead Johnson Nutrition, an American firm based in Glenview, Ill.
Steven Collens, a spokesperson for Abbott of Abbott Park, Illinois, said the company has a stringent policy to comply with all laws and regulations in all the countries it does business in. "We provide extensive training to our employees and conduct routine audits to ensure compliance," Collens told Thanh Nien Weekly in an emailed statement.
The International Code of Marketing on Breast-Milk Substitutes, sponsored by the WHO and UNICEF, is not legally binding. It is up to individual countries to implement the code by enacting their own laws and Vietnam did so in 1994.
But many loopholes in Vietnam's Decree 21 have enabled formula firms to market their brands freely.
"They are using back-door promotion by pushing products such as "milk for mothers and growing-up milk which are not covered by the Vietnamese Decree 21," said Yeong Joo Kean, a legal advisor for the International Code Document Center, a Malaysia-based nonprofit that seeks to eliminate the irresponsible marketing of baby foods.
Vietnamese laws prohibit advertising formula products for children under age one.
Nursery schools in Hanoi and HCMC are often found adorned with logos of many American and European formula brands.
Jan Bles, the Vietnam general director of FrieslandCampina Vietnam, confirmed funding nursery schools in Vietnam.
"We have provided many nursery schools with benches, playground equipment and gifts, which can help to improve the learning condition for kids to three to six years old in these schools," Bles told Thanh Nien Weekly.
Tentacles of influence
Experts have also pointed to huge influence that formula companies have, with tentacles reaching into every level of Vietnam's health sector.
35-year-old Huynh Thi Kim Hanh, an employee of a center at the HCMC Post, said she had not been advised to supplant or supplement breast milk with formula products when she delivered her baby at a major maternity hospital in HCMC.
"But before I was discharged, the midwives there gave me a package with a brochure promoting Abbott products and an invitation letter to their seminar that many doctors are participating in," Hanh said.
"Every mother in my room received a similar package."
Dr. Nguyen Mai Huong, an expert at the Health Ministry's Department of Mothers and Children's Health, confirmed that formula companies are cashing in on Vietnam's underpaid health workers to endorse their products for benefits in cash or kind.
In reality, the formula companies can approach health workers, offering them great benefits if they help advertise and sell their products to mothers after birth, said Dr. Jean-Marc Olivé, the WHO representative for Vietnam.
"At an organizational level we do need to be able to separate health workers from the influence of the companies, otherwise the advice that they give and task that they are expected to perform in ante-natal care clinics and maternity hospitals will be compromised," said Roger Mathisen of UNICEF Vietnam.
Other loopholes in Decree 21 have also made life easier for formula companies to reinforce their ties with the local medical community.
"The Decree does not allow the support for health facilities, but does not specify the ‘facility', leaving the gate open for supporting key professional associations, such as ABBOT providing support for meetings of the Pediatric Association, Mead Johnson for the Midwives' Association and FrieslandCampina Vietnam for the National Institute of Nutrition," said Dr. Huong of the Department of Mothers and Children's Health.
Formula milk companies confirmed funding the professional associations, but reiterated they were breaking no law.
"We sponsored seven hospitals to participate in the Clinical Nutrition Project [organized by the Ministry of Health and National Institute of Nutrition] to develop and apply nutrition as a therapy to hospitalized patients... Our business is mainly in daily nutrition for the community," said Bles of FrieslandCampina Vietnam.
"We have also cooperated with the National Institute of Nutrition to conduct research to define how micro nutrients impact on development of Vietnamese pupils. The research helps us to develop nutritional solutions that fit the best with Vietnamese children at age 6 to 12," he added.
But Dr. Huong insisted it was not right for associations to receive heavy funding from the formula companies.
"The members of these associations have a key role in guiding and providing correct advice on successful breastfeeding and they should remain outside the influence of the companies," Huong said.
Dr. Marjatta Tolvanen-Ojutkangas, UNICEF Vietnam's former Chief of Child Survival and Development Program, was even more forthright: "One of the serious issues is that National Institute of Nutrition is playing a double role: they are expected to be the source of sound and correct nutrition advice, but some of the staff members are also working for the companies, appearing in the company's promotion talk shows."
Dr. Nguyen Thi Lam, vice director of the National Institute of Nutrition, denied any ethical and or professional wrongdoing.
"I am not in a position to suggest any [formula] product that can replace breast milk," said Lam, a frequent speaker at many seminars and talk shows sponsored by different formula companies.
According to international health experts, breastfeeding within one hour after birth and exclusively during the first six months of life yields tremendous health benefits to the newborn baby.
It can prevent 13 percent of under-five deaths and also helps prevent a great number of diseases, in childhood and later in life, from infections to allergies and chronic conditions like hypertension, diabetes, obesity, cardiovascular disease and cancer.
This year's theme of the World Breastfeeding Week is "Ten Steps to Successful Breastfeeding - A call for action to health care providers and communities," which calls for every health facility providing maternity services and care for newborn infants to provide support to mothers in breastfeeding by following ten steps.
But so far, only 59 hospitals are certified as Baby Friendly Hospitals following the 10 steps. This number isn't enough compared to the 12,146 hospitals and health centers with maternal services in Vietnam, said Jean Dupraz, UNICEF acting representative in Vietnam.
Annelies Allain, director of the International Document Code Center, pointed out that breastfeeding promotion is not being given enough political support and resources in the country.
"Vietnam ranks very poorly in the region indeed, and companies must be having a heyday because of a weak laws and poor enforcement."