Breaking the rulesstretching the rules

eXcerPts FrOM:

2014

Evidence of Code Violations from Jan 2011 to Dec 2013

International Baby Food Action NetworkInternational Code Documentation Centre

Here are 7 pages where Latin American violations receive special mention. They appear in the Abbott, Danone and Nestlé chapters

of the Breaking the Rules 2014 report. Other evidence of violations brought to the attention of ICDC

have been written up in the various company chapters.

A soft copy of the full report (237 pages) will be made available to the LAC Regional Office after the press launch in May 2014. In addition a shorter version called BTR: in Brief will be printed for the launch and each IBFAN group in LAC will receive copies

(unfortunately only in English).

Please remember to send us evidence of violations as and when you find it.

Email: code@ibfan-icdc.org

Gifts delivered by company representatives to health workers: Similac Advance product samples and teddy bears resembling the brand mascot.

Free samples of infant formula for babies under 6 months.

Abbott samples jostle for space with products for other companies in paediatric wards.

In Ecuador, Abbott violates the Code in various ways. These include providing samples to mothers and displaying products in outpatient clinics, paediatric wards,

labor rooms and emergency areas. Promotional materials are also found in administrative offices, medical staff offices and training rooms.

El Salvador– Mothers receive, upon discharge from hospital,

diaper bags containing samples of Similac Advance infant formula and other gifts such as baby clothes, diapers and teddy bears resembling the Similac brand mascot, Rosco.

nIn Panama, the situation is very similar with samples of special formulas Isomil 1 and 2 found in pediatric wards for use by children with gastroenterology.

– Full size cans of powdered and ready-to-use liquid alternatives of Similac, Similac LF, Isomil and Gain Plus are given to hospitals and private clinics. These are, in turn, given to mothers by doctors or clinic staff.

The label of Gain Advance 2 contains promotion for Gain Plus Advance 3.

Breaking the Rules, Stretching the Rules 2013 • Abbott-Ross u 16

Where labelling is concerned, Abbott brands in Latin America, as is the case elsewhere, promote the ‘special properties’ of ingredients through unsubstantiated claims. These promotional texts are further accentuated by the use of idealising figures or drawings.

Look what they’re doing in Latin America

Panama

Breaking the Rules, Stretching the Rules 2013 • Danone u 33

Costa Rica

El Salvador

In Latin America, Danone markets through Nutricia which owns the Bebelac, Neocate and Nutrilon formula brands. The violations reported are from Costa Rica (law), El Salvador (law implemented after monitoring was carried out) and Paraguay (law only partially implements Code and is aimed

mostly at health workers). Where implementation and enforcement are poor, Danone takes advantage by flooding hospitals with promotional materials ignoring the Code Article 11.3 which requires companies to give effect to the Code at every level irrespective of government action.

Look what they’re doing in Latin America

Company materials are so plentiful that some are hung on top of one another as can be seen in the Cow & Gate wall poster (left) which is partially obliterated by a Pfizer clock.

Happy and healthy-looking babies feature prominently in company materials found in Costa Rican hospitals. Hardly scientific or factual. Some, regarding food allergies, are aimed at parents. Others focus on the Neocate family of products – “Nutrition appropriate for every age; products that grow with them”. (Danone gave a global undertaking in May 2012 to stop distributing materials for the public through the health care system).

But no matter. Even if posters are partially hidden by the competition, there are enough. Nutricia materials (top right and bottom left) distributed in El Salvador to send the message that Nutrilon should be the product of choice, even in materials that purport to promote breastfeeding (above centre).

Breaking the Rules, Stretching the Rules 2013 • Abbott-Ross u 16 Breaking the Rules, Stretching the Rules 2013 • Danone u 33

Cute little cloth booklets to entertain Paraguayan kids while waiting their turn to see the doctor. The kids may not recognise the Nutricia name but their mums will.

One of many gifts handed out to healthcare personnel, aside from calendars, are wall posters. These cover the window of a corridor leading to the Neonatology unit. They don’t make good curtains but are a strong declaration of product support by the hospital - as intended by Nutricia.

Nutricia behind every mother in Paraguay? These pamphlets for health professionals may say that “only mom can give baby a stronger immune system.” But it is clear that Nutrilon products are not very far behind with claims that the bifidobacteria found in Nutrilon products is similar to breastmilk.

The series of Nutricia booklets are widely found in waiting rooms of private hospitals. Titles from left – ‘Breastfeeding’, ‘I’m Born and I’m Here’ and ‘Your New Life’. The booklets acknowledge the value of breastfeeding but their contents are skewed towards artificial feeding implying that Nutrilon products are similar to breastmilk.

Paraguayan doctors may not realise it but they become sales people for Nutricia with prescription pads like these.

Refresher courses for health professionals are unique opportunities for promotion as this Nutrilon baby record (left) illustrates. A leaflet (right) explains how Bebelac provides optimal nutrition balance for growing babies.

Breaking the Rules, Stretching the Rules 2013 • Danone u 34

Look what they’re doing in Latin America (continued)

Paraguay

Breaking the Rules, Stretching the Rules 2013 • Nestle u 37

Look what they’re doing in Latin America

Nestlé claims in its PR statements that Latin America is a region where many countries shoulder the ‘double burden’ of malnutrition. So Nestlé “strives” to ensure more people can get the nutritious foods they need to stay fit and healthy throughout their lives. There is no mention

about its responsibility to comply with the International Code, subsequent WHA resolutions and the national laws that have been implemented to give effect to these recommendations. Below are examples of Nestlé’s marketing practices in selected Latin American countries.

nBrazilnBrazil

nCosta Rica

PROMOTION OF BREASTMILK SUBSTITUTES

A pendant in the shape of Blue Bear sleeping was distributed to paediatricians on Paediatrician Day. The pendant comes in a pouch with the Nestle logo and the “Start Healthy, Stay Healthy” slogan in Portuguese.

A confusing discount using NAN 3 shelf talker for Nan infant formula price reduction.

Using idealising image of mum and baby to promote the full NAN range.

An outdoor banner explains how NAN products with L. reuteri probiotics reduce crying and colic.

An ad for the new PreNAN packaging announces it is practical, convenient and safe.

Nestlé celebrates its 90th anniversary in the country with a larger-than-life size figure 90 covered with a collage of labels of Nestlé products including Ninho.

NESTLÉ

Evidence of violations of the International Code of Marketing of Breastmilk Substitutes and subsequent resolutions

Look what they’re doing in Latin America (continued)

Shelf talker in a supermarket announces “Healthy Start, Healthy Life. Good nutrition ensures a healthy future.” Nestogeno, NAN and NAN Pro 1 are promoted under this slogan.

The Nestlé booth at a nutrition congress in Guatemala City in September 2013 blatantly promotes a full range of Nestlé formula products with the slogan “Helping mothers to feed happy babies.”

A solution for every need – Nestlé materials remind health professionals of the full range of Nestlé formulas. The mélange of idealising claims include- for NAN: “has a mix of protective ingredients which activate the immune system”; for NAN Pro: “stimulates the immunological system at intestinal level”; for NAN HA: “routine formula for preventive use even if infants show no allergy symptoms”.

Claims on labels:(left to right): NAN products in various permutations show the fat birds logo on their labels. NAN 1 and NAN 2 show an additional Protect Plus logo with the additives in NAN products such as bifidus B, DHA, ARA and OPTI PRO. Nestlé claims these additives provide essential nutrients for optimal physical and mental development and to help trigger baby’s natural immune defenses in the early weeks of life.

nEl Salvador

nGuatemalanEcuador

Look what they’re doing in Latin America (continued)

Another NAN 1 brochure expounds the benefits of the Protect Plus combination of additives in NAN products.

Buying their souls? A bounty of USD 25,000 for the chosen winner of the best breastfeeding promotion campaign.

(left): Starting them really young; Nido 1+ is promoted as suitable for young babies in diapers!

(middle): Efforts to court health care personnel with inexpensive, but useful gifts such as pens and diaries.

(right): Like in El Salvador, the “Protect Plus” logo on NAN 1 is also found in Paraguay. It gives the impression that the product has protective qualities normally associated with breastmilk, as well as “enhanced protein efficiency”.

nNicaragua nPanama

nParaguay

nEcuadorPROMOTION OF COMPLEMENTARY FOODS

Blue Bear on the rampage - Multiple copies of this Nestle poster (at least 100) were found in health units in different cities.

Special display rack promotes Gerber, Nan 3 and Nestum. “Development and protection when they most need it” is the slogan for NAN PRO-3 from 12 months. Gerber’s slogan says: “Delicious and nutritious - each day of (the baby’s) development.”

Buy Nestlé growing-up milk and stand a chance to win a laptop.

NAN brochure destined for health professionals talks about “A specialty for every need.”

Look what they’re doing in Latin America (continued)

nEl Salvador

nParaguay

In defiance of WHO recommendations, Gerber continues to promote complementary foods for children under 6 months. The promotional shelf talker relates Stage 1 with the ability of the baby to lift its head (that occurs in the first weeks of life). The Gerber baby logo looms large over the products to attract shoppers.

These complementary feeding materials for recording baby’s growth data are distributed to mothers in healthcare facilities. They contain recommendations to use Gerber and Nestum products. Idealing texts include: “Gerber’s exclusive nutrition feeding plan in four stages”; “Gerber grows with your baby” and “Strengthen your baby’s natural immunity”.

Colourful Stage 1 Prescription Pads from Gerber and Nestlé are given to doctors in hospitals.

Height chart in healthcare facility shows a weight-lifting Blue Bear saying “¡Cuánto crecimos!” (We grew so much!)

Addressing mothers, this prescription pad says that Nestum is the first healthy semi-solid food for baby with the necessary nutrients for his protection and development.

The young baby in this Nestum 1st Cereal ad suggests that the product might be suitable for babies below 6 months.

A Nestum prescription pad with a big heading “Give him Love and Nutrition in a Small Spoon” encourages doctors to recommend all stages of Nestum.