Bottles, Babies and Breast-Feeding: Debating the Nestle Boycott

I am a physician, a nutritionist and scientist, and have throughly reviewed the medical literature on breast feeding. I am currently involved in research into the issue, and have for 20 years been writing about it. My interpretation of the scientific evidence leaves absolutely no doubt in my mind, first, that bottle feeding is a major cause of morbidity and mortality in developing countries and, second, that the promotion of formulas by corporations such as Nestles has contributed significantly to this most tragic of problems.

I have read the Nestle view and I have heard their statements. I find that their argument is clever yet largely fallacious. Nestles, like many of the large transnational corporations, can afford millions of dollars to promote their products while appearing to adhere to newly promulgated guidelines. What are the holes in the Nestle argument? I shall deal briefly with three of these.

(1) Nestles states that Infant Mortality Rates have improved in many countries over the last few decades at the same time that bottle feeding has increased. But to conclude from this that bottle feeding has caused, or even contributed to, this decline in infant mortality is statistical nonsense. Infant mortality rates in New York City declined markedly between 1940 and 1970, while addiction to heroin increased and while divorce rates rose dramatically. But no one would argue that infant deaths were reduced by heroin or divorce. Clearly, infant mortality rates have dropped because of a host of factors such as improved health care, immunizations, higher standards of living, etc.

(2) Nestles says that morbidity data are lacking, and imply that there is not good evidence of an increased disease incidence in bottle fed infants. That' is patently untrue. There are dozens of studies which show a much higher disease incidence in bottle fed than in breast fed infants. No scientist or immunologist can deny the fact that human colostrum and breast milk contain substances which confer immunity on the infant and protect him from infections, and that infant formulas do not contain these substances. A study published last year in the prestigious Journal of Pediatrics showed a significantly lower rate of infections in breast than in bottle fed infants, even in affluent Cooperstown, N.Y. The American Academy of Pediatrics has stated that "Breast feedilng is strongly recommended for full term infants," and that "ideally, breast milk should be practically the only source of nutrients for the first four to six months for most infants."

(3) Nestles states that "the preponderance of available evidence points to a mother's need, or desire, to work as the principal reason for the breast feeding decline." My review of studies from Third World countries and my own work suggests this is not the case. An analysis of recently published studies from five countries in Asia, Latin America, Africa and the Caribbean suggests that no more than 6 per cent of mothers in any country said they gave up breast feeding in order to work.

There are many factors which influence mothers in developing countries to bottle feed rather than breast feed their infants. These include a lack of encouragement by health professionals, the fact that the breast has become a sex symbol and the belief that breast feeding may alter the contour of the breast, and the false impression that breast feeding is primitive and bottle feeding is sophisticated. But the main reason that women in developing countries bottle feed is that they falsely believe it is better for their infants. This belief has come largely from the promotional practices of the corporations who market infant formulas.

Nestles and the other major corporations have been aggressive in their promotional campaigns. In my view, this promotion has been unethical and immoral. It helps persuade mothers to do something that may be harmful to their infants and may even be lethal. Large sums of money have been spent on promotion to the public and to physicians. Many different tactics have been utilized, including the wide use of mass media, the issuing of free samples to new mothers to get them hooked onto formula feeding, the employment of nurses (so called "milk nurses") to persuade mothers to bottle feed, and what must be regarded as "pay offs" to influential physicians.

The question one must ask oneself is whether he or she believes Nestles has helped persuade mothers to bottle feed and has encouraged them to do something that is not in the best interests of their babies' health. Nestles claims that it has made significant changes, and it is begging to be taken off the hook. It is clear that these small changes indicate first an admission of guilt, and second that the boycott and the adverse publicity have been effective.

The question is, is Nestles doing enough. The answer is clearly no. It has taken small steps--but giant strides are called for.

--Nestles has only modified its advertising to the public, while several other corporations have ceased all such advertising.

--It has apparently taken the white uniforms off the Nestle milk nurses, but it still ememploys such persons to peddle its products. This action is like taking the uniforms off the members of a firing squad, or the hood off the hangman.

--It has absolutely refused to cease promotion o the medical profession.

--It continues to provide free samples to hospitals and physicians, knowing full well that these samples start mothers on the dangerous road to dependence on the bottle.

--It claims that no action should be taken against its practices no, while we wait for the outcome of a World Health Organizations conference to be held some time in the future.

Efforts made to influence Nestles to adopt appropriate policies for marketing have failed. Because Nestles is a foreign-based company, it is not possible for Americans to force change by using shareholder resolutions or similar efforts, which might produce desirable alterations in the practices of U.S.-based corporations. Nestles is by far the largest of the sellers of manufactured infant formula to Third World countries, and currently has over one-third of the market. Evidence is clear that the Nestles boycott is worrying the company, and is beginning to result in policy changes. It is also obvious that Nestles is spending large sums to discredit those supporting the boycott and to try to stop its spread. But they are fighting a losing battle. The truth will come out.

Widespread support of the boycott would provide clear evidence of concern for the health of infants in the Third World--and it would be such a blow to Nestles that it may well persuade them to adopt the changes we seek. I am convinced that such support for the boycott will help to save the lives of innocent victims of bottle feeding in many countries.

Dr. Michael C. Latham is a professor of International Nutrition and Director of the Program on International Nutrition at Cornell University. This article is adapted from a statement he delivered last Friday before the Governing Board of the National Council of Churches in New York City.

This article was prepared for publication with the assistance of Daniel E. Cohn '79, an organizer of the Nestle boycott at Harvard.