Thursday, January 28, 2010
A tale of two logos: The Fairtrade mark added to KitKat while Nestlé tells mothers its formula will 'protect' their babies
The Independent newspaper has picked up a quote from me in an article today on "The great KitKat debate: is it fair?" See:
They invite comments, so feel free to give your views.
For the concerns over the way Nestlé is using the Fairtrade mark to divert criticism of unethical business practices, such as its pushing of baby milk, see my past blogs, such as:
It is ironic that as the Fairtrade logo appears on Nestlé KitKats, we continue to campaign for Nestlé to remove a logo from its infant formula labels that claims Nestlé formula 'protects' babies. It does not - babies fed on it are more likely to become ill than breastfed babies and, in conditions of poverty, to die. You can send a message to Nestlé about this via our Campaign for Ethical Marketing action sheet, which shows a tin from Malawi, one of the world's poorest countries:
While Nestlé is gaining worldwide publicity, much of it good, for its decision to source 1% of its cocoa from farmers within the Fairtrade scheme, Green and Black's has today announced it is going 100% Fairtrade. See:
US Fair Trade organisations have said they think far more should have been demanded of Nestlé, particularly as it has failed to deliver on its promise to end child slavery in its cocoa supply chain by 2006. See:
While we have added Fairtrade KitKat to the Nestlé boycott list, that does not mean we are anti-Fairtrade. Indeed, Fairtrade fortnight is coming up in the UK from 22 February to 7 March. You can find ideas to support it at:
If you are planning a stall or event, then feel free to contact Baby Milk Action for leaflets explaining why Nestlé Fairtrade KitKat is on our boycott list.
We need all the help we can get to stop practices such as Nestlé telling mothers around the world that its formula will 'protect' their babies. According to UNICEF: "Improved breastfeeding practices and reduction of artificial feeding could save an estimated 1.5 million children a year."
We have tried to enlist the help of the UN Global Compact Office and the offices responsible for overseeing the OECD Guidelines for Multinational Enterprises, but they are unprepared to do anything other than encourage us to 'dialogue' with Nestlé. We have been in 'dialogue' with Nestlé for decades and what we have learned is that Nestlé acts when it is pressure or shamed, particularly if it believes its profits and its image (which impacts on its profits) will be harmed.
So please do consider sending a message to Nestlé and reminding friends and colleagues of Nestlé malpractice. The launch of Fairtrade KitKat presents an ideal opportunity.
Nestlé spends millions on trying to improve its image. But with your help we are able to put the other side of the story into the national press, as with the article in The Independent today.
You might also like to consider becoming a member of Baby Milk Action, if you are not already, or sending us a donation. See:
Friday, January 22, 2010
Baby Milk Action produces a calendar with breastfeeding pictures from around the world on behalf of some of the groups belonging to the International Baby Food Action Network (IBFAN).
We are always on the look out for good-quality pictures, so contact us if you have any to offer.
Putting the calendar together is always a challenge because all the groups that will sell it to help raise funds for their activities to protect infant health have to be happy with the selection of pictures. There is a voting process that goes on to ensure that the views of each group are respected and everyone has mainly their favourite pictures, plus a few they just like a lot.
I have a vote myself and have always been a bit suspicious of disembodied pictures such as the one that appears in January, shown below.
But someone who has breastfed and loves these pictures pointed out to me that these are not pictures of disembodied breasts (though such pictures exist), but a Mum's-eye-view of breastfeeding and that is why these pictures are so popular.
Which just goes to show, you have to be open to other perspectives!
What do you think?
You can see the rest of this year's selection of pictures at:
Friday, January 08, 2010
Ben Goldacre has reproduced the press release from Professor Carlsen that generated the 'Breast NOT Best' news news stories this week. See:
The press release is headlined "Breastfeeding is not as beneficial as once thought". As I explained earlier, Professor Carslen's hypothesis is that mothers use formula because of excess male hormones, that also have a negative impact on the child in the womb, and it is the male hormones that explain the poorer health of formula-fed babies, rather than the method of feeding. To quote Professor Carlsen from the opening of the press release:
It is true that breastfed infants are slightly healthier than bottle-fed babies. But apparently it is not the milk that makes the difference. Instead, the baby’s overall health is all determined before he or she is born. So why do so many studies associate breastfeeding with better health for young babies. The answer is simple: If a mother is able to breastfeed, and does so, this ability is essentially proof that the baby has already had an optimal life inside the womb.
His research was about the impact of hormones on infant health and feeding method, but the articles reporting on this have implied that breastfeeding has no impact on infant health compared to formula feeding.
UNICEF Baby Friendly Initiative in the UK has commented: "the claims made in relation to these findings do not account for the large differences in breastfeeding rates between countries, with some having 99% of mothers successfully breastfeeding. They are also contradicted by the large body of evidence which shows that levels of successful breastfeeding can be increased by a range of improved support interventions."
UNICEF Baby Friendly has also taken issue with the suggestion that breastfed infants, as a population, are not healthier than formula-fed infants. While Professor Carlsen reviewed only 50 studies to state breastfed infants are 'slightly healthier', UNICEF cites a systematic review that examined evidence from 400 studies on infant feeding, after ensuring they were well designed, and "found that breastfeeding is associated with a significant reduction in the incidence of: acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, obesity, type 1 diabetes, type 2 diabetes, childhood leukaemia, sudden infant death syndrome, necrotizing enterocolitis, maternal breast cancer and ovarian cancer." See:
Professor Carlsen wasn't looking at the impact of feeding methods on health, but the impact of hormones during pregnancy on a mother's breastfeeding behaviour. He found increased use of formula (ie less breastfeeding) amongst mothers with higher levels of male hormones. However, it is interesting to note that the results state there was "correction for maternal age, education and smoking", apparently missing other factors such as birth weight, delivery methods, separation of mother and child after birth etc. which may have been relevant, particularly given the small sample size.
UPDATE: The UK National Health Service has analysed the research and pointed out today that Professor Carlsen did not even look at the impact of male hormones on infant health. It states:
---NHS analysis extract
This study did not compare levels of male hormones during pregnancy to the baby’s health, but only to whether the mother breastfed after giving birth. The researchers have supplied no evidence to back up their claim that there is no benefit from breast milk.
---extract and Update ends
Here is the abstract for the research, available at:
---Professor Carlsen research
Mid-pregnancy androgen levels are negatively associated with breastfeeding
Objective. Breastfeeding depends on endocrine changes during pregnancy. The association between gestational hormones and lactation has been sparsely investigated. Previously, androgens were used for lactation inhibition. We investigated a possible association between second trimester maternal androgen levels and breastfeeding. Design. Prospective observational study.
Setting. University hospital setting.
Population. Women from a random sample of pregnancies (n = 63) and from a group with an increased risk for giving birth to a small-for-gestational age newborn (n = 118) were included. All participants had singleton pregnancies and one or two previous births.
Methods. Maternal androgen levels were measured in gestational week 25. The association with reported breastfeeding was explored by univariate and multivariate linear regression analyses. Analyses were adjusted for factors known to be associated with breastfeeding.
Main outcome measures. Breastfeeding at six weeks, three months, and six months postpartum.
Results. In the random group, breastfeeding at three and six months was negatively associated with maternal testosterone, androstendione, and free testosterone index levels. After correction for maternal age, education and smoking, breastfeeding at both three and six months was negatively associated with the free testosterone index. In the group of women with an increased risk for giving birth to a small-for-gestational age newborn, breastfeeding at six weeks and three months was associated negatively with maternal dehydroepiandrosterone and this association persisted after correction for maternal age, education, and smoking.
Conclusions. Maternal androgen levels in mid-pregnancy are negatively associated with breastfeeding.
Some journalists do like rushing out 'Breast NOT Best' headlines, which do harm around the world and misrepresent or distort the real story. We faced a similar situation last year. You may recall a scientist, Professor Kramer, was quoted in literally thousands of articles around the world as questioning the benefits of breastfeeding. He soon criticised the journalists who wrote the original article for misrepresenting what he had said - but few journalists and media outlets that had run the earlier articles issued follow-up corrections. See:
Thursday, January 07, 2010
I wrote yesterday about a strange Norwegian study that is being reported under headlines 'breast is NOT best', when a more relevant headline would be 'Excess male hormone leads mothers to bottle feed and harms babies claims scientist'. See:
Not all journalists have been as sensationalist as the Daily Mail, amongst others. The BBC website ran with the headline: Hormones 'govern ability to breastfeed'.
The BBC report opens: "Mothers who find breastfeeding so hard that they give up should not blame themselves, researchers say. A Norwegian study concludes that difficulty feeding a newborn may be down to higher levels of the male hormone testosterone during pregnancy."
I've written in the past on the subject of guilt. My view is that it is a woman's decision on how she feeds her baby and no-one should try to make her feel guilty.
However, as UNICEF points out, there are some countries where 99% of mothers breastfeed, so the theory that excess male hormones prevent mothers from breastfeeding seems dubious.
Other doubts are being cast over this conclusion. The sample size was small - 180 pregnant women - and mothers with higher levels of male hormone are associated with lower birth weight babies. Whether medical interventions were made during birth also needs to be explored.
The research was looking at the hormone impact on pregnancy and breastfeeding, not on health outcomes from breastfeeding compared to formula feeding - Professor Carlsen's comments on this come from his interpretation of a selection of existing research and he agreed this finds health benefits, while disagreeing this was down to breastfeeding having intrinsic benefits.
His interpretation of the research on breastfeeding is not widely held. Journalists wrote similar sensationalist stories last year regarding Professor Kramer, who complained he had been misrepresented, but the damaging false information had gone around the world and few journalists published corrections to their stories. See:
UNICEF Baby Friendly Initiative in the UK has released a statement responding to the research, which is available at:
I include the full text below:
---UNICEF UK Baby Friendly Initiative statement on new breastfeeding research
A number of newspaper articles have today reported on a Norwegian study which has found an association between higher levels of male hormones in pregnancy and the ability to breastfeed after birth. The authors are reported to have extrapolated from their findings that mothers’ ability to breastfeed is entirely down to these hormone levels. They are also reported to have claimed that exposure to high levels of testosterone before birth account for the differences in health outcomes between breast and bottle fed babies. The findings of this small study are of interest and may warrant further investigation. However, the claims made in relation to these findings do not account for the large differences in breastfeeding rates between countries, with some having 99% of mothers successfully breastfeeding. They are also contradicted by the large body of evidence which shows that levels of successful breastfeeding can be increased by a range of improved support interventions.
The claims made relating to the health outcomes of breastfeeding do not account for the dose response found in many studies, which show that babies breastfed exclusively or for longer periods have the best overall outcomes.
The study does not account for or tally with the known mechanisms for how breastmilk protects against illness. For example, breastmilk contains a range of anti-infective properties including immunoglobulins, white cells, anti-inflammatory components, enzymes and non-antibody factors such as lactoferrin and the bifidus factor.
The body of evidence for the benefits of breastfeeding is very large and comes from a wide range of studies into many different illnesses, carried out by numerous researchers in many different universities. Systematic reviews of the literature have also been carried out and are especially useful, as they are able to eliminate weak studies and combine the findings of all the high-quality papers in order to demonstrate with the greatest reliability whether a protective effect truly exists. It is important to note that there is variability in the quality and depth of evidence in relation to some illnesses which is why the authors of these reviews tend to call for further research to clarify the finding. It remains the case, however, that the evidence for the advantages of breastfeeding is strong.
The two most recent and influential reviews were carried out by the Agency for Health and Research Quality and the World Health Organization and are summarised below:
Ip S, et al (2007) Breastfeeding and Maternal Health Outcomes in Developed Countries. AHRQ Publication No. 07-E007.Rockville, MD: Agency for Healthcare Research and Quality.
This review carried out in the USA screened over 9,000 papers and used evidence from 400. It refers only to health outcomes in developed countries. The review found that breastfeeding is associated with a significant reduction in the incidence of: acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, obesity, type 1 diabetes, type 2 diabetes, childhood leukaemia, sudden infant death syndrome, necrotizing enterocolitis, maternal breast cancer and ovarian cancer. Link.
Horta B et al (2007) Evidence on the long-term effects of breastfeeding. WHO.
This paper reports on a series of systematic reviews to assess the effects of breastfeeding on blood pressure, diabetes and related indicators, serum cholesterol, overweight and obesity, and intellectual performance. It found a significant reduction in the incidence of obesity and overweight and type 2 diabetes. It also found that breastfed babies had lower systolic blood pressure, lower cholesterol and better performance in intelligence tests. Link.
Although the protective effects of breastfeeding on gastroenteritis and respiratory infections have not been questioned, attempts have been made to dismiss these in developed countries as mere ‘tummy upsets’ or ‘coughs and colds’, whereas in reality a reduction in severe infection resulting in hospitalisation has been found. The Millennium Cohort Study is a nationally representative longitudinal study of 18,819 infants who were born in the UK in 2000-2002. Data on infant feeding, infant health, and a range of confounding factors were available for 15,890 healthy, singleton, term infants who were born during this period. This study found that 53 per cent of diarrheal hospitalisations each month could have been prevented by exclusive breastfeeding and 31 per cent by partial breastfeeding. A total of 27 per cent of lower respiratory tract infections could have been prevented each month by exclusive breastfeeding and 25 per cent by partial breastfeeding. Quigley M et al (2007) Breastfeeding and Hospitalization for diarrheal and respiratory infection in the United Kingdom Millennium Cohort Study. The full paper can be found here.
It is important to be aware that the protective effect of breastfeeding is stronger in relation to some illness, notably gastroenteritis, than it is for other illnesses such as allergies. This does not mean that there is no protective effect against those other illnesses, rather that the risk to the bottle-fed baby is greater for some illnesses than for others. Importantly, where the evidence shows a slight protective effect of breastfeeding, this can still be the result of well performed research. Therefore, to describe the evidence as weak because of a lower degree of protection is inaccurate and misleading. It is important to note that a small protective effect of breastfeeding against a significant illness will have a dramatic effect across a population.
The role of the Baby Friendly Initiative and of health professionals is to give pregnant women and new parents the full facts about infant feeding based on the best available evidence in an objective and non-judgemental manner in order to allow informed decision making. We then need to help mothers to make decisions appropriate to their circumstances and to support them in their decision whatever that may be.
Wednesday, January 06, 2010
UPDATE 7 JANUARY: For what Professor Carlsen actually said see:
Includes the comment from his press release: "So why do so many studies associate breastfeeding with better health for young babies. The answer is simple: If a mother is able to breastfeed, and does so, this ability is essentially proof that the baby has already had an optimal life inside the womb."
There is another round of articles suggesting that breastfeeding is not better for babies than infant formula. Yet looking at the details of the story, the above headline would be more relevant.
This latest round of articles is citing research from a Norwegian scientist, Sven Carlsen. Sensationalist journalists, such as one writing in the Daily Mail have declared: "Breast is NOT best... Women should forget what they have been told about the health benefits of breastfeeding..."
Read on, however, and you find that Prof. Carlsen does not disagree with the evidence regarding the benefits of breastfeeding.
Even the Daily Mail admits:
"Prof Carlsen's team reviewed data from more than 50 international studies looking at the relationship between breastfeeding and health. Most concluded that the more children were breastfed, the healthier they were. On the surface this was correct, said Prof Carlsen, from the Norwegian University of Science and Technology in Trondheim."
The hypothesis that Prof. Carlsen is proposing is that mothers reach for formula because they have excess male hormone. As the Daily Mail says later in its article:
The Norwegian scientists' own work pointed to links between levels of androgen male hormones in the wombs of pregnant women, the health of children, and breastfeeding.
'Pregnant women who have higher levels of androgens breastfeed less,' said Prof Carlsen. 'Probably this is a direct effect of hormones that simply limit nursing ability by reducing milk production in the breast.'
A pregnant woman's health affected hormones in her womb, which had knock-on effects on her unborn child, said the researchers.
Surely a more relevant headline would be: "Excess male hormone leads mothers to bottle feed and harms babies claims scientist".
We could perhaps question why the headline is not this, but "Breast is NOT best".
On past experience, some in discussion fora and email lists (possibly company trolls) will be seizing on the 'breast Not best' headline to shout down the evidence regarding breastfeeding. They too should be asked whey they are taking this line, rather than discussing the 'excess male hormones lead mothers to bottle feed' theory.
Rather than rushing to comment, however, I believe this whole story needs to be approached with a great deal more caution than that demonstrated by the Daily Mail and some other journalists.
Scientists who have conducted thousands of studies that have demonstrated that, taken as a population, formula-fed infant have poorer health outcomes than breastfed infants will no doubt claim that confounding variables have already been taken into account in their studies. Remember Pofessor Carlsen apparently admits that 'on the surface' these findings are correct - his claim is that it is not formula that has an adverse effect on babies, but supposed excess male hormone present in the mother during the pregnancy.
Whether there is any substance to this theory is something that will receive considered comment in the coming days. If there is any validity to this argument, how it has been possible to attribute 100% of the difference in health outcomes to male hormone rather than formula feeding needs to be scrutinised.
In the meantime some journalists run ahead with sensationalist headlines.
We faced a similar situation last year. You may recall the scientist, Professor Kramer, who was quoted in literally thousands of articles around the world came out and criticised the journalists who wrote the original article for misrepresenting what he had said - but few journalists and media outlets that had run the earlier articles issued follow-up corrections. See:
According to an advertising company, Nestlé is paying celebrities US$10,000 a tweet to push Nestlé products on Twitter, the social networking site.
This is not the only way Nestlé is attempting to use Twitter. Last year Nestlé caused a public relations disaster for itself by flying prominent parenting bloggers to California to blog and tweet on Nestlé products. People posted tweets questioning Nestlé's business practices, which were raised by the bloggers with Nestlé executives. Nestlé's demonstrably dishonest answers then fueled support for the boycott and a spontaneous Halloween boycott of Nestlé candy called Boo Nestlé.
It has now been revealed that Nestlé pays celebrities to tweet on its products through the 'In-stream advertising' company, Ad.ly.
Celebrities are typically paid US$ 10,000 for a single tweet mentioning a product from one of Ad.ly's clients. According to E! online: "Ad.ly, a new company whose sole purpose is to hook up tweeters (famous and otherwise) with ad partners, Kim Kardashian and Soulja Boy both earn that amount every time they tweet for cash, at least when they do it via Ad.ly. (Kardashian recently did a tweet like that for Nestle, says Sean Rad, CEO of the company.)"
According to Gossip Net, Kim Kardashian, who is listed on the Ad.ly site as one of their top 'publishers' has denied receiving funding from another firm for tweeting about a product.
Internet companies also provide tools for corporations to track how their brand is mentioned on Twitter and social networking sites so they can feed their own information into discussions. See:
Monday, January 04, 2010
As The Guardian reports today, the UK Freedom of Information Act is five years old:
I used the FOI Act back in 2005 to obtain information from Ofcom regarding a television sponsorship by Heinz for Farley's formula. Advertising of infant formula is illegal in the UK, but follow-on formula advertising is allowed.
For more details on the advertising campaign and complaint see:
International standards prohibit all advertising and make health workers responsible for advising parents (companies are limited to providing scientific and factual information to health workers). We see companies exploit this loophole in adverts that are ostensibly for follow-on formula, but promote the full range and direct parents to websites where infant formula is promoted. They also make health claims that are not substantiated by evidence, for example, claiming that formula builds the immune system whereas babies fed on it are more likely to become sick than breastfed babies (we have won cases at the voluntary Advertising Standards Authority, but that system does have serious flaws - another story).
Now, Ofcom had rejected a complaint about Heinz Farley's formula advertising (strapline 'closer - by nature') appearing on the Discovery channel and elsewhere, claiming it was clearly for follow-on formula. We said this was ridiculous as the only clue was the colour of the packshot in the advertisement.
The FOI Act led to a stack of document on the case (including copies of the letters I had sent to Ofcom), which included an email from Hillingdon Environmental Health (the home authority for Heinz) to Ofcom saying:
“I was unable to work out the precise product pictured in the video footage.”
There was also a reply from Ofcom’s investigator agreeing:
“I don’t know what product appears in the credits as no information is given on the pack shot. Discovery have told us that the product was follow-on formula.”
So Ofcom had let Heinz through the loophole, even though their own expert was confused. In its written response Ofcom had suggested it was obvious what product was being advertised : “...the purple background correlated with follow-on products. We do not see therefore where the connection to infant formula can be made.”
As a footnote, following on from this and other examples of the loophole being exploited, all UK health bodies and the government's own Scientific Advisory Committee on Nutrition called for follow-on formula to be treated the same as infant formula as regard advertising. However, the government refused these requests when introducing new legislation in 2007, instead following the industry line.
We continue to monitor and expose how the law is failing mothers and babies and call for the international standards introduced by the World Health Assembly to be implemented in the UK. See: