At a World Health Organization assembly, the Donald Trump administration goes on the attack on behalf of industrialized milk corporations and disfavors breastfeeding
June is cruel to children. The dry cold climate is a constant threat to the health of the little ones. Irritated throat and ears. Fever. Result: the Emergency Room. In an area containing ten beds located within the pediatric emergency department at Albert Sabin Hospital and Maternity Clinic in Atibaia, in the state of São Paulo, all beds are occupied. Girls and boys of all ages. One of them, only a tiny little boy, seems to be no older than one. Seated beside the bed, the tired-eyed mother has a large yellow backpack on her lap. She also holds a smaller black handbag on her shoulder, into which she frequently sticks her left hand and tries to get hold of something, to no avail. I offer to help hold the backpack. She accepts. Claudia doesn’t know yet, but in addition to her son’s health problem, she is in some way or other being confronted by Donald Trump and heavyweight international interests.
As the woman rummages through her belongings, I notice a very conspicuous tin sticking out of the front pocket of the baby’s backpack. In green and white, with a darker green garnishing the brand name, the package contains 800 grams of Nestogeno Infant Formula 2, produced by Swiss megacorporation Nestlé, one of the most widely consumed brands of “breast milk substitutes” in Brazil.
The backpack is not exactly a challenge to the muscles, but it bulges. Those who have small children know that it’s normal to have to walk around carrying baby size clothes, diapers, moist tissues – medications, if necessary – and the infamous feeding bottles. It is into the latter that the infant formula powder is dumped, to form a dysfunctional duo with the silicone nipple.
Claudia shakes a blue cellphone. Triumphant, she finds the lost object amongst her concern for her son. She doesn’t press a single number key. She’s just making sure the phone is there. In between rushing out from work to pick up Gabriel at the daycare center with a 39.5 degree fever until she got to the hospital, time whizzed by at a million miles an hour. And her mind is running at about the same speed.
The bag – and tin – are still on my left shoulder. We start a conversation, that has all the makings of a typical “so, you had to bring your kid to hospital, huh?” dialogue. Typical, were it not for the tin of Nestogeno, my curiosity and the Donald Trump Administration.
The boy’s name is Gabriel. I almost got the age right. He’s 11 months old.
– Do you still breastfeed him?
– No. Only up to four months, unfortunately.
Claudia and Gabriel are one more statistics item to be added to the list of “baby feeling hungry, low milk production, exhaustion, sore nipples, weak milk, milk’s dried up”, some of the excuses provided by healthcare professionals encouraged by the aggressive marketing by companies in the field suggesting the supplementing of infant feeding with formula milk or even substituting breast milk for tinned powder, as in the case that I am witnessing.
“I was having some difficulty breastfeeding and was going back to work, since my maternity leave had ended. I felt very tired, but I wanted to continue exclusively with breast milk. Only the pediatrician said that because I was so tired all the time, it wouldn’t work, that the best thing would be to introduce formula milk, because this way Gabriel would sleep better, on a full stomach”, Claudia tells me.
The first infant formula milk to be used by the family was Enfamil Premium 1, made by American corporation Mead Johnson, but after one month this disrupted the boy’s intestines and he would sometimes go up to four days without a bowel movement. Claudia still had milk. The pediatrician, however, opted for a simple change of formula.
At five months, Gabriel was already on his second mixture: Nestogeno, a starchy mass with many strange-sounding ingredients, from maltodextrin to N-pteroyl-L-glutamic Acid, which no label can elucidate.
“He didn’t take it very well. He spat it out as he suckled and rejected about half the bottle. The doctor said that’s just the way it was, that it was a matter of habit, that I had to insist. In the end, he got used to it, kind of by force, the hard way, you know?”, explains the mother, regretfully. She feels she should have insisted on the breast milk. Aware of the benefits of mother’s milk, she feels guilty. But fatigue simply added to the lack of encouragement by pediatrician and family. “Nobody gave me proper support”, she says.
The mother had no real difficulty in producing milk, but even if she had, which is rare in most cases, she could have used a human milk bank, where other mothers make donations.
This is one of the alternatives in order not to use supplements or artificial substitutes. Besides, the Oswaldo Cruz Foundation (Fiocruz) has a database dedicated towards locating points for human milk collection, storage, and donation.
It is June 6th 2018 and Claudia cannot imagine that a structural, systemic and even geopolitical situation forms the base of the problem that she and Gabriel are up against. The two of them and millions – maybe billions – more.
Trump wants to feed
Last week in May, Geneva, Switzerland, where the World Health Organization (WHO) World Health Assembly is taking place, with nutrition as the axis for this year. The assembly anticipated a non-controversial discussion about breastfeeding. It was anything but. The debate was replaced by pressure and bullying: “courtesy” of the histrionic Donald Trump administration, who prefer to play to their playground buddies and ignore public interests.
Since May 25th, The U.S. delegation was being accused of trying to obstruct a resolution that guaranteed the extension of babies’ and childrens’ rights to a healthy diet. At the service of the ultra-processed foods industry, trumpist agents closed ranks in order to dilute instruments regarding the regulation of aggressive marketing for breast milk substitutes.
Delegation representatives and activists from Latin America, from countries such as Brazil and Ecuador, did not hide their amazement and outrage at how great an influence the private sector still has on this issue, despite longstanding scientific evidence showing that exclusive breastfeeding is a far superior option compared to a form of feeding that includes alleged milk substitutes. African and Asian delegation members also felt the attacks.
The first draft of the text, whose wording was led by Ecuador, was immediately supported by Cambodia, Nepal, Sierra Leone and Sri Lanka, containing references to the International Code of Marketing of Breast-milk Substitutes, which delimits the “acceptable levels of marketing” to protect the health of infants and babies.
Warning lights then started flashing. Opposition by the U.S. delegation came with a fury. Signatories of the Code were threatened. Commercial retaliation would be the weapons deployed by Trump and co. if the resolution was presented as it stood. The representatives from Ecuador, feeling cornered, backed down.
“We heard many reports claiming that countries had been pressured by the United States”, said Patti Rundall, director of Ibfan (International Baby Food Action Network). “We felt uncomfortable, because democratic processes which should have been in effect were absent. All Member States should have an equal voice. It’s not right that the United States’ opinion has to be the most important.”
Nutrition researchers and activists reacted through social networks, mainly on Twitter in order to bring the situation to public attention and reverse the pressure scenario. Executive director of Human Rights defense organization 1000 Days Lucy Martinez Sullivan tweeted: “A battle against breastfeeding has been taking shape this week at the WHO headquarters. It is essential that countries maintain the protection for the resolution for breastfeeding at the World Health Assembly.”
At the same time, those in defense of exclusive breastfeeding were seeking consensus at the assembly. A satellite event provided the stage for a political maneuver in order to have the resolution approved. It was within this scenario that WHO director-general Tedros Adhanom highlighted the relevance of breastfeeding to prevent malnutrition, but pointed out that few countries have protection, promotion or support measures. “This is unacceptable”, he concluded.
A joint report released by the WHO and UNICEF also requested that the countries adopt rules to implement the International Code of Marketing of Breast-Milk Substitutes.
This alignment saw the arrival of a surprise element: Russia came in and proposed to present a resolution. Four meetings and ten hours were spent to draw up a common text. Not all recommendations contained in the draft led by Ecuador were kept, but there were advances if compared to the malnourished version that the Trump government wanted to impose.
Finally, on May 27th, Russia presented the document, accompanied by 13 other countries: Botswana, Canada, Gambia, Ghana, Georgia, Mozambique, Nepal, Panama, Pakistan, Senegal, Sierra Leone, Thailand and Zambia, with support from other States as well as Non-Government Organizations.
On that same day, the USA tried one more maneuver. Trump’s representatives wrote an “alternative decision” about stimulation for exclusive breastfeeding.
Written on a solitary page, all the text did was make froth. It didn’t mention the International Code or the need for marketing restrictions and safeguards that prevent and expose conflicts of interest in financing scientific research, in the academic environment and for healthcare professionals regarding relations to the food industry. It was just another attack, trying, this time, to neutralize the document presented by the Russians.
This exchange of punches resulted in the final resolution, which emphasizes exclusive breastfeeding and serves as a guide for countries about how to encourage it. The text does not, however, mention any action with regard to lobbying in the private sector, especially against aggressive marketing by the manufacturers of alleged breastmilk substitutes.
Just one mention for the International Code of Marketing of Breast-Milk Substitutes remained. The version also removed the possibility for countries to request the WHO director-general for technical support for the “implementation, financial resource mobilization, surveillance and assessment of the code” and to “enforce national laws and regulatory measures”.
The first proposal, much more straightforward, assertive and complete, had, moreover, the objective of extending information about new operational guidelines for children’s diets in emergencies and raising awareness among Member States with regard to the “Children’s Friend Hospital Initiative” (Iniciativa Hospitalar Amigo da Criança), which offers guidance on breastfeeding as a practical option.
What struck a nerve with regard to Trump and the ultra-processed foods corporations’ interests, however, was the passage in the text proposing to fight against the inappropriate promotion of baby and infant foods.
Attention: in 2016 this was already a WHO recommendation, seen as a form of support in order to strengthen the efforts for rights’ defense all over the world. Turning it into a resolution would represent an important step.
Civil Society organizations, such as Save the Children, classified the final draft as “significantly feeble” and said to be “shocked at the fact that the drafting committee was not able to reaffirm its commitment to implement WHO guidelines and policies that are vital to save the lives of children and mothers”.
Although the resolution is not mandatory for any country, statements such as this are historically significant, essentially for low-income nations devoid of resources to develop research independently.
Not for the first time
Since at least January of this year, the Donald Trump administration has been visited by corporate representatives to discuss maximum deregulation in the private sector, including, undoubtedly, food industry commercial interests.
More specifically, U.S. authorities have held “hearing sessions for interested parties” in WHO discussions. By “interested parties”, one should understand megacorporate infant formula manufacturers, who expressed their “objection with regard to the way the resolution was headed”. Even U.S. hypermarket chains like Walmart were heard and voiced their opposition to any regulation for breast milk substitutes.
With regard to dairy- based drink consumption in the USA, it’s worth reminding ourselves of the level of unawareness of local populations. Just to get an idea, it is worth rechecking a study made last year, in which 10% of Americans stated that they believe chocolate milk comes directly, all nice and ready to drink, from brown cows.
In an official e-mail announcement after the dissatisfaction declared by many delegations, a U.S. State Department employee said the country shares “a common objective with other nations, to promote breastfeeding, as well as an adequate and timely supplementary diet”.
Trump’s official sender finalized by saying that substitutes are appropriately used when necessary, based on information and through appropriate marketing and distribution.
Lessons learned – past and present: what about the future?
Lucy Martinez Sullivan, director of 1000 Days, says without hesitation that she doubts this year’s resolution will be of any use.
“The real argument is that there is a lot of opposition to things which should not be controversial and come from the Trump administration”, she says.
It comes from Trump because it’s typical of Trump.
“We evaluate that it’s led by industry and the strong ties they have with the Trump administration. Activists and consumers need to be aware of what has taken place behind closed doors. That’s the lesson”, Lucy points out.
Once again, it comes from Trump because it IS Trump. A straight, white, sexist man with a 19th century mindset.
As a matter of fact, it is in the 19th century that breastfeeding starts to “lose prestige” among the bourgeoisie. Considered the practice of poor women, it declines in the first decades of the 20th century. It’s when industry, always ready to pounce, starts commercializing powdered milk adapted for babies.
“It was considered a scientific breakthrough at the time, the salvation for babies who could not be nursed due to death or illness of the mother. But as sales grew, so did the industry’s greed: they realize that the big profits will come when all infants use the formulas, not just the ones who needed to for some reason or other. Thus starts the development of the powdered milk culture: disseminating the idea that breast milk is weak, bad, insufficient for a true strong healthy baby”, explains pediatrician Daniel Becker, one of the most critical doctors and specialists in Brazil towards the culture of baby and infant diets by means of breast milk substitution.
He tells us that after World War II, sales skyrocketed and that the generation born in the U.S. at the time had hardly any contact with mother’s milk.
“In the 1960’s, over 70% of American babies were fed formulas, due to aggressive campaigns for the distribution of powdered milk in maternity hospitals and the continuous propaganda to discredit breast milk. Most women of that generation believed totally and without criticism that powdered milk was better than breast milk”, he comments.
In Brazil, as in the USA, packages of infant formulas (for babies up to six months in cases of confirmed dietary deficiency only) and follow-up (used for healthy infants from 6 months old to 12 months [incomplete] and healthy infants in early childhood), are stocked side by side on the shelves and are very similar. The advertisement for one of them can influence sales for another. Those who work against this warn that some advertisements are not clear about which of the two products is being promoted.
Surveys carried out in Brazilian supermarkets and pharmacies verified that packages recurrently show the indication “zero to six months” and “for infants” on many packages that motivate the adoption of ultra-processed mixtures, which induces buyers into the mistake of believing the product is equivalent or close to breast milk.
The expressions are not put there without a reason. They are a tool for the industry to manipulate consumption, regardless of whether the formula is used on its own or “as a supplement” to breast milk (in this case, the baby tends to abandon the mother’s breast, either due to the palatability of the industrialized product or the false feeling of satiety).
And the sphere of influence goes beyond families. Health professionals, especially pediatricians, are the main marketing targets. Although surveys reveal that the majority of the Brazilian population is favorable towards breast milk, with recommendations of exclusive breastfeeding up to the age of 6 months, congresses, symposia and medical courses have recently seen a growing presence of transnationals who manufacture and introduce infant formulas into the routine of those who work in the field.
Under this strategy, Nestlé, the world market leader in sales of formula milk for infants since their birth, is the most aggressive megacorporation.
To this day, the corporation’s support is branded on the cover of the Brazilian Pediatric Society’s (Sociedade Brasileira de Pediatria -SBP) website. It’s right there, clear for all to see: “Nestlé is good for you”. Not to mention the countless activities hosted by the entity that the corporation has sponsored throughout the last few years, many of them emphasizing the “best breastmilk substitutes”, shunning breastfeeding.
Tins without borders
In a joint investigation conducted last February by British newspaper The Guardian and Save the Children Philippines, it was discovered in Asia that Nestlé offered doctors, midwives and healthcare professionals free trips to conferences, meals, concert and cinema tickets, even gambling, in violation of local laws that govern the relationship between sector workers and private companies.
Representatives from Nestlé, Abbott, Mead Johnson and Wyeth (now owned by Nestlé) were described as “a constant presence in hospitals in the Philippines, where only 34% of mothers breastfeed exclusively in the first six months”.
The investigation informs that hospital employees recommend specific formula brands in the “essential items” lists passed on to new mothers, openly targeted sponsored advertisement on Facebook and partnerships with digital influencers, essentially bloggers.
As we can see, Claudia and Gabriel can come across “Trump’s laws” way beyond their home town.
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