A Case Study of Infant Health Promotion and Corporate Marketing of Milk Substitutes

Abstract

The mismatch between the demand for, and supply of, health products has led to the increasing involvement of courts worldwide in health promotion and marketing. This study critically examines the implementation of one country's Milk Code within the framework of the International Code of Marketing of Breast-Milk Substitutes, and the efficacy of the judicial process in balancing corporate marketing and state regulatory objectives. Drawing upon the Philippine experience with its own Milk Code, it evaluates the capacities of courts to determine policy costs and risks against the benefits of delineating and containing corporate marketing strategies for milk substitutes and supplements. The study finds that the methodological and information-based challenges faced by courts in resolving multi-dimensional health issues may not be overcome without serious questions concerning the legitimacy of the judicial process itself. Despite the deficiencies of litigation and adjudication, the study notes the catalytic potential of a judicial decision in opening up vital policy space for future renegotiations among rival parties and interests. Third-party intervention is explored relative to this catalytic function.

Marketing breast milk substitutes: problems and perils throughout the world

“…In 2004 the Supreme Court of the Philippines issued a restraining order preventing introduction of the Revised Rules and Regulations of the Milk Code in response to intense lobbying by the pharmaceutical industry,21–23 and consequently formula use increased 21. Although the restraining order was lifted in 2007, the regulations had been weakened to suit the industry 21–23. In contrast, in India where advertising is strictly controlled by the Infant Milk Substitutes Act,28 exclusive breastfeeding at 4–5 months of age is 46% almost three times higher than that of the Philippines 21 29…”

“…Reports of violations are numerous. 17 – 23 In 1998 a study of 3442 mothers and health workers from Dhaka, Durban, Bangkok and Warsaw documented gifts of formula and information violating the Code. 17 In a 2003 survey of 186 healthcare providers in 43 health facilities in Togo and Burkina Faso, 80% had never heard of the Code.…”

“…Sales of formula are increased when regulations are weak. 21 In 2004 the Supreme Court of the Philippines issued a restraining order preventing introduction of the Revised Rules and Regulations of the Milk Code in response to intense lobbying by the pharmaceutical industry, 21 – 23 and consequently formula use increased. 21 Although the restraining order was lifted in 2007, the regulations had been weakened to suit the industry.…”

“…Even earlier, in 1977, Papua New Guinea had made formula, bottles or teats available only by prescription 15. However, despite further World Health Assembly resolutions (1986–2010) and the Innocenti declarations (1990 and 2005)16 protecting, promoting and supporting breastfeeding, the pharmaceutical industry has continued to undermine such efforts 17–23. As Coutsoudis et al 24 have pointed out, ‘voracious global marketing by the formula-milk industry over the past 60 years has …dislodged breastfeeding as a viable and desirable strategy for infant feeding’.…”

“…15 However, despite further World Health Assembly resolutions (1986–2010) and the Innocenti declarations (1990 and 2005) 16 protecting, promoting and supporting breastfeeding, the pharmaceutical industry has continued to undermine such efforts. 17 – 23 As Coutsoudis et al 24 have pointed out, ‘voracious global marketing by the formula-milk industry over the past 60 years has …dislodged breastfeeding as a viable and desirable strategy for infant feeding’. The fact that annual sales of breast milk substitutes exceed US$31 billion (£20 billion; €24 billion) 25 gives the industry little incentive to restrict advertising.…”