For decades, moms everywhere have been told that "breast is best" for babies. Healthcare experts say that message goes double in the developing world, where clean water for bottle-feeding is a luxury and, they say, breast-feeding can be a key factor in an infant's survival.
But global efforts to promote breast-feeding are stalling in East Asia, where many working mothers in urban areas are opting instead for infant formula.
The result, say UN officials and Asian health campaigners meeting this week in the Philippine capital of Manila, is a decline in breast-feeding in several countries, even while it's rising in Africa and other developing regions.
While the East Asian average for exclusive nursing is 35 percent for the first six months, that figure falls to 5 percent in Thailand, according to the World Health Organization (WHO). In Vietnam, the breast-feeding rate almost halved in four years, falling from 29 percent in 1998 to 15 percent in 2002.
Experts at the regional conference, organized by the United Nations Children's Fund (UNICEF) and WHO, say countries are backsliding in their efforts to tout the health benefits most physicians associate with breast milk. One of reasons for this trend, says a UNICEF expert, is multinational companies that dominate sales of breast-milk substitutes.
Health experts say US companies are among those using aggressive marketing to hawk infant formula in Asia's dynamic economies, the same kinds of tactics that sparked a boycott campaign of Nestle products in the 1970s. This led to the adoption in 1981 of a global marketing code for such products.
Targeted advertising for Asian wealth
A generation later, there is suspicion that milk companies are targeting gullible mothers in Asia with false advertising, contrary to the spirit of the code. Lost in the marketing deluge, say critics, is the scientific consensus that advocates exclusive breast-feeding, particularly for the first six months of a child's life.
Such tactics are common in developing Asian countries, where the market potential is greatest, says David Clark, a legal expert for UNICEF who advises countries on how to outlaw abusive marketing practices. As incomes rise and more women join the workforce, companies are zeroing in on Asia, which now accounts for 36 percent of global sales of infant formula.
"You have countries in Asia where people have more disposable income in the middle classes, so it becomes a target for aggressive promotions," he says. "And although it may be targeted at that population, the advertisements are seen by poorer members of the community who can't afford the product."
The battle over how to regulate marketing for milk formula has taken on particular prominence in the Philippines, which has sought to extend a 1986 law, known as the Milk Code. The law placed limits on formula companies' marketing practices.
Public-health officials want tougher rules in order to reverse a decline in breast-feeding in a country where nearly 1 in 3 infants are underweight at age 1.
The Philippine Supreme Court met Tuesday to hear a challenge from an industry group to the proposed new rules, which would tighten existing controls on advertising. The rules would also force manufacturers to include warnings of the risk of contaminated formula on their labels. The group says the Department of Health has overstepped its authority by extending the law.
Later Tuesday, the Philippine government ordered the recall of millions of cans of baby formula produced by US producer Wyeth, one of the companies behind the lawsuit. The government said the product may have been contaminated after a typhoon flooded a warehouse last year.
On formula, a question of intentions
Milk companies insist that they're offering a reliable alternative for mothers who are unable or unwilling to breast-feed their infant.
Tracey Noe, a spokeswoman for Chicago-based Abbott Laboratories, told the Associated Press on Tuesday that no companies disputed the benefits of breast milk over bottle-feeding. Abbott Labs, for example is a supporter of "Business Backs Breast-feeding," a program designed to help businesses meet the needs of breast-feeding mothers upon their return to work.
"The real focus here is that infant formula is the only healthy, safe, physician-recommended alternative for moms who can't breast-feed," Ms. Noe said. Abbott produces Similac, an infant formula.
That isn't the message that Ding Bing says she got from her managers at Nestlé in China where she worked for five years as a marketing rep for infant formula. Ms. Ding, who spoke by telephone from the UNICEF/WHO conference, said the Swiss company told expecting mothers attending antenatal classes that Nestlé's Good Start formula was superior and that many of them would be unable to produce sufficient breast milk for their baby.
"The company told the staff that infant formula is better. It didn't tell us that mother's milk is enough; they couldn't tell us the truth," she says.
Ding quit her job last year and now runs a breast-feeding website and volunteers on weekends to teach new mothers how to nurse. She says young women in Chinese cities are misled by false advertising and their own doctors, who are paid by formula companies to give out information sheets and free samples of their products.
"We are told that formula has additives and ingredients, that it's good for the child," says Yeong Joo Kean, a Malaysian lawyer for the International Baby Food Action Network, an advocacy group. "For this region, it's just so enticing, it's seductive. I'm not surprised that parents are falling for it."
Breast milk contains antibodies and enzymes that speed the healthy growth and development of infants and may also lower the risk of chronic diseases later in life, according to WHO.
Struggling parents who opt for formula often dilute the product or substitute rice flour and other powders that lack essential nutrients, say health experts. In the Philippines, where bottle-feeding costs a minimum $43 a month, an estimated 16,000 infants under 5 die annually because of such practices, according to UNICEF. Campaigners point to Cambodia as a sign of what can go right. A national campaign there has raised breast-feeding rates at six months to 60 percent, up from 10 percent in 2000. Over the same period, child mortality fell by one-third, a huge gain that can only be explained by the switch to breast milk, says Karen Codling, a nutritionist for UNICEF.