Evidence From Zimbabwe
Bottle-feeding is on the increase in Zimbabwe. Records of the O.K. Bazaars supermarket in central Salisbury reveal that sales of Lactogen, a Nestlé infant formula product, almost trebled between July 1979 and July 1980. During the war years bottle-feeding had been much lower because of the closure of matemity clinics, the difficulties of babyfood representatives visiting the countryside and the inability of ordinary Zimbabweans to buy even one tin of the product
Now living standards are higher supplies to shops throughout the country are easier to come by and the promotion by the infant formula companies is more intense.
The major seller of infant formula in Zimbabwe is Food Specialities Ltd, better known to the general public by its international name of Nestlé. Through their sales of Neslac (for the newborn up until five months old) and Lactogen (for infants more generally), Nestlé dominates the local market.
In an interview with the Ministry of Health, the Managing Director of Zimbabwe’s Nestlé subsidiary said that they were not advertising ‘for the time being’ because of the babyfood voluntary code agreed in 1979. But the company does promote in a way which could be described as indirect advertising. Four Nestlé ‘medical delegates’, all secondary school graduates with company training, visit rural and urban health institutions. There they discuss ‘matters of mutual interest’ with the public and with health personnel. The Managing Director claimed to the Ministry that Zimbabwe had a need for these delegates, because of the shortage of staff in the health service — although if they were not working for Nestlé, they could be using their expertise within the Zimbabwe health service itself.
These Nestlé delegates have a wide contact with health units. Nearly all urban health workers who completed a questionnaire sent out by Zimbabwe’s Ministry of Health said that their institution was visited by the representatives; nearly two-thirds of the health workers in the major farm regions also said that they had been visited.
A quote from one of the questionnaire replies gives an impression of the results of such a visit ‘If delegates from Food Specialities would visit us more often and give talks to mothers, say on a wellbaby day, there would be a higher percentage of mothers using infant formula.’
When Nestlé delegates visit an institution, they usually speak with the pregnant women and the mothers of infants they find there. Nearly two-thirds of those health workers who sent back the questionnaire and whose institution had been visited state that the delegates talk to mothers. The company said that their delegates usually speak to large groups on such subjects as housekeeping and budgeting. If there is a need to demonstrate the use of formula, the company said, then delegates ask a nurse to give a demonstration. The Health Ministry is worried that this gives professional legitimacy to the practice of using that product Always, said the company, the delegates put the emphasis on breastmilk. However, the report says that the mothers spoken to automatically associate the delegates with the use of infant formula.
Virtually all health workers who replied to the questionnaire and whose institutions had been visited by the delegates say they are given free samples. The company said this is for professional evaluation, for research and to help educate mothers by providing a ‘visual capacity’. The Ministry is concerned that such samples directly promote the infant formula product because:
• In some cases the health workers take home the samples to feed their own babies. This sets a bad example when a supposed expert is choosing to use bottle-feeding instead of breastfeeding.
• Some samples are given by health workers as a ‘supplement’ when mums are having difficulty lactating. This partial introduction of bottle-feeding has a bad effect on breast-feeding— the less a baby breastfeeds, the less milk a mother’s body will make.
• Publicity is generated for Nestlé products when free gifts are made to the lucky mothers of twins or triplets. When asked whether, after the initial gift, further supplies were sent to the mother by Nestlé the company replied that it was ‘the clinic’s responsibility’.
In the visits from Nestlé delegates, 90 per cent of the health workers said that their
At nearly every institution that was visited in connection with this report, the Nestlé Calendar for 1981 was seen on the walls. It shows a chubby (some nutritionists say obese) baby, flanked by pictures of boxes of Nestum No. 1, Nestum No. 2 and Cerelac.
To record babies’ health, all over the country the ‘Nestlé Road to Health’ card is used. But it is not just a health card. The publication is also an advert for the company, for the word ‘Nestlé’ appears just before the separate words ‘Health Card’ so that it reads ‘Nestlé Health Card’. Both the mothers who receive these cards and the health workers who give them out might reasonably assume that Nestlé products are vital for the health of infants. The card also gives the impression of professional approval by showing the phrases ‘Printed for the Medical Profession’ and ‘Approved by the Ministry of Health’. It might be true that the Rhodesian government of the past was happy about such cards, but the Zimbabwe government today is committed to wiping out the sources of disease from which people suffer.
The design of the Health Card encourages a mother to bottlefeed. If her baby falls below a certain weight line, she is led to believe that she needs the products with the Nestlé symbol to increase her infant’s weight.
More generally, the widespread attitude amongst the public to Nestlé is one of enthusiasm. When the Nestlé delegates visit some rural areas, all the people living there— including the elderly — recognise his car and come to greet him. The charm and appearance of genuine concern for the people, the Ministry’s report concludes, that dress up the activities of Nestlé make them particularly dangerous. They make it hard to recognize that these activities only serve to promote the gain of the Food Specialities Company — at the expense of the Zimbabwean people.