The Ministry of Health today will introduce guidelines to curb sales tactics by some foreign companies that they say pose a serious threat to Cambodian children.
Cambodian mothers, they charge, are being duped by unscrupulous baby-food manufacturers into giving their infants milk formula instead of breast-feeding them.
According to ministry officials, companies such as Nestle, Dumex and France Bebe use unfair sales tactics, such as distributing free samples in maternity wards, to get new mothers to use their products.
The companies are taking advantage of most Cambodians’ ignorance of the benefits of breast-feeding, widely acknowledged in developed countries, officials say. “The tendency in developed countries is breast-feeding [newborns and infants]. But in developing countries, it’s the opposite because of mass media campaigns, commercials on television,” Ministry of Health Director General Eng Huot said.
Traditionally, Cambodian women breast-feed their children, said Chhin Lan, breast-feeding program coordinator for the Ministry of Health. “The problem is that mothers get very confused when milk companies talk to them,” she said.
Hak Nika, a housekeeper at a Phnom Penh hotel, said she was breast-feeding her 4-month-old daughter but feared the infant would end up weak and under-nourished. So she began feeding the girl a milk product she received from her doctor.
“I saw the ads on television,” said Khun Leang Him, a street fruit seller. “[Milk products] have a lot of vitamins and can improve babies’ health.” She wishes she could buy them for her daughter, but she earns about $2.25 per day and can’t afford it, she said.
Sen Nary, a teacher who gave birth in a private clinic, said her children were fed milk products during their first 48 hours because “the doctor said that I needed to take care of my health first.”
Chan Soklin did not breast-feed the two children she had at the hospital because she was afraid breast-feeding would affect her appearance. “Besides, I thought that milk products were good because they got a license [to sell the products],” she said. Chan Soklin was not aware of any reason why she should breast-feed rather than use milk formula.
Directions on baby-food containers usually say breast-feeding is best, adding that it’s not always possible to breast-feed. But this is written in very small print, hard for mothers to read, said Nyunt Nyunt Yi, Unicef program officer for health and nutrition. In addition, the warning isn’t always printed in the Khmer language.
As a result, many mothers never hear the other side of the story. “If a mother does not breast-feed, her child suffers in two ways-he does not get the nutrients he needs to grow, and he becomes more vulnerable to infection,” said Nyunt Nyunt Yi. With proper breast-feeding, she said, “malnutrition that has affected children in Cambodia will be prevented.”
With nearly 10 children out of 100 dying before their first birthday-one of the highest infant mortality rates in Asia-Cambodia must take steps to encourage and protect breast-feeding, Chhin Lan said.
In addition to issuing the guidelines, the Ministry of Health is launching a media campaign to promote breast-feeding and a training program for health workers with support from Unicef and the World Health Organization.
These initiatives are scheduled to be announced during a seminar today at the National Maternal and Child Center, which coincides with World Breast-Feeding Week.
For decades, advocacy groups all over the world have battled marketing practices such as the ones used by baby-food companies in Cambodia. The International Baby Food Action Network links more than 150 of these groups operating in more than 90 countries. In 1981, the World Health Assembly adopted the WHO/Unicef International Code of Marketing of Breast-Milk Substitutes to regulate such practices.
The ministry is drafting its own version of the code that, once adopted, will regulate companies’ marketing practices in the country, Eng Huot said. In the meantime, the ministry is issuing guidelines for its staff to promote breast-feeding, prohibit the distribution of infant formula and the display of baby-food promotional material in healthcare facilities, and forbid health workers to accept products or gifts from companies.
The guidelines also require companies and distributors to respect the international code-meaning no direct contact with mothers and health workers in healthcare facilities. “Their products should be sold like medicine and other products,” not promoted through free samples in maternity wards, Chhin Lan said.
The ministry’s media campaign urges mothers to breast-feed their children within one hour of birth. “The first milk a mother produces, which is called colostrum, is like very powerful vaccination-it’s filled with protective agents,” explained Jenny Busch-Hallen, a WHO nutritionist.
The ministry’s message on posters and television spots stresses that mothers should nourish their babies exclusively with breast-milk for their first six months. “That means no water, no food, no sugar, no tea, no coconut juice,” said Busch-Hallen. “Babies will be getting all the food and liquid meeting all their nutritional requirements in breast-milk.”
Afterward, “they should get adequate complementary feeding and continue to be breast-fed up to two years of age,” Nyunt Nyunt Yi said.
Not only does breast-milk meet a baby’s needs, “it is hygienic, safe, cheap and readily available,” Busch-Hallen said. “Formula has to be made with water, and less than a third of people [in Cambodia] have access to safe water.” And it is expensive-some mothers have to dilute it to make it last longer, she said.
Some Cambodian women said they had their own reasons to resist the formula companies’ pitch. “We don’t know how long those products have been in the can,” said Sieng Thyda, who breast-fed her four children. They have been shipped from overseas and may have been on the store shelf for some time, she said.
And breast-feeding can forge an emotional bond, said Toun Sokhom, who had her first three children in a refugee camp in Thailand. “It gives a baby a feeling of warmth because his mother is there, feeding him. He sees his mother’s face and gets the tenderness of her touch,” she said.
Research indicates that breast-fed children tend to be more intelligent than children fed with milk products, Nyunt Nyunt Yi added.
Currently, 96 percent of Cambodian mothers breast-feed their children. “What is very nice here is that there does not seem to be a shame factor about breast-feeding,” which is not the case in all countries, said Busch-Hallen.
But most mothers don’t do it right, which explains the high infant mortality rate, said Chhin Lan. They may get rid of their first milk or wait days before starting to breast-feed, she said. Only 11 percent of mothers breast-feed their babies within one hour of birth, and only 5 percent feed their children exclusively breast-milk during the first five months or so, she said.
A program called the Baby Friendly Hospital Initiative will attack this problem by training medical staffers in seven provinces to give mothers information and assistance in breast-feeding correctly, Chhin Lan said.
However, breast-feeding can be dangerous. The national policy paper on breast-feeding, endorsed by the Ministry of Health in January, notes that one in seven mothers with HIV/AIDS infect their children through breast-milk around the world. As a result, 500 to 700 infants are infected daily worldwide.
But that number is less than “the estimated 4,000 children who die every day [globally] due to hazards associated with breast-milk substitutes,” such as malnutrition and infections, the paper states. The risk of HIV/AIDS infection must be addressed, but without altering the overall policy of promoting breast-feeding, it concludes.
Contacted by e-mail, Nestle and EAC Nutrition, manufacturer of Dumex products, said they voluntarily observe the international code in all countries, in addition to national regulations.
Iqbal Jumabhoy, spokesperson for EAC Nutrition, said the company gives product samples to medical professionals for them to use at their discretion, adding, “Medical professionals may give these samples to mothers who cannot breast-feed or who choose not to.”
Christina Drotz-Jonasson, spokesperson for Nestle, said Nestle is in the process of adding a clause to its product labels that the World Health Assembly added to the international code in 2001, to the effect that babies should get only breast-milk for the first six months of their lives, with complementary food afterwards.
