§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Gummer.]
10.10 pm§ Mr. Jack Ashley (Stoke-on-Trent, South)I quote:
Can a product which requires clean water, good sanitation, adequate family income and a literate parent to follow printed instruction be properly and safely used in areas where water is contaminated, sewage runs in the streets, poverty is severe and illiteracy is high?That penetrating question was asked by Senator Edward Kennedy in 1978 when he chaired Senate hearings on the use and promotion of artificial baby formulas in developing countries. He was focusing on the issue I want to put before the House tonight—whether familiar commercial activities such as promotion, advertising and marketing can be justified in developing countries if they result in illness or death for children.The issue is an important aspect of hunger and suffering in the world. It affects the health and, indeed, the lives of millions of children. If we fail to cope with this problem, more children will die unnecessarily in each year of this decade than the approximate 700,000 who are born each year in Britain.
In fact, James Grant, the executive director of UNICEF, said in a speech at the United Nations on 15 January of this year:
If we in the international community are successful in our efforts to promote and protect the practice of breast feeding, we can save one million infant deaths each year in the 1980s.Why should so eminent a man feel it necessary to promote and protect a human process that has evolved and supported mankind for 200 million years? It is because there has been a great social revolution. Breast milk substitutes which have been widely available for only 50 years or so have been sweeping on a tide of marketing into poor developing countries during the last: few decades. The effect, amid poverty and polluted water, has been disastrous.It is an unchallengeable fact that a mother's natural milk meets all a baby's nutritional requirements and gives resistance against disease. It is readily available, hygienic and free. Although there is some dispute as to the exact percentage of women who are unable to breast-feed, it is very low. Some companies claim that it is 5 per cent., the medical profession says 2 to 3 per cent., while the head of nutrition at the World Health Organisation believes it to be less than 1 per cent.
In this small percentage of cases where breast feeding is not possible or is rejected, an artifical product may, if properly used, be a satisfactory substitute. But when misused, because the instructions cannot be understood, or germ-ridden because of water contamination and unhygienic conditions, or over-diluted because of poverty, it becomes an instrument of ill-health. The baby's bottle becomes the poisoned chalice.
One of the most important reasons why mothers in under-developed countries have rushed to use products more suited to Western ways has been described by the Jelliffes, two eminent professors, as the
ill effects of exploitive commercial advertising and promotion".Thousands of loving parents, anxious that their babies should be as healthy as the blooming ones adorning the 1069 baby food tins, have been gulled and lulled by high-pressure advertising and aggressive salesmanship. It was a case of the despicable exploiting the gullible. Some companies were better than others, but the unscrupulous ones wrought havoc. There has been some considerable improvement in recent years, but there is still a long way to go.Of course, malnutrition is part of the wider problems of poverty, lack of resources and social justice. But questionable promotional methods of artificial substitutes have exacerbated rather than mitigated the problems.
The success of these promotional methods has been stiking. In Brazil, for example, one study showed that the percentage of breast-fed babies fell catastrophically from 96 per cent. in 1940 to 39 per cent. in 1974. Although there were other factors, the impact of promotional methods cannot be doubted. They included the use of newspapers, magazines, billboardings, posters and radio. In addition, there were free samples, gifts for doctors, and sales personnel dressed as nurses.
In Africa, Asia and South America, the use of breast-milk substitutes has spread rapidly. It is spreading still, and is a cause for continuing concern That is why the World Health Organisation and UNICEF have become so deeply involved. Their actions are due in part to the efforts of Governments involved, but a special debt is owed to those who have drawn the attention of Governments and citizens to what is happpening as baby milk powders flood into the underdeveloped world. The detailed research of Mike Muller, Andy Chetley, John Clark and others in the various organisations has illuminated the problem.
In October 1979, at a meeting in Geneva called by WHO and UNICEF, a series of recommendations was agreed by representatives of Governments, international agencies, non-governmental organisations, the baby food industry and its critics. There was also a call for an international code of marketing which has now been drafted by the executive board of WHO. It is to be discussed at the World Health Assembly in May—and that is where the British Government can play a very important role indeed. It is because we are approaching that important deadline that we are having this debate tonight.
There has been an acrimonious dispute between the industry and its critics about the recommendations agreed in 1979. When the first 117 allegations of violations were made by the critics, the industry sought to refute most of them, although the complainants stood by their strictures and offered photographic evidence. Since then, over 500 further charges of unfair marketing practices have been made, and no doubt these will be the subject of further dispute.
There has been a change in the companies' promotional activities in response to the pressure. Some of the firms' spokesmen say that they are convinced that breast milk is best, and many say so in their adverstisements and on their tins of powdered milk. However, it is reasonable to ask why they do not all make that message the main one rather than, as often happens, giving it a minimal mention which is insignificant compared with the textual and pictorial presentation of the product.
These are not merely issues of interpreting recommendations. These are questions of attitudes of companies and of corporate responsibility on matters of life and death. The concern about the health of the babies will 1070 diminish only if there is a significant return to breast feeding. That means a very considerable reduction in the use of tinned baby food.
The draft code, unanimously agreed by the executive board of WHO, is to be proposed as the minimum necessary. The code will ban all forms of of media advertising to the public in developing countries. It will place the responsibility for producing educational information in the hands of local health authorities and ban all forms sampling to the public. It will also establish a monitoring system and oblige the director general of WHO to report on the workings of the code at the assembly.
The industry's attitude to the code is mixed. Some welcome it, while simultaneously expressing reservations which would undermine it. The president of the International Council of Infant Food Industries, Mr. E. W. Saunders, appears to be in no doubt. He says that the code would be irrelevant and unworkable and could have a megative effect on child health by restricting the flow of factual and objective information. I hope that one will be influenced by this selective response—especially the Government.
It is the Government's response which is really important. That is why over 150 Members of the House have signed the early-day motion on this subject, and I would appreciate it if the Minister would clarify the Government's attitude to some vital qustions—and I pay tribute to him as a man who has accomplished much with the tobacco industry.
Can the Minister assure the House that the Government will not seek to weaken in any way the draft code agreed by the executive board of WHO? It would reduce Britain's moral and political standing in the world if we fell out of step now on an issue of such crucial importance to developing countries.
Does the Minister agree with the WHO executive board's view that the draft code should be regarded as an absolute minimum and that it should be reviewed in two years? Without detailed monitoring, this code can become just another piece of paper, especially as it covers such a wide area. Does the Minister agree that monitoring is crucial to its effective implementation and will he support the recommendation on monitoring? Does he agree that the code will be more effective if it is a regulation? Will he accept that this is an objective to be pursued, and is one for which the Government will press now?
Personally, I was concerned at the reply that I received to a parliamentary question asking if the Government would make the health and welfare of infants the sole consideration when considering the code. The Minister of State said it would be a prime consideration which, since we are dealing with issues of life and death, is a disturbingly different thing. It is possible that delicate and complex legal matters of trade relations have to be taken into account. However, may we have an assurance that no political or commercial considerations will be allowed to hold sway on this one specific and unique issue?
This country has a good record in the past and co-sponsored two resolutions at WHO in 1974–78. If the Government intend to put the health and welfare of children in developing countries above all other considerations, I believe that they will have the support of the whole House—apart, of course, from the few eccentrics who lurk around. Furthermore, I believe that a positive and constructive role by the Government will win the wholehearted consent of the people of Britain. It will 1071 increase our moral stature in the world. Above all, it will help to improve the health and save the lives of millions of children throughout the developing countries.
§ The Undersecretary of State for Health and Social Security (Sir George Young)I congratulate the right hon. Member for Stoke-on-Trent, South (Mr. Ashley) on once again identifying an important issue which has far-reaching effects upon the health and well-being of children and on championing an important cause which is of great interest to many hon. Members. I am grateful to the right hon. Gentleman for letting me see an advance copy of the text of his speech.
The right hon. Member has placed on the record his concern; it is a concern which is shared not only by this Government but by the Governments of a large number of countries throughout the world. I welcome this opportunity to outline the positive role played so far by the United Kingdom and to talk about the way in which we hope to be able to influence future developments.
It is all too easy for those of us living in developed countries to convince ourselves that, because we can see little adverse effects of the promotion of manufactured breast milk substitutes, the problem does not exist. It does exist, as the right hon. Gentleman has so graphically described, although I acknowledge that the scale and cause of the problem are the subject of disagreement between interested parties.
This Government continue to support all efforts to promote breast feeding both at home and overseas, being convinced that it is the natural and ideal way of feeding babies and of helping to secure their healthy development. While we of course recognise that in certain circumstances breast milk substitutes are necessary, there is a need to ensure that nothing is done to suggest to mothers that such substitutes are preferable to breast milk itself. Mother's milk is the perfect food for babies. Not only is it free but it has all the nourishment a baby needs, and provides protection against common illnesses and allergies. I speak as a beneficiary.
Despite the obvious advantages of breast milk, however, millions of mothers in poor countries are turning to manufactured substitutes. In many cases, mothers are too poor to be able to buy sufficient quantities of these substitutes to feed their children. Attempts to eke out the food which they do buy by over-diluting it or reducing the number of daily feeds recommended by the manufacturers results in malnutrition.
An even more alarming situation stems from the absence of a ready access to a clean water supply—a situation which unhappily exists in large parts of the developing world. This can result in feeds being prepared with unsafe water unless the most scrupulous precautions are taken to sterilise both the water and the utensils used. In both cases the results can be that babies become seriously ill and even die. Both situations may arise either because mothers are unable to understand, or because they are unable to comply with, the manufacturer's instructions as printed on the labels of the food containers.
Because we are conscious of this whole problem, our country has for many years supported measures designed 1072 to improve the standard of child nutrition. It is, therefore, hardly surprising that we should have a very close interest in the initiatives recently taken by the World Health Organisation and UNICEF. Officials from both the DHSS and the ODA took part in the WHO/UNICEF jointly sponsored meeting on infant and young child feeding which was held in Geneva in the autumn of 1979. They gave their full support to the recommendations which included the proposal that a code of marketing should be drawn up to cover the promotion and sale of breast milk substitutes. We believed then, and continue to believe, that such a code could play an important part in securing improvements in the standards of child feeding, particularly in developing countries.
The recommendations of that meeting were endorsed last May by the World Health Assembly, which is the governing body of the WHO. During the course of the assembly the United Kingdom delegation took an active part in the discussions. The assembly supported the idea of a code of the kind suggested, and instructed its secretariat to put forward proposals for consideration by the WHO's executive board. In the months that followed, the WHO sought the views of its 155 member States on the format of the code. As far as this country was concerned, close consultation was already being maintained between a number of Government Departments with specific interest in the subject.
The WHO produced a draft code which was discussed in detail with representatives of a number of member States, non-governmental organisations, the industry and organisations with a particular interest in the welfare of children in the developing world. Officials from the DHSS and MAFF took the opportunity to put forward the United Kingdom's views during that stage of the code's development.
I apologise to the right hon. Gentleman for recounting the earlier stages of the code's production in some detail, particularly as I am sure that the history is already known to him. However, I feel that it is important to emphasise that the United Kingdom has played a very active part in the development of the code.
Last month, the results of all these efforts were brought before the executive board of the World Health Organisation. Each member of that board is nominated to serve in a personal capacity as an expert in health care. The significance of this is that, in common with the other 29 members, our own nominee was not mandated to speak as a national representative. The board was presented with draft versions of the code together with a paper detailing its development. It was asked to submit the code to the next World Health Assembly, together with proposals for its promotion and implementation. The options for consideration were that the code be adopted either as a recommendation to member States under article 23 of the WHO constitution or by means of a regulation under articles 21 and 22.
I realise that for some months conflicting opinions have been expressed as to whether the code's adoption as a recommendation or as a regulation would be the more effective way of proceeding. Not surprisingly, there has been widespread feeling that by the very meaning of the word, a "regulation" must be a stronger form of adoption than a "recommendation".
1073 The board members discussed the issue at some length. One of the board's longest serving members said that in the 30 years of his association with the WHO he had never received so much correspondence on a single agenda item. Board members were clearly concerned that a number of member States thought that there would be difficulties in applying the code as a regulation in their national, legislative and constitutional frameworks. The result of such difficulties could be that at best long delays would take place before the effects of the code came into operation and that at worst, its implementation would become impossible. The executive board was concerned that in this case, as far as many babies were concerned, delay could literally be fatal. Furthermore, lack of unanimity among member States could persuade some countries to delay decisions still further. The code's adoption as a recommendation would introduce a degree of flexibility, enabling member States to avoid unnecessary delays of this nature.
In those circumstances, the board decided that on balance, the adoption of the code as a recommendation to the WHO member States would be the more effective course of action. In making its proposal, the board added two important recommendations. Firstly, it has proposed that the operation of the code should be reviewed after two years to establish the degree of compliance with its recommendations at country, regional and global levels. Secondly, it has proposed that the World Health Assembly should reserve the right to make future proposals, if necessary, for the revision of the code, including further measures for its effective application.
In its present form, the code seeks to achieve its objective by banning the advertising of breast-milk substitutes. It also seeks to ban the use of sale inducements such as free samples, gifts and discounts, either directly to mothers or to hospitals and clinics. It contains provisions to prevent manufacturers making financial inducements to health workers to promote breast-milk substitutes and paying their own employees bonuses based on the volume of sales of these products.
The code also calls for appropriate information on infant feeding to be provided by the health care system. In addition, it recommends action to govern the production and storage of infant feeding products and proposes that such products should meet international standards of quality and presentation, in particular those developed by the Codex Alimentarius Commission, and that their labels should clearly inform the public of the superiority of breast feeding.
The right hon. Gentleman will appreciate that the final decision on all aspects of the code rests with the World Health Assembly, which meets in May. Between now and May the code, as approved by the board, will be examined in detail by officials of the interested Government Departments who will continue to consult those with an interest in the matter. Our prime objective will be to press for the code that I have described to be adopted in the most effective form and manner, and the United Kingdom delegation will be briefed accordingly. I understand the right hon. Gentleman's concern that the code should be worded in such a way as to avoid loopholes that would enable its aims to be thwarted. I shall give careful 1074 consideration to the points that he has made during these final stages of the code's examination in order to see whether we can block the loopholes.
I should, however, like to reply to the specific questions raised by the right hon. Gentleman. I reassure him that it was not the Government's intention to try to weaken the code at any stage in its development. It is now generally accepted by all concerned that the earlier drafts of the code were impractical and inoperable, and in common with other Governments we took the opportunity to point out those difficulties. The United Kingdom delegation in May will have to use its discretion in considering proposals for further drafting changes in the light of discussions.
Turning to some of the other points that the right hon. Gentleman made about the proposal being the minimum, the final preambular paragraph of the executive board's proposed resolution for the assembly's consideration reads as follows:
Stressing that the adoption of and adherence to the International Code of Marketing of Breastmilk Substitutes is a minimum requirement and only one of several important actions required in order to protect healthy practices in respect of infant and young child feeding.I believe that statement to be true. We also support the proposals that the code should be subject to a review in two years' time.I am sorry if my hon. Friend the Minister of State's reply to the right hon. Gentleman's earlier question caused some doubt in his mind. There was no intention to suggest other than that the health and welfare of infants is of paramount importance in consideration of the code, more important than some of the other factors that the right hon. Gentleman mentioned towards the end of his speech. The other consideration which the Government had in mind was the vital one of getting the code adopted and operational without delay.
The question of monitoring is one that we shall have to consider in the light of the final version of the code. I have, however, taken on board the right hon. Gentleman's views on the matter.
I should perhaps also point out to the right hon. Gentleman that responsibility for controlling the advertising and marketing of breast milk substitutes within any country lies with the Government of that country. The code does not require individual countries to control the overseas marketing facilities of their baby food manufacturers. Any such action would trespass on the sovereignty of importing countries to manage their own markets. Within the United Kingdom, I am happy to say, British manufacturers already take a responsible attitude towards advertising and marketing their breast-milk substitutes, voluntarily confining their advertisements solely to specialist publications. Furthermore, unless they have been approved by MAFF and on my Department, certain foods which might be used as breast-milk substitutes are required by law to bear a warning statement that they are not fit for babies. That responsible attitude on the part of manufacturers towards advertising and quality standards is what is required in the developing world.
The WHO's 155 member States are clearly of the opinion that urgent action needs to be taken. Those who have devoted their lives to studying child nutrition know that there are quite sufficient problems to be faced in combating it throughout the world without adding problems of our own making.
1075 Finally, in thanking the right hon. Gentleman once again for his constructive comments, I give him an assurance that we shall continue to take account of the views expressed by all those with an interest in the subject before we finally brief the United Kingdom delegation to the World Health Assembly in May. I look forward to discussing the whole subject in more detail when I meettheright hon. Gentleman in the near future.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-two minutes to Eleven o'clock.