Baby Milk (Hansard, 22 March 1995)

§ Mr. Alex Carlile (Montgomery)
I am grateful for the opportunity to raise the important subject of the advertising of manufactured baby milk. I do not propose to speak for every minute of my allotted time because I have agreed that it would be appropriate to allow a contribution from the Labour Front Bench. That means that I shall not give way during my short speech.
As a male Cow and Gate baby, I speak on this subject with some diffidence. However, I recognise the importance of the subject, and particularly the pressures that women often believe are placed upon them in connection with it.
In 1981, the British Government signed the World Health Organisation international code of marketing of breast milk substitutes. The purpose of the code is to ensure that all carers, health workers and especially mothers receive totally impartial information and are protected from commercial pressures, to enable them to make informed decisions about feeding infants. It should be recognised that that information must include appropriate facts about artificial milk products, as not all mothers are able to breast-feed their babies successfully.
In 1990, the Government signed the Innocentri declaration, which committed them to taking action to give effect to the principles and aim of all the articles of the International Code … in their entirety". It also committed the Government to enacting imaginative legislation protecting the breastfeeding rights of working women … by the year 1995". The Government White Paper "The Health of the Nation" called for an increase in the rate of breast-feeding in the United Kingdom. That call was widely welcomed. The Government continued to pay lip service to breast-feeding promotion by supporting the World Health Assembly resolution No. 47.5 of 9 May 1994. We were given one last reason to trust the Government's concern for breast-feeding over bottled formula when they released a proposal for draft regulations in December 1993. The proposals came close to meeting the criteria set out in the international code, although not completely.
However, the true measure of a Government's commitment is in the legislation that they pass. According to that standard, the Government have fallen far short of the promises and alleged commitments that they have made over the past 14 years in their 1995 regulations—Statutory Instrument No. 77—which have been in force for three weeks.
The proposed regulations met with mostly positive responses, despite some calls to strengthen them. The only calls for the draft to be weakened came from baby food producers and their advertising agencies. The Government answered their call with the present regulations, which allow advertising to mothers via publications specialising in baby care and distributed to women through the health care system". Advice was obtained from 48 health, consumer and development organisations, including UNICEF, the British Medical Association, the British Paediatric Association, the Health Visitors Association, the Royal College of Nursing, the Royal College of Midwives, the National Consumer Council and the National Childbirth 315 Trust. However, their views were dismissed. The international code, to which I referred earlier, provides in articles 5.1 and 6.3 that There should be no advertising or other form of promotion to the general public of products within the scope of this Code … No facility of the health care system should be used for the purpose of promoting infant formula or other products within the scope of this Code". However, the international code does not preclude the dissemination of information to a very restricted group—health care professionals.
Regulation 17 of the new law flatly contradicts that code. It states: No person shall publish or display any advertisement for an infant formula except in a publication specialising in baby care and distributed only through the health care system". That is very different from disseminating information only to health care professionals. For example, leaflets may be picked up in any doctor's surgery, clinic or hospital.
Putting aside the Government's policy U-turn, it is correct in this debate to address the reasons why internationally agreed restrictions on milk advertising are necessary or advisable. The most important reason is that breast milk is significantly better for infants than manufactured formula. In 1994, the standing committee on nutrition of the British Paediatric Association stated: evidence convincingly indicates that … significant advantages in cognitive assumption have been associated with breast feeding". Gastro-enteritis and other common infections are less likely among breast-fed babies. Breast-feeding is also better for mothers as it may reduce the risk of pre-menopausal maternal breast cancer. They are just three examples of the many advantages of breast-feeding which are set out in scientific evidence.
The manufactured baby milk industry spends quite a lot of money on advertising. According to the information available to me, it spends between £5 million and £7 million. That translates to about £6.40 per baby. The Government spend between £100,000 and £150,000 on promoting the advantages of breast-feeding, which translates to a measly 20p per baby. It is not a very equal contest.
If the Government were to persuade more mothers to breast-feed, it would save a lot of money. Based on the widespread health benefits of breast-feeding, UNICEF estimates that the national health service in England and Wales would incur an additional cost of £560,000 for treating infants with gastro-intestinal illness for every 1 per cent. reduction in the number of women electing to breast-feed. In other words, breast feeding saves the NHS a lot of money.
The new regulations permit advertisements for formula in publications specialising in baby care and distributed to women through the health care system". One presumes that the Government would argue that that allows mothers access to information on the relative contents of different brands of formula and thus enables them to make an informed choice. However, one has only to look at the information that is provided to see that that is not so. If the scientific information were disseminated widely, it would tax the most expert on the subject. That is why it is important for advertising to be restricted to those professionals who are best qualified to advise mothers on an objective basis.
316 That a ban on the advertising of baby milk formula would make a significant difference to breast-feeding rates is evidenced by the three European countries which have little or no advertising of manufactured baby milk products. The breast-feeding rate in Norway is 99 per cent., in Sweden it is 97 per cent. and in Denmark it is 98 per cent. On the other hand, in countries where the bulk of information about breast-feeding and formulas comes from the manufacturers of those formulas, the rate of breast-feeding is alarmingly low. In Scotland it is 50 per cent., in France it is 50 per cent. and in Ireland it is a miserable 31 per cent.
The advertising of infant formula in the health service is simply unacceptable. The national health service is no place for mothers to be turned on to a product that is not as good for the baby as the mother's own breast milk and not as good for the mother as giving her own breast milk.
Brand name advertising is selective. It reaches mothers at an early stage with information packs, free gifts and even videos going to maternity wards. Manufacturers provide only the information that they want to be known, and it is not impartial. It is the responsibility of the health service and of the Government to provide impartial and unbiased information. We must keep it in mind that a ban on advertising would not deny anyone the right to buy baby milk if they chose to do so; it would just make it more likely that they would seek balanced, expert and professional advice before they chose to use manufactured milk.
Our responsibility is to protect the best interests of those people who are unable to exercise their own personal choice—the babies. That is the reason for this debate.

§ Mr. Martyn Jones (Clwyd, South-West)
I was astonished to discover that I have to speak from the Back Benches in an Adjournment debate.

§ Mr. Deputy Speaker (Mr. Michael Morris)
Order. Let me make it clear to the hon. Gentleman that Adjournment debates are Back-Bench debates.

§ Mr. Jones
I was not challenging your decision, Mr. Deputy Speaker. I am grateful that the hon. and learned Member for Montgomery (Mr. Carlile) has allowed me some time in his debate because he has raised an extremely important issue. He made a very good case and I endorse everything that he has said in his peroration. However, I should like to add one or two points, which need stressing.
The Government's draft proposals found favour, with virtually no dissent. I understand that, out of 231 letters sent, 216 replied in favour of a ban on advertising baby milk. It seems odd that the Government should carry out a consultation exercise and then not listen to the views of the professionals, which include 48 major health and consumer bodies, among them such organisations as the British Paediatric Association, the British Medical Association, the Royal College of Midwives and the Health Visitors Association. All those organisations are concerned about the health of the infant and not about selling baby milk. They are concerned about giving women an informed choice, thereby providing them with the opportunity to give their children a better start, better health and all the other advantages of breast-feeding.
317 Article 6 of the international code of marketing of breast milk substitutes produced by the World Health Organisation, which was mentioned by the hon. and learned Gentleman, states: No facility of a health care system should be used for the purpose of promoting infant formula or other products within the scope of this Code. That is precisely what the infant formula follow-on regulations do—they allow the advertising of products for sale within the health care system and during the most vulnerable period for mothers who do not have the opportunity to exercise an informed choice.

§ Dr. Lynne Jones (Birmingham, Selly Oak)
Last year, I visited the special baby care unit in my constituency and I was horrified to discover that, although the mothers of those babies were able to express sufficient breast milk to feed them while they were in intensive care, as soon as they went home the majority of mothers stopped breast-feeding. Women are under great pressure not to breast-feed, and advertising which juxtaposes slogans saying that breast-feeding is best with the logo of the baby milk company is effectively saying, "Breast milk may be best, but you cannot harm your baby by feeding our formula." That is the wrong message. The message should be, "Feeding breast milk substitutes harms you and your baby."

§ Mr. Jones
Obviously, in some circumstances it is necessary for a substitute milk to be used, but they represent a tiny minority of cases. The vast majority of babies do better and gain advantages from being breast-fed.
By producing the regulations and not banning the advertising of formula milk, the Government have ignored the demands of 48 major United Kingdom health and consumer bodies. They have broken their agreement on the 1981 World Health Organisation code and, more importantly, they may have created serious dangers to the health of babies. The latest evidence suggests that breast-feeding not only protects babies against gastro-enteritis but affects long-term brain development, with a significant difference between the brain development of breast-fed and baby milk-fed children.
We are not anti-choice. Mothers must be given information, but it must be unbiased and mothers must take decisions based on the health of their children and on their own future well-being. We have heard how much money is spent on promoting breast-feeding, which I thought was nearer 9p per nursing mother, but baby milk manufacturers spend more than £6. That is ridiculous, but it shows how much pressure is being brought to bear on mothers to give their babies baby milk rather than to breast-feed.
Finally, we demand a full debate on the matter at the earliest opportunity. It should at least be considered in Committee, so that all the issues can be fully discussed, rather than in Adjournment debates, in which we are happy to take part, but which cannot fully examine all the pros and cons. The Government have made a serious mistake. They should change their mind and ban infant formula advertising as soon as possible.

§ The Parliamentary Secretary to the Ministry of Agriculture, Fisheries and Food (Mrs. Angela Browning)
Perhaps I should begin by declaring an interest in that I am a mother and a mother-in-law. I am grateful to the hon. and learned Member for Montgomery (Mr. Carlile) for raising the subject. As a self-confessed Cow and Gate baby, he seems to have been nourished by, and thrived well on, the product. There is a great deal of interest about the subject. United Kingdom regulations, which include controls on the advertising of baby milks, were laid before Parliament on 16 January and came into force on 1 March.
I find it ironic that today the Government have been criticised for not going far enough because they have failed to ban the advertising of infant formula. Only last April, my hon. Friend the Minister of State for the Armed Forces, who was previously responsible for these matters, replied to a debate in the House and was criticised for going too far in proposing in the draft regulations to ban the advertising of infant formula to mothers.

§ Dr. Lynne Jones
The hon. Member for Westbury (Mr. Faber), who initiated that debate, represented the constituency in which Cow and Gate had its factory.

§ Mrs. Browning
That simply proves what a marvellous product it was for the hon. and learned Member for Montgomery.
Having been criticised from both sides, it seems that the Government have steered the right course in the regulations. With that in mind, I should like to set out for the House some of the background to the issue before I deal with the specific points that the hon. and learned Gentleman raised.
The hon. and learned Gentleman referred to the World Health Organisation code. The United Kingdom fully supports the aim of the code, which is to contribute to the provision of safe and adequate nutrition for infants by the protection and promotion of breast-feeding and by ensuring the proper use of breast milk substitutes.
I should clarify the fact that we totally endorse the need to encourage and inform on breast-feeding. We accept that it is the ideal method of feeding new-born babies. All mothers have to choose when to switch their babies from breast milk to powdered milk and, as the hon. and learned Gentleman admitted, some mothers cannot breast-feed. Adoptive parents and other small minority groups have also to be considered. I would not wish those women to be stigmatised or made to feel second-class mothers by any of the comments in the debate today.
Individual countries were left to decide how best to implement the recommendations of the WHO code. The UK Government decided that that could best be done through industry self-regulation. Following consultation with interested parties, a voluntary code of practice drawn up by the industry, in consultation with my Department and UK Health Departments, came into being in 1983, which gave effect to the WHO code's aims and principles. However, in the mid to late 1980s, the European Community started to consider the introduction of legislation, which is much tighter than a code. In 1991 the EC adopted directives on the composition, marketing and export of infant formulas and follow-on formulas.
319 While the EC directives implemented the aims and principles of the WHO code, they do not adopt its provisions in every detail. More importantly, the UK is required to implement the terms of the EC directive, not those of the WHO code. In the usual way, the Government considered the terms of the EC directives and drafted regulations to give effect to the directives in the UK, and a draft of the proposed regulations was issued for consultation in December 1993. The consultation generated a considerable response, most particularly about the extent of proposed controls on the advertising of infant formula.
Article 8 of the EC directive, which deals with advertising, states: advertising of infant formulae shall be restricted to publications specialising in baby care and scientific publications. Member states may further restrict or prohibit such advertising. That article's implementation led to this debate.
In July 1992, long before the draft regulations were issued for consultation, my right hon. Friend the Secretary of State for Health, in answer to a written question, announced: The Government are committed to ensuring that the existing restrictions on marketing and advertising are, at least, maintained."—[Official Report, 2 July 1992; Vol. 210, c. 680.] Bearing in mind that commitment, the Government thought it only right at least to explore other options in the draft regulations.
The draft regulations proposed that the controls on advertising should be far reaching, allowing advertisements to appear only in magazines whose intended readers would be professionals involved in maternal and baby care. It was no surprise that these proposed controls generated a considerable number of responses to the consultation from the public and from many hon. Members. In fact, the regulations were the subject of an Adjournment debate last April.
In the main, reaction was split between two opposing views. One view was that, while supporting the advertising controls proposed, the Government should go even further and use the directive's option to its fullest extent to ban all advertising of infant formula. The opposing view was that we should not use the option at all and should stick to the minimum controls required by the directive.
The latter view drew attention to the Government's policy of deregulation and to the thrust of my Ministry's legislative programme—to introduce regulation as a last resort. There was also a strong feeling—one that I share—that such strict controls would impinge on a mother's right to have access to information. I emphasise that, in essence, we are putting into statute a provision that has existed in voluntary form for some time. That means professionals will give the advice.

§ Mr. Martyn Jones
indicated dissent.

§ Mrs. Browning
The hon. Gentleman shakes his head. Does he not think that midwives, health visitors and similar people are professionals? They are the people who will vet whether material is appropriate to be sent to mothers. My colleagues in the Department are working hard to ensure the success of the campaign to put before mothers the positive benefits of breast milk, and that is the right way to go. However, the debate denigrates that part of a woman's body from her shoulders to the top of 320 her head. It assumes that women do not have the intelligence or the nous to form an opinion for themselves. Most of the professionals giving that opinion are also women.
Are Opposition Members who contributed to today's debate really saying that midwives and health visitors should not be allowed to see an advertisement for a product that is on sale in every chemist and Tesco branch in the country? One would think that it was a banned substance. The hon. and learned Member for Montgomery comes from a party that is constantly asking for deregulation of banned substances. He seems now to want to ban a substance that is available to anybody to purchase in any shop in the country.

§ Mr. Alex Carlile
That point was rather unworthy of the hon. Lady, particularly as I am personally opposed to the deregulation of the substances that the hon. Lady has in mind. She has been a little less generous than she should have been, given the spirit of the debate. My case is not that mothers are unintelligent or that professionals will not receive the information. It is that, under the regulations, it will be possible for freely available advertising material to lie about unsupervised and unadvised in doctors' surgeries, clinics, dentists' waiting rooms and so on. Surely the Government did not intend that.

§ Mrs. Browning
I assure the hon. and learned Gentleman that any publication placed in a doctor's or hospital waiting room will have been vetted by the professionals upon whose expertise we rely in giving advice to mothers.

§ Mr. Carlile
That is being complacent.

§ Mrs. Browning
Not at all. That is the restriction imposed by the directive. Does the hon. and learned Gentleman not trust health care professionals to vet an advertisement for a product that is freely available? I have not had occasion to buy the product in question for many years, so I made a point of examining its packaging and the claims made for it. I would be concerned if anything on the packaging said that the mother should stop breast-feeding and change to milk powder-feeding, but it does not say that.

§ Dr. Lynne Jones
It is more subtle than that.

§ Mrs. Browning
Women are subtle, and they are subtle enough to make intelligent, informed decisions for themselves. They do not need hon. Members to elevate their judgment above that of millions of mothers in this country. While we all agree on the benefits of breast milk-feeding, to assume that hon. Members have better judgment than mothers when it comes to the interests of their babies—

§ Mr. Carlile
I do.

§ Mrs. Browning
The hon. and learned Gentleman says that he does have better judgment. Good luck to him. I hope that he will take his advice to maternity units around the country and put it to the test.

§ Mr. Martyn Jones
I remind the Minister that the bodies to which the material will be submitted are the same organisations that are asking her to ban infant formula advertising.

§ Mrs. Browning
The hon. Gentleman is right when he says that the representations made by professional bodies 321 were in opposition, but when independent research is undertaken of professionals at the sharp end—health visitors and midwives—there is a different result. They are the professionals, and they say that they are the right people to give advice, and I agree. It is absurd of the hon. and learned Gentleman to put his judgment above that of an experienced midwife or health visitor. He should acknowledge the professionalism of those experts—mainly, but not exclusively, women—who advise women.

§ Dr. Lynne Jones
Will the Minister give way?

§ Mrs. Browning
No, because I have only a few more minutes and the hon. Lady merely intervened—it is not her Adjournment debate.
As I said, we were fully committed to supporting the promotion of breast-feeding, and therefore conscious that to adopt only the minimum in the directive would have meant controls less restrictive than those already in place under the voluntary agreement with the industry. We decided that that would not provide the support that the promotion of breast-feeding deserves.
After careful consideration, we concluded that the option that best served that dual purpose was the one that has been operating voluntarily and successfully since 1983. Under the voluntary code of practice, infant formula advertising that is to be read mainly by mothers and pregnant women is not permitted unless it is disseminated under the supervision or care of the health care system. I assure hon. Members that it will remain for the judgment of the professionals concerned. The regulations give statutory effect to the existing voluntary requirements, which means that infant formula advertising will continue to be allowed, but only in baby care publications distributed through the health care system, scientific publications and certain trade journals not seen by the public.
I am grateful to the hon. and learned Gentleman for initiating the debate. We share his concern about, and his enthusiasm for, breast-feeding, but I have to tell him that the women of this country, the mothers of this country and the professionals in the health service are able to make rational judgments. They do not need to be protected from something that is in daily use and that will continue to be so.