House of Commons Hansard Debates for 4 Apr 1995

Infant Formula

8.43 pm

Mr. Martyn Jones (Clwyd, South-West): I beg to move,

That the Infant Formula and Follow-on Formula Regulations 1995 (S.I., 1995, No. 77), dated 15th January 1995, a copy of which was laid before this House on 16th January, be revoked.

When the new regulations that we are discussing came in, all looked well, briefly. It seemed that at last we had law controlling the advertising of infant formula milks, but it soon became clear that the law was the weakest just where it was most needed. The new regulations allow the advertising of infant formula feeds in the health service, reversing a major part of the World Health Organisation code to which the Government signed up.

The new regulations allow advertising in maternity wards, clinics, doctors' surgeries and all the pre and post-natal wards, just where new mothers are most vulnerable, under the greatest pressure and in need of impartial information, advice and support, and just where the advertisers most want to get at them.

When the Government were consulting on the new regulations, they received 231 letters, 216 calling for a ban on advertising baby milk in the health service, from organisations including the British Medical Association, UNICEF, the Royal College of Midwives, the British Paediatric Association and all 48 of the relevant professional organisations. The only people supporting advertising of baby milk in the health service were the formula manufacturers themselves and--surprise, surprise--advertising agencies. To whom did the Government listen? The formula feed manufacturers.

Save the Children put the case clearly in a letter on 17 February, saying that it is

"very disturbing to know that the views of all health, consumer and development bodies have been discounted and only the views of the baby food industry have been taken into account".

Even the baby food manufacturers acknowledge that breast is best. Some may say that I am a living example of that, having been breast-fed. Of course, I may have been a foot shorter and not quite as intelligent had I not been breast-fed.

Breast-feeding develops a better brain, providing vital materials for the links within the brain. Gastroenteritis is 10 times more likely among bottle-fed babies. Infant gastroenteritis costs the national health service £18 million a year. Breast-feeding is acknowledged to protect against respiratory infections, glue ear and diabetes.

The high sugar levels in bottle feeds are one of the major causes of tooth decay in babies, leading to 21,000 cases of dental work on infants and the massive amount of pain and suffering that that causes, yet the new law will allow bottle feeds to be described as "sucrose-free". Some research, still in its early stages, shows that breast-feeding also protects the mother from breast and ovarian cancer.

Humans as a species have been around for at least 4 million years. It stands to reason that the milk produced by our species for our species is best developed for our needs and we should do everything to promote breast- feeding.

Only last week I spoke to representatives of the industry, who told me that advertising is all about promoting one brand over another, gaining market share

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and giving information to mothers. However, advertising is first and foremost about selling a product and often companies will sell their product using emotive and pressurising messages. One would have to be naive to believe that baby milk advertising is about giving impartial information to mothers.

We are not anti-choice on the issue; mothers have a right to choose whether to breast-feed. Some mothers are unable to breast-feed for a whole range of reasons and they need to be told which is the best infant formula for their babies by impartial professionals providing correct information, but giving advertisers the run of the health service is not the way to do it.

I am certain that we shall hear from the Government that mothers are grown- up adults who can make up their own minds on whether to believe the advertiser. I am even more certain that it has been a long time since any Conservative Members were in a maternity ward-- [Interruption.] Of course, I am sure that that does not apply to the Minister, who looks far too young to be a mother.

I have here a so-called information booklet produced by the infant formula industry. It is supposed to be about breast-feeding. There are two huge centrefolds of babies, one with the caption:

"I hope they give me Cow and Gate".

That is in the middle of a document about breast-feeding. Another caption is even more disgraceful. It states:

"Did you know it makes a baby's brain grow?",

referring not to breast milk, but to Cow and Gate. Bearing in mind the latest information on early links within the human brain developed by breast-feeding, that must be an exaggeration, to say the least.

All the images and words send out the message: breast is best, but bottle is just as good, which is simply not true. It is what the Government believe is the best way to give new mothers information about baby nutrition.

Dame Elaine Kellett-Bowman (Lancaster): Is not the hon. Gentleman slightly startled that there is currently one female on the Opposition Benches and four females on the Government Benches?

Mr. Jones: I am not in the least bit startled; it gives me something nice to look at--but I suppose that that is a sexist remark.

All the 48 professional bodies involved in the debate believe that advertising of breast milk substitutes should be banned. Mothers have a right to impartial information, which is currently being denied to them. United Kingdom baby food manufacturers admit to spending at least £4 million to £5 million on straight brand advertising. They also imply that they spend money on sponsorship, which we suspect totals at least £8 million. The Government cannot hope to match that figure, and they spend about £130,000 in supporting breast-feeding.

Dame Elaine Kellett-Bowman: Really?

Mr. Jones: Yes, really.

Dame Elaine Kellett-Bowman: The hon. Gentleman said that Conservative Members have not been in a maternity ward recently. I have not been in a maternity

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ward as a customer, but I regularly visit the maternity ward in my constituency at Christmas. Our hospital encourages women to breast-feed.

Mr. Jones: I certainly hope that it does. However, it also distributes booklets such as the one to which I referred earlier, which has "Cow and Gate" written all over it, and it distributes advertisements such as the one that I have just shown the hon. Lady.

Dame Elaine Kellett-Bowman: Hospitals in the hon. Gentleman's constituency may, but mine does not.

Mr. Jones: I am very pleased to hear that, but I would like to know how many women in the hospital in the hon. Lady's constituency breast-feed. Perhaps she might ask them that during her next Christmas visit; she may get a shock if she does. Perhaps she would like to give me the figures now.

Dame Elaine Kellett-Bowman: I ask every woman in the ward whether they propose to continue to breast-feed, and three out of four say that they do.

Mr. Jones: I am very pleased to hear it, but that is not the kind of mainstream information that we have received and that the Government push out. I would like the hon. Lady to visit women in clinics and to ask them whether they are still breast-feeding. I think that she will find that they are not, because that is the current trend.

Mr. Cynog Dafis (Ceredigion and Pembroke, North): My daughter-in-law is currently breast-feeding. Are there not statistics available which show the percentage of mothers in the United Kingdom who are breast-feeding? They reveal that the number is declining and that fewer women are breast- feeding now than were breast-feeding in 1980. Only 53 per cent. of mothers breast-feed their babies at age one week. That is only one statistic and there are more available. The evidence is quite clear.

Mr. Jones: I am grateful to the hon. Gentleman. He is quite correct and I shall refer to those figures in a moment. The fact is that many women would like to breast-feed--no doubt they are among the women whom the hon. Lady meets in her Christmas visits to the hospital. However, an awful lot of women do not continue to breast-feed and one of the reasons is the flood of advertising to which they are subjected.

The Parliamentary Secretary to the Ministry of Agriculture, Fisheries and Food (Mrs. Angela Browning): What

Mr. Jones: The Parliamentary Secretary knows that the lowest estimate of spending by baby food manufacturers is £6 per baby. The Government spend only 16p per baby--that is hardly a level playing field. Because of the Government's shabby funding on promoting breast-feeding, for the first time UNICEF was forced to spend money in a western developed nation--in Britain in 1994. The Royal College of Midwives has been forced to produce a booklet that explains simply and fairly the nutritional advantages of mothers' milk over formula, because the Government have not done so.

The World Health Organisation code, which the Government supported and signed in 1991 and for which they reaffirmed their support in 1994, has been completely ignored. Allowing advertising in the health service represents a huge climbdown, and the Government should

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admit it. In another place, the Under- Secretary of State for Health, Baroness Cumberlege, stated that the new regulations go beyond the minimum directive requirements of our WHO obligations. The WHO international code on marketing breast milk substitutes states very clearly in article 6.2:

"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".

The Government regulations allow advertising in

"publications specialising in baby care and distributed to women through the health care system".

It is clear that the Government no longer support the World Health Organisation code.

In a letter of 27 February 1995, the General Synod of the Church of England said:

"the new regulations . . . run counter to the cited articles of the International code".

When speaking on the subject on 22 March, the Parliamentary Secretary had to choose her words very carefully in order to continue the sham that the Government are still following the WHO regulations. She said that the Government now only "support the aim" of the code. We hope to hear better things than the hon. Lady's admittedly uncharacteristic bluster during the previous debate on this subject. The code was never meant to be a list into which people could dip and take out whatever suited them at the time. It is a full and comprehensive safeguard, which was agreed to globally. Some 11 nations use the entire code as national law and five European countries have banned advertising of breast milk substitutes--that is, France--

Dame Elaine Kellett-Bowman: Has the hon. Gentleman read regulation 7? It states:

"No person shall export from Great Britain to a third country an infant formula which is not--

(a) labelled in an appropriate language . . .

(b) labelled in such a way as to avoid any risk of confusion between an infant formula and a follow-on formula."

Some years ago, a bunch of clergymen asked me to allow a lot of powdered milk to be distributed free in third-world countries. I asked them whether they wanted to kill all the children, because the mothers would probably have used contaminated water and made extra-strong formula. The regulations are quite clear and they must be appended to every export from this country.

Mr. Deputy Speaker (Mr. Geoffrey Lofthouse): Order. I have been rather tolerant with the hon. Member for Lancaster (Dame E. Kellett- Bowman). It is a short debate of only an hour and a half and many hon. Members are hoping to catch my eye. Long interventions of that nature do not help.

Mr. Jones: I am not sure that the collective noun for clergymen is a "bunch"; possibly it is these days. I think that the hon. Member for Lancaster (Dame E. Kellett-Bowman) is slightly confused; we are discussing the effect of the international code in this country and not in foreign countries.

Dame Elaine Kellett-Bowman: Will the hon. Gentleman give way?

Mr. Jones: No, I will not give way again. We have a lot to get through.

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I am sure that later in the debate other hon. Members will refer to independent surveys that have shown that mothers do not want to see a ban on advertising. In fact, I think that the Parliamentary Secretary may have referred to them in the debate on 22 March. That so-called independent bit of research has been undertaken on behalf of Bounty Services Ltd., one of the major distributors of baby milk advertising to mothers in the health service. That is hardly an independent source. I have read the frankly loaded questions in its "independent" questionnaire, and I could have easily written some questions of my own that would reverse the figures that will be cited later this evening. The first question in that independent research states: "There has been a voluntary code in the UK for some years now for the purpose of ensuring that infant formula milk advertising does not cause a reduction in breastfeeding. I believe that this voluntary code should be retained and not replaced with new laws

agree disagree neither".

If one were to relate the truth of the matter--that there has been a voluntary code in the UK for some years now, which has not ensured that infant formula milk advertising does not cause a reduction in breast- feeding--I believe that the result would be completely different. It would be far better to ask women whether they would prefer a truly independent information package on breast-feeding. Then we would get overwhelming support from women.

We may also hear later how women give up breast-feeding because of the pressure of going back to work, which is simply not true. Most women stop breast-feeding in the first few weeks, long before going back to work. They stop because of the huge pressure from advertising and for social reasons. The truth is simple. Breast is by far the best. The Government are paying lip service to promoting breast-feeding while bottling out because of the demands of the baby milk manufacturers.

Mr. Alex Carlile (Montgomery): Ho, ho, ho.

Mr. Jones: I am glad that the hon. and learned Gentleman is awake.

The Government are more than willing to ignore the advice of all the relevant professional bodies, to put at risk the health of the nation and to increase the burden on the taxpayer simply to follow the now tired and discredited dogma that the free market always knows best. Where do those free market profits go? They go to Milupa in Germany; to Heinz and Wyeth, both of which are American companies, and own Farley's and SMA; and to Nutricia in Holland, which owns the good old English-sounding Cow and Gate.

The Government have made a serious mistake with the regulations. They should change their mind and ban baby milk and infant formula advertising as soon as possible, wherever it is promoted. Let me leave the House with an analogy. Let us suppose that four foreign companies had developed a children's snack food, for example, which was pretty nutritious, providing most nutrients, but which caused increasing gastroenteritis and slowed brain development. Suppose that it was promoted through the education system to the tune of £6-worth of advertising per child. There would be uproar. If on top of that, once the food was tasted, the children could eat nothing else for six months, it would be a national scandal of enormous proportions. What we have in baby milk versus breast

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milk is not too dissimilar to the example that I have just described. Baby milk should be available but should not be advertised. The regulations allow that and should be changed. 8.59 pm

The Parliamentary Secretary to the Ministry of Agriculture, Fisheries and Food (Mrs. Angela Browning): I should make it clear from the outset that I agree with everything that was said by the hon. Member for Clwyd, South-West (Mr. Jones) about breast-feeding being the best means of nurturing a baby. I do not think that any of us dispute that fact. He raised many points about the immunity of the child, its resistance to gastroenteritis, and so on. We have no problem with that at all and entirely agree with him. The hon. Gentleman admitted that he was a breast- fed baby, whereas in the Adjournment debate on 22 March the hon. and learned Member for Montgomery (Mr. Carlile) confessed to being a Cow and Gate baby. When it comes to assessing in mature adulthood their intelligence or the way in which they have thrived, I cannot see very much difference between them.

Mr. Alex Carlile: That is an outrage.

Mrs. Browning: I apologise if the hon. and learned Gentleman is outraged. I am simply forming perhaps a feminine opinion of these things. We have heard a lot of male opinion in the debate so far. The promotion of breast-feeding and the support for it is based on medical advice that is quite unequivocal about the advantages of breast-feeding, both for the mother and for the baby. Government policies have consistently supported breast-feeding, and that is reflected in the steps that we have taken, and are still taking, to promote it. I will cite two examples, but there are more. In 1988, the Government set up the very successful joint breast- feeding initiative, as a pilot project to assess new ways of supporting mothers who choose to breast-feed. In 1992, the national breast-feeding working group was set up and fresh guidance on breast-feeding based on its good work is soon to be issued to the NHS.

There is, then, no doubt about the Government's commitment to breast- feeding, and we believe that the final form of the regulations that we are debating today is compatible with our commitment to breast-feeding. Too often, the criticism that I have heard of the Government is that the regulations have failed to implement the World Health Organisation code. The hon. Gentleman mentioned it today. It was also mentioned in the Adjournment debate on 22 March, and I make no apology for repeating what I said then.

It is not the terms of the WHO code that the Government have to implement in their detailed regulations, but the terms of the European Community legislation. Those who have criticised the Government for not implementing the code also omit one important point. The code states, as does the EC directive--this is critically important, bearing in mind the criticisms that the hon. Gentleman has made--that Governments should

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implement measures in a way that is appropriate to their social and legislative framework. That is what we have done.

Dr. Lynne Jones (Birmingham, Selly Oak): That may be so, but is not this country free to improve on the regulations so that they are more in line with the WHO code of practice?

Mrs. Browning: The hon. Lady will appreciate that what the Government have done is to put into legislation something that has worked as a voluntary code of practice for many years.

I will now deal with specific points about advertising. Long before the draft regulations were issued for consultation, my right hon. Friend the Secretary of State for Health announced, in answer to a parliamentary question:

"The Government are committed to ensuring that the existing restrictions on marketing 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. Therefore, we initially proposed that the controls on advertising should be quite far reaching, allowing advertisements to appear only in magazines where the intended readers would be professionals involved in maternal and baby care. It was therefore no surprise that the proposed controls generated a considerable number of responses to the consultation, both from the general public and from hon. Members.

In the main, reaction was split between two opposing views. One view, while supporting the proposed advertising controls, held that the Government should go even further and use the directive's option to its full extent, banning all advertising of infant formula. The opposing view was that we should not use that option at all, but should stick to the minimum controls required by the directive. The latter view drew attention to the Government's policy of deregulation and the thrust of my Ministry's legislative programme: to introduce regulation only when there is no viable alternative.

There was also a strong feeling, which I share, that such strict controls would impinge on a mother's right of access to information. Following the Adjournment debate of 22 March, my robust defence of women's right not only to choose but to make informed choices is well documented. Mothers who are not able to breast-feed, or who choose not to do so, have a right to decide for themselves what is best for them and their children. Who are we to say that a mother cannot make a judgment for herself? But she should also have enough information to enable her to make an informed decision.

Industry takes the view--and many may agree--that advertising of infant formula is not about persuading mothers not to breast-feed but to bottle- feed their babies instead; it is about giving mothers who have already decided to bottle-feed information about the infant formulae available, so that they can make their own choices in regard to the products that they wish to select. While not denying the validity of such views, however, the Government are--as I have said--fully committed to supporting the promotion of breast-feeding. We were therefore very conscious of the fact that to adopt only the minimum in the directive would mean controls which were less restrictive than those already in place under the

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voluntary agreement with the industry. That, we decided, did not provide the support that the promotion of breast- feeding deserves.

Sir Teddy Taylor (Southend, East): What is the advantage of the directive? Would it not be far better for us simply to make up our own minds?

Mrs. Browning: We are simply putting into law rules that we have had until now in the form of a voluntary code. We are not adding to regulation, or detracting from it; we are simply putting into law something which has worked well, and has been agreed voluntarily for many years.

It was only after careful consideration that we concluded that the option which best served the dual purpose to which I have referred was that which has operated voluntarily and, indeed, successfully in this country since 1983. That means that advertising of infant formula will be allowed to continue--

Mr. Martyn Jones: By what definition has the voluntary code worked? If the Minister is going by breast-feeding rates, let me point out that they have fallen slightly since the voluntary code has been in operation.

Mrs. Browning: I believe that the statistics have remained static during the operation of the code. A telling statistic, however, is the fact that in the five years before the introduction of the code--1975 to 1980-- breast-feeding increased by 15 per cent.

Mr. Jones: Is the Minister blaming the Labour Government?

Mrs. Browning: No, I am not. It must be recognised that there is a range of influences on a mother's choice between breast-feeding and bottle- feeding. We want to encourage breast-feeding, but it is not just a matter of whether the mother sees an advertisement or not; I am sure that hon. Members appreciate that many other factors are involved in the decision.

Such methods are surely the best way to ensure that mothers who choose not to breast-feed make that choice in informed circumstances with professional advice readily available to them. That does not mean, as some would argue, that manufacturers will have even more freedom to advertise. In the past week or two, I have been concerned about some of the lobbying on the issue. It seems to imply that a free-for-all exists out there when in fact the reverse is the case. A number of restrictions apply. Local health care units will continue to make their own judgment about baby care

publications--containing permitted advertisements--which they wish to accept for distribution by them, or to be available in places such as waiting rooms of antenatal clinics. They will be screened by health professionals first. The wording of the regulation also specifies that such publications must be

"distributed only through the health care system".

It seems only sensible that professionals in the health care system have some controls over the publications distributed through that system.

Much has been made of the fact that, during the consultation, health professional bodies expressed support for a total ban on advertising, but the results of at least one independent survey, to which the hon. Member for Clwyd, South-West referred, seem to suggest that some

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of their members think differently. I hope that the hon. Gentleman will accept that a difference of view exists between the bodies which have made representations and the many thousands of individuals at the sharp end of health care.

The survey suggests that a ban on advertising infant formula is opposed by the majority of health care professionals involved in the care of mothers and babies. Surveys have shown that a wide range of complex social, cultural and psychological factors influence a woman's choice on how to feed a baby.

The people behind tonight's debate would have us believe that the restrained and limited amount of advertising that is permitted under the new regulations has an immense influence on mothers, and overrides all other considerations. I, for one, consider that to be nonsense and an insult to the intelligence of women, and especially of health care professionals, who will be able to monitor and vet the material.

9.11 pm

Dr. Lynne Jones (Birmingham, Selly Oak): Last year I visited the special baby unit at Birmingham maternity hospital, which looks after premature babies. All are fed on human milk, mostly provided by the babies' mothers. Happily, there is a good record of survival, and most go home after their period in intensive care. However, one piece of information that I gleaned from my visit worried me: despite the fact that mothers had been able to express enough milk to meet their babies' needs while in intensive care, most went on to bottle-feed their babies once they had taken them home. Why should that be so, when no one doubts that all mothers want to do the best for their babies, which must mean feeding them in the way nature intended? As we have heard, clear scientific evidence exists that not only is breast milk best, but the use of infant formulae is damaging to both babies' and mothers' health. Compared with breast-fed babies, bottle-fed infants are twice as likely to suffer from respiratory infections, and five to 10 times as likely to suffer gastroenteritis. Good evidence also exists to suggest that breast-fed babies turn out to be more intelligent-- [Interruption.]-- why that produces such humour, I do not know--and that breast-feeding reduces the risk of maternal breast cancer.

It is rare for a mother to be physiologically unable to breast-feed; yet it is sad fact that in Britain only about 60 per cent. of mothers start to breast-feed their babies and, worse still, after one week less than half of them continue, compared with Norway, for instance, where more than 90 per cent. of infants are still being breast-fed at three to four months.

I can testify from my own experience that breast-feeding is cheap, easy and convenient. Milk is available any time, day or night, at the correct temperature, avoiding the laborious processes involved in sterilising bottles and in infant formulae preparation. It is also enjoyable for both mother and baby, and best for the restoration of the mother's figure to its pre-pregnant state. With all those advantages, everything seems to be going for breast-feeding. Is it not strange, therefore, that so few women apparently choose to breast-feed? [Interruption.] I do not know why that creates such humour on the Conservative Benches.

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The Minister alluded to a number of factors which affect a woman's choice. I agree that other factors exist apart from advertising. Of course, there is too much unsuitable promotion of the role of the female breast as a secondary sexual organ, which makes it difficult for many women and their partners to relate to the breast in its other important role. I do not deny that women's breasts can and do give considerable pleasure to both sexes, but is it not a reflection of our society's strange attitudes that the naked female breast, portrayed in a manner which objectifies women as commodities for male gratification, is regarded as an acceptable daily sight on the top and bottom shelves of our local newsagent's shop whereas a mother who discreetly breast-feeds her baby in a public place is frowned upon and made to feel that she is somehow behaving indecently?

Sir Teddy Taylor: Hon. Members should appreciate the content of the regulations. The hon. Lady speaks with great sincerity, but is she aware that if she or any of her colleagues sought to publish an article in a newspaper which did not state the benefits and superiority of breast- feeding they could be subject to a substantial fine under regulation 22? I am sure that everyone, like me, is interested in what she has to say. Does she not regard this as the most monstrous example of silly bureaucracy that the European Community has ever produced?

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