The food question

Print edition : May 09, 2008

IN SIMILIPAL, ORISSA. Would the promotion of complementary baby foods help impoverished mothers and malnourished children?-?

Moves to float a corporate alliance to promote complementary baby food evoke protests.

THE efforts of a Geneva-based organisation called Global Alliance for Improved Nutrition (GAIN) to set up an infant and young child nutrition (IYCN) alliance in India have raised the hackles of groups involved in the promotion of breastfeeding and child and infant survival. At a time when the question whether cooked meals or packaged food should be served at ICDS (Integrated Child Development Services) centres is still debated, with overwhelming scientific and other evidence supporting the former, the attempts to form the new alliance is being viewed with suspicion. To add to the confusion, the Ministry of Women and Child Development has not clarified its position on what children should be fed at ICDS centres. Besides, the IYCN India Alliances attempts to mobilise public-private partnerships to promote its brand of feeding practices for infant and young children have not gone down well with public health experts and activists.

In its annual report for the year 2005-06, GAIN stated that along with global food giants Groupe Danone, Unilever and Cargill, it was working to fight hidden hunger and that unlike traditional aid campaigns, it looked to build new markets for nutritious foods. Also, it said it aimed to improve the nutrition level of populations through technical and financial support. The expected role of the alliance includes, among other things, building high-level opinion in favour of creating an IYCF (infant and young child feeding)-friendly policy, regime and a regulatory environment, removing the roadblocks in improving breastfeeding practices and increasing the availability of affordable complementary foods/complementary food supplements in accordance with the regulations in the country.

A kind of public-private partnership, the GAINs IYCN programme professedly aims to save lives and improve the health and cognitive functions of infants and young children. One of the principal arguments offered in its support is that while there has been some progress in breastfeeding practices, little has been done to promote complementary feeding and efforts are, therefore, needed to promote the IYCF package as a whole with complementary food, both home-processed and industrially processed. This coincides with the World Banks understanding on promoting private-public partnership in bringing about what is called behavioural change through high-quality communications campaigns involving the savvy private sector media groups in India.

The main, and perhaps the most fundamental, problem with this alliance is that its partners comprise multinational baby food manufacturers and packers. Names like Groupe Danone, described on the GAIN website as one of the leaders in the global food industry, Unilever, one of the worlds largest producers of food and care products, and Tetrapak, a global leader in packaging and processing, are partners of GAIN, apart from some United Nations agencies and the World Bank Institute.

In fact, the CEO of Groupe Danone is on the GAINs board. Interestingly, Micronutrient Initiative, another international organisation that is one of GAINs partners, has already set up base in India. It has offices in Johannesburg and elsewhere in Africa, too.

Is the IYCN programme really aimed at improving breastfeeding practices? Or does it only seek to promote packaged baby food in the name of complementary feeding?

According to a confidential e-mail correspondence between the GAIN India representative R. Sankar and the Department for International Development (DFID), a British government funding agency, the former wrote that there has been considerable progress in the implementation of interventions to improve breastfeeding practices. This has resulted in a steady improvement in breastfeeding practices, although a lot remains to be done. On the other hand, very little progress has been made in the area of promoting timely introduction of complementary feeding. Therefore, efforts need to be made towards promoting the IYCF package as a whole with adequate emphasis on appropriate complementary food both home processed and industrially processed.

Frontline is in possession of this correspondence.

Sankar, who is an endocrinologist by training, does not deny that GAIN is into private-public partnerships in a big way. He told Frontline that all that the organisation was trying to do was to bring together all stakeholders on infant and child feeding and to promote market-driven mechanisms to combat malnutrition. According to him, a six-month-old child needs certain essential nutrients that cannot be made available at home. It is so easy to say that food can be processed at home. If these women [poor women consumers] can buy a shampoo instead of shikakai, they can buy a pouch of milk powder as well, he said.

He added that the whole idea was to increase access to such products and that GAINs role was that of a facilitator. He did not deny that Groupe Danones CEO was on the GAIN board and also said that the problem started after Danone acquired a baby food manufacturing company called Numico. Manufacturing baby food is not illegal but marketing it at the cost of breast feeding is, he said. But, he said, GAIN was looking at ways to deal with the problem. Sankar said that those who were objecting to GAINs activities were misinformed. The problem is, we stand on different poles of the ideological divide, he said.

The Breast Feeding Promotion Network in India has been particularly agitated over GAINs activities, especially as it has sought to involve senior government functionaries. At the very first meeting of the alliance, on April 15, GAIN had on its list of invitees senior government officials representing the Ministries of Health, Women and Child Development and Food Processing, and some State governments.

From the academic world, there were the names of several luminaries, including the Director of the National Institute of Nutrition, the president of the Public Health Foundation of India, a representative from the Indian Council of Medical Research and six nutrition experts, among the invitees.

The meeting was disrupted by a protest by public health activists, right-to-food campaigners, paediatricians and representatives of some 15 womens organisations at the venue. Several government functionaries and some United Nations, agencies, which were supposed to attend the meeting, stayed away after being informed of GAINs association with food manufacturers. The World Health Organisation representative, who was supposed to chair the meeting, stayed away, too. (Naturally, he did not want to get involved in the controversy, said Sankar.) So did representatives of the Ministries of Health and Food Processing. The protesting groups issued a joint statement expressing concern that there was increasing interference from lobbies of manufacturers of food supplements for babies and children to influence policies on infant and young child feeding and nutrition. They said they were disturbed about the formation of the India Alliance by GAIN, whose purpose seemed to be to create markets for its collaborators.

On April 4, the Breastfeeding Promotion Network of Indias (BPNI) national coordinator, Arun Gupta, wrote to the Secretary of the Ministry of Women and Child Development, reminding him that the promotion of baby foods interfered with optimal breastfeeding practices.

That was one reason, he explained in his note, why the Indian government had formulated the Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992, as amended in 2003, after having accepted the International Code for Marketing of Breast-Milk Substitutes that was adopted by the World Health Assembly in May 1981. He reminded the Secretary of what the then Human Resource Development Minister, Arjun Singh, said while presenting the Bill in Parliament in 1992:

The promotion of infant milk substitutes and related products by manufacturers and distributors has been more extensive and pervasive than the dissemination of information concerning the advantages of mothers milk and breastfeeding.

Gupta got no response.

According to the National Family Health Survey (NFHS) III, child malnutrition in India came down by only 1 per cent (from 47 to 46 per cent) since NFHS II was conducted. And BPNI, quoting international studies, says that child malnutrition is essentially a problem among children under 24 months; that it is mostly undernutrition of both mothers and babies and young children that results in infant deaths; that most infant deaths occur in the very first year owing to infections caught soon after birth, diarrhoea and pneumonia; that breastfeeding, if started within an hour of birth, can avert 22 per cent of newborn deaths; and that universal administering of oral rehydration solution can avert 15 per cent of all under-five deaths.

The organisation argues that even if complementary feeding is required after six months, it should be basic, home-cooked food that is eaten by the rest of the family. There is little evidence to support that packaged foods meet such requirements. If anything, the cost of such foods would only further pauperise the poor, BPNI says.

On May 2, 2007, a delegation comprising public health activists and paediatricians met the Prime Minister to demand a budget to promote breastfeeding practices and the formation of a high-level authority to coordinate action on infant nutrition and survival. The group said that equal priority to breastfeeding issues needed to be given at the time of allocation of resources, such as incentives to the Accredited Social Health Activist (Asha), help for maternity protection to ensure that mothers stayed close to their babies, including maternity entitlements and creches. In effect, the group demanded a clear budget line for infant feeding on all child-related programmes.

A protest by public health activists, paediatricians and womens organisations at the venue of the first meeting of the IYCN launched by GAIN, in New Delhi on April 15.-SHANKER CHAKRAVARTY

Now, less than a year down the line, a global alliance with corporate interests in mind has joined the campaign to promote infant survival by pushing complementary foods in an indirect manner. Arun Gupta, who has been at the forefront of a campaign to promote breastfeeding in the country, feels that these moves are intended at circumventing the Infant Milk Substitutes Act.

He says that after unsuccessfully trying to introduce packaged food for midday meals in schools and then for the three-to-six age group in the ICDS centres, corporate lobbies, with the governments support, were trying to hard-sell complementary feeding for the zero-to-two age group. Who is to decide what will be eaten by Indian children? Is it the health and nutrition experts from India or corporate-driven bodies from abroad? he asks.

According to him, the GAIN-initiated alliance can have far-reaching consequences. He said that it was impossible to believe that the alliance would promote optimal feeding practices, especially when there was a conflict of interest involved with baby food manufacturers like Wockhardt listed as its potential partners. Danone, he said, had already approached paediatricians with its Probiotics yoghurt brand Danone Yakult.

Sankar did not deny Arun Guptas allegation that Wockhardt, which acquired the Farex infant formula recently, had gifted slip pads to paediatricians with Farex, the name of a baby food product, printed on them. We have written to them asking for an explanation, he said.

Gupta estimates that nearly 75 per cent of Indian women do not breastfeed their children within an hour of giving birth. Nearly 72 per cent did not exclusively breastfeed their children for six months though the practice is recommended by the World Health Organisation, the United Nations Childrens Fund and the Government of India.

It is not insignificant that at least 16 organisations, including BPNI, the Jan Swasthya Abhiyaan, the All India Drug Action Network, the Right-to-Food Campaign, the Trained Nurses Association of India and the Centre for Womens Development Studies, have repeatedly tried to secure government recognition for zero-to-six-month infants as entities in government programmes of food security. The promotion of breastfeeding is not yet seen as an area that needs core intervention by the government to prevent infant and child deaths.

It is evident that any intervention to check infant mortality and maternal mortality rates will be incomplete if the promotion of breastfeeding and the conditions that precede it, such as maternal nutrition, is not part of the larger vision. And certainly, public-private partnerships in areas where there is a clear conflict of interest should not be encouraged.

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