The Protection of Breastfeeding and Child Nutrition Rules 2014 released on Friday will take immediate effect. It stipulated that labelling of infant formula products sold in the area must “be designed to encourage breast-feeding and not to discourage it” and must display the aforementioned message in a “clear and easily understood” way that cannot be separated from the product, written in Urdu as well as English if the manufactures wishes.
The Department of Health’s board retained the right to suggest other or additional notices to “mother’s milk is the best food”, stating it may “contain any other message as may be specified by the board with respect to any designated product”.
In addition, the revision of the Punjab Protection of Breast-Feeding and Child Nutrition Act 2012 said labelling must not use expressions such as “materialised” or “humanised” or equivalent nor contain any comparison with mother’s milk. Photographs, drawings or graphics except those to illustrate preparation methods were also prohibited.
Responding to the changes, Nestle, a key manufacturer of infant formula in the area, said: “Nestlé promotes and supports breastfeeding as we believe breast milk is the best nutrition for infants.”
Health workers and gift lists
Within its remit, the board behind the changes is responsible for any reports of violations of these rules and may recommend investigation of cases against manufacturers, distributors or health workers found to be violating these provisions. The board also advises the Pakistani government on local strategies for the promotion of breast-feeding, laws, rules or regulations on breast-feeding and nutrition for infants and young children, as well as advising on the acceptance or denial of donations of products to health care facilities.
The rules stated that health workers must work to eliminate practices that “directly or indirectly retard the initiation and continuation of breast-feeding”.
It also stated that health workers or members of their families should not accept any gifts or contributions, financial or otherwise, nor product samples from a manufacturer or distributor. It added that formula demonstration should be done only in special cases and even then to “give a clear explanation of the hazards of the use of infant formula”.
Nestlé response
Infant formula manufacturer Nestlé has been operating in Pakistan since 1988 under a joint venture with Milk Pak ltd, which it took over management for in 1992.
The company’s website claims: “Nestlé Pakistan today is the leading food and beverages company in Pakistan with key focus on nutrition, health and wellness and reaching the remotest of locations throughout Pakistan to serve the consumers.”
Asked what the firm thought these new rules meant for the infant formula market and consumers, Lydia Méziani, senior corporate spokesperson for Nestlé, said: “In 152 countries which are considered to be higher risk in terms of infant mortality and malnutrition such as India, as a minimum, we do not promote infant or follow on formulas for children under 12 months of age.
“We also specify that complementary foods should be introduced to children from six months of age. In those countries, already for many years, we have been putting statements about the superiority of breastfeeding on infant formula products and warnings on labels of our milk products not adapted for infant feeding.”
Méziani added: “For infants who cannot be breastfed, infant formula is the only suitable breast milk substitute recommended by the WHO [World Health Organisation].”
Nestlé said the company pledged to make these formula products available in a responsible manner to those who need them, while maintaining global compliance with the WHO Code.