Nestle 40 Years Ago in Ethiopia, Baby Formula
THE CONTROVERSY OVER Babe FORMULA
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December 6, 1981
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When the Jamaican adult female brought her ii babies to Alan Jackson's clinic at the University of the Due west Indies in Kingston, the pediatrician was shocked by their condition. Her 4-month-old son weighed only five pounds - 2 less than at nascency - and her girl was in fifty-fifty worse shape. At 18 months, she weighed only 12 pounds, and soon lost four more.
When Dr. Jackson questioned the woman, who had x other children, he discovered that she had never breast-fed her two youngest. Their diets since birth had been infant formula. Considering the family unit income averaged only $7 a week, the female parent had to heavily dilute the expensive formula to make it last longer. ''For the 4-calendar month-quondam baby,'' Dr. Jackson later told Senator Edward M. Kennedy's Subcommittee on Health and Scientific Research, ''one tin can of feed should have lasted for something just under three days. She said that ane tin of feed lasted 2 weeks to feed both of the children.''
There is no 3rd-world poverty in Cooperstown, N.Y. The large homes and manicured lawns give the aura of a town happily stalled in the security of the 1950's.
But Allan Cunningham, who had been a pediatrician for a tribe of Sioux Indians earlier moving to Cooperstown, became aware of something odd about his new patients at Mary Imogene Bassett Infirmary: Nearly all of the sick in-fants he treated were formula-fed.
Dr. Cunningham'south subsequent investigation, published every bit two studies in The Periodical of Pediatrics showed that illness occurred twice as often amidst babies who were not breast-fed; in the first two months of life, the difference was xvi-fold.
Dana Raphael was one of the first scientists to hold the formula companies responsible for high infant mortality, but then she decided it wasn't quite that unproblematic. An anthropologist who heads the Homo Lactation Centre Ltd., in Westport, Conn., Mrs. Raphael changed her mind after a written report team she led spent two years observing how women in 11 unlike cultures around the world feed their babies.
What the team establish was that many poor and undernourished thirdworld women are physically unable to breast-feed and that others are too preoccupied with the nuts of survival to notice the time to exercise so. Though she still strongly favors chest-feeding when possible, Mrs. Raphael now believes that the general unavailability of food is responsible for high infant mortality. ''Formula is aureate for the mothers who tin afford information technology,'' she says. ''If every 3-month-onetime baby could accept a sufficient amount of formula, they'd all live. But the price is prohibitive. They're lucky if they can afford a cup of buffalo milk every day.''
The controversy and confusion over opinions such as these reached the scale of global conflict earlier this year when the Earth Health Organization (Due west.H.O.) voted 118 to 1 to adopt a nonbinding lawmaking restricting the promotion of baby-formula products.
The United States'south lone dissenting vote was explained, in part, by Elliott Abrams, Assistant Secretary of State for International Organisation Affairs (since nominated to be the Assistant Secretary of State for Human Rights). ''Despite our governmental interest in encouragement of breast-feeding,'' he said the West.H.O. recommendations for a consummate ban on advertising to the general public of infant formula and the proposed restrictions on the flow of data between manufacturers and consumers ''run counter to our constitutional guarantees of free speech and freedom of information.''
In protest confronting this stand up, two high-ranking health officials at the The states Agency for International Development (A.I.D.) resigned their positions and joined a chorus of critics at home and abroad. Lois Salisbury, for instance, a lawyer with Public Advocates, a San Francisco firm that represents 14 national organizations, rejected the Reagan Administration's contention that marketing standards were not needed in the United states. ''Studies accept shown,'' she said, ''that at that place is an epidemic of formula misuse amidst low-income families in cities like Houston and Los Angeles.''
At the eye of the increasingly bitter conflict are babies, millions of babies with the shriveled limbs and the distended bellies that signal kwashiorkor, the Ghanian term for malnutrition that has become part of the medical literature. Co-ordinate to Unicef, about 11 million infants in developing countries - more than than the combined populations of New York and Los Angeles - die each year before reaching their first birthday. Nearly of them succumb to malnutrition or diarrheal diseases. Although estimates vary widely, Dr. Stephen Joseph, i of the A.I.D. officials who quit last May, blames reliance on infant formula for about a million of these deaths.
The formula itself is a nutritious product, and it can be an adequate culling to breast milk nether certain conditions: when the mother can beget to buy sufficient quantities; when she has access to refrigeration, clean h2o and adequate sanitation, and when she can understand the directions well enough to mix the formula properly. And, as nutritionists point out, formula tin save lives. Dr. Joseph remembers a cholera epidemic in Chad in 1972, when ''a lot of mothers died.'' Fortunately, he says, ''nosotros had formula available through international agencies and we saved a number of kids.''
He and many other physicians argue, however, that virtually third-globe women cannot apply formula safely and that, every bit a result, their babies get seriously ill and malnourished. They also charge that aggressive marketing of formula has contributed to a vast shift away from breast milk, the safest and nearly nutritious food for infants.
The formula companies deny that their marketing has influenced the choice of feeding methods, and they fence that misuse of their products is rare. For them, a rich global market is at stake. Formula sales in this country reached $550 one thousand thousand last yr at the wholesale level, divided principally amongst Abbott Laboratories (50 to 55 percent), the Bristol-Myers Visitor (40 percent), and American Domicile Products Corporation (8 pct). In the world market, estimated to exist as nifty every bit $2 billion wholesale, Swiss-based Nestle commands a 50 percent share, while the American companies and dozens of other competitors divide the residuum.
Leah Margulies, a founder of Infact (Baby Formula Action Coalition), now associated with the Interfaith Center on Corporate Responsibility of the National Council of Churches, says that many antiforumula advocates are ''in favor of a selection that's real; we want mothers and families to make a decision that'south not based on the marketing strategy of a high-profit industry.'' (Amid the alternatives, Infact supports suggestions by nutritionists who recommend the mixing at home of powdered milk with sugar and oil, or yogurt.)
The controversy over formula did not eddy over until the publication in 1974 of a journalistic expose, ''The Baby Killer,'' by War on Want, a London organization. The booklet, which was widely translated and distributed, brought scores of groups, many of them church-related, into the fray. While some of them launched shareholder suits and resolutions confronting the American manufacturers, others began a nationwide cold-shoulder of Nestle products. The nervus center of the protest became the Interfaith Center on Corporate Responsibility. Commenting on the boycott, Rafael D. Pagan Jr., president of the Nestle Coordination Center for Nutrition in Washington, says: ''Nestle, of course, is a Swiss visitor and does not manufacture, distribute or sell infant formula in the United States, and thus in that location has never been any direct impact on the visitor through that production.''
The words that each side uses confronting the other are not the kind usually heard amid the pews on Sunday mornings. So vituperative is the rhetoric that information technology is easy to imagine both sides settling the outcome in a dorsum aisle after dark. It is a boxing in which politics and money, not scientific discipline, have come to boss.
And even so it is the scientists who must ponder such difficult questions as: How long tin can a malnourished female parent adequately suckle her baby? If formula is denied to mothers, volition they put watery gruel or weak tea into the feeding bottles instead? Can mothers combine local foods in a nutritious mixture, eliminating the demand for expensive formulas, as some international organizations and a few third-world countries have suggested might be an acceptable alternative?
Mother's milk is the earth's original and best fast food, a complex recipe containing more than a hundred nutrients, many of which are different chemically from those found in formula products. In near salubrious women, these nutrients are enough to sustain a baby's growth for the get-go four to six months of life.
Female parent'southward milk is also a stiff armament against infection. Like a soldier stripped of weapons, a baby at birth lacks many of the biological agents that fight bacteria. While its ain immune system matures, an baby acquires antibodies from its mother'south milk that are constructive against the abdominal infections that are the leading killers of infants in developing countries. ''The immune system in human milk has evolved over millions of years specifically to protect infants, and it'southward uniquely different from milks used as substitutes,'' says Dr. Armond S. Goldman, a professor of pediatrics and of human biological chemistry and genetics at the University of Texas's medical branch in Galveston.
Despite its advantages, human milk has always competed against other methods of feeding. Beginning, perhaps, with those whose mothers died in childbirth, babies have fed on the milk of cows, goats, yaks and camels, horses, reindeer and buffalo. Just these milks are unlike the human being variety.
Since the centre of the last century, scientists have tried to change cow's milk to make it biologically more than similar to human milk and to enhance its digestability. But bodily ''formulas'' did not appear until close to the turn of the century. A pediatric text in 1904 offered no fewer than two and a one-half pages of formulas for computing the limerick of baby nutrient. Shortly later, early versions of modern formula products became available without a prescription.
The infant formula is withal biochemically different from human milk. The protein components in it can cause serious allergic reactions in some infants, such as diarrhea, vomiting, abdominal pains and peel rashes. And it lacks some of the nutrients of man milk, such as taurine, which may exist involved in the early development of the brain. ''For us to think that in 40 years nosotros can indistinguishable what has happened in iv 1000000 years of human being development is very arrogant,'' says Dr. Gerald Gaull, a pediatrics professor at Mt. Sinai School of Medicine in New York.
The companies that make formula start either with skim milk or with whole milk from cows, and remove the fatty that infants detect difficu to digest. Afterward the milk has been diluted with water to reduce the level of protein, a milk sugar called lactose is added, too as a combination of vitamins and minerals. Finally, a blend of vegetable oils is used to restore the fat, which the babies need, in a form they tin can digest. The formula is marketed either already mixed or in a powdered form, to which mothers add together water.
The formula marketplace did non brainstorm its dramatic expansion until birthrates skyrocketed after Earth War II. Women in Western countries flocked to the feeding bottle as a ''scientific'' method that also liberated them from the home. The National Fertility Survey in 1965 showed that 68 percent of mothers born between 1911 and 1915 breastfed their first infant, compared with 35 pct of mothers built-in in the early 1940'south. Surveys by Ross Laboratories, which produces Similac, bear witness that the incidence of breast feeding at 1 calendar week of age fell from 34 per centum in 1951 to 23 percent in 1971. But breast-feeding resurged to 54 percent in 1980, probably considering of increasing sensation of the advantages of mother'due south milk and the activism of groups like La Leche League, whose insistence that nature'south manner is all-time appeals to a generation weaned on environmental.
Notwithstanding, a recently released written report conducted past the New York City Section of Health revealed that 68 percent of the mothers who gave birth in all types of city hospitals last year planned to employ infant formula; the figure rose to 82 percent in municipal hospitals, where about of the maternity patients are lower-income women. Babe formula is popular with some low-income women considering they run across information technology as ''a kind of status symbol,'' says Judith Gordon, formerly a researcher at the urban center's Bureau of Maternity Services, just doctors believe that a more significant contributing cistron is the need for many of these women to return to work presently subsequently giving nativity, which makes formula the simplest feeding method.
In the tertiary world, where the controversy over formula has been the most intense, the decline in breast-feeding has been more than rapid and more than contempo. Information technology started among the urban elite about 20 years ago and then spread quickly throughout the population, although, for the virtually part, rural villagers are much less afflicted. While many mothers have rejected breast-feeding entirely, the biggest changes involve an earlier termination of suckling and a more widespread practice of mixed feeding, utilizing both the chest and the bottle.
A number of powerful social and economical forces accept caused the shift away from the chest in developing countries. When rural mothers move to the big cities, as they have in massive numbers in recent years, the psychological stress of urban life sometimes causes a physical inability to lactate. Additionally, many of the women must accept jobs outside the home, and and then cannot conveniently chest-feed their children.
Aggressive promotion of formula seems to have played a large role in the decline of breast-feeding, besides, although its precise touch is difficult to measure. The companies which manufacture information technology debate that their promotions target simply urban families who have the money to buy formula in sufficent quantity and the facilities to prepare it hygienically. And they insist that they tailor their advertising campaigns in both adult and underdeveloped countries so that formula competes only with local foods, not with breast milk. ''Breast milk from a well-nourished mother is a superior product to ours,'' says Harry Levine, a vice president of Bristol-Meyers. ''The biggest market is moo-cow'southward milk, and that's what nosotros compete against.''
The companies have not always been surgically precise with their promotional activities, however. After surveying marketing practices in four underdeveloped countries during 1976 and 1977, the Due west.H.O. said: ''The distributors themselves reported that they were not limiting the distribution of products by either geographical or socioeconomic criteria.''
Until a few years agone, when they ended the practice in response to widespread protest, Nestle and the American formula companies advertised heavily in the impress and broadcast media of developing countries. In Brazil, where infant formula was the nearly advertised product after cigarettes and soap, the advertisements usually promised, if only subtly, that formula was the mod method of babe feeding, associated with upward mobility, and that it would produce babies with fat cheeks.
The formula companies have promoted near heavily, though, through health-care systems, both at home and away. Every bit Ross Laboratories indicated in a selling manual issued to its American personnel in 1975 (and later withdrawn): ''When one considers that for every 100 infants discharged from the hospital on a particular formula brand, approximately 93 infants remain on that make, the importance of hospital selling becomes obvious.'' Under a contract signed in 1974 with New York Urban center, Ross was given a guarantee that every new mother leaving a municipal hospital would be given a free i-twenty-four hours supply of Similac.
For a time, many companies employed ''mothercraft'' nurses, most of whom wore white uniforms, who visited women in motherhood wards and in their homes. As they helped mothers to cope with infant-rearing issues, many of the nurses also promoted their visitor'southward formula. Dressed in traditional nurses' uniforms, they conveyed the false impression that independent health professionals - not company employees - were recommending formula feeding. The major companies finally responded to harsh criticism of these practices by eliminating showtime the uniforms and then the nurses who had worn them.
In many tertiary-world hospitals, the staff routinely separates the mother and baby at birth and feeds formula to the babe during its entire stay in the pediatrics ward. On discharge, the mother receives a free tin of formula and a feeding bottle. By the time the mother has finished her free tin can of formula, she may exist a confirmed bottlefeeder and her baby, accustomed to the easy sucking on an artificial nipple, may rebel at the more enervating task of drawing milk from a breast. Or, says Dr. Carl Taylor, chairman of the Section of International Health at Johns Hopkins University, ''the mother's milk can dry up and and then the baby is hooked on formula.''
In Nigeria, co-ordinate to the West.H.O., the average dispensary may receive equally many every bit 8,000 free cans of babe formula each year. And about 5 meg feeding bottles - many of them gifts of the formula companies - were distributed each yr during the late 1970'southward in India, Nigeria, Federal democratic republic of ethiopia and the Philippines.
The companies defend these practices by pointing to the same West.H.O. study, in which none of the 23,000 women, mostly in developing countries, who were asked why they had stopped breast-feeding attributed the choice to promotional practices. Simply as some formula critics point out, the W.H.O. researchers were not trying to measure the effects of commercial promotion, and it seems unlikely, in any example, that questioning would have brought out the kind of subtle influence that advertizing tin can have on determination-making.
The health consequences of the shift to bottle-feeding in the 3rd globe have been severe. Halfdan Mahler, manager general of the Due west.H.O., says that ''evidence from developing countries indicates that infants chest-fed less than six months, or non at all, have a mortality charge per unit 5 to 10 times college in the second six months of life than those breast-fed 6 months or more than.''
A baby who does not suckle loses the immunological protection that mother's milk provides against the bacterial assault of polluted h2o and primitive sanitation. In Western countries, where contamination is seldom a problem, the loss of these antibodies is not disastrous. And yet the Cooperstown, N.Y., study suggests that even infants in developed societies, when denied the immune agents in mother's milk, take college rates of serious disease, though nutritionists caution that much more than research needs to be done.
Mother's milk also provides a clean and sterile method of feeding. When babies in third-world countries feed on formula, they face myriad dangers from their bottles. Fatima Patel, a nurse who works with Peruvian Indians in the Amazon, told Senator Kennedy'south committee in 1978 how villagers prepare formula in that expanse: ''The river is used every bit a laundry, every bit a bathroom, as a toilet and for drinking water,'' she said. ''Now, you can tell ... just to get the fuel to boil that water, she has to go into the jungle, chop a tree trunk with a machete ... and carry it on her back. No female parent is going to utilise that hard-earned slice of woods to eddy that water. ... So, the babies are drinking the contaminated h2o.''
And if the infant does not finish its bottle of formula, the female parent may save the residue, unrefrigerated, until the adjacent feeding. ''Stored at room temperature in a tropical country,'' says Dr. Taylor of Johns Hopkins, ''y'all have explosive bacterial growth. And so the bottle becomes a lethal musical instrument.''
Overdilution is another serious hazard of formula-feeding. ous hazard of formula-feeding. A medical team from an Indonesian university analyzed the mothers at 4 health clinics in that country. Their study, published last year in The Journal of Tropical Pediatrics, revealed that only one in iv women had mixed the milk reasonably close to its recommended strength, despite their aboveaverage economical and educational status and the articulate directions on the cans. The researchers likewise constitute ''gross contamination'' of the milk by fecal organisms, through the water supply, and ended that babies fed with a bottle should be classified ''high hazard.'' In other cases, mothers who cannot sustain regular formula purchases commencement using cheaper mixtures such equally rice water and sugared tea.
The primeval medical studies that demonstrated the benefits of breast-feeding were conducted in the United States and Western Europe more than than 75 years agone, when sanitation was poorer and baby mortality higher. These studies suggest that the risks of bottlefeeding in the third world are like to those faced by Western babies a century ago.
Contemporary reports are nearly unanimous in finding major benefits from chest-feeding. A research squad at the Sao Paulo School of Medicine, for instance, studied a low-income population in that Brazilian city for ii years. Its findings, published in 1980, indicated that 9 percent of the infants who were chest-fed up to the age of six months were suffering from malnutrition, compared with 32 percent of those who had received merely bogus feeding.
Some of the best evidence comes from hospitals that have radically changed their policy on infant feeding. In Baguio City, in the northern Philippines, doctors had routinely separated mothers and babies at birth and fed the babies with formula. In 1975, nevertheless, the hospital began returning each infant to its female parent within an hour of nascence, and mothers began breast-feeding on need. The results were dramatic. As the incidence of chest-feeding soared, the rate of morbidity (illness) and mortality dropped dramatically.
A similar plan worked only as successfully at a infirmary in Puriscal, a rural region of Costa Rica. Four years after babies began suckling at their mother's side, the charge per unit of diarrheal disease had dropped by 91 percentage, meningitis by 92 per centum, and lower-respiratory infection by 43 percent. The mortality rate for acute infection declined by 81 percentage.
Most studies coming out of underdeveloped countries, however, accept flaws in their methodology. Some compare breast-feeding with bottlefeeding without specifying what is in the bottle; others rely on the female parent to think what she was feeding her infant at various times during the infant'due south starting time year. Only a study conforming absolutely to the classic scientific method may not even exist possible. Mothers themselves cull their method of feeding, and their choice seems to reflect some inherent differences that tin can bias the results. In large third-world cities, mothers who choose breast-feeding, for example, are often better-educated and have greater financial means, which may affect infant-care practices. Some other difficult trouble is that breast-fed babies tend to be weaned at some bespeak to the bottle, and the reason for this change in individual cases - affliction of the infant, for example - may prejudice the report.
Does this mean that the studies are meaningless, that they will not support the making of public-policy decisions about the promotion of formula? With most every study from underdeveloped countries pointing in the same direction, most nutritionists conclude that bottle-feeding with formula or any other food places most poor thirdworld babies at a great risk of illness or decease.
Dr. Nevin Scrimshaw, director of the M.I.T.-Harvard International Food and Nutrition Program, puts information technology bluntly: ''The studies are conclusive. Failure to breast-feed in rural developing communities is tantamount to a decease sentence.'' A leading figure in international nutrition for several decades, Dr. Scrimshaw was director of the Institute of Nutrition of Central America and Panama for 12 years. He is a consultant to a new Yard.I.T.- Harvard project to develop supplementary foods that third-globe mothers can prepare in the domicile from local inexpensive grains and vegetables. ''Breast is best,'' he says, ''simply what comes next? The problem of babe nutrition won't be solved past emphasizing breastfeeding lonely. Breast-fed children in developing countries begin to falter at four months because the milk is non sufficient. The second aspect of insuring the health of children is attending to the weaning menstruum.''
The problem of what to feed infants during the weaning period is the most hard of all. Without homo milk, a infant's prognosis is ofttimes grim. Its new carte du jour may deliver the double whammy of leaner and low food value, starting it on a quick slide to malnutrition.
Many babies never breast-feed at all, or are weaned in the first month or two, and for them there are few options. Some blazon of milk production is a necessity for the youngest infants, who are unable to digest solid food. Formula is the closest alternative to human milk, and the companies that make information technology, of grade, strongly recommend it. ''When there is no chest milk, the chances of survival are small if the baby is not formula-fed,'' says E. Steven Bauer, vice president of Wyeth International, a subsidiary of American Home Products that makes SMA and its international equivalent, S-26.
Nutritionists hold that formula has a role in feeding the youngest infants in developing countries, but toll is the key, and but mothers who can afford to buy enough to prepare it at the proper forcefulness should use it, they say. The W.H.O. lawmaking on marketing recognizes this danger by permitting the distribution of formula to babies using chest-milk substitutes - but simply if the distribution is gratis or at low cost. Since the formula companies are not charitable institutions, the likelihood of sufficient quantities existence distributed under such circumstances cannot be great.
It is because so few people in developing countries can afford to buy sufficient amounts of formula - a day's feeding could cost up to one-half the average daily wage, as compared to about a dollar a day in the United States - that the Un subcommittee on nutrition has put information technology far down on its list of recommended foods. The subcommittee urges mothers to find a wet-nurse - in some cultures a relative serves this function, in others, nonrelatives will practice so for an corporeality less than the cost of babe formula. If this is non possible, the subcommittee suggests the utilise of animal milk or candy animal milk, such as evaporated or powdered skim milk, or fifty-fifty yogurt. It as well recommends the use of a cup and spoon, because they are easier to clean than a nipple and a narrow-necked canteen.
Babies who feed on breast milk, equally nutritionists recommend, all the same need solid weaning foods added to their diet in the kickoff year. In industrialized countries, babies can subsist on chest milk exclusively for upwardly to six months before they need a supplemental nutrient. But the situation is much different in the third world, where malnourished mother may not be able to produce plenty milk for a babe older than four months.
Roger Whitehead, a nutritionist at Cambridge Academy, who lived for a time in the pocket-size Gambian village of Keneba, found that lactating mothers in that location could provide practiced nutrition for their infants for only about the outset three months. Afterward that, the babies' weight gains began to autumn behind international standards until, by 1 year, their boilerplate weight was only 75 per centum of the standard.
In this critical flow, when the mother's milk can no longer meet all the baby'south needs, most nutritionists agree that for the vast majority of third-world women, a combination of breast-feeding and local foods works best.
Chosen wisely, local foods can make a nutritious supplement. Most ''multimixes,'' as they are chosen, are recipes for cereal-legume blends. In many nations, multimixes are packaged and sold in stores. One of the offset mixes was Incaparina, which Quaker Oats and other companies marketed in Cardinal and Southward America in the early 1960'due south. Though some have been successful, especially those heavily subsidized past local governments, near commercial mixes have been too expensive for the poor, who need them most, and have been taken off the market.
Dr. Gretchen Berggren, an banana professor of population sciences at the Harvard School of Public Health, coordinated a combined M.I.T.-Harvard health plan in Haiti, where nearly twothirds of all the children suffer from malnutrition. At Government nutrition centers, Haitian women learned how to prepare and cook mixtures fabricated by combining beans with rice, corn or sorghum, all local foods. Nutrition educators and doctors closely monitored the children receiving these foods. In ane district serving 100,000 people, infirmary admissions for severe malnutrition cruel more than 50 percent from 1968 to 1975, and deaths caused by malnutrition in children under the age of iv dropped by 83 percent.
Nepal has been another target for nutrition programs. In 1971, a team of international health workers began distributing supplies of powdered milk and corn-soy-milk mixtures to mothers of undernourished children in one area of the country, merely considering many mothers prepared it under unsanitary weather condition, this food caused diarrhea. Medical workers then discovered that even the poorest homes had an ample supply of grains. The nutritionists concocted a flour from local corn, wheat and soybean supplies, then taught Nepalese women how to set up it. Malnourished children were normally well on the way to recovery within five weeks of starting on the mixture.
In a recent effort to help infants in urban slums and poor rural areas of Thailand, a team of physicians from Bangkok prepared seven weaning supplements from locally available foods. Rice, the local staple, was the major ingredient in each mixture, to which physicians added combinations of vegetable oil, soybeans, mung beans, groundnuts, sesame and fishmeal. They reported that these gruellike mixes were nutritious, easy to prepare and acceptable to children'south tastebuds and digestive tracts.
Only large government subsidies can bring packaged mixes inside reach of the globe's poor, merely much smaller sums could aid people to prepare the same mixtures at dwelling house. The Grand.I.T.-Harvard project, one of the first steps in this direction, gets merely $200,000 a year out of America's billion-dollar-plus food-aid bundle.
The same companies criticized for marketing formulas may, ironically, agree one of the keys to improving the wellness of infants in the third world. They possess the expertise and the financial resources to aid develop weaning mixtures that women can prepare with ethnic foods in their homes. And they already have the sales personnel, distribution channels and marketing appliance to promote packaged mixtures of the aforementioned foods.
Help from this quarter, however, may exist a long time coming. Even so engaged in a bitter struggle over the marketing of formulas, the companies are worried that the boycott of Nestle products may spread to their ain. Others are reluctant to utilize their expertise to different areas. ''We're a pharmaceutical visitor,'' says Carol Emerling, secretary of American Home Products. ''We can brand a meliorate contribution to baby wellness by doing something we do well.''
Nevertheless, with the trend of scientific thinking favoring mixes of local foods, infants would profit from an brotherhood of the formula companies and their critics.
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