[Reader-list] RTF (Right to Food) Articles - 5

[Rakesh Iyer]

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*Volume 25 - Issue 09 :: Apr. 26-May. 09, 2008*
INDIA'S NATIONAL MAGAZINE
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*PUBLIC HEALTH*

* The food question *

 T.K. RAJALAKSHMI

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



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

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 Alliance’s 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 GAIN’s 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
Bank’s 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 world’s
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 GAIN’s board. Interestingly,
Micronutrient Initiative, another international organisation that is one of
GAIN’s 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 GAIN’s role was that of a facilitator. He did not deny that Groupe
Danone’s 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 GAIN’s
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 GAIN’s 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
women’s 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 GAIN’s 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 India’s (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 mother’s 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.
 SHANKER CHAKRAVARTY

* A protest by public health activists, paediatricians and women’s
organisations at the venue of the first meeting of the IYCN launched by
GAIN, in New Delhi on April 15. *

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 government’s 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 Gupta’s 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 Children’s
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 Women’s
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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