The Battle of the Bottle

By KURT ANDERSEN

In Geneva it was the U.S. against the world

The outcome of last week's World Health Organization vote was never in doubt. Delegates to the WHO meeting in Geneva were considering an international code of conduct to restrict the advertising and marketing of baby formula, a processed, usually powdered substitute for mother's milk. The formula can lead to infant malnutrition and death when used improperly, so the WHO code had the support of doctors and government health officials all over the planet. The final tally was 118 to 1, a near miracle of consensus in any international forum. Which nation was it that cast the only no vote, thus appearing to align itself in opposition to good health for babies? The U.S.

That dissent, ordered by the White House and based on concern that the code would restrict free speech and free trade, touched off a wave of outrage, much of it in the U.S. Dr. Stephen Joseph, the top health official at the U.S. Agency for International Development, and Eugene Babb, the agency's top nutrition expert, resigned their jobs in protest. Joseph called the vote "contrary to the best interests of my country, inexplicable to my professional colleagues . . . and damaging to the health and growth of the world's children." Senator Edward M. Kennedy of Massachusetts convened an unofficial hearing on the U.S. dissent, which he denounced as "shameful." Republican Senator Mark Hatfield of Oregon warned that the vote could send "a message of indifference to the sanctity of human life." Outside the U.S., the reaction was more puzzlement than anger, though even London's conservative Financial Times declared, "It is special pleading of the worst kind to invoke the right to free expression and free competition if a potential danger to life and health has been identified."

The infant-formula controversy began about ten years ago, when Dr. Derrick Jelliffer, a public health specialist, declared that infant malnutrition could be linked to the use of baby formula. That substance, usually made from a milk base with vegetable fat, milk sugar, vitamins and minerals added, is nutritious if correctly used. In poor areas of the world, however, that is sometimes impossible. Mothers may unknowingly mix powdered formula with contaminated water or, to save money, dilute it too much. Moreover, breast feeding is healthier and more economical, assuming a baby's mother is healthy and able to produce adequate nourishment for her child.

Critics have also complained that the infant-formula industry, which has world-wide sales of $2 billion, compounded those hazards by stepping up marketing efforts in Third World countries. Some of the sales tactics were questionable. Employees of some formula companies, dressed as medical personnel, would go from village to village promoting the products. New mothers were routinely given advertising brochures and free samples while still in the hospital.

As a result of such practices, a world-wide boycott was organized in 1977 against the Swiss-based Nestle company, which accounts for 50% of formula sales to the Third World. Three U.S. firms--Abbott Laboratories, American Home Products and Bristol-Myers--together share 20% of that market. Two years later, Nestle and the U.S. firms agreed to voluntary guidelines that banned such marketing abuses in developing nations. Antiformula activists say those rules were widely violated, so they pressed the WHO, an agency of the United Nations, to draw up the code adopted last week. Though they are not binding on any nation, the new guidelines apply to infant-formula promotion in industrialized countries as well. Strictly following the code, all nations would prohibit company incentives for doctors to promote formula, free samples for mothers, and consumer advertising generally.

At first, U.S. officials found the guidelines acceptable. Then, after months of lobbying by the three U.S. formula makers and the Grocery Manufacturers of America, an interagency task force recommended that the U.S. discreetly abstain on the WHO code. Yet days before the ballot, word came down from the White House to vote no. Elliott Abrams, Assistant Secretary of State for International Organization Affairs, declared that U.S. aid programs would continue to encourage breast feeding, but that the WHO limit on infant-formula advertising "has grave constitutional problems for us--we couldn't adopt it here at home, and we couldn't recommend it for anyone else." Furthermore, claims Abrams, the code could so restrict availability of infant formula that "the health of children may actually suffer." Legal scholars might disagree about the gravity of those constitutional problems, but the decision is consistent with the Administration's zealous support for American business, and its antagonism toward economic regulation.

The battle is far from settled. Iowa Democrat Thomas Harkin last week promised to introduce a bill in the House that would turn the WHO recommendations into law. And the National Council of Churches next month will publish a report claiming that powdered formula is not strictly a Third World concern: they found that increased use of baby formula among poor families accounts for infant illnesses in the U.S. Vows John Pedrotti, an antiformula activist: "We want the WHO code to be adopted in this country as well." --By Kurt Andersen. Reported by Bruce van Voorst/Geneva and Barbara Dolan/New York

With reporting by BRUCE VAN VOORST, Barbara Dolan

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