Baby Formula Brands Place Profit Above Health

Dara Raksmey, the owner of a pharmacy of the same name on Phnom Penh’s Street 294, keeps a record of every can of Dumex baby formula she sells.

“If you buy six large cans you get a scooter and if you buy 12 large cans you get a bicycle,” she said on Thursday.

Cans of France Bebe baby formula are seen on the shelves of a pharmacy in Phnom Penh. (Siv Channa)
Cans of France Bebe baby formula are seen on the shelves of a pharmacy in Phnom Penh. (Siv Channa)

Dumex provides the scooters and bicycles up front, and each month, Ms. Raksmey sends the company her sales record, along with a list of how many prizes were given out to customers.

Dumex, which markets itself as a child nutrition company, is one of numerous artificial baby milk brands that are brazenly contravening a sub-decree banning the promotion of the formula in stores and health-care facilities in Cambodia.

A report released last Wednesday by Unicef, the World Health Organization and three local NGOs said that breast milk substitute brands have continued to illegally promote their brands despite a law, passed in 2005, meant to reduce child malnutrition and mortality by encouraging breast feeding.

“This causes confusion between marketing techniques and medical advice, and can mislead parents and caregivers about the effects of breast milk substitutes versus breast milk,” the groups wrote.

However, the report failed to name which companies were violating the ban, and its authors also declined to identify the offending brands.

But in a tour of pharmacies in Phnom Penh last week, brands found to be ignoring the sub-decree included Physiolac, France Bebe and Dumex, whose parent companies are all based in France.

At a Pharmart pharmacy on the corner of Street 294 and Norodom Boulevard, shop assistant Nang Phally explained how a free T-shirt is awarded with a purchase of two large cans of Physiolac.

Asked about the sub-decree, she said: “We don’t know about that, we are just selling our products.”

“It is a problem between the company and the ministry,” Ms. Phally added.

A pharmacist near Olympic Market said the aggressive marketing practices of companies including France Bebe reached well beyond simply handing out prizes in exchange for purchases.

“They do their promotions mostly through midwives at clinics by noting down the mother’s name and telephone number. Then the company will contact the mothers later,” said the pharmacist, who declined to give her name for fear it could damage her business.

“When people come to my pharmacy, I always tell the people that breastfeeding is best for their babies,” she added. “One of my children I only breastfed, the other I gave some artificial breast milk. Look at him, he’s skinny and gets sick more,” she said, pointing toward her toddler.

Last Wednesday’s joint report said that 41 percent of stores in Phnom Penh selling infant formula had in-store promotions for the product and that a third of mothers who recently delivered a child reported seeing advertisements in hospital, both of which are banned under the law.

Article 13 of the Sub-Decree on Marketing of Products for Infant and Young Child Feeding states that manufacturers and distributors “shall not…promote the infant and young child feeding products as stated in this Sub-decree by him or herself, or by his or her representative, at a point of sale, in a hospital, health center or elsewhere.”

But since its inception, the law has gone largely unenforced.

A 2009 report titled “Unethical Marketing of Infant Formula and Breastmilk Substitutes in Cambodia,” compiled by the Australia-based Justice and International Mission Unit, named France Bebe as one of the most flagrant abusers of the promotion ban.

In the report a new mother says that when she “gave birth at the hospital, there was a [France Bebe] representative who brought the formula to the health workers, and she let me choose which one to buy.”

Two days later, a company representative visited her to check if she required more, she told researchers at the time.

Jennifer Cashin, a public health nutritionist who has worked in Cambodia and is currently based in Burma, said the dangers of using baby formula in lieu of breast milk were severe.

“Breast milk is the perfect food for babies. It is easy to digest and contains antibodies, passed from mother to baby, that help protect the baby against illness,” Ms. Cashin said. “Babies who receive formula are more likely to be exposed to contaminated water and in some cases, the formula itself is contaminated.”

Ms. Cashin said that children who are fed formula instead of breast milk are more susceptible to death and disease during infancy and “less likely to reach their full intellectual and physical potential” as adults.

But the public health message still doesn’t seem to be reaching many of the country’s mothers.

Sar Sinoun, a 30-year-old mother of two who was shopping at a Lucky Supermarket last week, said she fed her babies formula specifically to make them stronger and healthier.

“It helps the child grow fast, healthy and become less sick,” she said.

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