Recently an
advertisement of "Pediasure" by Abbott Nutrition
created lot of controversy and debate in academic
circles as many experts felt that the claims made in
it were not supported by authentic scientific data,
and it was violating the Infant Milk Substitutes (IMS)
Act. Previously, similar objections were raised
against advertisement of another food product, "Complan".
These controversies were further fuelled by a recent
report in lay media about a child committing suicide
as he perceived not to be gaining height even after
regularly consuming a popular nutritional product
which advertises dramatic increase in height. On
analysis of the ongoing discussions, at least three
core issues have emerged: legal, ethical, and
enforcement.
Legal Issues
The size of advertising industry
in India is Rs.16300 crore out of which snack food
market constitutes Rs. 4500 crore, and branded food
Rs.1300 crore. In India, only 2% of the amount of a
food company’s budget goes into research and
development of the product against 50% into
advertising(1). On the other hand, more than two
million child deaths occur in India each year, and
two-thirds of these deaths are related to
inappropriate infant feeding practices(2). To
protect infant health, India adopts Infant Milk
Substitutes (IMS), Feeding Bottles and Infant Foods
(Regulation of Production, Supply and Distribution)
Act which bans all forms of promotion of baby foods
for children under 24 months(2). However, there is a
lack of awareness at all levels and this shortcoming
is repeatedly exploited by these multinationals.
Their strategy focuses on direct promotion to the
public and through the healthcare system. Although
companies might argue that they are promoting their
foods for children above 2 years of age-a group
beyond the purview of IMS Act, their aggressive
marketing strategy focusing directly the public may
blind this segregation and the non-discerning
mothers may not be able to make appropriate
selection.
Ethical Issues
With the advent of fierce
competition and aggressive marketing strategies,
ethics in advertising has indeed become a virtue of
bygone era. Creating aspirations which are not
realistic or making claims which are not tenable or
claims which are misleading is either immoral or
illegal. But who has time to bother, unless it
affects us individually.
Take the case of Glaxo (now GSK).
Initially, it launched a food product called "Limical"-
a drink with limited calories- promoted among the
high end of the society who were weight and calorie
conscious. As it did not sale, the company
re-launched it with little variation in constituents
as "Complan", and aggressively marketed it as
complete planned food – targeting growing children.
It clicked and overzealous mothers switched on. The
growing kids section became the most sought after
segment amongst nutrition industry and many other
food companies started marketing such supplements
for them. The current platform of advertising is
targeting growth/height among the children despite
having no robust scientific proof for their claims.
New challenges are also emerging through the
public-private partnerships. Several groups such as
the Global Alliance for Improved Nutrition (GAIN),
which are linked and governed by the food and baby
food corporations, are lobbying with the government
to introduce micronutrients in national nutrition
policies and set up national alliances with their
support(2). This will further help the food
multinationals increase their markets.
Impact on Child Health
The deleterious effects of such
advertisements is not only limited to undermining
the breastfeeding practices and infringements on IMS
Act, but as witnessed in developed world, they can
contribute to the fast rising trend of attaining
childhood obesity by promoting indulgence in to
improper eating habits of growing children. A study
from Canada found that more than half of the
processed baby and toddler food products contain
more sodium and sugar than should be allowed(3).
High levels of sodium in the diet have been linked
to hypertension, and sugar, on the other hand, is
implicated in obesity. The rates of childhood
obesity in India are increasing especially amongst
the middle and high income groups. According to a
recent survey of well-to-do schools from Delhi found
that about 27% of school children were overweight
and 7% obese(1). But there is no regulation of any
ingredients that go into a baby food product in
India, let alone sodium and sugar.
The impact of these advertisement
trails on lower middle class is far more damaging.
Quite often these food brands acquire snob value and
people from not so well-to-do families get tempted
in purchasing them as nutritional supplements and a
way of becoming elite. And this in turn adversely
affects their spending on essential foods and
nutritional items. Little do they realize that the
same money could buy foods with much better
nutrition for their children!
These advertisements also have
adverse psychological impact on children when the
unrealistic claims are not fulfilled. Advertisers of
children’s television used to appeal to the parents
earlier but now they appeal directly to children
-who do not have the emotional or cognitive
capability to evaluate what’s being sold to them.
The Indifference
The indifference and ignorance
shown by the government, law makers, health agencies
and professional bodies is indeed disturbing.
Despite the presence of law and existence of a
strict act, its enactment is flawed and often lax.
Food companies keep on flouting the law and
enforcing agencies remain ignorant, indifferent, and
even accommodative at times. We are more concerned
about the indifference and apathy shown by the
professional bodies and our professional colleagues.
Indian Academy of Pediatrics (IAP), the largest
group of professionals working toward child health
in the country took a bold stand and adopted a
resolution in 1996 that states: "The IAP shall not
accept the sponsorship in any form from any industry
connected directly or indirectly with the products
covered by the IMS Act 1992". However, over the
years many of its members, chapters, and sometimes
even its stalwarts went ‘soft’ on the issue and even
contravened the very resolution they had adopted
decades back either inadvertently or intentionally.
Some even started challenging the utility of this
redundant act going by its performance or lack of it
over the years. They now even argue that
advertisement of these products is innocuous and
hardly have any deleterious effect on child health
unlike the advertisement of other products like soft
drinks which are harmful to the health. However,
they fail to realize their negative impact on child
eating habits and nutrition, breastfeeding rates and
on family economy especially of lower middle income
groups. They also fail to appreciate the hidden
agenda of food companies on building new markets for
fancy foods at the cost of cheap, affordable, and
more nutritious foods through these promotional
campaigns and by creating so called ‘nutrition
institutes’ in the gist of educating public and
professionals in the matter of pediatric nutrition.
What is Needed?
In most parts of the world, there
are few or no specific rules concerning food
advertising to children beyond the rules which must
apply to all advertising. In India, even general
rules pertaining to advertising are very lax.
‘Advertising Agencies Association of India’, and the
‘Advertising Standards Council of India’, both of
which are business organizations can only put moral
pressure on advertisers and companies to withdraw
objectionable advertisements. Government has also
enacted ‘The Commercial Advertisements on Electronic
Media (Regulation) Bill, 2005’ which lays down
standards for advertisements on electronic media(1).
There is urgent need for the
government to draft and implement laws that do not
deal with advertising in general but are specific
and relate to every aspect of advertising,
especially those that target young children and
pertain to food. Any food advertisement should be
scrutinized with regards to the claims they are
making, and the food ingredients should meet
standards laid down by some reputed organization
free of competing interest. The existing rules and
laws should not only be strictly implemented but
should be harmonized into a single strict law.
In the end, all members of the
medical profession need to come together and remain
vigilant to shield child health interests from
pressures of business and trade. Professional
medical bodies like IAP need to be proactive in
informing and educating their members about the
intent and provisions of the IMS Act.
Funding: None.
Competing interests: None
stated.
References
1. Nawathe A, Rohan GR, Sudhir
DS. Impact of Advertising on Children’s Health.
Proceedings of International Marketing Conference on
Marketing & Society, 8-10 April, 2007. Available
from: URL: http://dspace.iimk.ac.in/bitstream/2259/356/1/303-311.pdf.
Accessed September 10, 2010.
2. Gupta A. Manipulation by
Assistance: Undermining Breastfeeding. Econ
Political Wkly 2008. Available from: URL: http://www.ibfanasia.org/Article/EPW-Undermining-Breastfeeding.pdf.
Accessed September 10, 2010.
3. Elliott CD. Sweet and salty: nutritional
content and analysis of baby and toddler foods. J
Public Health (Oxf). 2010 Jun 28. [Epub ahead of
print].