12.08.21

Dear National Department of Health

RE: Nestlé’s violation of SA Regulation R991 (on foodstuffs for infants and young children)

It has come to our attention that Nestlé has sponsored a (now cancelled) free event that was planned for the 14 August 2021 that violates South African law. The event was advertised together with You, Drum and TrueLove magazines and shared on the News 24 platform. The advert referred to in this letter (which at the time of writing was still displayed online) prominently features Nestlé, as well as three Nestlé products (Cerelac, Nestum and Nido3+). The planned event was a one-hour online ‘Free Stokvel Mom and Child Forum’, where various panellists (including health professionals and Nestlé brand ambassadors) would share information with attendees. The event targeted “all moms, grandmas, aunties and guardians of little ones”. The virtual advert refers to “fab freebies” and “winning some epic prizes”. The emotive language in the advert creates the impression that this event supports and protects the audience: “Drum and the Nestlé INFANT NUTRITION team have our back!” We explain below why this planned event undermines attempts to improve short and long-term health in South Africa (SA) and violates SA Regulation R991 (on foodstuffs for infants and young children). 

The nutritional status of children in South Africa has been a cause for concern for many years and is set to worsen due to the impacts of the COVID-19 pandemic. Chronic malnutrition, manifested as stunting (or low height-for-age) affects more than a quarter (27%) of children in South Africa as reported in the 2016 South African Demographic and Health Survey. Pre-COVID-19, 11% of children (2.1 million) lived in households that reported child hunger. In the context of COVID-19, child hunger has increased with 1 in 7 (i.e. 14%) households reporting a child went hungry in April 2021. While undernutrition is still a major problem in South Africa, rates of overweight and obesity in children are also increasing with 13% of children under five being overweight for their height. A recent report by the World Obesity Federation anticipates that SA is likely to have the 10^th highest level of childhood obesity in the world by 2030. These rising rates of obesity are linked to increased ultra-processed food consumption.

The products advertised in this ‘Stokvel Mom and Child Forum’ are ‘baby cereals’ marketed for children from six months of age and a ‘fortified milk powder’ marketed for children over three years of age. All three products are ultra-processed, contain added sugars and are costly. In a country like South Africa, these products are unaffordable for most households. In 2018, 59% of children (close to 2 in 3) lived below the poverty line,  30% were without water on site, and 21% without adequate sanitation. If mothers or caregivers purchase these products, they may over-dilute them to make the product last longer. Additionally, there are challenges with keeping bottles clean in the absence of adequate water and sanitation, and the results are potentially life-threatening. These advertised products often interfere with optimal infant and young child feeding practices. The World Health Organization (WHO) and UNICEF, together with the National Department of Health (NDoH) recommend exclusive breastfeeding for the first six months of life and continued breastfeeding up until two years and beyond together with the addition of safe, affordable and nutritious complementary foods from six months. Unfortunately, in South Africa, breastfeeding under the age of six months remains low, at 32%, below the WHO target of 50%. South Africa also has high rates of the early introduction of complementary foods.  It is particularly pressing that South Africa promotes infant and young child practices that are healthy, affordable and sustainable both for children and the planet.

Furthermore, the marketing strategies used in the advert for this event contain emotive, persuasive language that could mislead the undiscerning public. The use of the word ‘stokvel’ in the name of the ‘Mom and Child Forum’ is problematic as a ‘stokvel’ refers to a community-based savings scheme that has traditionally been used in South Africa for essential items. A stokvel would not traditionally be used to purchase or access the types of products being advertised in these events. In South Africa, stokvels form part of many vulnerable people’s social protection net, allowing households to build resilience, particularly at a time when COVID has intensified poverty and hunger. However, the event organisers are instead using this event as an opportunity to promote their products, that are not essential for health or wellbeing, and can be viewed as harmful to health due to their ultra-processed ingredients. Furthermore, the organisers of this event, sponsored by Nestlé, have used emotive words in the advert, such as – “get ready to be empowered“; “you’ll learn valuable information“; “It’s all about learning together and building a community of like-minded caregivers who want to grow with their little ones” to persuade mothers that these products are necessary. The use of a health professional (a nurse with a PhD) on the panel is another marketing strategy used in this advert, intended to convince mothers or caregivers that these products are endorsed by health professionals. Not only are Nestlé promoting their ultra-processed products as suitable for feeding young children, but they are also in violation of South Africa’s R991 Regulations relating to foodstuffs for infants and young children.

Given the importance of exclusive breastfeeding and efforts by formula producers and related companies to undermine exclusive breastfeeding, the South African government implemented Regulation R991 to limit the promotion and marketing of an array of products including infant formula, complementary foods and powdered milks presented as suitable for infants and young children under the age of three years old.

Regulation 2(14) of R991 provides that “no incentives, enticements or invitations of any nature, which might encourage consumers to make contact with the manufacturer or distributor of a designated product which might result in the sale or promotion of a designated product for infants or young children shall be used on the label or in the marketing of a designated product(s) for infants and young children”. Not only are Nestlé incentivising consumers to make contact with Nestlé through this free event, but they are also providing those who attend the opportunity to win R500 Shoprite vouchers and for those who attend to receive information about the use of their products in childhood and infant feeding. This is a clear violation of the R991 regulations.

Regulation 7(5) of R991 states “No manufacturer, distributor, retailer, importer or person on behalf of the aforementioned shall produce, distribute and present education information relating to infant and young child nutrition“. In violation of this regulation, the webinar invite indicates that Nestlé (a manufacturer of infant formula) will be involved in providing infant and young child feeding advice. The invite states: “Feeding your littles one can be challenging, but it doesn’t need to be. We’ve got you covered! Join the FREE Stokvel Mom and Child Forum event on 14 August 2021 – brought to you by NESTLÉ   CERELAC, NESTLÉ NESTUM and NESTLÉ NIDO +3 – to learn everything you need to know about feeding your little one.“

Though the event is billed as educational, three of the speakers are described as Nestlé brand ambassadors representing or well-trained in infant (referring to a child younger than 12 months of age) nutrition. Regulation 7(5) of R991 prohibits the provision of education information related to infant and young child nutrition by a manufacturer. The event is billed as being about nutrition for infants and young children and nowhere does it specify that they will be speaking about nutrition of children over the age of 3 years.

Furthermore, the products being advertised are known to be subject to this prohibition and despite this, Nestlé intends to promote these products as an integral part of childhood nutrition. This is evidenced by the notices at the bottom of the advertisement which illustrate further violations of R991:

“1.1.   Important Notice for all in-scope products from 0-36 months (IF, FUF, GUM, all complementary foods)

IMPORTANT NOTICE. A well-balanced diet, both during pregnancy and after delivery, helps sustain an adequate supply of breastmilk. Exclusive breastfeeding is recommended during the first 6 months of life followed by the introduction of adequate nutritious complementary foods, along with sustained breastfeeding up to two years of age and beyond. As babies grow at different rates, seek advice with your health professionals on the appropriate time when your baby should start receiving complementary foods.

1.2 Important notice for IFSMPs

IMPORTANT NOTICE. A well-balanced diet, both during pregnancy and after delivery, helps sustain an adequate supply of breastmilk. Exclusive breastfeeding is recommended during the first 6 months of life followed by the introduction of adequate nutritious complementary foods, along with sustained breastfeeding up to two years of age and beyond. As babies grow at different rates, seek advice with your health professionals on the appropriate time when your baby should start receiving complementary foods.

1.3 IMPORTANT NOTICE. NESTLE NIDO 3+ is not a breastfeeding substitute and is formulated to meet the changing nutrition needs of healthy children older than 3 years.”

Point 1.1 above clearly contains education information relating to infant and young child nutrition, which is prohibited by provision 7(5) of R991.

Point 1.3 above indicates ‘that NESTLE NIDO 3+ is not a breastfeeding substitute’. However, simply labelling a product as for children above 3 does not exclude it from the ambit of R991. Specifically, a designated product includes ‘liquid milks, powdered milks, modified powdered milks, or powdered drinks marketed or otherwise represented as suitable for infants or young children.’ Placing a disclaimer that the NIDO is not suitable for children under 3 does not then allow Nestle to market the milk powder at an event on infant nutrition or engage in marketing activities about infant or childhood nutrition. If Nestle engages in activities, such as the ‘mum and child’ stokvel event where Nido is presented as suitable for infant feeding, it can be considered a designated product under R991. It also worth noting that public health recommendations are that breastfeeding should continue up until two years and beyond. Therefore, if a product like NIDO 3+ is marketed to the mother of a 3-year-old who is breastfeeding, it could be a breastfeeding substitute.

This event was only cancelled due to pressure placed on Nestle. This is clear by their initial response to an interview by the Daily Maverick, where they indicated that they would be proceeding with the event. Only after publication of the article, and pressure placed by various public health activists, did they cancel the event, which was not a once off event. Although this has come to our attention now, there have been past events. There are a series of “mum and child” stokvel events targeting followers of You, Drum and TrueLove magazines that fall within the News24 stable that have occurred in April 2021 and May 2021. Whilst we appreciate the attempt by these magazines to support families around infant feeding, partnering with infant milk companies is not recommended. We urge You, Drum and TrueLove Magazines to take the necessary action to re-imagine any similar events in the future. Future events need to be free from the influence of infant milk companies, or the ultra-processed food and beverage industry. Academic and non-governmental experts not aligned to or influenced by the food and beverage industry are a good unbiased source of information on infant and young child feeding.

We thank you for the leadership you showed as the National Department of Health, placing pressure on Nestle, and the role it has played in this event being cancelled. We urge you to consider taking legal action against Nestle for violating Regulation R991, to prevent this from ever happening again.

#NotTodayNestle

Regards,

A collective group of concerned individuals and organisations

Catherine Pereira-Kotze Dietitian, PhD Candidate, School of Public Health, University of the Western Cape	Safura Abdool Karim Public Health Lawyer SAMRC Centre for Health Economics and Decision Science/ PRICELESS, University of Witwatersrand School of Public Health	Tamryn Frank Dietitian, Researcher, School of Public Health, University of the Western Cape
Chantell Witten Lecturer, Division Health Sciences Education, Faculty of Health Sciences, University of the Free State	Lori Lake Communication and Education Specialist, Children’s Institute, University of Cape Town	Lisanne du Plessis Associate Professor, Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University
Rina Swart Professor, Department of Dietetics and Nutrition, and DSI/NRF Centre of Excellence in Food Security, University of the Western Cape	Karen Hofman Director, SAMRC Centre for Health Economics and Decision Science/ PRICELESS, University of Witwatersrand School of Public Health	HEALA Healthy Living Alliance
Uta Lehmann Director, School of Public Health, University of the Western Cape	RHAP Rural Health Advocacy Project	Linda Richter Distinguished Professor, University of the Witwatersrand
Lenore Spies Chairperson Professional Board for Dietetics and Nutrition	Carlos Monteiro Professor, Department of Nutrition, School of Public Health, University of Sao Paulo, Brazil	Luyanda Majija Communication Manager South Africa, Vital Strategies
Shu Wen Ng Associate Professor, Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, The University of North Carolina	Barry Popkin Kenan Distinguished Professor, Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, The University of North Carolina	Haroon Saloojee Professor, Division of Community Paediatrics, University of the Witwatersrand
Marita Hennessy Postdoctoral Researcher, College of Medicine and Health, University College Cork, Ireland	Inês Rugani Ribeiro de Castro Associate Professor, Department of Social Nutrition, Institute of Nutrition, State University of Rio de Janeiro, Brazil	Mélissa Mialon Research Fellow – Trinity College Dublin, Ireland & University of Sao Paulo, Brazil
Kimiellle Silva Researcher, State University of Rio de Janeiro, Brazil	Kate Sievert PhD Candidate, School of Exercise and Nutrition Sciences, Deakin University	Cecília Tomori Associate Professor, Director of Global Public Health and Community Health, Johns Hopkins School of Nursing
Healthy Food Systems Australia	Phillip Baker Research fellow, Institute for Physical Activity and Nutrition, Deakin University	Alexey Kotov Director, Vital Strategies, USA
Alexandra Jones Research Fellow (Food Policy and Law), The George Institute for Global Health, UNSW, Sydney, Australia	Makoma Bopape Lecturer, Department of Human Nutrition and Dietetics, University of Limpopo, South Africa	Rob Moodie Professor of Public Health and Deputy Head Melbourne School of Population and Global Health, Australia
Thandi Wessels District Paediatrician and Lecturer, Department of Paediatrics and Child health, Tygerberg hospital, Stellenbosch University	Julika Falconer CEO Zero2Five Trust, Durban, South Africa	Claudio Schuftan Member of WPHNA and PHM
Kim Jonas Specialists Scientist, Health Systems Research Unit, SAMRC	Zoe Duby Specialist Scientist, South African Medical Research Council	Namukolo Covic Senior Research Coordinator, International Food Policy Research Institute, Ethiopia, Member of the Nutrition Society of South Africa
Lynette Daniels Senior Lecturer, Division of Human Nutrition, Department of Global Health, Faculty Medicine and Health Sciences, Stellenbosch University	Britta Boutry-Stadelmann Consultant for IBFAN-GIFA, Geneva, Switzerland	Karessa Govender Rural Health Advocacy Project
Jaco Murray Head of Clinical Unit Department of Paediatrics, Paarl Hospital.	Catherine Mathews Chief Specialist Scientist, South African Medical Research Council	Ruth Hall Professor, SA Research Chair in Poverty, Land and Agrarian Studies, University of the Western Cape
Megan Marais Registered Dietitian, Khayelitsha Eastern Substructure, MDHS, Cape Town	Nomajoni Ntombela Chairperson.Technical Advisor IBFAN Africa	Wanga Zembe-Mkabile Specialist Scientist, South African Medical Research Council
Prof Susan Goldstein Public Health Medicine Specialist	Dr J Dippenaar Specialist midwife and technical advisor Health Systems Trust	Dr Louis Reynolds Paediatrician, People’s Health Movement.
Dr Jane Battersby Senior Lecturer, Department of Environmental and Geographical Science, UCT	Prof Robert Pattinson Emeritus Professor, UP Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies	Prof Ute Feucht Director, Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria
Dr Christiane Horwood Senior researcher, Centre for Rural Health, University of KwaZulu-Natal	Dr Valerie Vannevel Researcher, Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria	Dr Tsakane Hlongwane Researcher, Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria
Prof Jannie Hugo Director, Research COPC Research Unit, University of Pretoria	Sylvia Kimmie Program Associate IBFAN Africa	Dr Max Kroon Paediatrician, Mowbray Maternity Hospital, University of Cape Town
Dr Ben van Stormbroek Paediatrician, Victoria Hospital and University of Cape Town	Nazeeia Sayed Post-doc Reserach fellow, Dieititian. University of the Western Cape.	Aiesha Mohamed Dietitian Retreat CHC, Southern Western SS MDHS, DOH
Ass.Prof Diane Gray Department of Paediatrics and Child Health, University of Cape Town	Michael Hendricks Department of Paediatrics and Child Health, University of Cape Town	Fiona Duby Director, Babymilk Action, UK
Jane Badham Independent global nutrition consultant, Managing Director of JB Consultancy	Dr Adelaide Masu Paediatrician, Senior lecture University of Cape town	Shihaam Cader Chief and HOD Dietitian RCWMCH
Dr. Claire Procter Paediatric Intensivist, Red Cross Children’s Hospital	Inger Hendry Lecturer, Post Grad Child Nursing, University of Cape Town	Prof Brenda Morrow Professor, Department of Paediatrics and Child Health, University of Cape Town
Maylene Shung King Associate Professor, School of Public Health and Family Medicine, UCT	Aesha Arnold Isaacs Dietitian, Lady Michaelis CDC, Southern western Substructure MDHS DOH-western cape	Jane Vos Programme Coordinator, Children’s Nursing Development Unit, University of Cape Town
Assoc Prof Minette Coetzee Director, Children’s Nursing Development Unit, University of Cape Town	Mary Kinney Researcher, School of Public Health, University of the Western Cape	Scott Drimie Extraordinary Professor, Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University
Emmanuelle Daviaud Senior Specialist Scientist, South African Medical Research Council	Tanja Venter Dietitian, Delft CHC, Northern Tygerberg Substructure MDHS DOH – Western Cape	Dr Phumza Nongena Paediatrician, New Somerset Hospital, University of Cape Town
Tanya Doherty Chief Specialist Scientist, SAMRC	Diane Cooper Extraordinary Professor, School of Public Health, University of the Western Cape	Julian May Professor, Centre of Excellence in Food Security, University of the Western Cape
Sue-Ann Fortuin Registered Dietititan, MPICF, Klipfontein Mitchells Plain Substructure, Cape Town	Maryse Arendt Lactation consultant IBCLC, BFHI coordinator Luxembourg	Sara Nieuwoudt Senior Lecturer, School of Public Health, University of the Witwatersrand
Olinda Mugabe Member of IBFAN Mozambique and Reencontro Assotiation	Mark Richards Paediatrician, Red Cross Children’s Hospital	Christiaan Scott Paediatrician, Red Cross Children’s Hospital
Mphasha Pitso Parttime lecturer and PHD Candidate at University of Limpopo, South Africa	Anton Delport Social scientist, PhD candidate	Ditope Rabodiba Head of Department, University of Limpopo, Department of Human Nutrition and Dietetics
Yousouf Jhugroo Chairmain and Co-Founder of MAPBIN	Geeta Tekchandani Operations Director MAPBIN	David Clark Independent Consultant, Public Health and Human Rights Law
Leslie London Chair of Public Health Medicine, University of Cape Town	Constance Ching Technical Consultant (Code Implementation and Advocacy), Alive & Thrive	Hussein H.T.Tarimo WABA Steering Council member
Naefa Kahn Advocate and member of the Cape Bar	Leah Margulies, Esq. Founder, Infact, IBFAN and Nestle Boycott – Senior Staff Attorney, CAMBA Legal Services	Kent Buse Director, Healthier Societies Program, The George Institute
Yogan Pillay Affiliate, Center for Innovation for Global Health