Firstly, infant formula is not the same as bottle-feeding. e.g. in Sub-Saharan Africa when a feeding bottle is used, it most likely does not contain infant formula but rather plain water, cornstarch water or other traditional food mixtures. Infant formula can be fed by bottle, cup or cup and spoon.

If the mother is healthy, it is likely that the baby will be healthy and breastfeeding will be successful. Mothers should first and foremost be encouraged and supported to breast feed their baby. However, there are cases when babies are "at risk" (e.g. low birth weight, premature or when the mother has died) and may need supplements to compensate for this. These babies are more "at risk," than healthy, breast-fed babies. In cases like those it is unlikely that bottle-feeding has caused the risk. Both the risk and the need for a breast-milk substitute are possibly due to the baby's disadvantage at birth. Infant formula can be a life-saving product, if prepared and used correctly.

It may seem paradoxical to some, but the developing countries that have the highest use of infant formula also have the lowest rates of infant mortality. This is obviously not a cause and effect relationship - what the two statistics show is that as a country develops economically and as more women enter into paid employment, infant health and nutrition improves and the use of infant formula increases.

Of the total Nestlé sales, Infant Formula represents approx. 1%. Only about 5% of this is consumed in Sub-Saharan Africa. In fact more Infant Formula is sold in Belgium, with a population of 10 million, than in the whole of Sub-Saharan Africa covering a population of more than 650 million.

Actually the global rate of exclusive breastfeeding increased 18% (from 39% to 46%) between 1989 and 1999, according to UNICEF. This is a welcome development, however it is very difficult to make a general statement as the situation varies dramatically from country to country. e.g. the reported exclusive BF rate in Liberia is 73% while in Kenya reaches only 5% (1).

Many factors could have an impact on exclusive breastfeeding patterns and they are all linked to economical, social and cultural circumstances. e.g. it has been estimated that in parts of South Africa, 90 % of women breastfeed, however only 10% do so exclusively in the first months. This rate of exclusive breastfeeding drops further to 2% by the fourth month, with plain water being the most common additional substance used and very small number of women using infant formula.

Other Factors, which have an impact on breastfeeding, include the rapid urbanisation in developing countries, which has led to social and cultural changes, include an increasing number of women entering into paid employment.

(1) The State of the World's Children 2003; UNICEF: New York, USA; 2002

The fact that the lives of 1.5 million babies could be saved if exclusive breastfeeding was successfully promoted and maintained is often distorted to suggest the fault lies with the use of infant formula. The distorted use of this statement is expressed through campaign slogans like: "A baby dies every 30 seconds from unsafe bottle feeding" or "The World Health Organization (WHO) estimates that 1.5 million infants die as a result of diarrhea every year because they are not breastfed. Despite this, companies continue to promote artificial feeding in ways that undermine breastfeeding..."
 
This statistic is often attributed to the World Health Organization. In fact, the WHO has clarified that it has never made such a statement either in relation to infant formula or to bottle-feeding in general.
 
"... WHO has made no statement quantifying the impact on either morbidity or mortality of infants being fed on bona fide infant formula, i.e. breast-milk substitutes manufactured in accordance with the relevant standards of the Codex Alimentarius. In contrast, WHO has estimated that [this] number of infant deaths... that could be averted annually through effective breastfeeding promotion, and this irrespective of the breast-milk substitutes used to feed them or, for that matter, the feeding utensils employed for this purpose".
(WHO, 19 November 1992).
 
The challenge is to educate and encourage mothers to exclusively breast feed their baby during the first 6 months of life, and breastfeed along with the introduction of complementary food, for as long as possible. Because infant mortality is actually highest after 6 months of age efforts to improve complementary feeding practices are equally important.
 
The use of misleading statements should be stopped. Instead, the tackling of the root problem and proactive educational efforts about proper infant feeding are needed, as part of a global and structured solution that offers the most hope in improving infant health and reducing infant mortality in developing countries and regions.