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Infant Health is the Top Priority

July 16, 2018

In 1977, the boycott of Nestlé products and the pediatric internship of one of us (Dean Sten Vermund) started in the same month. The other one of us (Professor Rafael Perez-Escamilla) arrived at UC Davis in the early 1980s for graduate school, a journey that culminated with a Ph.D. in maternal-child nutrition strongly focusing on breastfeeding. We both supported the boycott due to Nestlé’s unethical marketing practices to encourage replacement feeding with formula (i.e., their products) in lieu of breastmilk in low-income nations (

Breastfeeding is the healthy choice globally and in low-income countries. Not breastfeeding can be a lethal choice as, for low-income families, infant formula is unaffordable and the water used to reconstitute powered formula is potentially dangerous. We recognize that some women cannot (this is rare due to millennia of human evolution) or do not want to breastfeed and that decision should be respected and supported. However, the great majority of women are choosing to breastfeed but more often than not cannot do it for as long as they would have liked because of a lack of lactation management and social support.

Formula manufacturers should market responsibly and the U.S. government should encourage, not interfere with, guidelines and policies to enable and assist women to breastfeed. In 1981, the U.S. Administration orchestrated the lone vote against the International Code of Marketing of Breast-milk Substitutes. Today, decades later, we see the U.S. Administration putting short-sighted business interests ahead of the lives of infants in low-income settings ( And the company boycotts are active again due to evidence from the field that unethical marketing designed to discourage women in low- and middle-income countries to provide formula in lieu of breastmilk is still pervasive ( Breastmilk is the healthy option for newborn infants globally, and is critically important in lower-income settings.

Sten H. Vermund, M.D., Ph.D. Dean, Yale School of Public Health

Rafael Pérez-Escamilla, Ph.D. Professor, Yale School of Public Health

Submitted by Elisabeth Reitman on July 16, 2018