Eti Khuman's face lies cradled on her mother's shoulder, her cheek resting in against Mina's collarbone. Eti is beautiful, but she is poorly: her breathing is heavy, and Mina has the distracted look of a mother who is very worried indeed. Eti's illness — first vomiting, then diarrhea — struck without warning. Like all mothers in Bangladesh, Mina knew to fear diarrhea: in this country, diarrhea can kill. So she wasted no time in bringing her eight-week- old daughter here, to the main diarrhea hospital near her home in the capital, Dhaka.
Eti was admitted, and now she and Mina are in the main ward, a sweltering room so packed with beds that there is barely space to walk between them. It's a general ward, but most of the patients are babies. Some, like Eti, are being held by their mothers: others lie quietly on their beds attached to drips. Not one is crying: they are all much too weak for that.
Twenty-five years ago, when Iqbal Kabir first came to work at this hospital, small babies were almost unknown as patients. Today, he says, infants make up as many as 70 percent of admissions.
The reason? Kabir shakes his head, and points to a poster on the wall above Eti's bed. The same poster is displayed, many times, around the ward. It shows a baby's bottle, with a big cross drawn heavily through it. The message is clear. "Bottle-feeding is harmful," says Kabir. "Because bottle-fed babies get diarrhea, since their formula is mixed with dirty water and since their bottles are not sterile. Do you know how many breast-fed babies are admitted here with diarrhea? The number is almost zero." Eti has been bottle-fed almost since birth: Mina says she wanted to breast-feed, but when she had difficulties there was no one to give advice or support. Mina's story was typical of those of many of the mothers I met in Bangladesh: when she hit problems and went to a doctor, the suggestion was to try formula. In doctors' surgeries and pharmacies across the country, it seems, health professionals are quick — far too quick, say breast-feeding campaigners — to suggest bottle-feeding as the way forward.
Kabir is appalled by her tale, as he has been appalled many times before: in a perfect world, he'd like to see formula milk and bottles removed from general shops, and available only as a last resort, on prescription. "It sounds extreme — but then, it sounded extreme when people first talked about banning smoking. This is the same issue — only with bottle-feeding in my country it's not consenting adults who die, it's tiny babies."
For the moment, though, Kabir's anger is directed at the manufacturers of baby formula. Like many of his fellow health professionals, he believes these manufacturers push their products too aggressively, sometimes breaching the stipulations of an international code on the marketing of formula milk drawn up in 1981, ratified by member states of the World Health Organization, and enshrined in law in Bangladesh since 1984.
That code, in turn, had been prompted by public support of an international boycott of the products of the company that seemed most culpable 30 years ago: Nestle. The code could have ended the boycott, but campaigners continue to flag it up because, they claim, the company — and many other baby-milk manufacturers — fail to abide by its requirements. Despite the safeguards it affords, they say, mothers in developing countries — the most vulnerable of mothers anywhere, the ones least able to afford formula milk, the ones whose babies most need the breast milk they could and should be getting for free — were being, and continue to be, targeted by corporate giants bent on carving out their share of a valuable market. Save the Children, which on Tuesday published a report on the baby-milk industry, reckons that the total value of baby-milk and baby-food imports is worth almost ?16 million (NT$1.1 billion) a year in Bangladesh alone — but the potential, if more mothers were bottle-feeding, is a lot higher than that.
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