This document provides further documentation of violations of the International Code of Marketing Breastmilk Substitutes in Greece. It includes examples of false health claims made by various formula companies, pictures of children on formula labels aimed at newborns, and products marketed for infants under 4 months of age. The document also shares complaints from women about the lack of breastfeeding promotion and support in Greek hospitals, including not being able to room-in with or feed their babies for long periods after birth. One example given is a pre-printed formula prescription with no option to breastfeed from a pediatrician at a maternity clinic.

1. ANNEX 3Further documentation of Violations of the International Code of Marketing Breastmilk Substitutes in Greece This documentation further accompanies the Report on the Situation of Infant and Young Child Feeding in Greece. Prepared by: 1. Group of individuals working with breastfeeding mothers in Greece –IBCLCs, pediatricians, midwives, La LecheLeague Leaders, candidate IBCLCs 2.Hellenic Lactation Consultant Association -Galaxias

2. Violation –false health claimsexample (1) Company : Humana Translation of first 2 points:-Breastfeeding is the best way to nourish your baby. Please discuss it with your pediatrician if you want to start formula.-Hypoallergenic nutrition with Humana HA1 does not protect 100% against allergies, but –as applies to mother’s milk too, it lowers the risk of allergy when compared with normal formula

3. Violation: false health claimsexample (2) Company: Nestle -Contains active colonies of Bifidus B. which under physiological conditions are present in intestinal flora. -Ideal mixture of proteins, which offers the necessary amount of proteins, without overwhelming the still immature organs. -Two necessary amino acids which appear in mother’s milk.

6. Violation: product for 0-4 months age Company: Milupa Drink from herbs Kinder tee Preparation: for babies 0-4 months old. Fill he bottle with 100ml warm water, which you have previously boiled, add 5 grams of the powder (one dessert spoon), mix and the Kindertee drink is ready.

7. Violation: false claims, comparison with breastfeeding Company: NUK An orthodontic teat with a valve, non-sticking Prototype NUK shape giving a feeling of natural breastfeeding. From silicone

8. Violation: selling bottle teats for ages 0-6 months + false claims Company: NUK Teat “First choice” Number 1 – for ages 0-6 months Supports breastfeeding Helps in preventing colic

9. Complaints of women about lack of breastfeeding promotion & support in Greek hospitals. We have gathered 17 written complaints signed by the women, who introduce themselves and are ready and willing to give further details if needed. They are from State Hospitals: University Hospital, Heraklion, Crete –3 Regional Hospital Ag Nikolaos, Crete – 1 Regional Hospital, Drama - 1 Aretaio, Athens –2 Private Maternities: Leto, Athens - 1 Mitera, Athens – 6 Iaso, Athens - 1 Geniki, Thessaloniki - 1 In one complaint the hospital is not specified. Two typical complaints follow in the next two slides.

10. A- translated from Greek My name is EleniStavrinou. I gave birth on 3.10.2009 being 39 weeks and 4 days pregnant by cesarean section in the Private Maternity Clinic Leto in Athens.. My baby daughter weighted 2350gr and was sent immediately to the Neonatal Intensive Care Unit (NICU), without presenting any problem, she was never put into an incubator, she was never given oxygen or needed some other therapy. They did not allow me to visit her for 48 hours, neither they supplied me with a pump so that I would be able to send milk to the NICU. I was allowed to visit her at the end of the second day and when I wanted to breastfeed her, the midwife in charge of the NICU spoke to me in the presence of my husband in a very strict and insulting way. She said that I would interfere with the feeding programmeof the NICU and the midwives would not be able to do their job correctly! Anyway, she added, my daughter needs formula to put on weight! The next day we asked for our daughter to be discharged from the NICU so that I could breastfeed her and we were told that it is the policy of this Maternity Clinic that all newborn that are below 2500grams are sent to the NICU to be given formula, so that they put on weight quickly. Anyway, they said, we do not have to worry our insurance company (IKA) pays for the whole duration of hospitalization! The same afternoon we were approached by the NICU Director, pediatrician, who told us that our baby will probably have to stay in the NICU more days for observation (although it started putting on weight normally), except IF we would ask to be discharged and she would follow the baby privately in her office. The last evening in the Maternity Clinic I called her on her mobile phone and told her that I would like her to take care of the baby and the reply that I got was” MrsStavrinou, that means that the baby will be discharged with you tomorrow.”I had very difficult time breastfeeding. Nobody said a word about a breast pump in the Clinic and information was non-existent. I was told that since I gave birth by cesarean I will not have milk. Later an IBCLC helped me and I did the best I could. In the my baby’s book it is written: Nutrition: Frisolac Premature, company Friesland

11. B – complaint in the original English Dear Sir/Madam, I would very much like to give my feedback to your survey, but as my Greek isn’t good enough to understand all your questions, I’ll give you a quick summary of what happened to me here: I gave birth in Mitera hospital august 2009. The baby was healthy with a good birth weight (3.8kg) and was born naturally, only with a vendouse ( i.e. vacuum extractor) to help her out. When she was born I was allowed to hold her (not skin to skin) for about 2-3 minutes and then she was taken away from me. Since I suffered severe tearing during the birth I was kept in recovery for 4 hours while they stitched my up and checked I was OK, and I didn’t see the baby again until 5 hours after she was born, at which point she was brought to me in the cot for an hour or so, but no-one took the time to sit and help me breastfeed her. The next day I asked for help from the nurses and they gave me maybe 10 minutes of their time for basic advice, but never asked how things were going. Despite the fact I had made it clear she should be exclusively breastfed, I am certain they gave her a bottle when she wasn’t with me, since she was never crying and never seemed hungry for all the 4 days we were in the hospital. Since I was in a shared room in the hospital the baby was taken away from me most of the time, which made bonding and breastfeeding very difficult indeed. The end result was I breastfed for the first month, with a very supportive pediatrician who gave me lots of encouragement, but due to very bad weight gain, the pediatrician eventually and reluctantly told me to switch to formula milk - my experience was that the baby simply didn’t have the ability to suck hard enough to get any milk (I had milk, which was seen to be nice and creamy yellow when I expressed with a machine, but eventually just went a watery white color), and usually either just fell asleep or got very frustrated while trying to feed. Good luck with your survey, Kay Martin

12. Violation: prescription for formula without medical reason is a daily practice The following slide is a copy of a pre-printed prescription for formula, with pre-printed logo of the Maternity Clinic (Mitera, ΜΗΤΕΡΑ) and the name and titles of the pediatrician with all the details how to contact him/her. The prescription concerns “Instructions for nutrition” and the only method of feeding that is an option is formula of one brand, which the doctor can only circle and hand out to the mother. At the end of the page there are two lines in small print saying: Breastfeeding: mother’s milk is the ideal food for babies. Parallel administration of formula can have negative effect on breastfeeding. Discuss it with your pediatrician before you start giving formula.

13. ΣΤΟΙΧΕΙΑ ΙΑΤΡΟΥ ΣΤΟΙΧΕΙΑ ΙΑΤΡΟΥ ΣΤΟΙΧΕΙΑ ΙΑΤΡΟΥ ΣΤΟΙΧΕΙΑ ΙΑΤΡΟΥ ΣΤΟΙΧΕΙΑ ΙΑΤΡΟΥ ΣΤΟΙΧΕΙΑ ΙΑΤΡΟΥ ΣΤΟ