Although the merits and problems of breast-feeding versus using infant formula are debated in the United States and other developed countries, the issue is not so balanced in third-world nations. Studies have demonstrated the difficulties and risks of bottle-feeding babies in such places. First, refrigeration is not generally available, so the formula, once it is mixed or opened (in the case of premixed types), cannot be stored properly. Second, the lack of purified water for mixing with the formula powder results in diarrhea or other diseases in formula-fed infants. Third, inadequate education and income, along with cultural differences, often lead to the dilution of formula and thus greatly reduced nutrition. Medical studies also suggest that regardless of the mother's nourishment, sanitation, and income level, an infant can be adequately nourished through breast-feeding. In spite of medical concerns about using their products in these countries, some infant formula manufacturers heavily promoted bottle-feeding. These promotions, which went largely unchecked through 1970, included billboards, radio jingles, and posters of healthy, happy infants, as well as baby books and formula samples distributed through the health care systems of various countries. Also, some firms used "milk nurses" as part of their promotions. Dressed in nurse uniforms, "milk nurses" were assigned to maternity wards by their companies and paid commissions to get new mothers to feed their babies formula. Mothers who did so soon discovered that lactation was undermined and could not be achieved, so the commitment to bottle-feeding was irreversible..........................

 Discussion Questions
1. If you had been an executive with Nestlé, would you have changed your marketing approach after the boycotts began?
2. Did Nestlé suffer long-term damage because of its third-world marketing techniques?
3. How could a marketing plan address the concerns of the AAP and WHO?
4. Is anyone who worked in the infant formula companies responsible for the deaths of infants described in the United Nations study? Is there a line that companies could draw that emerges in this case?
5. Is the moratorium on distributing free formula samples voluntary? Would your company comply?
6. If you were a hospital administrator, what policy would you adopt on discharge packs?
7. Should formula makers advertise directly to the public? What if their ads read, "Remember, breast is best"?