Crying over spilt milk: Are the marketing practices to promote infant baby formula jeopardising breastfeeding?

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Crying over spilt milk: Are the marketing practices to promote infant baby formula jeopardising breastfeeding?

7 September 2022

The role of a mother in the development of an infant is invaluable. Whether it be supporting intellectual development or social development at an early age, there remains and even more crucial form of development. Nutritional development. To mark the significance of nutritional development in the early weeks and months of a babies’ life, the first week of August (1st-7th) is considered World Breastfeeding Week by the World Alliance for Breastfeeding Action (WABA). WABA is a global network of individuals and organisations dedicated to the protection, promotion and support of breastfeeding worldwide. However, it would seem that the message and rationale promulgated by WABA faces much challenge whilst heading towards a collision course with the proprietors of instant baby formula milk (IBFM) a form of breast milk substitute (BMS) and their proliferation over the previous decades.

This article will explore how and whether the marketing practices deployed to promote BMS affects and hence jeopardises breastfeeding. We shall look at the importance and significance of breastfeeding, the current challenges and barriers to breastfeeding. We’ll review the marketing practices used by brand labels of IBFM and rebuttals they propose to these claims. Finally, we shall conclude on the repercussions of these claims on the marketing practices and their impact on breastfeeding and IBFM, before providing a conclusion.

Breastfeeding is one of the earliest and vital acts a mother engages in to support the physiological and nutritional development of her baby. It is for this reason why the World Health Organisation (WHO) recommends solely breastfeeding babies for the first six months of their life. ¹ The WHO’s recommendation stems from the constituents of human breast milk, all of which contain basic essential nutrients such as carbohydrates, protein and fats too. Apart from breast milk being tailor made for a mother’s baby, breast milk is rich in million of live cells (white blood cells and stem cells etc.) that are immune-boosting and help organs develop and heal. Breast milk contains enzymes, growth factors, antibodies known as immunoglobulins (key in protecting the baby from illness and infections) by neutralising bacteria and viruses. In addition to this breast milk includes long-chain fatty acids, which play a pivotal part in the development of a babies nervous system, brain and eye development. Finally, breast milk contains 1,400 microRNAs which are thought to regulate gene expression crucial in preventing or halting disease development, whilst supporting the babies immune system and remodeling of the mother’s breast. ² The development and properties of breast milk occur over three stages; colostrum, transitional milk and mature milk (foremilk & hindmilk).

Source: Very Well

There are numerous research studies attesting to benefits of breastfeeding considering that cognitive development was improved by breastfeeding and as such, breastfed babies performed better on intelligence tests. ³ Though these findings have been challenged, as it remains unclear whether there is a direct relationship or whether other characteristics are associated. ⁴ Irrespective of establishing a correlation, breastfed babies had lower rates of obesity, diabetes (both type 1 & 2), hypertension, cardiovascular disease, hyperlipidemia and some types of cancer. ⁵ Though the benefits of breastfeeding seem numerous and a conclusive option, there remains challenges and barriers to breastfeeding.

For some mothers, the act of breastfeeding is not possible and as such it proves to be a challenge in meeting the nutritional needs of the baby. According to the latest data collated by the NHS, the UK had one of the lowest breastfeeding rates at last count in 2010 with 55% of women breastfeeding at six weeks and just 34% doing so at six months. ⁶ From the latest data, 2016-17, despite a slight increase in the two previous years (2014-15 and 2015-16) breastfeeding prevalence at six to eight weeks afterbirth is 44.4%, a considerably lower rate in comparison to nations like Norway, which achieves rates of 71% at six to eight weeks. ⁷ Furthermore, only 1 in 200, 0.5%, UK women do any breastfeeding after a year in comparison to Germany with 23%, USA with 27% and Brazil with 56%. ⁸ Despite, the above findings, 90% of mothers who stop breastfeeding in the early days do so before they wanted to. ⁹ About 80% of new mothers in England attempt to breastfeed after giving birth, with only 1% of babies being exclusively breastfed until they are six months old, contrary to the recommendations made by the NHS. ¹⁰ Common reasons for prematurely stopping breastfeeding given by mothers, include pain and lack of support as reported in a 2016 survey by 60% of 300 mothers surveyed. ¹¹ Difficulties and challenges in breastfeeding can prove a sensitive topic not to mention a period of greater vulnerability to mothers, especially first time mothers. Social pressures can further compound this feeling and amplifies myths speaking, erroneously, to the quality of the mother and relationship (maternal bonding) she has with her baby. Such angst over this period in motherhood is detrimental psychologically to the mother and nutritionally to the baby. Remedies to these situations arise from the use of BMS, especially IBFM.

IBFM is the leading form of BMS, with the global formula market currently valued at over US$ 52bn (£44bn). ¹² IBFM may indeed be inferior to human breast milk, but it does contain necessary vitamins, minerals, proteins and fats to meet the basic nutritional needs of babies. As a result of this, IBFM is a staple a majority consumer’s shopping basket with a newborn in the household. According to UK consumers data, IBFM grew by 8.6% to £295.8m, up by £23m, a resilient performance considering a challenging year. ¹³ Higher prices have placed pressure on parents, yet they have not served as a deterrent and as such has resulted in own brand labels (supermarket labels) growing a head of branded with own labels growing 6.8% in value against brands 6.2% increase. Irrespective of this, brand labels still outperformed own label 14.1%. ¹⁴ The growth in sales for branded IBFM is a recipient of the economic phenomenon of market demand, equating to value, necessity and in relation to branded labels, confidence, legacy and trust in the eyes of the consumer. However, this booming and bullish growth in revenue has drawn much controversy and scrutiny over the concerning marketing practices used by proprietors of leading brand labels to attain such gains at the expense of breast feeding and human breast milk.

Source: Grocer Kantar 52w/e May 2022

In response to the current marketing tactics deployed by proprietors of IBFM & BMS, the World Health Assembly adopted the International Code of Marketing Breast Milk Substitutes (also referred to as The Code) in 1981. Within this charter, Article 5 states:

“…there should be no advertising or any form of promotion of BMS to the general public.”

Yet despite this article encoded within the charter, the promotion of BMS such as IBFM continues unperturbed and unyieldingly to concerning result uncovered by research undertaken by the WHO. According to the research finding of WHO; 4 million social media posts about infant feeding reached 2.47 billion people and generated more than 12 million likes, shares or comments. Around 264 BMS brand accounts posted content around 90 times per day and reached 229 million users and that social media posts that referenced BMS brands or products reached three times as many people as posts about breastfeeding, with people most likely to share or click on the posts relating to the former. ¹⁵ This is by no means an exhaustive list of the findings. As seen above, the prominent medium used by which IBFM proprietors use to deploy their marketing strategies utilises digital marketing and social media and online channels given than 80% women who reported seeing BMS advertisements reported having seen them online. ¹⁶ In addition to this, WHO’s research disclosed some of the marketing techniques implemented by IBFM proprietors and these included engaging in real time contact with women, joining or having access to virtual groups and “baby-clubs”, the use of social media influencers, the use of user-generated promotions via competitions and resorting to privately messaging and providing professional advice. Again, this is not an exhaustive list. The marketing techniques adopted and executed by IBFM proprietors have culminated into the core concerns surrounding their marketing practices. The findings from the WHO report have shown that:

i) BMS companies buy direct access to pregnant women and mothers in their most vulnerable moments from social media platforms and influencers.

ii) BMS companies are using strategies that aren’t recognised as advertising.

iii) That digital marketing can evade scrutiny from enforcement agencies. This could require the exploration of new approaches to code implementing regulation and enforcement. ¹⁷

To highlight these digital marketing practices is to say nothing of the irresponsible claims made by one BMS brand Danone, who was subsequently found to have broken the rules, by claiming that their Cow & Gate brand was easier to digest than regular cows milk as well as confusing infant formula and follow on formula. ¹⁸ Nestle too, along with Danone, have made dubious claims over the additional benefits of artificially created human milk oligosaccharides (HMO), essential to building a babies immune system, when added to their cow’s milk based infant milk. ¹⁹ With such misleading health claims marred by the backdrop of the controversy surrounding the marketing practices of IBFM proprietors marketing strategies that has seen the likes of articles “Could baby formula be the new tobacco?” it is fitting to find some rebuttal to the concerns and accusations levelled at the BMS brands. To this current perception and zeitgeist surrounding the practices of IBFM brands Olivier Lechanoine, VP of specialised nutrition at Danone UK & Ireland proffers a rebuttal. Mr. Lechanoine's opening gambit to the idea of equating formula milk to cigarettes as:

“…an unreasonable comparison.”

Furthermore, he acknowledges the benefits of breastfeeding, yet remind critics that breastfeeding is not an option for all families and that;

“…it is important that parents can make informed choices about the nutrition options that are right for their baby and situation. We need to support parents with factual, science-based nutritional information. This cannot be compared to cigarette marketing.” ²⁰

Mr. Lechanoine concludes by affirming Danone’s commitment to contributing to sensible debate about the responsible marketing of baby formula and the protection of breastfeeding. As welcomed as these words are, there remain repercussions over the irresponsible claims and current marketing practices of IBFM.

One of leading repercussions is the “discouragement” of breastfeeding that currently costs the NHS £50m a year from preventable childhood illness and the reduction in the risk of developing breast cancer. ²¹ A secondary repercussion is the economic consequences associated with overregulation and fines. The stance to adopt here is not to throw the baby out with the bathwater. Instead, its better to acknowledge that any harsh sanctioning or disproportionate response to the current marketing of BMS brands could result in raised prices for the consumer causing cost-push inflation. The danger here is that some IBFM products may possess a degree of inelastic demand to certain households. To effectively enforce The Code’s charters, regulations or fines must be done in a sensible, equitable and measured fashion that accepts that digital marketing is a more cost effective and efficacious way of marketing than traditional means. After all, these BMS brands have a duty to their shareholders to deliver value or a return on their investment. The finally repercussion we’d put forward, is the concerns surrounding the increased cost of living and escalating inflationary environment that is hitting consumers hard. BMS brands can be vulnerable to food insecurity given the rising cost of constituents and fuel prices. With inflation projected to rise to 18% by early 2023, as of the time of writing, it highlights the concern of dependency on a sub-optimal nutritional product a caveat that human breast milk surmounts (by offering complete food security) and why breastfeeding should be encouraged and promoted. Despite the current climate and existing concerns there are solutions to trying to encourage breastfeeding more amidst the backdrop of BMS brands marketing tactics and pervasive digital presence within the UK.

Firstly, breastfeeding must be seen as a public health priority by policymakers and it would seem that such an attempt has been made. In 2015, the UK government mandated that every pregnant woman would receive five health checks from a registered health visitor. ²² In May of 2021 a recently updated Public Health England Guidance document entitled: Early years high impact area 3: Supporting breastfeeding was released to support families in breastfeeding and increasing the number of babies who are breastfed.

However, these initiatives and intention devised by public health bodies and policymakers are curtailed by cuts to supportive services. Therefore, the second solution is to reverse those cuts made to supportive services by increasing funding or reallocating ring-fenced capital and resources to help breastfeeding women. According to UK-wide Better Breastfeeding campaign, at least 44% of local authority areas in England and affected by recent cuts to breastfeeding services. These cuts further corroborate with other studies that saw 58% of respondent report that cuts to services (which included health visitors visits) as a barrier to breastfeeding. For completeness, 48% and 47% respondents reported closures of children centre services and cuts to infant feeding support groups irrespectively contributed to increasing the barriers of breastfeeding. ²³ ²⁴

A third solution would involve the true and utter commitment to markedly tackling the long-term issues of socioeconomic implications, specifically health inequalities and cultural stigma within the UK. In relation to the former, the current cost of living and inflationary climate has placed more of an importance upon the influence of socioeconomics and food insecurity upon breastfeeding in a high income. For instance, taking qualitative findings from a fellow high-income country as Canada, suggest food insecurity may be root cause of breastfeeding cessation due to maternal fears of producing milk that is inadequate in quality and quantity. ²⁵ The danger here, as alluded earlier, is the dependency of lower socioeconomic households upon IBFM something that contributes to infant food insecurity. In relation to the latter, point on cultural stigma as a barrier to breastfeeding, 63% of mothers would feel embarrassed breastfeeding in the presence of people they didn't know. A further 59% and 49% felt the same about doing so in front of partner’s family and siblings or wider family members respectively. ²⁶ These figures highlight the need for more breastfeeding-friendly spaces as well as discussions and education, as a nation, on the subject of breastfeeding and doing so in public.

The final solution we propose to support breastfeeding entails the revision and reasonable implementation and enforcement of the codes stipulated within the international code of marketing of BMS. The intended achievement of the codes will most likely come to fruition if they serve as a proportional deterrent to over zealous marketing and the dissemination of unsubstantiated and grossly misleading claims. This must be a collaborative endeavour between public health bodies, policy-makers, charities and of course proprietors of IBFM and other BMS brands.

In conclusion and in answering the question posed we would subscribe to the idea that IBFM and BMS are not jeopardizing breastfeeding, though proportional regulation and enforcement is necessary to support and champion the optimal form of baby nutrition that is breastfeeding. Furthermore, it is worth acknowledging that whilst IBFM is suboptimal to human breastmilk, it remains irrefutably patient-centric. It supports the psychological welfare of the mother and meets the standard nutritional requirement of the baby. Both BMS and human breast milk can indeed “co exist” effectively. However, the current situation must be reviewed. Firstly, there must be a change in narrative towards the “demonisation” of IBFM and other BMS brands that make outlandish associations between IBFM and cigarettes for instance. To achieve a more constructive and productive dialogue on this subject that is conducive to the goal of ideal baby nutrition then a collaborative and reasonable environment must be fostered and maintained. Secondly, accountability and transparency from IBFM proprietors is crucial to ensure that mothers are able to make informed decisions regarding their baby’s nutrition based on scientifically substantiated data. Failing to do so should allow for the appropriate enforcing of the 1981 Code. A lack or lose of credibility is detrimental to the life science industry and in this case the pharma and nutritional companies. Finally, policymakers and health strategist within the UK government, local authorities and NHS must reverse cuts and again ring-fence capital and resources to support mothers with breastfeeding be it through visitations, local groups or educational material. Given the economic benefits of breastfeeding to the NHS and nutritional benefits to babies’, it calls for the continued reevaluation and financial support to be available and ever-present.

Signposting:

LatchAid: https://latchaid.com/app - An informative app designed to t and encourage and support mothers breastfeeding with breastfeeding. There is useful information and statistics of interest too.

Medela: Breast milk composition: What’s in your breast milk? https://www.medela.com/breastfeeding/mums-journey/breast-milk-composition

National Breastfeeding Helpline: https://www.nationalbreastfeedinghelpline.org.uk/ - You can now contact them on Instagram. Contact number: 0300 100 0212.

NHS Breastfeeding Help and Support: https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding/help-and-support/ - The website consists of a host of information and contact numbers and details of organisations that can help with breastfeeding.

Disclaimer: Recommendations made in the signpost are not endorsements nor do we have commercial interest or conflict of interest. We seek not to advertise any third party provider. If you have any questions please speak with your GP, midwife or local pharmacist.

References:

1. World Health Organisation (WHO). Breastfeeding. <https://www.who.int/health-topics/breastfeeding#tab=tab_1> accessed 26th August 2022.

2. Medela. Breast milk composition: What’s in your breast milk? < https://www.medela.com/breastfeeding/mums-journey/breast-milk-composition> accessed 26th August 2022.

3. Der G Batty GD Deary IJ. Effect of breast feeding on intelligence in children: prospective study, sibling pairs analysis and meta-analysis. BMJ (Clinc. Res. Ed.) 2006 333:945.

4. Oxford Population Health. University of Oxford. NPEU. New study finds evidence that breastfeeding directly supports children’s cognitive development. < https://www.npeu.ox.ac.uk/news/2248-new-study-finds-evidence-that-breastfeeding-directly-supports-children-s-cognitive-development> accessed 26th August 2022.

5. Binns C Lee M Low WY. The Long-Term Public Health Benefits of Breastfeeding. Asian Pac J Pub Health. 2016.

6. Brown R. Could baby formula be the new tobacco? The Grocer. 16th July 2022. William Reed.

7. Royal College of Midwives (RCM): J Griffiths. New Breastfeeding statistics for England. 2017. < https://www.rcm.org.uk/news-views/news/new-breastfeeding-statistics-for-england/> accessed 26th August 2022.

8. LatchAid. Breastfeeding in the UK. < https://latchaid.com/breastfeeding-in-the-uk> accessed 26th August 2022.

9. Ibid.

10. Davis N. Breastfeeding support services ‘failing mothers’ due to cuts. The Guardian. 2018 < https://www.theguardian.com/lifeandstyle/2018/jul/27/breastfeeding-support-services-failing-mothers-due-to-cuts> accessed 26th August 2022.

11. Davis N. Low UK breastfeeding rates down to social pressures over routine and sleep. The Guardian 2016. < https://www.theguardian.com/lifeandstyle/2016/sep/09/low-uk-breastfeeding-rates-down-to-social-pressures-over-routine-and-sleep> accessed 26th accessed 2022.

12. WHO. Scope and impact digital marketing strategies for promoting breast milk substitutes. 2022. < https://apps.who.int/iris/bitstream/handle/10665/353604/9789240046085-eng.pdf?sequence=2> accessed 26th August 2022.

13. Ibid 6, - Kantar 52 w/e 15 May 2022.

14. Ibid 6

15. Ibid 12

16. Ibid

17. Ibid.

18. Ibid 6

19. Ibid

20. Ibid

21. Ibid 8

22. Removing the Barriers to Breastfeeding: A Call to Action. How Removing Barriers Can Give Babies Across The UK The Best Start in Life. Unicef United Kingdom The Baby Friendly initiative. https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2017/07/Barriers-to-Breastfeeding-Briefing-The-Baby-Friendly-Initiative.pdf accessed 01st September 2022.

23. Ibid 8.

24. Ibid 22.

25. Dinour LM Rivera Rodas EI Amutah-Onukagha NN Doamekpor LA. The role of prenatal food insecurity on breastfeeding behaviours: findings from the United States pregnancy risk assessment monitoring system. Int Breastfeeding J. 2020.15:30

26. Ibid 22.

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Our Patron: Archangel Michael

6 December 2024

Following on from our “Faith & Medicine” article and in keeping with the theme of spirituality, I’d like to announce that the Archangel Michael stands as the patron of Nnadi’s Healthcare & Pharmaceuticals Ltd. “St Michael the Archangel, defend us in battle, be our protection against the wickedness and snares of the devil. May God rebuke him we humbly pray; and do thou, O Prince of Heavenly host, by the power of God, cast into hell Satan and all evil spirits who prowl about the world seeking the ruins of souls.” Whilst Nnadi’s Healthcare & Pharmaceuticals remains a company that will always stay true to the principles of evidence-based medicine and “Good Science”, we pledge to utilise the scientific skill, talent and ambition that this company possesses to best serve patients & customers be they in the United Kingdom or abroad. Our privilege to serve those in need of our goods & services is a commitment we do not take lightly. We are most humbled and grateful to undertake this responsibility, and thus ask for the guidance & protection of St Michael the Archangel in all our endeavours henceforth. Most Sincerely, Sonny A. Ume Founder & Managing Director

Faith & Medicine: How Understanding the Relationship between Faith and Western Medicine to Better Improve Primary Care Health.

6 December 2024

In the Western world, and specifically to Western medicine (allopathic medicine), faith commonly tends to meet medicine at the intersect of “last resort”. Sporting analogies vividly depict such dire occasions, the “Hail Mary Pass” of American Football, “The bottom of the ninth” of American baseball or “90 minutes plus stoppage time” in football (soccer). Once the game plans and tactics have been tried and exhausted to no avail, the game of the respective sports take on a more urgent, opportunistic and hopeful complexion for the teams involved. This scenario is very much reminiscent of when medicine has been deployed as the opening gambit to tackle ill health only to find it is yielding little to no dividends towards improving to the patient’s health or condition. In this situation desperate times call for desperate measures and in the face of such desperation faith is sought and clung onto. Faith and medicine enjoy a polarising duality; Spirituality versus Science, “The Unseen” versus “The Proven”, subjectivity versus objectivity, belief versus evidence. Even in the face of this presented incompatibility between Faith and Medicine, there resides a common thread that unifies both. Patients. This article will look at the importance of acknowledging faith in medicine and the role faith plays in healthcare, particularly in primary care. The opening sentiment of this article on the relationship between Faith and Medicine may appear somewhat flippant and reductive. For some patients, faith does not follow a sense of hopelessness or vulnerability. Rather faith, in their respective religion, is their North Star. Their compass in navigating their day-to-day life of which, their healthcare needs are no different. Faith is central to the identity of an individual and for the collective community and demographic. An understanding of a patient’s faith in the healthcare sector is necessary in a multicultural country like the UK and more so in her multicultural major cities such as London. According to the latest data from the ONS (Office for National Statistics) 2021 Census, Christianity remains the largest religion in London with 40.66%, with Islam, Hinduism, Judaism, Sikhism and Buddhism following in sequential order at 14.99%, 5.15%, 1.65%, 1.64% and 0.99% respectively 1. When making an eyeball comparison of the religions distribution chart from the ONS 2011 Census against the ethnic group distribution chart from the 2021 Census, it provides a quantitative and qualitative insight into where specific demographics are situated across London 2. For instance you will find a majority of the Black Afro-Caribbean demographic in South East London an area with a high number of individuals identify as Christians, Asian-Indian in West London, an area where a large majority identify as Hindus and Sikhs, Asian Pakistanis far West & East London where Islam is the dominant religion and individuals who identify as Jewish are predominantly situated in the North and North West London area. A majority people who identify within an ethnic group demographic will have some connection to a religion, which plays an integral part to shaping their culture as well as their faith. This is of significance as these individuals then to be those as risk of preventative chronic disease of which the health outcome can be a poor prognosis. The data derived from the charts below will form the basis for strategies that are to be deployed in meeting the clinical needs of the multicultural demographic in London.

Investment is a Waiting Game: Mini Update from Managing Director

9 September 2024

Dear Reader, We’d like to apologise for our absence and inconsistency in our posting activities. We had planned for 2023 to be the year to springboard growth for the company. However, by August 2023 our plans were derailed by unapproved amendments to an investment deal, unforeseen operational changes by appointed service partner and the negligent damage to our current stock. Due this catalogues of disruptions, it resulted in the business having to concentrate its efforts on stabilizing and navigating through this thorny period. Sadly the decisive actions we took have impacted our agility and growth for 2023 heading into early 2024. It would be no stretch of the English language to deem 2023 as an annus horribilis for Nnadi’s Healthcare & Pharmaceuticals. Despite the hurdles of learning and operational obstacles to surmount, we persevere not out of foolishness or folly but out of a sense of duty and determination to contribute something positive to the country. Something positive for the nation’s economy and the health of the population too. Through Fergie’s Sparkling Water®, we have had the opportunity to connect and listen to people. We have come to gain an insight into people’s relationship with their nutrition, GP and the NHS as a whole. Through these conversations with the public, it is apparent there is still much work to do. Aside from these conversations, I would be remiss not to mention and acknowledge the kind words of support and gradual return business we have accrued in spite of all these difficulties since August 2023. We are grateful to these customers and supporters, we shall repay their faith by continuing to make strides towards securing investment. Our path towards securing investment now adopts a strategy of patience (as much as we can afford). The investment climate in the UK is constricted and conservative to nascent SME science ventures. According to an experienced business advisor, investments in the UK have dropped by 61%. Aside from the slow velocity of investment capital, there seems to be a shortage of courage and patience towards modest & sustainable business model. Investing in STEM ventures is not for the faint-hearted, but it is an investment that pays dividends both financially and socially. In this climate, we have to wait discerningly for the correct investing partner that will pull us out of the vicious cycle of traction against capital. I have full confidence in the company’s potential and mission. I hope this is a sentiment shared by our investors. We shall indeed wait and see. In the meantime, we shall continue with our daily operational activities and ambitions. We have come to accept that investment is very much now a waiting game. Kindest Regards, Sonny Ume Founder & Managing Director

Nnadi’s Healthcare & Pharmaceuticals Annual Report of 2022: Letter from Managing Director

23 December 2022

Dear Reader, This year has been a year of marked progess and incremental growth in comparison to the previous year. Early into Q1, we began officially trading with Fergie’s Sparkling Water ® and have been garnering sales throughout the year. Between late Q2 and mid Q3 , we encountered challenges and hinderances in involving our marketing campaign impeding us from fully capitalising upon the double heatwave that swept through the UK in the Summer. Due to thte unwelcomed impact, we have parted ways from the responsible marketing firm that oversaw our campaign during the periods of the aforementioned quarters. New marketing partners have been identified for 2023. Despites seeing sales and an increase in social media follwers across all platforms, we have had to contend with difficult macroeconomic factors. The leading macroeconomic factor has indeed been the steep rise in inflation, exacerbated by the Russia-Ukraine conflict in March of this year leading to soaring commodity prices affecting businesses, families and individuals alike. As a result of this, the UK, amongst other countries in Europe, are enduring a cost of living crisis. In relevance to our sector, for Fergie’s Sparkling Water ® , grocery shopping (food) inflation currently stands at 14.6% (down 0.1%, 6 Dec 2022), significantly higher than this time last year’s recorded at 4.2%. To combat this inflationary environment we have decided on two courses of action. Firstly, we have opted not to engage in cost-push inflatuion from our end, which would see us pass the additional cost onto the consumer. This is clearly demonstrated by us not levying a delivery charge on the customer’s orders. Secondly, we have offered small sample packs and have revised and reduced our prices across our current SKU (flavours/lines) which now includes multiflavour packs. These practices have created new customers, returning customers and prospective customers. Regarding the later, we have seen an increase in orders left at the basket checkout (a common practice observed by e-commerce merchants and retailers). We would prefer to convert these incompleted orders to sales. We shall indeed concentrate attention and focus on this practice and these prospective customers in the coming year. Aside from opening achievements and current challenges, we have achieved milestones on a marketing and parternship front this year. In mid Q2 we were part sponsors of a well known health conference with leading dietician and nutritionist . We will explore the possibility of sponsoring this event again. In addition to this come Q1 of 2023 we will be sponsoring a University Netball Team Club for the second half of their season. We intend for this to be a promising promotional endeavour. Whilst forming sponsorship links we enagegd in our first out-of-home (OOH) marketing campaign in a thriving and bustling area within the city of London. This achievement and opportunity allowed us for to showcase our distinctive golden cans and unique and delicious flavours to passers-by in the capital. Again, we aim to incorporate this form of marketing into future marketing campaigns. Rounding up on positive fronts, the final preparations are being made towards the end of Q4 following the better articulation of our product portfolio and strategy heading into 2023. On behalf of the company I am filled with much confidence and optimism as to what lies ahead for 2023. Overall, 2022 has provided an additional 12 months that have served as an invaluable learning curve. Both in evaluation and identification and better yet, realization. And come the end of this year we realize the necessity and central importance of securing funding in 2023. I believe my confidence and optimism are not misplaced surrounding the current potential and awaiting achievements of this company. For, if we can successfully complete our next round of funding and secure sufficient capital investment, it would serve as both fuel and vehicle to propel our commercial ambitions and endeavours. Nnadi’s Healthcare & Pharmaceuticals aspires to make its contribution to the gauntlet and satellite challenges that have arisen following the aftermath of the COVID-19 pandemic and subsequent scrutiny of the pharmaceutical industry. Given our stance towards the current perception of the pharmaceutical industry and our intended efforts to a propose remedy to the heightened scrutiny through Nnadi’s Healthcare & Pharmaceuticals’ operating model, hence there has not been a more enticing time to be involved in this sector. Nnadi’s Healthcare & Pharmaceuticals will strive to be among those enterprises, big and small, who wish to use all their efforts in tackling the challenges and seizing the opportunities that lie ahead in this field. Again, our ambition can only be realized with the necessary capital to fortify and grow based on what we have achieved so far. In closing, and returning to current matters, I would like to take this time to thank you for reading this and subsequent articles we have posted this year. I would like to thank all those who have supported and offered advice to bring us this for. And finally, above all else I would like to thank our customers who have invaluable not just in support through purchase, but in patience too. I would like to wish you and you a very Merry Christmas and a happy and prosperous New Year. May 2023 be a year of achivements and delivery for you as I hope it will be for Nnadi’s Healthcare & Pharmaceuticals. Kind Regards, Sonny Ume Founder & Managing Director Nnadi’s Healthcare & Pharmaceuticals Ltd.

Sponsorship Announcement: Unversity of Strathclyde Netball Club x Fergie’s Sparkling Water®

23 December 2022

Fergie’s Sparkling Water ® is delighted to announce it will be a sponsor for the second half of the University of Strathclyde Female Netball Club (USFNC). Fergie’s Sparkling Water ® can be enjoyed as part of a healthy diet, but as a thirst-quenching healthier alternative after physical activity such as sports. Increasing and encourage physical activity, through the medium of sports, is something we wish to do now and in the future. A club officer and player of the USNC, Oriana Smith said; “We have chosen Fergie's Sparkling water as one of our sponsors this year because we really believe in their product of a healthy alternative to sugary soft drinks. As a netball team who take our sport seriously, we can't wait to enjoy Fergie's drinks after our games and around Strathclyde Campus. Thanks so much Fergie's for being one of our sponsors this year!” We will certainly cheering the team on!

The Gauntlet: The Challenges that Lie Ahead for Big Pharma and the Industry as a Whole

14 November 2022

The pharmaceutical industry is a force for good! Our opening remark serves as a reminder and maxim within our company’s mission statement of elevating the patient’s and consumer’s perception of the pharmaceutical industry. Now more so than ever in recent times, this maxim of ours is necessary to recalibrate the perception of our industry. For failure to do so will have far reaching consequences, not just upon the pharmaceutical industry but also on public health. As it stands, Big Pharma and the remaining stakeholders within the pharmaceutical industry must, if not currently are, run through a gauntlet consisting of disenfranchised, incredulous and angry members of the public. This brief will look at the current obstacles and challenges that await Big Pharma and other industry players, whilst proffering solutions that go some way to repairing the strained relationship between pharma and the public. The objective of this reconciliation between both pharma and public seeks to restore the lack of confidence and subsequently the trust that has been broken. The future and integrity of the pharmaceutical industry depends on the mending of this relationship. Beginning with confidence itself, it is its latter crystalised end product of trust, that has been eroded or completely shattered resulting in the pharmaceutical industry being brought into disrepute. The leading contributing factor has been the lack of transparency in commercial activities and the decisions of Pfizer Inc. surrounding their vaccine. The earliest sense of opacity and perceived artifice involved the non-attendance of Albert Bourla pulling out of an initially scheduled European Parliament’s special committee on COVID (COVID committee). Mr. Bourla was not legally bound to attend nor was he subjected to any criminal punishment, as this was not an inquiry. Mr Bourla was intended to speak off the record. Mr. Bourla’s non-attendance proved irksome and did little to quell the committee’s frustration in the pursuit of answer. Another invitation has been extended to Mr Bourla. In Mr. Bourla’s place Janine Small, Pfizer’s Regional President of International Developed Markets stood in. The committee sought to address their concerns surrounding the heavily redacted vaccine purchase contract and the text messages between the Pfizer CEO and EU President Ursula von der Leyen. French MEP and COVI Committee member Veronique Trillet-Lenoir put these questions to Ms. Small. The purpose of Ms. Trillet-Lenoir’s line of questioning was to establish the relevant components about the operations in the manufacturing and delivery of the vaccines. 1 To this, Small answered that the information remains confidential for “competition reasons. This answer in the eyes of the COVI Committee ran contrary to Pfizer’s initial claim of transparency.

Inflation: The Biggest Threat to Diabetes?

8 June 2022

Inflation, defined in simple economic terms, is when prices of goods and services generally increase (along with a rise in demand) whilst reducing the purchasing power of money as each unit of currency buys fewer goods and services. The 40th President of the United States, Ronald Reagan, once quipped, “Inflation was violent as a mugger, frightening as an armed robber and as deadly as a hit man.” And as this perpetrator is very much on the loose and as of the time of writing, poses a clear and present danger to family and households in the West. The global economy, in particularly those of the West, is emerging from the embers and effects of the COVID-19 pandemic and whilst still undergoing a jittery and steady recovery, inflation seems to have stalled and in some cases reverse growth in the West. In the United States inflation has hit an annual rate of 8.3% down from 8.5% in March, but still an inflation rate that remains close to a 40-year high.1 Across the pond, Western European nations are grappling, with inflation across the Eurozone reaching 7.5%.2 In addition to this, the raging conflict between Russia and Ukraine has exacerbated the inflationary pressures on the continent. This article will look at how inflation is impacting the UK population and the dangers towards diabetes prevention and what attainable steps or measures can be taken to tackle this. Despite the backdrop of the COVID-19 pandemic, the escalation of geopolitical tension between the US, Russia and Ukraine has now regrettably broken out into military conflict as of Thursday 24th February 2022 and has sent commodity prices soaring. As of 2019, Russia and Ukraine exported more than 25% of the World’s wheat.3 Ukraine is considered the breadbasket of Europe, as 71% of Ukraine land is agricultural. Ukraine is also home to a quarter of the World’s “black soil” or “Chernozem”, which is highly fertile.

Tipping Point: Body Positivity vs. Weight Management

27 May 2022

“Be yourself” , “Love who you are” and “Never apologise for being you” are common self affirmations associated with wellbeing but can extend to body positivity. The fashion, beauty and sporting industry are leading the vanguard on the encouragement of body positivity in the name of representation and diversity of body types. This is indeed a good thing and very much welcomed. However, there must be a sense of awareness and caution to the indirect promotion of any health implications, in particularly prediabetes. This article will explore the dichotomy between social norms of body positivity versus clinical (health) concerns surrounding body positivity. This article will cover, to an extent, the relationship and impact of body positivity and body image may have upon mental health, healthy weight management and how best to beat prediabetes and Type-2 diabetes. Finally, we shall cover how a healthy weight is calculated, its significance and metabolic difference between individuals. This article will not cover nor engage in any post-discussion or debate on the topic of body positivity in relation to attraction. From a medical viewpoint, attraction is a subjective, fickle and not germane to this article. Given the sensitivity of the subject it would be appropriate to cover the impact on mental health and psychological well-being. Body positivity is inextricably linked to our self-image, which is key to our sense of identity. Simply put, how we look equates to how we feel. The perpetuation and desirability in the pursuit of the “perfect body” arises primarily from various forms of consumption. Common sources and outlets of this category include; Hollywood, Reality TV, ITV’s mega-successful Love Island franchise and Meta’s Instagram, all offering a window into innocuous entertainment, whilst showcasing the latest beauty trends that go on to become the societal standard. However, this harmless form of entertainment ceases to be so when the perpetuated trends by A-listers, well-known celebrities or recognised public figures (devoid of malice or agenda on their part), are, perceived as unattainable. It is this realisation that is impactful and leaves a detrimental effect on the most vulnerable members of the public on the uses of body image- teens and adolescents. The data to support this is worrying. According to UK survey of 11-16 years olds conducted by Be Real found that 79% said how they look is important to them. Over half (52%) often worried about how they looked. 1 In a survey of young people aged 13-19, 35% said their body images cause them to ‘often’ or ‘always’ worry. Research has shown that girls are more likely to be dissatisfied with their appearance an their weight than boys.2 3 In a survey by Mental Health Foundation, 46% of girls reported that their body image caused them to worry ‘often’ or ‘always’ compared to 25% of boys.4 In addition to this UK survey by Be Real, targeted at UK adolescents, it was revealed that 36% agreed they would do whatever it took to look good with 57% saying they had considered going on a diet and 10% saying they had considered cosmetic surgery.5 Disturbingly among secondary school boys, 10% said they would consider taking steroids to achieve their goals.6 Through these surveys, young people have expressed that body image is a substantial concern. Body satisfaction and a pressure to be thin is linked to depressive symptoms such as anxiety disorders (social anxiety or panic disorder) particularly in those children who do not match societal views of the ideal body.7 8 9 Possessing a poor body image may also prevent young people from engaging in healthy behaviours, as studies have found that children with poor body image are less likely to take part in physical activity. Survey data has shown that 36% of girls and 24% of boys avoided taking part in activities like physical exercise/physical education (P.E.) due to worries about their appearance. Body image is a substantial concern identified by 16-25 year olds and is the third biggest challenge currently causing harm to young people behind a lack of employment opportunities and failure to succeed within the education system being the first two.10

What is Prediabetes?

27 May 2022

To mark the Diabetes (Type-2) Prevention Week, we shall provide you with a brief overview of what prediabetes is, why it is significant, who is most at risk and what can be done to tackle it. What is prediabetes? Prediabetes, also known as non-diabetic hyperglycaemia, is a serious health condition that sees a person’s blood glucose level reside above the healthy range, but reside just below the range required for the person to be diagnosed with Type-2 Diabetes (T2D). An individual is deemed prediabetic if they have an HbA1c reading of between 42mmol/mol (6%) to 47.9mmol/mol (6.4%) or a fasting plasma glucose (FPG) of 5.5mmol/l to 6.9 mmol/l. In the UK, statistics suggest that there are 13.6 million people at risk of developing Type-2 diabetes.

Diabetes (Type-2) Prevention Week

25 May 2022

This week, 23 rd May-28 th May, marks Diabetes (Type-2) Prevention Week 2022. Type-2 diabetes is seems somewhat manageable and at times treated with a “matter of fact” attitude or simple as inevitable. This is far from the case. Type-2 diabetes is indeed a very serious and chronic disease that requires the appropriate amount of respect and discipline in controlling their blood glucose and blood pressure. If not, Type-2 Diabetes can be fatal. The one positive or optimistic angle one can adopt with Type-2 Diabetes is that it can be arrested and reversed if caught early at the prediabetic stage. This week we shall be posting articles covering: Prediabetes: What is it? Tipping Point: Body Positivity vs Prediabetes Is inflation influential in causing Type-2 Diabetes? In addition to these articles, we are also running a campaign throughout this week with a discount on Fergie’s Sparkling Water ® . Use the promo code: DPW10 for “ 10% OFF ” your total order. We shall also be providing appropriate signposting to direct or support you to the most relevant and sufficient services. We would love for you to be a part of this week!