Experts have called for an end to irresponsible and exploitative formula milk marketing techniques, according to a new three paper Series published in The Lancet. They have argued that formula milk companies manipulate scientific information and exploit parents' emotions to generate sales at the expense of the health and rights of families, women and children.
According to experts, regulations must be urgently strengthened and properly implemented to end exploitative formula milk marketing tactics. They have called for an international legal treaty to end political lobbying by formula milk companies, and urged more effective breastfeeding support worldwide.
WHO recommendations on breastfeeding
The World Health Organization (WHO) and the United Nations International Children's Emergency Fund recommend that children initiate breastfeeding within the first hour of birth and be exclusively breastfed for the first six months of life, which means that no other foods or liquids should be provided, including water. The organisations also recommended that infants should be breastfed on demand, which means that the child should be breastfed as and when he or she wants, day and night.
However, less than half of infants globally are breastfed in accordance with the WHO's recommendations. Despite formula feeding failing to offer the same nutrition, health and development benefits as breastfeeding, formula milk sales are on the rise.
The Lancet 2023 Series highlights the economic and political power of the dominant formula milk companies and public policy failures. Due to these factors, millions of women are prevented from breastfeeding as recommended.
Breastfeeding is a collective responsibility of society, the authors noted in the Series. The authors have called for more effective promotion, support and protection for breastfeeding, including a much better trained healthcare workforce.
In a statement released by The Lancet, Professor Nigel Rollins, WHO, said the sale of commercial milk formula is a multi-billion-dollar industry which uses political lobbying alongside a sophisticated and highly effective marketing playbook to turn the care and concern of parents and caregivers into a business opportunity. He added that it is time for this to end, and that women should be empowered to make choices about infant feeding which are informed by accurate information free from industry influence.
Rollins further said that the Series finds society, politics, and economics all contribute to why fewer than half of infants globally are breastfed as recommended. He added that breastfeeding should be considered society's collective responsibility, and not the sole concern of women.
Rollins said that researchers need to see wide-ranging actions across different areas of society to better support mothers to breastfeed for as long as they want.
Series co-author Professor Rafael Pérez-Escamilla, Yale University School of Public Health, said babies are mostly likely to survive and grow to their full potential when breastfed.
He added that breastfeeding promotes brain development, protects infants against malnutrition, infectious diseases and death, while also reducing risks of obesity and chronic diseases in later life.
He explained that the barriers faced by women who wish to breastfeed include insufficient parental leave and lack of support in healthcare systems and at the workplace.
How the formula milk industry is using exploitative marketing practices
The formula milk industry has made several profits which benefit companies located in high-income countries, the Series stated. Low-and middle-income countries are the ones most affected due to social, economic and environmental harms associated with the formula milk industry's marketing tactics.
In 1981, the World Health Assembly, triggered by The Baby Killer investigative report into Nestle's marketing of formula milk in the Global South in the 1970s, developed the voluntary International Code of Marketing of Breast-milk Substitutes and subsequent resolutions (the Code).
However, the milk formula industry continues to violate the Code through its marketing techniques. Over the past twenty years, the sales from commercial milk formula have rapidly increased. Now, they are at more than $55 billion a year.
Some of the exploitative tactics used by the formula milk industry to sell their products include taking advantage of parents' concerns about the health and development of their children.
Some parents believe that their children experience disrupted sleep and persistently cry because the breast milk they consume is insufficient. This is what urges them to feed formula milk to their children.
However, the unsettled sleep behaviour of kids has nothing to do with the consumption of breast milk. Rather, such behaviours are common. Therefore, it is important to support mothers so that their concerns can be addressed without the use of formula milk, the Series said.
Professor Linda Richter, Wits University, South Africa, said the formula milk industry uses poor science to suggest, with little supporting evidence, that their products are solutions to common infant health and development changes. Advertisements for baby formula milk show that consumption of the product will alleviate fussiness in infants, increase with their night-time sleep, and encourage superior intelligence.
There are often labels on the packaging of baby formula milk that use words such as 'brain', 'neuro' and 'IQ' with images, because the companies want to emotionally manipulate parents into believing that the consumption of this product will help with early development.
However, studies have shown no benefit of these product ingredients on academic performance or long-term cognition, Richter explained.
The marketing technique violates the 1981 Code, according to which labels should not idealise the use of formula.
Formula milk marketing also uses gender politics to sell its products, and exploits the lack of support for breastfeeding by governments.
The authors noted in the series that the formula milk industry frames breastfeeding advocacy as a moralistic judgement that is anti-feminist and damaging to women. Meanwhile, the industry presents milk formula as a convenient and empowering solution for working mothers.
Digital communication also plays a major role in the irresponsible marketing of baby milk formula products. This is because digital marketing, such as industry-paid influencers, use tactics such as sharing the difficulties of breastfeeding. Also, there are industry-sponsored parenting apps with 24/7 chat services that enable people to place orders and avail free samples online.
The authors noted that there is very little regulation of the formula milk industry online and the 1981 Code is regularly violated.
The authors conducted a new review for the Series. A review of 153 studies, it details how marketing practices in violation of the Code have continued in nearly 100 countries and in every region of the world since its adoption more than 49 years ago. The Series has called for an international legal treaty on the commercial marketing of food products for babies to protect the health and wellbeing of mothers and families.
Lobbying by the formula milk industry
The milk formula industry also has the power to influence national political decisions and interfere with international and national regulatory processes, the Series said.
By establishing a network of trade associations and front groups that lobby against the Code and other breastfeeding measures, the formula milk industry has built a system of lobbying, according to the Series.
For instance, due to setbacks from industry lobbying, it took nine years since 2012 for South Africa to pass new national legislation to plant The Code into law.
The Infant Feeding Association is another lobby group formed by Formula Milk manufacturers. It applied pressure for amendments to the regulations.
The authors noted that broader actions across workplaces, healthcare, governments and communities, and an end to the marketing tactics and industry influence of formula milk companies are needed to more effectively support women who want to breastfeed.