Ending the marketing of breastmilk substitutes

This is a summary of a Field Exchange views article that was included in issue 67. The original article was authored by Gwénola Desplats

Gwénola Desplats is a Nutrition Advisor with ENN

- Despite the introduction of the International Code of Marketing of Breastmilk Substitutes in 1981, the marketing of formula milk continues to violate women’s and children’s rights to good health.

- A recent multi-country study provided strong evidence of the pervasive and exploitative nature of infant formula marketing, including the use of scientific language and misleading messaging to exploit parents’ anxieties and appeal to their aspirations while undermining women’s confidence in their ability to breastfeed.

- The public health sector must use its strengths to reverse the harmful impacts of formula milk marketing through enforcement and accountability mechanisms as well as ensuring that health professionals are trained to support pregnant women and new mothers.

Background

For decades, breastfeeding has been acknowledged as the best source of nutrition for infants. However, breastfeeding rates are suboptimal with only 41% of infants under six months of age being exclusively breastfed. The impact of the marketing of formula milk on infant feeding practices is also well known. In 1981, the International Code of Marketing of Breastmilk Substitutes (the Code) was passed by the World Health Assembly (WHA) to regulate the marketing of breast milk substitutes including formula milk. However, 40 years on, the marketing of formula milk remains one of the most overlooked violations of women’s and children’s rights to good health.

The influence of marketing

Marketing is experienced by virtually everyone as part of everyday life. In early 2022, the World Health Organization (WHO) highlighted the need to protect children from exposure to harmful food marketing which promotes the consumption of less healthy foods. For formula milk, the consequences of marketing are particularly serious since the way children are fed during the first three years of life has long-term implications for their survival, health and development. Thus, decisions on how infants and children are fed should be based on clear, evidence-based information and not on commercial interests.

Marketing of formula milk: targeted, pervasive and misleading

In a report of a multi-country study also released this year (WHO & UNICEF, 2022), both United Nations agencies presented findings on women’s exposure to, and experience of, formula milk marketing. The study shared experiences of over 8,500 women and 300 health professionals from eight countries – Bangladesh, China, Mexico, Morocco, Nigeria, South Africa, the United Kingdom and Vietnam.

The study findings exposed the aggressive marketing tactics used by the formula milk industry to influence how babies and young children are fed:

• Formula milk companies use sophisticated techniques and misleading messaging to market their products. This includes the use of scientific language and imagery, targeting and exploiting parents’ anxieties and emotions and appealing to their aspirations.
• Companies also assume friendly, supportive roles to manipulate pregnant women and mothers and increase sales.
• Most women (93% in the survey) were exposed to formula milk promotions online or in-store and many (68%) had directly received formula milk promotions.
• Digital marketing platforms such as social media are increasingly used and are viewed as more effective than traditional advertising methods. These methods also provide formula milk companies with rich personal data to sharpen and focus their marketing campaigns.
• Women’s strong desire to breastfeed is often counterbalanced by a sustained flow of misleading marketing messages that may reinforce myths about breastfeeding/breastmilk and reduce women’s confidence in their ability to breastfeed.

Opportunities for action

Based on the strong evidence that the marketing of formula milk (not the product itself) disrupts informed decision-making and undermines breastfeeding, the report proposed the following opportunities for action:

• Recognise the scale and urgency of the problem 
• Legislate, regulate and enforce the Code: countries should urgently adopt or strengthen comprehensive national mechanisms to prevent formula milk marketing
• Protect the integrity of science and medicine: mechanisms should be set up to prevent conflict of interest and to counter commercially driven messages on infant feeding so that decisions on how infants and children are fed is based on reliable information and evidence that supports what is best for the parents and the child
• Safeguard children’s health on digital platforms
• Invest in mothers and families, divest from formula milk companies
• Expand coalitions to drive action

The report also presented the opportunity for health and nutrition practitioners to learn from the field of marketing, highlighting the need to respond to the needs of mothers, appropriately tailor messages to address their challenges and provide timely support in the face of breastfeeding constraints. This is particularly important in humanitarian settings and conflict-affected areas where the life-saving potential of breastfeeding is even more critical.

Heeding the call to action

Several thousand stakeholders participated in the launch of the report in February 2022 which featured prestigious panels of speakers from national governments, human rights groups, civil society organisations and marketing experts. The message was clear: despite the Code and WHA resolutions, formula milk companies continue to put sales and shareholder interests before infant and population health, employing ever evolving tactics to defy and circumvent regulations. This, alongside subsequent media coverage, triggered actions including a statement being issued by the President of Ireland, substantial traffic on social media using the hashtag #EndExploitativeMarketing and the dissemination of an open letter that registered over 4,000 signatures in just a few days.

Conclusion

This report provides strong evidence of the pervasive and exploitative nature of infant formula marketing and is a call to action towards the better protection of children. Some women choose not to breastfeed for a variety of reasons and should be supported in their decisions. However, marketing plays a critical role in women’s decision making, often undermining their confidence in their ability to breastfeed.  

Formula milk industries invest USD 55 billion in marketing each year – a larger budget than the WHO has available for its entire portfolio of operations over two years. Thus, the public health sector must use its own strengths to reverse the harmful impacts of formula milk marketing by ensuring robust enforcement and accountability mechanisms, ensure that health professionals are trained to provide the necessary support to pregnant women and mothers and invest in systems that prevent health professionals from engaging in conflicts of interest.

For more information, please contact Gwénola Desplats at gwenola@ennonline.net

References

World Health Organization & UNICEF (2022) How the marketing of formula milk influences our decisions on infant feeding. https://www.who.int/publications/i/item/9789240044609