Fewer than half of infants in the world are breastfed as recommended by the World Health Organization (WHO), thanks to the rise in sales of baby formula that fails to offer the same nutrition, health and development benefits as breastfeeding.
This statement was made in a just-published series of articles by The Lancet medical journal in the UK that insists the formula milk companies “exploit parents’ emotions and manipulate scientific information to generate sales at the expense of the health and rights of families, women and children.”
The series highlights the economic and political power of the dominant formula milk companies and the public policy failures that prevent millions of women from breastfeeding as recommended.
The authors stress that breastfeeding is a collective responsibility of society and call for an international legal treaty to end irresponsible formula milk marketing and political lobbying, accompanied by more effective breastfeeding support worldwide.
Formula milk marketing tactics are “exploitative, and regulations need to be urgently strengthened and properly implemented,” according to a new three-paper series published by the prestigious medical journal. Series co-author Prof. Nigel Rollins of the WHO wrote that “the sale of commercial milk formula is a multi-billion-dollar industry that 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. It is time for this to end. Women should be empowered to make choices about infant feeding which are informed by accurate information free from industry influence.”
The Israeli Health Ministry did not respond to a query by The Jerusalem Post on the matter.
Next month’s issue of Breastfeeding Medicine will highlight a survey of some 200 practicing American pediatricians about their routine interactions with infant formula companies and their representatives. Over 85% of them reported that a formula company representative visited their clinic and in 90% of the time distributed free formula samples.
Written by the journal’s editor and chief, Prof. Arthur Eidelman – former chairman of the pediatrics department of Jerusalem’s Shaare Zedek Medical Center – 64% of the pediatricians reported that medical educational conferences they attended were sponsored by formula companies and that routinely they partook in meals sponsored by the “reps.” These results inevitably raise concern as to how these practices impacted the pediatricians’ breastfeeding support and advocacy and recommendations regarding infant feeding practices, Eidelman wrote.
“Babies are most likely to survive and grow to their full potential when breastfed,” added series co-author Prof. Rafael Pérez-Escamilla of the Yale University School of Public Health. “Healthy breastfeeding promotes brain development and protects infants against malnutrition, infectious diseases and death, while also reducing risks of obesity and chronic diseases in later life. Yet, globally, many women who wish to breastfeed face multiple barriers, including insufficient parental leave and lack of support in healthcare systems and at the workplace, in the context of exploitative marketing tactics of the commercial milk formula industry.”
The series describes how profits made by the formula milk industry benefit companies located in high-income countries while the social, economic and environmental harms are widely distributed and most harmful in low- and middle-income countries.
Triggered by “The Baby Killer” investigative report into Nestle’s marketing of formula milk in the global south in the 1970s, the WHO Assembly developed the voluntary International Code of Marketing of Breast-milk Substitutes and subsequent resolutions (the Code) in 1981. However, the powerful influence of the milk formula industry and the marketing of their products is in violation of the Code continues, with sales from commercial formula milk having rapidly increased over the past 20 years and now at more than $55 billion a year, the authors stated.
How is baby formula marketing exploitative?
THE SERIES outlines the exploitative tactics used by formula milk companies to sell their products, including taking advantage of parents’ worries about their child’s health and development. One common reason women introduce formula milk is their interpreting unsettled baby behavior, especially disrupted sleep and persistent crying, as a sign that breast milk is insufficient. But, the authors added, the sleep patterns of babies are not the same as for adults and unsettled baby behaviors are common. When mothers are appropriately supported, concerns can be addressed successfully without the use of formula milk.
“The formula milk industry uses poor science to suggest, with little supporting evidence, that their products are solutions to common infant health and developmental challenges. Advertisements claim specialized formulas alleviate fussiness, help with colic, prolong night-time sleep and even encourage superior intelligence. Labels use words like ‘brain,’ ‘neuro’ and ‘IQ’ with images highlighting early development, but studies show no benefit of these product ingredients on academic performance or long-term cognition. This marketing technique violates the 1981 Code, which says labels should not idealize the use of formula and exploits poor science to create an untrue story to sell more product,” wrote Prof. Linda Richter of Wits University, South Africa.
In recent years, digital communications have greatly increased the reach of marketing in ways that blur the difference between advertising and the provision of nutrition and care advice. The series highlights examples of digital marketing such as industry-paid influencers sharing the difficulties of breastfeeding as preludes to formula milk marketing, and industry-sponsored parenting apps with 24/7 chat services that enable product placement, offer free samples or deals and promote online sales. The authors argue there is very little regulation of the formula milk industry online and there are regular violations of the Code.
The authors of the series included 153 studies that showed 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 four decades ago.
This outsourcing of lobbying allows the corporations themselves to project an image of benevolence and corporate social responsibility, suggesting that they can adequately self-regulate through corporate policies on responsible marketing. However, their self-regulation falls far short of compliance to the Code.
As well as influencing political organizations, the authors argued that formula companies draw on the credibility of science by sponsoring professional organizations, publishing sponsored articles in scientific journals and inviting leaders in public health onto advisory boards and committees, leading to unacceptable conflicts of interest within public health.
“The voluntary Code is not working – formula milk companies choose to disregard the guidance and lobby at every opportunity to weaken regulation. We need a stricter international legal treaty on the marketing of milk formula which is incorporated into law across the world. The treaty must protect policymaking from industry influence, with obligations for senior public officials to divulge meetings with lobbyists and requirements for scientific organizations to disclose funding sources and members of expert advisory groups.
"We need a stricter international legal treaty on the marketing of milk formula which is incorporated into law across the world."
Prof. David McCoy
“This would regulate the commercial milk formula industry while not restricting the sale of the products to those who need or want them. More generally, the global and public health community must also be much more critical about public-private partnerships that enable or tolerate conflicts of interest” wrote Prof. David McCoy, a public health physician who works for the International Institute for Global Health as part of the United Nations University.
A large expansion in health professional training on breastfeeding, as well as statutory paid maternity leave and other protections are vital. This requires changing the way society views breastfeeding as the sole responsibility of individual women and putting the onus across all levels of society,” wrote Prof. Rafael Pérez-Escamilla of the Yale School of Public Health.
A Lancet editorial concluded that “some women choose not to breastfeed or are unable to. Perceived pressure, or inability, to breastfeed, especially if it is at odds with a mother’s wishes, can have a detrimental effect on mental health, and systems should be in place to fully support all mothers in their choices… All information that families receive on infant feeding must be accurate and independent of industry influence to ensure informed decision making.”