“Deeply troubling” marketing landscape across infant formula, WHO flags

23 Feb 2022 --- The infant formula industry is “marred with systematic and unethical marketing strategies to influence parents’ infant feeding decisions,” a World Health Organization report reveals. According to the findings, even health care professionals are roped into tactics that promote formula over breast milk.

However, industry stakeholders tell NutritionInsight they adhere to the International Code of Marketing of Breast-milk Substitutes.

“We market breastmilk substitutes responsibly and comply with the WHO Code as implemented by national governments or our industry-leading Nestlé policy, whichever is stricter. We welcome scrutiny by external bodies as it helps us further improve our practices,” says Marie Chantal Messier, head of food and industry affairs, Nestlé.

However, the study argues that formula milk is a US$55 billion per year industry that systematically “undermines parents’ infant feeding decisions and compromises women’s and children’s health and human rights.”

Companies use data-driven algorithms that target digital advertising to women whose online behavior suggests they may be pregnant.Aggressive marketing?
Practices carried out by companies are described as “deeply troubling” and violating the International Code of Marketing of Breast-milk Substitutes.

The report surveyed 8,500 parents and pregnant women and 300 health workers in cities across Bangladesh, China, Mexico, Morocco, Nigeria, South Africa, the UK and Vietnam. It is described as the most complete picture to date of mothers’ and health professionals’ experiences of formula milk marketing.

“This report shows very clearly that formula milk marketing remains unacceptably pervasive, misleading and aggressive. Regulations on exploitative marketing must be urgently adopted and enforced to protect children’s health,” says Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. 

Women expressed a strong desire to breastfeed exclusively, ranging from 49% of women in Morocco to 98% in Bangladesh. The report details that “a sustained flow of misleading marketing messages is reinforcing myths about breastfeeding and breast-milk, and undermining women’s confidence in their ability to breastfeed successfully.” 

“These myths include the necessity of formula in the first days after birth, the inadequacy of breastmilk for infant nutrition, that specific infant formula ingredients are proven to improve child development or immunity, the perception that formula keeps infants fuller for longer and that the quality of breast-milk declines with time.”

Calls for tougher regulation
As part of the findings, the WHO suggests countries should urgently adopt or strengthen comprehensive national mechanisms to prevent formula milk marketing. Any legal loopholes in domestic legislation, including health, trade and labor, should be in line with the International Code of Marketing of Breast-milk Substitutes, closing all loopholes. 

Robust enforcement and accountability mechanisms should be implemented, including holding formula milk companies accountable for their practices and commitments, the report outlines.

Regulatory measures, including plain packaging for formula products and higher standards of evidence for product development, should also be instilled, according to the WHO.Industry stresses its support for breastfeeding and the relevant WHO Code. 

Industry maintains commitment to Code
The British Specialist Nutrition Association reacted to the report outlining that manufacturers of infant and young child nutrition are working to actively raise ‎awareness of the WHO Code principles and applicable laws ‎through education and training, as well as monitoring independent websites to identify ‎regulatory and compliance issues.‎

“We believe that unilateral action is not enough to drive meaningful change in the sector,” says Messier. 

Messier iterates Nestlé's previous decision to unilaterally stop the promotion of infant formula in all countries for babies aged 0 to 6 months by the end of 2022. “This was the only substantial commitment among major industry players. This significant step is particularly relevant to the USA, Canada and Japan, where no regulations currently exist,” she highlights.

FrieslandCampina outlines it “adheres to the WHO’s International Code of Marketing Breast Milk Substitutes and complies with national legislation and national code. Products in the scope of our policy include, as a minimum, formulas for infants from birth to six months in all countries where we market our products.”

The company points to International Special Dietary Foods Industries, which issued a statement saying: “Breastfeeding is the optimal way to ensure the healthy ‎growth and development of infants during the first months of life. When breastfeeding is not ‎an option, however, the only recognized and proven alternatives are scientifically developed and ‎clinically demonstrated breastmilk substitutes.”

Manipulation, distortion and exploitation
Common marketing channels used include TV, digital marketing, digital influencers, free samples, gifts, sponsored events as well as baby clubs. 

“Formula milk marketing, especially digital marketing, is relentless and highly targeted. Formula milk companies use nuanced marketing techniques to exploit parents’ anxieties and aspirations,” the study highlights. 

The study outlines that formula companies have used “manipulative marketing tactics” that exploit parents’ anxieties and aspirations. It cited an unnamed brand manager from a formula milk company in Beijing, who said: “If the consumers could provide a birth certificate, they can be given a can of stage 1 formula for free.” 

“This is a very effective way for formula companies to get new clients. If a baby drinks stage 1 formula from one brand, in most of the cases, will drink stage 2 and 3 of the same brand.”

Additionally, formula milk companies were also found to “distort science and medicine to legitimize their claims and push their product. They make false and incomplete scientific claims and position formula as close to, equivalent or superior to breast milk despite growing evidence that breast milk and breastfeeding have unique properties that cannot be replicated by artificial formula.”

A British study previously highlighted that trials on formula milk have a high risk of bias.

Samples were particularly common in China and Vietnam, where 46% and 35% respectively of women surveyed had received at least one free sample.Networking with healthcare professionals
The study also reveals industry systematically targets health professionals – whose recommendations are influential – to encourage them to promote formula milk products. 

Sponsorship, incentives and training activities are used – either directly or through their institutions – to build relationships and influence health workers’ practices and recommendations.

“Companies infer scientific credence of health claims for their products with carefully crafted and tested language and labeling. Relationships of trust – in particular, those between health professionals and parents – are manipulated by formula milk companies, who incentivize and often unwittingly co-opt health professionals to endorse and promote their products.” 

Exposure to formula milk marketing reaches 84% of all women surveyed in the UK; 92% of women surveyed in Vietnam and 97% of women surveyed in China, increasing their likelihood of choosing formula feeding, the study notes.

“Formula milk marketing still represents one of the most underappreciated risks to infants’ and young children’s health.”

During the onset of the COVID-19 pandemic, the WHO and UNICEF called for stronger marketing restrictions on infant formula after it highlighted that countries were falling short in their efforts to stop the harmful promotion of breast milk substitutes.

By Andria Kades