WHO and UNICEF call for stronger marketing restrictions on infant formula amid COVID-19

27 May 2020 --- A report is calling for new legal measures to prohibit the promotion of breast milk substitutes to health workers and in health facilities. Released by the World Health Organization (WHO), the UN’s Children’s Fund (UNICEF) and the International Baby Food Action Network (IBFAN), the report states that countries are falling short in their efforts to stop the harmful promotion of breast milk substitutes. This is amplified as COVID-19 leaves an opening for the breast milk substitute industry to “capitalize on the crisis.” The agencies argue that the pandemic is highlighting the need for stronger legislation to protect families from false claims about the safety of breast milk substitutes or aggressive marketing practices.

“No one knows what the full impact of COVID-19 will be, but we can anticipate that disruptions to normal health care and community services will last for many more months or even well into 2021. We know that this kind of interpersonal support is critical to help women build confidence in breastfeeding or solve problems when they occur. Without it, breastfeeding rates are likely to drop.  In addition, we have seen numerous examples of industry using fears about COVID-19 to push breast milk substitutes, so we are very concerned,” Dr. Laurence Grummer-Strawn, Unit Head of Food and Nutrition Action in Health Systems at WHO, tells NutritionInsight.

“The fear of COVID-19 transmission is eclipsing the importance of breastfeeding. In too many countries, mothers and babies are being separated at birth, which makes breastfeeding and skin-to-skin contact difficult, if not impossible. All of this is based on no evidence. Meanwhile, the baby food industry is exploiting fears of infection, promoting and distributing free formula and misleading advice – claiming that the donations are humanitarian and that they are trustworthy partners,” adds Patti Rundall of IBFAN’s Global Council.

Of the 194 countries analyzed in the report, 136 have some form of legal measure in place that is related to the International Code of Marketing of Breast milk Substitutes and subsequent resolutions adopted by the World Health Assembly (the Code). Additionally, 44 countries have strengthened their regulations on marketing over the past two years.

The Code bans all forms of promotion of breast milk substitutes, including advertising, gifts to health workers and distribution of free samples. Labels cannot make nutritional and health claims or include images that idealize infant formula. Instead, labels must carry messages about the superiority of breastfeeding over formula and the risks of not breastfeeding.

“Many countries have laws that cover some ways of promoting breast milk substitutes but that ignore many others.  People don’t always think about how gifts to health care workers or claims on package labels can be promotional, and so various types of promotion get left out of legislation. Strong legislation usually comes about when there is strong leadership in the government or parliament that focuses on infant and child health.  Advocacy organizations fighting for children’s health often provide the push to get these laws passed,” explains Dr. Grummer-Strawn.

Gaps in legal restrictions
However, the agencies note that the legal restrictions in most countries do not fully cover marketing that occurs in health facilities. Only 79 countries prohibit the promotion of breast milk substitutes in health facilities, and only 51 have provisions that prohibit the distribution of free or low-cost supplies within the health care system. 

Additionally, just 19 countries have prohibited the sponsorship of scientific and health professional association meetings by manufacturers of breast milk substitutes, which include infant formula, follow-up formula and growing-up milks marketed for use by infants and children up to 36 months old.

WHO and UNICEF recommend that babies be fed nothing but breast milk for their first six months, after which they should continue breastfeeding – as well as eating other nutritious and safe foods – until two years of age or beyond. Major guidelines released late last year state that children under the age of five should not drink any sweetened beverages, including plant-based milks. 

“The aggressive marketing of breast milk substitutes, especially through health professionals that parents trust for nutrition and health advice, is a major barrier to improving newborn and child health worldwide,” says Dr. Francesco Branca, Director of the WHO’s Department of Nutrition and Food Safety. “Health care systems must act to boost parent’s confidence in breastfeeding without industry influence so that children don’t miss out on its lifesaving benefits.”

In February, researchers revealed that formula companies have quadrupled their spending on toddler milk marketing in ten years, which often feature unsubstantiated claims.

WHO is encouraging women to breastfeed regardless of the pandemic. Continuing to breastfeed throughout the pandemic
According to the WHO, active COVID-19 virus has not, to date, been detected in the breast milk of any mother with confirmed or suspected COVID-19. Thus, it appears unlikely that COVID-19 would be transmitted through breastfeeding or by giving breast milk expressed by a mother who is confirmed or suspected to have COVID-19. Therefore, it is recommending that women with confirmed or suspected COVID-19 should continue to breastfeed if they wish to do so. 

However, health care services aimed at helping breastfeeding parents have been strained as a result of the pandemic. Additionally, infection prevention measures – such as physical distancing – make it difficult for community counseling and mother-to-mother support services to continue. 

The WHO states that babies who are exclusively breastfed are 14 times less likely to die than babies who are not breastfed. However, today, only 41 percent of infants younger than six months old are exclusively breastfed, a rate WHO Member States have committed to increasing to at least 50 percent by 2025. 

“As the COVID-19 pandemic progresses, health workers are being diverted to the response and health systems are overstretched. At such time, breastfeeding can protect the lives of millions of children, but new mothers cannot do it without the support of health providers,” says Dr. Victor Aguayo, UNICEF’s Chief of Nutrition. “We must, more than ever, step up efforts to ensure that every mother and family receive the guidance and support they need from a trained health care worker to breastfeed their children, right from birth, everywhere.”

This is not the first time that breastfeeding has come under the spotlight in relation to COVID-19. In March, the University of California San Diego (UC San Diego) and the Family Larsson-Rosenquist Foundation (FLRF) launched an investigation into the safety and protective functions of breast milk as it relates to the coronavirus pandemic. 

To keep readers informed of these rapid developments, NutritionInsight is updating its daily news feed for the coronavirus-related information and insights you need to guide your business through this challenging period.

By Katherine Durrell