WHO calls for cigarette-style plain packaging on infant formula

16 Mar 2022 --- The World Health Organization (WHO) is calling on countries to adopt tougher regulatory measures on infant formula to combat what it describes as a “deeply troubling” marketing landscape. A key proposal lies in having plain packaging for formula products, which according to the WHO, is a source of confusion for parents.

“Plain packaging would protect mothers and families from misleading claims and graphics. Industry invests in marketing slogans, claims and these branding details often at great expense because they know it is influential,” Dr. Nigel Rollins, a scientist with WHO’s Department of Maternal, Newborn, Child and Adolescent Health and Aging, tells NutritionInsight.

“Plain packaging is about providing mothers and families with accurate information, not information and graphics to increase sales.”

Figuring out the specifics
The WHO’s call for plain packaging begs the question of what this actually means. Rollins acknowledges there is no agreed definition of plain packaging for formula milk products.

“If plain packaging was introduced, it might simply include the list of ingredients and possibly detail how much sugar is included, which surprisingly, can vary by region. Health or nutrition claims alongside images or embellishments such as gold ribbons to infer some sort of ‘premium’ quality would not be allowed.”

Additionally, Rollins suggests the age for which specific products are intended could be indicated by an age range instead of a number in a series, as seen in current terminology such as “stage 1, stage 2, stage 3.”

“Marketing uses this cross-promotional technique to build brand loyalty when, in fact, there is little difference between the products.”

Another suggestion includes standardizing can colors where all products for infants 0-6 months are pink, and all products for infants 6-12 months are blue, he notes.

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The WHO suggests the onus should be on countries to adopt or strengthen comprehensive national mechanisms that can prevent formula milk marketing.

According to Rollins, any additional wording on the packaging would be decided and designed by national health authorities, so that information on packaging is objective and truthful.

“In this way, packaging could become a means for communicating public health information that is valuable for mothers and families as opposed to messages that are driven by commercial interests. It is also about consumer rights and access to impartial information on feeding at a critical time in a child’s development.”

“Together, the importance of child and maternal health, as well as the influence of packaging on decision-making, justify a public health intervention such as plain packaging.”

Enforcement as root of the problem
The issue driving the WHO’s recommendation is due to “constant violations” of the WHO Code on the marketing of breastmilk substitutes, Dr. Ada Garcia, senior lecturer in public health nutrition, University of Glasgow, whose own research has flagged unregulated claims on baby food packaging, tells NutritionInsight.

Packaging-related recommendations in The Code include: “Neither the container nor the label should have pictures of infants; nor should they have other pictures or text which may idealize the use of infant formula.”

The Code is not mandatory or legally binding, with only a handful of countries having legislation that enables its protection, Garcia notes.

“This is a problem because there is no enforcement of the recommendations which undermines breastfeeding promotion.”Industry should not inflate expectations or make unsubstantiated promises to parents, the WHO says.

Confusing claims
The Code also outlines nutrition and health claims should not be permitted for breastmilk substitutes, except where specifically provided for in national legislation.

This is one of the most problematic areas because of the lack of robust evidence to substantiate or support the use of nutrition and health claims, Garcia notes.

“An example of this is enriching formula milk with nutrients – which are normally present in breast milk – such as long-chain polyunsaturated fatty acids like docosahexaenoic acid (DHA). Such milks are branded as ‘pro’ or ‘advanced.’”

“These connotations imply a superior product that might confuse parents on the quality of breastmilk. However, the existing body of scientific evidence does not confirm a benefit on cognitive performance in children-fed DHA enriched formulas.”

Rollins adds that additional design features such as gold bands or ribbons are used on packaging to suggest some sort of higher quality product when there is little difference in the actual contents.

“Furthermore, these approaches are used to justify higher costs and increase returns, which exploit families who use formula milk for their children.”

Comparisons to tobacco
The WHO’s proposal for plain packaging on formula products is expected to draw comparisons with tobacco marketing regulations, which have been in place in the UK since 2017.

Commenting on reports of this, Rollins outlines the WHO does not equate formula milk itself to tobacco, nor does it seek to reduce the availability of formula milk for families who want to use it.

“We are, however, concerned about exploitative marketing practices from industry – including through packaging – that undermine access to impartial information on infant feeding.”

Defending the role of tougher regulations, Garcia adds: “Every child on the planet has the fundamental right to be protected from commercial interests that undermine their health. The recommendations given by WHO in the Code are not being followed by the producers of breastmilk substitutes, so why are stronger regulations not justifiable when the marketing of such products undermines breastfeeding and puts global infant health at stake?”

By Andria Kades

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