The report, How marketing of formula milk influences our decisions on infant feeding, draws on interviews with parents, pregnant women and health workers in eight countries. The WHO and UNICEF said it uncovers systematic and unethical marketing strategies used by the formula milk industry – now worth $55bn – to influence parents’ infant feeding decisions.
The report found industry marketing techniques include unregulated and invasive online targeting; sponsored advice networks and helplines; promotions and free gifts; and practices to influence training and recommendations among health workers. The report said messages parents and health workers receive are often misleading, scientifically unsubstantiated, and violate the International Code of Marketing of Breast-milk Substitutes (the Code) – a public health agreement passed by the World Health Assembly in 1981 to protect mothers from aggressive marketing practices by the baby food industry.
“This report shows very clearly that formula milk marketing remains unacceptably pervasive, misleading and aggressive,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
“Regulations on exploitative marketing must be urgently adopted and enforced to protect children’s health.”
According to the report – which surveyed 8,500 parents and pregnant women, and 300 health workers in cities across Bangladesh, China, Mexico, Morocco, Nigeria, South Africa, the UK and Viet Nam – exposure to formula milk marketing reaches 84% of all women surveyed in the UK; 92% of women surveyed in Viet Nam and 97% of women surveyed in China, increasing their likelihood of choosing formula feeding.
“False and misleading messages about formula feeding are a substantial barrier to breastfeeding, which we know is best for babies and mothers,” said UNICEF executive director Catherine Russell.
“We need robust policies, legislation and investments in breastfeeding to ensure that women are protected from unethical marketing practices – and have access to the information and support they need to raise their families.”
Across all countries included in the survey, women expressed a strong desire to breastfeed exclusively, ranging from 49% of women in Morocco to 98% in Bangladesh. Yet the report said 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.”
The report said these myths include the necessity of formula in the first days after birth, the inadequacy of breast-milk 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.
Breastfeeding within the first hour of birth, followed by exclusive breastfeeding for six months and continued breastfeeding for up to two years or beyond, offers a powerful line of defense against all forms of child malnutrition, including wasting and obesity. Breastfeeding also acts as babies’ first vaccine, protecting them against many common childhood illnesses. It also reduces women’s future risk of diabetes, obesity and some forms of cancer. Yet globally, only 44% of babies less than six months old are exclusively breastfed. Global breastfeeding rates have increased very little in the past two decades, while sales of formula milk have more than doubled in roughly the same time.
The report also states health workers in all countries had been approached by the baby feeding industry to influence their recommendations to new mothers through promotional gifts, free samples, funding for research, paid meetings, events and conferences, and commissions from sales. More than one third of women surveyed said a health worker had recommended a specific brand of formula to them.
To address these challenges, WHO, UNICEF and partners are calling on governments, health workers, and the baby food industry to end exploitative formula milk marketing and fully implement and abide by the Code requirements.
This includes passing, monitoring and enforcing laws to prevent the promotion of formula milk, in line with the International Code, including prohibiting nutrition and health claims made by the formula milk industry.
It also advocates investing in policies and programs to support breastfeeding, including adequate paid parental leave in line with international standards, and ensuring high quality breastfeeding support.
WHO and UNICEF are also requesting industry to publicly commit to full compliance with the Code and subsequent World Health Assembly resolutions globally.
They are also looking for a ban on health workers from accepting sponsorship from companies that market foods for infants and young children for scholarships, awards, grants, meetings, or events.
The research was commissioned by WHO in Bangladesh, Mexico, Morocco, Nigeria, South Africa, the UK and Viet Nam and by UNICEF in China, with the study designed and implemented by a specialist research division within M&C Saatchi.
The Bill & Melinda Gates Foundation provided funding to support the research.
IBFAN welcomes WHO report
The International Baby Foods Action Network (IBFAN) has praised the publication of the report.
“We have been monitoring company practices and helping governments bring in strong effective legislation for the last 40 years so have seen how marketing evolves over time. WHO and UNICEF and the Committee on the Convention on Children’s Rights have such a crucial role to play in protecting child health and survival and we hope this new report will help policy-makers and the public at large recognise how corporate marketing tactics mislead and undermine children’s rights to health (and the environment they live in) and how to minimise their impact,” IBFAN said.
“Following the failed attempt in 2020 to persuade companies to abide by the International Code and the subsequent WHA Resolutions - it should be clear that there is no point chasing after corporations - or ‘ economic operators’ – for watered down here-today, gone-tomorrow promises. Certainly no baby food company should be considered as a ‘partner’ in health and based on our long experience in monitoring and with this new report, governments should be in no doubt that strong legislation is the only way forward,” IBFAN said.