Marketing of formula milk as a replacement for breast milk continues to grow despite a global code condemning the practice.

“Advertisements will make me buy infant formula," says a mother in Lagos, Nigeria, “if I see a beautiful and chubby baby on TV, well fed and smiling, and there is a container of milk there with all the nutritional facts on it, detailed.”

Adds a mother in London, “I felt like... the formula milk is a good thing because it will support your child’s growth later on as they’re growing… So, I feel like I was tricked into follow-on formula, to be honest.”

These two women are far from alone in being manipulated into feeding infant formula to their children instead of breast milk. More than half of parents and pregnant women (51%) surveyed for a new report say they have been targeted with marketing from formula milk companies.

Marketing reaches 97% of women in China

Among all women asked, exposure to formula milk marketing reached 84% in the United Kingdom, 92% in Viet Nam and 97% in China. The report, by the WHO and UNICEF, surveyed 8,500 parents and pregnant women and 300 health workers in cities across Bangladesh, China, Mexico, Morocco, Nigeria, South Africa, the United Kingdom and Viet Nam.

There are no doubts about the benefits of breastfeeding. Started within the first hour of birth, followed by exclusive breastfeeding for six months and continued for up to two years or more, it offers a powerful defence against all forms of child malnutrition, including obesity. Breastfeeding 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 6 months old are exclusively breastfed. Breastfeeding rates worldwide have increased very little in the past two decades, while sales of formula milk have more than doubled in roughly the same time.

Marketing code ineffective

The International Code of Marketing of Breast-milk Substitutes (the Code) was passed by the World Health Assembly in 1981 to protect mothers from aggressive marketing by the baby food industry. But it is voluntary and "Unfortunately, only 25 countries have implemented measures that are substantially aligned with the Code," wrote WHO and UNICEF in a statement to mark the Code’s 40th anniversary in 2021.

The marketing messages that parents and health workers receive are often misleading, scientifically unproven and violate the Code, found the report.

“Marketing messages reinforce myths about breastfeeding and breast milk, which are frequently repeated by women,” it says. “These myths include the necessity of formula in the first days after birth, the inadequacy of breast milk for infant nutrition, the perception that formula keeps infants fuller for longer, and that the quality of breast milk declines with time.”

In China and Viet Nam, women who were exposed to more marketing were significantly more likely to answer that ‘nutrition is more comprehensive and balanced in formula’ compared to breast milk, the report found. In Mexico and Morocco, women who saw more marketing were significantly more likely to agree with the statement ‘formula is very like breast milk.

“After six months, the nutrition in breast milk is not enough. Though it has immunity, its nutrition source is not as good as formula,” says a mother in Ho Chi Minh City, Viet Nam, quoted in the report.

Marketers take advantage of COVID-19

In 2021, NCDA’s then Policy and Campaigns Manager Lucy Westerman blogged about how makers of infant formula took advantage of the COVID-19 pandemic to put a spin on their marketing.

“In China, the dairy industry worked hard to ensure that their milk formula products were seen as both immune-boosting and 'safer' as part of the pandemic response, with brands providing medical care, virtual assistance, and home delivery of formula to stranded mothers. In Mexico, breast milk substitute brands partnered with pharmacies to promote their milk formulas alongside giveaways to people in poverty,” she wrote.

Lucy pointed out how such practices violate the Code, but as the WHO and UNICEF recommend in their report: “governments need to pass, monitor and enforce laws to prevent the promotion of formula milk. This includes prohibiting nutrition and health claims made by the formula milk industry.”

Just making laws isn’t enough, as the example of Nepal shows. The South Asian country passed the Substitute of Breast Milk Act in 1992 to control the sale and distribution of breast milk substitutes. It penalizes health professionals who push and manufacturers who promote baby food formulas.

Yet, “we have been working to promote breast milk and convinced a large proportion of mothers in Nepal to exclusively breastfeed. However, we have not been able to regulate the activities of the manufacturers of breast milk substitutes,” said Bikash Lamichhane at the Department of Health Services in 2018.

A recent study examined breastfeeding in the capitals of Nepal and Cambodia, Kathmandu and Phnom Penh. It found “promotion is taking place in health facilities throughout urban Phnom Penh and Kathmandu Valley, despite the strong laws in each county.” Nearly one-third of new mothers asked in Cambodia (31.7%) reported seeing promotion for infant formula in health facilities. Most of these were companies’ logos or branding on health equipment.

Unsurprisingly, formula makers are also going online. “There were a few brand X adverts on the side of the bus stops, that I saw. Obviously, we were looking online and that little (advert for) brand X milk popped up,” says a mother in the WHO/UNICEF report. “With these cookies, they must know we’re looking at baby stuff, and it’s popped up out of nowhere to tell us about this brand X milk. I think there was a brand Y milk advert too.”

The WHO/UNICEF report also recommends:

• Investing in policies and programmes to support breastfeeding, including adequate paid parental leave in line with international standards, and ensuring high quality breastfeeding support.
• Requesting industry to publicly commit to full compliance with the Code and subsequent World Health Assembly resolutions globally.
• Banning health workers from accepting sponsorship from companies that market foods for infants and young children for scholarships, awards, grants, meetings, or events.