New reports are damning the formula milk industry’s aggressive marketing tactics, with one by The British Medical Journal (BMJ) finding that producers are making health claims for their products, in comparison to breast milk, that in most cases are not backed by science.

“Multiple ingredients were claimed to achieve similar health or nutrition effects, multiple claims were made for the same ingredient type, most products did not provide scientific references to support claims, and referenced claims were not supported by robust clinical trial evidence,” found The BMJ.

Despite multiple attempts to regulate such marketing practices, progress has been slow, adds the report, whose findings on marketing are echoed in a new series of articles published in The Lancet journal. The BMJ recommends that a “revised regulatory framework” be created to protect consumers from “aggressive marketing” of companies, which earn about US$ 55 million a year globally.

Breastfeeding’s multiple benefits

The evidence of the benefits of breastfeeding is strong: it boosts children’s immune system and protects them against obesity, dental caries, and other diet-related noncommunicable diseases (NCDs), such as cancer, later in life. Breastfeeding also reduces women’s risk of developing diabetes, obesity, and some types of cancer. It also plays a role in addressing malnutrition in all its forms, including undernutrition.

The BMJ reports that not breastfeeding according to global standards “is estimated to result in about 600,000 child deaths from pneumonia and diarrhoea and 100,000 maternal deaths from ovarian or breast cancer each year.”

WHO and UNICEF recommend that breastfeeding starts within one hour of birth; to exclusively breastfeed children for the first six months of life; and to introduce safe nutritionally-adequate complementary foods at six months of age, together with continued breastfeeding up to two years of age or longer.

Industry’s extraordinary disinformation campaigns

But the formula milk industry has long gone to extraordinary lengths to market its products as healthy substitutes for mothers milk. A recent study that examined breastfeeding in cities in Asia found that nearly one-third of new mothers asked in Cambodia (31.7%) reported seeing promotion for infant formula in hospitals and other health facilities. Most of these were companies’ logos or branding on health equipment.

According to the new Lancet series, “For decades, the commercial milk formula industry has used underhand marketing strategies, designed to prey on parents’ fears and concerns, to turn the feeding of infants and young children into a multibillion-dollar business… The industry’s dubious marketing practices—in breach of the breastfeeding Code—are compounded by lobbying of governments, often covertly via trade associations and front groups, against strengthening breastfeeding protection laws and challenging food standard regulations.”

The ‘code’ is the International Code of Marketing of Breast-milk Substitutes, which 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 result of the deluge of formula marketing? “Only 48% of the world's infants and young children are breastfed as recommended,” says a commentary article in The Lancet series. It continues: “The series provides evidence of the overwhelming influence of commercial milk formula (CMF) marketing in the promotion of CMF as a positive choice and the solution to every feeding challenge, thereby eroding breastfeeding practices.”

97% exposure to marketing in China

More than half of parents and pregnant women (51%) surveyed for a report published in 2022 by the World Health Organization (WHO) and UNICEF said they had been targeted with marketing from formula milk companies. Among all women interviewed for the report, exposure to marketing reached 84% in the United Kingdom, 92% in Viet Nam and 97% in China.

“Marketing messages reinforce myths about breastfeeding and breast milk, which are frequently repeated by women,” found the WHO and UNICEF report. “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.”

The industry is also known to have taken advantage of the COVID-19 pandemic, falsely suggesting formula milk as “safer” or “necessary” to protect children from COVID-19 in some countries, or by including breastmilk substitutes in donations – practices breaching the International Code.

At the WHA meeting in 2022, countries requested that WHO develop guidance on regulatory measures to restrict digital marketing practices and further support implementation of the code. Expected in 2024, this guidance will aim to support member states to update or implement fuller regulations on infant formula that consider digital marketing, as up to 80% of exposure to breastmilk substitute advertising occurs online.