Estimated reading time: 10 minutes
Updated April 2016
Elizabeth Myler, BS, BSN, RN, IBCLC, LLLL
Photo: Leilani Rogers
Breast is best, right? Why is baby milk marketing thriving?
Public health messages promote breastfeeding as an unequalled way to provide babies with the ideal food. We know improper feeding can make infants substantially more vulnerable to infectious diseases like diarrhea and pneumonia, the leading causes of infant death worldwide. Contaminated water and food are a major cause of malnutrition and mortality in disadvantaged communities, where improper formula preparation (often over-dilution) is common.1
Not being breastfed can disrupt optimal growth and development, especially in the first two years, when the key components of the immune system are forming to protect the child for life from chronic illnesses such as diabetes, cancer, and autoimmune diseases. Formula-fed babies are at a higher risk of Sudden Infant Death Syndrome (SIDS), chronic, and non-infectious illnesses. Mothers who have not breastfed their babies have higher rates of heart disease, diabetes, breast, uterine and ovarian cancers.2
Certainly, formula milk can be necessary, especially in places where access to human milk banks is limited, non-existent or prohibitively expensive. When used in the appropriate circumstances, in the correct amount, for the least amount of time needed, formula can even be life saving. However, too few feedings on days 1–3 and common birth practices, such as induction and cesarean sections, which can interfere with normal lactation and infant feeding behaviors, are still the leading preventable reasons for inappropriate supplementation. 2
Yet, despite the published evidence of harm, the global baby food industry is projecting double-digit growth in sales, projected to be over $US 38 billion by 2015.3
This thriving industry is attracting new and loyal customers around the world. Why would a mother who plans to exclusively nurse her newborn in 2015 end up feeding that infant artificial baby milk (ABM) also known as “formula”? Which brand does she choose and why?
Free gifts with hidden costs
Mary, a first-time mom in the Eastern United States was confused when a package arrived in the mail for her from a well-known baby food company. She knew she hadn’t ordered anything or even shared her name and address. She planned to breastfeed her baby. As she wondered about her personal privacy, she pondered what to do with the cans of ABM inside the box: throwing them away seemed wasteful. Donating them to a food pantry might discourage other mothers from breastfeeding. Maybe, she should just put them away in the back of her closet, just in case?
Mary’s story is just one of thousands worldwide. Doctors’ offices, billboards (China, Laos, Vietnam), maternity hospitals (especially those who do not have Baby Friendly status 4), baby fairs, baby and maternity stores (US), and even “health promotion tables” at local supermarkets (UAE/Middle-East) are all popular venues for baby food companies to target mothers, build brand awareness and loyalty, and hand out “donations” or “free gifts.”
Today mothers are just a click away. The fastest growing means of marketing are online in developed nations. Companies target mothers with links to coupons on sites that are supposed to promote breastfeeding education or general postpartum mother and baby support.
Giving bottles of ABM to newborns interferes with the supply and demand nature of lactation. If a mother stops producing milk because she is using ABM, she then has to purchase more milk once her free samples are gone.
Marketing works! But is this type of advertising legal? Is it ethical?
The WHO CODE
The World Health Assembly (WHA) adopted the International Code of Marketing of Breastmilk Substitutes in 1981 as a minimum requirement to protect mothers, such as Mary, from the fiercely aggressive marketing tactics of the companies who sell ABM substitutes, bottles, teats and weaning foods. The WHA comprises the Ministers of Health of the world’s governments and their advisors, eminent experts in health issues.
The Code is an international public health recommendation and member states are supposed to implement it in law in their countries. It does not regulate or limit access to formula milk for which there is a legitimate market, but recognizes that usual marketing practices are unsuitable and have the power perniciously to undermine breastfeeding. Because the Code is open to interpretation, the baby feeding industry continues to use imaginative methods to circumvent some of its provisions.
“Inappropriate feeding practices lead to infant malnutrition, morbidity and mortality in all countries, and improper marketing of breastmilk substitutes and related products can contribute to these major public health problems” WHO Code Preamble.
In countries where formula marketing is not restricted, exclusive breastfeeding rates and breastfeeding education are lower.5 In the UK, for example, artificial baby milk companies spend ten times more on advertising than the Department of Health spends on breastfeeding promotion; and the UK formula marketing regulations omit many important provisions of the Code. The UK has some of the lowest breastfeeding rates in the industrialized world. Whereas in Norway, where advertising and promotion are strictly controlled, exclusivity rates at four months are high (roughly 64%). New legislation in 2012 tightening up the rules on marketing has been effective In South Africa.
Some nations openly profit from the lack of regulation of sales of formula, where the relative cost of decreasing breastfeeding rates may not even be considered. “A kilo of infant formula is worth ten times the value of a kilo of milk powder, so it’s obvious which product New Zealand should be selling.” 6
The International Baby Food Action Network (IBFAN)
IBFAN comprises international groups that may work on infant feeding issues alone, or they may be mother support groups, consumer associations, development organizations, or citizens’ rights groups. All take action to bring about the implementation of the Code. IBFAN exerts pressure on national authorities to fulfil their obligations under international agreements and human rights treaties.
From January 2011 to December 2013, 813 violations of the WHO Code were documented in 81 countries worldwide.
To learn more about IBFAN visit www.ibfan.org
- National Alliance for Breastfeeding Advocacy is the IBFAN group in the United States of America www.naba-breastfeeding.org .
- INFACT is the IBFAN group for Canada and is the North American coordinator for IBFAN http://www.infactcanada.ca/
- Baby Milk Action is the IBFAN group in the United Kingdom and coordinates the International Nestlé Boycott www.babymilkaction.org.
“The State of the Code by Country,” a report published by IBFAN, details nations which have adopted Code provisions. You can report violations here: ibfan.org/code-watch-form.
How formula companies reach you
Today’s patients still rate their “Health Care Provider” as their top choice for health questions and concerns. 7 It follows that access to health care workers via maternity hospitals and doctors’ offices remains marketers’ principal method of product promotion (often via advertising ABM on prescription pads and infant immunization booklets).8 The tireless efforts of IBFAN are making some progress in shutting down these avenues to unethical promotion of breast milk substitutes.
Digital direct marketing and social media
More than 90% of mothers born after 1982 are finding answers to their health questions online, but this is also where they are connecting to social support too.9
This bodes well for advertisers and makes it easier and cheaper for ABM companies to reach more mothers than ever, wherever they live. Social media sites are now being used to interact with mothers or prospective mothers with promotions, information, free samples, and contests. Sometimes companies have separate, personalized pages for each country where they market. Paid “mommy bloggers” further promote products.
Mother and baby clubs are easy to join and often do not mention feeding methods at first. Some companies send mothers articles about breastfeeding, which include links leading to other feeding choices. They send out timed and personalized sequences of gifts and coupons via email, which have been shown to build brand loyalty and attract new consumers even before the baby is born. The subtle creation of brand loyalty is developed prior to the baby’s arrival: there’s been an upsurge in nutritional drinks for moms-to-be during pregnancy with names and logos to match the artificial baby milks, as well as an increase in thickening agents to add to breast milk, the efficacy of which is questionable.
Apps such as Similac’s (Abbott) “StrongMoms” offer all kinds of general information about nutritional guidelines during pregnancy and beyond, but the tagline reveals their ultimate goal, “Motherhood is tough, Similac can help.” The company sponsored a campaign designed to empower moms to “stop judging one another’s choices.” Who can argue with this statement? Yet, by framing the use of ABM as just another “lifestyle choice” for which some mothers are wrongly judged, we seriously obscure the risks of choosing not to breastfeed. In fact, it seems that Similac confuses the concept of mothers supporting and respecting one another, a practice much favored by our own LLLI, with the idea that feeding choices have equal consequences.10
The tireless efforts of IBFAN are making some progress in shutting down these avenues to unethical promotion of breast milk substitutes.
Bribery. In 2013, a company named Dumex (owned by Danone) was exposed for bribing 116 doctors and nurses in 85 medical institutions in just one Chinese city alone. In the same year, six companies were fined $US 108 million for price-fixing of formula (escalating the price when demand for imported products exceeds supply). Also in China, state-owned Chinese hospital officials were bribed to recommend Wyeth’s products and to provide access to records of new births to be used for marketing purposes (a well-known industry practice).11
Upselling “premium” products. Since the superiority of breast milk is widely appreciated, formula companies now advertise their newest products as “closer than ever to breast milk.” The Nestlé owned company, Wyeth, launched a new product line called Illuma, a “human affinity formula.” Their ads praise the virtues of human milk but focus on how years of research inspired a mixture that includes just a few key synthetic nutrients, present naturally in breast milk, like DHA, ARA, prebiotics and probiotics. Often, these key additions make the product “premium,” which means they can command higher prices. Brands like “Gold” and “Premium” have set new trends with lofty and unsubstantiated claims for newborn health and achievement, such as increased intelligence, musical ability and even better eyesight. Meanwhile, mothers may wrongly assume their own milk is lacking something crucial, which only leads to more mixed feeding and eventually early weaning.
More mixed feeds
A study in the US in 2011 calculated a $US 13 billion annual cost saving if exclusive breastfeeding could be increased to 90% for the first six months of life. 12 Even though initiation rates are increasing globally, exclusivity rates are declining (in East Asia the drop was from 45% in 2006 to 29% in 2012).
Formula companies have brazenly proposed to mothers they may both formula feed and breastfeed at the same time, enjoying the “convenience” and “freedom” of bottles of ABM without sacrificing giving baby the best at home. Many working and busy mothers find such a proposition tempting and are not well informed about the real risks to their milk supply if they cut out milk removal in favor of formula supplementation. Abbot’s newest formula “Similac for Supplementation” even claims to improve long-term breastfeeding rates. There are reasons a mother may need to supplement her baby with formula, either for a brief period of time or indefinitely, but presenting mixed feeds as just another “lifestyle choice” without long-term consequences is not evidenced-based.13
GUMS (growing-up milks) are projected to have one of the largest international growth rates among formula products. Having similar brand names and logos as regular infant formula they promote the use of early milks in the range too. Companies claim such a marketing strategy is not a violation, though these toddler milks (and complementary foods) come within the scope of the Code if they are marketed as replacements for that part of a child’s diet which is best fulfilled by breast milk. Companies dispute this interpretation and attempt to limit the scope of the Code to infant formula alone. Meanwhile more mothers give up breastfeeding as a result.
Tigers are fighting
Using modern technology and tactics to get their message across, WHO Code supporters are busy online, especially in Facebook groups “Friends of the WHO Code” and the group for LLL Leaders “WHO Code for LLL.”
In the Fall of 2014, a new movie Tigers was released to standing ovation and critical acclaim. It is a true story of a courageous Pakistani whistle-blower Syed Aamir Raza, who uncovers just how far baby food companies can go in their pursuit of profits.
Two resources that tackle many of the issues raised in this article are Marsha Walker’s Still Selling Out Mothers and Babies: Marketing of Breastmilk Substitutes in the USA (2007) and Gabrielle Palmer’s The Politics of Breastfeeding (2009).
While the baby food industry has its own profits at heart, as breastfeeding mothers and advocates, we can work together locally and globally to protect mothers’ rights to receive unbiased and evidenced-based information about infant feeding.
1. Marino, D. Water and food safety in the developing world: global implications for health and nutrition of infants and young children. J Am Diet Assoc 2007 Nov;107(11):1930-4.
2. American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics 2012; 129(3): e827-e841.
3. IBFAN-ICDC Breaking the Rules, Stretching the Rules Evidence of Violations of the International Code of Marketing of Breastmilk Substitutes and subsequent resolutions compiled from January 2011 to December 2013 (2014).
The Rules are the International Code of Marketing of Breastmilk Substitutes and subsequent World Health Assembly resolutions (the Code), which are the yardstick to measure compliance by all companies in all countries.
4. “Baby Friendly” status is a global accreditation program of UNICEF and the World Health Organization designed to support breastfeeding and parent infant relationships by working with public services to improve standards of care.
5. Brady, J. Marketing breast milk substitutes: problems and perils throughout the world. Arch Dis Child 2012;97:529-532 doi:10.1136/archdischild-2011-301299.
6. Radio New Zealand News 2010, as reported in Breaking the Rules, Stretching the Rules 2010 by IBFAN.
8. Breaking the Rules, Stretching the Rules (2014) See 3 above.
9. Howe, N., Strauss, W. et al. Millennials Rising: The Next Great Generation. New York, NY: Vintage Books; 2000.
IBFAN: Report on carbon footprint due to milk formula April 22 2016
Elizabeth Myler, BS, BSN, RN, IBCLC, LLLL is a Registered Nurse, International Board Certified Lactation Consultant, and writer with a background in reproductive biology, psychology and maternal/child health. She is the owner of a busy private lactation practice and breastfeeding center, Mahala Lactation and Perinatal Services, LLC, in Northern New Jersey, USA where she lives with her husband and three sons.