New report details exploitative practices employed by $55 billion formula industry, compromising child nutrition, violating international commitments
More than half of parents and pregnant women (51 per cent) surveyed for a new WHO/UNICEF report say they have been targeted with marketing from formula milk companies, much of which is in breach of international standards on infant feeding practices.
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. It uncovers systematic and unethical marketing strategies used by the formula milk industry – now worth a staggering US$55 billion – to influence parents’ infant feeding decisions.
The report finds that 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 messages that parents and health workers receive are often misleading, scientifically unsubstantiated, and violate the International Code of Marketing of Breast-milk Substitutes (the Code) – a landmark 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 United Kingdom and Viet Nam – exposure to formula milk marketing reaches 84 per cent of all women surveyed in the United Kingdom; 92 per cent of women surveyed in Viet Nam and 97 per cent of women surveyed in China, increasing their likelihood of choosing formula feeding.
Across all countries included in the survey, women expressed a strong desire to breastfeed exclusively, ranging from 49 per cent of women in Morocco to 98 per cent in Bangladesh. Yet the report details how 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. 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 per cent of babies less than 6 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.
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.
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.
About the research
This ‘first of its kind’ systematic and cross-regional research was commissioned by WHO in Bangladesh, Mexico, Morocco, Nigeria, South Africa, the United Kingdom and Viet Nam and by UNICEF in China, with the study designed and implemented by a specialist research division within M&C Saatchi.
A comprehensive analysis was conducted in each country to assess the volume and dynamics of formula milk marketing and to map various types of advertisements, messengers, content and forms of dissemination. Research ethics approvals were granted by relevant ethics committee in each country. As well as interviews with parents and health workers and focus groups, the research included a sub-set of in-depth interviews with marketing executives in China, providing insight into the evolving tactics of formula milk companies in a key emerging market.
Formula milk and tobacco are the only two products for which international recommendations to prohibit marketing exist, in this instance, through the International Code of Marketing of Breast-milk Substitutes.
The Bill & Melinda Gates Foundation provided funding to support the research.
UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across more than 190 countries and territories, we work for every child, everywhere, to build a better world for everyone.
The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with 194 Member States, across six regions and from 149 offices, to promote health, keep the world safe and serve the vulnerable. Our goal for 2019-2023 is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing.