New mothers exploited by firms misusing science to drive over-consumption of formula milk: report

A groundbreaking report made public on Wednesday by the World Health Organisation (WHO) and UN Children’s Fund reveals how the aggressive marketing of infant milk formula is discouraging women from breastfeeding.

Drawing on interviews with parents, pregnant women and health workers in eight countries, including SA, the report, “How marketing of formula milk influences our decisions on infant feeding”, uncovers “systematic and unethical” marketing strategies used by the $55bn (about R826bn) formula milk industry to influence parents’ infant feeding decisions.

“Formula milk companies use myriad channels, both mass and highly personalised, to maximise the number of women they reach and the number of times they reach them,” the report reveals.

The manufacturers are accused of deliberately misusing science to drive the over-consumption of formula milk, of undermining women’s confidence and “cynically exploiting” parents’ instincts to do the best for their children.

More than half (51%) of the 8,500 parents and pregnant women surveyed in the UK, China, Bangladesh, Mexico, Nigeria, Vietnam and SA said they had been targeted with marketing from formula milk companies, much of which is in breach of international standards on infant feeding practices.

In SA, 300 pregnant women and 750 mothers in Cape Town and Johannesburg kept marketing diaries for a week and took part in focus group discussions, and 40 health workers from the public and private sectors were interviewed.

The global abuses revealed include:

• unregulated and invasive online targeting;
• sponsored advice networks and helplines;
• promotions and free gifts; and
• influencing the training of health workers and the recommendations they make.

“Many women express the desire to breastfeed, yet a sustained flow of strategic and persuasive marketing messages undermines their confidence in breastfeeding and in themselves.

“Relationships of trust, in particular those between health professionals and parents, are manipulated by formula milk companies, who incentivise and often unwittingly co-opt health professionals to endorse and promote their products,” says the report.

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 defence against all forms of child malnutrition, including wasting and obesity, the report stated.

“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 younger than six months 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 messages parents and health workers receive are often misleading, scientifically unsubstantiated and violate the International Code of Marketing of Breast Milk Substitutes. This landmark public health agreement was passed by the World Health Assembly in 1981 to protect mothers from aggressive marketing practices by the baby food industry,” says the report.

“This report shows very clearly that formula milk marketing remains unacceptably pervasive, misleading and aggressive,” said WHO director-general Dr Tedros Adhanom Ghebreyesus.

“Regulations on exploitative marketing must be urgently adopted and enforced to protect children’s health.”

The report revealed the marketing of infant formula to be less pervasive in SA than in other countries which took part in the research because the country has legislation — R991 — which prohibits the marketing of formula to children under the age of three.

“But there is no such barrier to the marketing of so-called ‘stage 4’ milks,” said Tanya Doherty, professor in the Health Systems Research Unit at the SA Medical Research Council (SAMRC) and an adviser to the WHO on the local research.

“So we have widespread marketing of those ‘follow on’ milks and as a result brand recognition of all the formula products is high,” she said.

While R991 was rigorously enforced in the public sector, that wasn’t the case in private hospitals.

“None of the public sector healthcare workers said they had direct contact with formula reps in hospitals, and there are no displays of formula tins to be seen. But it’s a very different story in private hospitals. Reps for the companies visit monthly to meet with neonatal ward staff, and they attend conferences sponsored by the formula manufacturers,” Doherty said.

“As a result, the staff repeat the companies’ marketing claims, and believe formula is a necessity immediately after birth.

“Giving newborns top-up feeds of formula is normal in post-natal wards, which dramatically reduces the likelihood of the mother being able to breastfeed successfully and diminishes her confidence.

“Mothers are led to believe their breastmilk is not enough for their baby in the first few days, that they will not gain enough weight, and that it will not prevent them from getting colic, she said.

“It’s seen as a solution to normal newborn issues — a crying, hungry baby.”

Less than half of the healthcare workers surveyed for the report had heard of R991, Doherty said.

Doherty and her colleagues proposed that the packaging of the products be restricted.

“The use of words such as 'Opti', 'Supreme', 'Pro-Advance' in brand names, and lots of gold along with terms that relate to human milk, create the impression of superiority, which is not justified,” Doherty said.

“We are not about taking formula off the shelves. There is clearly a need for the product.

“We want to make sure consumers are not being coerced to buy things that are not necessary,” Doherty said.

Dieticians advise that children can be given cow’s milk from the age of 12 months.

The report concludes: “All sectors of government including health, labour and trade, health professionals and their associations, investors and those with economic leverage should fulfil their responsibilities and exert their influence to insist on practices that prioritise children and parents over commercial interests.”

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