Intended for healthcare professionals


Formula milk industry “misuses and distorts” information to manipulate parents, says report

BMJ 2022; 376 doi: (Published 23 February 2022) Cite this as: BMJ 2022;376:o433
  1. Elisabeth Mahase
  1. The BMJ

Formula milk companies have used manipulative marketing tactics to exploit parents’ anxieties and undermine their confidence in breastfeeding, says a damning report commissioned by the World Health Organization and the United Nations Children’s Fund (Unicef).1

The report assessed the influence of formula companies over two years in eight countries: Bangladesh, China, Mexico, Morocco, Nigeria, South Africa, the UK, and Vietnam. It included feedback from more than 8500 pregnant women and mothers, 300 health professionals, and partners, family members, and friends.

“Across all eight countries, marketing practises actively seek to influence women’s and families’ infant and young child feeding decisions,” the report said. “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.”

It found that relationships of trust between health professionals and parents had been manipulated by formula milk companies “who incentivise and often unwittingly co-opt health professionals to endorse and promote their products.” Companies also played on parents’ fears during the covid-19 pandemic to “sow doubt and enhance sales,” the report said.

WHO has said that the feeding practices of children in their first three years of life profoundly affect their long term survival, health, and development. It said that increasing uptake of breastfeeding could prevent an estimated 800 000 deaths of children under 5 and prevent 20 000 breast cancer deaths among mothers each year.

Distorting the science

In the countries studied, self-reported exposure to marketing (seeing or hearing formula milk messaging) was highest among women in urban China (97%), Vietnam (92%), and the UK (84%). The authors noted that in these countries the marketing was “ubiquitous, aggressive and carried out through multiple channels.”

The report also highlighted that companies had been distorting the science to legitimise marketing their claims, including making false or incomplete scientific claims and positioning formula “as close to, equivalent or superior to breast milk” despite evidence to the contrary.

It found that ingredients such as human milk oligosaccharides (HMOs) and docosahexaenoic acid (DHA) were being advertised as “informed” or “derived” from breast milk and linked to child developmental outcomes—claims unsupported by the evidence cited by the companies.

Undermining confidence

In all of the countries assessed, the researchers said that women expressed a strong desire to breastfeed exclusively, ranging from 49% in Morocco to 98% in Bangladesh.

But this was undermined by a “sustained flow of strategic and persuasive marketing messages,” which led to many women expressing fears and doubts about breastfeeding that mirrored the themes of the marketing. These messages were found to reinforce common myths, including 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 the quality of breast milk declining over time.

“The need for society and governments to call out the unethical nature of formula milk marketing to a much broader audience, and to take decisive action to end this marketing and increase support to mothers and families is long overdue,” the report said. “Doing so will inevitably unnerve the vested interests of this US$55bn [£40.1bn; €48.6bn] industry and the shareholders and stakeholders who benefit from increasing sales.”

The authors urged countries to take immediate action, including:

  • Fully recognising and exposing the “pervasive and invasive nature” of formula milk marketing and the harm it causes

  • Urgently adopting or strengthening comprehensive national mechanisms to prevent formula milk marketing

  • Developing enforceable regulations that protect child health and development from harmful commercial marketing, and

  • Scaling up investments in wide ranging measures to support mothers and families, including support for breastfeeding and health systems, as well as maternity and parental leave.

It also called on health professionals and their associations to implement strong policies on conflicts of interest to help prevent corporate interests from influencing critical health guidance and training on feeding infants and young children.

In 2019 The BMJ announced that it would no longer carry advertisements for breast milk substitutes, citing concerns over their “aggressive promotion” and the “harmful effect on global rates of breastfeeding.”2


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