Infant formula manufacturers have used predatory marketing tactics to prey on the fears of new parents for decades—to the tune of billions of dollars annually, according to a new series in The Lancet, backed by the World Health Organization.
Such companies strive to keep the formula industry under-regulated and breastfeeding resources under-supported. Some have even lobbied against proposed breastfeeding protections and improved parental leave programs, which could help facilitate breastfeeding, The Lancet wrote in an editorial prefacing its 2023 series on breastfeeding.
The result: Fewer than half of babies worldwide are breastfed per WHO recommendations, “resulting in economic losses of nearly $350 billion each year,” according to the medical journal.
Meanwhile, the industry rakes in around $55 billion each year and spends about $3 billion on marketing—despite an international code adopted by the WHO’s decision-making body in 1981 that prohibits the marketing of such formulas in the majority of instances.
“This new research highlights the vast economic and political power of the big formula milk companies, as well as serious public policy failures that prevent millions of women from breastfeeding their children,” said Dr. Nigel Rollins, WHO scientist and author of one of the papers, in a WHO press release regarding the series.
“Actions are needed across different areas of society to better support mothers to breastfeed for as long as they want, alongside efforts to tackle exploitative formula milk marketing once and for all.”
Among other “stark” assertions made in the series:
- Crying, fussiness, and poor nighttime sleeping among babies is “developmentally appropriate,” but baselessly portrayed by the formula industry as signs of a medical issue that formula can rectify.
“The formula milk industry uses poor science to suggest, with little supporting evidence, that their products are solutions to common infant health and developmental challenges,” said Linda Richter, a professor at the University of the Witwatersrand in South Africa, in the press release. “This marketing technique clearly violates the 1981 code, which says labels should not idealize the use of formula to sell more product.”
- Manufacturers circumvent and outright ignore the international code prohibiting most infant formula marketing by creating “follow on” toddler formulas and “growing up” milks that they promote in an attempt to create brand loyalty.
- Formula manufacturers have used gender politics to frame formula as a “convenient and empowering solution for working mothers,” while lobbying against federal paid leave programs.
- The industry has promoted the notion that breast milk provides insufficient nutrition, even among healthcare professionals who guide the decisions of parents. It has done so via the funding of research, advertising in scientific journals, and conference sponsorship, among other tactics.
The series is “a call for companies … to act with greater social responsibility,” as well as for governments to “correct for market failures,” Dr. Jay Varma, chief medical adviser at the New York-based think tank Kroll Institute, tells Fortune.
“When the market is too heavily tilted in a way to harm public health, it’s important for governments to push back a bit,” he says, as they do via campaigns to promote fruit and vegetable consumption amid markets saturated with unhealthy food choices. “We need to have some of that push-back, potentially in the form of regulation to protect babies.”
Oblivious to the benefits of breastfeeding
The new series sheds light on an industry influencing the decisions of parents and even healthcare providers to a largely unrealized extent, Dr. Jessica Nash, a pediatrician who specializes in breastfeeding at Children’s National Hospital in Washington, D.C., tells Fortune.
The infant formula industry is “embedded everywhere, with marketing and quotes that undermine breastfeeding efforts,” she says. “As we move health and families forward, we now have to ensure families understand that the ‘innocent’ pictures of baby faces on jars, and formula names on bags given in birthing hospitals, can change or influence families’ decisions.”
She recalls receiving bags during medical school, and lanyards at medical conferences, that had formula names on them, leaving those brands “engrained into practice” when she emerged as a doctor. She wonders how many other doctors were incorrectly trained to think that formula and breastmilk are equally beneficial to babies.
With so many medical providers oblivious to the benefits of breast milk, she figures myriad more parents are as well, thanks to the deeply entrenched marketing of so-called “Big Formula.”
“A lot of people breastfeed and don’t even know the benefits,” she says. They “aren’t even aware that they’re lowering their risk of ovarian cancer, and decreasing their child’s risk of obesity and asthma.”
She worries that efforts to promote breastfeeding simply don’t have the multibillion dollar budgets that formula manufacturers do.
“I’ve gone to conferences and I’ve tried to figure out, what is the solution?” she says. “What industry has the money to spend billions on marketing breastfeeding to counteract this?”
Nash is mother to a formula-fed baby who spent time in the NICU, and there’s nothing wrong with formula-feeding, she says. “But I think people also need to understand that you get to choose, and that you should make a very informed decision based on the evidence, versus making a decision based on convenience.”
Whether to breastfeed is a personal choice—and not all women are able to, the series points out, adding that mothers’ choices should be supported, especially for mental health reasons.
But “all information that families receive on infant feeding must be accurate and independent of industry influence to ensure informed decision-making,” the authors insist, adding that marketing by the industry is an “interconnected, multifaceted, powerful system that knowingly exploits parents’ aspirations.”
Misleading claims about formula made by manufacturers amount to misinformation, which governments “have a duty to tackle” under the 1989 United Nations Convention of the Rights of the Child, they add.
Breastfeeding is “one of the most effective ways to ensure child health and survival,” according to the WHO, which calls breast milk “the ideal food for infants.” Breast milk contains antibodies that protect against many common childhood illnesses and provides all nutrients needed for an infant’s first months of life. It provides around half of a child’s nutritional needs for the second half of the first year of life, and up to a third of nutritional needs during a child’s second year of life.
Fortune reached out to a number of leading infant formula manufacturers Tuesday, after The Lancet’s publication of the series, requesting comment. As of Wednesday evening, it had not heard back from any of them.
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