The impact of marketing on infant feeding decisions and practices

February 2022

This report by the WHO and UNICEF draws insights from parents and health professionals across eight countries and uncovers systematic and unethical marketing strategies used by the infant formula industry, including here in the UK.

The UK Committee for UNICEF (UNICEF UK) Baby Friendly Initiative welcomes this global insight into how the $55billion infant formula industry uses pervasive, personalised and powerful methods to target parents and manipulate scientific claims to promote their products whilst undermining parents’ confidence.

‘How marketing of formula milk influences our decisions on infant feeding’  found that infant formula companies:

• use a range of tactics to relentlessly engage women through online and offline channels and platforms
• use manipulative marketing tactics that exploit parents’ anxieties and aspirations
• distort science and medicine to legitimise their claims and push their products
• systematically target health professionals – whose recommendations are influential.

Background

Since its development in 1991, the Baby Friendly Hospital Initiative (BFHI) has worked with health care services to improve care for all babies, their mothers and families. The initiative requires that Baby Friendly accredited services adhere to the WHO International Code of Marketing of Breastmilk Substitutes (the Code) in order to regulate the marketing of breastmilk substitutes and the harmful effects this was having on babies’ short- and long-term health.

The UK context

In the UK, the UNICEF UK Baby Friendly Initiative is working in maternity, neonatal, community and university settings to ensure healthcare professionals are equipped with the knowledge and skills to protect parents from the misleading marketing of infant formula companies. Thanks to the National Infant Feeding Network (NIFN) and NHS staff, this has been largely successful, and in this study ‘the majority of health professionals who were interviewed in the UK vehemently opposed the marketing of formula milk’ (p17). The UNICEF UK Baby Friendly Initiative advocates for all parents, irrespective of feeding method, to be equipped with evidence-based information upon which to make an informed choice about how to feed and care for their babies so that they can get the best possible start in life.

However, this research highlights that over half of all parents and pregnant women surveyed (84% in the UK) reported that they had been targeted with marketing from infant formula companies, including through online and offline channels and platforms outside of the health care system.

For example, findings from the report showed that in the UK ‘each of the four biggest formula brands have established baby clubs and 24/7 carelines targeted at pregnant women, mothers and fathers’, with one company providing ‘a COVID-19-specific baby club, positioning itself as offering support and advice during “uncertain times”’(p15). These clubs can influence parents’ awareness of – and receptivity to – infant formula companies and brands in a way that is personalised and misleading.

This report highlights again how infant formula companies spend billions on sophisticated and often confusing marketing in order to encourage women not to breastfeed or to stop breastfeeding before they want, and to use an array of different, expensive infant formula products as soon as possible for as long as possible. The research shows that the marketing practices of the infant formula industry systematically disrupts informed decision-making, thereby compromising the health and human rights of parents and children.

Anna Kettley, Deputy Executive Director for Advocacy, Safeguarding and Programmes at the UK Committee for UNICEF (UNICEF UK) said, “This report is about how powerful multi-national infant formula companies push the boundaries of existing legislation to promote their products, not about how parents choose to feed their babies.

We need to make sure all babies and parents are protected from commercial interests and misleading marketing practices. UNICEF UK recognises the challenges parents continue to face, in particular as a result of the pandemic, and hopes the recommendations in this report will help to strengthen the UK law to protect babies, their mothers and families and to ensure that all parents are supported to give their baby the best start in life.

Babies are extremely vulnerable and how they are fed in the first months of life can have a profound effect on their short- and long-term health. The WHO and UNICEF recommend that counter measures are urgently needed from governments, health professionals, the baby food industry and society in order to end this unethical marketing of infant formula products and to prioritise children and families over commercial interests. Recommendations include:

• Passing, monitoring and enforcing laws to prevent the promotion of infant formula in line with the Code, including prohibiting nutrition and health claims made by the infant formula companies
• Investing in policies and programmes to support infant feeding
• Requesting industry to publicly commit to full compliance with the Code and subsequent World Health Assembly resolutions globally
• Prohibiting health workers from accepting sponsorship from companies that market foods for infants and young children for scholarships, awards, grants, meetings, or events.

Access the full report here.

Further Information

The UK Law

The UK regulates the marketing of breastmilk substitutes through the Infant Formula and Follow-on Formula Regulations 2007 and accompanying guidance notes which are designed to help with interpretation of the law. The regulations implement the European Commission Directive 2006/141/EC which is intended to ‘give effect to the principles and aims of the WHO Code’. The UK regulations are intended to ‘regulate labelling and restrict advertising and presentation of infant and follow-on formula so as not to discourage breastfeeding’. However, they are not as robust as the Code and so the companies find ways around the law. One of the biggest weaknesses is that, while the Code considers follow on formula (i.e. milk marketed for babies over six months) as a breastmilk substitute, the UK law does not. This allows the companies to advertise their brand name and logos on TV, online in magazines and elsewhere.

Baby Friendly in the UK

Services working towards Baby Friendly accreditation are required to adhere to the International Code of Marketing of Breastmilk Substitutes (the Code) and must ensure that there is no advertising of infant formula, bottles, teats or solid food for babies under six months old to mothers and their families. This requirement is intended to restrict the influence of commercial interests related to infant feeding. It does not in any way prohibit the provision of factual information about bottle feeding or introducing solid food or require that mothers who bottle feed be denied information or care. It is intended to ensure that all parents, whichever way they feed their baby, have access to accurate and effective information free from the influence of marketing campaigns designed to protect profits rather than babies.

We work with health professionals to support all parents who formula feed by providing information on making up feeds and feeding responsively and as safely as possible and how feeding can be a source of not only nutrition, but also of love, comfort and reassurance between babies and parents. Crucially, we support health professionals to provide compassionate, non-judgemental and mother-centred support.