In the middle of May, delegations from member states of the World Health Organization logged into the first virtual meeting of the World Health Assembly, WHO’s decision-making body, for a shortened agenda. Unsurprisingly, the meeting focused almost exclusively on COVID-19.
As WHA reconvenes this week, it is expected to take up an issue that requires urgent attention, particularly during the time of COVID-19: the digital marketing of breast milk substitutes, or BMS.
The need for this discussion is urgent. Every year, hundreds of thousands of children and mothers die due to inadequate breastfeeding. And research suggests that in the middle of the pandemic — as has occurred during past health crises — mothers and other caregivers who are concerned about the health of their children are having their fears played on. It’s hardly surprising; the BMS industry has seen annual growth of about 8%, and the global market for BMS products was forecast to reach $71 billion in 2019.
The industry is not shy about leveraging opportunities to sell the products. The Bureau of Investigative Journalism reported in July that in Indonesia, Nestlé formula brand Dancow ran ads featuring tag lines such as “Bunda, Lindungi Si Buah Hati” — or “Mother, protect your sweetheart” — next to images of children drinking formula. It’s galling to see companies up to old tricks, which violate the spirit — if not the letter — of the International Code of Marketing of Breast-milk Substitutes, adopted by WHA in 1981.
Multiple forms of misinformation are causing women to avoid breastfeeding during the pandemic — an outcome that United Nations agencies and NGOs are working to reverse.
Guidance against breastfeeding due to COVID-19 transmission fears, issued early in the pandemic by various national centers of disease control, has not helped the situation. WHO guidance is clear, however, that nursing mothers should not be separated from babies. This was reminiscent of similar guidance issued during the HIV/AIDS epidemic. And as if it needed any more favorable press, preliminary research suggests breast milk helps fend off COVID-19.
The scale of the issue
According to research on the impact of BMS marketing, such promotion not only discourages breastfeeding, but imposes a heavy triple blow on the nutrition of mothers and children. As well as depriving infants and mothers of breastfeeding’s clear health benefits, it imposes costs on families and health systems, as illustrated by an online tool on the cost of not breastfeeding.
Recent research, however, suggests the need to address BMS marketing on social media is even more urgent. A revealing paper in the Globalization and Health journal suggests that BMS companies are using ever more sophisticated measures — such as on social media platforms — to promote their products. In the research, BMS company insiders — former marketing executives — explain how they are able to use social media to reach mothers with BMS promotion.
But despite being promulgated in an age when a “facebook” was an actual book and “Instagram” would have probably referred to a faster telegram, the international code applies to social media. David Clark, UNICEF’s expert on the code, said in a recent interview that when it was drafted in 1981, it was very clear the code applied to any type of promotion — and that this is wide enough to cover social media.
Calls to action for WHA
The results showed one case of the virus found in the vaginal mucosa, one case found in breast milk, and two cases where babies tested positive for the virus via nasopharyngeal swabs, according to one of the study leads.
WHA needs to act decisively and send a clear message to member states and to companies: These promotions are wrong and must be stopped. The meeting should highlight the harmful practices and violations of the international code and call for member states to enforce laws on curbing this marketing where such regulations exist and to pass relevant laws where they do not.
To date, progress on enforcing the BMS code has been anemic. Only 32 countries have the monitoring and enforcement mechanisms to ensure compliance with regulations, and even fewer report that their mechanisms are functional.
In June, a number of stakeholders issued a call to action — signed by FHI Solutions, which manages Alive & Thrive — for BMS companies to commit to respecting the code. The profits to be had are obviously incredibly attractive, so governments and civil society at the same time need to work strenuously to promote breastfeeding — and enforcement of the BMS code.
We will continue to work around the world to improve the nutrition of mothers and children. But now, more than ever, we need WHA to act on the digital marketing of BMS that is causing serious harm to millions of children and mothers around the world.