WHO sounds alarm on 'unethical,' 'aggressive' formula milk marketing

Countries need to toughen up their laws to combat companies’ “aggressive” baby formula marketing, according to the World Health Organization as a new report reveals the industry’s pervasive marketing tactics promoting formula milk over breastfeeding across eight countries.

Formula milk companies’ marketing strategies continue to be in breach of international standards, “unethical,” and misuse science by conveying misleading messaging on the benefits of formula milk, according to the report commissioned by WHO and UNICEF, published Wednesday. It details the different ways the industry influences mothers’ choices, increasingly via digital platforms, as well as health professionals to recommend formula feeding.

In the United Kingdom and China, companies employ the help of digital influencers to promote their products. Companies giving out free samples of formula milk to mothers, including inside hospitals and by health professionals, is also evident across the eight countries surveyed.

In other cases, companies also use promos, discounts and gifts to promote their products and entice consumers, as well as organize “baby clubs” that offer parents “access to ‘carelines’” providing 24/7 support and advice. “Interviews demonstrate that these clubs can influence women’s awareness of, and receptivity to, formula milk companies and brands,” the report states.

Companies also use marketing language that positions formula milk as similar or superior to breast milk, or convey the message that breastmilk alone is insufficient to meet children’s nutritional needs. Company representatives also attempt to influence health professionals through a range of incentives, such as research funding, sales commissions, and all-expense paid trips, according to the report.

The report is based on a survey of 8,500 parents and pregnant women, as well as 300 health workers in urban areas in Bangladesh, China, Mexico, Morocco, Nigeria, South Africa, the United Kingdom, and Vietnam. More than half of the parents and pregnant women surveyed said they’ve been targeted with formula milk marketing. WHO did not name any company in the report but said there were no major differences between companies’ marketing practices.

WHO says the report is not about calling for the removal of formula milk from supermarkets, or in limiting mothers and families’ access to formula milk, as there are women who need or choose formula milk for a number of reasons. But it aims to highlight the industry’s “disruptive and manipulative” marketing strategies, which has an impact on a child’s health as well as that of their mothers.

According to the U.N. agency, exclusive breastfeeding of infants for their first six months of life, and continued breastfeeding for up to two years and beyond, help prevent children from suffering from all forms of malnutrition, and protect them from many childhood illnesses. It also reduces mothers’ risk of diabetes, obesity, and some forms of cancer such as breast and ovarian cancer.

But there’s also a human rights aspect. Dr. Nigel Rollins, a scientist at WHO’s Department of Maternal, Newborn, Child and Adolescent Health, said in a press briefing ahead of the report’s launch that families have the right to have access to “impartial, objective, truthful information and support” under the U.N. Convention on the Rights of the Child. However, “what we see in the marketing is just how that access is disrupted, and often manipulated.”

The World Health Assembly has also agreed against the aggressive and inappropriate marketing of breast milk substitutes, under the International Code of Marketing of Breast-milk Substitutes, passed in 1981, and subsequent WHA resolutions.

But while global breastfeeding rates have increased in the past two decades, sales of formula milk have also more than doubled during this period, with the industry now worth $55 billion, according to a news release. Only 44% of babies less than six months old are exclusively breastfed globally. And based on analysis done by WHO and UNICEF, only 25 countries have legislation “substantially aligned” with the International Code of Marketing of Breast-milk Substitutes.

“What that means is that seven out of eight countries have loopholes in their legislation that [are] not aligned with what's been agreed upon internationally. So the companies say that they are abiding by the law, but there are many loopholes in those laws that let them get around it,” said Dr. Laurence Grummer-Strawn, unit head of the WHO Department of Nutrition and Food Safety.

WHO and UNICEF have been in dialogue with the largest formula milk manufacturers for years, and in 2020 collaborated with several NGOs to ask companies to commit to complying with the International Code of Marketing of Breast-milk Substitutes over the next decade.

However, Grummer-Strawn said the response was disappointing. Seventeen companies responded to the call, but only two were willing to commit to comply with the code. The road map the two companies gave to achieve that however was “very vague,” and they cover less than 1% of the global formula milk market.

“So the large players really were not willing to make a commitment that even over a long period of time they would change their practices in this direction,” said Grummer-Strawn.

Patti Rundall, policy director of the International Baby Food Action Network Global Council, said in an emailed response to Devex that as none of the companies are willing to abide by the International Code of Marketing of Breast-milk Substitutes and subsequent resolutions voluntarily, “there is no point chasing after them for watered down promises.”

She said governments need to recognize the “extent and influence of corporations” that goes beyond formula promotion, and ensure that policies are free from commercial influence. But it is also important that member states as well as civil society are able to present evidence, every two years, to the World Health Assembly and that new resolutions are adopted to keep pace with industry marketing tactics.

She said WHO needs to expand its policy on conflicts of interest, making sure that industries that produce “health harming products are excluded,” and she warned against the idea of “rewriting” the international code.

While she was not surprised with the industry marketing strategies detailed in the report, she said she was “very very pleased that WHO is doing work that goes deeper than the accepted marketing tactics.”

“Marketing evolves with time and [it’s] critically important that policy makers understand their extent and how to control and minimise the risks,” she said.