The baby formula industry has been working hard to convince mothers to choose formula over healthy breast milk.

For decades, the commercial milk formula (CMF) industry has used underhand marketing strategies, designed to prey on parents’ fears and concerns at a vulnerable time, to turn the feeding of young children into a multibillion-dollar business. The immense economic power accrued by CMF manufacturers is deployed politically to ensure the industry is under-regulated and services supporting breastfeeding are under-resourced. These are the stark findings of the 2023 Breastfeeding Series, published in The Lancet today.

The three-paper Series outlines how typical infant behaviours such as crying, fussiness, and poor night-time sleep are portrayed by the CMF industry as pathological and framed as reasons to introduce formula, when in fact these behaviours are common and developmentally appropriate. However, manufacturers claim their products can alleviate discomfort or improve night-time sleep, and also infer that formula can enhance brain development and improve intelligence – all of which are unsubstantiated.

Infant feeding is further commodified by cross-promotion of infant, follow-on, toddler, and growing-up milks using the same branding and numbered progression, which aims to build brand loyalty and is a blatant attempt to circumvent legislation that prohibits advertising of infant formula.

Breastfeeding has proven health benefits across high-income and low-income settings alike: it reduces childhood infectious diseases, mortality, and malnutrition, and the risk of later obesity; mothers who breastfeed have decreased risk of breast and ovarian cancers, type 2 diabetes, and cardiovascular disease. However, less than 50% of babies worldwide are breastfed according to WHO recommendations, resulting in economic losses of nearly US$350 billion each year. Meanwhile, the CMF industry generates revenues of about $55 billion annually, with about $3 billion spent on marketing activities every year.

The industry’s dubious marketing practices are compounded by lobbying, often covertly via trade associations and front groups, against strengthening breastfeeding protection laws and challenging food standard regulations. In 1981, the World Health Assembly adopted the International Code of Marketing of Breast-milk Substitutes, a set of standards to prevent inappropriate marketing of formula. It includes prohibition of advertising of CMF to the public or promotion within health-care systems; banning provision of free samples to mothers, health-care workers, and health facilities; no promotion of formula within health services; and no sponsorship of health professionals or scientific meetings by the CMF industry. However, despite repeated calls for governments to incorporate the Code’s recommendations into legislation, only 32 countries have legal measures that substantially align with the Code. A further 41 countries have legislation that moderately aligns with the Code and 50 have no legal measures at all. As a result, the Code is regularly flouted without penalty.

The prioritisation of trade interests over health was brought to the forefront in 2018, when US officials threatened to enforce trade sanctions and withdraw military aid to Ecuador unless it dropped a proposed resolution at the World Health Assembly to protect and promote breastfeeding. Some CMF lobby groups have cautioned against improved parental leave. Duration of paid maternity leave is correlated with breastfeeding prevalence and duration, and absence of, or inadequate, paid leave forces many mothers to return to work soon after childbirth. Lack of safe spaces for breastfeeding or expressing milk in workplaces, or facilities to store breastmilk, mean that breastfeeding is not a viable option for many women.

Some women choose not to breastfeed, or are unable to. Perceived pressure, or inability, to breastfeed – especially if it is at odds with a mother’s wishes – can have a detrimental effect on mental health, and systems should be in place to fully support all mothers in their choices. Women and families make decisions about infant feeding based on the information they receive, and a criticism of the CMF industry’s predatory marketing practices should not be interpreted as a criticism of women. All information that families receive on infant feeding must be accurate and independent of industry influence to ensure informed decision making. Marketing by the CMF industry is an interconnected, multifaceted, powerful system that knowingly exploits parents’ aspirations. Under the Convention of the Rights of the Child, governments have a duty to tackle misinformation – and governments need to embrace the breastfeeding Code without further delay to ensure that manufacturers making misleading claims about their products are held to account.

Original source: https://www.thelancet.com


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