That is amongst the findings of the 2023 Lancet Series on Breastfeeding, which comprises three papers launched in South Africa on 10 February and within the UK on 8 February.
The Series interrogates baby formula corporations’ exploitative marketing playbook and the business formula lobby.
It highlights the economic and political power of the dominant formula corporations and the general public policy failures that lead to thousands and thousands of ladies not breastfeeding as beneficial.
In a novel evaluation, the Series describes how profits made by the formula milk industry profit corporations situated in high-income countries while the social, economic, and environmental harms are widely distributed and most harmful in low- and middle-income countries, resembling South Africa.
Milking mothers’ misery
The Series outlines the exploitative marketing playbook utilized by formula corporations to sell their products, including making the most of parents’ worries about their child’s health and development.
One common reason women introduce formula is that they misinterpret unsettled baby behavior, especially disrupted sleep and chronic crying in the primary few months of life, as signs that their breast milk is insufficient.
Nevertheless, sleep patterns of babies aren’t similar to for adults and unsettled baby behaviors are common adaptations to life outside of the womb.
When moms are appropriately supported, concerns may be addressed successfully without the usage of formula milk.
Linda Richter is a Distinguished Professor within the Department of Science and Innovation (DSI)-National Research Foundation (NRF) Centre of Excellence for Human Development (CoE: Human) at Wits University and co-author on paper 1 and paper 2 of the Series. Richter is one among only three contributors from Africa, together with Lancet issue Commentary co-author Dr Chantell Witten on the University of the Western Cape, and Series co-author Dr Kopano Mabaso, Senior Programme Officer, Health, Africa, on the Bill & Melinda Gates Foundation.
Richter says, “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. Adverts claim specialized formulas alleviate fussiness, help with colic, extend night-time sleep, and even encourage superior intelligence. Labels use words like ‘brain’, ‘neuro’ and ‘IQ’ with images highlighting early development, but studies show no good thing about these product ingredients on academic performance or long-term cognition. These marketing techniques violate the 1981 World Health Organization International Code of Marketing of Breastmilk Substitutes, to which countries agree that labels mustn’t idealize the usage of formula, nor exploit poor science to create an unfaithful story to sell more product.”
‘The Baby Killer’ and the Code
The 1981 Code to which Richter refers demonstrates that exploitative formula milk marketing tactics aren’t latest. A Nineteen Seventies The Baby Killer investigative report into Nestlé’s marketing of formula milk within the Global South prompted the World Health Organization (WHO) to develop the voluntary International Code of Marketing of Breast-milk Substitutes and subsequent resolutions (the Code) in 1981 – the important thing word being ‘voluntary’.
Nevertheless, the powerful influence of the formula industry, and the marketing of their products in violation of the Code, continues into the twenty first Century and much more insidiously with digital social media and artificial intelligence to focus on individual women. Sales from business formula milk have rapidly increased over the past 20 years and now stand at greater than $55 billion a 12 months.
A latest review of 153 studies, conducted for the Series, details how marketing practices in violation of the Code have continued in nearly 100 countries – including South Africa – and in every region of the world since its (voluntary) adoption greater than forty years ago.
This continued exploitation persists resulting from the facility of the formula industry to influence national political decisions and to interfere with international and national regulatory processes.
The formula milk lobby
The Series also draws attention to the formula industry’s establishment of a network of trade associations and front groups that lobby against the Code and other breastfeeding protection measures.
For instance, in 2012, South Africa passed latest national laws to implement the Code into law. Nevertheless, this took nine years with many setbacks resulting from industry lobbying. Formula milk manufacturers formed a latest lobby group, the Infant Feeding Association, which applied pressure for amendments to the regulations.
This outsourcing of lobbying allows the companies to project a picture of benevolence and company social responsibility, suggesting that they’ll adequately self-regulate through corporate policies on responsible marketing. Nevertheless, their self-regulation falls far in need of compliance to the Code.
In addition to influencing political organizations, the Series authors argue that formula milk corporations also draw on the credibility of science by sponsoring skilled organizations, publishing sponsored articles in scientific journals, and welcoming leaders in public health onto advisory boards and committees, resulting in unacceptable conflicts of interest inside public health.
Creating an enabling environment for moms to optimally breastfeed their babies needs a whole-of-society approach, with stronger monitoring and enforcement of our regulations to manage the marketing of formula milks for kids.”
Dr Chantell Witten, Co-Creator on the Commentary, Centre of Excellence in Food Security, University of the Western Cape
Society-wide changes needed
Along with ending the marketing tactics and industry influence of formula milk corporations, broader actions across workplaces, healthcare, governments, and communities are needed to more effectively support women who wish to breastfeed, in response to the Series.
Half a billion working women globally aren’t entitled to adequate maternity leave. A scientific review of studies found women with a minimum of three months maternity leave, paid or unpaid, were at the least 50% more more likely to proceed breastfeeding in comparison with women returning to work inside three months of giving birth.
The Series authors call for governments and workplaces to acknowledge the worth of breastfeeding and care work, by actions resembling extending the duration of paid maternity leave to align with the six month WHO beneficial duration of exclusive breastfeeding.
Women also face a scarcity of breastfeeding promotion, protection and support inside healthcare systems resulting from limited public budgets, adequate training of and expert support by health staff, influence from the milk formula industry including through the distribution of samples, and an absence of care that’s culturally appropriate and led by the needs of ladies.
Authors argue that breastfeeding outcomes improve when health systems actively empower women and enable experienced peers to support women while pregnant, childbirth and onwards.
Breastfeeding a collective responsibility of society
The Series authors stress that breastfeeding is a collective responsibility of society and call for more practical promotion, support, and protection for breastfeeding, including a a lot better trained healthcare workforce and a world legal treaty to finish exploitative formula milk marketing and prohibit political lobbying.
A linked Editorial published within the The Lancet states:
“Some women select to not breastfeed or are unable to. Perceived pressure, or inability, to breastfeed – especially whether it is at odds with a mother’s wishes – can have a detrimental effect on mental health, and systems needs to be in place to completely support all moms of their selections.
Women and families make decisions about infant feeding based on the knowledge they receive, and a criticism of the CMF [Commercial Milk Formula] industry’s predatory marketing practices mustn’t be interpreted as a criticism of ladies.
All information that families receive on infant feeding should be accurate and independent of industry influence to make sure informed decision making.”
Source:
University of the Witwatersrand
Journal reference:
Rollins, N., et al. (2023) Marketing of economic milk formula: a system to capture parents, communities, science, and policy. The Lancet. doi.org/10.1016/S0140-6736(22)01931-6.