Experts call for an end to the exploitative marketing used by the commercial milk formula industry following 2023 Lancet Series on Breastfeeding launch

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The Lancet Series Launch 2023 with image of a man and woman with the woman breastfeeding

Professor Amandine Garde, Director of the Law & NCD Research Unit at Liverpool Law School, has contributed to the 2023 Lancet Series on Breastfeeding, which is being launched today in London and explores how breastfeeding is undervalued and underinvested in by governments and public health, and how the vulnerabilities of women and children are exploited by the commercial milk formula industry.

Formula milk marketing tactics are exploitative, and regulations need to be urgently strengthened and properly implemented according to a new three Paper Series published in The Lancet, launched today, which calls for more effective breastfeeding support worldwide.

As Professor Nigel Rollins points out in the editorial accompanying the launch of the Series:

“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 Lancet Series found society, politics, and economics all contributed to why fewer than half of infants and young children globally are breastfed as recommended by World Health Organization (WHO). Authors are appealing for breastfeeding to be society’s collective responsibility and for it to be effectively promoted, supported, and protected.

The Lancet Series was written by an interdisciplinary team of 25 colleagues from around the world. Professor Amandine Garde, Director of the Law & NCD Research Unit at the University of Liverpool, co-authored the third Paper in the Series, which provides insight on how power imbalances, and political and economic structures, determine feeding practices and health outcomes.

The commercial milk formula industry

The global formula milk market is dominated by a small number of trans-national corporations with considerable economic power that is used to drive up demand using a sophisticated marketing playbook, made more influential and dynamic through digital platforms and technology, and also includes political lobbying and interference with international regulatory processes.

The marketing tactics of formula milk companies include exploiting the emotions and aspirations of parents, and using misleading and false claims to generate sales at the expense of the health and rights of women and children. Formula milk companies in all regions regularly violate the International Code of Marketing of Breast-Milk Substitutes and subsequent Resolutions. Furthermore, the formula milk industry engages in lobbying to block implementation and enforcement of the WHO’s Code.

This outsourcing of lobbying has allowed the corporations themselves to project an image of benevolence and corporate social responsibility, suggesting that they can adequately self-regulate through corporate policies on responsible marketing. However, their self-regulation falls far short of compliance to the Code.

Speaking of the research findings in the Series, Professor Amandine Garde says:

“Over the years, the commercial milk formula industry has grown rapidly through market expansion and product diversification. Such economic power, facilitated by the deployment of aggressive marketing strategies, has translated into increased political power, which the industry has used to opposed legitimate regulation to the detriment of public health, sustainable development and human rights. In this Series, we expose these strategies and argue that States must effectively regulate the commercial milk formula industry to comply with their legally binding obligations to respect, protect and fulfil human rights, and particularly the right to the enjoyment of the highest attainable standard of health and the right to sufficient, nutritious, adequate food. It is only then that women will be in a position to genuinely choose how they feed their young children.”

As well as influencing political organisations, the authors of this Lancet Series argue formula milk companies also draw on the credibility of science by sponsoring professional organisations, publishing sponsored articles in scientific journals, and inviting leaders in public health onto advisory boards and committees, leading to unacceptable conflicts of interest within public health.

Society-wide changes needed

In addition to ending the marketing tactics and industry influence of formula milk companies, broader actions across workplaces, healthcare settings, governments, and communities are needed to more effectively support women who want to breastfeed.

Half a billion working women globally are not entitled to adequate maternity protection. A systematic review of studies found women with a minimum of three months maternity leave, paid or unpaid, were at least 50% more likely to continue breastfeeding compared to women returning to work within three months of giving birth. The authors call for governments and workplaces to recognise the value of breastfeeding and care work, by actions such as extending paid maternity leave duration to align with the six month WHO recommended duration of exclusive breastfeeding.

A large expansion in health professional training on breastfeeding, as well as statutory paid maternity leave and other protections are vital. Ultimately, we need to change the way society envisages breastfeeding. Breastfeeding is not the sole responsibility of individual women; it is a societal responsibility that concerns us all.


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