BREASTFEEDING CONNECTION
CAROL BARTLE POLICY ANALYST
WORLD HEALTH ORGANISATION REPORT:
HOW THE MARKETING OF FORMULA MILK INFLUENCES DECISIONS ABOUT INFANT FEEDING The International Code of Marketing of Breast-milk Substitutes (the Code), and the regular updates in the form of the World Health Assembly resolutions, are designed to not only protect breastfeeding by stopping inappropriate and misleading marketing of breastmilk substitutes, bottles and teats, but to also protect infants fed on breastmilk substitutes. All parents should have access to unbiased, commercial-free information about infant feeding, and health professionals also need a source of unbiased, scientific and factual information which is not provided, or influenced by, industry. In 2020 the WHO and UNICEF published a national implementation of the Code status report which presented the legal status of the Code, including the extent of the provisions incorporated into national legal measures in member states (WHO, 2020). Of 194 WHO Member States (countries), 136 (70%) had enacted legal measures with provisions to implement the Code. Of these, 25 countries had measures substantially aligned with the Code, 42 had measures which were moderately aligned, 69 had included some provisions, and 58 had no legal measures at all. Only 31 countries had legal measures that covered the full breadth of breastmilk substitutes, which includes milk products targeted for use up to at least 36 months of age. In this report, Aotearoa was identified as having no legal measures in place. Although infant formula products are regulated by the Australia New Zealand Food Standards Code, which covers quality issues
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such as composition, safety requirements and nutrient content, it does not apply to marketing or advertising practices. Due to the absence of legal measures, the positive aspects of Code implementation in
Of the 8,528 pregnant and postnatal women surveyed, 51% reported exposure to formula marketing in the preceding year. It was reported that companies were seeking engagement with younger newly pregnant women, referred to as the “holy grail” for sales.
Aotearoa’s maternity system, such as the Baby Friendly Hospital Initiative and Ten Steps to Successful Breastfeeding, were not considered in this Code status report. The 2022 report by the WHO and UNICEF about infant formula marketing summarises the findings from a multicountry research study and presents opportunities for action. The Code was adopted by the World Health Assembly in 1981 but now, over 40 years later, the marketing of formula milk is described as “one of the most underappreciated risks to infants’ and children’s health” (WHO/ UNICEF, 2022). The countries involved in the 2022 study were Bangladesh, Mexico, Morocco, Nigeria, South Africa, Vietnam, the United Kingdom of Great Britain and Northern Ireland. The study aimed to capture the experiences of women, and those who influence them, such as health professionals, partners, family members and friends, and their exposure to, and experience of formula marketing. Over 8,500 pregnant women/mothers of young children, and 300 health professionals were surveyed. There were 80 in-depth interviews and 100 focus groups conducted. Of the 8,528 pregnant and postnatal women surveyed, 51% reported exposure to formula marketing in the preceding year. It was reported that companies were seeking engagement with younger newly pregnant women, referred to as the “holy grail” for sales, and data-driven algorithms were used to target digital advertising to women whose online behaviour indicated that they may be pregnant. Multiple channels, including television, digital marketing, digital influencers with large social media followings, celebrity and paediatrician endorsements were identified as being significant. Marketing messages were misleading and expansion of the portfolio of products, into follow-on, toddler and growing up milks to circumvent the Code, was found to be a common strategy. Marketing using sciencebased messages was impactful despite the incomplete evidence and unsupported health outcome claims.
