Infant milk formula popularity is on the rise in Africa despite sustained efforts to limit its use

By Mary Wanjira

roper infant nutrition is fundamental to a child’s continued health, from birth through adulthood. Correct feeding in the first three years of life is particularly important due to its role in lowering morbidity and mortality, reducing the risk of chronic disease throughout their lifespan, and promoting regular mental and physical development.

Breastfeeding is considered the best source of nutrition for the healthy growth and development of infants. A 2016 study by Lancet found that scaling up breastfeeding to nearuniversal levels could prevent the deaths of over 820,000 children under five. It is for this reason that WHO recommends that babies everywhere be breastfed exclusively for the first six months, at which point safe, appropriate complementary foods (CF) should be introduced to meet children’s evolving nutritional requirements. WHO also notes that CF should not be used as breast milk substitutes (BMS), and infants and young children should continue to be breastfed until they are two or older. perceptions and misinformation. Women’s perceptions of insufficient breast milk, beliefs about infant thirst and the need for water, and the cultural and family norms that support the early introduction of food and liquid are a few examples of barriers that prevent the universal adoption of EBF in Africa.

A Booming Market For Infant Formula

Previously, the early introduction of water and porridge to infants inhibited exclusive breastfeeding practices. Today, it is the introduction of infant milk formula. Infant formula is a breast milk substitute designed to meet the full nutritional needs of babies under 12 months of age. Internationally, the required components for formulas are set by the Codex Alimentarius, a joint food standards program overseen by the Food and Agriculture Organization of the United Nations and the World Health Organization. Individual countries can also set additional guidelines. In total, the Codex lists more than 30 required nutritional ingredients for infant formula, including vitamins and minerals, but the three major constituents are fats, proteins, and carbohydrates –the primary building blocks that little humans need to grow and develop.

Despite these advantages, exclusive breastfeeding (EBF) in Africa remains rare. Only 37% of infants under 6 months of age in Africa were exclusively breastfed in 2017, according to a study published in the Nature Medicine Journal. Many of EBF’s primary barriers involve cultural

The shift towards infant milk formula has been accelerated by urbanization and more women entering employment, leaving them with little time to breastfeed their babies. With Africa lacking sufficient infant formula production capacities, the rising demand for these products is satisfied by imports. According to a new report by the International Trade Centre, titled "Made by Africa: Creating

Value through Integration," Africa imports US$627.2 million of food preparations for infant use every year, and this figure is projected to exceed US$1.21 billion by 2026. Leading brands in the region include Nan by Switzerland-based food giant Nestle, Aptamil, which is produced by French food company Danone, Similac, which is owned by USbased Abbott Industries, and Enfamil, which is produced by UK-based consumer goods company Reckitt & Benckiser. Aspen Pharmaceutical, which was the only major infant formula producer on the continent, sold the business to Lactalis for US$860.1 million in 2018, giving the Francebased dairy company ownership of the Alula, Infacare, and S-26 brands.

Regionally, South Africa stands out as the most important infant milk formula market. South Africa's baby food market value was estimated to be US$618.999 million in 2020 and is expected to grow at a compound annual growth rate of 4.89% to reach a market size of US$864.499 million in 2027. West Africa as a region comes in second. According to Data Bridge Market Research, the market is growing with a CAGR of 6.4% in the forecast period of 2021 to 2028 and is expected to reach US$1.088 billion by 2028. Nigeria, West Africa’s largest market, imported infant foods worth US$36.6 million in 2021, a 25% increase from the previous year, according to data from Statista. In North Africa, Egypt is an important formula market. In the first nine months of 2022, data from the Central Agency for Public Mobilization and Statistics revealed that baby formula imports increased by 2.5% in the first eight months of 2022 to US$73.9 million. In Egypt, infant formula prices are sensitive, and the government, through the military, has previously intervened by directly importing the products in an effort to reduce the retail prices.

OF US$864.499 MILLION IN 2027.

The key distribution channels in the African infant formula market are drugstores & pharmacies and hypermarkets & supermarkets. Drugstores & pharmacies are the primary distribution channel in the sector in 2021, creating the impression that the formula is physician-approved. Being a business of mostly perception and less science, UNICEF in its report also observed that women thought expensive formula products - sometimes containing specific ingredients such as human milk oligosaccharides (HMOs) or polyunsaturated fatty acids (PUFA) - were better than cheaper alternatives. This, despite systematic reviews reporting no health or brain development benefits from the addition of specific ingredients such as HMOs or PUFA, the report highlighted. When they can afford it, women also reported that they would go for expensive products out of the desire to give their child 'the best,' sometimes as a result of feeling guilty about not being able to breastfeed.

Working Moms Drive Growth

Growth is mainly fueled by more women in Africa joining the workforce, which gives them high disposable incomes necessary to buy infant milk formula and less time to exclusively breastfeed their babies. A good example is in South Africa where the participation of women in wage employment has more than doubled from 23% in 1970 to about 49.54% in 2021, according to data from Statista. This can be directly associated with the high uptake of infant milk formula products when compared to other regions. Overall,

2021 World Bank data shows that Africa has seen women's participation in wage employment rise to 39.2% and 46.2% when the total labor force is considered. Faced with limited time with their kids, these women are more open to the idea of substituting breast milk with infant milk formula than to go back to work." Others, according to the report, start giving their babies formula because they will be going back to work say in two months' time, and they worry that their babies might not want formula if they are only introduced to it once they go back to work. they would have if they had sufficient time to nurse their children to adulthood. A 2022 report by WHO and UNICEF validates this argument. According to the report, more than three-quarters (76%) of women agreed with the statement "formula feeding is the better choice if the mother plans

High birth rates and rising numbers of women of reproductive age in Africa are also expected to drive the infant formula milk market in the future. UNICEF, in 2015, projected that almost two billion babies would be born in Africa over the next 35 years. If the current trends remain, more children will mean a higher demand for infant milk formula, further increasing Africa's share of the market. With growth slowing in China, a major importer of infant milk formula, manufacturers are certainly expected to increase their focus on Africa to offset lost sales in the largest economy in Asia.

Perception of formula as a more desirable or modern option compared to breastfeeding is also one of the factors behind the growth being witnessed in Africa. Marketing by the major infant formula providers in the region, including Nestle, Danone, Lactalis, and FrieslandCampina, has been cited by many reports as the major reason behind this perception change. A 2022 report by UNICEF titled "How the marketing of formula milk influences our decisions on infant feeding" noted that formula companies used sophisticated techniques and misleading messaging to market their products, including scientific language and imagery, pain points, emotional and aspirational appeals, influenced South African women's perception towards breast milk.

When it comes to marketing, formula producers stop at nothing in the quest to bring their products to as many women as possible. In South Africa, where marketing of formula for children under 1 year is highly restricted, UNICEF noted that formula products that fall outside this category are commonly packaged, branded, and labeled to closely resemble similar products for younger children — i.e. cross-promotion — creating brand awareness and some confusion over which products are BMS and which are not. The same practice was observed in Nigeria by ATNF, suggesting widespread occurrence on the continent.

Marketing goes further and involves using healthcare officials whose opinion is highly regarded by nursing mothers as brand ambassadors. Almost half (43%) of South African health professionals interviewed by UNICEF in 2022 reported that they had been directly contacted by a formula company representative, while others stated that their hospital was sponsored by a particular brand, so they recommended that formula product to women. The report further notes that one in five women (21%) had been advised to formula feed by a health professional and (20%) had received a brand recommendation from a health professional. Although unethical, these practices are influencing women towards preferring infant milk formula, subsequently resulting in rapid market growth.

Recalls Raises Questions About Safety

Early last year, consumers reported four infants who were sick, including three with Cronobacter sakazakii infections and one with Salmonella Newport, who had been fed formula products produced by Abbott Industries. This sparked a global recall that eventually led to an acute shortage of infant formula products in the United States and further raised concerns over the safety of infant formula products.

Although promises of far-reaching actions to enhance safety were made, nothing much seems to have happened as we continue to witness product recalls by various other companies, some of which export their products to Africa. In March 2023, Canadian officials posted a recall for Nestle Goodstart infant formula brand over possible contamination with Cronobacter, which can cause serious infections and often death, especially among young babies. That same month, Perrigo announced a voluntary recall of particular lots of their Gerber Good Start SoothePro Powdered Infant Formula in the United States due to a potential presence of an opportunistic, Gram-negative pathogenic bacterium. In infants, the bacterium can cause blood infections, meningitis, and necrotizing enterocolitis. A month earlier, Reckitt announced that it was voluntarily recalling some 145,000 cans of ProSobee Simply Plant-Based Infant Formula "due to a possibility of cross-contamination with Cronobacter sakazakii.” The recalls raise concerns over the safety of infant formula and further raise the profile of breast milk as the safest form of nutrition that an infant can ever receive.

Factors Limiting Infant Formula Market

Although the infant formula market in Africa is growing, a number of factors are expected to limit its potential. Perhaps one of the largest inhibitors to growth is the high cost of these products. For instance, Nestle's Nan Infant Optipro sells at an average retail price of US$6 in most parts of the continent, a price which is way out of reach for more than 75% of the population that lives on less than 2 dollars a day. ATNF, in its 2021 report on infant formula, notes that the cost of purchasing economy brand infant formula by Nigerian families can be significant - up to 34% of a family's earnings for the first two years of a child's life. Such high costs make it difficult for most African families to afford formula, even when it is medically necessary.

The second greatest impediment is sustained efforts against widespread infant milk formula adoption by governments and non-governmental organizations. At the forefront of this fight is the World Health Organization, which in 1981 published the International Code of Marketing of Breast-Milk Substitutes that greatly limits the ability of infant milk formula producers to reach mothers. WHO is joined in its efforts to promote exclusive breastfeeding by other non-governmental organizations, including UNICEF, The International

Baby Food Action Network, and the Access to Nutrition Foundation (ATNF). These organizations monitor the implementation of the code and also regularly carry out awareness campaigns on the benefits of such practices to both infants and mothers.

Key Numbers Value Of Imported Infant Foods In Nigeria

US$36.6M

Kenya have clarified several issues in existing legislation to make additional provisions enforceable. This trend is expected to greatly limit formula marketing, which will have an overall negative effect on market growth.

Great Market Potential Lies Ahead

Despite efforts by governments and NGOs in supporting EBF, breastfeeding rates have increased very little over the past two decades. Formula milk sales have more than doubled in roughly the same time due to a number of reasons, including more women joining the workforce and an increasing perception of baby food as a safe substitute for breastfeeding. These trends clearly present Africa as the next growth frontier for formula producers, particularly now that childbirths are declining in major markets, including North America and China.

To succeed in this market, formula producers must prioritize the quality and safety of their products as mothers who purchase infant formula in Africa are more often than not highly educated and thus demand products that have a strong, safe brand image and good health credentials for infants. Previous studies have shown that mothers' preferences for a 'best brand' were attributed to qualities such as being 'premium,' helping babies to gain weight, and being the 'closest to breastmilk.'

A growing number of African countries are fighting back against the unethical marketing of breastmilk substitutes by tightening laws to protect the health of mothers and children from misleading marketing practices. Three countries in the African region that previously had no legislation related to the CodeMauritania, Sao Tome & Principe, and Sierra Leone - have now passed new measures. Ethiopia has enacted a strong new directive to replace older legislation that covered only a few provisions of the code. A new decree in Côte d'Ivoire and regulations in

Laws restricting infant formula marketing and limited disposable incomes, however, present the greatest impediments to growth. Understanding the regulatory frameworks of different countries and producing affordable products will therefore be key to succeeding in Africa. Finally, local production in Africa has been an unexploited opportunity until now. Formula producers could exploit this gap to shorten their supply chains and produce more affordable products now that the market is forecasted to exceed US$1 billion by 2026. FBA