Dr Mary-Anne Land – PHAA
Forty years ago, the World Health Assembly adopted the International Code of Marketing of Breast-milk Substitutes (the Code) to regulate the marketing of breast-milk substitutes, and protect mothers from aggressive marketing practices. Yet forty years on, formula marketing still represents one of the most underappreciated risks to infants’ and children’s health. Scaling up breastfeeding could prevent upwards of an estimated 800,000 deaths of children under five and 20,000 breast cancer deaths among mothers each year. Despite the Code, formula companies continue to violate principles established by these international agreements, putting sales and shareholder interests before infant and population health.
For example, more than half of parents and pregnant women (51 per cent) surveyed for a new WHO/UNICEF report say they have been targeted with marketing from formula milk companies, much of which is in breach of international standards on infant feeding practices.
The report – How marketing of formula milk influences our decisions on infant feeding, finds that industry marketing techniques include unregulated and invasive online targeting; sponsored advice networks and helplines; promotions and free gifts; and practices to influence training and recommendations among health workers. The messages that parents and health workers receive are often misleading, scientifically unsubstantiated, and violate the Code.
According to the report – which surveyed 8,500 parents and pregnant women, and 300 health professionals in cities across Bangladesh, China, Mexico, Morocco, Nigeria, South Africa, the United Kingdom and Viet Nam – exposure to formula milk marketing reaches 84 per cent of all women surveyed in the United Kingdom; 92 per cent in Viet Nam, and 97 per cent of women in China, increasing their likelihood of choosing formula feeding.
Across all countries surveyed, women expressed a strong desire to breastfeed exclusively, ranging from 49 per cent of women in Morocco to 98 per cent in Bangladesh. Yet the report details how a sustained flow of misleading marketing messages is reinforcing myths about breastfeeding and breast-milk, and undermining women’s confidence in their ability to breastfeed successfully. These myths include the necessity of formula in the first days after birth, the inadequacy of breast-milk for infant nutrition, that specific infant formula ingredients are proven to improve child development or immunity, the perception that formula keeps infants fuller for longer, and that the quality of breast-milk declines with time.
Are these findings relevant to Australia? Yes. The ubiquitous nature of marketing and the tactics and strategies used by formula milk companies are likely generalizable globally.
In Australia, the International Code of Marketing Breast-Milk Substitutes is not legally enforceable. The Marketing in Australia of Infant Formulas (MAIF) Agreement is Australia’s response to the Code. The MAIF agreement is a voluntary, self-regulatory code of conduct. Individuals, members of industry, community and consumer groups are able to lodge a complaint with the Department of Health alleging a breach of the MAIF Agreement. In 2017, an independent review of the process found unsatisfactory aspects including low awareness and visibility of the process; poor timeliness from lodgement to determination and reporting; and lack of transparency of the process and the need for more frequent real-time reporting.
PHAA and Dietitians Australia have on several occasions outlined the weaknesses of the MAIF agreement, which include:
- Not all manufacturers and importers are signatories
- It omits prohibition of free and subsidised breast milk substitutes in the health care system
- It omits guidelines for the marketing of bottles, teats and complementary foods
- It omits code for retailers
- It omits prohibition of cross-promotion via marketing of toddler milks
- It’s not actively enforced by Department of Health, Infant Nutrition Council or other stakeholders
- There are significant conflicts of interest in governance and enforcement
Both health groups have strongly advocated that Australia needs to enforce the Code and subsequent resolutions under Australian law. Formula milk marketing, not the product itself, disrupts informed decision-making and undermines breastfeeding and child health.
Protect against unhealthy products is one of seven key focus areas of PHAA’s Federal Election Campaign, Vote For Public Health. Companies make substantial profits from unethical marketing and promoting unhealthy commodities, including gambling, formula milk, fast and ultra-processed foods, sugar-sweetened beverages, alcohol, and tobacco (including e-cigarettes. Industry self-regulation does not work. Regulation – with the powers only government can exercise – is required. PHAA is calling for government-led mandatory regulation monitored and enforced to stop unethical marketing.
Image: Photo by Nandhu Kumar from Pexels