On 7 February 2023, The Lancet launched a new Series on Breastfeeding, outlining the “multifaceted and highly effective strategies used by commercial formula manufacturers to target parents, health-care professionals, and policy makers.” Worldwide, the health benefits of breastfeeding to both mothers and babies are astoundingly positive. And yet, less than half of babies born globally are breastfed in line with WHO recommendations. Why?
The commercial milk formula industry has wielded unethical and at times illegal marketing and lobbying practices, praying on new parents’ vulnerabilities, and turning infant feeding into a multibillion-dollar business. In some circumstances, formula milk is necessary. But in many cases, new parents receive false information and insurmountable pressure from companies and healthcare professionals that lead them to use formula when it is neither necessary nor advisable. Private companies and their political accomplices have encouraged and benefited from this grossly negative alteration in the infant and child feeding ecosystem.
The launch of the Series was moderated by Kathriona Deveraux, who noted that the focus of the series was on unethical action by commercial companies – not the choices or situations of individual mothers and families. Next came an opening address from The Lancet’s Editor-in-Chief, Richard Horton, who argued that the needed emphasis on maternal and child health has waned in the wake of the universal health coverage (UHC) agenda.
The report’s key findings were presented by Nigel Rollins from the World Health Organization and David McCoy from the United Nations University, who laid out the intricate relationship between biology, marketing, and political economy which have come to determine the feeding ecosystem of infants and children. The first paper, by Rafael Pérez-Escamilla and colleagues, lays out normal infant behaviours and how they develop over the first few months of life. Parents’ perceptions of their behaviour, and the anxieties and worries that come along with these perceptions, largely influence the decision to breastfeed or use formula.
Building on this, the second paper, by Nigel Rollins and colleagues, shows how the formula industry reframes normal infant behaviours to promote their products as solutions to normal infant activity such as crying, fussing, and irregular sleeping. Commercial milk companies leverage parents’ insecurities and aspirations for their baby, using false information to drive up the demand for milk formula.
The third and final paper in the Series, by Philip Baker and colleagues, takes a political economy lens, exposing how the industry has grown, driven by corporate greed and political power and facilitated by harmful marketing.
As Nigel Rollins said at the launch, there is a “commercial system of influence undermining breastfeeding, child and maternal health, and human rights.”
One thread throughout all three papers is the clear recognition that mothers need support to successfully ward off these marketing pressures and breastfeed their child without sacrificing economic security or emotional health. As argued by Professor Gita, co-author of the series, breastfeeding is a public good which no country is sufficiently recognising or resourcing, and this must be corrected.
After the three papers were introduced, there was an insightful panel discussion with Helen L. Ball, Professor of Anthropology from Durham University; Katie Gilbert, Managing Director at M&C Saatchi World Services; Guddi Singh, paediatric doctor and health campaigner; and Alison Thewliss, Member of Parliament from Glasgow Central. They discussed how milk formula companies have propagated misconceptions about infant health to pressure new mothers into using formula, and the role of politics in legislating and enforcing Codes around breastfeeding.
The closing remarks were given by CAP-2030’s Senior Advisor, Anthony Costello, who summed up the series in the following way: “commerce, and the political backing of commerce, triumphs over infant mortality.”
CAP-2030 has been pioneering work on the harmful effects of commercial marketing on children’s health as part of its mandate to implement the recommendations of the 2020 WHO-UNICEF-Lancet Commission report, which was an early voice on this issue. Since then, CAP-2030 organised an expert meeting bringing together 75 key stakeholders and advocates working on harmful commercial marketing to children.
The CAP-2030 team has also teamed up with KIDSforSDGs and participated in the Learning Planet Festival earlier this year, facilitating a panel discussion with young people on the harms of commercial marketing and their policy ideas for combatting it. The conversation shone a light on how educated young people are of the unethical and damaging practices of commercial marketing. Nathalie from Hong Kong told the group she saw her own doctor on television promoting breast milk substitutes. Anthony Costello, in sharing this story at The Lancet Series, said that children are shocked by the adult world they are growing in to, and even at young age know these lenient marketing practices are exploitive and damaging to children’s health.