The formula milk industry’s marketing tactics are exploitative and urgent clampdowns are needed to tackle misleading claims and political interference, according to a new three-paper series published in The Lancet. Industry influence – which includes lobbying against vital breastfeeding support measures - seriously jeopardizes the health and rights of women and children, the papers show.

“This new research highlights the vast economic and political power of the big formula milk companies, as well as serious public policy failures that prevent millions of women from breastfeeding their children,” said Professor Nigel Rollins, Scientist at WHO and author of a paper on formula milk marketing. “Actions are needed across different areas of society to better support mothers to breastfeed for as long as they want, alongside efforts to tackle exploitative formula milk marketing once and for all.”

Breastfeeding provides immense and irreplaceable benefits to babies and young children. It helps children survive and develop to their full potential, providing vast nutritional benefits, reducing infection risks and lowering rates of obesity and chronic diseases in later life. Yet, globally, only around 1 in 2 newborns are put to the breast within the first hour of life while fewer than half of infants under 6 months are exclusively breastfed, as per WHO recommendations.

Given the significant contributions of breastfeeding to people’s health, the Lancet series recommends much greater support for breastfeeding within healthcare and social protection systems - including guaranteeing sufficient paid maternity leave. Currently, around 650 million women lack adequate maternity protections, the papers note. Misleading marketing claims and strategic lobbying from the dairy and formula milk industries further add to the challenges parents face, by increasing anxiety around breastfeeding and infant care.

An exploitative marketing playbook

Triggered by The Baby Killer investigative report into Nestle’s marketing of formula milk in low and middle-income countries in the 1970s, the World Health Assembly developed the International Code of Marketing of Breast-milk Substitutes (the Code) in 1981 and several subsequent resolutions. However, intensive marketing of infant formula continues largely unabated, with sales from these products now approaching US$ 55 billion a year.

The first paper in the Lancet series documents how misleading marketing claims directly exploit parental anxieties around normal infant behaviours, suggesting that commercial milk products alleviate fussiness or crying, for instance, that they help with colic, or prolong night-time sleep. The authors stress that, when mothers are appropriately supported, such parental concerns can be managed successfully with exclusive breastfeeding.

“The formula milk industry uses poor science to suggest, with little supporting evidence, that their products are solutions to common infant health and developmental challenges,” says Professor Linda Richter from the University of the Witwatersrand, South Africa. “This marketing technique clearly violates the 1981 Code, which says labels should not idealise the use of formula to sell more product.”

The series explains how formula milk marketing exploits the lack of support for breastfeeding by governments and society, while misusing gender politics to sell its products. This includes framing breastfeeding advocacy as a moralistic judgment, while presenting milk formula as a convenient and empowering solution for working mothers.

The series further draws attention to the power of the milk formula industry to influence national political decisions and interfere with international regulatory processes. In particular, the dairy and formula milk industries have established a network of unaccountable trade associations and front groups that lobby against policy measures to protect breastfeeding or control the quality of infant formula.

Society-wide changes needed

In addition to ending exploitative marketing tactics and industry influence, broader actions across workplaces, healthcare, governments, and communities are needed to effectively support women who want to breastfeed so that it becomes a collective societal responsibility, the authors state, rather than placing the onus on women.

In particular, the authors highlight the need to ensure women have adequate maternity protections assured by law, including paid maternity leave that aligns, at minimum, with the WHO-recommended duration of six months for exclusive breastfeeding. Maternity protections should further be extended to the millions of women working in the informal sector who are currently excluded from these benefits, the papers note.

Beyond parental leave, the authors call for formal recognition of the contribution of women’s unpaid care work to national development. Globally, women are estimated to perform three-quarters of all unpaid family care work - more than three times that of men. By some accounts, this contributes to around a third of a country’s Gross Domestic Product (GDP).

“Given the immense benefits of breastfeeding to their families and national development, women who wish to breastfeed need to be much better supported so that they can meet their breastfeeding goals,” said Professor Rafael Pérez-Escamilla from the Yale School of Public Health. “A large expansion in health professional training on breastfeeding, as well as statutory paid maternity leave and other protections are vital.”

Expanding training for health workers on breastfeeding is critical, the papers state, so that they can offer skilled counselling to parents before and after birth.

The reports can be accessed here