Countries should clamp down on the “aggressive” and “unethical” marketing of formula milk for babies, including forcing companies to sell products in plain packaging, a report by the World Health Organization and Unicef has said.
In research, commissioned 41 years after the global health community drew up guidelines aimed at regulating the industry, experts found that the marketing of formula had “no limits” and had become more “unregulated and invasive” in the digital age.
Dr Tedros Adhanom Ghebreyesus, WHO director general, said it was clear the marketing was “unacceptably pervasive, misleading and aggressive”. He said: “Regulations on exploitative marketing must be urgently adopted and enforced to protect children’s health.”
One measure the report suggests that governments explore is the standardised, plain packaging of formula products, a controversial proposal that will draw comparisons with tobacco marketing regulations in place in the UK since 2017.
Dr Nigel Rollins, a paediatrician in the WHO’s department of maternal, newborn, child and adolescent health, said that while nobody was equating formula milk with cigarettes, the way both products were marketed were “not dissimilar”.
“The commonalities are there,” he said. “But instead of packaging being an opportunity for commercial marketing, it should be a place where public health can actually give accurate information to women. And if that type of information can be given clearly and honestly, then I think that’s a good thing.”
In the report, Tedros and Henrietta Fore, Unicef’s executive director until last month, said that while formula milk “has its place for women and parents who are not able or do not want to breastfeed”, babies’ best possible source of nutrition was their mother’s milk.
The message carries particular weight in developing countries where parents often do not have easy access to clean water or sufficient supplies of formula powder, which public health bodies say can result in milk that is potentially harmful and can lead to diarrhoea and malnutrition.
The long-term benefits of breastfeeding, to both mother and child, applied “across the board”, said Rollins. The WHO advises that babies everywhere be exclusively breastfed for the first six months and are given breastmilk alongside solid food until they are two years old.
The new research – which comes 41 years after a set of non-binding regulations known as the international code of marketing of breastmilk substitutes was passed by the World Health Assembly – surveyed 8,500 parents and pregnant women and 300 health workers in eight countries, including Britain, China, Nigeria and Bangladesh.
It found that the $55bn (£40.5bn) formula-milk industry was sending “misleading, scientifically unsubstantiated” messages, many of which violated the 1981 code.
Large numbers of health workers internationally had been approached by the industry to influence their recommendations to new mothers through promotional gifts, free samples, funding for research, paid meetings, events and conferences, and even commissions from sales, the research found.
Formula-milk manufacturers often carried out “exploitative” practices known as “pain-point marketing”, which purport to present solutions to common infant problems, such as colic, reflux and broken sleep, it added.
The collective effect of this marketing was that parents were making crucial choices based on wrong information, Rollins said.
“Decisions on something as fundamental and as influential as infant feeding should be primarily based on the most accurate and truthful information and not information that is somehow linked with commercial interests and commercial gain,” he added.
The report makes no formal WHO recommendations, but suggests how countries could act, from tougher legislation on the promotion of formula to greater investment in programmes to support breastfeeding, including paid parental-leave policies.
It calls for governments to look at the possibility of banning health workers from accepting sponsorship from formula-milk companies, and forcing products to be sold in plain packaging.
“Exploring the area of plain packaging is definitely an area that we’re looking [at] because it was an area brought up by the mothers [surveyed],” said Rollins.
“Mothers said they found the packaging confusing, not clear, and they were left uncertain what to do, or what to choose, because of the messages on the package.”
The idea of formula in plain packaging was mooted in the UK in a 2017 private member’s bill put forward by the Scottish National party MP Alison Thewliss, chair of the all-party parliamentary group on infant feeding.
At the time, Vicky Fallon, now a lecturer in psychology at Liverpool University, wrote that while a marketing clampdown was welcome, this move made her feel “conflicted”.
“The message this conveys to mothers is really concerning – that in terms of health risks, formula is somehow on a par with tobacco or more risky per se than alcohol or other products known to negatively impact health.
“To enforce plain packaging on a product which is not inherently harmful is neither justifiable nor proportionate,” she wrote.
