On Wednesday, Feb. 23, WHO and UNICEF will launch a major new study on the marketing of breastmilk substitutes (BMS; sign up for the global webinar here. Despite the adoption of the International Code of Marketing of Breastmilk Substitutes 40 years ago, the sales of BMS have only grown – from $2 billion annually in 1987 to $55 billion today. Constance Ching of Alive & Thrive says that digital marketing is largely the problem, particularly the companies’ use of social media.

Growing concerns over the widespread use of digital marketing to promote breastmilk substitutes (BMS) have spanned decades. As early as 2001, the World Health Assembly (WHA) adopted a Resolution highlighting that “new modern communication methods, including electronic means, are currently increasingly being used” to promote baby formula products. Advocates are hoping the new report – the largest of its kind to date – will renew the global efforts desperately needed to end the inappropriate marketing of BMS.

But how did we get here? How has the BMS industry grown so rapidly despite evidence that the products are often unnecessary and even harmful? One part of the answer is digital marketing, which has opened up new, more effective avenues for companies to reach mothers and caregivers with misleading, deceptive, and harmful messages. 

The ultimate costs of their marketing are devastating: More than 600,000 infants and 100,000 mothers die annually due to inadequate breastfeeding. Economically, the costs are huge, too: the world loses US$ 1 billion a day due to inadequate breastfeeding. 

The advent of social media, together with technologies in data mining and algorithm design, enable immediate and direct access to consumers, and bespoke marketing that appears as genuine advice and personalized solutions.   

The COVID-19 pandemic has pushed digital marketing to new heights. Not only are BMS companies taking advantage of the elevated use of digital media, they also capitalize on the public sentiment associated with the COVID-19 pandemic to market their products and boost public image. 

BMS companies thrive on the infodemic cultivated by digital marketing, which obfuscates the harmful effect and risks of formula feeding on children’s health. Practices include unsubstantiated health claims that falsely promote formula products’ immunity-building properties to fear-driven misinformation that casts doubt on breastfeeding, discounts and free samples offered to families with financial hardships, and unsolicited donations to communities. 

The claims and idealizing messages are scientifically-unfounded and merely promotional – they play on the emotions of soon-to-be or new parents who want the best for their children. Some audacious comparisons assert that formula's benefits are close, or even equal, to breastmilk. The artificially derived non-human oligosaccharides in formula milk can never compare to breastmilk’s 200+ oligosaccharides that are genetically-unique to each mother and her infant. The properties in breastmilk confer immunological protection that is specific to each infant’s evolving needs – a life-saving property that breastmilk substitutes are unable to replicate. 

Not only are formula companies inaccurately marketing their products as safe and beneficial - parents are also not fully warned of the inherent health risks of using formula products.

The 2005 WHA resolution has called for warnings of intrinsic contamination in powdered infant formula to be conveyed to the public. However, the product recall announced last week, spurred by reports of illness and death of infants from Cronobacter and Salmonella contamination in the U.S., affected at least 37 countries. This incident illustrates that 17 years after the WHA resolution, parents are still not clearly warned of such risks. 

A recent study continues to show the link between formula use in preterm and low birth weight infants and the risk of developing necrotizing enterocolitis (NEC), a dangerous and potentially fatal gastrointestinal illness that mostly affects premature babies. Although studies that reveal such links dated back to as early as 1990, and scientific evidence continues to support that premature babies fed human donor milk were less likely to develop NEC than those fed with infant formula derived from cow’s milk, today yet there is no warning of NEC with these products that are directly promoted to parents as retail items. 

Numerous studies revealed the exploitative marketing strategies of BMS companies in digital media at the dawn of the pandemic. As a result, in 2020, the World Health Assembly requested the WHO Director-General to compile a comprehensive report to further understand its scope and impact for the World Health Assembly in 2022. 

As part of the response, WHO and UNICEF, together with partners such as FHI Solutions, Save the Children, and Partnership for Maternal, Newborn and Child Health, will launch the new report on Feb. 23: How the marketing of formula milk influences our decisions on infant feeding. 

This multi-country report, which forms part of the extensive body of new research conducted by WHO and partners on misleading marketing practices of the BMS industry, is the largest of its kind to date. It includes insights from over 8,500 women and 300 health professionals across eight countries: Bangladesh, China, Mexico, Morocco, Nigeria, South Africa, the United Kingdom, and Viet Nam.

The launch event will feature a discussion panel that is joined by Alive & Thrive, presenting civil society’s perspective. The report also informs the Decision recommended in the 150th WHA Executive Board meeting that took place last month, which urges the WHO Director-General to provide guidance to governments on restricting digital marketing of BMS. 

The resources afforded by companies to accelerate their technological and marketing advances make a stark comparison to those available for protecting, promoting, and supporting breastfeeding. Within these enormous gaps lie the pervasive disinformation that enables formula feeding to become a social norm with which breastfeeding must compete. 

The series of WHO reports bring new hope to raising the awareness of harmful BMS marketing to new levels – undoing the kind of structural vulnerability that entraps women and children - one that undermines women’s confidence in their own ability to breastfeed, distorts access to accurate health information, and promotes the misbelief that formula milk is a comparable alternative to breastmilk. 

Bringing these marketing practices to light adds to the breadth of knowledge on which more proactive action can be based. One of these is to hold social media platforms accountable for enabling deceptive marketing to go viral, reaching millions of parents. This is not to deny formula companies as the ultimate culprit – but to highlight the fact that far too much evidence and too many policy recommendations have existed for decades for social media platforms to remain neutral and turn a blind eye to the blatantly biased and misleading health messages that can cost children’s lives. 

The WHA resolution adopted back in 2001 had called for national regulations to ensure “all forms of advertising, and commercial promotion in all types of media” to be in compliance with the International Code. More recently, the 2016 WHA resolution “urges the media and creative industries to ensure that their activities across all communication channels and media outlets” are in accordance with the Code and relevant WHA resolutions to end inappropriate marketing. Social media is certainly not exempt from this. 

This report, together with other monitoring findings, hopefully will lead to concrete actions to hold companies accountable for their practices: Full Code implementation, in particular adoption of legal measures that give effect to the International Code and all relevant WHA resolutions.

Read more about the Code, including an in-depth series on its history and implementation around the world, and access a variety of resources related to the Code on Alive & Thrive's BMS Code page.