As representatives of 130 countries meet in Geneva this week to discuss how to counteract the tactics of baby formula manufacturers, the World Health Organization (WHO) has urged member states to update their laws to prevent the marketing of baby formula in the wake of increasing industry sophistication.  

The meeting is aimed at beefing up the International Code of Marketing of Breastmilk Substitutes, adopted in 1981 as a means to encourage exclusive breastfeeding, which was being undermined by the aggressive promotion of baby formula.

Since the code was adopted, almost three-quarters of countries have enacted legislation that puts in place at least some of the code’s provisions. As a result, exclusive breastfeeding feeding has increased globally by 10%, reaching 48% of children under six months – the highest level since the 1980s, said WHO Director-General Dr Tedros Adhanom Ghebreyesus. 

“But little progress has been made in high-income countries where the code has not been made into effective legislation and, as a result, exclusive breastfeeding rates are stagnating,” Tedros told a media briefing on Wednesday.

“Manufacturers of breast milk substitutes are also using increasingly sophisticated marketing tactics, including targeted ads on pregnant mothers’ mobile phones, clandestine participation in online baby clips, or coaxing mothers to market formula to one another,” he added.

High-income countries have “the lowest rates of exclusive breastfeeding in children under six months”, according to Dr Francesco Branca, WHO Director of Nutrition.

Meanwhile, only 32 countries are fully compliant with the code and many others needed to update their legislation to address the “new forms of marketing”, including digital outreach and donations to professional societies, added Branca.

“Definitely WHO is recommending that member states… have much greater and stricter legislation because we have seen that that is associated with increased rates of breastfeeding,” added Branca, commending countries in South Asia and Africa for “producing legislation which is closest to the implementation of the code”. 

Behind closed doors

But two days of the three-day talks are taking place behind closed doors at WHO’s Geneva headquarters. Media access to the proceedings has been limited to the opening statements  – with no virtual press access granted even to that portion.

Asked why the forum was closed to the public, and only open to Geneva media, WHO said only: “The meeting is really geared towards countries, as we hope to provide an opportunity for member states to make plans on how they can improve the implementation of the code.” 

Decades of aggressive marketing of breastmilk substitutes have led to significant reductions in rates of exclusive #breastfeeding.
 
However, rates of exclusive breastfeeding are 20% higher in countries that have legislation substantially aligned with the International Code of… pic.twitter.com/XJ6A3twbvt

— Tedros Adhanom Ghebreyesus (@DrTedros) June 20, 2023

Rates of exclusive breastfeeding are 20% higher in countries that have legislation substantially aligned with the code, noted WHO’s Director General Dr Tedros Adhanom Ghebreyesus at the start of the meeting.

Continuation of breastfeeding in the first two years of life is more than twice as high when the legislation is substantially aligned with the code. “Let’s put a stop to the commercialization of our children’s health. It’s time to end exploitative marketing,” said the WHO Director General. 

“Inadequate breastfeeding increases the risks of childhood obesity, sudden, unexplained unexplained infant death, leukaemia and other cancers,” Tedros told the media briefing. “WHO recommends exclusive breastfeeding for the first six months of life and continued breastfeeding for two years or beyond.”

The World Health Assembly (WHA) adopted the code in 1981, when global awareness about the health impacts of infant formula reliance, particularly in developing countries with unsafe water, first emerged. While there has been “clear progress” in the 42 years since it was adopted, formula milk manufacturing companies have sharpened their marketing tools, using “exploitative” practices on new digital platforms to market milk formula, according to WHO. 

A report released in April 2022 revealed what WHO described as the “shocking” extent of such practices, used by the baby formula industry, estimated to earn some $55 billion a year. 

The report detailed how formula milk companies are paying social media platforms and influencers to access and influence pregnant women and new mothers using personalized social media content that is often not recognizable as advertising. 

Through tools like apps, virtual support groups or ‘baby clubs’, and with the support of paid social media influencers, formula milk companies offer women competitions, advice forums or services – buying and collecting their personal data to further hone down their promotions. 

The report summarizes findings of research that sampled and analyzed four million social media posts about infant feeding published between January and June 2021, reaching some  2.47 billion people.

Meanwhile, experts said last year said that infant formula companies have “pathologised” normal baby behaviour to promote their products, and there should be “an international, legal treaty” to prevent their marketing, and that political lobbying by milk formula companies to influence public policy should be sharply curtailed.

These comments were contained in a three-part series published in The Lancet, in which the authors said that formula milk companies “exploit parents’ emotions and manipulate scientific information to generate sales at the expense of the health and rights of families, women, and children”.

“The sale of commercial milk formula is a multi-billion-dollar industry which uses political lobbying alongside a sophisticated and highly effective marketing playbook to turn the care and concern of parents and caregivers into a business opportunity. It is time for this to end,” says series co-author, Professor Nigel Rollins from WHO’s Department of Maternal, Newborn, Child and Adolescent Health.

Image Credits: WHO.