Research on Marketing and the Code

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Milking it: How Milk Formula Companies are Putting Profits Before Science

This report from the Changing Markets Foundation investigates the products of four formula milk companies across 14 global markets. It finds wide disparities in price across different markets, and concludes that increasing product differentiation is not science-based, but instead informed by careful research into consumer preferences, guided by a desire to increase profits. https://changingmarkets.org/portfolio/milking-it/ (October 2017)

Long chain polyunsaturated fatty acid (LCPUFA) supplementation in infants born at term

Some formula milk companies have begun supplementing their products with LPCUFA; this review explored the marketing claim that such supplementation supports term infants’ development. The authors found that full-term babies fed formula milk supplemented with LCPUFA did not have better outcomes than were reported for full-term babies fed formula milk without LCPUFA.

Jasani, B, et al (2017). Long chain polyunsaturated fatty acid supplementation in infants born at term, Cochrane Database of Systematic Reviews, DOI: 10.1002/14651858.CD000376.pub4

New Review of Breastmilk Substitutes Advertising Launched 

First Steps Nutrition Trust has published “‘Scientific and factual?’ A review of breastmilk substitutes advertising to healthcare professionals.” The document examines the evidence given to support advertising claims about formula milk, revealing a worryingly common use of misleading and unscientific information contrary to international, EU and national regulations over formula milk advertising.

The review points out that there is “no mechanism to challenge whether adverts are in fact ‘scientific and factual’ in their content and presentation. Manufacturers of breastmilk substitutes advertise their products to healthcare professionals in magazines, through company representatives’ information, healthcare professional websites, at study days and via helplines. Many of the claims made by manufacturersare, however, not accepted by scientific bodies, the evidence may be weak or non-existent and it may relate to a product other than that being advertised. We believe that this misleads healthcare professionals.

This is an insightful and essential read for any health professional working on infant feeding, demonstrating the need fto be extremely vigilant before accepting any claims.

Read the review of breastmilk substitutes advertising

Find out more about First Steps Nutrition

The impact of marketing of breast-milk substitutes on who-recommended breastfeeding practices 

This study describes sales and marketing of breast-milk substitutes and their influence on World Health Organization-recommended breastfeeding behaviours, focusing on low- and middle-income countries.

Global sales of breast-milk substitutes reached US$40 billion in 2013. Growth in sales exceeds 10% annually in many low- and middle-income countries, while it is close to stagnant in high-income countries. Breast-milk substitutes are marketed directly to consumers via mass media and print advertisements and indirectly via incentives, free supplies, and promotions to and through health workers and facilities, retailers, and policy makers. Internet marketing via company web sites and social media is on the rise. Marketing influences social norms by making formula use seem to be extensive, modern, and comparable to or better than breast milk. Clear evidence of a negative impact is found when breast-milk substitutes are provided for free in maternity facilities and when they are promoted by health workers and in the media. Influences through other channels are plausible, but rigorous studies are lacking. Marketing remains widespread even in countries that have adopted the International Code of Marketing of Breast-milk Substitutes to restrict such activities.

The authors conclude that adopting stricter regulatory frameworks coupled with independent, quantitative monitoring and compliance enforcement are needed to counter the impacts of formula marketing globally.

Piwoz, E.G. & Huffman, S.L. (2015). The Impact of Marketing of Breast-Milk Substitutes on WHO-Recommended Breastfeeding Practices. Food and nutrition bulletin, doi: 10.1177/0379572115602174.

Enforcing the code for better promotion of exclusive breastfeeding 

This study explored the implementation challenges regarding the Code.
The authors recommend establishing national breastfeeding committees with authority to improve regulations, investigate violations, and enforce the laws. They stress that managers of multinational companies must be held accountable for international violations, and international legislative enforcement needs to be established.

Barennes, H., Slesak, G., Goyet, S., Aaron, P., Srour, LM. (2015) Enforcing the International Code of Marketing of Breast-milk Substitutes for Better Promotion of Exclusive Breastfeeding: Can Lessons Be Learned? Journal of Human Lactation, doi:10.1177/0890334415607816

Advertisements of follow-on formula and their perception by pregnant women and mothers in Italy 

Findings highlighted in this study:

  • Qualitative study, interviewing mothers about magazine advertisements for follow-on formula
  • Ambiguity of advertisements meant that the follow-on formula was confused with infant (first) formula
  • A majority of women thought that the products advertised were to be used from birth

Cattaneo et al (2014). Advertisements of follow-on formula and their perception by pregnant women and mothers in Italy. Archives of disease in childhood, doi:10.1136/archdischild-2014-306996.

Unicef UK Baby Friendly Initiative Supports Call for Adherence to International Code of Marketing Breastmilk Substitutes 

9 April 2013

UNICEF UK Baby Friendly Initiative today urged supporters to join the call for formula milk companies to change their marketing techniques, as outlined in the recent Save the Children report ‘Superfood for Babies’.

Since the International Code of Marketing of Breastmilk Substitutes (the Code) was adopted by the World Health Assembly in 1981, UNICEF has worked with national governments to make the Code part of national law, and to date more than 100 countries have done so, at least in part. UNICEF has also promoted the adoption of the principles of the Code in health-care facilities across the world through the Baby Friendly Initiative.

Despite the Code now being over 30 years old, aggressive marketing practices from the formula milk industry continue to be reported (as highlighted by the recent Save the Children report and ongoing work of groups such as IBFAN). Such practices can influence a mother’s decision not to breastfeed, with the subsequent impact on child health.

To find out more about Save the Children’s action on breastmilk substitutes, click here.

UNICEF UK has recently published A guide for health workers to working within the International Code of Marketing of Breastmilk Substitutes. This comprehensive guide provides health professionals with guidance on all the forms of professional interactions with the formula milk industry from using their materials to attendance at study days to accepting accepting money in the form of grants or research funding. Click here to download.

The importance of breastfeeding in tackling malnutrition in developing countries was underscored in the UNICEF UK report The right ingredients: the need to invest in child nutrition, launched on Mother’s Day, which highlights the potential of exclusive breastfeeding to dramatically reduce child deaths. To find out more about the report, click here.

New Report Calls for Global Action to Support Breastfeeding 

18 February 2013

Save The Children has today launched a new report calling for more support for breastfeeding and action to prevent formula companies using damaging marketing practices.

The report, Superfood for Babies, estimates more than 800,000 deaths could be prevented each year if babies were given breastmilk in the first hour of life. It highlights four major barriers to breastfeeding:

Community and cultural pressures: In many cases a mother may not be free to make her own choice about how she feeds her baby. Education and awareness of the benefits of breastfeeding are instrumental in helping to change views.

The health worker shortage: Currently, one third of babies are born without a skilled attendant present at birth. Resources are needed to improve this.

Lack of maternity legislation: Maternity leave, pay and workplace provision for breastfeeding are all key factors needed to support mothers to continue to breastfeed.

The big business barrier: Formula milk companies use marketing practices and target healthcare workers in ways that threaten lives and violate the International Code of Marketing of Breastmilk Substitutes. These practices can lead to infant formula being used unnecessarily and improperly, ultimately putting children at risk. Changes in company policy and stronger legislation are required to restrict these activities.

The report calls for action on all these issues, and particularly calls on the UK to use its presidency of the G8 this year to secure funding for breastfeeding programmes as part of plans to tackle malnutrition.

You can read the full report here.

Sign the petition calling for changes to formula milk marketing practices.

Circumventing the WHO Code? An Observational Study 

This study compares the formula milk advertisements appearing in parenting magazines in four countries – the USA and Canada where there are no restrictions on formula advertising, the UK where formula milk advertising is prohibited but advertising for follow-on formula is not and Australia where both formula milk and follow-on formula milk advertising is prohibited.

The authors found that promotion of formula products or brands occurred in all the magazines, however the type of product advertised differed. Follow-on formula advertisements occurred most frequently in the UK and toddler milk advertisements in Australia.

The authors conclude that bans on the advertising of some infant formula products do not reduce the advertising of infant formula per se, and that products such as follow-on formula are presented in ways that encourage consumers to associate the claims made in them with a group of products (a product line) that includes infant formula, reducing the effectiveness of any advertising restrictions.

UNICEF UK comment – This study demonstrates that comprehensive and complete legislation is required to implement the International Code of Marketing of Breastmilk Substitutes if such legislation is to be effective.

Click here to read the report ‘A weak formula for legislation’.

Berry NJ, Jones SC, Iverson D, et al. Circumventing the WHO Code? An observational study. Arch Dis Child (2011). doi:10.1136/adc.2010.202051