Still Pushing It: nearly 40 years on, formula companies are still breaking the rules

A thriving industry

Business is booming in the formula milk industry. Sales are estimated to have reached $44 billion in 2014 and are set to reach $70 billion by 2019. Company CEOs and senior leaders speak openly about their ambitious plans for expansion:

“we have to be able to win share, win the shelf space, win the consumer, win the physician, win the recommendation, etc; and that’s where we put a lot of our emphasis” Miles D. White, CEO of Abbott, producer of formula brand Similac

Flourishing sales are great news for the bottom line of the executives and shareholders in this billion-dollar business. But they’re disastrous for global breastfeeding rates. It’s estimated that 823,000 child deaths could be prevented each year in low- and middle- income countries if breastfeeding were adopted at close-to-universal levels.

The billions of dollars spent each year on marketing formula milk aren’t the only barrier to breastfeeding. Urbanisation, increased female participation in the labour force, and inadequate workplace policies and legislation to support breastfeeding each play a significant role. Nevertheless, the evidence is clear on the impact of marketing:

“I used Bonna [a Nestle formula brand] because I saw it on TV commercial. That’s why I tried it. And my baby liked it too.” Leslie, mother of baby Xian (pictured above), Philippines, 2017

Read our report: Don’t Push It

From pregnancy through until well into the second year of their child’s life, mothers are subjected to a barrage of information in which milk formula companies seek to influence the choices they make – through TV advertising, social media and, in some parts of the world, directly influencing or even bribing of healthcare professionals.

A mother we interviewed in Myanmar said she fed her baby ‘Gain IQ’ formula, a Similac brand owned by Abbott, because the midwife said it would improve her baby’s IQ. Abbott spent over $480,000 here in 2015 on promoting its products, the biggest advertising spend in the country according to one report.

This SMS message was received by a mother from the Dumex brand, which is owned by Danone. The message promotes a Dumex product for infants of one year and over, claiming it helps them be ‘strong and happy’. It also offers a free sample. This is in violation of several articles of the Code, including that manufacturers and distributors should not provide samples directly to mothers.


The vaccinating powers of breastfeeding

Meanwhile, children are not getting the life-saving protection from disease that breast milk provides. An overwhelming and growing body of scientific evidence makes clear that no industrially processed substitute comes close to providing the benefits of breast milk. It gives babies essential antibodies. The benefit to the health of mothers has also been widely reported: it’s estimated that 20,000 maternal breast cancer deaths could be avoided in low- and middle-income countries if breastfeeding was adopted at close-to-universal levels.

By removing barriers to breastfeeding, we can also contribute to the fight against the biggest infectious killer of children under five, pneumonia. The risk of dying from pneumonia among infants under five months is about nine times greater among those not breastfed compared with those partially breastfed.

A problem you thought had gone away

These marketing activities – including the familiar ‘follow-on milk’ adverts we see on TV in the UK – are in spite of an international set of rules adopted by the World Health Assembly nearly 40 years ago, called the International Code of Marketing of Breast-milk Substitutes (the Code).

When I’ve talked to my friends and family about companies marketing formula milk, a common response has been: “Wasn’t that something Nestlé did in the 80s?”

But this issue hasn’t gone away. Today 6 companies own more than 50% of the global formula milk market. All have talked openly about their ambitions to grow the industry, particularly in emerging economies such as China and parts of East Asia. Save the Children’s analysis shows that Nestlé, while coming out slightly better than other companies, is still only 40% compliant with the Code.

Formula should be available to those who need it

Of course, there’s a recognised medical need for some babies to be formula fed. And some parents choose to formula feed for a number of different reasons. Breastfeeding can be challenging, it can be inconvenient for mothers returning to work, and it’s still stigmatised in public in most societies.

But in situations where clean water isn’t available, mixing formula with dirty water can be dangerous and life-threatening. And when parents can’t afford enough product and have to dilute it, or don’t have access to safe preparation instructions, babies’ lives are at risk.

One mother called La Min, from Myanmar, told us last year:

“I thought that formula was better than my own breast milk… then, I realised that my child was getting sick at least twice a month, and I needed to bring her to the hospital very frequently.”

Don’t push it

Save the Children has been advocating for increased breastfeeding rates for decades. Our new report launched today, Don’t Push It – endorsed by Helen Keller International, BRAC, Sun CSN Pakistan and FHI360 – zeroes in on aggressive formula marketing.

The time has come for companies to enter a race to the top to become the most ethical and exemplary formula company, putting mothers’ and babies’ health as their priority and leading the way for others to follow suit.

We’re calling on:

  • companies to publicly commit to upholding the Code and agree to meet targets set to achieve full compliance
  • investors of formula companies to consider their ethical investment policies and urge their formula companies to align with them
  • governments to adopt the Code into legislation, as the evidence is clear that legislation is the strongest motivator for these industry giants to play fair.


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