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In February 2023, BMJ and The Lancet, two authoritative scientific journals, published articles simultaneously on the promotion of infant formula. The authors of the publication in BMJ analyzed how often manufacturers make claims of their products being beneficial for children and the scientific evidence backing those claims. The authors of the series of articles in The Lancet described the marketing techniques used in the promotion of infant formula in detail. The scientists concluded that manufacturers deliberately mislead parents, leading to decisions based on distorted data.
The assertion by companies that infant formula can relieve colic and enhance intellectual development is frequently unsupported by evidence.
Scientists from fifteen countries conducted a study on the frequency of infant formula manufacturers making claims about their benefits, and the evidence behind these claims, between 2020 and 2022. The study revealed that the USA had the highest number of such claims, with an average of 4.5 claims per type of formula.
Manufacturers frequently highlight that their formula “develops the brain/eyes/nervous system” or “supports” them. Other claims can include how infant formula “boosts the immune system,” “facilitates the growth of beneficial bacteria in the gut,” “caters specifically to infants with constipation,” or “provides rapid relief from crying and colic.” The range of claims is quite extensive. However, researchers discovered that there is incredibly scarce scientific evidence to back up these claims.
Manufacturers only provided references to support their claims in 30% of cases. Even in cases where manufacturers did provide sources, the sources did not always validate their claims. Less than half of these references could be considered reliable sources. Scientists have discovered that in the vast majority of cases, there is no objectivity in these works. Researchers often uncover dubious manipulations during the research process, as well as in the presentation of results. Additionally, these studies were typically funded by companies with vested interests. In other words, there are very few studies that can confirm the claims made by manufacturers.
It is worth noting that in medicine, a single study is seldom sufficient, and a comprehensive analysis of multiple works is usually necessary to draw reliable conclusions. Researchers working for advertisers have discovered independent studies that address various commonly-made claims about infant formulas, but are not acknowledged by manufacturers. These studies do not establish a connection between individual ingredients and health benefits.
The study’s authors also highlight that manufacturers frequently link particular properties of the formula to specific ingredients. In contrast, breast milk contains thousands of components that provide benefits both individually and in combination, and its composition varies based on multiple factors. Infant formula manufacturers suggest that a single component is vital for a child’s development, but the reality is much more complex.
Dr. Nigel Rollins, who works for the World Health Organization (WHO), commented on this study in a BMJ editorial. He notes that the composition of infant formulas is also an issue of equality. If some formulas genuinely provide additional benefits as claimed by manufacturers, then why are they only accessible to families who can afford more expensive food? If the composition of the formula provides an advantage, then it should be made standard so that all infants have an equal starting position in this regard.
Baby formula manufacturers use several dubious tactics to promote their products, including the exploitation of feminist concepts.
The Lancet has published a series of articles that describe the various tactics used by companies to promote baby formula. These companies target different groups, including expectant parents, current parents, healthcare workers, opinion leaders, healthcare organizers, and politicians, using a range of methods.
One such tactic is to label normal situations as pathological and promise to improve everything. For example, companies may market products for bloating, crying, or brief infant sleep, even if these are normal occurrences. Hypoallergenic and other specialized formulas are also marketed to babies without any allergies or intolerances, “just in case.” Scientific language is used to lend weight to these claims.
Manufacturers emphasize that formula allows parents to avoid the limitations associated with breastfeeding, enabling both parents to participate in feeding and giving mothers the opportunity to work. They also argue that “moralizers” advocate the preference for breastfeeding.
There are indeed people, including healthcare workers, who openly criticize those who choose formula. However, modern medical organizations take a different approach (as The Lancet editorial emphasizes): providing all necessary information about the pros and cons of different options is the most important thing for those making the decision about infant feeding. This information includes the fact that breastfeeding is better for the health of the mother and child than any formula (even “premium” formulas) – although other factors can influence parental decisions. Therefore, it is crucial for breastfeeding mothers to have all the necessary conditions, such as paid parental leave, flexible schedules, and the ability to safely express milk in the workplace.
Milk formulas are essential, but their promotion should be limited
Milk formulas save lives in cases where breastfeeding a child is not possible and donor milk is unavailable or undergoes insufficient testing. They are necessary when the benefits of artificial feeding outweigh those of breastfeeding for parents, and in other situations. Scientists do not advocate banning or restricting the sale of formulas. The primary issue lies in the promotion methods used, which authors in The Lancet describe as “predatory.” The WHO uses terms like “unacceptable, pervasive, misleading, and aggressive” to describe these methods (in 2022, the WHO published a significant report on marketing methods for formulas in different countries).
Meanwhile, over 40 years ago, the WHO released the International Code of Marketing of Breast-Milk Substitutes, which outlines acceptable and ethical marketing practices. For instance, companies should not give free formula samples to parents of infants, advertise formulas, or offer incentives to healthcare workers. Currently, only 32 out of 194 countries have implemented this code well enough, while 144 have only implemented some provisions of it in their laws.