In 2018, Milka Muthoya, a new mother, recalls being sent home with two jars of formula milk with every visit to the hospital for her postnatal care.

“I had absolutely no problem with my breastmilk production. But my three-month maternity leave had elapsed, and I had resumed work. This meant I leave expressed breastmilk for my new-born to take while I was away during the day. But he did not enjoy the milk and often refused to drink it and would wait until I got home to breastfeed directly,” Ms Muthoya recollects.

When she narrated her ordeal to her baby’s paediatrician, it was recommended that she switch from expressed breastmilk to an infant formula milk. “The baby might like it,” the doctor had opined.

In spite of the baby refusing the formula milk, on every consecutive post-natal clinic visit, the paediatrician switched up the formulas advising that the baby might like a different brand better.

Big formula milk companies are accused in a new study of using false and predatory marketing tactics and targeting health professionals including paediatricians, midwifery, and nutritionists to undermine breastfeeding.

The new study, Marketing of Commercial Milk Formula released in The Lancet last week, criticised the quasi-medicalisation of formula milk resulting from marketing manoeuvring over science and national policies, by an excessively powerful system of influence that generated demand and sales of its products at the expense of the health and rights of children.

The target group of this marketing scheme were found to be parents, medics and politicians.

Common approach

Despite the proven benefits of breastmilk, less than half of infants and young children globally are breastfed in accordance with World Health Organisation recommendations to breastfeed for the first six months of life.

In comparison, Commercial Milk Formula (CMF) sales have increased to about $55 billion annually, with more infants and young children receiving formula products than ever.

The report said about 1 in 3 neonates in low-income and middle-income countries received pre-lacteal feeds (or formula), and only 1 in 2 neonates were put to the breast within the first hour of life.

“We report how CMF sales are driven by multifaceted, well-resourced marketing strategies that portray CMF products, with little or no supporting scientific evidence, as solutions to common infant health and developmental challenges in ways that systematically undermine breastfeeding,” said the team of researchers led by Prof Nigel Rollins, from WHO Department of Maternal, New-born, Child and Adolescent Health and Ageing.

The scientists spoke of the industry’s exploitation of parents’ desire for good health and a good life for their children.  They said a common approach by the CMF industry was to suggest a solution to parents’ concerns about infant behaviour, even though that behaviour according to the scientists is part of normal development.

The scientists warned that specialised formula such as that sold as comfort milks for hungry babies, colic, sensitivities, and prolonged sleep, further commodify infant and child feeding even though, according to the scientists, the offered solutions are scientifically unsubstantiated solutions for medical or quasi-medical problems.

They also criticised labelling on CMF packaging indicating superior brain development and others claiming to influence health outcomes as well as allergy de-risking, as misleading and not scientifically proven.

Health consequences

The scientists noted studies and systematic reviews showed no benefit of the ingredients added to these products on academic performance or long-term cognition and, sugar, sweeteners, emulsifiers, and thickeners were added to enhance taste and acceptability without thorough independent study of their health consequences in infants and young children.

The team recommended that product development be better regulated and health claims by CMF manufacturers be prohibited due to their potential for harm.

Oversight of CMF products, including their composition, quality control, and review of specific claims, generally falls under National and International Food and Nutrition Standards rather than pharmaceutical regulations.

Being classified as food products, the CMF industry is not obliged to provide evidence at the same level of certainty as international standards for medical interventions.

The report added that with sales stagnating in high-income countries through the mid-20th century, European companies successfully expanded these marketing strategies to Africa, the Middle East, Asia, and the Americas.

The scientists said the industry had systematically distorted science, captured health-care providers and parents, altered public opinion, and influenced policy makers. Through these divisive practices, CMF marketing impinges on the human rights of women and children, harmed their health.

“Brand X is being sponsored to the hospital. If it doesn't work [for the mom], we will recommend another one within the Brand X range.” revealed a doula from Johannesburg.

This seemingly professional advice influences mothers.