Its weekend editorial follows on from a recent World Health Organization (WHO) report that found laws to protect breastfeeding were inadequate in most countries. Infant formula makers have called that report ‘vague’ and in denial of the nutrition science backing milk consumption in infants.
“From tobacco, to sugar, to formula milk, the most vulnerable suffer when commercial interests collide with public health,” The Lancet editorial concluded.
“Robust advertising regulation – covering all milk products for children up to three years, and banning social media promotion – is the next step to protect them.”
It noted the WHO report, written with UNICEF (United Nations Children's Emergency Fund) and the International Baby Food Action Network (IBFAN), found only 39 of 194 countries “have comprehensive legislation covering all aspects of the Code.”.
The Code being the 1981 Code of Marketing of Breast-Milk Substitutes.
Social media campaigns have drawn fire for building maternal communities and then promoting breast milk substitutes.
Protecting the breast
The editorial noted “Encouragingly, 135 of 194 countries in the analysis had at least some legal measures in place, compared with 103 countries in 2011.”
The Lancet highlighted how richer countries often have the lowest breastfeeding rates and “fewest legal protections”, especially for formula marketed for babies over six months of age.
Code adherence was typically retarded by “lack of political will, poor coordination between stakeholders, industry interference, and insufficient resources for monitoring and data gathering.”
“Mothers deserve a chance to get the correct information: that they have readily available the means to protect the health and well-being of their children,” said UNICEF chief of nutrition Werner Schultink. “Clever marketing should not be allowed to fudge the truth that there is no equal substitute for a mother’s own milk.”
The white stuff?
But groups like the National Milk Producers Federation (NMPF) in the US and Specialised Nutrition Europe (SNE) have criticised elements of the WHO report.
“The WHO guidance document is a de facto criticism of all milk consumption by toddlers,” said Jim Mulhern, president and CEO of NMPF. “This flies in the face of all credible, international nutrition research, and would confuse consumers across the globe.”
A 2014 European Food Safety Authority (EFSA)-commissioned report found infant formulas (0-6 months), follow-on milks (6-12 months) and toddlers' milks (12-36 months) enhanced with omega-3s, prebiotics, probiotics and vitamins and minerals were little better than ‘control formula’.
UK All Party Parliamentary Group for Infant Feeding and Inequalities
In the UK, pro-breastfeeding group Baby Milk Action (BMA) welcomed the WHO report and last week made a Westminster presentation to the All Party Parliamentary Group for Infant Feeding and Inequalities, headed by Scottish National Party MP, Alison Thewliss.
In his presentation to the working group, BMA campaigns coordinator Mike Brady highlighted ‘aggressive’ marketing actions of formula companies and called for greater enforcement of the Code.
“Advertising is not the same as information,” he said. “We have won cases at the UK Advertising Standards Authority (ASA) proving companies have misled parents about their products. Under the Code, health workers are responsible for advising parents on infant and young child feeding.”
“Companies are limited to providing health workers with scientific and factual information on products - though analysis shows their claims often cite irrelevant, inadequate or the company’s own research.”
A spokesperson for Thewliss told us the working group, established in November last year, sought to address the reasons the UK had the lowest breastfeeding rates in Europe, especially for infants over six months of age.
“There really hasn’t been the political will to address this situation – even under 13 years of Labor government,” the spokesperson said. "The group will be used to advance promotion of breastfeeding and look at wider policy issues.”
He noted the UK government had recently cut the Infant Feeding Survey – important for understanding breastfeeding rates and trends; along with breastfeeding helplines.
The parliamentary group next meets at Westminster on July 5.
33 UK MPs have signed an early day motion on the issue since it was tabled in March.
Most of the major formula firms like Nestlé and Danone-Nutricia have come under fire for illegally promoting the use of formula in various countries in recent years.
WHO recommends breastfeeding commences “within the first hour of birth and be exclusive for six months, with the introduction of complementary food after six months and continued breastfeeding up until two years or beyond.”
Euromonitor International put the global infant formula market at €40bn in 2014, up from about €22.5bn in 2009. At that time, Nestlé had about 22% of this market, Mead Johnson Nutrition had 13.6%, Danone-Nutricia 11.8%, Abbott Laboratories 9.5% and Royal Friesland Campina 3.8%.