In the same week of February that Abbott, one of the largest infant formula makers in the United States, began withdrawing a number of products that were causing shortages in the country, the World Health Organization (WHO) released an important report, but it went almost unnoticed . The researchers added another problem to this class of drugs: Much of the world is overly dependent on them because of manufacturers’ aggressive and misleading marketing techniques.
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“The marketing of milk formula knows no borders. It misuses and distorts information to influence decisions and practices,” the authors denounced. The report looked at infant formula marketing practices in eight countries around the world, but was largely overshadowed by other news from the United States.
The current shortage of baby food in the US shows that it is a necessary product that can be indispensable, especially for working mothers, mothers with preterm babies or those who are struggling to breastfeed. The need is so fundamental that Joe Biden’s administration announced last June that it would import nearly 20,000 kilos of Nestlé infant formula from Switzerland for distribution in the United States.
Breastfeeding strengthens babies’ immune systems and reduces the risk of the mother developing diabetes or cancer
However, there is a global health consensus that whenever possible, breast milk is better for the baby’s health than commercial products. The benefits of breastfeeding are well documented: it strengthens the immune system, so babies are better protected against infections, and it reduces the risk of the mother developing diabetes or even cancer. In rich countries, thanks to major public health campaigns — coupled with tighter controls on corporate advertising — mothers are more likely to make informed decisions about when to use infant formula.
Instead, according to the WHO, in Vietnam, the companies that make the substitutes are implementing some of the most aggressive marketing strategies in the world. Women are bombarded with TV ads and social media posts that often distort scientific evidence to legitimize their claims and sell their products. Corporate reps known as “promo girls” even hang out in hospital lobbies to meet up with unsuspecting new moms.
A third of young mothers in Vietnam report receiving product samples, a higher number than any other country surveyed by WHO, with the exception of China
Practices are effective. About 76% of babies in Vietnam are partially or fully formula-fed. The United Nations has set a goal of reducing this number to 50% globally by 2025, a target that will certainly not be reached.
“They put a lot of energy into fast-growing economies like Vietnam,” explains Laurence Grummer-Strawn, WHO nutritionist. “They know that the market will grow in them. People’s incomes are rising, women are getting more jobs and are therefore doing a lot of advertising.”
Around a third of new mothers in Vietnam say they have received product samples, a higher number than in any other country surveyed by the WHO except China. But the problem is global. The World Health Organization research team found the same aggressive tactics in Bangladesh, Mexico, Morocco, Nigeria and South Africa, among others. One of the most serious cases is that of Mexico, where the WHO confirmed that health workers were separating babies from their nursing mothers and beginning to unnecessarily give newborns formula milk.
In Mexico, WHO found that health workers were separating babies from their breastfeeding mothers and beginning to give newborns formula milk unnecessarily
These strategies endure despite the International Code of Marketing of Breastmilk Substitutes, a framework of best practices similar to the Global Tobacco Agreement. In fact, both products are the only ones that have global recommendations for their marketing. However, due to the non-binding nature of the document, companies continue to put their economic benefits ahead of people, particularly in countries where public health infrastructure and enforcement mechanisms are weaker.
The WHO adopted the framework in 1981 after the London-based non-profit organization War on Want published a report entitled The Baby Killer. The report examined the aggressive and inaccurate marketing tactics of the multinational breast milk companies of the time. Investigators accused Nestlé and Abbott — to date the biggest players in the market — of selling artificial milk to mothers who couldn’t afford it and who would have preferred to breastfeed. From Jamaica to Jordan, they documented how the early introduction of formula replacements led to higher infection rates and, in the most extreme cases, to baby malnutrition because the product was expensive and mothers tried to make it last longer by diluting the formula. Solution. The report shocked public opinion and prompted the world to take action.
However, according to the WHO, only 44% of children under the age of six months worldwide are exclusively breastfed today. On the other hand, the value of the formula milk production sector has increased to 53.6 billion euros. These benefits, in part, reflect the growing number of mothers around the world who are entering the workforce and turning to formula feeding because they are breastfeeding their babies less frequently. But it is also the result of forced marketing practices in countries where healthcare infrastructure is weak and lactation counseling services are overwhelmed. From China to Nigeria, young mothers are faced with a deluge of information praising the breast milk formula.
According to the WHO, only 44% of children under the age of six months worldwide are exclusively breastfed today.
The Internet offers these businesses a powerful and convenient tool that they didn’t have decades ago. Digital marketing is cheap, and with the help of influencers, Facebook parent groups, and Google search ads, baby replacement companies are promoting their products — and their questionable health claims — in ways that aren’t easily recognizable as advertising.
To Huong, 35, lives in Vietnam and saw the formula makers’ marketing tactics firsthand when she gave birth to her first child via cesarean section seven years ago. From her friends, family, and the chaos of information she found here and there on the internet, she believed that women who had cesareans could not breastfeed. “I felt insecure,” she admits, “and after giving birth I didn’t have milk right away, so I switched to formula.” Little did she know at the time that with the help of a lactation consultant, she probably could have breastfed her son.
Choosing the brand of replacement was just as stressful as his decision to use it. She says she’s “overwhelmed by the various ads” promising everything from improving a baby’s digestive health to reducing crying.
Over the past year, Alive & Thrive, a global organization dedicated to maternal and child health, worked with a team of technicians to analyze the Vietnamese market. After examining more than 16,000 online posts, ranging from social media content to e-commerce websites, more than 4,000 violations of the International Code of Marketing of Breastmilk Substitutes were found. Japan’s GuunUp MBP was the main offender in the country: 80% of its publications did not comply with the code’s rules. Other multinationals, from America’s Mead Johnson to Switzerland’s Nestlé, have also been caught using questionable tactics.
For example, Alive&Thrive investigators found that Mead Johnson discounted its Enfagrow brand infant formula in violation of the code for marketing products to children under 24 months of age. In the advertisement, the company included a photo of its product for older children to comply with regulations. The organization also discovered that Nestlé attempted to contact parents directly through its Facebook page in Vietnam, in another violation of the code.
Manufacturers have even tapped into parents’ fears of Covid-19, focusing their marketing strategy on vague claims that their products boost immunity. According to the International Journal of Environmental Research and Public Health, a Vietnamese brand used a photo of WHO Director-General Tedros Adhanom Ghebreyesus from a Facebook post about the pandemic to suggest by association that its milk substitute could fight the virus.
A Vietnamese brand used a photo of the WHO director-general from a Facebook post about the pandemic to imply, by association, that their milk substitute could fight the virus
Nestlé Vietnam did not respond to the specific allegations, but issued a statement saying the company markets breast milk substitutes responsibly and has “a strict policy and a strong compliance and governance system to hold accountable for its actions.” The other companies mentioned in this article have not responded to requests for comment.
Vietnam passed laws in line with the code a few years ago, meaning the government can take action against those who break advertising rules. However, Vu Hoang Duong, regional technical specialist for Alive&Thrive, believes that “there are few staff to investigate all violations on digital platforms”. The Department of Health has only three inspectors responsible for enforcing the code. The ministry did not respond to requests for its version of the article.
As a result, the task of countering the pseudoscience and confusing hype often falls to mothers working to publicize the benefits of breastfeeding over formula. To Huong, who regrets feeding her son artificial products, has a message for women in Vietnam: “Please research the origin and ingredients of formula milk thoroughly before giving it to your babies. And if you’re having trouble, seek the help of a lactation consultant.”
With information from Vo Kieu Bao.
This report was originally published on The Fuller Project.
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