The baby formula industry uses increasingly manipulative messaging to target healthcare professionals and mothers. This is one of the findings of the 2023 Lancet Breastfeeding Series released last week. The series of three reports highlights falling breastfeeding rates in low-income countries, including South Africa.

The authors reviewed 153 studies for the series and found the industry’s marketing practices violate regulations in nearly 100 countries, including South Africa.

One reason mothers opt for formula over breastfeeding is the misrepresentation of typical, unsettled baby behaviours as signs of milk insufficiency. The market-driven world of formula milk companies exploits parents’ concerns about these behaviours with unfounded product claims and advertising messages. 

Professor Linda Richter from the Centre of Excellence for Human Development at Wits University and a study co-author says commercial milk formula companies have stepped in where public health has left a vacuum. 

The feelings of anxiety, confusion, and desperation in those first few months of life are where, Richter says, companies took the opportunity to sell the idea of an alternative solution that will ease infants and mothers. 

Richter notes formula milk companies sell normal newborn experiences such as gas, sleeplessness, and excessive crying as neediness and requiring formula milk.

Formula industry: violators of the law 

Kristin Husselmann, Coordinator at Philani Maternal, Child Health and Nutrition Trust, says commercial milk marketing has worsened.

“Mothers who have just given birth are seeing more ads on formula benefits and getting links to buy them online. They are getting free samples at hospitals. And often paediatricians opt for promoting using formula during breastfeeding struggles.” 

Marketing formula as “similar to breastmilk” is the most misleading way to get mothers to switch, and they struggle to say no.  Despite laws and regulations on marketing infant formula, the country has seen no improvement in breastfeeding rates. Mothers and families are increasingly exposed to marketing through social media and maternity wards in health facilities.

Failure to Enforce Regulations on formula

South Africa has regulated the marketing of infant formula in regulations relating to Foodstuffs for Infants and Young Children since 2012. The country has full legal provisions prohibiting the advertising of designated products to the general public through the International Code of the Marketing of Breastmilk Substitutes. The code has long been ratified in SA and includes a total prohibition of any promotion of formula milk within healthcare settings. 

However, Professor Tanya Doherty from the South African Medicine Research Council (SAMRC) states, “We are failing to enforce and monitor this code, particularly in the private sector. We need to step up in this area.”

The government’s failure to strengthen existing legal and regulatory frameworks to eliminate advertising and promotion of formula milk places infant health at the bottom of the list.

Vulnerable mothers captured in maternity wards

The study found almost 43% of health professionals interviewed in SA reported being directly contacted by a formula company representative. Several health professionals stated they recommend the brands they received information about from representatives or that their hospital was sponsored by a particular brand.

In her work, Husselman encountered mothers who are living in poverty that use formula milk because they feel inadequate because their diet is not nutritious enough. They feel their breastmilk cannot be “enough” for their baby. 

She says mothers are most vulnerable in the postnatal maternity wards of hospitals and community health centres. Other places include during follow-up visits where growth is lagging, when breastfeeding challenges arise when community health workers visit them within their own homes, and when getting help from other parents who have formula-fed, saying their child “turned out fine.”

The report also reveals the local formula milk industry has systematically targeted health professionals, particularly in the private sector. This may seem like a small 20% of users, but if one considers that companies like Dischem and Clicks provide vaccines from the department of health for a small fee, the impact is higher.

A working but low-paid mother who doesn’t want to sit at the clinic all morning visits one of these contracted facilities. Here she is exposed to the clinic sisters, who are overwhelmed by representatives from formula milk companies.

Society intervention

Experts agree that mothers need more information on breastfeeding while still pregnant. Commentary co-author Dr Chantell Witten says all of society must intervene to protect, promote, and support breastfeeding.

Doherty says Placing more stringent rules on the packaging of formula milk will impact mothers’ buying habits.  “We should demand plain packaging. Take away pictures, illustrations, and words that allude to the false claims that infants will be healthier or calmer with its use”.

Richter adds that health professionals also need more training and support to feel confident in supporting women to breastfeed and emphasises the importance of impeding the marketing alongside this to achieve an improvement in breastfeeding numbers.  – Health-e News

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