Is Formula Marketing Really The Reason For Low Breastfeeding Rates?

Anyone who’s ever been in an online mom group, especially in the early days of infancy, can tell you how heated and triggering discussions of “formula feeding vs breastfeeding” can get. The topic stirs up big feelings — indignation, shame, anger, defensiveness, and hubris — no matter what side of the argument you’re on. That’s perhaps not a surprise, considering the subject lies at the intersection of child-rearing, food, and women’s bodies. But now a series about formula feeding published in The Lancet, an influential British scientific journal, highlights another force that is no less prone to visceral reactions: Capitalism.

The series aims to take a comprehensive view of the factors that contribute to lackluster global breastfeeding rates, far lower than what the World Health Organization’s (WHO) recommends, which is that all children are exclusively breastfed for the first six months of life and continue to breastfeed for “up to two years and beyond” after they start solid food. But The Lancet pays special attention to the marketing of infant formula. “The commercial milk formula (CMF) industry exploits concerns of parents about [unsettled baby] behaviours with unfounded product claims and advertising messages,” the summary reads.

In other words, by pathologizing normal infant behaviors, such as fussiness and frequent wakings, the formula industry undermines parents' confidence in their ability to adequately feed their children with breast milk alone, to detrimental effect.

These findings echo a 2022 report from the WHO that highlighted formula marketing tactics that can generously be classified as shady, including false claims about the formulation of products, efforts to incentivize healthcare workers to promote formula by offering gifts and trips, and the monitoring of social media posts by women about breastfeeding in order to send them direct messages about the benefits of formula. Furthermore, a recent study published in the British Medical Journal found that formula manufacturers routinely make dubious or insufficiently backed claims regarding the health benefits of their products. (Ed note: infant formula is tightly regulated, and when used correctly, the brands on the market are safe and provide excellent nutrition for infants and young children.)

Reaction to the series on social media has been, predictably, intense. Some felt the report was a veiled attack on women and the complex decisions they must make to get their babies fed; others felt the report vindicated a long-held belief that formula marketing undermines breastfeeding.

“I cannot believe we are still doing this,” tweeted Liz Skoski of Reproaction, a reproductive justice organization, alongside an article about the series. “Free samples, coupons, and chat lines are not 'underhanded' or 'predatory'! They are vital resources for so many parents who need help using, accessing, and affording formula to feed their babies.”

“‘Underhand’ formula milk ads stop millions from breastfeeding, experts say. What a surprise! Who knew,” mused @CllrBazMargetts sarcastically. “Company profits put before global health. Stop all forms of promotion and marketing of formula milk. Prescription only access.”

“Lies, damned lies, statistics & breastfeeding statistics in the Lancet,” scoffed @drruthannharpur of the Infant Feeding Alliance. “Out of date, inaccurate and utterly misrepresented data used to stir moral panic & harangue women.”

“We (in La Leche League and the lactation community) have been screaming this from the rooftops for years and years,” one commenter wrote on Facebook, “and now they admit it. .... Profit was the mission. Not health.”

“These manufacturing behemoths are motivated, like any private industry, by their bottom line. They have a vested interest in ensuring that more and more parents choose formula.”

Once again the topic took on the contours of an either/or debate: Breastmilk pitted against formula, mothers who embrace a fed-is-best mentality versus those who virtuously go the distance to breastfeed their babies into toddlerhood. After calling out the big bad formula industry for corrupting the world’s breastfeeding mothers, The Lancet did note that there were several other factors that “also” contribute to lower-than-desired breastfeeding rates. There is (per the series’ Executive Summary) the industry’s “lobbying of governments, often covertly via trade associations and front groups” against social policies that would make breastfeeding easier, such as breastfeeding protection laws and parental leave.

As the authors of one of the papers put it, “absent, inadequate, or poorly enforced maternity protection policies” as well as “poor access to paid maternity and paternity leave, flexible scheduling to accommodate breastfeeding, or appropriate breaks and facilities for breastfeeding or milk expression” all undermine breastfeeding among working mothers.

It was a relief to see the series highlight the need to address factors such as maternity leave and integrating unpaid care work (like breastfeeding) into macro-economic policies. But these are not mere “compounding” factors — these are the factors the formula industry depends on in order to effectively structure its marketing plans. In short, this is not an issue that would be solved by better regulation of private industry; this is a public policy crisis.

To be clear, I’m not arguing that formula companies are beleaguered humanitarians who just want to feed the poor hungry babies. (Nor are the women who avail themselves of formula samples dupes to a predatory industry — as Liz Skolski herself wrote in Romper, for many women formula feeding is their first and best choice.) But formula manufacturers are motivated, like any private industry, by their bottom line. Per The Lancet, they protect their $55 billion annual profit by reinvesting $3 billion of that into marketing; they have a vested interest in ensuring that more and more parents choose formula. The goal of government (at least in a best-case scenario) is to promote the general welfare of its citizens. Just because private entities pressure and wave money around doesn’t mean governments have to say yes to their agenda.

This report is certainly not the first time formula manufacturers have been chastised for their marketing. In fact, in 1981 the WHO ratified the International Code of Marketing of Breastmilk Substitutes, which suggested regulating the marketing of breast milk substitutes in order to encourage breastfeeding. Let’s say the world governments decided to officially codify this currently voluntary (read: toothless) set of guidelines. Suddenly, there would be no advertising of breast milk substitutes at all, no free samples of products in clinics, hospitals, or the private sector (something lots of new parents actively appreciate for economic or biological reasons), and a slew of new regulations regarding how infant formula can be discussed and labeled in public.

“Presenting the issue as one primarily of corporate greed — rather than government capitulation to corporate greed — misses the mark.”

Would these restrictions magically address many of the issues breastfeeding parents cite as the reason they stop (or don’t even start) breastfeeding, such as mental health challenges and “self-reported insufficient milk” (SRIM), which the series seems to regard with skepticism? (The Lancet treats SRIM as a minor detail that can be “prevented or addressed successfully with appropriate support.”) The biggest hurdle to breastfeeding that parents site is the return to work. In low-, middle-, and high-income countries alike, breastfeeding rates decline around the time nursing parents return to work. While the WHO recommends exclusive breastfeeding for the first six months of a baby’s life, not one country offers fully-paid leave for a six month period.

Certainly, some parents continue exclusive breastfeeding via pumping after they go back to work, but even in the best of circumstances (adequate time, space, and support to pump) this can prove exceedingly difficult. It’s not just clever marketing that makes these parents turn to formula.

Disentangling, on a global level, the reasons many parents either choose not to breastfeed, cannot breastfeed, or stop breastfeeding before official WHO recommendations is no easy task. The Lancet series does a good job presenting the many factors that can contribute to this public health concern and, in its best moments, speaks truth to power by highlighting the need for systemic changes. But ultimately, presenting the issue as one primarily of corporate greed — rather than government capitulation to corporate greed — misses the mark.

“Breastfeeding is not the sole responsibility of women and requires collective societal approaches that take gender inequities into consideration,” write the authors of one of the papers. “Absent, inadequate, or poorly enforced maternity protection policies also undermine breastfeeding among working women through poor access to paid maternity and paternity leave, flexible scheduling to accommodate breastfeeding, or appropriate breaks and facilities for breastfeeding or milk expression.”

Exactly. Now we might be getting somewhere.