Influencers, help forums, baby clubs, seminars with paediatricians and gynaecologists... Companies that manufacture milk replacement for breastfeeding are advancing faster than ever on the internet with promotional messages that are misleading and have an impact on nursing decisions. mothers, warns the World Health Organization, which has published a report, entitled 'How the marketing of breast milk substitutes influences our decisions about infant feeding', in which it tries to measure the scope of advertising in eight countries.
"Provide Dumex Dugrow 1 plus for children 1 year and older. This helps your child to be strong and happy. Call for a free sample at 02-740-3400." This is one of the texts included in the report, distributed in Thailand Other examples have been collected in Mexico, Bangladesh, Morocco, Nigeria, Vietnam, China and the United Kingdom through 8,500 people surveyed and samples of how digital strategies work In the last three countries, more than eight out of every ten women had received advertising for formula milk or artificial feeding.
"This report makes it very clear that the marketing of breast-milk substitutes is too widespread, misleading and insistent. Regulations on misleading marketing are urgently needed and must be enforced to protect children's health," he said in a statement. WHO Director-General Tedros Adhanom Ghebreyesus in February when the first part of the study was presented. This Friday a second one has been released, focused on new forms of advertising.
This advertisement is not just any advertisement. In 1981, the World Health Assembly approved the International Code of Marketing of Breast-milk Substitutes, a public health agreement to protect mothers from the practices of infant food manufacturers. The product is, along with tobacco, the only one for which there are international recommendations that place restrictions on marketing activities. It should not be supplied free of charge to hospitals, or promote products for children under six months, or give gifts to mothers or workers.
The new forms of advertising on social networks and the internet violate this code, according to the WHO, in addition to sending messages "unrelated to science". The problem, says Carmela del Moral, responsible for childhood policies at Save the Children, is that "it is considered as something equivalent to breast milk."
There is solid scientific evidence about the benefits of breastfeeding "a long time ago," says Marta Cabrera, a neonatologist at the La Paz hospital (Madrid) and coordinator of Neo iHAN, a non-profit initiative that has an agreement with the Ministry of Health to humanize care at birth and lactation. "It is the best option for newborns - he continues - because it is species-specific, it has growth factors and hormones that do not exist in formula milk, it protects against infections and allergies and reduces hospital admissions in children under one year of age. There is no no doubt, all scientific societies support it".
The target of the brands are especially pregnant and young. Through algorithms, brands identify their behavior and target them with abundant advertising to convince them that their product is better than breast milk, explains the WHO. Also through influencers who camouflage the promotion in personal opinions and even mothers who are used as opinion leaders in "industry-sponsored" support groups, said Niu Umar, president of the Indonesian nursing mothers association, in a meeting organized by the WHO this Friday.
More than 400 influencers promoted formula milk brands between January and June 2021, according to the study. "It's a very aggressive marketing to reach new mothers," analyzed Umar. "You play with women at a vulnerable moment, which is special and beautiful but also critical because women assume responsibility for feeding their children," says Cabrera.
However, the experts consulted ask for caution to prevent the debate from leading to the "demonization" of mothers who opt for formula milk. There can be a range of circumstances and contexts that explain these decisions, they should not be judged and "the important thing is that they are made in an informed manner," defends Cabrera. "Mothers who decide on infant formula must also be supported, of course, so that the milk is prepared properly and improve the bond with the baby." "In a brutal emotional and hormonal moment, if your response is to give her a bottle, the mother's mental health has to be protected," adds Del Moral, who regrets that there is a "certain pressure" to breastfeed that generates a lot of weight in the progenitors.
Regardless of the decisions that each one makes, there are structural elements that can favor the increase in women who breastfeed, such as the training of health professionals, more midwives or the increase in maternity leave, argue from Save the Children. Spain is at the bottom of the OECD countries in the ratio of midwives to women. "There remains to be done", she considers the person in charge of childhood policies, but Spain is not one of the worst countries. "Developing territories are more vulnerable because pneumonia is more frequent and breastfeeding can be a shield," says Del Moral. "There is always room for improvement," assumes the neonatologist.
Save the Children published in 2018 a report on the business of formula milk brands which reveals that six companies (RB, Abbott, Kraft Heinz, FrieslandCampina, Danone and Nestlé) own more than 50% of the market for breastmilk substitutes and spend €5.6 billion a year on advertising, the equivalent of €40 for each baby born into the world. The WHO maintains that, while the rate of women breastfeeding their children has slowly increased over the past two decades, sales of milk substitutes have doubled. 44% of children under 6 months are fed exclusively through breastfeeding in the world.
The WHO is also concerned about how manufacturers target health workers "to influence the recommendations" they make to women who have just given birth: "They give health workers gifts, free samples or funds for research ; organize meetings, events and conferences with expenses paid, and even offer commissions on sales, all of which directly affect the decisions of mothers regarding the feeding of their children". More than a third of the women surveyed reported that a health worker had recommended a particular brand of infant formula.
"In the last ten years there has been an improvement. Commercials practically no longer come to the hospital and there is a greater awareness among professionals when it comes to giving a conference, for example, or advertising with milk," says Cabrera, from the La Paz, although she clarifies that professionals must know what milks are on the market in case they have to be indicated.