Despite proven benefits, less than half of infants and young children globally are breastfed in accordance with the recommendations of the World Health Organization. In comparison, commercial milk formula (or CMF) sales have increased to about $55 billion annually, with more infants and young children receiving formula products than ever, according to new research.

This trend is explored in a series of papers published recently in The Lancet, “Breastfeeding 2023,” in which co-authors, including Kathryn M. Russ, UC Davis professor of economics, describe their findings. Russ and co-authors will present the series of papers at the UNICEF House in New York on Tuesday, April 18. A media statement on the series of articles is available here.

The last year has reminded Americans how we are at the mercy of a handful of large companies who produce infant and follow-up formulas — Kadee Russ

In this blog, we summarize one of the articles in the series co-written by Russ, “Marketing of commercial milk formula: a system to capture parents, communities, science, and policy,” published online here. All papers in the series are available here.  

Marketing of formula, the authors discuss, is not inherently bad or unethical. However, CMF marketing strategies, also used in other industries, systematically distort science, capture health-care providers and parents, alter public opinion, and influence policy makers.

“The last year has reminded Americans how we are at the mercy of a handful of large companies who produce infant and follow-up formulas, said Russ. “The vulnerability came as a surprise, but it is in no small part the result of decades of collective policy choices that make it harder than it needs to be to breastfeed in the United States.”

The key findings of the research

• • The marketing of commercial milk formula for use in the first three years of life has negatively altered the infant and young child feeding ecosystem. CMF sales approach $55 billion annually. Nowadays, more infants and young children are fed ultraprocessed formula milks than ever before. Breastfeeding and breastmilk are unparalleled in composition, immune properties, and health and development outcomes.
  • CMF marketing is a multifaceted, sophisticated, well-resourced, and powerful system of influence that generates demand and sales of its products at the expense of the health and rights of families, women and children. Digital platforms and use of individual data for personalized and targeted marketing have substantially enhanced the reach and influence of this system.
  • CMF marketing oversimplifies parenting challenges into a series of problems and needs that can be resolved by buying specific products. Marketing of CMF manipulates and exploits emotions, aspirations, and scientific information with the aim of reshaping individual, societal, and medical norms and values.
  • CMF marketing targets health professionals and scientific establishments through financial support, corporate-backed science, and medicalization of feeding practices for infants and young children. Conflicts of interest threaten the integrity and impartiality of health professionals.
  • Violations of the International Code of Marketing of Breast-milk Substitutes and subsequent resolutions, which express the collective will of the World Health Assembly, have never stopped. These violations occur despite 40 years of effort by World Health Assembly member states and the international community to hold CMF industries accountable. CMF companies continue to defy the principles and recommendations of the code knowingly and regularly.
  • Governments have obligations to ensure their citizens have access to impartial information about feeding infants and young children and to enact policies that are free from commercial influence. Fully and equitably supporting women and children's rights at home, at work, in public spaces, and in health care is a societal responsibility.
  • Marketing of CMF products should not be permitted. A framework convention, placing the rights of children and women at its heart, is needed to protect parents and communities from the commercial marketing of food products for and to children younger than 3 years old, including CMF marketing systems. The framework would restrict marketing but not the sale of these products.

Through these divisive practices, the co-authors maintain, CMF marketing impinges on the human rights of women and children, harms their health, and adversely affects society. The evidence affirms that past efforts to have the CMF industry adhere to the Code have not been sufficiently successful. Citizens desire — and have a right to — objective information and policies that are free from commercial influence. A concerted effort is needed to attain this adherence to the Code, researchers said. They maintain that addressing CMF marketing is insufficient on its own. Policies must remove structural barriers and society must fully enable and support women who choose to breastfeed.

Fact-based information on feeding infants and young children that is free from commercial influence is a human right that must be made available to all, researchers said. The vital human process of feeding infants and young children should be off limits to commercial marketing, the paper concludes.