Lancet series calls for legal treaty on baby formula promotion

In a series published in The Lancet, the experts call for a international legal treaty to end irresponsible formula marketing and political lobbying, saying the voluntary code introduced in the 1980s has failed.

The Australian dairy industry's involvement in infant formula production was tarnishing its reputation, one of the authors, Australian National University Associate Professor Julie Smith, said.

"We've got a lot vested in the formula industry," she said.

"In recent years we've really jumped onto the bandwagon with infant formula exports, which leaves our industry quite exposed.

"Our industry needs to unhitch ourselves from this particular bandwagon because it's not good for their reputation."

Assoc Prof Smith said Australia was increasingly being caught up in controversies in Asia where formula marketing was starting to cause trouble.

"We are pushing it in Cambodia, we're pushing it in Myanmar," she said.

"Australia is a 'bad policy actor' both at home and abroad.

"It joined US efforts to stop Thailand from strengthening its milk formula marketing and breastfeeding protection law."

Assoc Prof Smith said the Australian infant formula industry had resisted attempts by the Australian Competition and Consumer Commission to apply Australia's self-regulated marketing agreement to marketing of Australian products in overseas markets.

The World Health Assembly developed the voluntary International Code of Marketing of Breast-milk Substitutes in 1981 in response to The Baby Killer investigative report into Nestle's marketing of formula milk in poor communities in third world countries in the 1970s.

But The Lancet authors say sales from commercial formula milk having rapidly increased in the past 20 years and now total more than $55 billion a year globally.

One of the authors, Professor David McCoy, United Nations University, said the voluntary code was not working.

"Formula milk companies chose to disregard the guidance and lobby at every opportunity to weaken regulation," he said.

"We need a stricter international legal treaty on the marketing of milk formula which is incorporated into law across the world."

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The authors accused the dairy industry - including Australia's - of having a vested interest in expanding infant formula markets and of aggressively lobbying against formula-related regulations.

They said major dairy and infant formula producing countries - especially the United States, Australia, the European Union and New Zealand - had advocated on behalf of these industries on the international stage.

They accused them of using World Trade Organisation and bilateral processes to challenge, and ultimately weaken, breastfeeding protection laws in other countries.

The experts also call for more effective breastfeeding support.

Assoc Prof Smith said broader actions across workplaces, healthcare, governments and communities were needed to more effectively support women who wanted to breastfeed.

"Advice that breastfeeding is best for their babies' health is no use if women are not supported to understand and manage unsettled baby behaviours or if mothers without maternity leave or pay are forced to go back to work out of financial necessity," she said.

The Lancet series accuses formula companies of exploiting parents' emotions and manipulating scientific information to generate sales.

It also says companies are using digital marketing to get around marketing restrictions.

The series highlights examples of digital marketing such as industry-paid influencers sharing the difficulties of breastfeeding as a prelude to formula milk marketing.

Another example was industry-sponsored parenting apps with 24/7 chat services enabling product placement, offering free samples or deals and promoting online sales.

The authors argue there is little regulation of the formula milk industry online and there are regular violations of the code.

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One of the authors, Professor Linda Richter, Wits University, South Africa, said the companies took advantage of parents' concerns about their child's health and development.

"The formula milk industry uses poor science to suggest, with little supporting evidence, that their products are solutions to common infant health and developmental challenges," she said.

"Adverts claim specialised formulas alleviate fussiness, help with colic, prolong night-time sleep and even encourage superior intelligence.

"Labels use words like 'brain', 'neuro' and 'IQ' with images highlighting early development, but studies show no benefit of these product ingredients on academic performance or long-term cognition.

"This marketing technique violates the 1981 code, which says labels should not idealise the use of formula, and exploits poor science to create an untrue story to sell more product."

The authors say the exploitative marketing and failure to support breastfeeding means fewer than half of infants globally are breastfed as recommended by the World Health Organisation.

Series co-author Professor Rafael Pérez-Escamilla, Yale University School of Public Health, US, said babies were most likely to survive and grow to their full potential when breastfed.

"Breastfeeding promotes brain development, protects infants against malnutrition, infectious diseases and death, while also reducing risks of obesity and chronic diseases in later life," he said.

"Yet, globally, many women who wish to breastfeed face multiple barriers, including insufficient parental leave and lack of support in healthcare systems and at the workplace, in the context of exploitative marketing tactics of the commercial milk formula industry."

The Lancet in a linked editorial said it acknowledged some women chose not to breastfeed or were unable to breastfeed.

"Perceived pressure, or inability, to breastfeed - especially if it is at odds with a mother's wishes - can have a detrimental effect on mental health, and systems should be in place to fully support all mothers in their choices," it said.

It said criticism of the milk formula industry's predatory marketing practices should not be interpreted as a criticism of women.

"All information that families receive on infant feeding must be accurate and independent of industry influence to ensure informed decision making," it said.

The Infant Nutrition Council of Australia and New Zealand has a Code of Conduct that requires members to support the Marketing in Australia of Infant Formulas: Manufacturers and Importers Agreement 1992 (MAIF Agreement) and the Infant Nutrition Council Code of Practice for the Marketing of Infant Formula in New Zealand.

The MAIF Agreement and INC Code of Practice are voluntary and self-regulatory codes of conduct, applying to the marketing of infant formula products suitable for infants up to the age of 12 months.

They include the protection and promotion of breastfeeding.

The council represents the interests of the infant formula industry in Australia and New Zealand and its membership is made up of global and local companies; formula manufacturers; and ingredient manufacturers and suppliers.

The council says its members agree to work together to resolve issues concerning the industry codes, the support of breastfeeding, possible false and misleading claims, food regulations and standards, food safety issues or company representatives' conduct and activities.

Members must include a breastfeeding statement on members' websites that includes information about infant formula to the following effect:

"Breast milk is the normal way to feed a baby and is important for baby's health. Professional advice should be followed before using an infant formula. Introducing partial bottle feeding could negatively affect breast feeding. Good maternal nutrition is preferred for breast feeding and reversing a decision not to breast feed may be difficult. Infant formula should be used as directed. Proper use of an infant formula is important to the health of the infant. Social and financial implications should be considered when selecting a method of feeding."

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