How formula companies continue to thwart breastfeeding

Parents around the world want what’s best for their babies. Many have heard that breastfeeding is good for their babies’ health, and most expectant mothers want to breastfeed, but many can’t attain that goal. A new series of papers published in The Lancet — of which I am a co-author — makes clear that a key reason for this is the marketing tactics of companies selling formula.

These companies portray their products as scientifically “closer” to human milk and suggest that formula milks make babies settle, digest with ease, sleep better, and even become more intelligent. Marketing messages portray developmentally typical human infant behavior like fussiness or crying as problematic — and suggest that these problems can be solved with specifically formulated products.

Mothers’ reports confirm that these messages are highly effective and lead many to lose confidence in breastfeeding and seek out premium expensive formula products, even though these claims are not supported by evidence.

Health care providers, many of whom have received limited quality training on breastfeeding, often worsen the problem by recommending formula to address common concerns about infant behavior, thereby lending authority to these marketing claims.

The 2023 Lancet Series on Breastfeeding highlights that these misleading claims are part of a marketing playbook designed to actively target parents, health professionals, and even policymakers. Companies making baby formula have examined every step of the infant feeding decision-making process and created tactics to manipulate it. Using consumer data and digital technologies, they have perfected messaging for different kinds of parents.

As described in the series, some company officials have admitted they are selling “sleep” or “peace of mind.” Other messaging downplays the critical importance of breastfeeding for maternal and child health and frames infant feeding decisions as the sole responsibility of mothers. Such messaging obscures the glaring inadequacy of support for breastfeeding, from health care providers to the workplace, and the need for collective societal responsibility for enabling breastfeeding.

Formula milk companies know that health professionals play a pivotal role in infant feeding decisions, both in shaping guidelines and providing authoritative recommendations to parents. They understand that clinicians serve as the best possible entry points for marketing messages to take hold. Companies sponsor health professional education, professional meetings, and other events to reach this group. The presence of formula companies in health professional settings reinforces the false impression that company claims are backed by rigorous science, but few realize that the science itself is simultaneously influenced.

Claims about formula milks are based on selective, misleading, or poor-quality evidence, and much of the work is plagued by conflicts of interest. Industry influence is manifest at every level of the process from research sponsorship to the recruitment of scientists and public health professionals for advisory panels.

Formula milk companies work together to erode, evade, and undermine regulatory protections that would hold them to higher standards and greater accountability. The industry has actively undermined the implementation of global guidance, including the International Code of Marketing of Breast-Milk Substitutes that was adopted by the World Health Assembly after international outrage at predatory marketing practices in the 1970s. These companies also work to loosen international food standards and even lobby against maternity protections that are essential for mothers to have paid time off after birth and support for initiating breastfeeding as well as continuing breastfeeding at the workplace.

The formula milk industry’s marketing playbook is not unique to breastfeeding. Iterations of it have been deployed across industries, from tobacco to fossil fuels. The objective of the playbook is to increase sales and shareholder profits.

But breastfeeding is a human right, and so should access to evidence-based information to be able to make informed decisions about it. As the 2023 Lancet Series on Breastfeeding demonstrates, breastfeeding plays a pivotal role in maternal and child health, and health equity. To realize this right, society and policymakers must recognize and close the industry playbook and provide the needed investment and support across sectors to make breastfeeding possible.

Cecília Tomori is an anthropologist and public health scholar at the Johns Hopkins School of Nursing, with a joint appointment at the Johns Hopkins Bloomberg School of Public Health.