Call for stronger regulation of ‘exploitative’ formula industry

Evidence on the health benefits of breastfeeding is robust, with health advantages ranging from nutrition to physical and psychological wellbeing.
 
Both the World Health Organization (WHO) and UNICEF recommend that breastfeeding be initiated within the first hour of birth and that infants be exclusively breastfed for the first six months of life.
 
Despite this, less than half (48%) are exclusively breastfed to six months worldwide, while in Australia, that rate drops to only one in three (35.4%).
 
Simultaneously, the infant formula market has grown significantly, with a value of US$50.46 billion (AU$72.62 billion) in 2019, which is projected to more than double by 2027.
 
As a result, concerned health experts are now sounding the alarm, calling for more to be done to regulate the formula industry and promote breastfeeding.
 
In a special three-paper series, published in The Lancet, 25 experts from 12 countries claim companies are exploiting parents’ emotions by manipulating scientific information to generate sales. They argue that this is coming at the expense of people’s health and rights.
 
Lead author Dr Phil Baker is a senior lecturer in human nutrition at Deakin University’s School of Exercise and Nutrition Sciences.
 
He says Australia is not going far enough to support women breastfeeding, noting it is one of only a few countries that has yet to implement the WHO International Code of Marketing of Breastmilk Substitutes into national law.
 
‘Instead, we have a voluntary code of conduct – so-called “self-regulation” – that is supposed to stop this marketing. But it clearly doesn’t,’ Dr Baker said.
 
‘The Australian and New Zealand governments lobbied against other governments to weaken their efforts to regulate formula marketing. This goes completely against their supposed commitments to supporting women to breastfeed.
 
‘What’s also clear is that the milk formula industry has consistently, and at times aggressively, lobbied against the regulation of formula marketing in many countries.’
 
The experts liken the tactics being used to those by the tobacco industry to sway compliant governments and avoid industry regulation. This includes taking advantage of parents’ anxieties about their child’s health and development by using misleading information to make false promises.
 
Among them are claims about alleviating fussiness, assisting with colic, prolonging night-time sleep and even encouraging superior intelligence.
 
‘These marketing techniques violate the International Code of Marketing of Breastmilk Substitutes, which says labels should not idealise the use of milk formula, and exploits poor science to create an untrue story to sell more products,’ co-author Associate Professor Julie Smith from the ANU College of Health and Medicine said.
 
Chair of RACGP Specific Interests Antenatal and Postnatal Care Dr Wendy Burton has been caring for women both during and post their pregnancies for more than 30 years.
 
She told newsGP that while she agrees more needs to be done to regulate the promotion of infant formula, she is also mindful of demonising women who cannot, or do not wish to, breastfeed.
 
‘But placing that on the record, and then putting it to one side, we absolutely could be and should be doing more to normalise, support and encourage breastfeeding,’ Dr Burton said.
 
‘The evidence is unequivocal – the benefits to the infant, to the breastfeeding person, to society are just enormous. But there are still so many barriers.’
 
To enable women to continue breastfeeding, the Queensland GP says workplace conditions, including the lack of understanding and flexibility, need to be addressed.
 
‘I was fortunate myself that I was able to bring my firstborn to work and feed him there, but that was because my GP boss was happy for me to do that – I am one of the privileged few,’ Dr Burton said.
 
‘But it is sad that it is 25 years later and we’re not encouraging it.’
 
Associate Professor Smith agrees and says governments and workplaces must recognise the value of breastfeeding to better support women. She says this includes extending paid maternity leave to align with the WHO’s recommendation of exclusively breastfeeding for six months.
 
‘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 employment out of financial necessity,’ she said.
 
Meanwhile, Dr Burton believes policy needs to go one step further to incorporate more mindful building design, ensuring spaces are accessible to all, including those who are breastfeeding.
 
‘I remember going to the Opera House and the only place I could breastfeed my child was in the women’s toilet. But if you wanted a quiet, private space, there just weren’t any,’ she said.
 
‘If they can build buildings with prayer rooms, and I encourage us to do that, we can build buildings with multipurpose or breastfeeding rooms.
 
‘Yes, there’s a cost to that, but there’s a saving to that too … the cost benefit analysis is really clear.’
 
As it stands, there are good breastfeeding initiation rates in Australia, at 96%, but continuity drops off significantly with only 39% of infants being exclusively breastfed by around three months.
 
Dr Burton says there is a clear need for more targeted education around the benefits of breastfeeding – not only for parents, but other caregivers such as grandparents, as well as healthcare professionals – and the earlier, the better.
 
‘I think we do the preparation for birth a whole lot better than we do the preparation for parenthood,’ she said.
 
‘Somehow, we have to walk that line between appropriate education, encouragement and health literacy.
 
‘But if everybody understands why breastfeeding is so important to that child and we start that message before conception has even occurred … they’re much more likely to start and much more likely to continue breastfeeding. And that’s what we want to encourage.’
 
Dr Burton also says it is vital that the messaging is consistent.
 
‘The thing that drives women crazy is they get different advice from the early childhood nurse, different advice from the midwife, different advice from the next midwife, different advice from the GP – it does their head in,’ she said.
 
‘Then they go to Facebook and somebody says, “Oh, your baby will sleep if you give them formula”. That’s a promise that’s hard to compete against.
 
‘I’m pleased that we’ve got clean water, I’m confident in the quality of our formulas for Australia and New Zealand, but that’s the basic calories and some of the nutrition.
 
‘If we talk about breast milk as a living substance and all of its incredible qualities, nothing compares.’
 
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