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 The marketing techniques can push women away from breastfeeding and
include everything from giving free samples, to executives setting
up or joining "mums' groups" on popular messaging apps, the report
from the World Health Organization (WHO), UNICEF and M&C Saatchi
said.
Health workers are also targeted, with gifts, funding for research
and even commission from sales, all practices that are banned under
international guidelines for the marketing of formula milk.
The WHO recommends exclusive breastfeeding for newborns, where
possible, as the healthier option.
The report's authors and several external experts said it was time
to reform the International Code of Marketing of Breast-milk
Substitutes. The code was set up by WHO in 1981 in a bid to regulate
the industry after scandals in the 1970s when Nestle was accused of
discouraging mothers, particularly in developing countries, from
breastfeeding.
Nigel Rollins, lead author of the report and a WHO scientist, told
Reuters in an interview: "Are there areas for strengthening the
code? Unquestionably."
Formula milk and tobacco are the only two products for which there
are international guidelines to prevent marketing.
Despite this, only 25 countries have fully implemented the code into
legislation, and over the last four decades, sales of formula milk
have more than doubled, while breastfeeding rates have only slightly
increased, the WHO said. The formula milk industry is now worth $55
billion annually.
The report found that more than half of the 8,500 parents across the
eight countries surveyed - Bangladesh, China, Mexico, Morocco,
Nigeria, South Africa, the United Kingdom and Vietnam – reported
exposure to marketing, much of which was in breach of the code.
Titled "How marketing of formula milk influences our decisions on
infant feeding", the report also included interviews with marketing
executives and 300 health workers, and is the largest of its kind.
In China, 97% of women surveyed had been exposed to formula milk
marketing; in the UK it was 84% and in Vietnam, 92%. More than a
third of women across all of the countries said that health workers
had recommended a specific brand of formula to them.
While the code allows factual informational about formula to be
provided, and the authors acknowledged the importance of formula
milk for women who cannot or do not want to breastfeed, they said
the marketing practices were a key reason for low breastfeeding
rates worldwide.
The WHO recommends exclusive breastfeeding for at least the first
six months of life, but at the moment, only 44% of babies this age
are fed this way.
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 A major study in 2016 suggested more than
800,000 babies’ lives could be saved annually if
breastfeeding rates improved to reach this
milestone.
"False and misleading messages about formula
feeding are a substantial barrier to
breastfeeding, which we know is best for babies
and mothers," said UNICEF executive director
Catherine Russell in a statement.
Rollins said digital marketing in particular
needs work, because of the potential for
personalised targeted messaging and because it
is now a major area of expansion for formula
milk companies, alongside milks for older
children and milks for allergies.
In a statement on behalf of the companies, the
International Special Dietary Foods Industries (ISDI)
said its members complied with all laws and
regulations in the countries in which they
operate.
"Our members support efforts by national
governments to ensure compliance with all
national laws and regulations. Our members are
ready to work together with all stakeholders to
support optimal infant health and well-being,"
it added.
The WHO declined to comment on individual
companies, and does not name them in the report,
but said that there were no substantial
differences between their practices.
However, an index by the Access to Nutrition
Initiative in 2021 found that some companies
were more compliant with the code than others:
for example, Danone's marketing is 68% in line
with the rules, and Nestle, 57%. However, three
of the leading companies operating in China –
Feihe, Mengniu and Yili – all scored zero.
External experts said that wider reform was
needed to bring all companies, and countries,
into line, as well as tougher punishments for
those who break or skirt the rules.
Gerard Hastings, emeritus professor of marketing
at the University of Stirling, Scotland, said
regulators like the Food and Drug Administration
(FDA) should be more involved.
 "We need to rethink how to actually make it (the
code) work, so that it can be enforced much more
strongly," he told Reuters.
"These agencies really need to go back to the
drawing board and think of infant formula
products in the same way as you would think of
drugs."
(Reporting by Jennifer Rigby; Additional
reporting by Silke Koltrowitz in Zurich,
Dominique Vidalon, Toby Sterling, Manas Mishtra
and Sophie Yu; Editing by Josephine Mason and
Nick Macfie)
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