Challenging formula companies

For too many years, formula companies formed strong alliances with healthcare professionals and institutions

May marked the 40th anniversary of the World Health Organisation (WHO) Code of Marketing of Breastmilk Substitutes. This Code was developed by the WHO/UNICEF to address unethical advertising practices by large formula companies that adversely affect breastfeeding rates globally.

The Code is a model document, and it is up to each country to enact it into law. Many countries, including Ireland, have failed to implement the Code substantially. Despite this, the Code is the desired standard for every individual and institution. In an ideal world, the Code would no longer be necessary. Unethical marketing of baby milk substitutes would have ceased with an increase in breastfeeding rates. This is not the case. The Code is still relevant today as this $70 billion per year commercial milk formula industry continues to find loopholes that circumvent the recommendations.

One of these recommendations is that “healthcare providers, hospitals, and medical facilities should not promote, advertise, or distribute breastmilk substitutes that may undermine attempts to encourage breastfeeding”. So, it was apt that a motion passed at the 2021 ICGP AGM in May stated that the College would cease to accept sponsorship and advertising revenue from commercial formula companies. In doing this, the ICGP has followed in the path of the BMJ, a global healthcare knowledge provider that publishes over 70 medical journals and the Royal College of Pediatrics and Child Health. The decision to disentangle from commercial formula companies resulted in an almost €350,000 deficit in revenue for the BMJ.

Another positive development for Irish mothers and children is the publication of A Position Paper on Breastfeeding by the Faculty of Paediatrics, the Faculty of Public Health and the Institute of Obstetricians and Gynaecologists, Royal College of Physicians. This paper aims to highlight the health benefits of breastfeeding and propose actions to improve breastfeeding rates in Ireland, which are currently the lowest in Europe.

Many of the recommendations contained in this paper are self-explanatory: Increased community resources for maternal and child health, including public access to International Board-Certified Lactation Consultants; improved education for health professionals including GPs; implementation of existing breastfeeding policies; and yet again, the protection of mothers and babies from the influence of industry as per the WHO Code.

Many people are aware of the unethical practices of formula companies, but may think that the 1970s Nestle boycott ‘fixed’ the problem. Some marketing methods have changed, such as not allowing company sales personnel direct access to mothers. But when complying with one recommendation, commercial formula companies have consistently devised new ways of reaching customers. The development of ‘follow-on milk’, ‘good night milk’, ‘anti-reflux milk’ and ‘anti-colic milk’ are examples of unnecessary products manufactured solely to circumvent the Code and entice new customers.

Many mothers choose not to breastfeed, making infant formula a necessary product. But their decision is often not well-informed. They believe that formula milk is equal or superior to breastmilk. Formula feeding is entrenched in our society, partly due to the relentless marketing of breastmilk substitutes. Mothers who choose formula deserve scientific, factual, and non-promotional information about infant feeding. They need to know that the WHO recommends that infants be exclusively breastfed for six months and continue breastfeeding with complementary foods until two years and beyond.

Mothers need to understand that this recommendation applies regardless of where they live – Ireland, New York, or Bangladesh. They need to know that this is the best practice whether their baby has reflux or colic, is hungry, sleepy, or awake all night. They need to be aware that all infant formula is standardised and not to believe what they read on the packet.

As health professionals, we can keep parents informed, but only if we possess the necessary knowledge, skills, and attitudes. We can open our eyes to Code violations and pressurise the Government to implement the Code to create a more level playing pitch for families. We need to do this even though Ireland has a substantial share in the commercial milk industry. We need to practise total sequestration from commercial entities to avoid conflicts of interest and remain uninfluenced. For too many years, formula companies formed strong alliances with healthcare professionals and institutions, which has served them well.

Breastfeeding is a public health imperative. It protects babies from infections, allergies, and diabetes, and mothers from ovarian and breast carcinoma. It reduces social inequality and is better for the environment. There is not one single scientific study (to the best of my knowledge) that indicates that breastfeeding is harmful. The international Code has been described as the most significant international consumer protection standard of modern time. It is past time that Ireland implemented it in full.