It is well-established and extensively researched that breastfeeding has strong health benefits for both mother and baby. This means exclusive breastfeeding up to 6 months of age, and breastfeeding alongside complementary foods up to the age of 2 years old and beyond.
Even though rates of exclusive breastfeeding in the first 6 months of life have encouragingly increased over the past decade (pdf), they reached only 48% in 2023. More than half of babies younger than 6 months old are fed with breastmilk substitutes globally. The rates of exclusive breastfeeding are higher in low- and middle-income countries, with 22 countries (pdf) reporting an over 10 percentage points increase in exclusive breastfeeding between 2017–23. In contrast, rates of exclusive breastfeeding in high-income countries are estimated to reach 18%, much lower than the global average.
Why is breastfeeding so important?
For mothers, breastfeeding helps to protect against breast cancer. For babies, benefits start from the first days of life and have an impact over the life course. Being breastfed helps protect children against excess weight gain, overweight and obesity, which are linked to many cancers later in life. Babies who have been breastfed also have a lower risk of asthma and type 2 diabetes. Further, feeding behaviours, such as our bodies knowing when we are full, are established through breastfeeding.
Breastfeeding is often not straightforward, and infant feeding can be challenging, especially without adequate support. This includes:
- pre- and post-natal counselling
- maternity and parental leave or financial support for mothers not in formal employment
- breastfeeding facilities in shared spaces
Further, some babies will need breastmilk substitutes to ensure adequate and safe nutrition. However, sales of breastmilk substitutes continue to grow at a rate not commensurate with need, and breastmilk substitutes are promoted and aggressively marketed at the expense of breastfeeding, with parents unduly influenced.
Parents and health professionals have fallen victim to predatory marketing practices, and breastfeeding has a history of being undermined by corporations, with serious consequences for maternal and infant health. This prompted the World Health Organization (WHO) and Unicef, the UN’s children’s agency, to develop international guidance on breastfeeding and infant nutrition called the International Code of Marketing of Breast-milk Substitutes. First developed in 1981, the Code has been updated to meet the challenges of new forms of marketing and new types of baby food products. However, the Code is not always supported by appropriate national legislation – only 32 countries worldwide have implemented legislation that is substantially aligned with this global guidance.
Aggressive marketing has become more sophisticated
Sales of breastmilk substitutes continue to grow, reaching $55bn annually, as do marketing budgets. Often the most aggressive marketing is targeted at the most vulnerable groups (pdf). For example, the UK has seen record-high formula prices and large variations between products (pdf), driving parents to food banks.
To complicate matters, there has been a proliferation of milks marketed for babies over 6 months, which is the age where complementary foods such as fruits and vegetables should be introduced in babies’ diets, rather than different milk products. Nonetheless, new products include “follow-on milks” (up to 12 months), or “growing-up milks” (13–36 months), often cross-promoted (pdf) as part of a range, a known strategy to build brand loyalty. The range of new products also includes specialised milks, marketed as comfort milks to reduce colic, prolong sleep or deal with allergies. These claims are part of marketing strategies that medicalise normal baby behaviour such as fussiness or crying. Companies aggressively market these products using claims about baby and toddler milks promoting brain development and meeting other developmental milestones, while also using new forms of marketing through social media influencers and their babies.
Lastly, complementary baby food such as jars and pouches have also been found to be marketed against WHO guidance, to babies younger than 6 months (pdf). As complementary foods have become commonplace and are part of food environments for babies and infants, their marketing must also meet strict rules, highlighted in international guidance on marketing foods for infants and young children (pdf).
In a clear example of how food environments affect what babies eat, a recent investigation found that the same Nestlé baby cereal contains added sugar when it is sold in low- and middle-income countries such as Ethiopia or Thailand, but not in a high-income country such as Switzerland. In other words, if you live in a high-income country, baby food is less likely to contain added sugar, which is unnecessary and bad for health. If, however, you have a baby and happen to live in a low- or middle-income country, the same product will contain more added sugar and may be marketed more aggressively.
This is a clear example of how manufacturers shape infant feeding practices, in some cases removing choice from parents by offering different formulations of the same products in different parts of the world.
No excuses when it comes to babies’ nutrition
Producers of breastmilk substitutes, follow-on milks and complementary baby foods often argue that their production and marketing practices follow national guidance (pdf). Indeed, it is clear that national nutrition guidance needs to improve in many countries, with stricter regulations on medical or developmental claims allowed on packaging, as well as enforcement of existing rules.
However, this is no excuse. Producers of breastmilk substitutes and complementary baby foods are often multi-national companies that supply markets globally at huge profits. They are well aware of the minimum requirements for marketing such products set out in international guidance. The baby milk industry, for example, predominately benefits a small group of shareholders and investors based mostly in high-income countries (pdf).
Simply put, such multi-national companies know better – as shown by Nestlé removing added sugars in baby cereals sold in Switzerland, but not in other countries. While companies reap the benefits of a globalised market, they should equally be held accountable to the minimum global standard in protecting babies’ nutrition.
