Despite the evidence on the importance of breastfeeding on lowering breast cancer risk for the mother, and on childhood obesity – particularly within the first 1,000 days (2.7 years) of a child’s life – rates both globally and in Europe are still astonishingly low.
In Ireland, my home country, breastfeeding rates have continued to decline. In 2016, breastfeeding rates upon discharge from a maternity hospital stood at 46% and by 2019, this figure had dropped to 37%.
Ireland has one of the lowest rates of breastfeeding both globally and in Europe, which was a great surprise to me – the World Health Organization (WHO) World Health Statistics 2013 reported that only 15% of children in Ireland are exclusively breastfeed for the first 6 months of their life, compared with a global average of 38% and European of 25%.
This shocked and prompted me to explore where the barriers to breastfeeding are, given that 1–7 August is World Breastfeeding Week. The theme, “Step Up for Breastfeeding: Educate and Support”, seeks to highlight the necessity of protecting, promoting and supporting breastfeeding.
The week promotes the importance of an enabling environment, while acknowledging that some women have physiological, practical, emotional or medical reasons for not being able to breastfeed, and not to dismiss how hard breastfeeding is.
Why are breastfeeding rates so low?
From looking into the situation in Ireland, I found that many mothers – both expectant parents and those already with a young child – fall victim to destructive tactics used by formula milk companies through targeted promotions, marketing techniques and digital media.
Such persuasive marketing tactics can create a barrier to increasing the uptake of breastfeeding and undermine parents’ capabilities, which is unacceptable. Many of these harmful tactics are a breach of international standards set by Unicef and the WHO to protect women from such marketing practices through policies and legislation.
Most high-income countries have adopted legislation or regulations to support breastfeeding yet, disappointingly, many do not take into consideration the availability and accessibility of breastfeeding in public and workspaces. While some countries do have legislation in place, implementation and enforcement can often be weak and exploited.
Exploitation of marketing practices
The WHO recently published two reports on digital marketing restrictions for breastmilk substitutes, highlighting how companies have focused their activities online and on the lack of government action.
The first report details marketing techniques used by the formula milk industry, many of which are unethical, misleading and not grounded in scientific evidence. Some of these techniques include promotions, and sponsored and targeted advertisements when thinking about breastfeeding or not. This type of scaremongering can stimulate fear, apprehension and confusion, particularly for new parents.
The second report covers the digital space and persuasive techniques used to promote infant formula through websites, social media and emails. These techniques use highly targeted algorithms and cross-promotional techniques across various digital platforms.
It was interesting to learn that formula milk companies reach 3x as many people through social media than non-commercial accounts on breastfeeding. There are roughly 90 social media posts a day by formula milk companies, reaching 229 million users.
Promoting breastfeeding and the marketing of formula milk substitutes is something World Cancer Research Fund have spoken about at the highest level of public health at the WHO. We welcome plans for the WHO to introduce new guidance on digital marketing restrictions for breastmilk substitutes.
To address the ongoing issues surrounding the marketing of formula milk, the WHO and Unicef are calling out to governments and health workers to comply with international standards. Some of these include monitoring and enforcing laws on the prevention and promotion of formula milk, creating policies and programmes in support of breastfeeding, and prohibiting health workers from engaging in sponsorship with formula milk companies.
We know breastfeeding rates are low, so in the first guidance report, the WHO surveyed 8,500 parents, pregnant women and health workers on their exposure to formula milk marketing in a range of countries such as China, Mexico and the UK.
Such exposures reached 84% of women in the UK and 97% in China, impacting the likelihood of using formula milk. These results may help to explain the low uptake of breastfeeding in Ireland.
Green shoots of progress?
Good progress has been made at an international level on baby-friendly hospitals and the baby-friendly community initiative. The Food and Agriculture Organization has reported positive signs of breastfeeding rates increasing globally, with nearly 44% of infants under six months of age being exclusively breastfed in 2020. We hope the new guidance from the WHO will encourage governments to take even further action to promote breastfeeding.
World Breastfeeding Week is an opportunity to showcase the positive benefits of breastfeeding where possible, and drive the noise away from the harmful marketing tactics used by the formula industry. Let’s hope that message is heard loud and clear globally and in Ireland so women are supported to breastfeed where they can.