A major part of the problem, these experts say, is baby formula manufacturers’ aggressive marketing and promotional practices, which undermine breastfeeding practices for new mothers and influence their decisions to use formula. The United States takes a lax approach to formula marketing, unlike many other countries.
The formula industry “systematically undermines parents’ infant feeding decisions,” the report said, comparing the efforts to tobacco or gambling marketing.
To be sure, formula is a crucial, life-saving option for parents who are unable to breastfeed or who can’t take time off work to do so. But there are concerns that the industry is marketing it to people who don’t need it.
Infant formula makers, however, say they are providing a safe, nutritious option for babies who can’t or do not receive breast milk.
“Mothers should be encouraged and supported to breastfeed,” said a spokesperson for the Infant Nutrition Council of America, a trade group representing formula makers. “However — if breast milk is not available or not chosen — parents should have access to accurate, balanced information on all appropriate infant feeding options.”
The formula playbook
Infant formula makers’ aggressive strategies play a key role in pushing mothers to use formula.
“The failure of the United States to regulate the marketing practices of the $55 billion formula industry has meant that families in our country are not supported and protected against exploitative messaging at vulnerable times in their lives,” said Amelia Psmythe Seger, the deputy director of the U.S. Breastfeeding Committee.
The committee has called for stricter regulations, enhancing a national network of nonprofit donor milk banks and policies such as national paid family leave to improve infant nutrition security.
A spokesperson for the Infant Nutrition Council of America, the group representing formula manufacturers, said that its member companies support and promote the “aims and principles” of the WHO Code. Formula makers “have extensive internal approval and audit processes in place” to ensure their practices meet all legal, regulatory and nutritional science requirements.
Formula companies in the past have focused their efforts on getting products to new mothers while they’re still in hospitals, the crucial window for breastfeeding that determines how successful moms are once they return home.
“The linchpin of their marketing strategy is to get free samples into the hands of breastfeeding mothers,” said Melissa Bartick, an assistant professor at Harvard Medical School. “What they hope will happen is if a breastfeeding mother runs into any trouble at all she will have formula already in a bottle and ready to put in her baby’s mouth.”
This is a “vicious cycle,” she said, because the more often mothers breastfeed, the more milk they produce. “If a mom starts using formula, her body will make less milk….Before you know it her milk production will shut down and she becomes dependent on giving formula.”
More recently, digital marketing aimed directly to pregnant women online is also driving their decisions to use formula, according to an April WHO report.
Formula companies use tools like apps, online support groups or “baby clubs,” paid social media influencers and promotions to cast doubt on the benefits of breastfeeding and advantages of formula, the report found.
‘It’s very hard to be a breastfeeding mother in the United States’
The tactics are part of larger environment in the United States in which breastfeeding has become a struggle for new mothers.
Savvy marketing is, of course, not the only reason why mothers turn to formula.
Health experts say the lack of robust policies in the United States to support breastfeeding mothers contribute to this dropoff in breastfeeding rates after babies are born and disparities in breastfeeding rates across racial and economic lines.
After moms leave the hospital, it often becomes difficult to breastfeed — particularly for low-income mothers. Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) account for more than half of infant formula used in the United States.
“It’s very hard to be a breastfeeding mother in the United States,” said Bartick.