Digital marketing of formula milk linked to unhealthy parental feeding practices

Digital marketing of formula milk and commercial baby foods is linked to unhealthy parental feeding practices, suggests research published in the open access journal BMJ Global Health.

Mums exposed to extensive digital marketing were less likely to exclusively breastfeed within the first 6 months and more likely to give their children processed foods and sugary drinks, the findings show, prompting the researchers to call for tighter regulations to safeguard young children’s nutrition and health.

The International Code of Marketing of Breast-milk Substitutes (Code) stipulates that any informational and educational material should state the benefits and superiority of breastfeeding, as well as instructions for the proper use of infant formula, and should not contain visuals idealising the use of breast milk substitutes.

The Code also states that no company should seek direct or indirect contact with pregnant women or parents and caregivers, including through social media channels.

The researchers wanted to estimate the exposure of Mexican parents with infants aged under 24 months to digital marketing of formula and baby food, its association with the purchase of these products, and breastfeeding and complementary feeding practices.

Parents (1074) were recruited from a nationally representative market research panel, and surveyed about the brands, products, and digital platforms where they reported seeing ads for formula milk and baby foods between December 2020 and January 2021. 

The survey included questions about how and why purchases were made, and how feeding practices were influenced by digital marketing. Parents’ knowledge of the Code, their views of digital marketing regulations, and whether the ads made them think that formula milk and commercial baby foods were as good or better than breast milk were also captured.

Exposure to digital marketing of formula and baby foods was classified as the weekly frequency with which parents reported observing advertisements and the number of advertised products they reported seeing over the past month. 

Nearly two thirds (62%) of the participants were women. On average, they were 28 and had 2 children, half of whom were under 12 months of age. They were mostly educated to degree level and relatively affluent. 

A third of the mums (33%) exclusively breastfed their infants under 6 months and nearly half (45%) continued breastfeeding after 12 months. 

Among children up to 23 months, 58% were given formula milk, 43% consumed sugary drinks, and nearly three quarters (72%) had eaten processed foods the day before the survey.

During the preceding month, most (82%) parents said they had bought formula milk or baby foods. The main reasons given were nutritional content (45%), convenience (37%), and shelf life (22.5%). 

In all, 94% of parents reported seeing digital marketing on at least one site in the preceding month, with 86% reporting weekly frequency. Marketing was seen primarily on social media (77%). 

The average number of advertised products reported was 26; the most advertised formulas on digital media were infant formulas (0-6 months; 92%) and growing-up milk (12-36 months; 89%). Porridge (77%) and yoghurt (71%) were the most commonly advertised baby foods. 

Only 13% of parents knew about the Code, and only around half (48%) felt that the existing regulations for marketing formula and baby foods were inadequate. Close to 55% felt that advertising portrayed formula as equal to or better than breast milk.

Ninety-five parents were asked to make three 10-minute screen recordings of their mobile device while browsing the internet or checking their social media and smartphone apps.

The number of ads for formula and baby food products seen in each recording were counted and classified as intentional or unintentional searches.

Eighty-nine (94%) observed at least one formula and/or baby food ad in their 30 minutes of recordings, with an average of around 7 ads seen in each recording during an intentional search, and around 2 during unintentional searches. 

The most advertised product seen was growing-up milk (42%), although advertising for infant formulas (0–6 months) was also identified (20%). In each recording, at least one ad for infant formula or baby food was identified and all contained Code violations. 

These were primarily absence of statements about the superiority of breastfeeding (96%); lack of warnings on the risks of improper formula preparation (95%) or advice to consult health professionals about the use of these products (93.5%); and invitations to visit websites, social media, or links to purchase their products (70%). 

Overall, parents who reported seeing a higher number of ads were 62% less likely to exclusively breastfeed their children during the first 6 months than those reporting a lower number, and more than twice as likely to feed them breast and other milks.

They were also 84% more likely to give their children formula, more than twice as likely to give them processed foods, and 66% more likely to give them sugary drinks. 

Higher exposure to ads was associated with a two-fold greater chance of purchasing products on the basis of nutritional and organic claims made in digital marketing.

This is an observational study, and as such, can’t establish cause. And the participants were relatively affluent and well educated, so the findings may not be more widely applicable, caution the researchers.

Nevertheless, they conclude: “Marketing regulations should ban breast-milk substitutes and baby food promotion in digital media and the use of health claims, since they may confuse parents about optimal [infant and young child feeding practices]. 

“This call for action is urgent to safeguard the health and right of children to breastfeeding and natural, nutritious, sufficient and quality food.”