by Marion Nestle

Currently browsing posts about: Breast-feeding

Mar 8 2024

How the food industry exerts influence V: Professional journals (Infant formula companies)

Dr Katie Pereira-Kotze, a part time Senior Nutritionist at First Steps Nutrition Trust wrote me to ask if I might comment on the conflicts of interest displayed at a conference sponsored by the British Journal of Midwifery (BJM).  This journal accepts sponsorship for its annual conference from breastmilk substitute companies (Nutricia, Kendamil, Nestle).

Groups concerned about the historic role of infant formula compnanies in discouraging breastfeeding in new mothers, have asked the BJM not to permit this funding.

For example, the Baby Feeding Law Group UK wrote a letter to the conference organisers in 2022.

We would also like to share with you our perceptions of the motivations of companies such as Kendamil and Nutricia for sponsoring events such as your conference. It is against the law in many countries including the UK for companies to promote infant formula. By partnering with organisations or sponsoring events, these companies avoid workplace controls on advertising and gain direct access to health care workers, including in the case of the BJM conference, midwives, and in doing so create a valuable link to pregnant and post-partum women.

The British Medical Journal (BMJ) also commented on these conflicted interests: Midwifery conference is criticised over formula milk sponsors.

Three companies that market formula milk (Aptamil, Kendamil, and Nestlé) are sponsoring the conference and have each been given a 40 minute slot during the one day conference programme.

This journal contrasted its own position on infant formula complany sponsorship with that of the midwifery jounral:

In 2019 The BMJ announced that it would no longer carry advertisements for breastmilk substitutes,4 and after pressure from clinicians and campaigners the Royal College of Paediatrics and Child Health also said that it would stop accepting funding from formula milk companies. Robert Boyle, a clinical reader in paediatric allergy at Imperial College London, told The BMJ, “Formula company marketing aims to disrupt breastfeeding, their main competitor, so that the companies can sell more formula.

Comment: The role of the commercial infant formula industry in pushing its products and discouraging breastfeeding has been well documented for decades, most recently in a series of Lancet Commission reports.  Conferences are expensive to run and the  British Journal of Midwifery undoubtedly can use the infant formula company money—but at some cost to its reputation.  The optics do not look good.  Sometimes, the money isn’t worth it.  Infant formula companies have joined cigarette and opioid companies in being viewed as producing products with great capability of doing more harm than good.  The sooner the BJM stops taking their funding, the better.

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Nov 28 2023

The hazards of feeding babies and young children: What to do?

I’ve been collecting items on feeding kids.  Here are four.

I.  FDA Warning Letters: The FDA has sent warning letters to ByHeart, Mead Johnson Nutrition (Reckitt), & Perrigo Wisconsin for violating basic food safety standards in manufacture of infant formula.

They [letters] reflect findings from FDA inspections of these facilities over the last several months. At the time of each inspection, the FDA issued inspectional observations and exercised oversight of each firm as they initiated recalls (in December 2022, February 2023 and March 2023) to remove product potentially contaminated with Cronobacter sakazakii from the marketplace…The FDA is issuing these letters now as part of its normal regulatory process and to reinforce to these firms the importance of instituting and maintaining appropriate corrective actions when they detect pathogens to ensure compliance with the FDA’s laws and regulations. As part of this, the firms must, among other things, thoroughly conduct root cause investigations and perform subsequent cleaning and sanitation activities. Notably, firms also need to properly evaluate their cleaning and sanitation practices, schedules, and procedures before releasing product. 

Comment: What shocks me is the implication that the companies are not already doing this as part of their normal routines.

II.  Baby food pouches with lead sicken children.   

At least 18 more children have been sickened by the recently recalled applesauce fruit pouches due to dangerous lead contamination, the Food and Drug Administration said, in a recent update.  That brings the total number of affected children to 52. Applesauce pouches recall timeline:From recalls to poisoned kids in multiple states

Comment: Yes, I know self-feeding pouches are convenient, but I sure don’t like them much.  They are usually loaded with sugar and they don’t teach kids about diverse food flavors and textures.  Quality control, apparently, is a big issue.  My vote: avoid.

III. Environmental Working Group study finds 40% of commercial baby foods to contain toxic pesticides.

  • EWG sampled 73 products from three popular brands: 58 non-organic, or conventional, baby foods and 15 organic.
  • At least one pesticide was detected in 22 of the conventional baby foods.
  • No pesticides were detected in any of the 15 organic products.

Comment: Pesticides may be in all foods but they get concentrated in baby foods.  The moral here is clear; if you want baby foods free of harmful pesticides, buy organic.  For more on this, see article in The Guardian.

IV. The marketing of ultra-processed foods especially targets infants and young children.   A study done in the UK provides ample documentation of anything you would want to know about this practice.

Comment: Food companies say they have to market to young children in order to meet sales growth targets.  Ethics is not a consideration here.

Given that situation, what to do?

Understand: commercial infant and baby foods are convenient, but enormously profitable to manufacturers.  Profits induce corporations to cut safety and health cautions.  This tension should make you think twice about using commercial infant and child feeding products.

To the extent you can:

  • Breast feed when possible, for as long as possible
  • If you use infant formula, switch around the brands (they are all the same, nutritionally); buy organic if you can afford it.
  • Make your own baby foods (put whatever healthy foods you are eating or have around in a tiny blender).; buy organic foods if you can afford them.
  • Feed kids real foods as soon as they can grab, chew, and swallow them without choking.

If you eat a generally healthy diet, get your kids eating it as soon as they can.

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Feb 17 2023

Weekend reading: Lancet Commission on Breastfeeding vs the Infant Formula Industry

The Lancet has just published its commissioned series on breastfeeding, vs the commercial formula industry: three papers, an editorial, and a comment.

Breastfeeding has proven health benefits for both mothers and babies in high-income and low-income settings alike. Yet, less than 50% of babies worldwide are breastfed according to WHO recommendations. For decades, the commercial milk formula industry has used underhand marketing strategies, designed to prey on parents’ fears and concerns, to turn the feeding of infants and young children into a multibillion-dollar business—generating revenues of about $55 billion each year.

Editorial: Unveiling the predatory tactics of the formula milk industry

For decades, the commercial milk formula (CMF) industry has used underhand marketing strategies, designed to prey on parents’ fears and concerns at a vulnerable time, to turn the feeding of young children into a multibillion-dollar business. The immense economic power accrued by CMF manufacturers is deployed politically to ensure the industry is under-regulated and services supporting breastfeeding are under-resourced.

Breastfeeding: crucially important, but increasingly challenged in a market-driven world. R Pérez-Escamilla,, et al.

In this Series paper, we examine how mother and baby attributes at the individual level interact with breastfeeding determinants at other levels, how these interactions drive breastfeeding outcomes, and what policies and interventions are necessary to achieve optimal breastfeeding.

Marketing of commercial milk formula: a system to capture parents, communities, science, and policy.  N Rollins et al.

We report how CMF sales are driven by multifaceted, well resourced marketing strategies that portray CMF products, with little or no supporting evidence, as solutions to common infant health and developmental challenges in ways that systematically undermine breastfeeding. Digital platforms substantially extend the reach and influence of marketing while circumventing the International Code of Marketing of Breast-milk Substitutes.

The political economy of infant and young child feeding: confronting corporate power, overcoming structural barriers, and accelerating progress.  P Baker, et al.

First, this paper highlights the power of the commercial milk formula (CMF) industry to commodify the feeding of infants and young children; influence policy at both national and international levels in ways that grow and sustain CMF markets; and externalise the social, environmental, and economic costs of CMF. Second, this paper examines how breastfeeding is undermined by economic policies and systems that ignore the value of care work by women, including breastfeeding, and by the inadequacy of maternity rights protection across the world, especially for poorer women. Third, this paper presents three reasons why health systems often do not provide adequate breastfeeding protection, promotion, and support.

Comment: Stemming commercial milk formula marketing: now is the time for radical transformation to build resilience for breastfeeding, by Tanya Doherty et al.

One of the striking messages of the Lancet Breastfeeding Series is that the consumption of commercial milk formula (CMF) by infants and young children has been normalised. More children are consuming CMF than ever before. Only 48% of the world’s infants and young children are breastfed as recommended, despite the huge body of evidence on the lifelong benefits of breastfeeding. This situation reflects the stranglehold the CMF industry has on governments, health professionals, academic institutions, and increasingly on caregivers and families through pervasive social media.

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Jul 1 2022

Weekend reading: Discouraging breastfeeding: digital strategies

Here’s a recent report from WHO: Scope and impact of digital marketing strategies for promoting breastmilk substitutes

 

The report’s findings:

Why should we care?  Because it is so easy to discourage breastfeeding, and digital marketing does just that.

Here are some comments on this report:

And here are links to the first WHO report and to other reports on digital marketing.

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Oct 7 2021

Yes, you can make ice cream from infant formula and breast milk

Last week, I posted a list of articles about odd ice cream flavors, mostly Lithuanian.  Several readers pointed out that the links all went to the same article (oops, my bad).

They particularly wanted to see the ones about ice cream made from infant formula and breast milk.

Really?  People do this?  Yes, they do.

Especially in the UK.

If you are in the UK, you can buy commercial products, like one “made with love in the Lake District.”

Or you can make your own with breast milk or formula.  A company tried this in 2011, but got into trouble over safety issues.

It’s pretty easy to do this at home.

Have on hand:

  • A banana or other fruit, sliced.
  • 2 ounces of breast milk or formula.
  • A blender.

Freeze the fruit.

Place frozen fruit in the blender.  Slowly add breast milk or formula.

Blend until the mix reaches a soft serve texture.

Serve immediately or store in freezer.

Note: no unhealthy additives.  Teething babies might like it.

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Aug 2 2021

Unethical food marketing ad of the week: infant formula, organic no less

When my partner, Mal Nesheim, showed me this ad in Sunday’s New York Times, I had two immediate questions.

Question #1: Who paid for this?

The answer: Bobbie’s Infant Formula “inspired by a mom’s choice.”

When I went to the website, I learned that Bobbie’s infant formula is organic.  I am greatly in favor of organics, but just as organic junk food is still junk food, organic infant formula is still infant formula.

Breast feeding isn’t easy in today’s society and yes, some mothers (and fathers, of course) can’t do it.

But breast feeding is unquestionably best for babies.  Mothers who can breast feed need all the help and encouragement they can get.

That’s why this week has been designated World Breastfeeding Week.

Breastfeeding mothers do not need to be undermined by infant formula marketing.

If Nestlé (no relation) or the other leading infant formula manufacturers put an ad like this in the paper, the result would be worldwide outrage.  This leads to my second question.

Question #2: Doesn’t this ad appear to violate the World Health Organization’s International Code of Marketing of Breast-milk Substitutes?

OK, so the ad does not display infant formula products or even say that Bobbie’s is an infant formula company, let alone an organic one.  But it doesn’t take much to figure both out.

Recall the Nestlé boycott of  the 1980s, a worldwide boycott of the company because of the way it marketed infant formula to women in low-resource countries without clean water supplies.  The women were unable to use the products safely; contaminated or improperly diluted infant formula sickened and killed babies.

Opposition to Nestlé’s marketing strategies led to development of Marketing Code, now ratified by all WHO member nations (the United States and South Africa were the two holdouts, but both eventually agreed).

The boycott was so damaging to Nestlé’s sales and reputation that the company discusses it and defends its current marketing practices on its website.

If you have any concerns about our breast milk substitutes marketing practices, we encourage you to raise them with us so that we can continue to improve.

I’d say this Bobbie ad is morally and ethically wrong on four counts:

  • It undermines breast feeding
  • It directly undermines the intent of World Breastfeeding Week.
  • It violates the spirit if not the letter of the International Marketing Code.
  • It organic washes—it implies that because its products are organic, this company is above the Code.

This is the kind of marketing that gives organics a bad name.

Bobbie’s should not be doing this.

Time for another boycott?

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Jul 16 2018

The Trump Administration’s support of infant formula v. breastfeeding

By this time, you have no doubt heard about the Trump Administration’s attempts to stop the World Health Organization from promoting breastfeeding.  Incredible but true.

Here is a brief timeline of how this story got out.

May 25   Lucy Sullivan, executive director o 1000 Days (the first 1000 days of life are critical to an infant’s survival) sent out a tweet warning of a battle brewing over breastfeeding at WHO’s World Health Assembly, where countries are negotiating a resolution on infant and young child feeding.

June 7   Amruta Byatnal writes about “A Moment of Reckoning for Nutrition Advocates at the WHA” [World Health Assembly: “Nutrition advocates have accused the U.S. of siding with private sector interests, sparking a controversy over what they assumed would be a routine effort to provide advice on breastfeeding and the use of breast milk substitutes.”

July 8  The New York Times takes the story national: “Opposition to Breast-Feeding Resolution by U.S. Stuns World Health Officials.”  The Guardian also publishes an account.   These make it clear that the Trump Administration threatened Ecuador to drop its support of breastfeeding.  As the Times put it,

The Americans were blunt: If Ecuador refused to drop the resolution, Washington would unleash punishing trade measures and withdraw crucial military aid. The Ecuadorean government quickly acquiesced….The confrontation was the latest example of the Trump administration siding with corporate interests on numerous public health and environmental issues.

Ironically, Russia stepped in and introduced the measure, which passed despite US attempts to block it.

July 9  President Trump sends out a tweet:

July 9  Alex Azar, Secretary of Health and Human Services, also sends out a tweet, supporting the President: “America has a long history of supporting mothers and breastfeeding around the world and is the largest bilateral donor of such foreign assistance programs. Those unable to breastfeed shouldn’t be stigmatized; they should be equally supported with info and access to alternatives.”

July 9  The New York Times publishes an editorial: “Why Breast-Feeding Scares Donald Trump.”  Its answer: “It comes down to public health abroad could hurt American companies’ profits.”

What this is about

Infant formula works for babies, but breastfeeding is demonstrably better.  This is especially true for women who cannot afford formula, do not have clean water to dilute the powder properly, or lack refrigeration to store formula properly.

But breastfeeding has a serious political problem: it does not make money for formula companies.  As I explained in Waht to Eat:

Infant formulas cause controversy and are endlessly contentious for three important reasons.  Formulas are (1) largely unnecessary (most mothers can breast feed their infants), (2) not as perfect as breast milk for feeding babies, and (3) more expensive than breast feeding.  Breast milk is nutritionally superior to formula, but from a marketing standpoint it has one serious disadvantage: it is free.   Beyond one-time purchases of breast pumps, storage bottles, or special clothing, nobody makes money from it.

Formula companies are happy to pay lip service to “breast is best,” as long as policies do not promote breastfeeding over formula.

This is not the first time the US has taken this position.  In 1981, when the United Nations developed the International Code of Marketing of Breast-Milk Substitutes, all of its member countries agreed to abide by the Code except for the United States and South Africa.  Eventually, South Africa signed on.  The U.S. was the last hold out and did not agree to abide by the Code until 1994.  Why not?  Because the Code could set a precedent that might adversely affect U.S. corporations.

The Washington Post (“US efforts”) and The Atlantic (“epic battle”) review this history.

The formula industry’s problem

As I also explained in What to Eat, only about 4 million babies are born in the US each year, meaning that the formula market is limited and static.  That is why formula companies work so hard to convince mothers that breastfeeding is too difficult, unsanitary, inefficient, and ineffective to continue, and that they would be better off switching to formulas and staying on formulas long past the time when babies should be eating solid foods.

The reactions

My favorites are from

Add this to the growing list of ways the Trump Administration favors corporate interests over public health. Alas.

Additions

Maplight reports:

Three of the largest infant formula companies — U.S.-based Abbott Laboratories, Swiss-based Nestle, and U.K.-based Reckitt Benckiser — have spent $60.7 million lobbying U.S. lawmakers and officials during the last decade….While the New York Times reported that the formula manufacturers didn’t play a visible role in the debate over the WHO resolution, lobbying records show they have a significant Capitol Hill presence that often extends beyond infant nutrition.

Stephen Colbert’s take

 

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May 2 2017

Breastfeeding policies are a barrier to trade? The U.S. trade office thinks so

Trade rules are not easy to understand because they are so remote from most people’s lives.  But Public Citizen is keeping an eye out on what’s happening in the trade world, and making its meaning clear.

It reports that the Office of the United States Trade Representative (USTR) has just released its latest National Trade Estimate.  This reviews our trading partners’ actions that we think constitute “significant trade barriers” and want to eliminate.

What might these be?

This may be hard to believe but high on the list are other countries’ policies to promote breastfeeding, of all things.

The Trump administration wants to get rid of these “technical trade barriers:”

  • Hong Kong draft code designed to “protect breastfeeding and contribute to the provision of safe and adequate nutrition for infants and young children.” This, according to USTR, could reduce sales of food products for infants and young children.
  • Indonesia: USTR wants to get rid of a draft regulation to ban advertising or promotion of milk products for children up to two years of age.
  • Malaysia: USTR doesn’t like its code restricting corporate marketing practices aimed at toddlers and young children.
  • Thailand: USTR wants to eliminate penalties for corporations that violate laws restricting the promotional, and marketing activities for modified milk for infants, follow-up formula for infants and young children, and supplemental foods for infants.

This is about protecting sales of infant formulas and weaning foods heavily marketing to mothers in developing countries as superior to breastfeeding, this despite vast amounts of evidence for the superiority of breastfeeding over any other method for promoting infant health.

Public Citizen’s Eyes on Trade reminds us:

For decades, infant formula manufacturers have been accused of aggressive marketing campaigns in developing countries to discourage breastfeeding and instead, to push new mothers into purchasing formula.  The famous boycott of Nestlé in the 1970s led to the development and adoption by nations worldwide of the UNICEF/World Health Organization (WHO) International Code of Marketing of Breastmilk Substitutes (The Code) in 1981. The Code sets guidelines and restrictions on the marketing of breastmilk substitutes, and reaffirms governments’ sovereign rights to take the actions necessary to implement and monitor these guidelines.

To promote and protect the practice of breastfeeding, many countries have implemented policies that restrict corporate marketing strategies targeting mothers. These policies have led to increased breastfeeding in many countries even though greater progress is still needed.

These are the policies the USTR wants eliminated.

For shame.

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