Trick #1: Get your logo everywhere
FACT: Exposure to formula promotion increases signiﬁcantly breastfeeding cessation in the ﬁrst 2 weeks. Also, among women with uncertain goals or breastfeeding goals of 12 weeks or less, exposure to formula promotion results in exclusive, full, and overall breastfeeding duration being shortened (Howard C et al. Obstetrics and Gynaecology Vol 5, No 2, Feb 2000 p296-303).
This is bad news for babies, but great news for formula companies. The less women who breastfeed – the more formula is purchased. This means lots of wonga for the shareholders. To put this scenario in context, check out the following stats:
The advertising spend for formula companies in 2006/07 was £7,626,847, an increase of 36.6% on the previous year.
The UK Government budget for promoting breastfeeding was £729,011 in 2006/07, a decrease on the 2004/05 ﬁgure of £747,000.
(Figures published by Save the Children).
The key to successful product marketing is to get as much exposure as possible, and the formula companies have got this down to a tee. They’ve been churning out hard sell marketing for decades. Here’s a Cow & Gate advertisement published widely in 1940s and 1950s UK:
With so many formula companies paying vast amounts of money to parenting magazines, is it any wonder the deputy editor of Mother and Baby magazine wrote an article describing breastfeeding as “creepy” (The Guardian).
Along with magazines, formula companies also place their advertisements on third-party websites, forums and blogs, promoting their infant formula brand name and encouraging mothers to visit their company website. One of the reasons I am reluctant to activate advertising on this blog is the inevitability that a formula company will detect the parenting content and submit their advertisements to the server. Formula companies know that online presence leads to increased sales. They know that the internet is where new mothers go for advice when they are feeling fragile; some of the biggest formula companies have commissioned research into it (Made For Mums).
Not content with bombarding your computer when you’re online, formula companies want dibs on it offline too. The idea is that every time you switch on your PC or laptop you’ll see their brand. Here’s Aptamil’s free desktop calendar:
You’ll also be targeted in supermarkets, where Cow & Gate branded gifts such as dummies and growth charts are distributed. This photo was taken in Sainsbury’s, September 2007:
Trick #2: Exploit the lazy
The rise of the bottle-feeding culture has fundamentally distorted our perception of the normal biology and psychology of new motherhood. It has produced a growing number of women who do not want babies’ feeds to dictate their lives. They cannot cope with the frequency of feeds required to maintain a good milk supply; that is, they cannot content themselves to sit and feed.
Why do a significant proportion of women now find that they 'can't cope' with something that's a biologically normal part of parenting? Women coped sufficiently well until formula marketing kicked off in the late 19th and early 20th centuries. They also coped during the Second World War when formula was unavailable.
10 (Selfish) Things I Love About Breastfeeding”, formula feeding is anything but convenient and in many cases it’s tantamount to a pain in the arse.
No time is formula feeding more of a pain than during the night. Kettles to boil, powder to mix, milk to cool - it’s enough to wake the neighbours; so formula companies have produced ‘Goodnight Milk’. The name itself is an idealizing claim, as it suggests the milk is necessary for babies to sleep through the night. The suggestion itself is concerning, as sleeping deeper puts babies at higher risk of cot death. UNICEF has maintained that “Goodnight Milk is not necessary for any baby and there is no independent evidence to support the claim that they help babies settle or that they are easy to digest.” (UNICEF 2010).
Goodnight milks are thickened with cereals to make them harder to digest. Aside from the risk that they will be used to replace a night time breastfeed, another worry is that the products could encourage parents to put their baby to bed immediately after bottle-feeding which would rot a baby's developing teeth.
As with goodnight milk, the following SMA television advertisement plays on mothers’ insecurities and concerns about night feeding. It features a voice over from a man promising not to pretend to be asleep when his young baby wakes up and promising to do his share of night feeding. A scene from the ad shows a dad falling asleep next to a boiling kettle and a tin of SMA Progress in the middle of the night:
I’m sorry to burst SMA’s bubble but as Gabrielle Palmer (The Politics of Breastfeeding, 2009) has pointed out, “The reality is that few fathers actually do take the whole responsibility of infant care and most artificial feeding is still done by mothers”. Pauline Lim, author of the very useful book Teach Yourself Successful Breastfeeding, concurs that:
"In reality few partners actually share the night feeds, so don't be tempted to stop breastfeeding for this reason. There might be an odd occasion when this happens but the novelty wears off very quickly, leaving you firmly back in charge of the night-feed. This is particularly true when your partner has to get up for work".
Trick #3: Evade the law
(Warning: this section contains boring yet necessary legal content - I knew my law degree would come in handy one day). Twenty-six years ago, in recognition of the damage to infant health caused by the promotion of formula, the world’s highest health policy setting body – the World Health Assembly (WHA) - adopted a set of rules called the International Code of Marketing of Breastmilk Substitutes (click here to view). It was intended “as a minimum requirement” to be “implemented in its entirety” by “all countries.” The aim of the Code is to protect all parents from commercial exploitation and to outlaw biased and inappropriate information. The Code was implemented into UK law in 1995 by the Infant Formula and Follow-on Formula Regulations (click here to view). They specify claims that companies are allowed to make about formula. Only claims specified in the law are permitted.
Obviously this Fairy Story didn’t end Happily Ever After. The Code’s implementation into UK law was piecemeal and littered with loopholes. This unfortunate state of affairs was no accident. It was an attempt by the UK Government to pacify the formula companies and prevent their business fleeing the UK. One example (and the biggest obstacle to change) is the Better Regulation Executive which forms part of the UK Department for Business, Innovation and Skills. It serves to block any rule that might interfere with a company's ability to make money. It gives businesses direct influence on how regulations that affect them are devised and delivered. It makes it easier to change or remove regulations, where this would be beneficial for the business. It also aims to reduce existing regulatory burdens affecting businesses. In the realm of baby milk, it places corporate profits above the health and welfare of babies.
Furthermore, Trading Standards Officers do not take action against formula companies anywhere near as often as they should because such action is expensive. Formula companies have much more disposable cash to pay lawyers than the Government can glean from the public purse.
Therefore currently we are stuck with a rather impotent law, yet it is still law nonetheless. Sometimes the formula companies’ evasion of the law is subtle using manipulation and strained interpretation, and sometimes the evasion is blatant criminality. On the face of it, the latter strategy seems more risky for the formula companies, however with laws so weakly drafted and with the risk of legal action being so sparse, law breaking is a profitable gamble for the formula companies.
One of the most prolific and blatant evasions of the law occurred when formula companies created so-called “follow-on” milk (formulated for babies aged 6 months plus). UNICEF have commented that “It is not necessary to move your baby on to these milks” (UNICEF 2010). In fact they have less nutritional value than first milks. Follow-on milks did not exist as a separate classiﬁcation of product when the International Code of Marketing of Breastmilk Substitutes was adopted. They were introduced in an attempt to escape the provisions of the Code (which prohibits advertising formula for babies less than 6 months). Likewise, they were not invented because health professionals begged formula companies to produce a less-modified milk for older babies. They created these products as a means of promoting their entire formula range.
A lot of the time, when parents see adverts for follow-on formula they think they are seeing adverts for infant formula; and this of course, is the intention of formula companies. The tins of infant and follow-on milk sit next to each other on the supermarket shelf; thus completely ignoring the requirement in the Code’s Guidance Notes that infant formula and follow-on formula should be placed in separate areas in retail outlets. Also as you can see from the photo bellow, the formula companies use almost identical packaging to make the formulas cross-promotional. Thus, advertising for one product is likely to encourage sales of the other. This has proven to be an effective, if underhanded, way to exploit the fact that follow-on formula advertising is permitted.
The effectiveness of this cross-labelling strategy was highlighted in a 2007 study (available from Baby Milk Action). Amongst a nationally representative sample of women of childbearing age, there was a high recognition of formula manufacturer’s logos and a very high association between the logo and formula for babies less than 6 months. Taking SMA’s logo for example, 89% of women linked the logo to formula for very young babies. Formula companies have strengthened this effect by making their logos (SMA, Cow&Gate, Aptamil, etc) more prominent on their advertising and packaging than the actual product name (Gold, Follow-on, Progress, etc).
Campaigners have pointed to some adverts that don't make it clear which of the two products they are promoting. When Baby Milk Action complained to the Advertising Standards Authority, it was told that the authority would not investigate unless the adverts specifically mention infant formula. Thus token reference to follow-on milk (usually in miniscule small print) seems to be sufficient to dissuade Trading Standards and the ASA from acting.
The Consumer Committee of the EU Parliament questioned the scientiﬁc basis for follow-on milks back in 1985, calling them “extremely dubious”. More recently, the UK Government’s Scientiﬁc Advisory Committee on Nutrition (SACN) has maintained that follow-on formula is an unnecessary product. They maintain that: “There is no case for allowing the advertising of follow-on formula... there is no scientiﬁc evidence demonstrating nutritional advantage of this product over infant formula...[both these] are breast milk substitutes as deﬁned by the Code (which sets no upper infant age limit on this term)...We ﬁnd the case for labelling infant formula or follow on formula with health or nutrition claims entirely unsupportable”.
The fact that follow-on formula is unnecessary and was created purely to circumvent law is illuminated in Scandinavia. The follow-on formulas marketed in the UK would not appear in Scandinavian countries because they do not have a culture of using follow-on milks. Instead the culture in Scandinavia is for those who wish to bottle-feed to use the same formula from birth to one year of age. If follow-on formula was necessary to a baby’s diet there would be a demand in Scandinavian countries. In fact, the UK Department of Health in their “Birth to 5” manual recommends that if a mother is not breastfeeding, she should continue using ordinary infant formula for the ﬁrst year of her babies life. There is no mention of follow-on milk.
Trick #4: Get them while they’re young (very young)
As I outlined above, advertising infant formula (milk for babies under 6 months) has been illegal in the UK since 1995. The main reasoning behind this ban was to prevent the undermining of breastfeeding. In turn, it was hoped that this would enhance the health of the nation, as breastfed babies have greater immune health, fewer infections, reduced risk of sudden infant death syndrome, less diabetes, less childhood obesity and less tendency to develop allergic diseases, to name a fraction of the benefits. An honourable goal. Needless to say, it’s not one the formula companies aspire to. In fact, they became rather agitated by the law’s attempt to put a lid on their profits. If they cannot advertise their products for young babies, how can they convince mothers to choose bottle over breast, and more importantly, to choose their brand over other formulas? One strategy they developed to overcome this legal roadblock was to target pregnant women.
There’s a snag though, seeking direct or indirect contact with pregnant women is prohibited by the Code. However, formula companies, knowing that they have bigger penises than the law, roll their eyes at this minor inconvenience and proceed with their antenatal marketing anyway. Before your baby has even taken its first breath, she is already earmarked by the formula companies as a valuable source of revenue. This takes “cradle to grave” marketing to a whole new level.
Trick #5: Fabricate similarities to breastmilk.
Just to point out the obvious, formula milk is an entirely different substance from human milk, containing no living cells and not adapting to each baby’s individual changing needs. In fact, cow’s milk is the commonest basis of formula, not because it is the most appropriate breastmilk substitute - “chimpanzees’ or horses’ milk might be better” (Palmer 2009) - but because it is the cheapest and most readily available and therefore most used.
Some may praise formula companies for quoting the superiority of breastfeeding on their packaging: “breastfeeding is best for your baby” they cite. They do this, not merely because they are required to do so by law, but because it also affords them various benefits. By citing 'breast is best' the formula company is making a purely token concession, referring to one of the weaker arguments on the side of breastfeeding (even lactivists have criticize the slogan 'breast is best' for being misleading and counter-productive). This concession polishes the formula company's own image by adding to it the gloss of apparent objectivity.
It was not long before the formula companies discovered that they could go even further and change the ‘breast is best’ required notice into an endorsement by suggesting their product is close to or inspired by breastmilk. The term “closer than ever to breastmilk” is not compliant with UK Regulations. However in 2007 the front of Cow & Gate's tin read “Closer than ever to breastmilk”. SMA Gold read “now even closer to breastmilk”, while Aptamil read “the closest to breastmilk”. It is depressing yet predictable that a poll by Mori for the National Childbirth Trust found that a third of women believe that infant formula was “as good as” or “better than” breastmilk. For a mother who is struggling with breastfeeding (and most do, in the initial weeks), who is worried about her milk supply, the packaging of formula appears to offer reassurance: “Closer than ever to breastmilk” might sound close enough. It is unsurprising that most women switch from breast to formula at this stage.
When the law requested a change to formula packaging to reflect the fact that the term “closer than ever to breastmilk” was false and misleading, a spokesman for SMA, said: “We are changing our packaging in April. We would say the claims are fair and accurate, however the FSA has asked for a change and we will comply.”
So they changed their logo from this:
Notice how the new logo replicates a stylised image of a breastfeeding mother. *headdesk*
Furthermore, an email sent to parents from SMA claimed that, for mothers who don’t breastfeed: “They can still provide all the necessary goodness by choosing infant milk with a balance of nutrients as close to breast milk as possible, like SMA Gold.” The claim “close to breastmilk” is purposely vague. Closer to breastmilk than what? If you compare formula to say, petrol, then yes I guess it is closer to breastmilk. But how many parents would consider giving their beloved offspring a refreshing sippy cup of petrol?
Cow & Gate case; Aptamil Case; and in The BBC).
Aptamil also jumped on the bandwagon with these gems:
This advertisement for Aptamil appeared in The Independent newspaper during National Breastfeeding Awareness Week in May 2005. It draws equivalence between Aptamil and breastmilk.
A recent television and internet advertisement for Aptamil follow-on formula touts that the formula is “inspired by breastmilk.” Check out the Readybrek style blue glow around the breastfed baby. It’s supposed to signify protection. In the next shot there is a baby being bottle-fed with the same blue protective 'glow' implying equivalence with breastmilk.
Here’s an advertisement from a parenting magazine in Germany. It shows Aptamil (surprise, surprise) follow-on formulas with an obvious link to breastfeeding:
In 2006 Heinz promoted its formula on the back of the UK Government’s Healthy Start scheme claiming its formula was closest to breastmilk.
In 2010 Hipp (bellow) claimed that their formula contains “the key nutrients found in breastmilk but with an added bonus: they’re organic”. Bizarre. What is breastmilk if not organic? In fact, breastmilk is more organic than any formula could ever be. And as for their claim: “doesn't it go without saying that after the breast you want to give the very best”; Firstly, the breast is the very best; and secondly, the advertisement implies that every mother should switch to formula after breastfeeding which is absurd.
Amongst this frenzy of promoting new ingredients as equivalent to breastmilk, the subject the formula companies like to avoid is ‘nutrient bioavailability’ (i.e. how much is actually taken up by the body). The nutrients in breastmilk are so well-absorbed that there is very little waste. Compare the nappies of breastfed and formula fed babies (if you’re that way inclined) and you’ll see the contrast.
Trick #6: Throw in some pseudo-science
What do the following sentences have in common?
- 'Prebiotics support natural defences'.
- 'Beta carotene... to help maintain a healthy immune system'.
- 'Nucleotides help growth and the immune system'.
- 'Omega 3 long-chain polyunsaturated fatty acids (LCPUFAs) - for development'.
- ‘Now with “Immunofortis”.
- “Alphan lactalbumin, new betapol, LCP and betapol improve calcium absorption.
They’re all banned in UK advertising because they are not compliant with the Regulations. Despite this fact, Trading Standards have allowed them to work through the distribution system, which means that they’ve been on the supermarket shelves for a year or more.
These smart-arse sounding ingredients are a form of pseudo-science. In other words, they are exaggerated or made up names for made up ingredients with no proven benefits. Pseudo-science specializes in the use of technical jargon to deceive parents into supposing that claims of a scientific nature are being made, and that objective experimental evidence supports them. The white coat of technical jargon is so dazzingly clean (never having been tainted by any real scientific work) that it blinds parents to the true merits of what is being claimed. Just as loaded words try to manipulate parents emotionally, so does pseudo-scientific jargon try to induce an unearned respect for what is said.
The European Commission's scientific advisory body has maintained that formula companies should remove all nutrition claims from their advertising and packaging except 'lactose free'. However this is merely a recommendation rather than solid law. You don’t need to be Mystic Meg to have foreseen that formula companies chose to turn a blind eye to this request, instead opting to continue making statements for which scientists say there is no evidence.
Take for example LCPUFAs, they are a poor imitation of the LPCAs found in breastmilk. Formula companies make them from laboratory-grown fermented algae and fungus. Scientific studies have found that artificial LCPUFAs do not enhance infant health or development in any way (Simmer K. Longchain polyunsaturated fatty acid supplementation in infants born at term. The Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD000376). More worryingly, some studies have reported unexpected deaths among infants who consumed formula supplemented with LCPUFAs (Palmer. G 2009). You won’t see that information on the can.
The claim that “prebiotics support a baby's natural defences” is also not compliant with UK Regulations. Yet one particular formula company has bent over backwards to tell you that “babies thrive when their natural immune system is supported, so Cow & Gate milks are developed with special nutrients, such as prebiotics, that can do this. It's our way of helping you to protect your baby.” Aptamil packaging claims that “prebiotics ... support your baby's natural immune system”. It also made claims, about fatty acids, nucleotides and betacarotene which contravene the Regulations.
In the rare occasion that a formula advertisement features references as evidence for its claims, in most cases there are substantial conﬂicts of interest. The formula company has often donated the formula used in the study, part-fund the study and provided the randomization schedule of study participants to the researchers, who work for a foundation receiving ﬁnancial support from the formula company. Sleazy business. This kind of behaviour makes politicians appear positively angelic.
In amongst the flaunts of pseudo science there is no mention that a child fed on formula is more likely to suffer from gastro-enteritis, respiratory infections and other illnesses than a breastfed child, no matter how hygienic the feed preparation. How convenient that they forgot to enter that information on the labelling.
Another formula company strategy is to attempt to medicalise normal feeding conditions such as possetting and “hungrier babies”, and then suggesting they need specialised formulas. UNICEF have maintained that “There is no evidence that babies settle better or sleep longer if given these milks. They are based on the curd of cow’s milk and take your baby longer to digest than first milks" (UNICEF 2010). In the UK Mead Johnson and Nestle conduct their entire business around specialised formulas, an indication of the cash to be made from this growing niche. They both promote ‘hypoallergenic’ formula, a health claim which is prohibited in the US after infants fed on it suffered allergic reaction (New Scientist).
What's more, parents are encouraged to self-diagnose and ask doctors to prescribe products such as Wysoy soya formula (from the same corporation that produces SMA). Soya beans are used as the basis for such formula, not because they are best for babies, but because the soya industry sought profitable outlets. The Food Standards Agency’s advice on soya formula and milk intolerance is “the use of soya formulas should be discouraged through professional and parental education as more suitable alternatives are available.” Soy formulas contains substances which inhibit nutrient-absorption and a high phytoestrogen content, which could pose a risk to the long-term reproductive health of infants (for more information see research by the National Toxicology Program; the American Medical Association; the Journal of Human Reproduction; the British Dietetic Association; UNICEF; and The Guardian).
Trick #7: Lure mothers with gifts
Any gift makes us feel cherished and loved by the giver. A mum or indeed, a health worker, can feel obliged, even affectionate, towards the salesperson who have given an attractive or much-needed pen, notepad and diary, and of course this is why it is done. “The recipient’s bias towards the gift-giver is unconscious and unintentional” (Palmer. G 2009).
With this in mind, dare you enter my Aladdin’s Cave of formula tat? It showcases a range of formula company freebies aimed at ensuring that you and your baby become walking billboards. Click on the image below to enter:
A mother is more likely to need breast pads during her baby’s first few months as her breasts learn to regulate milk production. It also happens to be the period which the majority of mothers find challenging and are most likely to quit breastfeeding. Here we see Aptamil making sure they’re on hand to salvage the spoils of breastfeeding failure.
Trick #8: Get mothers’ personal details
Formula companies go to great lengths to get mothers onto their databases. Most of the large formula companies target pregnant mothers in clinics to gather contact details. Then the company bombards them with advertising in the form of leaflets, emails, website endorsements, and so on. Recently an Alpha Parent reader emailed me about a ton of formula samples she had just received:
"I'm 36 weeks pregnant with my second, nursed my first for 21 mos with no formula and I have every intention of doing the same (or longer!) with this baby.
So imagine my surprise when I came home yesterday and found a Similac package on my doorstep. It's addressed to me, although my first name is spelled incorrectly. Inside is a 1.45 lb tub of Similac Advance, a bottle and a 12.6 oz tub of Similac sensitive. Not to mention coupons and other paperwork, including The Art of Feeding, a pamphlet that has such gems as "reasons for bottling your breastmilk," and "if you'll be gone for an extended period during the day on a regular basis, you'll want to switch to formula a few weeks ahead of time so that your body will gradually decrease your milk supply."
This is not an isolated example. Once the child is born, email and postal mailshots intensify. Companies continue to try to get mothers to sign up to their lists, with leaﬂets in clinics, advertising, materials in bounty packs and free gifts.
In 2007 Registry offices were recruited by Hipp in some cities to distribute a sticker booklet on ‘Baby’s ﬁrst year’ - which promotes its formula brand, website and careline telephone number.
Let’s not forget the dads! (see right for a Cow&Gate website ad). If your partner forms an affinity with a certain formula company, then he is more likely to suggest formula (and in particular, that brand) when you encounter your first breastfeeding problem. Formula companies, of course, know this. Which leads us to the next formula company trick...
Trick #9: Undermine breastfeeding
The sad fact is that formula companies must lure a great mass of women away from breastfeeding to keep their products profitable. Here is a genuine Cow & Gate advert on a mailshot pamphlet:
It says: “I’m thinking of getting a t-shirt made – ‘Danger! Sore boobs!” Inside it encourages mothers to go to the Cow & Gate website, which promotes all their formulas, and to telephone the Cow & Gate careline. Baby Milk Action have commented on the advert saying, “Ostensibly offering to support mothers, it preys on a mother's concerns and pain she may be experiencing to promote its formula brand name on the card and specific products on the site. Some mothers do experience pain as they and their child get used to breastfeeding. But if a mother experiences problems she needs help from reputable health care professionals and mother support groups, not a mailshot dropping through the letter box promoting Cow & Gate”. The mailshot was timed for when the recipient mother was most vulnerable. It was sent out when her baby was 3-4 weeks old.
In 2008 Heinz placed the following claim on their label for newborn formula: “Giving your newborn Heinz Nurture Newborn infant milk will give you the reassurance that your baby is getting total nutrition”. This claim undermines the status of breastfeeding and is 100% false. It is impossible for formula to contain ‘total nutrition’ when it does not contain many of the components found in breastmilk (Click here to see an illuminating list of the contents of breastmilk and formula).
The Baby Feeding Law Group has highlighted another formula company strategy for undermining breastfeeding, namely idealising bottle use: “The information on the Aptamil ‘experts in infant nutrition’ website about bottle feeding undermines breastfeeding by highlighting how others can feed and ‘bond’ with the baby. It suggests that bottle feeding will become essential for working mothers and undermines breastfeeding again by suggesting that mothers who express milk feed this in a bottle, which is not recommended due to the different sucking reﬂexes that can lead to lactation being compromised (cup feeding is recommended)”.
It seems that Aptamil and friends have a lot to ‘advise’ parents about; because parents are incompetent right? They need corporations to tell them how to do what their ancestors have been doing naturally for thousands of years. Which leads us to...
Trick #10: Claim to be ‘experts’ on nutrition and childcare
Formula companies want to be seen as the source of information on infant care - then they promote the company’s brands and health claims for formula. The SMA tagline is “for infant nutrition trust the experts - we know”; Because the best person to tell you about your baby, nutrition and formula, is the company making a profit from selling it to you. Obviously.
This strategy was brought to the world’s attention by the infamous Nestle 1970s lawsuit involving their “milk nurses”. Nestlé employed sales reps dressed as nurses who promoted Nestle formula to new mums in developing countries. They were paid on commission and their uniform carried the prestige of the health worker and inspired trust.
The lawsuit lost Nestle a lot of consumer support and inspired the popular “Boycott Nestle” campaign. Consequently Nestle lay low for a few years until the dust settled, then in China in 2005 Nestle positioned doctors in ‘Nutrition Corners’ in supermarkets to promote formula products to pregnant and breastfeeding women. It seems this leopard has its spots permanently tattooed on.
Nestle are not alone in employing the “disguise yourself as experts” strategy. All the major formula companies have created telephone ‘carelines’ to idealize their products and undermine independent advice from health workers. There appears to be scant regulation of the content of company advice provided via these carelines. Needless to say, the ‘information’ (read: marketing) is not objective. Not only does advertising for formula company carelines direct parents away for reputable helplines such as NHS direct, the information given is at times misleading and dangerous.
At this point it is worth highlighting that the primary purpose of formula companies is not to do good or even provide useful products. Rather the companies have a statutory duty to put the needs of their shareholders first, which means generating as much profit as possible. The ‘caring’ image is simply part of marketing and has nothing to do with the realities of business. This fact was illuminated in one particular study. Baby Milk Action called the carelines in the role of a confused parent wanting to know the difference between the formulas on the market and the particular health claims made about the company’s product.
SMA advertised their careline in Prima Baby magazine. As an inducement to call the careline, the ﬁrst 200 callers in August and September 2008 were offered an SMA-branded baby towel (seen in my Aladdin's Cave above). Article 23 (2) of the Regulations is clear that branded gifts such as this are not permitted. When phoned, the SMA’s careline advisor was asked about its ‘new protein balance’, promoted on labels. She said: “It makes it closer to the protein found in breastmilk.” She was asked how SMA could be the closest to breastmilk when the Aptamil label and advertising says it is the closest and replied: “Ours is balanced. It is closest.”
I strongly believe that every mother should be empowered to make the best decision for herself and her child based on accurate and independent information. Would it be wise to trust a company for breastfeeding support when that company has a vested interest in making as much money as possible from a mother’s *failure* to breastfeed? Would you expect impartial advice on washing machines from Hotpoint? Baby care and feeding advice should not come from corporate carelines, and certainly not from a z-list soap star! Instead, a lot of people would advise that mothers go to health care professionals; however read on to discover how that route is equally troublesome ...
Trick #11: Manipulate the professionals
“Accurate, independent information on new ingredients and products should be prepared for communication to health workers by the Food Standards Agency, or other authority to equip them to advise parents rather than formula companies delivering this information” (Baby Milk Action).
Back on planet earth... midwives, health visitors and GPs are persistently subject to very clever and insidious marketing from formula companies via advertising, gifts, conferences and ‘training days’. Many health workers are so used to being bombarded with covert formula marketing that they do not perceive its function. In the absence of good knowledge about how to recognise when breastfeeding needs fixing and how to do it, health professionals fill the gap with biased instruction from formula companies. How many times have you heard a health visitor recommend topping up with formula at the first sign of a breastfeeding issue? Wonder where they got that idea.
Aptamil love this lark. Here is one of their advertisements, the second page of double page spread, featured in the British Journal of Midwifery, March 2008, April 2008. Here Aptamil tell professionals to “count on Aptamil First” (a deliberate play on words):
Here is another advertisement in the British Journal of Midwifery, April, May, June 2008:
Here’s an advertorial that Aptamil placed in Community Practitioner February 2009. Here they spoon-feed practitioners on how to reply to parents’ queries:
idealize (also idealise) : verb regard or represent as perfect or
better than in reality. Oxford dictionary
Now we come to the beast they call Nestle. Despite claiming they would not enter the UK infant formula market Nestle launched a video at a Royal College of Midwives Conference in 2008. They failed to obtain the necessary approval to do this from the Secretary of States as required by the Regulations, but went ahead and launched the video anyway. Those whom viewed the video found that it undermined breastfeeding by highlighting difficulties in an exaggerated and needless fashion. The RCM has since announced that it will no longer take advertisements from formula companies (Babyfeeding Law Group 2009).
The site (click here to access it if you must) offers leaflets, study days and training days. It includes downloadable patient podcasts, information sheets, on such things as the benefits of all that chemical junk they put in formula.
At one ‘training event’ health workers were given a branded bag of promotional materials and gifts, refreshments from Starbucks and a £10 food voucher, encouraging them to walk to the food hall with the bags:
Midwives don’t have the time to probe each advertisement and may believe that what they read is science because of the charts and language. Here’s another example from Cow&Gate:
There is currently no legal obligation for formula companies to supply evidence of their claims to health workers. A frustrating consequence of this is that health workers have no access to accurate information about formula products. They only have the marketing information produced by the formula companies from which to advise parents.
As a side note, if you’re a midwife fond of magazines consider buying Practicing Midwife instead of The British Journal of Midwifery - no formula ads.
Magazines are not the only stream through which formula companies influence health care professionals. These cards (bellow) were sent to health workers from Cow & Gate in the hope that they would be distributed to mothers, thus giving the impression that the health worker endorses Cow & Gate. They carry the formula brand name on the back. As an inducement to promote the careline, health workers could win £250 in Marks and Spencer vouchers by calling the line themselves.
However it must be said that health care professionals are not entirely blame-free reluctant sheep, led naively astray by formula companies. There is a significant degree of mutual benefit involved in this collusion. As formula fed babies are more prone to illness, this means that doctors, nurses and health visitors are becoming increasingly important fixtures in infant life. So there are more jobs, more careers, and more sales of drugs in health care.
Furthermore, aside from the small freebies which formula companies bestow on health workers, large gift incentives are also given. An important proportion of medical and nutritional research is financed by formula companies. Also, professional health bodies frequently receive funding for salaries, grants and conferences from formula companies. In America for example, formula companies donate $1 million annually to the American Academy of Paediatrics in the form of a renewable grant that has already netted the AAP $8 million. The formula industry also contributed at least $3 million toward the building costs of the AAP headquarters. The American College of Obstetrics and Gynaecology received $548,000 from two of the four major formula makers in 1993. The American Medical Association television program is sponsored by the makers of the infant formula: Similac. Moreover, the American Dietetic Association, the National Association of Neonatal Nurses, and the Association of Women's Health, Obstetric and Neonatal Nurses all receive generous funding from the formula industry. In the Philippines health care professionals earn 500 pesos for every 10 infants they convert to using a particular formula brand.
Trick #12: Obscure the health risks of formula
The mantra "Breast is Best" implies that formula is normal and safe, and that breastfeeding is a bonus. The reality is far from that...
Click here to view the NHS instructions for preparing formula. These instructions were updated via information from the Food Standards Agency following deaths of infants in Belgium and France linked to Enterobacter Sakazakii contamination. The FSA warned that powdered formula is not sterile and that steps can be taken to reduce the risks, such as ensuring that water used to mix up formula is at least 70oC. No company has given this information to parents as set out by the NHS, and some directly contradict it. After all, it’s not their problem, “ignorance is a mother’s crime” (Palmer. G 2009).
Incorrectly prepared formula is a major cause of malnutrition and illness. It can result in feeding difficulty and specific health problems like malnourishment, dehydration, and gastrointestinal inflammation. In some cases it can even result in death. The World Health Organisation has recommend that all parents should be informed through an explicit warning on the packaging that powdered infant formula may contain pathogenic microorganisms. Yet only one company has included the information that powdered infant formula is not sterile on its new labels (Hipp), and sadly it instructs parents to use water at 50-60oC. WHO experts say that mixing formula with water at the correct temperature of 70oC is the single most effective decontamination step which could reduce the risk 10,000-fold (WHO Guidance can be found here).
More worrying than the lack of information on safe preparation is the presentation of inaccurate information. When Baby Milk Action phoned the Aptamil careline in the role of confused parent enquiring about sterility and the need to use hot water, the Aptamil advisor said it wasn’t necessary: “The reason we say 30 minutes is that is the optimum time. It is a health and safety issue, we don’t want people scalding their hands. People can make it at room temperature”.
The Cow & Gate careline recommended using cold water(!) When asked whether Cow & Gate formula was sterile, the advisor said “No formula is sterile.”Asked if that was a problem, she said: “Makes no difference.” She advised: “Prepare bottles of sterile water in advance. That stays fresh without refrigeration for 24 hours. Take from the bottle and mix.”
When the Heinz careline were asked about the need to use hot water as powdered formula is not sterile, the advisor’s advice was: “Heat the water and let it cool. I don’t know if it gives the temperature. It says 30 minutes.” The NHS guidance says no more than 30 minutes. Asked if using hot water was important, she said: “It mixes better” and had nothing to do with sterility.
When the SMA careline were asked about sterility, their advisor said: “No formula is sterile if it is exposed to the air.” A bizarre statement, as formula powder is not sterile even when sealed in the tin.
Hipp were arguably the scariest. Their Careline advisor did not have an answer to questions on sterility, so the nutritionist phoned back. She said Hipp did not follow the NHS guidance for parents of using water above 70oC because “you kill the protein and it would be dangerous to hold it.” When asked about the NHS guidance, she said water at 70oC would cool when it was mixed with the powder so “the temperature would be lowered anyway.” She claimed “no-one does it at 70.C”.
Aside from the improper preparation of formula carrying substantial health risks, the ingredients in the formula themselves have also proven to be dangerous. Formula companies regularly add new ingredients - before their safety has been properly evaluated - simply to gain competitive advantage. This is equivalent to a mass uncontrolled trial on babies. Surprisingly there is currently no legal requirement that the ingredients are evaluated by an independent scientific body prior to introduction onto the market. Baby Milk Action has commented that:
“Formula can be the sole source of nutrition during a critical period of rapid growth and development. Minor modifications can have major effects on infant health. The Report of the Scientific Committee on Food, 2003, identifies problems that have occurred with the introduction of modified infant formulae. Examples include reduced protein availability with impairment of growth; trace element deficiency with severe clinical disease; chloride deficiency with long-term neurological damage and thiamine deficiency with severe clinical disease, including neurological damage and several cases of infant death.”
I must point out (because the formula companies won’t) that children who are formula fed are more likely to suffer from:
- Ear infections
- Blood infections
- Sudden Infant Death Syndrome (cot death)
- Childhood cancers
- High blood cholesterol
- Reduced effectiveness of vaccinations
- Reduced effectiveness of organ transplants
- Haemophilus Influenza
- Necrotizing Enterocolitis
- Pneumococcal Disease
- Respiratory Infections (general)
- Respiratory Infections (protective effect against exposure to tobacco smoke)
- Respiratory Syncytial Virus
- Sepsis in Preterm Infants
- Urinary Tract Infections
- Anemia and Iron Deficiency
- Autoimmune Thyroid Disease
- Constipation and Anal Fissures
- Cryptorchidism (undescended testicle)
- Gastroesophageal Reflex
- Inguinal Hernia
- Lactose Malabsorption
- Morbidity and Mortality
- Pyloric Stenosis
- Wheezing and Asthma
- More pain during medical procedures
- Impaired jaw and teeth development
- Reduced Development and Intelligence
- Reduced Brainstem, Cognitive, and Motor Development
- Reduced IQ
- Reduced Gastrointestinal and Immune Development
- Hormone imbalance
- Reduced Neurological, Psychomotor and Social Development
- Disturbed Sleep Cycles and Arousal
- Reduced Speech and Language Development
- Reduced Thymus Development
- Poor Bone mass
- Cardiovascular Disease (Atherosclerosis, Cholesterol Concentration)
- Celiac Disease
- Diabetes Mellitus
- Helicobacter pylori infection
- Haemophilus Influenzae Meningitis
- Inflammatory Bowel Disease (Crohn's Disease, Ulcerative Colitis)
- Juvenile Rheumatoid Arthritis (JRA)
- Poor Mental Health
- Menopause (timing of) – I’m not joking
- Multiple Sclerosis
- Reduced Oral and Dental Health
- Reduced Protection against toxins (environmental contaminants, chemicals, heavy metals)
- Reduced Stress Resilience
(Read about each of these conditions and their links to formula feeding here).
I hope the points I have raised above put to rest the popular yet ignorant argument that “formula is only dangerous in developing countries where they have poor sanitation”.
Trick #13: Manipulate the scales
The Independent). Weight charts based on cow’s milk are not in babies’ best interests.
Here’s a weight conversion wheel (right), the type you’ve probably seen your midwife use. It’s made by Cow&Gate and given free to health professionals in the hope that they will use it in front of parents, thereby giving the illusion that the healthcare professional endorses Cow & Gate. It is based on the growth of formula fed babies.
Trick #14: Get emotional
Pregnant women and new mums are a hormonal bunch. Perfect fresh meat.
This advert (bellow) plays on parents’ emotions; it talks about giving up career, social life and figure. These sacrifices are arguably more relevant in the first six months of a baby's life; readers will not differentiate this from infant formula milk; the words 'follow-on milk' or 'not before 6 months' are not clearly visible and not in the same size text as the logo.
Mike Brady, coordinator of the Baby Feeding Law Group's monitoring project has said: “If the Advertising Standards Authority really believes that parents should be basing their decisions on how to feed a child during the most important phase of its development outside the womb on the heart-tugging, greeting-card sentiments of SMA’s advertisement then they have seriously failed in their responsibility to protect the public” (Baby Milk Action Press Release).
While the small print on the advert states that the product is not intended to replace breastfeeding it also states: “When used in conjunction with solid feeding, it provides the nourishment essential to a baby’s healthy and sustained growth.” Needless to say, this is contradictory to the UK Department of Health and World Health Organisation recommendation of continued breastfeeding. It also implies a false equality between the formula product and breastmilk.
Sometimes the most simple emotional hooks are the most effective. Polar bears, cuddly cows and fuzzy ducks are all used on formula packaging and in advertising. They convey no information and exist for the sole purpose of eliciting a positive emotional response to the product. Should parents be encouraged to use a polar bear as a good basis for selecting what is to be the sole nutrition for their child’s tender months? Naturally, the WHO Code thinks not. It requests that “Labels should not feature words or pictures idealising artificial feeding”.
Trick #15: Exploit New Media
Any marketing bod will tell you that the best way to suck in customers – and keep them - is to interact with them on a regular basis. Aside from their carelines, formula companies have other techniques aimed at keeping mothers coming back.
In 2008 Hipp launched a blogging network encouraging mothers to blog on its site (right). They point out that their blogs are FREE. Yeah, and so are all the other non-formula-advertised blogging hosts (Blogger, Wordpress, Livejournal).
here) so that one of the little dears can rival that ugly fucker they put at the end of their adverts. You know the one.
And while you’re at it, they want you to send in photos too (here).
The company's most recent exploitation of new media is the launch of their iPhone app, plastered from top to toe with their logo and marketing. The application sucks parents in by offering the ability to add Cow&Gate branded frames and captions to their baby's photos. Then the app encourages parents to share the photos with family and friends (i.e. do the company's marketing for them). Other features of the app include: "discover some extraordinary facts about your toddler’s development" and: "contact our careline for any other toddler questions". The company are so eager for you to contact their careline that they can connect you directly from the app; no need to actually type in the number. Read more about the app here.
A few weeks later Cow&Gate launched another app, this time targeted squarely at pregnant women. The app encourages expectant mothers to monitor their diets during pregnancy. "Our unique Pregnancy Diet Calculator will help you check you're eating enough of the right foods to give your baby the best start in life" touts the company (website here). It's disappointing that Cow&Gate's encouraging mothers to give their babies "the best start in life" does not extent to life outside the womb.
Above I have outlined just some of the tricks used by formula companies to generate cash from parents and in the process, diminish the health of mothers and babies worldwide.
Feeling angry? You can sign up to the Breastfeeding Manifesto campaign, send a message to your Member of Parliament and find out full details at:
Also, if you have any formula tat to feature in my Aladdin’s Cave, do email me a photo.