One of the consequences of the UK’s vote to leave the European Union has been a call for the EU regulations on the promotion of formula to be relaxed. At the moment, EU law prohibits retailers from discounting new baby formula milk and from offering coupons or points with loyalty schemes. Those who oppose this law feel that it makes women who are giving formula feel judged and that they have to justify how they are feeding their babies.
However, the EU laws have never been intended to pass judgement on mothers. They do so much more than ban advertising and are in place to ensure that both breastfeeding and formula feeding mothers get accurate information. La Leche League GB believes that relaxing regulations will be a step backwards and could lead to mothers being misled and inferior products being sold.
What happened in the past
Before 1991 there were few restrictions on how formula was manufactured or promoted in the UK. Voluntary agreements with the formula companies meant that they could give out free samples – or include them as offers with other purchases – to all new mothers to try to encourage them to use their brand.
Formula companies could offer healthcare providers incentives for promoting their brand of milk, and free samples and supplies were common in hospitals. Breastfeeding initiation rates were much lower than they are today and this really undermined the confidence of those mothers who were struggling to breastfeed in the early days. With formula in their cupboards, it was all too easy to feel it was needed.
Even mothers who wanted to breastfeed could be targeted with marketing for formula and offered rewards and free samples. As all these incentives were funded by formula companies, they were ultimately being paid for by those who purchased it.
Seeing formula advertised gave women the impression that breastfeeding was not possible for most mothers. The health claims made by the manufacturers were often confusing and misleading and sometimes gave the impression that there was no difference between formula and breastmilk.
The way formula was marketed was sometimes even more underhand in other countries, with company representatives wearing nurse type uniforms, and packets showing healthy, chubby babies.
How legislation tried to protect all mothers
In 1981, the World Health Assembly in Geneva adopted The World Health Organization/UNICEF International Code of Marketing of Breast-milk Substitutes.1 This document was produced as a global health strategy, intended to set out minimum standards for the marketing of infant formula, bottles, teats, and any foods that replace breastmilk. This includes breastmilk substitutes and bottle feeding complementary foods which are marketed or represented as suitable for partial or total replacement of breastmilk.
The International Code, frequently referred to as the WHO Code, aims to protect, promote and support breastfeeding through regulating the inappropriate marketing and promotion of breastmilk substitutes and other related products. The Code does not ban the sale or use of these products, it simply sets out a framework to control their promotion.
The Code says that these items should not be advertised or promoted. It also addressed the quality, availability and information concerning the use of breastmilk substitutes, the labelling of these items and the claims made. The key point is that they should not be marketed to undermine breastfeeding.
This document was not intended to prevent a woman’s choice in how she feeds her baby. Its aim is to ensure that all women have access to objective, consistent and complete information about feeding practices, which is free from commercial influence. The Code is regularly clarified and extended at World Health Assemblies.
The legal obligation to regulate the market
The UK was one of the strongest endorsers of the International Code of Marketing of Breastmilk Substitutes in 1981 and has supported it and the subsequent WHO Resolutions ever since. As a signatory to the United Nations Convention on the Rights of the Child 2 that came into force in 1990, the UK has had a legal, as well as moral, obligation to protect breastfeeding and fully implement the International Code and WHO Resolutions.
In 2004, the Directorate of Public Health and Risk Assessment of the European Commission in Luxembourg decided to address the issue in the report “Protection, promotion and support of breastfeeding in Europe: a blueprint for action”.3 In 2006, the European Commission adopted a Directive on infant and follow-on formulae 4 which consolidated existing EU legislation on their composition, labelling and marketing. The UK implemented the EC Directive by adopting “The Infant Formula and Follow-on Formula Regulations 2007”.5
These regulations are intended to protect all babies. They say there should be no promotion to induce sales, discount vouchers, premiums special sales, loss leaders or tie-in sales on formula. Shops don’t give rewards for formula via points schemes as this has been interpreted as a promotion, causing some controversy. However, this is meant to prevent companies from using rewards to aid sales and not to cause mothers distress.
Implementing new GB legislation
In the past, the UK Government has claimed that EU laws prevent it from implementing different laws. Brexit supporters said that after the referendum the UK would be free to make our own laws. However, it’s important that any new laws that may be approved once the UK leaves the EU endorse the current regulations and ensure that children are protected from harmful products.
Repealing current laws could leave parents at the mercy of misleading marketing that undermines children’s health.
LLLGB was a part of the World Breastfeeding Trends Initiative assessment of the UK’s implementation of key infant feeding policies and programmes. The 2016 WBTi UK report has specific joint recommendations on this and other essential legislation, policy and programmes to protect breastfeeding. See Indicator 3 in the WBTi UK 2016 Report, Report Cards and online supplement Part 2: https://ukbreastfeeding.org/.
Formula manufacturers need strict regulation with products and advertising
There is often an assumption that formula manufacturers will always offer the best possible product. However, in countries where they are unregulated there are instances of corners being cut by looking for the cheapest source of ingredients, which may not be of the highest quality.
The positives of current legislation
Current legislation states that formula must not contain substances to endanger the health of infants and young children; it controls the levels of individual pesticides (they must not exceed 0.01mg/kg); it insists that ingredients in formula have to be examined and studied in relation to expected benefits and safety and be subject to expert guidance.
If a new infant formula is marketed, the manufacturer has to have labelling checked to ensure it gives the quantity of each mineral substance and the energy value. It must clearly explain how to prepare and store the product safely. It has to be tested to ensure it is of a required standard. In retail outlets, first formula and follow-on formulas should be displayed separately and use different colour schemes.
Marketing and advertising has to be truthful and must not be “aggressive or inappropriate.”6 There have been several instances of formula advertising being challenged by Baby Milk Action 7 and companies having to retract their claims.
The Cost of Formula
According to the United Nations, “access to good quality breast milk substitutes should be regulated and affordable.”8 However, selling formula and breastmilk substitutes is a massive business and companies want to attract new consumers in any way they can. Regulations are needed to ensure new mothers are not mislead by sponsored posts on social media which appear to be from a new mother who is having difficulties, but are actually placed by manufacturers who then target those who engage.
Without regulation, it’s possible that breastfeeding mothers’ confidence will be undermined by manufacturers. Ironically, they will also be paying for this via the cost of formula.
Supporting breastfeeding is not meant to make formula feeders feel guilty
It’s important that mothers get accurate information so they can make informed choices. Not everyone chooses to breastfeed, but mothers who do often stop before they would have liked to. In England, 83% of mothers breastfeed their babies after birth, but only 57% are still doing so by six weeks.9 Infant Feeding Surveys show that up to 85% of mothers who stopped breastfeeding between one and two weeks did so before they intended to.10 Amazingly, the UK has the lowest breastfeeding rates in the world at 12 months, less than 0.5%.11
There’s an enormous market for formula manufacturers looking to expand their sales. Only by ensuring that legislation prevents the undermining of breastfeeding and inaccurate marketing of breastmilk substitutes can we ensure that all women make the right choices for them.
Read a summary of this post here.
1 WHO: “International Code of Marketing of Breast-milk Substitutes”, 1981 (https://www.unicef.org/nutrition/index_24805.html)
2 “The United Nations Conventions on the Rights of the Child”, 1990 (https://353ld710iigr2n4po7k4kgvv-wpengine.netdna-ssl.com/wp-content/uploads/ 2010/05/UNCRC_united_nations_convention_on_the_rights_of_the_child.pdf)
3 EU Project on Promotion of Breastfeeding in Europe: “Protection, promotion and support of breastfeeding in Europe: a blueprint for action”, European Commission, Directorate Public Health and Risk Assessment, Luxembourg, 2004. (http://ec.europa.eu/ health/ph_projects/2002/promotion/fp_promotion_2002_frep_18_en.pdf)
4 “COMMISSION DIRECTIVE 2006/141/EC of 22 December 2006 on infant formulae and follow-on formulae and amending Directive 1999/21/EC” (http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32006L0141&from=EN)
8 “Joint Statement by the UN Special Rapporteurs on the Right to Food, Right to Health, the Working Group on Discrimination against Women in law and in practice, and the Committee on the Rights of the Child in support of increased efforts to promote, support and protect breast-feeding” (http://www.ohchr.org/SP/NewsEvents/Pages/DisplayNews.aspx?NewsID=20871&LangID=E)
9 “NHS England Statistical Release Breastfeeding Initiation & Breastfeeding Prevalence 6-8 weeks, Quarter 1 2015/16”, September 2016 (https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2014/03/Breastfeeding-1516Q11.pdf)