Formula feed industry engagement with academia sours the breastfeeding agenda

As we reach the end of the decade, child malnutrition, obesity and stunting are at higher levels than they were in 2015. As we commemorate World Food Day, hunger and food insecurity have increased among households.

In the fight against malnutrition, government and the public turn to academia as the think tank of solutions. So, when academia fraternises with big food and accepts seats at the tables of industry — whose main aim is product sales and profits — what is the real cost academia is paying for these industry engagements? 

There is no such thing as a free lunch. This is no more apparent than in the longstanding and deeply intertwined relationship between big business and academia in which academia becomes the extension of big business marketing. Look no further than the alcohol industry, tobacco and sugar industries. As child malnutrition increases, the magnifying glass is focused on the role of the formula industry and inadvertently on its relationship with researchers and academia. Especially academia that trains health professionals. Health professionals who influence, and counsel mothers on their infant feeding choices.

The impact of formula feeding on children casts a long shadow over the duration of their lives as they pay now with rising rates of malnutrition — obesity and stunting — but also in future due to their predisposition to non-communicable diseases like diabetes and cardiovascular disease. Yet the formula industry takes no responsibility for this public health nutrition crisis nor do they see their marketing of their products as aggressive displacement of breastfeeding. Rather, they see it as a business strategy to increase market share. This is at the cost of children’s health, well-being and futures.

In South Africa, the percentage of exclusively breastfed infants is stagnating compared to the formula industry’s increased market shares. National data from 2016 reported then that for infants 0-3 months 24% have never been breastfed, for infants 6-9 months this increased to 40% and by 20-23 months an overwhelming 87% no longer breastfeed. This is despite the global and national recommendation for all children to breastfeed for the first two years of life. Evidently, the majority of children in South Africa are missing out on the health-promoting and immune-boosting benefits of breastmilk, and mothers are missing out on the protective benefits of breastfeeding in reducing the risk for breast and ovarian cancer. Both conditions are of public health concern for women globally. Is the formula industry not costing children, mothers, the state and the planet more than what their products promise of convenience and better sleep?

These statistics prove that the formula displaces breast milk. While we recognise that formula has a purpose in the continuum of feeding patterns.  It cannot be the norm for feeding infants. It cannot be that breastfeeding is the alternative to formula feeding. More importantly, we should ask how did this situation come into being? In South Africa, we have the legacy of HIV and the mark it left on the child-feeding landscape. 

But after more than a decade of discontinuation of free formula distribution as part of the prevention of mother-to-child-transmission of HIV programme, and a decade of the Regulations of Foodstuff for Infants and Young Child Feeding — the R991 — to regulate the inappropriate marketing of foods that displace breastmilk, how is it that formula feeding is the norm in a country that supports breastfeeding as the optimal choice for child health and development?

Earlier this year, a report was published by the World Health Organization (WHO) and United Nations Children’s Fund (Unicef) following a multi-country study, in which South Africa was included as a study site, How the marketing of formula milk influences our decisions on infant feeding. The report highlights how the formula industry exploits mothers and cleverly uses convincing, sophisticated and misleading advertising that promotes false scientific claims that formula is equivalent to breastmilk. Formula companies engage mothers on social media platforms and through influencers, building very personal and intimate relationships with mothers, offering advice, support and companionship through their motherhood journey. These tactics build mothers’ trust and confidence in the formula industry. To the point that mothers perceive any negative response to the formula industry as a personal attack on them. The formula industry has manipulated mothers by positioning the industry as a friend of mothers. In fact, the industry is a wolf in sheep’s clothing. Breastmilk is the undisputed optimal feeding choice for infants and the formula industry has intentionally displaced breastmilk.