Before you reach out for the fancy box of infant formula for your baby, read a recent analysis that warns there are grave consequences to substituting mother’s milk with ultra-processed formula milk or baby milk powder.
According to the analysis, The deadly toll of marketing infant formula in low- and middle-income countries, published on October 31, the introduction of infant formula — a substitute for breast milk — in low and middle income countries has caused a steep decline in breastfeeding. This decline, coupled with lack of access to clean drinking water, has led to approximately 10.9 million excess infant deaths between 1960 and 2015.
The analysis focused on the Swiss food and drink processing conglomerate Nestlé which is by far the largest infant formula supplier worldwide. Nestlé products are also sold in India and its breastmilk substitutes come under the brand name of Lactogen.
“A careful examination of Nestlé’s marketing behaviour shows that Nestlé’s entry into low- and middle-income formula markets caused about 212,000 infant deaths per year among mothers without clean water access at the peak of the Nestlé controversy in 1981,” the study authored by six researchers from University of San Francisco, University of California Berkeley, and OpenResearch Lab noted.
How infant formula is affecting babies’ health
There are two primary channels through which formula could plausibly affect infant mortality, note the researchers.
First, the increased use of infant formula could cause a decline in breastfeeding. There is a strong consensus that the substitution of formula for breastmilk compromises a child’s physical health and immune response.
That is the reason, the World Health Organization (WHO) recommends that infants be breastfed within the first hour of birth, exclusively breastfed for the first four to six months of life, and continue to receive breastmilk (alongside complementary foods) for up to two years of age.
However, less than half of newborns worldwide are breastfed within an hour of birth, and only 44 per cent are exclusively breastfed from birth to six months, notes the study.
Second threat comes when caregivers mix infant formula powder with unclean water, resulting in bacterial infection and diarrheal disease that increases the risk of infant mortality through sickness and dehydration.
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The findings of the study are based on assembling a dataset with over 2.6 million infant births and deaths across 38 countries from the Demographic and Health Surveys (DHS), matching children’s year of birth to data on the timing of Nestlé entrance into country infant formula markets collected from the Nestlé corporation’s annual investor reports.
The Genesis of infant formula
According to the authors, the infant formula was first developed in Germany in 1865 and marketed as a medically endorsed product ‘closest to mother’s milk’.
This formula gained popularity during the Industrial Revolution given the large number of women who were leaving home to enter the labour market.
“Infant formula use rose steadily in subsequent decades, peaking during the post-World War II baby boom, after which sales began to decline in higher income countries due to lower birth rates and a growing belief in the positive health effects of breastfeeding,” notes the study.
It goes on to state that formula producing companies then attempted to offset declining sales and turned to other markets, expanding into the developing world in the 1960s and 70s.
“Infant formula companies, in particular Nestlé, began aggressively marketing infant formula as scientific, modern, prestigious, and (falsely) nutritionally superior to breastmilk,” the article mentioned.
“Many in the public health community accused the infant formula firms of promoting formula to mothers in LMICs [low and middle income countries] who were unlikely to have access to clean water sources and sufficient knowledge of nutrition, physiology, or mechanisms of disease transmission to prevent the health risks associated with formula contamination,” it added.
Likewise, concern arose over the decline in breastfeeding associated with the introduction of infant formula across LMICs.
Also, there is evidence that the introduction of infant formula into a country’s market was correlated with a substantial reduction in breastfeeding.
For example, the dramatic decline in breastfeeding in Chile, where breastfeeding declined from 90 per cent of all children in 1960 to only 10 per cent by 1968 after the introduction of formula.
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Mother’s Milk is the Best
According to WHO, breastfeeding is a cornerstone for child survival and health especially during early life because it provides essential irreplaceable nutrition for a child’s growth and development.
It serves as a child’s first immunisation – providing protection from common childhood illnesses, such as diarrhoea and pneumonia, few of the leading causes of under-five mortality in WHO’s South-East Asia Region.
Breast milk promotes sensory and cognitive development and is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers.
Regulating the Sales of Breastmilk Substitutes
In order to curb the reckless dependence on breastmilk substitutes, the WHO established the International Code of Marketing Breastmilk Substitutes (ICMBS) in 1981.
But the recent analysis noted that the compliance with it remains voluntary, and banned marketing practices continue.
To regulate the sale of such products, India enforced the Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Promotion, Supply and Distribution) Act, 1992 on August 1, 1993.
However, as per a research paper titled The IMS Act 1992: Need for More Amendments and Publicity, following are the limitations of the Act:
The rules and regulations regarding infant food advertisements have many loopholes as compared to that for infant milk substitutes and feeding bottles. It seems that more emphasis was laid over restricting the use of milk substitutes and feeding bottles rather than on the commercial, artificial baby food products.
There are no stringent rules to tackle the issue of sponsoring scientific sessions, inducements and other gifts by infant food manufacturers.
Though there are restrictions for infant food companies and health workers, the chemists have been exempted from many provisions of the Act. Thus the chemists continue to advertise and promote the baby food products through their shops.
Since its enactment, there has not been any major amendment to detect and plug the loopholes or to make it more effective.
However, a research paper titled India’s Infant Milk Substitutes Act, Monitoring, and Enforcement published in the Yale School of Public Health in 2018 mentioned that internationally, from 36.8 per cent in 2000, exclusive breastfeeding rates have jumped to 58.3 per cent while infant formula sales in large markets such as China have risen dramatically from USD $1 billion in 2002 to USD $3.5 billion in 2008.
“India has held steady at under USD $500 million, indicating a commitment to keeping the infant formula companies at bay in lieu of promoting breastfeeding and its inherent benefits,” it mentioned.
