On Wednesday (Feb. 13), the UK’s Royal College of Pediatrics and Child Health (RCPCH) announced it would no longer accept financial contributions from the baby formula industry. That decision will cost the group somewhere around £40,000 ($51,150) a year. The RCPCH was vague about the reasons behind its decision, focusing instead on its support for breastfeeding. But health advocates have celebrated this decision as part of a growing backlash against what is known as “Big Formula“—an industry worth $70 billion that produces and markets breast milk substitutes.
The debate over when it is appropriate for doctors to counsel women to use formula instead of breast milk is heated, and tied to a broader discussion about the relative benefits of breastfeeding and the fault lines that separate medical care in poor and rich countries. A related question is whether the medical industry can put its trust in baby formula companies that have engaged in deceptive marketing practices in the past to encourage mothers to cut down on or abandon breastfeeding.
To understand the import of the RCPCH’s recent decision, then, it’s necessary to understand its context in a much larger conversation about children’s and mothers’ health, and the powerful institutions that wield influence in this space.
Major medical bodies around the world recommend that moms breastfeed their babies exclusively for the first six months of life. But in some cases, mothers are unable to produce enough breast milk for that long, or at all, while others face obstacles because of work or school.
That’s where high-quality infant formula can be useful. But it’s not a perfect choice. And in some countries—where water quality is poor, formula is expensive, and refrigeration is often unavailable—breast milk substitutes can be actively dangerous. As Annalisa Merelli has written for Quartz:
“The main concern isn’t whether breastfeeding should be supplemented with formula, but what happens when formula becomes a substitute for breast milk entirely. When breastfeeding mothers feed their babies exclusively with formula, they quickly stop producing breast milk, making it impossible to revert back. This makes formula particularly problematic for poor mothers, who may not be able to buy sufficient amounts of the product, and end up watering it down [with contaminated water] or feeding the child smaller quantities, which then leads to malnourishment.”
This is where the debate differs in rich and poor countries. Some scientists in developed countries have questioned whether exclusive breastfeeding confers inherent health advantages to kids and moms compared to formula. But in developing countries, breast milk has been shown to save lives. For example, the World Health Organization estimates that “nearly half of all diarrheal diseases and one-third of all respiratory infections in children in low- and middle-income countries could be prevented with increased rates of breastfeeding.”
The history of baby formula companies in poor countries is tainted with scandal. According to Save the Children (pdf), a children’s rights nonprofit, six companies—Nestlé, Danone, RB, Abbott, FrieslandCampina and Kraft Heinz—”successfully established a supposed ‘equivalence’ in the minds of many people between breast milk and milk formula, creating the perception that the latter is simply an artificial replica of the former.”
But formula is not a substitute for breast milk. A slew of studies have shown that human milk has unique health, nutritional, immunologic, developmental, psychological, social, economic and environmental benefits for children, and breastfeeding has been linked with positive health outcomes for mothers as well. According to The New York Times (paywall), “no formula can completely mimic the composition or immunological benefits of breastfeeding.” There is even a global legal text that prevents companies from promoting breast milk substitutes as superior to or interchangeable with breast milk: the WHO’s 1981 International Code of Marketing of Breast Milk Substitutes (pdf).
But throughout the years, nonprofits (pdf) and media outlets have accused “Big Formula” of skirting this code, as well as other local codes outlining rules for the industry, to promote its products in hospitals and with new moms as a substitute for breast milk. In 2013, a unit of Danone was accused of bribing doctors in Tianjin, China to push its product. That same year, a Reuters investigation found that Nestlé and Mead Johnson distributed advertising materials for their products in hospitals, handed out free samples to new mothers, and gave doctors “small gifts” to promote their products. A Guardian investigation uncovered similar practices in Bangladesh and the Philippines.
The RCPCH recently found itself at the center of a controversy tied to this history. In January, the group came under fire for organizing its first international conference in Egypt with the financial backing of Nestlé, Nutricia, and Danone. Dozens of medical professionals and nonprofit groups sent the RCPCH an open letter urging it to drop the sponsors from all its materials. “We strongly condemn BMS manufacturers sponsoring any child health conference,” they wrote, “but particularly one taking place in a low- or middle-income country, which is the market most vulnerable to predatory advertising and where most WHO Code violations are reported.”
The RCPCH responded 10 days later by saying in a statement that they had temporarily suspended all funding agreements with these companies because of “concerns raised by members.” A spokesperson for the group later clarified via email that “Members flagged concerns that the acceptance of funding from formula milk companies was incompatible with the promotion of breastfeeding,” and that “The RCPCH is a strong proponent of breastfeeding and advocates for it as the best method of infant feeding.” The outcome of that review was this week’s decision to cut all financial ties with these companies, though the group said it would “continue to engage and work in partnership with formula milk companies with regards to specialist formula milks.”
Patti Rundall, the policy director of Baby Milk Action, the UK chapter of the International Baby Food Action Network, told Quartz that her organization was celebrating the RCPCH’s decision. As she explained, if a doctor takes “money from some corporate [group] who has a vested interest in what you say, you’re threatening the trust that the public put into you that you will speak independently.” And that matters, she said, because in some cases, “breastfeeding is a matter of life and death.”
Read more from our series on Rewiring Childhood. This reporting is part of a series supported by a grant from the Bernard van Leer Foundation. The author’s views are not necessarily those of the Bernard van Leer Foundation.