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In 1865, the first infant formula was developed, patented, and marketed. (Stevens, E.E.

2009) The invention of a product that could nourish infants to whom breastmilk was not

available was an enormous scientific accomplishment. The availability of infant formula

provided a much-needed alternative for these babies. Unfortunately, a little over a century

later, a product intended to provide nutrition to babies in need would also be contributing to

infant death rates around the world. Though by this time the science of the product had

improved significantly and ingredients were very closely monitored, unethical marketing

practices of formula companies in underdeveloped countries proved to be successful at

“creat[ing] a need where none existed” and “convinc[ing] consumers that [their] products

[were] indispensable for the ‘good life’”. (Baer, E., 1982)

Boycotts, U.S. Senate hearings, and international meetings that happened between

1977 and 1981 resulted in changes to help reduce infant deaths. Though many of the unethical

marketing practices that were leading to neonatal deaths at that time have since been

hindered, the advertising and marketing of infant formula still affects infant mortality rates

today. The World Health Organization’s International Code of Marketing of Breast-milk

Substitutes, written in 1981, states that companies who make and produce breast-milk

substitutes (BMS) should not advertise to the general public, or give free samples to pregnant

women, mothers, or their families, and that there should not be any point-of-sale advertising or

coupons to induce sales at a retail level. However, the implementation of the WHO Code comes

down to individual governments of countries, therefore these practices still continue in many

areas of the world. The United States is one of only two United Nations states who have not
done anything to enforce the code. (Country implementation of the International Code of

Marketing of Breast-milk Substitutes: Status report 2011)

Breastfeeding and breastmilk are recognized as the best source of nutrition for infants.

Allowing the advertising and marketing of breast milk substitutes, such as infant formula,

lowers breastfeeding rates and therefore effects the overall health of babies and mothers.

Formula advertising lowers breastfeeding rates by undermining the biological benefits of

breastmilk, by preying on doubt mothers may have about themselves, and by creating the

illusion that infant feeding is simply a lifestyle choice, creating a supposed rift between women

depending on how they end up feeding their babies.


“Enfamil® formulas for newborns are individually

tailored to help nourish brain development and help

support newborn milestones.”3 “The only formula that

has a fat-protein blend of MFGM and DHA, previously

only found in breast milk.”3 “It is also our closest

formula to breastmilk.”4 (emphases added) Formula labels frequently compare their product to

the benefits of breastmilk, undermining the benefits by including similar terms that give the

illusion that the formula is closer to breastmilk than it actually is. Breastmilk truly is individually

tailored for a baby; breastmilk is a living tissue (Riordan J., and Womback 2012) that changes

constantly to meet the immunity and cognitive needs while formulas are a one-size-fits-all.

While infant formula is made to provide necessary nutrition for a baby, the ingredients do not

come close to those of breastmilk.


Against the WHO code, U.S. mothers frequently receive formula samples upon discharge

from the hospital. I did a survey of mothers who delivered their babies in Utah hospitals and

who were breastfeeding with plans to continue at the time they were discharged. Of the 400

who responded, 242 (60.5%) said they received formula samples. Some women argue that they

were comforted knowing that there was a back-up “just in case”, and that is exactly what the

purpose is of providing samples- formula companies stealthily hint that breastfeeding may not

work. Then when women do run into breastfeeding difficulties, they may not put forth as much

effort to get proper support to continue, as they already have formula and can supplement or

fully replace their breastmilk. A study titled Marketing Infant Formula Through Hospitals: the

Impact of Commercial Hospital Discharge Packs on Breastfeeding came to the conclusion that:

Commercial hospital discharge packs are one of several factors that influence
breastfeeding duration and exclusivity. The distribution of these packs to new
mothers at hospitals is part of a longstanding marketing campaign by infant
formula manufacturers and implies hospital and staff endorsement of infant
formula. Commercial hospital discharge pack distribution should be
reconsidered in light of its negative impact on exclusive breastfeeding
(Rosenberg, K. D., Eastham, C. A., Kasehagen, L. J., & Sandoval, A. P. (2008).)

The figures from this study showed that receiving a discharge pack (that contains

formula) had a correlation

with shorter breastfeeding duration as well as incidence of supplementing breastfeeding

with formula.
Most mothers have emotions tied to the journey of feeding their baby. Whether

things went as planned, or they ended up going a different route than they had

originally thought, the atmosphere surrounding breastfeeding “versus” formula feeding

incites many strong emotions. Formula companies love to advertise and promote their

products as a lifestyle choice, creating a rift between women who chose the “best” way

to feed their baby (“breast is best”) and those who chose the more critiqued way. It is

my belief that without formula advertisement, these rifts and defensive feelings women

seem prone to have when they “fail” to breastfeed would be much less prevalent. If the

power of marketing and free samples were taken away from formula companies, it

would help make breastfeeding the norm instead of just one of the options. More

energy would need to be given to supporting the success of breastfeeding, as health

care workers wouldn’t have free samples and large inventory of formula to give out

when difficulties surfaced. Women would all be working toward the same goal of

successful breastfeeding, and they would each need to find and receive support, ideally

meaning that each woman would exhaust all support options before turning to formula.

Formula would still be available when breastfeeding did not succeed, but with all of the

focus was put on supporting breastfeeding and none of the focus on contributing to

profits of formula companies, breastfeeding rates would surely rise.

Many mothers read benefits about breastfeeding and feel guilty or that they are

being personally attacked. Sharing the facts of breastfeeding is not meant to incite any
negative feelings, it is simply for the education of women so they can make informed

decisions. As for the purpose of my paper, I want to reiterate that I am of the position of

opposing the advertisement and marketing of formula- not the invention or use of it.

The option of formula, when used appropriately, saves babies lives. However, based on

scientific fact, breastmilk remains the best source of nutrition for infants and should be

the first choice when available.

Much has been done worldwide in the past 40 years to try to increase the

incidence and duration of breastfeeding, but more work needs to be done. The United

States needs to make laws and policies in support of infants’ health, rather than to the

benefit of formula companies profit margin. The WHO’s International Code of Marketing

of Infant Formula needs to be followed and enforced so that our citizens can enjoy the

benefits that come from a nation of breastfed infants.


Baer, E. (1982, April 1). Babies Means Business. New Internationalist, 110. Retrieved July 15,
2019, from https://newint.org//features/1982/04/01/babies/

Country implementation of the International Code of Marketing of Breast-milk Substitutes:


Status report 2011
https://apps.who.int/iris/bitstream/handle/10665/85621/9789241505987_eng.pdf?ua=1

(3) Newborn. (n.d.). Retrieved from https://www.enfamil.com/products/newborn

(4) Our Closest to Breastmilk. (n.d.). Retrieved from https://www.gerber.com/gerber-good-start-


gentle-powder-formula

Riordan, J and Wamback (2012). Breastfeeding and human lactation, 4th ed, Jones and Bartlett
Publishers, Sudbury, Massachusetts.

Rosenberg, K. D., Eastham, C. A., Kasehagen, L. J., & Sandoval, A. P. (2008). Marketing Infant
Formula Through Hospitals: the Impact of Commercial Hospital Discharge Packs on
Breastfeeding. Am J Public Health, 98(2), 290-295.

Stevens, E. E., Patrick, T. E., & Pickler, R. (2009). A history of infant feeding. The Journal of perinatal
education, 18(2), 32–39. doi:10.1624/105812409X426314

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