(Bloomberg) -- Makers of infant formula use misleading marketing and aggressive lobbying tactics to drive sales in a $55 billion-a-year industry, according to a three-paper series from the World Health Organization.
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Manufacturers make unsubstantiated claims about their products, such as that they are very similar to actual breast milk, say the WHO papers published Tuesday in The Lancet medical journal calling for an industry crackdown. New products, such as hypoallergenic or organic formulas, are also sometimes marketed with the implication that they have special benefits and are sold at premium prices, the authors said.
The US infant formula supply has been scrutinized since a recall by Abbott Laboratories that was linked to contaminated products led to a nationwide shortage. Yet concerns about the global industry's outreach, particularly in developing countries, goes back to the late 1970s, when women were discouraged from breastfeeding their children, the WHO says, denying them key health benefits needed in childhood. That problem remains despite public-health efforts to get more women to breastfeed, according to the Lancet series.
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"The formula milk industry uses poor science to suggest, with little supporting evidence, that their products are solutions to common infant health and developmental challenges," said Linda Richter, a developmental psychologist at the University of the Witwatersrand in South Africa. The technique violates the WHO's 1981 International Code of Marketing of Breast-Milk Substitutes, which advises against free samples and sets standards for labeling, said Richter, who helped write the reports, in a statement.
Nestle SA, Abbott, Reckitt Benckiser Group, Danone SA, China Feihe Ltd. and Dutch dairy cooperative Royal FrieslandCampina are among the biggest makers of infant formula. None of the companies were directly accused of unethical marketing or lobbying by the international coalition of researchers. The reports reviewed 153 studies to show how marketing practices have violated the WHO's code in nearly 100 countries since its 1981 adoption.
Nestle said it's prepared to encourage implementation of the WHO code in legislation. The Swiss company said it fully complies with the code and doesn't promote formula for infants up to 6 months. Danone also said it has voluntarily extended its prohibition on promotion for infants up to 12 months old. Reckitt said it's complying with all local laws and regulations, and FrieslandCampina said it complies with national legislation implementing the code.
Formula makers claim without evidence that their products can ease infants' discomfort or improve sleep, intelligence or brain development, one of the reports said, without singling out manufacturers or products. In addition, products derived from the milk of sheep and goats have been marketed as having beneficial properties, the WHO reports said.
Producers also devote huge resources to lobbying against legislation to protect breastfeeding, the reports said, particularly in the US, the only high-income country without legislated paid maternity leave.
Consuming commercial formula has been normalized, the reports charged, despite scientific evidence that breastfeeding provides superior energy and nutrients while reducing infection risks and lowering rates of obesity and chronic diseases in later life. Still, fewer than half of infants under 6 months are exclusively breastfed, as WHO recommends. The agency suggested greater support for breastfeeding with measures such as giving women paid maternity leave so they won't need to work following delivery, when infants most need breast milk.
While it's been in place for decades, WHO's marketing code for formula has done little to stem sales. Only 32 countries have legal measures that substantially align with the code and multinational manufacturers continue marketing the substitutes, according to the international agency.
Some companies have adopted some provisions of the WHO's code but loopholes remain, according to the Access to Nutrition Initiative, a nonprofit advocacy group based in the Netherlands. Companies tend to market their products more responsibly where regulations are aligned with the code, the group said.
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