1. Spatz, Diane L. PhD, RN-BC, FAAN

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On February 26, 2022, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) released a key report and launched an international event to address the 55-billion-dollar formula industry and its negative impact on breastfeeding decisions (WHO & UNICEF, 2022). The report was based on a large study commissioned by WHO & UNICEF that included participants from eight countries (Bangladesh, China, Mexico, Morocco, Nigeria, South Africa, England, Northern Ireland, and Vietnam) and was conducted in urban populations as this is where trends and values about infant feeding are established and spread to other communities (WHO & UNICEF, 2022). The researchers spoke directly to women and those who influence them including health professionals, partners, family members, and friends.


There were six major findings (WHO & UNICEF, 2022): 1) Formula marketing is pervasive, powerful, and personalized; 2) Companies use manipulative marketing tactics and make claims that their products solve common infant problems and position themselves as a trusted friend and advisor; 3) They distort science and medicine and make false and incomplete claims about formula; 4) They systematically target health care providers through sponsorships, incentives, and training activities to influence their practices and recommendations; 5) Sustained flow of strategic and persuasive marketing undermines parents' confidence in breastfeeding. Fears and doubts that families express about breastfeeding often mirror themes and messaging of formula company marketing; and 6) Countermeasures can be effective but only if scaled up and comprehensively expanded.


Findings mirror what U.S. families experience. Since the pandemic, there has been a decrease in families being able to access lactation support and care and in-person peer-to-peer support. Fifty percent of U.S. childbearing families are enrolled in the Women, Infants, and Children Supplemental Food and Nutrition program (Spatz, 2021). Women, Infants, and Children Supplemental Food and Nutrition program continues to be the largest U.S. purchaser of formula (Spatz, 2021). Our families are exposed to the same formula marketing strategies as in the WHO report. Free formula and coupons are available in many obstetric and pediatric practices. Hospitals routinely receive free formula and give formula to families.


The WHO calls for six key action strategies (WHO & UNICEF, 2022). 1) Need to recognize urgency and scale of the problem. We must recognize and expose invasive and pervasive nature of formula marketing. 2) Need for legislation, regulation, and enforcement to prevent aggressive marketing of formula. 3) Integrity of medicine and science should be protected. Governments should invest in training and building of health professionals so they can provide evidence-based lactation care and counteract the commercially driven messages of the formula industry. 4) Safeguard health of children on digital platforms. 5) Governments, donors, and investors must scale up support for breastfeeding families and divest from formula companies. 6) Coalitions must be expanded to drive action across all parts of society not just those groups and individuals involved in child health and infant feeding. Marketing of formula is emblematic of products such as tobacco and gambling.


This quote from the WHO report is quite powerful. The evidence is strong. Formula milk marking, not the product itself, disrupts informed decision making and undermines breastfeeding and child health (WHO & UNICEF, 2022, p. xi). As nurses, we play a crucial role in changing the landscape for breastfeeding families. We should make it a priority to discuss the WHO report with other health care providers and with people in neighborhoods, schools, religious organizations, and all members of the community. We must do better for childbearing and breastfeeding families because they are the future of our society.




Spatz D. L. (2021). WIC: Is the United States investing in Breastfeeding or Agriculture? MCN. The American Journal of Maternal Child Nursing, 46(2), 124.[Context Link]


World Health Organization and the United Nations Children's Fund. (2022). How the marketing of formula milk influences our decisions on infant feeding.[Context Link]