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Milk formula companies – violating rules and threatening lives


Photos, interviews and b-roll available from Jordan and the Philippines

  • New Save the Children analysis reveals six companies spend the equivalent of £36 on marketing for each baby born worldwide - amounting to £5 billion every year
  • Marketing activities of Nestlé, Danone, RB (Mead Johnson), Abbott, Kraft Heinz and FrieslandCampina routinely violate a World Health Organisation code set up to stop aggressive marketing to new mu
  • Parents bombarded with advertisements including false health claims and social media promotions, while doctors report receiving gifts and incentives to promote infant formula
  • Report documents five-fold growth in formula industry over just two decades - three times faster than global economy - with more babies fed formula than ever before
  • Breast milk offers all the antibodies a baby needs. 823,000 child deaths could be prevented each year by near universal breastfeeding, yet marketing spend by just six breast milk substitute companies dwarfs public health budgets to promote breastfeeding
  • Charity ranks the six companies based on Code compliance and calls on global manufacturers, investors and governments to commit to putting an end to dangerous marketing practices

Save the Children today reveals the scale of aggressive marketing for breast-milk substitutes, much of which violates World Health Organisation (WHO) code.

This is helping to drive unprecedented growth in sales of infant formula across the world. As a result, millions of families - many in low-income settings - have fed their babies formula they don’t need and very often can’t afford, endangering countless children’s lives.

The charity’s report, Don’t push it, shows that between them six infant formula companies - Nestlé, Danone, RB (Mead Johnson), Abbott, FrieslandCampina and Kraft Heinz - spend an estimated £5 billion on marketing per year[i]. That’s the equivalent of over £36 for every single baby born worldwide.[ii]

The WHO code, established in the aftermath of a Nestlé boycott of the 1970s, states there should be ‘no promotion to the public’ of breast milk substitutes because of incontrovertible evidence that breastfeeding provides children with the best start in life.

Breast milk offers all the antibodies a baby needs to ward off lethal diseases like pneumonia, which kills more children under five than any other disease.

An estimated 823,000 child deaths would be prevented each year if almost all babies were breastfed[iii]. That’s nearly one in seven of all deaths of children under the age of five, globally. Babies who are not breastfed are about nine times more likely to die from pneumonia than those who are.[iv]

Kevin Watkins, Save the Children UK CEO, said: “Today’s report uncovers a ‘battle for baby bucks’ in which companies are deliberately using aggressive marketing to create a fog of uncertainty around breastfeeding.

“This a first in the history of human evolution. Never before has the way babies and small children are nourished changed so dramatically and on such a scale.

“It’s a matter of life and death – there is little doubt many babies in low and middle income settings are dying as a result. It’s time the breast-milk substitute industry put babies before profit.

With the right commitment these companies can show the leadership needed to change the industry. We are hopeful this will be the wake-up call they need to do so.”

Sales are booming and more babies and small children are being fed infant formula than ever before. A global market worth less than £11 billion in 1998 reached sales of £32 billion in 2014 and is set to reach £50 billion by 2019[v]. That’s a five-fold increase in little more than two decades. It’s three times faster than the growth of the global economy, and far outpaces the increase in the number of babies in the world[vi].

Today’s report does not deny that milk formula has a positive role to play in the right conditions. There is a recognised medical need for some infants to be formula-fed, and for several reasons it is a choice made by parents around the world. Instead, it details clear evidence that these six formula companies are running powerful marketing campaigns that counter established guidelines, often by establishing a supposed ‘equivalence’ between breast milk and milk formula. This results in mothers without the right information limiting or abandoning breastfeeding altogether.

Much of the promotional activity taking place violates the World Health Organisation’s International Code of Marketing of Breast-milk Substitutes. This Code sets out measures for companies to follow, including ‘no promotion to the public’, ‘no gifts to mothers or health workers’ and ‘no free samples’.

Code violations catalogued include:

  • In Bangladesh private doctors interviewed described monthly visits mostly from Nestlé representatives and reported receiving gifts and invitations to training on at least an annual basis.
  • In Thailand, Dumex, owned by Danone, sent mothers promotional text messages. One read “Introduce Dumex Dugrow 1 plus for child 1 year old and up… This helps your child to be strong and happy. Call to get free sample at 02-740-3400.”
  • A 2018 study found more than 3,000 violations in Thailand, including at least one on each of the 119 BMS products assessed.
  • In 2015, Mead Johnson agreed to pay $12 million to settle charges that in China its subsidiary allowed the use of “off-the-books slush funds” to pay doctors and other healthcare professionals so that they would recommend their milk formula.
  • Also in China, Abbott markets its Similac product as benefitting brain development, growth and bone development for premature babies. This is in direct contradiction to WHO advice.[vii]

All six manufacturers have also become increasingly sophisticated in their use of social media. Facebook, Instagram and other digital channels have enabled companies to engage in the behavioural targeting of formula products in ways that were never before possible - and are ever-harder to monitor and regulate.

Save the Children’s report scores the six companies on their compliance to the Code using analysis from the Access to Nutrition Index[viii].

The rankings are:

  1. Nestlé – 40%
  2. Danone – 36%
  3. FrieslandCampina – 24%
  4. Kraft Heinz – 22%
  5. Abbott – 15%
  6. RB (Mead Johnson) – 13%

RB appear here following their recent acquisition of Mead Johnson.

The world would also reap huge benefits from investment in breastfeeding. Such are the benefits to health and development – which in turn bolster education, participation in the workforce and earnings over a lifetime – that for each dollar invested in breastfeeding, $35 is generated in economic returns[ix].

Yet these six companies spend on marketing 30 times the amount the WHO says is needed to raise breastfeeding rates enough to save 520,000 lives by 2025[x].

The largest global fund management firms have more than $110 billion invested in companies that market milk formula[xi]. Almost all big fund managers and pension funds have signed up to the UN’s Principles for Responsible Investing. The marketing of milk formula by companies they have invested in contradicts these pledges.

Save the Children is calling for:

  • The chief executives of these companies publicly and unequivocally to commit to upholding the Code and agree to meet targets set to achieve full compliance.
  • Investors to recognise that aggressive marketing harms families, infants and young children globally and to use their influence to encourage companies to comply with the Code.
  • Governments to incorporate the Code and subsequent resolutions fully into their laws and regulations and should invest in independent monitoring and effective enforcement.



Notes to Editors:

  • All information and figures found in Don’t push it: Why the formula milk industry must clean up its act, Save the Children, 2018.
  • In the UK, the £9.1 million spent on marketing breast-milk substitutes was more than ten times that spent by the government to promote breastfeeding in 2006–07[xii].
  • Between them RB, Abbott, Kraft Heinz, FrieslandCampina, Danone and Nestlé together own more than 50% of the market in breast-milk substitutes.
  • If sales and administration costs are included the yearly marketing spend it could be could be as high as £12 billion – or £86 for each baby born.[xiii]
  • The World Health Assembly’s International Code of Marketing of Breast-milk Substitutes calls for:
  1. No promotion to the public
  2. No gifts to mothers or health workers
  3. No promotion in healthcare facilities or to healthcare workers
  4. No free samples or supplies to pregnant women or mothers of infants and young children, their families or health workers
  5. No promotion of complementary foods before they are needed
  6. No sponsorship of meetings of health professionals or scientific meetings by companies
  7. Adequate labels
  8. Companies must comply with the Code, independent of other measures taken for the implementation of the Code
  • The World Health Assembly is the decision-making body of the World Health Organisation.
  • Only some Code violations are illegal in some countries. By March 2016 only 39 countries had comprehensive legislation that reflects all or most provisions of the Code. To this day, 49 countries have made no provision for the Code in their statute books.
  • Breastfeeding is vital in preventing pneumonia, which kills two children under five every minute. That’s more than malaria, diarrhoea and measles combined. Save the Children has launched a global campaign against pneumonia, which aims to save a million lives in the next five years.
  • Save the Children helps mothers to breastfeed in development and emergency contexts worldwide, ensuring they have the information and support they need to make the best choices for their babies.
  • In advance of publication we shared our findings and recommendations with each of the formula milk companies named in the report, giving them the right to reply. We stand by the content of our report and welcome their responses. Read them here.


[i] Don’t Push It, Save the Children, 2018, p. 18: Using Mead Johnson as a proxy and applying it to the six companies in this report, global marketing spend on breast-milk substitutes would have reached some $7.2 billion in 2015. Exchange rate from xe.com on 21.02.18: $7.2 billion = £5.2 billion Including sales and administration, that figure might have been closer to $17 billion. Exchange rate from xe.com on 19.02.18: $17 billion = £12.1 billion.

[ii] 386,000 babies born each day (https://www.unicef.org/media/media_102362.html). 386,000 x 365 = 140,890,000. 2015 marketing budget = $7,200,000,000. 7,200,000,000 / 140,890,000 = $51.10. Exchange rate from xe.com, 21.02.18: $51.10 = £36.63

[iii] The global under 5 mortality rate for 2015 was 5.9 million, Unicef: https://www.unicef.org/publications/files/UNICEF_SOWC_2016.pdf. 823,000 is 13.9% of 5.9 million.

[iv] Don’t Push It, Save the Children, 2018, p. vi

[v] The Lancet, http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)01044-2.pdf; Don’t Push It, Save the Children, 2018, p. vi. Exchange rates from xe.com, 19.02.18:

  • $15 billion = £10.7 billion
  • $44.8 billion = £32 billion
  • $70.6 billion = £50.5 billion

[vi] The United Nations DESA/Population Division (https://esa.un.org/unpd/wpp/DataQuery/)

[vii] Don’t Push It, Save the Children, 2018; and The Access to Nutrition Foundation (ATNF), ‘Marketing of breast-milk substitutes: Thailand 2018’, 2018 (https://www.accesstonutrition.org/media/new-report-marketing-breast-milk-substitutes-thailand-launched-atnf)

[viii] Compliance scores refer to the methodology of the Access to Nutrition Indexes combining what they say in their policies with the reality of what they do in the market place. A score of 100% would indicate that a company is in full compliance with the ATNI methodology. See p. 28 of Don’t push it for further details.

[ix] Unicef and the World Health organisation, Nurturing the Health and Wealth of Nations: The Investment Case for Breastfeeding, 2017, http://www.who.int/nutrition/publications/infantfeeding/global-bf-collective-investmentcase.pdf

[x] Don’t Push It, Save the Children, 2018, p. 18. The WHO needs $570 million per year to fund its target for increasing the number of exclusively breastfed infants by 2025. This would result in 520,000 lives saved. 2015 marketing budget = $17,000 million. 17,000 / 570 = 29.82

[xi] Don’t Push It, Save the Children, 2018, p. 44

[xii] Don’t Push It, Save the Children, 2018, p. 18

[xiii] 386,000 babies born each day (https://www.unicef.org/media/media_102362.html). With sales and admin: 386,000 x 365 = 140,890,000. 2015 marketing budget = $17,000,000,000. 17,000,000,000 / 140,890,000 = $120.66. Exchange rate from xe.com, 20.02.18: $120.66 = £86.22




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