Content analysis of on-package formula labelling in Great Britain: use of marketing messages on infant, follow-on, growing-up and specialist formula

Abstract

Objective: To explore on-package formula messaging with reference to legislation and government issued guidance in Great Britain (GB). Design: Formula products were identified, pictures of all sides of packs collated, and on-package text and images were coded. Compliance with both GB legislation and guidance issued by the Department of Health and Social Care (DHSC) was assessed. Setting: All formula packs available for sale over the counter in GB between April and October 2020. Participants: Formula packs (n71) including infant formula, follow-on formula, growing-up formula and specialist formula were identified, coded and analysed. Results: In total, 41% of formula packs included nutrition claims and 18% included health claims that may be considered non-permitted according to DHSC guidance. Additionally, 72% of products showed images considered ‘non-permitted’. BMS legislation states infant and follow-on formula packs should be clearly distinguishable but does not provide criteria to assess similarity. Based on DHSC guidance, 72% of infant and follow-on formula packs were categorised as showing a high degree of similarity. Marketing practices not covered by current legislation were widespread, such as 94% of infant formula packs including advertisements for follow-on formula or growing-up formula. Conclusions: Text and images considered non-permitted according to DHSC guidance for implementing Breast Milk Substitute (BMS) legislation were widespread on formula products available in GB. As terms such as 'similarity’ are not defined in BMS legislation it was unclear if breaches had occurred. Findings support the WHO call for loopholes in domestic legislation to be closed as a matter of urgency.

Perceived influence of commercial milk formula labelling on mothers’ feeding choices in Great Britain: a qualitative study

“…Thematic analysis taking an interpretivist approach was used, which acknowledges the role of researchers in interpreting participant experiences 24 25. RC listened to all recordings, read transcripts and generated an initial thematic framework using both deductive and inductive methods, informed by prior knowledge of CMF regulations and findings from quantitative analysis of on-pack labels 11. IR then familiarised herself with transcripts and coded them with NVivo software, using RC’s initial framework.…”

“…For example, direct-to-consumer advertising of IF is prohibited. However, there is concern that parents still see advertisements for FOF and growing-up formula (GUF) marketed as ‘stage 3’ for toddlers from 12 months in almost identical packaging to IF 8–11. Mothers have even reported ‘seeing’ IF advertisements despite their legal inexistence 12 13.…”

“…However, little is understood (by those outside the CMF industry) about caregivers’ overall experience and interpretation of packaging. Our previous research found labels on CMF sold in GB often contravene government guidance 11. This study aims to: (1) understand how mothers use CMF labels to inform their feeding choices; and (2) explore mothers’ beliefs about differences between CMF products.…”

“…Our previous research found labels on CMF sold in GB often contravene government guidance. 11 This study aims to: (1) understand how mothers use CMF labels to inform their feeding choices; and (2) explore mothers’ beliefs about differences between CMF products.…”

Response to Conway et al. (2023) from mothers and grandmothers: anti-industry bias, not formula marketing, is hurting us

“…Conflict of interest: None of the authors have accepted money from any person, company or organisation associated with the infant feeding industry, whether formula companies, feeding equipment or breastfeeding support services. Authorship: All of the authors engaged in an online discussion about Conway et al (2023). Dr Ruth Ann Harpur wrote the manuscript summarising the key points from the discussion.…”