Spotlight on infant formula: coordinated global action needed

McFadden, Alison; Mason, Frances; Baker, Jean; Bégin, France; Dykes, Fiona; Grummer‐Strawn, Laurence M.; Kenney-Muir, Natalie; Whitford, Heather; Zehner, Elizabeth; Renfrew, Mary J

doi:10.1016/s0140-6736(16)00103-3

Cited by 58 publications

(46 citation statements)

References 9 publications

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“…a shift from 'breastfeeding' to 'formula-feeding' culture) at the population level. Commercial marketing and promotion facilitates this dependency by normalizing formula as an appropriate food for all infants rather than as a specialized food for those unable to breast-feed (45)(46)(47) . Dependency can impair infant and young child food security when there are disruptions to formula supply, accessibility (including affordability) and capacity to utilize (48) .…”

Section: Discussionmentioning

confidence: 99%

Global trends and patterns of commercial milk-based formula sales: is an unprecedented infant and young child feeding transition underway?

Baker

Smith

Salmon

et al. 2016

Public Health Nutr.

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151

162

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Objective: The marketing of infant/child milk-based formulas (MF) contributes to suboptimal breast-feeding and adversely affects child and maternal health outcomes globally. However, little is known about recent changes in MF markets. The present study describes contemporary trends and patterns of MF sales at the global, regional and country levels. Design: Descriptive statistics of trends and patterns in MF sales volume per infant/ child for the years 2008-2013 and projections to 2018, using industry-sourced data. Setting: Eighty countries categorized by country income bracket, for developing countries by region, and in countries with the largest infant/child populations. Subjects: MF categories included total (for ages 0-36 months), infant (0-6 months), follow-up (7-12 months), toddler (13-36 months) and special (0-6 months). Results: In 2008-2013 world total MF sales grew by 40·8 % from 5·5 to 7·8 kg per infant/child/year, a figure predicted to increase to 10·8 kg by 2018. Growth was most rapid in East Asia particularly in China, Indonesia, Thailand and Vietnam and was led by the infant and follow-up formula categories. Sales volume per infant/ child was positively associated with country income level although with wide variability between countries. Conclusions: A global infant and young child feeding (IYCF) transition towards diets higher in MF is underway and is expected to continue apace. The observed increase in MF sales raises serious concern for global child and maternal health, particularly in East Asia, and calls into question the efficacy of current regulatory regimes designed to protect and promote optimal IYCF. The observed changes have not been captured by existing IYCF monitoring systems. Keywords Infant and young child feedingNutrition transition Formula Breast-milk substitutes Breast-feeding is important for infant and young child health and development, and for maternal health, in both developed-and developing-country settings (1)(2)(3) . It is ranked as the single most effective intervention for the prevention of deaths in children under 5 years of age (4) . To achieve optimal growth, development and health the WHO recommends that infants should be exclusively breast-fed for the first 6 months of life and thereafter receive nutritionally adequate and safe complementary foods while continuing breast-feeding for up to 2 years of age or beyond (5,6) . Although significant progress has been made in some countries, the global exclusive breast-feeding rate improved only marginally from 33 % in 1995 to 37 % in 2014 (7) . Every year an estimated 823 000 deaths, or 13·8 % of total deaths, in children under 2 years of age would be prevented if breast-feeding were scaled up to a near-universal level in high-mortality low-and middleincome countries. For mothers, a universal level of breastfeeding in all countries would prevent an estimated 20 000 deaths from breast cancer annually (8) . Suboptimal infant and young child feeding (IYCF) also incurs higher health system expenditures through increas...

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Section: Discussionmentioning

confidence: 99%

Global trends and patterns of commercial milk-based formula sales: is an unprecedented infant and young child feeding transition underway?

Baker

Smith

Salmon

et al. 2016

Public Health Nutr.

Self Cite

151

162

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“…Aiding and promoting the next generation’s health includes calling on scientists, clinicians, and health care agencies globally [122] to work together and step up to the policy challenges that impact individuals from the youngest ages. It is time for the medical and scientific community to recognize the attention needed here on two levels.…”

Section: Discussionmentioning

confidence: 99%

Promoting Healthy Growth or Feeding Obesity? The Need for Evidence-Based Oversight of Infant Nutritional Supplement Claims

2016

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The Developmental Origins of Health and Disease (DOHaD) model recognizes growth in infancy and childhood as a fundamental determinant of lifespan health. Evidence of long-term health risks among small neonates who subsequently grow rapidly poses a challenge for interventions aiming to support healthy growth, not merely drive weight gain. Defining healthy growth beyond “getting bigger” is essential as infant and young child feeding industries expand. Liquid-based nutritional supplements, originally formulated for undernourished children, are increasingly marketed for and consumed by children generally. Clarifying the nature of the evidentiary base on which structure/function claims promoting “healthy growth” are constructed is important to curb invalid generalizations. Evidence points to changing social beliefs and cultural practices surrounding supplementary feeding, raising specific concerns about the long-term health consequences of an associated altered feeding culture, including reduced dietary variety and weight gain. Reassessing the evidence for and relevance of dietary supplements’ “promoting healthy growth” claims for otherwise healthy children is both needed in a time of global obesity and an opportunity to refine intervention approaches among small children for whom rapid subsequent growth in early life augments risk for chronic disease. Scientific and health care partnerships are needed to consider current governmental oversight shortfalls in protecting vulnerable populations from overconsumption. This is important because we may be doing more harm than good.

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“…The emphasis on “health benefits”, however, signals contemporary perceptions of breastfeeding as extraordinary, measured against cultural norms of infant feeding with artificial milk substitutes (Berry & Gribble, 2008; Stuebe, 2009; Wiessinger, 1996). In many Euro-American settings intergenerational breastfeeding knowledge has been lost, there is limited structural or sociocultural breastfeeding support, and milk substitutes remain the primary source of nutrition over the course of infancy (Hausman et al, 2012; McFadden et al, 2016; Rollins et al, 2016; Victora et al, 2016). Moreover, both the content and form of breastfeeding promotion remain controversial.…”

Section: Introductionmentioning

confidence: 99%

Contested moral landscapes: Negotiating breastfeeding stigma in breastmilk sharing, nighttime breastfeeding, and long-term breastfeeding in the U.S. and the U.K.

Tomori

Palmquist

Dowling

2016

Social Science & Medicine

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Recent public health breastfeeding promotion efforts have galvanized media debates about breastfeeding in wealthy, Euro-American settings. A growing body of research demonstrates that while breastfeeding is increasingly viewed as important for health, mothers continue to face significant structural and cultural barriers. Concerns have been raised about the moralizing aspects of breastfeeding promotion and its detrimental effects on those who do not breastfeed. Far less, however, is known about the moral experiences of those who pursue breastfeeding. This study draws together research on breastmilk sharing (2012–2016) and nighttime breastfeeding from the U.S. (2006–2009), and long-term breastfeeding from the U.K. (2008–2009) from three ethnographic projects to address this gap. Comparative analysis of these cases reveals that while breastfeeding is considered ideal infant nutrition, aspects of its practice continue to evoke physical and moral danger, even when these practices are implemented to facilitate breastfeeding. Breastmilk sharing to maintain exclusive breastmilk feeding, nighttime breastfeeding and bedsharing to facilitate breastfeeding, and breastfeeding beyond the accepted duration are considered unnecessary, unhealthy, harmful or even deadly. The sexual connotations of breastfeeding enhance the morally threatening qualities of these practices. The cessation of these “problematic” breastfeeding practices and their replacement with formula-feeding or other foods is viewed as a way to restore the normative social and moral order. Mothers manage the stigmatization of these breastfeeding practices through secrecy and avoidance of health professionals and others who might judge them, often leading to social isolation. Our findings highlight the divide between perceptions of the ideal of breastfeeding and its actual practice and point to the contested moral status of breastfeeding in the U.S. and the U.K. Further comparative ethnographic research is needed to illuminate the lived social and moral experiences of breastfeeding, and inform initiatives to normalize and support its practice without stigmatizing parents who do not breastfeed.

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Spotlight on infant formula: coordinated global action needed

Cited by 58 publications

References 9 publications

Global trends and patterns of commercial milk-based formula sales: is an unprecedented infant and young child feeding transition underway?

Global trends and patterns of commercial milk-based formula sales: is an unprecedented infant and young child feeding transition underway?

Promoting Healthy Growth or Feeding Obesity? The Need for Evidence-Based Oversight of Infant Nutritional Supplement Claims

Contested moral landscapes: Negotiating breastfeeding stigma in breastmilk sharing, nighttime breastfeeding, and long-term breastfeeding in the U.S. and the U.K.

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