Regulating the infant formula industry: What’s your ‘purity criteria’?
There’s been a bit in the news in the last few months about the regulations around formula milk and the promotion of formula milk.
On the one hand, the United Nations have made a statement calling on all member countries to make sure families are protected from ‘aggressive and inappropriate’ promotion of breastmilk substitutes. [1]
On the other hand, the UK laws that oversee formula promotion were referred to negatively in story about a mother buying formula at a supermarket and unable to validate a parking voucher.
Regulations that originated in the EU were apparently to blame. A tabloid newspaper reported that a Department of Health spokesperson had said, “the rules might be a contender for being axed under the Great Repeal Bill.” [2] (The Bill that aims to undo a series of laws post-Brexit.)
I’m going to go out on a limb here and say that I bet the spokesperson doesn’t secretly hope that the level of pesticide in formula milk can be increased in the future.
Or that levels of protein in formula are up for grabs and won’t be determined by appropriate studies and expert guidance.
I’m also willing to bet the Secretary of State for Health doesn’t wish for those things.
You’d have to be having evil on toast for breakfast if you don’t see why regulations around the formula industry are a good idea and that they protect all babies. This is not about breastfeeding. This is about protecting the thousands of babies who rely on this product and trust us to make sure it is safe.
What laws are we talking about?
There were European Directives that decided it might be sensible to put some regulations in one place about the safety of formula and the way formula companies behave. Then the UK nations came along and put those ideas into laws. They are called snappy things like, “The Infant Formula and Follow-on Formula (England) Regulations 2007” and, “The Infant Formula and Follow-on Formula (Scotland) Regulations 2007." There’s no reference to parking vouchers but a lot of reference to protecting babies who drink formula.
I don’t think you are going to find anyone who doesn’t think that there are some useful concepts in these laws (unless we are talking about the evil on toast folks).
How about “Formula shall not contain any substance in such quantity as to endanger the health of infants and young children?” Can’t spin that one as political evil.
“Formula shall not contain residues of individual pesticides at levels exceeding 0.01mg/kg.” Surely we can all get around that one?
The suitability of any ingredients in formula needs to be established by, “systematic review of available data relating to expected benefits and safety considerations and studies following expert guidance.” How dare they? Get the pitchforks! Let’s get ‘em. We’ll meet in the town square.
No, I think we’re all happy with that one too.
And the regulations go on: We want a product where only water needs to be added. A food business operator that wants to place a new infant formula on the market needs to give prior notice and their label needs to be checked to make sure it reaches the required standard. Labelling needs to explain the quantity of each mineral substance, the energy value, how to safely prepare and store the product. Parents shouldn’t be confused by similarities between first formula and follow-on formulas and they should use different colour schemes and be displayed separately.
Formula must meet the relevant “purity criteria”, the legislation states.
Families that use formula milk, whether by choice or because they’ve struggled to make breastfeeding work, understandably care about the quality of the ingredients and the ‘purity’ of the product they use.
I think for most families, that ‘purity criteria’ would also extend to the ethics of the company that make their baby’s milk.
We wouldn’t leap to buy a baby blanket that was known to be made by the hands of enslaved hungry children, wrap our loved ones in it and snap a photo for Facebook.
We wouldn’t jump at the chance of moisturising our newborns with body lotion made by a company that was widely publicised as being involved in rainforest destruction and the extinction of the orangutan.
It would feel wrong.
It would feel unethical.
We’d feel weird selecting these products from the shelves and putting them in our baskets.
It wouldn’t be what we’d want for our babies as they enter the world.
And when it comes to formula milk, it also feels better if the company making the milk behave in a classy way. They make formula to the best of their ability and they go about selling it in a way that the United Nations doesn’t describe as ‘aggressive and inappropriate’.
Would you want your baby’s milk company to be the one that was prosecuted for behaving unethically?
Imagine your chosen formula milk company paid healthcare professionals a bonus every time they convinced a new mother to stop breastfeeding and start using their product. That would feel a bit icky for most people.
Imagine your formula milk company sent targeted texts to new mothers they KNEW to be wanting to breastfeed but were struggling to do so, encouraging them to move to their brand of formula.
What about if they gave a free sample of formula to anyone buying nappies? Or to anyone having a new baby? Or anyone buying lanolin for sore nipples?
What about if they gave points every time a new family bought formula and those points added up to a flat screen TV or money off the weekly food shop?
To a family who chose to use formula, some of those might sound actually quite cool and some clearly sound plain dodgy.
To the family that starts out wanting to make breastfeeding work, to the healthcare professionals that try and support them, to the managers trying to save money on hospital admissions for babies in the first year of life, they would be unhelpful at best.
At worst, it would be scary to imagine a world where those things could happen unchecked.
What about if you made it clear you wanted to breastfeed but you were given a free sample of formula once you’d had your baby, more was sent to your home and then you received daily texts, letters and emails focusing cleverly on the insecurities around new parenthood, offering rewards, offering your extra resources if you just started to use one particular brand of formula milk?
Nothing would stop that happening in the UK if these regulations disappeared overnight.
Not only would the choice to breastfeed be undermined but the families who choose to use formula would be paying for all this promotion out of their own pockets. Families with new babies would be paying for the bonuses of healthcare professionals, the pretty bags with free samples in that contain the leaflets cleverly worded, the reward schemes.
Formula is not cheap. The United Nations also said, “access to good quality breast milk substitutes should be regulated, and affordable.” How do we make sure it’s ‘good quality’? By regulation. How do we make it affordable? Partly by ensuring families don’t have to pay for anything more than the milk itself.
Some of these scary promotional schemes exist in countries that lack regulations and a lot more besides. Some of these are happening in countries that DO have regulations and companies need to be nudged back into place.
I think sometimes in the UK we like to imagine people are basically nice.
I think some of the people who feel like the regulations around formula milk promotion are unfair have faith that companies are basically ‘nice’.
Why can’t mums who buy formula get reward points or get free samples? That seems fair, doesn’t it? Only if we believe that at their core, companies will behave nicely and honourably and not step over the line to undermine the confidence of women trying to breastfeed.
Individual people might be nice – but we decided long ago as a nation that sometimes we need protections because not everyone in industry can be. We protect people against companies in lots of ways. They are not allowed to target and manipulate people we consider vulnerable. They are not allowed to tell lies in advertising. Their products need to reach required standards and be tested. We don’t trust them to always be lovely all by themselves.
If you leave formula milk companies to it, they may look for the cheapest source for ingredients and not necessarily the highest quality. Corners might be cut. We can’t assume companies will voluntarily reduce their own profits because ‘it’s the nice thing to do.’
Global sales of breastmilk substitutes total 44.8 billion US dollars and they are expected to rise to 70.6 billion by 2019 [3]. These are massive corporations who are looking to increase their slice of the pie and niceness is unlikely to hold them back when they need to increase profits for shareholders and increase their market share.
Companies want to get to new mums with babies and they will do it any way they can. They will do it cleverly and subtly. They will do it with a heck of a lot of money at their disposal. They do not care where the lines are when it comes it behaving fairly.
The world of ‘advertising’ is changing. This isn’t about the posters at the bus stop any more or the colourful pages in your magazine. At the more benign end of the spectrum, this is about the celebrity you follow posting photos with products made by a company who have given her money. This is also about the social media account that sounds a lot like a new mum struggling but perhaps she isn’t what she appears to be. This is about the sponsored posts that appear when you ask a question about breastfeeding and the emails that target you days later.
You’ve just googled something about sore nipples (and you are desperate to breastfeed). Excellent. Future marketing will find a way to get to you.
And in the 21st century, who knows where it might end. The supermarket sells the data of who is buying nipple cream or nipple shields and a mum is on the list for a targeted focus over the next few days. She gets a phone call/ text/Facebook tag from someone who appears to be trying to help but has been meticulously trained to press all the right buttons in getting you to move away from breastfeeding. They might even have the online profile of an ‘ordinary mum’ or a breastfeeding counsellor. It sounds sci-fi but this is on the cards and it only won’t happen if we stay on our toes.
In England, 83% of mums start breastfeeding and by 6 weeks only 57% still are [5] That's a lot of mums who can be targeted. 85% of mothers who stopped between one and two weeks wanted to breastfeed [6]. This isn't a world where everyone makes feeding choices freely and many new mums are vulnerable.
Regulations might mean that the mums who buy formula miss out on the reward points and the buy-one-get-one-frees. That can feel annoying and at times, unfair. But this is about protecting your friend and your sister and your neighbour from scary people who aren’t as nice as you are.
Yes, it’s a bit about supporting breastfeeding mums to reach their goals but it’s about their friends and sisters and neighbours who have chosen to use formula and want it to be a product that is monitored carefully and priced reasonably and behaves classily and ethically. As a lactation consultant working with mums who may be struggling with breastfeeding, I support dozens of babies who have formula milk every week. I want them to be protected for decades to come. I’m not sure we can always trust the people who focus on profit.
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http://www.who.int/nutrition/topics/UNhumanrights-statement-breastfeeding-rights/en/
Daily Mail, 11th November 2016.
United Nations press release. http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=20904&LangID=E
As above
https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2014/03/Breastfeeding-1516Q11.pdf
http://content.digital.nhs.uk/catalogue/PUB08694/ifs-uk-2010-chap4-bir-post-nat-earl-wks.pdf
