Large global corporations are taking advantage of the COVID-19 pandemic to aggressively promote baby formula, playing on mothers’ fears of transmitting coronavirus through breastfeeding, the International Baby Food Action Network (IBFAN) has warned.

Nestlé baby formula has been distributed as part of COVID-19 relief efforts in Pakistan and India, despite laws and global health rules restricting donations.

Other large companies have been running digital ads for baby formula across the world that draw on parents’ worries about “viruses” and promote industry-sponsored COVID-19 advice groups for parents, despite bans on direct marketing.

There is currently no evidence that COVID-19 can be transmitted through breastfeeding, and the World Health Organization (WHO) recommends that all women, including those infected with COVID-19, should breastfeed their babies.

A recent report from the WHO, Unicef and IBFAN warns that many countries are “failing to stop the harmful promotion of breast-milk substitutes”.

“The COVID-19 pandemic highlights the need for stronger legislation to protect families from false claims about the safety of breast-milk substitutes or aggressive marketing practices,” says the report.

Violations during the pandemic

The WHO’s International Code of Marketing of Breast-milk Substitutes, adopted by the World Health Assembly in 1981, recommends a ban on the promotion of baby formula and that formula marketers should have no access to pregnant women or mothers of babies and small children.

Since the adoption of the code, 136 countries have passed laws curtailing the promotion of formula. India outlaws the promotion of all infant formula and foods to children under the age of two and prohibits its donation except to orphanages, while various Pakistani states including Punjab and Sindh have endorsed all aspects of the code and enacted local regulations in support.

The European Union tightened its regulations in April, restricting formula advertising to “publications specialising in baby care and scientific publications” and prohibiting the distribution of samples, or free or cheap products, either directly to consumers or indirectly or via healthcare workers.

Despite these global, national and local regulations, there have been a number of violations during the pandemic.

New evidence has emerged that Nestlé’s Lactogrow brand has been distributed to needy families in Pakistan and India. A tweet on 4 May from the Provincial Disaster Management Authority (PDMA) of Punjab in Pakistan thanked Nestlé Pakistan for donating products including Lactogrow to “families whose income has been impacted due to #lockdown”. This was retweeted by Nestlé Pakistan the same day.

Meanwhile a video report on 24 April from Indian journalist Dilli Aajtak for India Today shows Lactogrow being distributed in India as part of pandemic relief efforts.

Nestlé’s head office in Switzerland told openDemocracy: “We have not donated any of our baby food products, at any time to any individual, organization or local authority.” It adds that the company was “carrying out relief work with the support from our NGO partners and various local governments, for vulnerable communities during Covid-19” in India and Pakistan.

But Laurence Grummer-Strawn, a technical officer at World Health Organization’s department of nutrition dealing with infant feeding, says that “the code is clear that companies cannot donate breastmilk substitutes to be included in distributions to families in need” and that “emergency situations do not create any exceptions”.

Social media advertising

Other multinationals have been using social media in Latin America and Europe to promote their infant formula products during the pandemic.

In Paraguay, Danone’s advertisements for its Nutricia formula ask whether it is safe for mothers with COVID-19 to breastfeed.

In Brazil, Nutritia invited parents to access an app for free to enable them to reach out to health experts to ask them questions related to COVID-19.

Danone also launched a “Voice of Experts” YouTube series in India aimed at mothers concerned about COVID-19, and a social media information campaign in Europe for parents of babies “born in the pandemic”.

Danone’s international spokesperson, Shivani Kumar, said her company subscribed to a strict policy about formula promotion. “During the Covid-19 pandemic we remain committed to protecting breastfeeding and to providing parents with science-based and factual information to make the nutritional choices best suited to their individual situation. In doing so, we always operate in line with our policy and local laws,” said Kumar.

She also clarified to openDemocracy that the company "believes breast milk is the best source of nutrition for babies".

In Mexico and Peru, Abbott’s advertisements for Similac infant formula claim that it strengthens children's immune systems against “viruses and bacteria”.

According to Abbott spokesperson Katie Stafford: “The Similac campaign currently airing on TV and digital in Mexico has been in circulation since August 2019. It is aimed at educating parents on the immune-nourishing benefits of HMO and other nutrients in Similac Stage 3 products – backed by more than 21 clinical and preclinical studies, and more than fifteen years of scientific research.”

Responding to openDemocracy’s findings, Laurence Grummer-Strawn said that the WHO code restricts formula manufacturers, distributors and health professionals to “scientific and factual matters”.

“Questioning the safety of breastfeeding by women with COVID-19 infection is counter to WHO guidelines and thus would not appear to be based on ‘scientific and factual matters’,” said Grummer-Strawn.

“Suggesting that formula strengthens the immune system is similarly problematic – WHO is not aware of any evidence suggesting that formula is immunologically superior to breastfeeding, so this claim would also not be scientific or factual,” he added.

In the WHO, Unicef and IBFAN report, Patti Rundall from IBFAN’s Global Council said: “The fear of COVID-19 transmission is eclipsing the importance of breastfeeding – and in too many countries mothers and babies are being separated at birth – making breastfeeding and skin to skin contact difficult if not impossible. All on the basis of no evidence.”

“Meanwhile, the baby food industry is exploiting fears of infection, promoting and distributing free formula and misleading advice – claiming that the donations are humanitarian and that they are trustworthy partners.”

The report also says: “Active COVID-19 virus has not, to date, been detected in the breastmilk of any mother with confirmed or suspected COVID-19”, and it is thus “unlikely” that the virus is transmitted through breastfeeding.

“The numerous benefits of breastfeeding substantially outweigh the potential risks of illness associated with the virus. It is not safer to give infant formula milk,” it concludes.

The infant formula market is estimated to be worth $62.5-billion at present – more than double what it was worth a decade ago. Baby health activists and researchers have a long history of conflict with the industry, including a global boycott of Nestle in the 1980s, for undermining breastfeeding. Experts warn that the use of formula is particularly dangerous in communities that don’t have access to clean water.