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Fulltext Breastfeeding: crucially important, but increasingly challenged in a market-driven world

Pérez-Escamilla R, Tomori C, Hernández-Cordero S, Baker P, Barros AJD, Bégin F, et al.

Lancet, 2023 Feb 11;401(10375):472-485.
PMID: 36764313 DOI: 10.1016/S0140-6736(22)01932-8

In this Series paper, we examine how mother and baby attributes at the individual level interact with breastfeeding determinants at other levels, how these interactions drive breastfeeding outcomes, and what policies and interventions are necessary to achieve optimal breastfeeding. About one in three neonates in low-income and middle-income countries receive prelacteal feeds, and only one in two neonates are put to the breast within the first hour of life. Prelacteal feeds are strongly associated with delayed initiation of breastfeeding. Self-reported insufficient milk continues to be one of the most common reasons for introducing commercial milk formula (CMF) and stopping breastfeeding. Parents and health professionals frequently misinterpret typical, unsettled baby behaviours as signs of milk insufficiency or inadequacy. In our market-driven world and in violation of the WHO International Code for Marketing of Breast-milk Substitutes, the CMF industry exploits concerns of parents about these behaviours with unfounded product claims and advertising messages. A synthesis of reviews between 2016 and 2021 and country-based case studies indicate that breastfeeding practices at a population level can be improved rapidly through multilevel and multicomponent interventions across the socioecological model and settings. Breastfeeding is not the sole responsibility of women and requires collective societal approaches that take gender inequities into consideration.

Matched MeSH terms: Milk Substitutes*
Fulltext Marketing of commercial milk formula: a system to capture parents, communities, science, and policy

Rollins N, Piwoz E, Baker P, Kingston G, Mabaso KM, McCoy D, et al.

Lancet, 2023 Feb 11;401(10375):486-502.
PMID: 36764314 DOI: 10.1016/S0140-6736(22)01931-6

Despite proven benefits, less than half of infants and young children globally are breastfed in accordance with the recommendations of WHO. In comparison, commercial milk formula (CMF) sales have increased to about US$55 billion annually, with more infants and young children receiving formula products than ever. This Series paper describes the CMF marketing playbook and its influence on families, health professionals, science, and policy processes, drawing on national survey data, company reports, case studies, methodical scoping reviews, and two multicountry research studies. We report how CMF sales are driven by multifaceted, well resourced marketing strategies that portray CMF products, with little or no supporting evidence, as solutions to common infant health and developmental challenges in ways that systematically undermine breastfeeding. Digital platforms substantially extend the reach and influence of marketing while circumventing the International Code of Marketing of Breast-milk Substitutes. Creating an enabling policy environment for breastfeeding that is free from commercial influence requires greater political commitment, financial investment, CMF industry transparency, and sustained advocacy. A framework convention on the commercial marketing of food products for infants and children is needed to end CMF marketing.

Matched MeSH terms: Milk Substitutes*
Fulltext Breastfeeding, first-food systems and corporate power: a case study on the market and political practices of the transnational baby food industry and public health resistance in the Philippines

Baker P, Zambrano P, Mathisen R, Singh-Vergeire MR, Escober AE, Mialon M, et al.

Global Health, 2021 10 26;17(1):125.
PMID: 34702285 DOI: 10.1186/s12992-021-00774-5

BACKGROUND: The aggressive marketing of breastmilk substitutes (BMS) reduces breastfeeding, and harms child and maternal health globally. Yet forty years after the World Health Assembly adopted the International Code of Marketing of Breast-milk Substitutes (The Code), many countries are still to fully implement its provisions into national law. Furthermore, despite The Code, commercial milk formula (CMF) markets have markedly expanded. In this paper, we adopt the Philippines as a case study to understand the battle for national Code implementation. In particular, we investigate the market and political strategies used by the baby food industry to shape the country's 'first-food system', and in doing so, promote and sustain CMF consumption. We further investigate how breastfeeding coalitions and advocates have resisted these strategies, and generated political commitment for a world-leading breastfeeding policy framework and protection law (the 'Milk Code'). We used a case study design and process tracing method, drawing from documentary and interview data.
RESULTS: The decline in breastfeeding in the Philippines in the mid-twentieth Century associated with intensive BMS marketing via health systems and consumer advertising. As regulations tightened, the industry more aggressively promoted CMFs for older infants and young children, thereby 'marketing around' the Milk Code. It established front groups to implement political strategies intended to weaken the country's breastfeeding policy framework while also fostering a favourable image. This included lobbying government officials and international organizations, emphasising its economic importance and threats to foreign investment and trade, direct litigation against the government, messaging that framed marketing in terms of women's choice and empowerment, and forging partnerships. A resurgence in breastfeeding from the mid-1980s onwards reflected strengthening political commitment for a national breastfeeding policy framework and Milk Code, resulting in-turn, from collective actions by breastfeeding coalitions, advocates and mothers.
CONCLUSION: The Philippines illustrates the continuing battle for worldwide Code implementation, and in particular, how the baby food industry uses and adapts its market and political practices to promote and sustain CMF markets. Our results demonstrate that this industry's political practices require much greater scrutiny. Furthermore, that mobilizing breastfeeding coalitions, advocacy groups and mothers is crucial to continually strengthen and protect national breastfeeding policy frameworks and Code implementation.

Matched MeSH terms: Milk Substitutes*
Effect of flaxseed oil towards physicochemical and sensory characteristic of reduced fat ice creams and its stability in ice creams upon storage

Lim, C.W., Norziah, M.H., Lu, H.F.S.

International Food Research Journal, 2010;17(2):393-403.
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This study investigates the effect of flaxseed oil towards physicochemical and sensory properties of reduced fat ice creams and its stability in ice-creams upon storage. Three formulations, (F1, F2, F3) were developed by substituting milk fat with flaxseed oil at levels of 2.5%, 5.0% and 7.5%, (w/w) respectively. Samples were subjected to sensory evaluation and analyses such as meltdown, titratable acidity, pH, total solids, protein and fatty acids composition. Incorporation of flaxseed oil into ice-cream showed no effects on physicochemical properties of the ice-creams. However, it increased the colour of ice-cream towards yellowness, decreased the sweetness, smoothness and creaminess. Flaxseed oil incorporation also slightly (P < 0.05) decreased the acceptance level of aroma, flavour, texture and overall acceptability of formulated icecreams. The most acceptable level of flaxseed oil substitution is at 2.5 %. Gas chromatography analysis showed that fatty acids slightly decreased upon storage.

Matched MeSH terms: Milk Substitutes