Tubs of formula line supermarket shelves; their packaging awash with promises to satisfy hungry, colicky or reflux-hit babies. The vast array of products – offered at an even vaster array of prices – could leave any new parent scratching their head over which to choose. And more confusing still? The NHS website says there is “no evidence” to support many of the claims a lot of them make in the first place.
So goes the world of baby-formula marketing in Britain, where companies have learned to artfully skirt around regulations, many familiar with the industry believe, in the knowledge that enforcement will probably never come. The industry has raised prices by up to 45% during the cost of living crisis, leading to such a rise in thefts that many supermarkets now put security tags on tubs, or place them behind tills. Less discussed, though, is how big business lobbying allows spurious claims to abound in an industry estimated to be worth up to $109bn globally by 2027.
In February, a study published in the British Medical Journal (BMJ) found that of 757 formulas analysed, all bore at least one health or nutrition claim – yet these were “often not backed by scientific references. When they are, the evidence is often weak and biased”, the authors wrote; where clinical trials had been carried out, 88% were at least part-funded by or affiliated with the industry.
In a paper published online a month before, researchers at University College London concluded that formula “manufacturers are marketing their products in ways that contravene guidance from the Department of Health and Social Care (DHSC), with 18% of packs displaying health claims, and 41% bearing nutritional promises that are ‘not permitted’”.
The DHSC did not respond, saying only that unpermitted claims were for the local authority to enforce. The rules state that infant formulas cannot be advertised or subject to special promotions, nor feature any text or images that appear to discourage breastfeeding, or make health claims without evidence.
But loopholes are rife in our longstanding bottle-feeding culture, says Robert Boyle, reader in paediatric allergy at Imperial College London, who was involved in the BMJ study. Britain has among the lowest rates of breastfeeding globally; 1% of mothers feed their child this way exclusively by the six-month point the NHS recommends. While the NHS says that “breastfeeding into your baby’s second year or beyond, alongside other foods, is ideal”, this figure drops to 0.5% after one year (compared with 23% in Germany or 27% in the US), with eight out of 10 women in the UK stopping breastfeeding before they wanted to, according to Unicef. The charity is fervent that breast is best, pointing to studies that suggest breastfed children are less likely to be prone to diabetes or obesity later in life, perform better on intelligence tests, and that their mothers have a lower risk of breast and ovarian cancers.
Still, poor breastfeeding support before birth has helped to dilute its benefits – and spurious products play a role too, Boyle adds, by “falsely convincing [women] that formula is better than it really is, or that breastfeeding is less good than it really is. The claims that the companies make about their products are part of a wider picture of undermining women’s confidence and competence in doing the best for treating their baby.”
Though the ingredients in each formula product are by and large the same, ever-expanding ranges and price differences “make it look like there are endless variations and they’ve all got very exciting differences between them,” says Boyle. A 2019 study by charity First Steps Nutrition Trust found that 40% of parents who use formula felt the more expensive varieties were better.
Formula for problems such as reflux or colic is sold by brands such as Cow & Gate and SMA at about £14 per 800g tub. Colic (or “comfort”) formula contains cow’s milk protein that has already been partially broken down, which is meant to make it easier to digest – yet the NHS website states that “there’s no evidence for this”. So why is it marketed as such?
You could ask the same question of “growing-up milk” aimed at babies aged over one year, of which the NHS declares there is “no evidence” of a need; ditto “hungry-baby formula”. Again, despite the claims for “hungry-baby” formulas, the NHS website asserts that there is “no evidence that babies settle better or sleep longer when fed this type”.
Danone, the parent company of Cow & Gate (the biggest UK formula provider; it also owns Aptamil and Nutricia), said its formulas were “based on over 50 years of breastmilk research … Our ‘hungry’ milks are nutritionally complete and are made with a special balance of milk protein to keep hungry babies feeling fuller for longer.” Pressed for studies to demonstrate this, it repeated that its offering was “nutritionally complete”.
Concerns are now rising that the industry’s claims not only fail to deliver, but are potentially exacerbating other health concerns. Feed, an infant nutrition charity, has found that the cost of living crisis has led to a rise in parents requesting hungry-baby formula from health visitors, “because they are believing the companies’ unsubstantiated claims”, says Erin Williams, its co-founder. “This false sense of security that the formula company has created could lead to babies being inadequately fed.”
For many parents, picking the “right” formula remains desperately unclear. Rachel Evans still feeds her 16-month-old son some formula “because he’s quite picky and I don’t think he gets everything he needs from what he eats”, but only recently learned – when listening to a podcast – that their [manufacturers’] promises “often aren’t evidence-based”. Evans, a psychologist, says she remains “really confused about if he needs the formula or if I’d be better off giving him a multivitamin”. Meanwhile Frankie Jones, a bowel health practitioner, agrees that she felt “completely clueless” when choosing formula for her son and tried three in the space of 10 weeks – including an anti-reflux variety that helped him to settle, but brought on “terrible constipation. So [that] milk helped with one problem but triggered another.”
Alison Thewliss MP has raised the issue of baby formula advertising in parliament via debates and a private member’s bill, and says she has seen “very little interest in enforcing” existing legislation, probably because “the formula industry is far too close to the government”. The current state of play “absolutely shouldn’t be allowed to go on”, Thewliss adds, referring to concerns over products that promise to clear up allergies (as parents should be made aware that this requires a diagnosis, rather than thinking they can “[buy] something off the shelf without medical advice”). She adds that adverts for products targeted at over-ones (the age at which marketing is permissible) feature “idealising images of these lovely healthy babies” younger than the age group they have been designed for, “because it’s the conviction of the industry to sell more products”.
Mounting evidence against formula companies’ claims and a spotlight on spiralling costs have produced no legislative crackdown, a sign to many that the government’s priority remains business over babies. “The only solution is to ban claims [on packaging] completely,” Boyle suggests. Until that happens, “I don’t think you can have a fair playing field.”
