Eat This Newsletter 199: Accept no substitute
Hello
One overarching topic this week; the other couple of things I saved will keep.
The Commercial Milk Formula Industry
[W]e use the term CMF instead of breastmilk substitute to highlight the artificial and ultraprocessed nature of formula products.
Monday saw a letter (in The Guardian) from Sue Miller, aka The Baroness Miller of Chilthorne Domer. She was thinking back 30 years to a local campaign against the commercial milk formula industry, and a response she got a couple of years ago from the UK government when she asked about the prevalence of breastfeeding in the UK.
“The UK has one of the lowest breastfeeding rates in the world. Data published in the Lancet shows that 0.5% of babies in the UK are being breastfed up to one year compared with 23% in Germany.”
What’s interesting about that is that the figures come not from government but from the Lancet. The UK government collects data on breastfeeding only to 6–8 weeks. Those show that just under half of all babies got at least some breast milk, while about a third were totally breast fed. The most recent Infant Feeding Survey dates to 2010. From it, we know that more than half the mothers were feeding commercial milk formula by the time their babies were one week old. Exclusive breastfeeding at six months — as recommended by the World Health Organization — was “around 1%”.
The UK gave up on the Infant Feeding Survey after the 2010 edition, which may be why its reply to Baroness Miller in 2020 quoted the Lancet. And it was the latest Lancet report, Breastfeeding 2023, that prompted Sue Miller’s letter to The Guardian.
The Lancet’s overall summary pulls no punches
For decades, the commercial milk formula industry has used underhand marketing strategies, designed to prey on parents’ fears and concerns, to turn the feeding of infants and young children into a multibillion-dollar business—generating revenues of about $55 billion each year. …
The industry’s dubious marketing practices — in breach of the breastfeeding Code — are compounded by lobbying of governments, often covertly via trade associations and front groups, against strengthening breastfeeding protection laws and challenging food standard regulations.
As the papers make clear, this is a global problem. Of course there are special cases of mothers who absolutely need commercial milk formula for one reason or another. I don’t know how numerous they might be, but I’m pretty sure it isn’t many. Nobody wants to block their supply. For the rest?
Being a man with no experience of needing to feed an infant might not be a great place from which to start, but I think there are some good, rational arguments in favour of breastfeeding, quite apart from the proven health benefits for mothers and babies.
Cost is one. Why do mothers, especially those living in more deprived areas (in the UK) pay for something that they can produce almost for free? Maybe because they have to work in jobs that make it difficult to breastfeed and that do not give them enough paid maternity leave. But also, surely, because the CMF industry pushes the idea that it somehow isn’t proper to breastfeed.
Resilience is another. It is a year now since Abbott Nutrition closed its largest plant in the US after issuing one of the largest recalls of formula in US history. Helena Bottemiller Evich, who broke that story and continues to cover it in detail, has a detailed round-up in her newsletter Food Fix. The details are fascinating and disturbing, and there does seem to be a reasonably simple message: When a mother directly produces the food her infant eats, there’s not a lot that can disrupt the supply chain.
Of course there are many other factors, large and small, that influence a person’s decision to breastfeed. I do find it striking, nevertheless, that rich countries can best increase falling birth rates not by crudely paying women to have more babies but by using their wealth to provide better opportunities for young people. The Economist’s recent round-up on the low birth-rates of Southern Europe doesn’t mention breastfeeding, but I’d be willing to bet that the same factors that promote fertility also promote breastfeeding.
What, then, is the problem?
The Lancet concludes that “the consumption of commercial milk formula (CMF) by infants and young children has been normalised. More children are consuming CMF than ever before.” And it blames the CMF industry; the title of the relevant paper is almost all you need: Marketing of commercial milk formula: a system to capture parents, communities, science, and policy. If you have any interest at all in how industrial food serves its own interests and not those of its customers, I suggest you at least read the Introduction and Key messages.
In 2016, in an earlier series on breastfeeding, the Lancet pointed out that breastfeeding “is one of the few health-positive behaviours more common in poor countries than rich ones”. Perhaps that is because, despite the excesses of formula-makers in the past, it is still less profitable to peddle their stuff there than in richer countries.
Worse, if possible, the benefits that CMF makers claim for their products are largely unsupported by scientific evidence. A week after the Lancet series, another massive paper in the BMJ looked specifically at Health and nutrition claims for infant formula, investigating 757 products across 15 countries. Most made one or more health and nutrition claims, the most common, in more than half the products, being that it “helps/supports development of brain and/or eyes and/or nervous system”. And after reviewing all the claims, the authors conclude:
Multiple ingredients were claimed to achieve similar health or nutrition effects, multiple claims were made for the same ingredient type, most products did not provide scientific references to support claims, and referenced claims were not supported by robust clinical trial evidence.
The snake oil the CMF industry is peddling isn’t even snake oil.
The Lancet’s recommendations are clear. I don’t expect them to have any impact.
Take care.
p.s. In case you’re new here, let me point you to two recent episodes: Mothers and Milk and a kinda, sorta follow-up, Feed Your Baby Like a Fascist.