A study by the Instituto de Saúde Pública da Universidade do Porto (ISPUP) concluded that women exposed to infant formula marketing techniques (also known as “artificial milk”), are more likely to abandon both exclusive and any breastfeeding.
The investigation concluded that mothers who receive free formula samples from a health professional are more likely to abandon exclusive breastfeeding and those who have access to discounts on this type of formula are at a greater risk of abandoning any and exclusive breastfeeding. The study also showed that the impact of these marketing techniques on breastfeeding practices does not differ between Portuguese mothers and migrants.
The study, entitled The Impact of Formula Industry Marketing on Breastfeeding Rates in Native and Migrant Mothers, published in the Breastfeeding Medicine, sought to understand the degree of exposure of Portuguese and migrant women to the breastmilk substitutes marketing. The objective was to ascertain whether this type of marketing would have any impact on the breastfeeding of their children, including exclusive breastfeeding, and whether it produced different effects among Portuguese women and migrants.
According to Cosima Lisi, first author of the study, coordinated by Henrique Barros, “we all know the benefits of breastfeeding for the health of the child and the mother. When there are no contraindications for breastfeeding, breast milk is recommended exclusively until 6 months of age. From the age of 6 months, you can start introducing complementary feeding into your baby’s diet. But there are many factors that can influence breastfeeding. Among these is the marketing of breastmilk substitutes, including artificial milk, which can make mothers choose to stop breastfeeding, even if it is not necessary. In this study, we tried to verify the impact of this type of marketing, both on Portuguese women and on migrants”.
The women participating in the study
In the context of this research, conducted within the scope of the baMBINO project (an ISPUP project developed to learn more about access to health care and the level of satisfaction of migrant mothers in Portuguese hospitals), around 2400 women who gave birth in several hospitals in the country were evaluated: 1150 Portuguese and 1251 migrants. The latter were originally from Portuguese-speaking African countries (PSAC), Brazil and other countries.
Information on the participants was collected, after their recruitment at the maternity hospital and about three months after delivery. Additionally, the mothers answered a series of questions about their exposure to different types of formula marketing and other related products – whether they received any kind of samples, gifts, brochures or pamphlets from any health professional, if they saw exhibitors of this type of formulas and, if so, where, and whether they were exposed to advertising or discounts. In addition, information was obtained on how mothers were feeding their children at the time they were interviewed.
The influence of marketing on the abandonment of breastfeeding
The results of the study showed that the marketing techniques for breastmilk substitutes have an impact on the abandonment of exclusive and any breastfeeding, both in Portuguese women and migrant women.
It was concluded that women who received free formula samples from a health professional or who had access to discounts on this type of formulas more often stopped exclusive breastfeeding. Access to discounts on formulas is a risk factor for abandoning breastfeeding.
Although the marketing techniques for breastmilk substitutes affect Portuguese mothers and migrants alike, it was found that migrants are less exposed to this type of marketing and are less likely to stop exclusive and any breastfeeding. Among migrants, women from PSAC are the least exposed.
However, as Cosima Lisi points out, “if migrants are exposed to formula marketing techniques, they are also influenced, thereby increasing the likelihood of stopping breastfeeding”.
One of the explanations for the lower exposure of PSAC women to marketing is due to the fact that the majority have had births in Baby-Friendly hospitals. In these hospitals, any form of promotion of breastmilk substitutes is not allowed, including the distribution of formula samples and brochures with the company name. Another reason may be related to the fact that these mothers are not fluent in Portuguese. Although Portuguese is the official language of the PSAC, there are other languages that are spoken in these countries, so the language may have been a barrier to the access of marketing strategies.
The role of health professionals in supporting mothers
It should be noted that the participants in the study reported that they were less exposed to marketing artificial milk in a hospital environment or in a health center than in other contexts, such as supermarkets or pharmacies. However, those who were exposed to free samples of artificial milk by health professionals more often abandoned exclusive breastfeeding than those not exposed.
For this reason, the study authors underline the importance of these professionals sending clear messages. “Doctors and nurses are considered to be a reliable source of information on the part of mothers. When they deliver samples of artificial milk to women, they can convey the message that they support breastmilk substitutes. It is important to avoid confusing messages and properly inform mothers about the benefits of breastfeeding”says Cosima Lisi.
The researcher points out that one of the ways to ensure that exposure to marketing does not negatively affect breastfeeding is the appropriate monitoring of future mothers.
“The first thing to keep in mind is that when women receive health care, they have to have all the support they need. If they have difficulties with breastfeeding, they must be properly informed, because a mother may decide that she does not want to breastfeed, and is free to do so, but it is crucial that she is well informed about the benefits of breastfeeding, international recommendations, and protected from influence of marketing. Migrant mothers, being a vulnerable population, need to be more protected, because, if they are equally exposed to this type of marketing, they will have the same consequences observed among Portuguese mothers”
The cross-promotion technique of the artificial milk industry
It is important to note that, in the study, mothers were asked about exposure to the marketing of any type of artificial milk, without distinguishing between infant milk, targeted at babies up to 6 months of age, in transition (for babies aged 6 to 12 months) and growth (for babies from 12 to 36 months).
In Portugal, the promotion of milk for babies up to 6 months of age is prohibited, such as, for example, the distribution of free samples and discounts, but not of other types of infant formulas.
To overcome this difficulty, the industry uses a marketing technique called “cross-promotion”, where a product, such as transition milk for babies from 6 to 12 months, is used to promote another, in this case, the formulas for infants (up to 6 months), using similar brand, label, colors and logos. “This technique can make mothers confused, making it impossible for them to distinguish between the different types of formula. For this reason, it is important to ban discounts on any type of artificial milk”, emphasizes Cosima Lisi.
Researcher Cláudia de Freitas from ISPUP is another author of this investigation.
About the baMBINO Project
The baMBINO project was created by ISPUP in 2017, to study whether Portuguese hospitals were prepared to receive migrant women from different cultural backgrounds, and to assess their satisfaction with the health care received during pregnancy, at the time of delivery and after delivery, compared to Portuguese women.
Additional information about the project and its results is available on its official website.
