Commercial Milk Formula Research Articles

Lower Adherence to Breastfeeding Recommendations in Mothers Treated With Antirheumatic and Antidepressant Medications.

Exclusive breastfeeding for 6 months is recommended, but breastfeeding safety data is insufficient for several medications. To determine if mothers treated with chronic medications are less likely to breastfeed. For this secondary analysis, 6383 pregnant women in the MotherToBaby cohort recruited from the United States and Canada between 2010 and 2022 were included. Participants treated with antirheumatic medications (ARM), selective serotonin reuptake inhibitors (SSRIs), and asthma medications during pregnancy were divided into two groups based on their medication use: continuers and discontinuers. Breastfeeding initiation, supplementation with commercial milk formula, and discontinuation of breastfeeding before 6 months were compared between those exposed and unexposed to medication use. Adjusted risk and hazard ratios (aRR, aHR) and 95% Confidence Intervals (CI) were calculated with modified Poisson and Cox regressions adjusted for year, parity, socioeconomic status, body mass index, smoking, illicit drug use, race and ethnicity. The sample included 799 (12.5%) continuers and 475 (7.4%) discontinuers of ARM, 293 continuers (4.6%) and 63 (1.0%) discontinuers of SSRIs, and 217 (3.4%) continuers and 97 (1.5%) discontinuers of asthma medications. There were 4,439 (69.6%) participants who were unexposed to the study medications. Both ARM continuers and discontinuers were more likely to not breastfeed (aRRs 95% CI: 3.92 [3.03, 5.07] and 3.08 [2.19, 4.33]), to supplement (aRRs 95% CI: 1.12 [1.01, 1.26] and 1.25 [1.10, 1.43]) and stop breastfeeding before 6 months (aHRs 95% CI: 1.72 [1.29, 2.31] and 1.41 [0.92, 2.15]). SSRI continuers were more likely to supplement (aRR 95% CI: 1.26 [1.08, 1.47]). Participants treated with chronic medications, primarily ARMs, were less likely to breastfeed. Targeted lactation support for mothers with chronic illnesses is recommended along with development of breastfeeding safety data for these medications.

Economic and environmental impacts of commercial milk formula in Indonesia: estimates and comparisons using the Cost of Not Breastfeeding, Green Feeding, and Mothers’ Milk Tools

BackgroundSales of commercial milk formula products (CMF) are rising rapidly. This study analysed key economic and environmental impacts CMF feeding in Indonesia, which are often overlooked in policy discussions despite their relevance.MethodsWe assessed the economic and environmental impacts of CMF in Indonesia in 2020 using the Mothers’ Milk Tool (MMT), the Green Feeding Tool (GFT) and the Cost of Not Breastfeeding Tool (CONBF). We compared the estimated values from these tools with calculations based on Euromonitor data on CMF retail sales in Indonesia.ResultsIn 2020, according to the MMT, women in Indonesia produced around 455 million litres of breastmilk for infants aged < 6 months, which had an estimated monetary value of US$45.5 billion. The MMT and GFT shows substantial economic losses from displacement of breastfeeding in Indonesia; 62–96 million litres of breastmilk were lost in 2020 compared to the biologically feasible potential. The GFT tool calculates a carbon footprint of 215–274 million kg of CO2 eq. and a water footprint of 93,037 million litres. The CONBF estimates that the annual cost to families of purchasing CMF for infants aged < 24 months was US$598.6 million. By comparison, Euromonitor retail sales data suggests that in 2020, the retail value of sales of CMF products targeting the age group 0–36 months was around US$2.25 billion. Euromonitor also reports 27,200 tonnes of CMF products targeting infants < 6 months were sold in Indonesia in 2020. We calculate a carbon footprint from these sales of 299–381 million kg CO2 eq. and a water footprint of 129,064 million litres, higher than the GFT estimate.ConclusionsBreastfeeding’s economic importance to Indonesia far exceeds the retail value of CMF sales. Displacing breastfeeding carries high but largely undocumented economic and environmental costs. Losses are greater when measured as a food resource than as health costs, lost lives, or cognitive decline. Environmental impacts based on sales data are higher than those from survey data. Our findings and the discrepancies between tools reveal a critical gap in national statistics and highlight the need to recognise breast milk as an economically valuable, healthy, and sustainable national resource in Indonesia.

Breastfeeding problems and associated factors: a cross-sectional study after the 2023 Türkiye earthquake

BackgroundBreastfeeding offers critical benefits in disasters but faces significant barriers. In this study, we aimed to determine the association between experiencing the 2023 Türkiye earthquake and breastfeeding problems.MethodThis cross-sectional descriptive study was conducted in pediatric clinics in eight different provinces of Türkiye, three earthquake-affected provinces and five earthquake-unaffected provinces, between April and July 2023. Breastfeeding mothers and their 0–23 month infants were included in the study. A structured questionnaire was applied to mothers face-to-face. Multivariate logistic regression analysis was performed to determine independent parameters associated with breastfeeding problems.ResultsA total of 761 mother-child pairs participated in the study. Among these mothers, 49% (n = 373) were living in the earthquake-affected region, and 51% (n = 388) were not. Breastfeeding problems were more common in the earthquake-affected mother-child pairs (48.8%) compared to unaffected pairs (28.6%). Perceived insufficient milk supply was the most common breastfeeding problem, reported by 33.0% in earthquake-affected regions and 11.1% in unaffected region. Breastfeeding problems were 2.01 times more common in mothers from earthquake-affected region (95% CI: 1.45, 2.77) and 1.66 times more common in those who bottle-fed their infants (95% CI: 1.45, 2.37). Perceived insufficient milk supply was 4.12 times more prevalent in earthquake-affected regions (95% CI: 2.73, 6.22) and 1.78 times higher in bottle-feeding mothers (95% CI: 1.23, 2.57). The likelihood of perceived insufficient milk supply was lower in mothers receiving mental health support (AOR: 0.53, 95% CI: 0.33, 0.84) and nutritional support (AOR: 0.49, 95% CI: 0.27, 0.89).ConclusionPerceived insufficient milk supply is the most common breastfeeding challenge reported by mothers affected by earthquakes, occurring more frequently than among mothers who were not affected. This issue is associated with increased bottle feeding, limited mental health support, and inadequate nutritional support. Addressing this issue through adherence to the International Code of Marketing of Breast-milk Substitutes, controlling donation and distribution of commercial milk formula to discourage bottle feeding, alongside ensuring nutritional and mental health support for mothers, could significantly mitigate breastfeeding difficulties during disasters.

Healthcare professionals’ perspectives on commercial milk formula marketing in the UK: a qualitative study

ObjectivesTo understand (1) healthcare professionals’ (HCPs) perceptions and experiences of commercial milk formula (CMF) marketing to consumers and HCPs and (2) HCPs’ perspectives on regulation of CMF marketing.SettingUK.DesignIn-person and online...

Community pharmacists’ support for nursing mothers in Serbia: potential cost savings due to breastfeeding continuation

BackgroundDespite many health benefits to infants, the overall breastfeeding rate remains low among Serbian women. The community pharmacists’ efforts aimed at supporting nursing mothers are important. The aim of the study was an evaluation of the pharmacists’ training for breastfeeding support and their perception about its usefulness. The second aim was an evaluation of the provided structured pharmaceutical care service (SPS) over four months, through a calculation of theoretical cost savings for counseled families in case of the risk for introduction of commercial milk formula (CMF).MethodsThe continuation of breastfeeding instead of starting with CMF was theoretically monetized through cost savings analysis, which is based on energy equivalent human milk and CMF, regardless of the differences in health, social and ecology outcomes of breastfeeding. Cost savings for the counseled families were calculated as financial differences between continuing breastfeeding and switching to CMF.ResultsThe 256 pharmacists showed high satisfaction rates with the quality and the usefulness of the training (mean scores: content value 4.89 ± 0.51, technical value 4.91 ± 0.41, program value 4.96 ± 0.20, and usefulness value 4.94 ± 0.25, respectively), as well as a statistically significant higher level of knowledge (p < 0.001 for each of the 10 questions). The prospective observational study enrolled 256 community pharmacists who voluntarily underwent training aimed to breastfeeding support. Of all the trained pharmacists, 151 (59%) actively provided 1,243 SPS focused on breastfeeding support. Of all, 599 mothers of children under 6 months of age received SPS, while 590 provided full data In 275 cases (22.1%), a risk for early breastfeeding cessation was identified. The average age of children whose mothers had undergone SPS was 2.83 months, and the total average potential cost savings until 6 months of children age was 35,884.80 RSD (approximately 306 EUR) for average of 3.17 months.ConclusionsThe training of pharmacists adds significant value to their knowledge and skills for breastfeeding support, which may lead to potential cost savings for families.

South African health professional associations urged to end commercial milk formula industry sponsorship

Despite the wealth of evidence about the benefits of breastfeeding, the commercial milk formula (CMF) industry continues to grow and project future profits, fuelled by aggressive and pervasive marketing practices that include the targeting of health care professionals. When health professionals and their associations accept funding from the CMF industry, this creates a conflict of interest (COI). The World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) have therefore issued clear unequivocal guidance including through World Health Assembly resolutions that health care institutions and professional associations should refuse sponsorship from the CMF industry. We urge health professionals in South Africa to heed this call to protect their professional integrity and ensure that care and support for pregnant and breastfeeding women, children and families is free from commercial influence.

Consecutive Lactation, Infant Birth Weight and Sex Do Not Associate with Milk Production and Infant Milk Intake in Breastfeeding Women.

Optimal infant growth is reliant on the sufficient intake of human milk. Studies in animal models speculate that multiparous mothers produce a higher milk yield compared to primiparous mothers. We aimed to examine if there are relationships between consecutive lactations and infant demographics and both maternal 24 h milk production (MP) and infant milk intake (MI). Lactating mothers 1-6 months postpartum (n = 36; 25 fully breastfeeding (FBF), 11 supplementing with commercial milk formula (partly breastfeeding (PBF)) test-weighed their infants for 24 h during two consecutive lactations and provided demographic information. Twenty-four-hour MP by breast, infant MI (including mothers' own expressed milk and formula), breastfeeding and expressing frequencies were measured. The statistical analysis used linear mixed modelling accounting for infant birth weight (FBF) or time postpartum (PBF) and for the random effect of the participant. In the FBF group, there were no differences between lactations in terms of MP (p = 0.31) or the infant mother's own MI (p = 0.14). The birth weight was higher for consecutive lactation infants (p = 0.008). Infant sex was not associated with MP (p = 0.12) or the infant mother's own MI (p = 0.090). In the PBF group, the breastfeeding frequency (p = 0.042), MP (p = 0.025) and infant mother's own MI (p = 0.019) were higher in consecutive lactations whilst formula intake was lower (p = 0.004). This study suggests that in fully breastfeeding women, there is no significant effect of consecutive lactation or infant sex on MP or infant MI during established lactation.

Balancing Ethics and Equity: Rethinking Commercial Milk Formula Industry Partnerships in Maternal and Child Health.

Balancing Ethics and Equity: Rethinking Commercial Milk Formula Industry Partnerships in Maternal and Child Health.

Evidence-Based Lessons from Policy Implementation Research in Two Countries Achieving Progress on Global Breastfeeding Targets: Recommendations from the Philippines and Viet Nam

Background/Objectives: There is extensive evidence that breastfeeding saves lives, improves health, and provides value to the economy and societies worldwide. The Philippines and Viet Nam have progressive policies to enable breastfeeding, and breastfeeding rates in these countries have substantively improved. In the Philippines, exclusive breastfeeding under six months (EBF) increased from 35.9% (2008) to 60.1% (2021) and, in Viet Nam, in just over a decade, EBF has more than doubled, from 17.0% (2010) to 45.4% (2021). We aimed to use an evidence synthesis to consolidate learnings from policy support to enable breastfeeding in the Philippines and Viet Nam, to identify insights to improve future programming to improve breastfeeding practices in these two countries, and glean learnings that can potentially be adapted for similar contexts. Methods: This manuscript presents a qualitative evidence synthesis of seven purposively selected research articles from the Philippines and Viet Nam. Results: Since the 1960s, the Philippines and Viet Nam have notably improved policies protecting breastfeeding. Both countries have implemented legislation that is substantially aligned with the International Code of Marketing of Breast-milk Substitutes and subsequent World Health Assembly resolutions. Both countries have improved paid maternity leave provisions, with Viet Nam providing 6 months of paid leave, yet insufficient coverage to informal workers, and the Philippines providing 3.5 months of paid maternity leave while expanding maternity protection coverage to informal workers. From 2006–2021, breastfeeding rates increased in both countries alongside policy improvements yet barriers to implementation remain. Conclusions: Implementation research has documented policy progress and improved breastfeeding rates in the Philippines and Viet Nam. Our analysis offers valuable lessons potentially applicable beyond these contexts, emphasizing the need for addressing policy gaps and targeted cross-sectoral policy actions to enhance breastfeeding practices. Learnings from implementing national marketing restrictions of commercial milk formula and associated products and maternity protection policies in these countries could inform the implementation of newly developed regional standards together with supportive policies, facilitating the harmonization of regional regulatory environments.

A Content Analysis of Digital Marketing Strategies of Formula Companies and Influencers to Promote Commercial Milk Formula in Hong Kong

ABSTRACTThis study examines the compliance of the digital marketing strategies used by formula companies and social media influencers in promoting commercial milk formula (CMF) for infants and young children with the International Code of Marketing of Breast‐milk Substitutes (International Code) and the Hong Kong Code of Marketing of Formula Milk and Related Products, and Food Products for Infants & Young Children (HK Code). Content analyses on influencers' posts, websites and social media sites of five major formula companies were conducted to identify the digital marketing strategies used, evidence of product cross‐promotion, and compliance with the International and HK Codes. Statistical analyses were performed to assess the associations between marketing strategies and social media interactions (likes/comments/shares). The findings revealed widespread noncompliance to the two codes by both influencers and formula companies. Of 1036 influencer (n = 493) and formula company (n = 543) materials mentioned products covered by the Codes, all influencer materials and 95% of company materials violated at least two provisions of the Codes. Persistent brand promotion and cross‐promotion strategies were observed in CMF marketing in Hong Kong, with tactics such as parents' sharing, showing images of happy children and families, and celebrity endorsements leading to higher social media interactions. The extensive CMF promotion by influencers and the covert cross‐promotion and brand promotion are of particular concern given the lack of regulation in this area. The study calls for a comprehensive review and introduction of legalisation in Hong Kong to govern CMF marketing, ensuring enforcement as outlined in the Convention on the Rights of the Child.

Content Analysis of Austrian Print and Online Newspaper Coverage of Breastfeeding Over Two Decades.

In the first 6 months, breastfeeding is the optimal nutrition for newborns, but the breastfeeding prevalence in Austria is still below the official WHO Guidelines (64% breastfeeding and 1.9% exclusive breastfeeding after 6 months). Exclusive breastfeeding rates in the first 6 months are low in the European Region but higher globally at 48%. Breastfeeding behaviour and the decision to breastfeed can be influenced by many factors, such as social norms, the social environment, health, commercial milk formula (CMF) marketing, and media reports. Therefore, it is important to understand how breastfeeding and CMF are presented in Austrian media and the possible impact these portrayals have on mothers and thebroader community. The aim of this study was to analyze print and online newspaper coverage in Austrian newspapers related to breastfeeding between 2002 and 2022 with a special focus on the valence of reporting on breastfeeding and CMF in different genres of online and print newspapers. For this analysis, more than 2500 unique articles were identified, coded, and analysed (e.g., main topic, valence towards breastfeeding, and valence towards CMF). The results showed that media coverage of breastfeeding has decreased slightly over the last 20 years, particularly with the start of the COVID-19 pandemic. Print and online newspaper coverage of breastfeeding was mostly neutral, with a focus on breastfeeding and its association with disease, health benefits of breastfeeding, and event announcements related to breastfeeding. The valence on breastfeeding was more positive than on CMF. Middle-market newspapers appear to report more about breastfeeding than tabloids and broadsheets. To normalise breastfeeding, informative, unbiased, and extensive media coverage is important. Collaboration between breastfeeding advocates and journalists could be beneficial in increasing positive coverage of breastfeeding in the long term.

Factors Associated With Prelacteal Feeding of Commercial Milk Formula: An Analysis of Cohort Data From the BADUTA Study in Indonesia.

Introducing commercial milk formula (CMF) as prelacteal feeds can disturb exclusive breastfeeding and shorten breastfeeding duration. However, the prelacteal feeding of CMF has been growing alongside its increasing sales in Indonesia. This study examined predictors of the CMF feeding in the Malang and Sidoarjo districts of Indonesia. This analysis used post-delivery data collected from 676 mothers in a cohort evaluation of a cluster randomised controlled trial (Baduta study). Multivariate random effects logistic models were employed to assess factors associated with the CMF feeding. A total of 467 (69.1%) respondents reported giving CMF to their infants during the first 3 days after delivery. Mothers with low breastfeeding self-efficacy (BFSE) were at a higher risk of providing CMF within 3 days of birth compared to those with medium or high BFSE (adjusted odds ratio (aOR) 8.12; 95% confidence interval (CI) (4.26-15.48). Receiving explanations to solve breastfeeding problems from health professionals (aOR: 1.87; 97% CI: 1.12-3.11) and primipara parity (aOR: 1.71; 95% CI: 1.12-3.04) were positively associated with the CMF feeding. Early initiation of breastfeeding (EIBF) was protective against CMF feeding (aOR: 0.40; 95% CI: 0.22-0.58). There was an interaction between EIBF and BFSE. EIBF was protective among mothers with high or medium BFSE, but had no effect among those with low BFSE. CMF feeding was prevalent in Indonesia. Future strategies should focus on improving health-staff capacity to strengthen BFSE during pregnancy and provide adequate counselling for mothers with breastfeeding problems.

Views on wet nursing and expressing breastmilk for sharing and human milk bank donation among mothers in two parenting social media communities in Vietnam.

Nutrition in early life plays a key role in shaping an infant's future health. There is limited understanding of the perspectives of Vietnamese mothers with children under 24 months of age regarding breastmilk expression, donationand use. In this cross-sectional study, an online survey was administered through two parenting social media communities to assess opinions on breastmilk expression, breastmilk donation including contributions from bereaved mothersand the use of donor human milk. A 4-point Likert scale was used to evaluate respondents' opinions, and demographic and breastfeeding information was collected. Among 375 respondents, almost 30% had received breastmilk from another woman, either through direct breastfeeding (14.7%), expressed breastmilk (12.5%)or from a human milk bank (2.7%). In this survey of 375 mothers, 84.0% indicated they would store excess breastmilk, while 75.7% and 69.6% would donate to a human milk bank or another mother, respectively. When faced with insufficient breastmilk, 88.5% of mothers would seek ways to increase supply, whereas 23.8% considered using commercial milk formula. Regarding milk expression among the 375 mothers, 78.4% preferred electric pumps, compared to 48.6% for manual pumps and 45.9% for hand expression. Additionally, 80.5% of the 375 mothers would suggest donating stored milk to bereaved peersand 85.6% would suggest mothers with mild COVID-19 to continue breastfeeding with precautions. These findings indicate that this sample has positive views on breastfeeding, breastmilk donationand the use of donor human milk.

A Call to Action: Healthcare Professionals to Become Independent of the Commercial Milk Formula Industry.

Health-care professionals (HCP) have a responsibility to protect and promote maternal and infant health and breastfeeding is one of the most effective measures to support this. Increasing breastfeeding rates in Australia is crucial to improving population health, but the absence of robust policies, programmes and education for HCP undermines this effort. The pervasive marketing of commercial milk formulas (CMF), including sponsorship of HCP and their organisations, has introduced significant conflicts of interest that distort clinical practice, education, research and guidelines developed in the infant feeding domain. This paper calls on all HCP to seek independence from the CMF industry and to actively support breastfeeding in their practice.

The Natural Formula Design Uses Mobile Application in Data Management

&lt;p&gt;The purpose of this study is to apply Unified Modeling Language (UML) to the development of commercial tube-feeding milk formulas and establish the most suitable processing method for natural formula tube feeding. The study also incorporates response surface methodology (RSM) to explore the UML workflow for formula design and optimize processing conditions. According to the formula design process, the raw material composition for each 300-kcal can consists of 5 grams of germ rice, 60 grams of potatoes, and 15 grams of corn flour. The optimal viscosity for passing through a nasogastric tube is 223 cps. The processing steps include fine grinding, sterilization, and sensory evaluation at different rotation speeds, temperatures, and durations. The optimal fine grinding conditions are 1500 rpm for 5 minutes, which allows 95% of the raw materials to pass through an 80-120 mesh sieve. Sterilization is best achieved at 121&amp;deg;C for 20 minutes, which minimizes nutrient degradation. In a taste test, the egg formula had the highest acceptance rate. Overall, the use of UML modules for processing workflow and data analysis enables optimal operational procedures, precise data analysis, and the fulfillment of nutritional requirements.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Women’s exposure to commercial milk formula marketing: a WHO multi-country market research study

BackgroundMarketing of commercial milk formula (CMF) is well resourced and has influenced societal beliefs and practices that have undermined breastfeeding. This has occurred despite legislation in many countries largely reflecting the provisions of the International Code of Marketing of Breast-milk Substitutes.MethodsA cross-sectional survey was conducted in seven countries: Bangladesh, Mexico, Morocco, Nigeria, South Africa, United Kingdom and Viet Nam to explore the scope and nature of CMF marketing among pregnant women and mothers. A marketing-research methodology was adopted using convenience sampling of women stratified according to infant feeding practices and the infant’s age.Participants were identified in hospitals and clinics, as well as in the street, markets and shopping malls. In each country the sample size comprised 300 pregnant women, 150 mothers of children aged > 18 months who were breastfeeding without giving CMF and 600 women feeding their children with CMF. Data were collected using a questionnaire administered on tablets by trained field workers.ResultsInterviews were conducted with 8528 women between October 2019 and March 2021. Overall, 3095/7480 (41.3%) of women reported exposure to CMF marketing ranging from 3% in Morocco to 92% in Viet Nam. The commonest marketing site in all countries was television, but advertising in-store and in magazines and newspapers was also common. In most countries, CMF advertising on social media, websites and YouTube was less compared to traditional media. Reports of receiving free CMF samples varied from 3.1% in Nigeria to 34.6% in Viet Nam. Health professionals were the most common source of advice to mothers about starting CMF and which CMF brand to use.ConclusionsThe study provides quantitative data about CMF marketing and insights on how marketing companies develop effective messages, helping to explain how individual vulnerabilities or aspirations are integrated into marketing strategies. The findings reaffirm the need for action across political and health domains to counter actions of CMF companies. This will require effective national legislation fully reflecting the Code and action by professional bodies to protect health professionals from targeting by CMF marketing. Marketing-research methods could be employed to develop messaging in support of breastfeeding and breastfeeding-friendly policies.

The characteristics of formula milk marketing on health system: a qualitative study from Beijing and Jinan in China

BackgroundBreastmilk is widely regarded as the healthiest choice for both infants and mothers due to its numerous advantages over formula, such as higher concentrations of essential nutrients and antibodies, easier digestion, and superior taste. The World Health Organization International Code of Marketing of Breast-milk Substitutes was adopted over 40 years ago to mitigate the effects of infant formula marketing on a woman’s decision to breastfeed. Yet, the commercial formula milk industry has continued to market their products aggressively and through an increasing variety of social media channels. This study examines the impact of formula milk marketing on specific components of the health system to understand how systems that are built to support and sustain breastfeeding may have been captured and repurposed by industry practices.MethodsAs part of A Multi-country Study of Early Infant Feeding Decisions, this qualitative study was conducted in two representative cities in China, Beijing and Jinan, in 2020. The participants were recruited through convenience sampling and snowballing sampling methods. Data were collected through 40 in-depth interviews and 10 focus group discussions with health professionals, pregnant women, and formula milk marketing executives. A thematic analytical method was used to analyze the main themes and sub-themes that detail the characteristics of formula milk marketing and its impact on the health system in China.ResultsOur results identified the most common practices used by the formula milk industry to reach health workers as well as mothers and their families through health systems. Such practices include (1) provider/facility-based marketing to sponsor academic activities (e.g., seminars, conferences, and research projects) and promote specialized infant formula that targets health care providers and facilities, which influence the health consultations and recommendations provided by health professionals to mothers and families; and (2) receiver-based marketing that targets Chinese women and increases marketing exposure through lectures provided by maternity schools at health facilities during the antenatal period and health promotion activities organized by formula milk companies outside of facilities during the postnatal care period.ConclusionsFormula milk marketing aims to influence the practices and services within the health system in China, both directly through health professionals and facilities, and also indirectly by targeting mothers. These marketing strategies have impacted the perceptions of providers on formula milk, and strategies targeting consumers have aimed to further influence and undermine mothers’ intentions to continue breastfeeding. Stricter regulation of industry marketing practices is needed to create a supportive environment for mothers to breastfeed.

Individual- and system-level determinants of breastfeeding in a low-resource setting.

The benefits of breastfeeding are widely established and therefore the World Health Organization recommends that every child be exclusively breastfed for the first 6 months of life and continue breastfeeding up to 2 years of age or beyond. However, the rate of exclusive breastfeeding is low globally and has declined in Bangladesh in recent years. In this review, Bangladesh is used as an example to demonstrate the complex individual- and system-level determinants of breastfeeding in a low-resource setting. Mothers face barriers to breastfeeding within the context of marketing by commercial milk formula companies, limited safe alternatives to breastfeeding directly from the breast, and insufficient resources to support breastfeeding in the hospital, community, and workplace setting. Future research and implementation science is required to investigate the overlapping effects between breastfeeding and the high antibiotic use and Caesarean section rates in Bangladesh, along with public health efforts to promote breastfeeding based on robust evidence.

Empowering Global Health Systems to Protect, Promote and Support Optimal Breastfeeding.

Breastfeeding is a critical public health strategy for optimal child development and maternal health across the life course. The 2021 Global Burden of Diseases, Injuries and Risk Factors Study reveals that, despite reductions in mortality and disability-adjusted life years (DALYs) attributed to suboptimal breastfeeding practices-namely, non-exclusive breastfeeding during the first 6 months or early discontinuation within the first 2 years-low- and middle-income countries (LMICs) continue to bear a staggering 50-fold higher burden compared to high-income nations. This inequity signals a pressing global health priority. Hence, we propose to address these challenges by first, expanding the Baby-Friendly Hospital Initiative (BFHI) reach through community-driven efforts such as the Baby-Friendly Community Initiative (BFCI) to enhance breastfeeding support in both clinical and community settings; second, embedding breastfeeding counselling within national health and social protection programmes to fill in gaps in culturally competent care, drawing on large scale breastfeeding peer counselling programme experiences like the one being implemented by the US Supplemental Nutrition Program for Women, Infants and Children (WIC); third, improving maternity leave policies and workplace accommodations for breastfeeding women and fourth, stringent regulation of exploitative commercial milk formula (CMF) marketing to combat misinformation and reduce health inequities. Governments must implement strong, evidence-driven policies-such as strict monitoring and regulation of product labelling and digital media marketing-to establish safeguards against the powerful influence of the CMF industry. Collectively, these strategies will enhance breastfeeding outcomes, reduce health disparities and drive progress across countries towards meeting the UN Sustainable Development Goals.

Commercial milk formula marketing entry points: setting the course of infant and young child feeding trajectories

BackgroundThere is a limited understanding of the dynamic influences that shape infant and young child feeding (IYCF) decisions over time. We conducted an innovative qualitative study to reconstruct IYCF trajectories across early life course phases, in the context of the socioecological model (SEM) and the commercial determinants of IYCF.MethodsWomen of different socioeconomic status were interviewed in two large metropolitan areas in Mexico. Our specific goal was to allow us to better understand if and how the commercial milk formula (CMF) marketing influenced breastfeeding decisions in a complex dynamic way involving the individual, relational, community and societal levels.ResultsHospitals, health professionals, and interactions with social media were key category entry points throughout the prenatal, perinatal, early infancy period and beyond. The CMF industry interfered by engaging a wide array of actors across the different layers of the SEM, most prominently the health care system and the workplace. Through its marketing strategies the CMF operates subconsciously and its messages are most effective when health institutions, health care providers, workplace spaces and social norms are weak in their support for breastfeeding.ConclusionsThe cases in our study highlight how, together with a weak breastfeeding counseling system, and health professionals who lack training in breastfeeding and normal infant behavior, lead to the opportunity for CMF marketing to shape infant feeding, and ultimately to the decision to feed formulas that some mothers were not planning to use and cannot afford.