Commercial Milk Formula Research Articles

Healthcare professionals and commercial milk formula recommendations in the urban Mexican context.

Breastfeeding (BF) is considered an essential component of optimal care for child health and development. In the past two decades, global data have shown improvements in some, but not all, BF indicators. Despite these positive changes sales and per capita intake of commercial milk formula (CMF) have increased globally. The CMF industry invests millions of dollars in marketing, which targets families and healthcare professionals (HCP). In Mexico, more than half of the mothers (53%) who feed their infants with CMF chose their Brand on the recommendation of HCP. Understanding the reasons behind the current recommendations for the use of CMF by HCP is important for the design of BF interventions. The primary objective of this study was to explore Mexican HCP' beliefs, attitudes, perceptions, and practices about early infant feeding practices, and reasons for recommending CMF. The secondary objective was to explore pregnant women and mother's perceptions of the infant feeding recommendations they received from HCP, and of the factors that influenced their infant feeding decisions. The study was based on a secondary qualitative data analysis of a WHO/UNICEF multi-country study. We analyzed focus group discussions (FGDs) and in-depth interviews (IDIs) from Mexico. Data were collected through convenience sampling in Mexico City and Guadalajara. HCP (n = 34) analysis was based on IDIs, and pregnant women or mothers of children 0-18 months (n = 74) on FGDs and IDIs. Through a thematic analysis, we identified the socioecology of BF and triangulated HCP and women's accounts. HCP, pregnant women, and mothers recognized that several factors might have influenced their infant feeding decisions including healthcare facilities' policies and maternal work conditions. Although HCP believed that BF is the best way to feed newborns and young children, they routinely recommended CMF. On the other hand, pregnant women and mothers had a strong belief that BF is the best way to feed their babies. However, when women sought support from HCP, the latter often recommended switching to CMF. This study highlights the discordance between HCP perceptions and mothers' experiences of HCP recommendations about infant feeding. Our findings support a national call for policy actions.

How the marketing practices of commercial milk formula companies impact infant breastfeeding practices in China

BackgroundThe marketing practices used by commercial milk formula (CMF) companies undermine breast feeding. However, it remains unclear how specific types of marketing practices result in suboptimal breast feeding.ObjectivesWe aimed to...

The impact of the international code of marketing of breast-milk substitutes in Ghana and Tanzania

Abstract Background Measures that promote and protect breastfeeding have a major impact on child survival rates, as it was estimated that increasing breastfeeding rates can reduce child mortality by 13% in Africa. The International Code of Marketing of Breast-Milk Substitutes is an important measure to protect and promote breastfeeding and the safe use of commercial milk formulas. Ghana and Tanzania adopted measures that are substantially aligned with the Code into national legislation in 2000 and 1994, respectively. Methods In this study, we estimate the effects of the Code implementation through national laws on child mortality in Ghana and Tanzania by using the synthetic control group method and performing placebo tests to assess statistical inference. The main outcome is the effect of the national laws on overall child mortality and secondary outcomes are the effect of the laws on child mortality by lower respiratory infections and diarrhea in both countries. Results Two-sided inference tests showed a statistically significant treatment effect for deaths by lower respiratory infections in Ghana (p = 0.0476; LTE = - 0.8423) and one-sided inference tests showed statistically significant treatment effects for deaths by lower respiratory infections in Ghana (p = 0.0476; LTE = -0.8423) and Tanzania (p = 0.0476; LTE = - 5.1627), and for diarrhea in Tanzania (p = 0.0476; LTE = - 8.1694). To corroborate our results, we also performed the analysis for two major causes of child mortality that are not affected by the intervention, namely congenital diseases and birth asphyxia and trauma birth, for which we did not find significant treatment effects. Conclusions The results demonstrate that the Code had a potentially beneficial impact on child mortality in Ghana and Tanzania and corroborate previous research that the Code is a necessary but insufficient step to alone improve child health outcomes. Key messages • The results show that the implementation of the Code had a potentially beneficial impact on child mortality in Ghana and Tanzania. • Policymakers should consider implementing or strengthening the Code within countries in order to improve child and health outcomes.

Law matters - assessment of country-level code implementation and sales of breastmilk substitutes in South Asia.

This study examines the status of implementation of the International Code of Marketing of Breast-milk Substitutes of eight countries in the South Asia region (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka), and describes the sales value and volume of commercial milk formula (CMF) marketed as breastmilk substitutes (BMS) and baby food in four countries (Bangladesh, India, Pakistan, and Sri Lanka). A mix of descriptive methods is used to assess national status of Code implementation, including a desk review of the 2022 WHO/UNICEF/IBFAN Code Status Report, systematic content analysis of national Code measures, and insights generated from the participation of key government and UNICEF/WHO actors in a regional workshop that aimed to identify each country's barriers, gaps, and the status of Code implementation. Data on the sales value and volume of CMF and baby food between 2007 to 2021 and with the prediction to 2026 in Bangladesh, India, Pakistan, and Sri Lanka were obtained from Global Data. There are major gaps in Code implementation in countries even with legal measures considered substantially aligned with the Code, such as the inadequate age range of CMF covered in the scope, insufficient safeguards against conflicts of interest in the health system, lack of warning of risks of intrinsic contamination of powdered milk formula, and an absence of effective monitoring and enforcement mechanisms. Data on CMF sales shows health facilities and pharmacies sustain the highest sales. Lower sales volume of infant formula (including special formula), compared to other CMF such as follow-up formula and growing-up milk, has been observed in three of the four countries (Bangladesh, India, and Sri Lanka). Overall, GUM, followed by baby cereals, accounted for a large portion of CMF and baby foods sales in the same three countries. (1) Closing the gaps between national measures and the Code, (2) Ensuring effective monitoring and enforcement mechanisms, (3) Strengthening conflicts of interest safeguards in the health system, (4) Tackling digital marketing, and (5) Galvanizing political support and support from in-country public health and women's rights jurist networks.

Breastfeeding and infant care as 'sexed' care work: reconsideration of the three Rs to enable women's rights, economic empowerment, nutrition and health.

Women's lifelong health and nutrition status is intricately related to their reproductive history, including the number and spacing of their pregnancies and births, and for how long and how intensively they breastfeed their children. In turn, women's reproductive biology is closely linked to their social roles and situation, including regarding economic disadvantage and disproportionate unpaid work. Recognizing, as well as reducing and redistributing women's care and domestic work (known as the 'Three Rs'), is an established framework for addressing women's inequitable unpaid care work. However, the care work of breastfeeding presents a dilemma, and is even a divisive issue, for advocates of women's empowerment, because reducing breastfeeding and replacing it with commercial milk formula risks harming women's and children's health. It is therefore necessary for the interaction between women's reproductive biology and infant care role to be recognized in order to support women's human rights and enable governments to implement economic, employment and other policies to empower women. In this paper, we argue that breastfeeding-like childbirth-is reproductive work that should not be reduced and cannot sensibly be directly redistributed to fathers or others. Rather, we contend that the Three Rs agenda should be reconceptualized to isolate breastfeeding as 'sexed' care work that should be supported rather than reduced with action taken to avoid undermining breastfeeding. This means that initiatives toward gender equality should be assessed against their impact on women's ability to breastfeed. With this reconceptualization, adjustments are also needed to key global economic institutions and national statistical systems to appropriately recognize the value of this work. Additional structural supports such as maternity protection and childcare are needed to ensure that childbearing and breastfeeding do not disadvantage women amidst efforts to reduce gender pay gaps and gender economic inequality. Distinct policy interventions are also required to facilitate fathers' engagement in enabling and supporting breastfeeding through sharing the other unpaid care work associated with parents' time-consuming care responsibilities, for both infants and young children and related household work.

Commercial milk formula marketing following increased restrictions in Singapore: A qualitative study.

The promotion of commercial milk formula (CMF) negatively impacts breastfeeding outcomes. In 2019, Singapore updated its 1979 Code of Ethics of the Sale of Infant Foods Ethics Committee Singapore (SIFECS) to increase marketing restrictions on CMF for infants 0-12 months. However, little is known about industry tactics to undermine these restrictions. This qualitative study explores health workers' and mothers' experiences with CMF marketing in Singapore following the 2019 restrictions. We conducted a qualitative study, using semistructured interviews with 14 mothers of infants aged less than 5 months and 20 health workers with expertise in antenatal, maternity, or paediatric care. We analysed data thematically using inductive coding. Five themes were identified. Mothers and health workers reported digital marketing, product line extensions with toddlers' milk and milk for mothers, and CMF sponsorships in the healthcare setting. Expert endorsement, competitive price, nutritional claims, and brand reputation influenced mothers' infant formula choices, yet both mothers and health workers appeared to be unaware of the impact of CMF marketing tactics on their own perceptions. The restriction of CMF marketing and infant feeding practices varied widely between hospitals, with private hospitals and practices having less strict controls on CMF marketing. Despite the updated SIFECS restrictions, CMF companies continue to target mothers and health workers in Singapore. SIFECS restrictions should be tightened to align with international guidelines, by increasing their scope to include toddlers' milk and prohibiting cross-promotion, digital marketing, and any sponsorships of events targeting health workers that may create a conflict of interest.

Global lessons for strengthening breastfeeding as a key pillar of food security.

Breastfeeding is identified as a central pillar of food security by the World Health Organization, however globally significant challenges remain in achieving breastfeeding targets for early initiation, exclusive breastfeeding for 6 months, and continued breastfeeding for 2 years and beyond. Inadequate support in health systems, poor maternity protections and workplace policies, and insufficient regulation of commercial milk formulas, among other barriers, continue to undermine this key pillar across nations. This paper highlights the central importance of breastfeeding for food security across diverse global settings by examining three case studies: Honduras, Pakistan and the USA. The cases highlight the complex layering and intersections of key challenges that threaten breastfeeding in the era of pandemics, the climate crisis, conflict and global inequality. Lessons drawn from these case studies, combined with additional insights, reinforce the importance of multisectorial collaboration to scale up investment in creating equitable, enabling environments for breastfeeding. These structural and systems approaches can successfully strengthen the breastfeeding ecosystem to ensure greater first food system resilience in the face of global crises, which compound maternal and infant vulnerabilities. Additionally, the cases add urgency for greater attention to prioritizing breastfeeding and incorporating IYCF-E protocols into disaster preparedness and management into the policy agenda, as well as ensuring that first food security is considered in energy policy. An integrated approach to policy change is necessary to recognize and strengthen breastfeeding as a pivotal part of ensuring food security across the globe.

Perceived influence of commercial milk formula labelling on mothers’ feeding choices in Great Britain: a qualitative study

ObjectiveTo understand how mothers use commercial milk formula (CMF) labels to inform their feeding choices and explore mothers’ understanding of differences between CMF products.DesignQualitative study with recruitment via social media....

Violations of the Code in Argentina: analysis of promotions, advertising and labeling of commercial milk formula and complementary foods products

Breastfeeding has unique benefits for the child and the mother, and its decline may be one of the most significant mass phenomena in infant feeding. While there are several causes, standing out among them is the marketing practices of commercial milk formula (CMF) and commercial complementary foods (CCF). This descriptive cross-sectional study was conducted using qualitative and quantitative methodology, between August 2018 and August 2020. Regarding the promotion, advertising and labeling of CMF and CCF, none of the companies in Argentina at the time complied with the International Code of Marketing of Breast-milk Substitutes or the related laws in force in the country. The multiple forms of violation found emphasize the need to establish and strengthen monitoring and enforcement mechanisms to curb abuses by the CMF and CCF industry in Argentina, safeguarding the rights of mothers, families, and their newborns. Likewise, the Government must lead the political process and adapt its regulatory framework in terms of transparency and conflict of interest, as well as generate comprehensive and intersectoral public policies on the protection of breastfeeding.

Innovative financing for a gender-equitable first-food system to mitigate greenhouse gas impacts of commercial milk formula: investing in breastfeeding as a carbon offset

Women’s contributions to food production and food security are often overlooked, thus perpetuating inequitable and unsustainable globalized commercial food systems. Women’s role as producers in the first-food system, breastfeeding, is largely invisible and underfunded, encouraging the production and consumption of environmentally unsustainable commercial milk formula (CMF). This policy brief highlights opportunities for including and funding interventions enabling breastfeeding under carbon offset schemes such as the United Nations Clean Development Mechanism (CDM). A Green Feeding Tool is being developed to account for the national carbon and water footprints of CMF. The tool will help ensure that women’s contributions to a sustainable first-food system are not ignored by the CDM and other mechanisms funding greenhouse gas emissions reductions.

The financial need of feeding infants for the first six months of life in West Java Province of Indonesia and the implications of socioeconomic and mental health factors

BackgroundIn Indonesia, nearly half of all children aged less than six months were not exclusively breastfed in 2017. This study aimed to compare the cost of providing direct or indirect exclusive breastfeeding 0–6 months, partial exclusive breastfeeding and commercial milk formula only. This study also assessed the maternal socioeconomic and mental health factors to providing exclusive breastfeeding.MethodsData were collected in 2018 via a cross-sectional survey of 456 mothers in Bandung City and Purwakarta District, West Java Province, Indonesia, who had children aged less than six months. We used micro-costing to calculate the cost of productivity, equipment, supplies, and training of mothers when providing direct exclusive breastfeeding, indirect exclusive breastfeeding, partial exclusive breastfeeding (a mix of breastfeed and commercial milk formula), and infant formula/commercial milk formula only. Logistic regression was used to determine the impact of several independent variables, including mother’s level of depression, on exclusive breastfeeding.ResultsTo provide direct exclusive breastfeeding, the cost per mother in the first six months is US$81.08, which is less expensive than indirect exclusive breastfeeding (US$171.15), partial exclusive breastfeeding (US$487.8) and commercial milk formula (US$494.9). We also found that education and age are associated with the decision to provide direct exclusive breastfeeding. Mothers who work will most likely provide indirect exclusive breastfeeding, commercial milk formula, or partial breastfeeding as opposed to direct exclusive breastfeeding. Finally, although severe depression symptoms have a positive relationship with the decision to provide commercial milk formula over direct exclusive breastfeeding, the evidence here is not strong.ConclusionsThe total cost of providing only commercial milk formula is 6-times higher than the cost of direct exclusive breastfeeding. The presence of severe depression symptoms is positively related to mothers opting for other feeding methods aside of direct exclusive breastfeeding and indirect exclusive breastfeeding. This study shows that direct exclusive breastfeeding is economically preferable to other methods, supports policies to reduce the time cost of exclusive breastfeeding (e.g., paid maternity leave and maternal cash transfers), and addresses the importance of mother’s mental health to ensure successful breastfeeding.

Marketing of commercial milk formula during COVID-19 in Indonesia.

Baby food marketing poses a substantial barrier to breastfeeding, which adversely affects mothers' and children's health. Over the last decade, the baby food industry has utilised various marketing tactics in Indonesia, including direct marketing to mothers and promoting products in public spaces and within the healthcare system. This study examined the marketing of commercial milk formula (CMF) and other breast-milk substitute products during the COVID-19 pandemic in Indonesia. Using a local, community-based reporting platform, information on publicly reported violations of the International Code of Marketing of Breast-milk Substitutes and subsequent World Health Assembly resolutions (the Code) was collected. It was found that a total of 889 reported cases of unethical marketing of such products were recorded primarily through social media from May 20 through December 31, 2021. Our results suggest that the COVID-19 pandemic has provided more opportunities for the baby food industry in Indonesia to attempt to circumvent the Code aggressively through online marketing strategies. These aggressive marketing activities include online advertisements, maternal child health and nutrition webinars, Instagram sessions with experts, and heavy engagement of health professionals and social media influencers. Moreover, product donations and assistance with COVID-19 vaccination services were commonly used to create a positive image of the baby food industry in violation of the Code. Therefore, there is an urgent need to regulate the online marketing of milk formula and all food and beverage products for children under the age of 3.

Cross-sectional multimedia audit reveals a multinational commercial milk formula industry circumventing the Philippine Milk Code with misinformation, manipulation, and cross-promotion campaigns.

The Philippine Milk Code was enacted in 1986 to protect breastfeeding and reduce inappropriate marketing of breastmilk substitutes (BMS). The Philippine Milk Code is categorized as "substantially aligned" with the International Code of Marketing of Breast-milk Substitutes ("the Code"), but its provisions are assessed as relatively weak in prohibiting promotion to the general public. The extent to which violations of the Philippine Milk Code persist in traditional media platforms and in the digital space has not been systematically explored. This study employed a cross-sectional multimedia audit to examine the marketing and promotion of products under the scope of the Code, as well as those regulated by the Philippine Milk Code. Through a media monitoring conducted from March to September 2018, a total of 430 unique television (n = 32), printed (n = 87) and online (n = 311) promotional materials were identified. A coding tool was used to analyze the content, including the marketing elements used in the materials. Our findings show that commercial milk formula (CMF) for children ≥36 months old was the most promoted type of product (n = 251); and staging of events (n = 211), provision of special discounts or financial inducements (n = 115) and the use of taglines (n = 112) were the most used marketing elements. Promotion of CMF for children <36 months old was uncommon, which supports the conclusion that there is broad compliance with the Philippine Milk Code in terms of the types of products promoted. However, analysis of marketing elements reveals that the CMF industry circumvents the Philippine Milk Code through the use of false and misleading health and nutrition claims, emotionally manipulative language in promotional materials, and cross-promotion. The findings indicate gaps in enforcement and regulatory measures that require urgent attention.

Stemming commercial milk formula marketing: now is the time for radical transformation to build resilience for breastfeeding

Stemming commercial milk formula marketing: now is the time for radical transformation to build resilience for breastfeeding

Digital marketing of commercial breastmilk substitutes and baby foods: strategies, and recommendations for its regulation in Mexico

BackgroundParents are exposed to breastmilk substitutes and baby foods marketing on the internet and social media, which hinders adequate breastfeeding and complementary feeding. This study identifies digital marketing strategies for breastmilk substitutes, specifically commercial milk formula and baby foods used by the industry to influence infant and young children’s feeding practices in Mexico and proposes regulatory recommendations that can be useful for similar countries.MethodsQualitative study based on the CLICK monitoring framework developed by the World Health Organization, adapted for digital marketing of commercial milk formula and baby foods. Semi-structured interviews (n = 53) with key actors were conducted between November 2020 and March 2021, and used grounded theory for the analysis and interpretation with the MAXQDA 20 software.ResultsCommercial milk formula and baby food companies use digital media to contact and persuade parents to use their products by sending electronic newsletters with advertising. Companies hire influencers to market their products because there is no regulation prohibiting the advertisement of breastmilk substitutes on social media, and promote formula among health professionals inviting them to participate in sponsored webinars on infant nutrition, ignoring conflict of interest and the International Code of Marketing of Breastmilk Substitutes. Parents trust formula and baby food advertisements, which use emotional messages and health and nutrition claims to encourage their consumption. Health professionals consider that claims contribute to the indiscriminate use of formula, and some actors propose the use of plain packaging for these products.ConclusionsBreastmilk substitutes companies promote their products in digital media using unethical strategies that fail to comply with the International Code of Marketing of Breastmilk Substitutes. They generate strong conflicts of interest with health professionals, taking advantage of legal framework gaps and the lack of monitoring and effective sanctions for non-compliers. Updating the legal framework and monitoring compliance, including digital media, is urgently needed to protect children’s right to breastfeeding, healthy nutrition and life, and the rights of women to health and informed decision-making.

Babies before bottom lines: A call for Australia to end exploitative marketing of commercial milk formula at home and abroad

Babies before bottom lines: A call for Australia to end exploitative marketing of commercial milk formula at home and abroad

Racial capitalism and the US formula shortage: A policy analysis of the formula industry as a neocolonial system.

The U.S. is currently experiencing a formula shortage and an infant feeding crisis that began with a formula recall and the hospitalization of 4 infants, 2 of whom died. Since 1981, governments around the world have been calling for an end to blatant human rights violations made by the commercial milk formula (CMF) industry. These practices not only involve targeting nutritionally vulnerable populations of mothers and newborns to turn a profit, but also actively undermining the implementation of policies, legislation, and regulatory oversight that might compromise their accumulation of wealth. In this paper we analyze the 2022 formula-shortage-as-infant-feeding-crisis through the lens of the history of colonialism and critical theory in the anthropology of reproduction. First, we provide an overview of the colonial roots of the formula industry from a global perspective. We then focus on how the mechanisms of racial exploitation remain entrenched in the U.S. approach to infant feeding policies, regulation and investment, setting the stage for the current infant feeding crisis. Through our analysis of the 2022 infant feeding crisis we demonstrate how the multinational CMF industry perpetuates racial capitalism and racialized health inequities and disparities through its operations as a neocolonial enterprise. Finally, we offer policy interventions and potential solutions that are grounded in structural interventions for more equitable, anticolonial, antiracist infant feeding systems.

On the influence of the source of porcine colostrum in the development of early immune ontogeny in piglets

The effects on the ontogeny of serum cytokines and immune cells caused by feeding suckling piglets with sow/gilt colostrum and milk replacer was assessed in the present study. After farrowing, the piglets born were randomized into six groups: GG and SS (n = 10/group): piglets were kept with their dam; GS (n = 10): piglets were changed from gilts to sows; SG (n = 10): piglets were changed from sows to gilts; GMR (n = 6) and SMR (n = 8): piglets from either gilts or sows were isolated from the dams and were bottle-fed ad libitum with commercial formula milk replacer. The piglets remained in the groups during the first 24 h of life and were later returned to their respective mothers. Serum immunoglobulin concentration and lymphocyte proliferation from the blood, spleen, thymus, and mesenteric lymph node of the piglets were assessed at 24 h and at 28 days of age. Serum cytokine concentrations were measured through a cytokine multiplex assay at 24 h. Overall, piglets suckling on sows (SS and GS) had a higher concentration of serum immunoglobulin at 24 h, which was also associated with a rise in plasma cytokine concentration and greater ability of B and T cells from lymphatic organs and blood mononuclear cells to respond to mitogens. We suggest a bias towards Th1-, Th2-, and Th17-cell polarizing and cytokines during the suckling period, which may be influenced by maternal immunological factors in the colostrum, such as dam parity. All findings suggest sow parity having a possible role, which may contribute to exerting a modulating action on immune response development.

Effect of baby food marketing exposure on infant and young child feeding regimes in Bangkok, Thailand

BackgroundBaby food marketing undermines breastfeeding by influencing women’s attitudes and decision-making favourably toward commercial baby food. This study aimed to explore the effects of various baby food marketing techniques on Thai mothers’ opinions about commercial milk formulas (CMF) and commercial complementary foods (CCF) and their infant and young child feeding behaviours.MethodsThis study used a cross-sectional survey employing the World Health Organization (WHO) NetCode Toolkit Protocol for Periodic Assessment, and the United Nations International Children’s Emergency Fund (UNICEF) Multiple Indicator Cluster Survey to collect data on mothers’ experience with and their opinion on the various types of marketing of CMF and CCF, and their feeding behaviour. Data collection used structured interviews of mothers with children aged two years or below attending 33 health facilities in Bangkok. Univariable and multivariable regression analysis then investigated links between mothers’ reported exposure to baby food marketing and their infant and young child feeding behaviours, employing a semantic scale and considering key sociodemographic and other variables.ResultsThree hundred and thirty mothers were surveyed in Bangkok. Around 90% reported experiencing exposure to at least one type of baby food marketing during the previous six months, mostly from electronic media. More than half of the women had positive opinions of CMF. Virtually all children had been breastfed initially, but 74.6% were given CMF and 72.8% stopped breastfeeding before six months. Multivariable analysis showed that mothers who lived in a couple were significantly less likely to favour CMF, and mothers in middle-income households and those who had received advice about CMF from others were more likely to have a favourable opinion. Mothers in formal employment were over six times more likely to feed formula than those not in employment. Women who experienced baby food marketing at health facilities were four times more likely to feed CMF to their children than those not experiencing such marketing.ConclusionsSpecific types of baby food marketing were strongly linked to mothers’ opinions on and use of CMF in Bangkok, Thailand. It is recommended that breastfeeding policies in health facilities and employment are fully implemented and enforced.

Overcoming barriers to breastfeeding.

Breastfeeding is the evolved human infant feeding norm, practiced historically and across cultures. Over the past 200 years, breastfeeding practices have eroded, reaching a nadir in the middle of the 20th century. Mobilization from grassroots social movements, with support from public health and medicine, has yielded a substantial rise in overall breastfeeding prevalence. However, timely initiation, exclusive breastfeeding, and duration of breastfeeding still lag behind global targets. Inadequate breastfeeding leads to substantial morbidity and approximately 600,000 child deaths and an additional 100,000 maternal deaths annually. Most women and pregnant people are physiologically able and desire to breastfeed, however, they face substantial barriers. Effective interventions address health systems, workplace policies, and engage communities and families. However, substantial work remains to implement fully supportive policies across multiple social sectors. Urgent action is needed to limit the pervasive influence of commercial milk formula (CMF) marketing in policy, healthcare, and on families to achieve more equitable outcomes.