Digital Marketing of Breastmilk Substitutes: How Social Media and Influencer Marketing Undermine Informed Choice

"The manipulation of parental vulnerabilities through social media and influencer marketing raises significant ethical and public health concerns. Parents deserve the right to make informed decisions without commercial influence."

This report, published by Save the Children, investigates the latest strategies deployed by the breastmilk substitute (BMS) industry in digital marketing, specifically focusing on social media platforms. It also assesses social media marketers' adherence to the International Code of Marketing of Breastmilk Substitutes (the Code). The report is based on a scoping review of 12 peer-reviewed scientific research articles published between 2020 and 2023 that documented various types of social media and influencer marketing.

As explained in the report, "Breastfeeding is widely recognized as the best source of nutrition for infants, providing significant benefits to both the infant and mother. However, the use of infant formula has become increasingly common on a global scale, largely due to powerful marketing strategies employed by the formula industry... Despite the efforts of many international organizations working to protect and promote breastfeeding, advertising of infant formula remains widespread and effective, due to sophisticated marketing techniques that indirectly promote the formula. Driven solely by commercial interests and financial gains, BMS companies consistently disregard the regulations of the Code in their relentless pursuit of increased sales." Digital marketing in particular, which includes platforms like websites, social media, email, search engines, and mobile apps, has provided BMS companies with unique ways to connect with their intended audience in a more personalised manner, allowing them to more effectively engage with consumers and influence their purchasing decisions.

This scoping review was conducted to examine these digital marketing strategies more closely. It identified inappropriate marketing practices on social media platforms across 18 countries and found 5,183 instances of digital marketing that violated the Code. These violations were categorised by their specific marketing strategies and linked to corresponding provisions within the Code that prohibit such practices.

The results illustrate how social media and influencer marketing of BMS influences parents' informed choice. The review found that the BMS industry uses social media marketing strategies prohibited by the Code, such as initiating direct contact with mothers, providing educational materials through sponsored healthcare professionals, and making unsubstantiated health and nutrition claims. The following illustrates the distribution of different BMS marketing strategies and violations found in the review:
 

• Images and text idealising formula use, absence of required statements: 15%
• Influencer and mommy influencer marketing, celebrity endorsement: 12%
• Provision of educational material: 16%
• Health and nutrition claims: 5%
• Promotion to the general public, advertisement, product range: 12%
• Promotions, mechanisms for sale: offering coupons, discounts, free samples and gifts: 19%
• Initiation of direct contact and engagement building: 21%

The report highlights in particular the use of influencers and mommy influencers as a marketing strategy, which poses a significant challenge for promoting breastfeeding, as BMS companies leverage the special, intimate, trusting relationship between influencers and their audience to portray BMS as a convenient and simple solution for addressing challenges related to infant feeding.

The report concludes with several recommendations on how to strengthen the protection of
breastfeeding and parents' informed choice from social media marketing: 
 

• Strengthen national legislation on social media marketing: The Code must be strengthened through the adoption of a new resolution on digital marketing (drawing on the World Health Organization (WHO) 2023 Guidance on Regulatory Measures Aimed at Restricting Digital Marketing of Breast-milk Substitutes), and governments should also update their national legislation to include regulations on social media marketing.
• Develop technology for monitoring of violations: Governments should prioritise the integration of modern technologies into their national strategies to effectively monitor the digital marketing of BMS.
• Develop research tools to collect and analyse evidence of new forms social media marketing: The research community would greatly benefit from updated tools to effectively collect and evaluate evidence regarding social media marketing of BMS.

Click here for a 1-page summary of the report in PDF format.