Formula milk surrogate marketing blamed for sharp decline in exclusive breastfeeding rates

Public health experts say surrogate marketing by commercial milk formula companies is contributing to declining exclusive breastfeeding rates in India. Despite strict advertising restrictions under the IMS Act, indirect promotions through doctors, influencers and digital campaigns are influencing parents' feeding decisions.

Hyderabad: Breastfeeding infants continues to remain the gold standard for nutritional and immunological protection. And yet, the overall Exclusive Breastfeeding (EBF) rate for the first six months of an infant in the country has seen a sharp decline, dropping from 63.7 per cent in NFHS-5 to 55.8 per cent in the latest NFHS-6 data.

Public health experts and activists blame the sophisticated web of ‘surrogate marketing’, a tactical workaround that has fuelled the surge in the sales of commercial milk formula (CMF) for the pharma giants and a drop in breastfeeding rates.

---

The Infant Milk Substitutes, Feeding Bottles, and Infant Foods (IMS) Act in India prohibits direct advertising of infant formula. Companies in India are legally barred from overt product promotions. However, the industry has now embraced the ‘soft sell’ approach to bypass the regulations.

Corporations are increasingly adopting indirect digital campaigns and strategic, high-profile partnerships to promote CMF brands, a senior doctor here said.

Just a few years ago, The Lancet carried a three-paper series highlighting the way CMFs are promoted by pharma companies.

“The CMF industry has used underhanded marketing strategies, designed to prey on parents’ fears and concerns at a vulnerable time, to turn the feeding of young children into a multibillion-dollar business.

The immense economic power accrued by CMF manufacturers is deployed politically to ensure the industry is under-regulated and services supporting breastfeeding are under-resourced,” The Lancet findings on Breastfeeding Series in 2023 said.

The pharma giants have come up with unique indirect ways to promote commercial milk replacements. By funding ‘expert panels’ consisting of prominent pediatricians and engaging high-profile social media influencers, manufacturers are embedding their brand identity into the very advice parents receive during their most vulnerable moments.

The ‘educational’ content is rarely recognised as advertising; instead, it is packaged as scientific guidance on ‘child wellness’, allowing brands to remain top-of-mind for parents without ever explicitly airing a commercial.

“Surrogate marketing for formula milk is the ”in thing” now. That’s how they are circumventing the loopholes in the IMS Act. Mostly pediatricians and celebrities for sure. Including some pediatricians who appear on national media and prominent social media channels,” says a senior pediatrician from Hyderabad, Dr Sivaranjani Santosh.

Senior doctors point out that when trusted medical professionals or popular parenting influencers subtly align their recommendations with corporate imagery, the line between objective medical advice and commercial influence gets blurred.

“For a new mother, who recently underwent a C-section and is recovering, such ‘expert-led’ messaging can make formula milk appear as a modern, scientific, and convenient solution to the challenges of breastfeeding. As a result, new mothers give up breastfeeding quickly,” doctors said.

Infant Nutrition

* Surrogate promotion of Commercial Milk Formula (CMF) is on the rise

* CMF sales have surged in the country in the last few years

* Social media campaigns, high-profile influencers, and doctors promote brands related to CMF indirectly

* Corporate-funded conferences, workshops, and training sessions for pediatrics and dietitians

* Such brands invited prominent pediatricians to join advisory boards and expert panels

* CMF brands often host educational webinars or create training modules for caregivers, thus building the brand image