Marketing of breastmilk substitutes during the COVID-19 pandemic.

It is of concern that the US$70 billion infant formula industry has been actively exploiting concerns about COVID-19 to increase sales, in violation of the WHO International Code of Marketing of Breast-milk Substitutes (the Code) and national law in many countries.

Globally, infants who are not exclusively breastfed are 14 times more likely to die than infants who are exclusively breastfed. Lockdown measures have diminished household income, and the UN World Food Programme estimates that by the end of 2020, 265 million people may be facing food insecurity,3, 4 making breastfeeding even more important. Public bodies that are independent of industry influence, including WHO5, 6 and the Royal College of Paediatrics and Child Health, have unanimously asserted that no evidence exists to suggest breastfeeding increases the risk of infants contracting COVID-19, and that skin-to-skin contact remains essential for newborn health and maternal health.

By contrast, large manufacturers of breastmilk substitutes have inappropriately positioned themselves as sources of public health expertise, and suggested various unnecessary hygiene measures, the use of expressed breastmilk, and the separation of mothers from their babies. Such recommendations undermine breastfeeding and thus increase the risk of infant death. Baby Milk Action and the International Baby Food Action Network have documented numerous infringements of both the Code and laws associated with COVID-19.

In a recent online survey of 1360 mothers in the UK who had breastfed during the national lockdown in the UK (Brown A, unpublished), 80% reported contact from formula companies, typically on social media, despite the Code forbidding formula manufacturers from directly contacting mothers.

Indian law explicitly forbids contact with mothers and pregnant women for any form of promotion of infant milk substitutes or infant foods. Nevertheless, in April, 2020, Danone (Mumbai, India) facilitated a YouTube channel called VoiceofExperts that advised women with COVID-19 to maintain a distance of at least 6 feet from their infants and to stop breastfeeding until they had been free of fever for more than 72 h and free of other symptoms for at least 7 days and had two negative PCR results. This advice is incompatible with breastfeeding. Danone have since removed many of the videos, having recognised that some of the views did not align with WHO's advice. However, the channel still exists. We contacted Danone about the channel and were told: “Danone facilitated the ‘Voice of Experts’ initiative in India as an exchange between independent medical experts and parents...for guidance about parenting and caregiving during the COVID pandemic, in compliance with our policies and local laws. The views expressed by medical experts in this forum were their own.”

During the COVID-19 pandemic, many companies have donated milk powder and other food to communities in Canada, India, Italy, Pakistan, the Philippines, and the UK, violating both national laws and the WHO Code.

Improved implementation and enforcement of the WHO Code in every country is urgently required, with severe sanctions for any violations.