A new WHO report looking for the first time at the marketing of breastmilk substitutes around the world describes 'systematic and unethical' marketing tactics by formula milk companies. (Photo: silverson.com / Wikipedia) 
International regulations and local laws bar formula companies from marketing directly to parents. Instead, companies are using the people you trust most – healthcare workers – to push their products and side-step regulations … and your nurse might not even know it.
Dr Chris van Tulleken recently bought a new knife sharpener. The University College London lecturer didn’t need one, he admits, but he couldn’t ignore the television advert.
“It said this new knife sharpener makes knives so sharp that, until recently, it was illegal for anyone who wasn’t a professional chef to buy one,” he explains. Van Tulleken was speaking at a recent webinar hosted by the British Medical Journal on Friday.
“It wasn’t until the product arrived at my house and started making my knives a lot less sharp that I started to question,” he continues, eyes narrowing, “whether it was true that chefs needed licences to buy knife sharpeners.”
The irony did not escape him.
Why marketing aimed at healthcare workers matters
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BBC presenter Dr Chris van Tulleken explains why healthcare workers play an influential role in selling infant formula despite its risk.
When most of us think of marketing, we might imagine glossy magazine spreads or blaring radio adverts, but marketing directed at healthcare workers looks different. It can be as small as a free branded pen or free, sponsored breakfast symposium, and as major research funding, often through non-profit organisations aligned with corporations.
In 1981, more than 11 dozen countries, including South Africa, adopted the World Health Organization’s (WHO’s) international code to stop aggressive infant formula marketing that, for decades, targeted poor countries and increased infant and child deaths. The rise in deaths was partly because formula feeding without access to clean water puts babies at an increased risk of deadly diarrheal disease.
South Africa implemented local laws to enforce the code in 2015.
The code and local regulations may ban companies from publicly marketing infant formula or talking directly to parents. Instead, firms look to see how they can influence families through the people they trust most with their children’s health: Healthcare workers.
Your nurse is just another data point in a marketer’s spreadsheet
“Marketers are really good at understanding why you are buying in the first place,” says Katie Gilbert. Gilbert is the managing director at M&C Saatchi World Services, the social marketing arm of the advertising agency M&C Saatchi Group. Gilbert’s firm recently collaborated with the WHO to investigate infant formula marketing.
Early in her career, Gilbert had worked on campaigns selling frozen chips, but even then, she knew it wasn’t about the spuds.
“People aren’t buying frozen chips — they are buying happy meal times where children don’t grumble because they like what’s on their plate,” she explains. “If you have had a stressed-out day as a mom, a relaxing, peaceful mealtime is what you’re looking for.”
Why people buy a product is, in marketing science, one of five “category entry points” — or the reasons or situations that drive why we buy what we do.
Category entry points boil down to "why" we buy, “when” consumers buy a product, “where” they buy it, “with whom” they buy it and “with what” other products they might buy an item with.
And healthcare workers, she says, are a valuable category entry point because families trust their advice on infant feeding — and because new parents are vulnerable when they meet them.
“One of the most acutely vulnerable moments for parents is in the hospital post-birth,” she says. “Parents are tired and exhausted — first-time parents haven’t done this before … that’s a really stressful moment.”
Gilbert says if brands can get new parents to associate their infant formula products with easing that stress, that’s enough to get them hooked. And it’s also a brilliant sales strategy for another reason, she warns:
“If companies can get a mum or dad using formula milk in the first couple of days, that’s far more likely to disrupt milk supply, which makes breastfeeding difficult to do and therefore creates a need for their product.”
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/file/dailymaverick/wp-content/uploads/2022/09/MC-Formula-Milk_2-Breastfeeding-in-South-Africa-graphic.jpg "South African breastfeeding rates remain low, in part because the country lacks policies that support families in breastfeeding, including paid parental leave. Emerging research shows that rising rates of hunger may also deter women from being able to breastfeed exclusively.")