Victoria Sibson, Marko Kerac, Robert Boyle, Amandine Garde, Andrea Gideon, Shereen Fisher, Catherine Pereira-Kotze
{"title":"Prioritising Profits Over Public Health? Why UK Commercial Milk Formula Marketing Regulations Need to be Strengthened and Enforced, Not Weakened","authors":"Victoria Sibson, Marko Kerac, Robert Boyle, Amandine Garde, Andrea Gideon, Shereen Fisher, Catherine Pereira-Kotze","doi":"10.1111/mcn.70002","DOIUrl":null,"url":null,"abstract":"<p>Current UK public health recommendations for feeding in the first years of life align with those of the World Health Organization and recognise breastfeeding as optimal for infant and maternal health. Exclusive breastfeeding for the first 6 months is therefore recommended, and so is continued breastfeeding, alongside a diet of appropriate, nutritious complementary foods, to 2 years and beyond (SACN <span>2018</span>; World Health Organization [WHO] <span>2023a</span>). Beyond health benefits, breastfeeding also has environmental and climate benefits (Joffe et al. <span>2019</span>).</p><p>Most UK women want to breastfeed (McAndrew et al. <span>2012</span>), and most start breastfeeding (NHS Digital <span>2024</span>). However, too few receive the support they need to meet their breastfeeding goals (McAndrew et al. <span>2012</span>). One major factor undermining their efforts is aggressive and misleading marketing of breastmilk substitutes (including commercial milk formulas, bottles and teats) (World Health Organization [WHO] and the United Nations Children's Fund (UNICEF) <span>2022</span>; Rollins et al. <span>2023</span>). Such marketing contributes to the widespread use of commercial milk formulas in the first weeks and months of life for most UK infants (NHS Digital <span>2024</span>). This is unfortunate: whilst infant formula is safe and suitable to support adequate growth and development, it cannot match full health benefits of breastfeeding (NHS <span>2023</span>). Other commercial milk formulas are unnecessary for healthy children (NHS <span>2023</span>; Sibson and Westland <span>2024</span>; Childs et al. <span>2024</span>). Effective controls on the marketing of all commercial milk formulas are thus necessary to ensure women and families can make properly informed, independent decisions on how they feed their babies and young children, protected from undue commercial influence.</p><p>Kamata and others have exposed the shockingly poor compliance of commercial milk formula companies with UK marketing regulations on the labelling of infant and follow-on formula (Kamata et al. <span>2025</span>). This is happening despite clear guidance from the Department of Health and Social Care (Department of Health and Social Care [DHSC] <span>2024</span>) and even though these domestic regulations are already less stringent than the international minimum standards outlined in ‘the Code’ (World Health Organization [WHO] <span>2022</span>). Formula companies exploit weaknesses in the UK's overburdened and under resourced enforcement system (Conway et al. <span>2023</span>; Baby Feeding Law Group [BFLG-UK] <span>2025</span>) to maximise their sales, whilst undermining breastfeeding as well as safe and appropriate formula feeding (UNICEF <span>2024</span>). Whilst companies benefit from the current regulatory environment, the taxpayer is ultimately burdened with the long-term costs of poor health outcomes that arise from suboptimal infant and young feeding.</p><p>Kamata's work was done well before the 19 February 2025 statutory deadline by which the UK Government watchdog, the Competition and Markets Authority (CMA), is due to publish the results of a ‘market study’ into the UK's infant and follow-on formula market (CMA <span>2024a</span>). Using its powers to request disclosure, the CMA has obtained market data from formula companies and retailers to accurately describe the current structure of the UK infant and follow-on formula market and consider possibilities for “how to drive better market outcomes for parents and carers” (CMA <span>2024b</span>).</p><p>The CMA ‘interim report’ published in November 2024 shows how the commercial milk formula market in the UK has become hyper concentrated, being dominated by a small number of companies. The CMA has reported limited retail competition, widespread non-compliance with marketing regulations and a disproportionate reliance on brand-building and inaccurate product differentiation by companies in attempts to capture new customers (CMA <span>2024b</span>).</p><p>This CMA market study is also consistent with previous CMA work, which found that ‘big brand’ formula companies were profiteering during the ‘cost of living’ crisis (CMA <span>2023</span>), even if this has meant that infant formula has become unaffordable for some families on low incomes (Haydon and Brindsen <span>2024</span>). This exposé of company profiteering on infant formula was made possible because of price data the UK charity First Steps Nutrition Trust have been collecting, reporting and advocating on since 2018 (All-Party Parliamentary Group on Infant Feeding and Inequalities <span>2018</span>) and which continues to be reported every 6 months (First Steps Nutrition Trust <span>2024</span>).</p><p>The CMA's final market study report will include recommendations to the Government on how to address unjustifiably high infant formula prices which threaten infant health.</p><p>The CMA investigation represents an unprecedented opportunity to fix the myriad problems with the UK's commercial milk formula market to the benefit of parents/carers and ultimately their babies and young children. But in doing so, it is imperative that public health concerns are placed at the centre of the process.</p><p>The CMA's interim report suggests some sound policy solutions, e.g. price controls, standardised product labelling and improved provision of DHSC-approved information to parents. In contrast, the proposal to encourage competition between companies through price promotions is alarming. For non-essential and luxury goods, such promotions can drive demand, sales and brand loyalty. However, for essential goods where need rather than supplier-induced demand should be the main factor driving use, there is clear potential for adverse consequences. Those who would otherwise have chosen—and benefited from—breastfeeding could be encouraged to switch to formula feeding and prematurely stop breastfeeding (Michalopoulou et al. <span>2024</span>). As outlined above, the Code makes clear that usual marketing practices cannot be applied to commercial milk formulas.</p><p>The proposed policy solution to allow price promotions appears particularly misplaced in a context in which the extremely high profit margins of both manufacturers and retailers exposed by the CMA remain unchallenged (Changing Markets Foundation <span>2017</span>). A far simpler way to make infant formula more affordable would be to place limits on businesses' currently large profit margins (Lex <span>2023</span>) so forcing a reduction in marketing spend. Even moderate controls would leave a healthy profit margin for businesses, but without the risks to public health that company-led pricing causes.</p><p>Victoria Sibson wrote the first draft of the editorial. All authors contributed, reviewed, and approved the final version.</p><p>Victoria Sibson and Catherine Pereira-Kotze declare paid employment by First Steps Nutrition Trust, and Marko Kerac declares being a Trustee of First Steps Nutrition Trust. Robert Boyle declares payment from Wiley and the British Society for Allergy and Clinical Immunology for editorial work, from World Health Organization for consultancy, and for expert witness work in food anaphylaxis and infant formula health claim cases. 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引用次数: 0
Abstract
Current UK public health recommendations for feeding in the first years of life align with those of the World Health Organization and recognise breastfeeding as optimal for infant and maternal health. Exclusive breastfeeding for the first 6 months is therefore recommended, and so is continued breastfeeding, alongside a diet of appropriate, nutritious complementary foods, to 2 years and beyond (SACN 2018; World Health Organization [WHO] 2023a). Beyond health benefits, breastfeeding also has environmental and climate benefits (Joffe et al. 2019).
Most UK women want to breastfeed (McAndrew et al. 2012), and most start breastfeeding (NHS Digital 2024). However, too few receive the support they need to meet their breastfeeding goals (McAndrew et al. 2012). One major factor undermining their efforts is aggressive and misleading marketing of breastmilk substitutes (including commercial milk formulas, bottles and teats) (World Health Organization [WHO] and the United Nations Children's Fund (UNICEF) 2022; Rollins et al. 2023). Such marketing contributes to the widespread use of commercial milk formulas in the first weeks and months of life for most UK infants (NHS Digital 2024). This is unfortunate: whilst infant formula is safe and suitable to support adequate growth and development, it cannot match full health benefits of breastfeeding (NHS 2023). Other commercial milk formulas are unnecessary for healthy children (NHS 2023; Sibson and Westland 2024; Childs et al. 2024). Effective controls on the marketing of all commercial milk formulas are thus necessary to ensure women and families can make properly informed, independent decisions on how they feed their babies and young children, protected from undue commercial influence.
Kamata and others have exposed the shockingly poor compliance of commercial milk formula companies with UK marketing regulations on the labelling of infant and follow-on formula (Kamata et al. 2025). This is happening despite clear guidance from the Department of Health and Social Care (Department of Health and Social Care [DHSC] 2024) and even though these domestic regulations are already less stringent than the international minimum standards outlined in ‘the Code’ (World Health Organization [WHO] 2022). Formula companies exploit weaknesses in the UK's overburdened and under resourced enforcement system (Conway et al. 2023; Baby Feeding Law Group [BFLG-UK] 2025) to maximise their sales, whilst undermining breastfeeding as well as safe and appropriate formula feeding (UNICEF 2024). Whilst companies benefit from the current regulatory environment, the taxpayer is ultimately burdened with the long-term costs of poor health outcomes that arise from suboptimal infant and young feeding.
Kamata's work was done well before the 19 February 2025 statutory deadline by which the UK Government watchdog, the Competition and Markets Authority (CMA), is due to publish the results of a ‘market study’ into the UK's infant and follow-on formula market (CMA 2024a). Using its powers to request disclosure, the CMA has obtained market data from formula companies and retailers to accurately describe the current structure of the UK infant and follow-on formula market and consider possibilities for “how to drive better market outcomes for parents and carers” (CMA 2024b).
The CMA ‘interim report’ published in November 2024 shows how the commercial milk formula market in the UK has become hyper concentrated, being dominated by a small number of companies. The CMA has reported limited retail competition, widespread non-compliance with marketing regulations and a disproportionate reliance on brand-building and inaccurate product differentiation by companies in attempts to capture new customers (CMA 2024b).
This CMA market study is also consistent with previous CMA work, which found that ‘big brand’ formula companies were profiteering during the ‘cost of living’ crisis (CMA 2023), even if this has meant that infant formula has become unaffordable for some families on low incomes (Haydon and Brindsen 2024). This exposé of company profiteering on infant formula was made possible because of price data the UK charity First Steps Nutrition Trust have been collecting, reporting and advocating on since 2018 (All-Party Parliamentary Group on Infant Feeding and Inequalities 2018) and which continues to be reported every 6 months (First Steps Nutrition Trust 2024).
The CMA's final market study report will include recommendations to the Government on how to address unjustifiably high infant formula prices which threaten infant health.
The CMA investigation represents an unprecedented opportunity to fix the myriad problems with the UK's commercial milk formula market to the benefit of parents/carers and ultimately their babies and young children. But in doing so, it is imperative that public health concerns are placed at the centre of the process.
The CMA's interim report suggests some sound policy solutions, e.g. price controls, standardised product labelling and improved provision of DHSC-approved information to parents. In contrast, the proposal to encourage competition between companies through price promotions is alarming. For non-essential and luxury goods, such promotions can drive demand, sales and brand loyalty. However, for essential goods where need rather than supplier-induced demand should be the main factor driving use, there is clear potential for adverse consequences. Those who would otherwise have chosen—and benefited from—breastfeeding could be encouraged to switch to formula feeding and prematurely stop breastfeeding (Michalopoulou et al. 2024). As outlined above, the Code makes clear that usual marketing practices cannot be applied to commercial milk formulas.
The proposed policy solution to allow price promotions appears particularly misplaced in a context in which the extremely high profit margins of both manufacturers and retailers exposed by the CMA remain unchallenged (Changing Markets Foundation 2017). A far simpler way to make infant formula more affordable would be to place limits on businesses' currently large profit margins (Lex 2023) so forcing a reduction in marketing spend. Even moderate controls would leave a healthy profit margin for businesses, but without the risks to public health that company-led pricing causes.
Victoria Sibson wrote the first draft of the editorial. All authors contributed, reviewed, and approved the final version.
Victoria Sibson and Catherine Pereira-Kotze declare paid employment by First Steps Nutrition Trust, and Marko Kerac declares being a Trustee of First Steps Nutrition Trust. Robert Boyle declares payment from Wiley and the British Society for Allergy and Clinical Immunology for editorial work, from World Health Organization for consultancy, and for expert witness work in food anaphylaxis and infant formula health claim cases. Other authors declare no conflicts of interest.
目前,英国关于生命最初几年喂养的公共卫生建议与世界卫生组织的建议一致,并承认母乳喂养是婴儿和孕产妇健康的最佳选择。因此,建议头6个月纯母乳喂养,并继续母乳喂养,同时补充适当的营养补充食品,直至2岁及以上(SACN 2018;世界卫生组织[卫生组织]2023a)。除了健康益处之外,母乳喂养还具有环境和气候益处(Joffe et al. 2019)。大多数英国女性想要母乳喂养(McAndrew et al. 2012),大多数人开始母乳喂养(NHS Digital 2024)。然而,很少有人获得了实现母乳喂养目标所需的支持(McAndrew et al. 2012)。破坏其努力的一个主要因素是母乳代用品(包括商业配方奶、奶瓶和奶嘴)的积极和误导性营销(世界卫生组织[世卫组织]和联合国儿童基金会(儿基会),2022年;Rollins et al. 2023)。这种营销有助于在大多数英国婴儿出生后的最初几周和几个月内广泛使用商业配方奶粉(NHS Digital 2024)。这是不幸的:虽然婴儿配方奶粉是安全的,适合支持足够的生长和发育,但它无法与母乳喂养的全部健康益处相提并论(NHS 2023)。其他商业配方奶粉对健康儿童来说是不必要的(NHS 2023;Sibson and Westland 2024;Childs et al. 2024)。因此,有必要对所有商业配方奶粉的营销进行有效控制,以确保妇女和家庭能够在不受不当商业影响的情况下,就如何喂养婴儿和幼儿作出适当的知情和独立的决定。Kamata等人揭露了商业配方奶粉公司对英国婴儿和后续配方奶粉标签营销法规的遵守程度之差令人震惊(Kamata et al. 2025)。尽管卫生和社会保障部(2024年卫生和社会保障部[DHSC])给出了明确的指导,尽管这些国内法规已经不如《守则》(世界卫生组织[世卫组织]2022年)中概述的国际最低标准严格,但这种情况仍在发生。配方奶粉公司利用英国负担过重和资源不足的执法系统的弱点(Conway et al. 2023;婴儿喂养法律小组[BFLG-UK] 2025),以最大限度地提高其销售,同时破坏母乳喂养以及安全和适当的配方喂养(联合国儿童基金会2024)。虽然公司从目前的监管环境中受益,但纳税人最终要承担因婴幼儿喂养不佳而导致的不良健康结果的长期成本。Kamata的工作在2025年2月19日的法定截止日期之前完成得很好,在此之前,英国政府监管机构竞争和市场管理局(CMA)将公布英国婴儿和后续配方奶粉市场的“市场研究”结果(CMA 2024a)。CMA利用其要求披露的权力,从配方奶粉公司和零售商那里获得了市场数据,以准确描述英国婴儿和后续配方奶粉市场的当前结构,并考虑“如何为父母和护理者带来更好的市场结果”的可能性(CMA 2024b)。CMA于2024年11月发布的“中期报告”显示,英国的商业配方奶粉市场已变得高度集中,由少数公司主导。CMA报告称,零售竞争有限,普遍不遵守营销法规,企业在试图吸引新客户时过度依赖品牌建设和不准确的产品差异化(CMA 2024b)。这项CMA市场研究也与之前的CMA工作一致,该研究发现,“大品牌”配方奶粉公司在“生活成本”危机期间暴利(CMA 2023),即使这意味着婴儿配方奶粉对于一些低收入家庭来说已经变得负担不起(Haydon和Brindsen 2024)。由于英国慈善机构第一步营养信托基金自2018年以来一直在收集、报告和倡导价格数据(2018年婴儿喂养和不平等问题全党议会小组),并且每6个月继续报告一次(第一步营养信托基金2024年),因此对婴儿配方奶粉公司暴利行为的曝光成为可能。CMA的最终市场研究报告将包括向政府提出的关于如何解决威胁婴儿健康的不合理的高婴儿配方奶粉价格的建议。CMA的调查代表了一个前所未有的机会来解决英国商业配方奶粉市场的无数问题,以造福父母/照顾者,最终造福他们的婴儿和幼儿。但要做到这一点,必须将公共卫生问题置于这一进程的中心。CMA的中期报告提出了一些合理的政策解决方案,例如: 价格控制、标准化产品标签和改进向家长提供dhsc批准的信息。相比之下,通过价格促销鼓励公司之间竞争的提议令人担忧。对于非必需品和奢侈品,这样的促销可以推动需求、销售和品牌忠诚度。然而,对于必需品来说,需求而不是供应商引起的需求应该是推动使用的主要因素,显然有可能产生不利后果。那些本来会选择母乳喂养并从中受益的人可以被鼓励改用配方喂养,并过早停止母乳喂养(Michalopoulou et al. 2024)。如上所述,《守则》明确指出,商业配方奶粉不能采用通常的营销做法。在CMA暴露的制造商和零售商的极高利润率仍然没有受到挑战的背景下,允许价格促销的拟议政策解决方案显得尤其不合时宜(Changing Markets Foundation 2017)。让婴儿配方奶粉更便宜的一个更简单的方法是限制企业目前的高利润率(Lex 2023),从而迫使企业减少营销支出。即使是适度的控制也会给企业留下健康的利润空间,但不会给公众健康带来由公司主导的定价带来的风险。维多利亚·西布森撰写了这篇社论的初稿。所有作者都贡献、审阅并批准了最终版本。维多利亚·西布森和凯瑟琳·佩雷拉-科策宣布受雇于第一步营养信托基金,而马科·克拉克宣布成为第一步营养信托基金的受托人。Robert Boyle宣布Wiley和英国过敏和临床免疫学学会支付编辑工作费用,世界卫生组织支付咨询费用,以及食物过敏反应和婴儿配方奶粉健康索赔案件的专家证人工作费用。其他作者声明没有利益冲突。
期刊介绍:
Maternal & Child Nutrition addresses fundamental aspects of nutrition and its outcomes in women and their children, both in early and later life, and keeps its audience fully informed about new initiatives, the latest research findings and innovative ways of responding to changes in public attitudes and policy. Drawing from global sources, the Journal provides an invaluable source of up to date information for health professionals, academics and service users with interests in maternal and child nutrition. Its scope includes pre-conception, antenatal and postnatal maternal nutrition, women''s nutrition throughout their reproductive years, and fetal, neonatal, infant, child and adolescent nutrition and their effects throughout life.