Latin American Considerations for Infant and Young Child Formulae.

Infant formula is the only acceptable substitute for breastmilk from 0 to 6 months old when human milk cannot be provided in sufficient amounts. Manufacturers have developed options that intend to meet the changing needs of the child aged from six to twelve months (follow-on formulae) and after the age of one year (young child formulae). The international code for marketing breast milk substitute stipulates standards for marketing practices of these products. In Latin America there are local variations of marketing practices. Novel marketing strategies such as advertising through social media and influencers pose new threats for breastfeeding success in Latin America. This review aims to examine variations in local regulations for marketing of infant formulae and to analyze the emerging phenomenon of influencer advertising. We reviewed the local norms for Latin American countries and examined differences and possible gaps. Emerging evidence of influencer marketing was explored. The results indicate that national regulations differ among Latin American countries, particularly with respect to product labelling and the requirement to use a local native language, highlighting the cost of the product, and different regulations prohibiting certain messages and illustrations. Regarding new marketing strategies, there is limited evidence on advertising infant formula through social media influencers, where different categories of marketing strategies can be described. More transparent reporting of social marketing by formula providers and more independent research on novel marketing strategies are needed.

Beliefs and Norms Associated with the Use of Ultra-Processed Commercial Milk Formulas for Pregnant Women in Vietnam.

Commercial milk formula for pregnant women (CMF-PW) is an expensive, ultra-processed food with a high concentration of sugar, the consumption of which may be linked to negative health outcomes. However, CMF-PWs are promoted as beneficial for pregnant women and lactating mothers as well as their children. To date, little is known about the factors associated with the use of CMF-PW among pregnant women. We performed this analysis to examine the association between the use of CMF-PW and related beliefs and norms among pregnant women in Vietnam. We interviewed 268 pregnant women in their second and third trimesters from two provinces and one municipality representing diverse communities in Vietnam. Multinomial (polytomous) logistic regression, structural equation modeling (SEM), and propensity score matching (PSM) analysis were used to examine associations between beliefs and social norms related to CMF-PW and reported consumption, characterized as occasional, recent, and never during the current pregnancy. Overall, 64.6% of pregnant women reported using CMF-PW during the current pregnancy and 34.7% consumed CMF-PW on the day prior to the interview. Strong beliefs that CMF-PW will make a child smart and healthy (53.7%) and the perception that use of CMF-PW is common (70.9%) were associated with increased use on the previous day (beliefs: aOR: 3.56; 95% Confidence Interval (95% CI): 1.65, 7.71; p < 0.01 and social norms aOR: 2.29; 95% CI: 1.13, 4.66; p < 0.05). SEM and PSM analyses confirmed these findings for both occasional and regular CMF-PW use. Results are consistent with observations of CMF-PW product labels and marketing tactics in Vietnam. The prevalent use of CMF-PW in Vietnam is associated with the belief that these products make children smart and healthy and the perceived social norm that most mothers use these products, which mirrors marketing messages and approaches employed by the CMF industry.

Marketing Breastfeeding Substitutes: A Discussion Document.

Marketing influences knowledge, attitudes, and decisions related to infant and young child nutrition, safety, development, parental confidence, and other aspects of health and wellbeing of the child. These attitudes and behaviours of parents, health workers, policy makers, and other influencers have short- and long-term effects on the child. There is an International Code of Marketing of Breast-Milk Substitutes. Is it time to have a code of marketing of breastfeeding substitutes?

Infant formula and toddler milk marketing and caregiver's provision to young children.

The World Health Organization International Code of Marketing of Breast-milk Substitutes prohibits claims and other marketing that may confuse caregivers about benefits of formula and other milk-based drinks for infants and toddlers, but such marketing is common in the United States. This study assessed caregivers' provision of milk-based products to their infants and toddlers and potential confusion about product benefits and appropriate use. Online survey of 1,645 U.S. caregivers of infants (6-11 months) and toddlers (12-36 months). Respondents identified infant formula and toddler milk products they served their child (ren) and provided relative agreement with common marketing claims. Logistic regression assessed relationships between agreement and serving these products, controlling for individual characteristics. Over one-half of caregivers of infants (52%) agreed that infant formula can be better for babies' digestion and brain development than breastmilk, and 62% agreed it can provide nutrition not present in breastmilk. Most caregivers of toddlers (60%) agreed that toddler milks provide nutrition toddlers do not get from other foods. Some caregivers of infants (11%) reported serving toddler milk to their child most often. Agreement with marketing claims increased the odds of serving infant formula and/or toddler milks. For caregivers of toddlers, odds were higher for college-educated and lower for non-Hispanic White caregivers. Common marketing messages promoting infant formula and toddler milks may mislead caregivers about benefits and appropriateness of serving to young children. These findings support calls for public health policies and increased regulation of infant formula and toddler milks.

Estimativa do consumo de leite e produtos afins por crianças em instituição filantrópica da cidade do rio de janeiro / Estimating the consumption of milk and related products by children in a philanthropic institution in the city of Rio de Janeiro

O leite é a melhor fonte de cálcio na alimentação, seu consumo é importante principalmente nas fases pré-escolares e escolares, sendo necessária a ingestão de 3 copos (600 mL) de leite por dia para suprir a quantidade de cálcio. A avaliação da ingestão de leite é importante para permitir o cálculo da ingesta de cálcio, vitaminas e minerais e possíveis resíduos e contaminantes como agrotóxicos e micotoxinas, entre outros. O objetivo deste estudo foi avaliar o consumo de leite e produtos relacionados, em crianças na faixa etária de quatro meses a três anos, de uma instituição pública com fins filantrópicos localizada no município do Rio de Janeiro. O projeto foi aprovado pelo comitê de ética da Fundação Oswaldo Cruz (FIOCRUZ) sob o número 641/2011. Na creche a avaliação do consumo foi realizada contabilizando a quantidade de leite preparada menos a consumida e o resto deixado pelas crianças. A avaliação do consumo na residência foi realizada através de entrevista com os responsáveis e preenchimento do questionário estruturado. Foi possível identificar: o consumo de leite na residência, o tipo de leite consumido (UHT, pasteurizado, pó) e a quantidade de leite em pó utilizada no preparo do produto. Pode-se concluir que na residência 88% das crianças, consomem leite, com regularidade, 9% o fazem esporadicamente e somente 3% não consomem o produto por motivos alérgicos ao alimento, consumindo fórmulas especiais e produtos à base de soja. Verificou-se que 59% dos responsáveis que utilizam o leite em pó, preparavam o produto em desacordo com o valor recomendado pelo fabricante (VR=0,13 g.mL-1). Dentre esses 34% prepararam o leite com menor quantidade de pó adicionada à quantidade de água recomendada e 25% o fazem usando excesso de leite em pó a água adicionada no preparo. Na creche, foi possível observar o baixo consumo de leite infantil na instituição.

Breast-milk substitutes: a new old-threat for breastfeeding policy in developing countries. A case study in a traditionally high breastfeeding country.

BACKGROUND: Developing countries with traditionally breastfeeding are now experiencing the increasing pressure of formula milk marketing. This may endanger lives and undermine the efforts of national policies in achieving the objectives of the Millennium Development Goals. We examined the use of, and factors for use, of all available breast-milk substitutes (BMS) in a country with a traditionally high rate of breastfeeding. METHODS: Randomised multi-stage sampling surveys in 90 villages in 12/17 provinces in Laos. PARTICIPANTS: 1057 mothers with infants under 24 months of age. TOOLS: 50-query questionnaire and a poster of 22 BMS (8 canned or powdered milk; 6 non-dairy; 6 formulas; 2 non-formulas). OUTCOME MEASURES INCLUDED: prevalence of use and age of starting BMS in relation to socio-demographic characteristics and information sources, by univariate and multivariate analyses. RESULTS: Of 1057 mothers: 72.5% currently breastfed; 25.4% gave BMS (10.6% infant formula); 19.6% gave BMS before 6 months of age (of them: 83% non-dairy or cereals; mean age: 2.9 months; 95% Confidence interval: 2.6-3.2). One formula and one non-formula product accounted for 85% of BMS. BMS were considered as milk by the majority of mothers. Thai TV was the main source of information on BMS for mothers. Lao Loum mothers (the main ethnic group) living in concrete houses with good sanitary conditions, were more likely than others to use BMS before 6 months (OR: 1.79, (1.15-2.78), p<0.009). Mothers who fed their infants colostrum at birth were less likely to use BMS before 6 months of age (OR: 0.63, (0.41-0.99), p = 0.04). Unemployed mothers living in rural areas were less likely to consider BMS better than breast milk. CONCLUSION: In Laos, mothers with the highest socio-economic status are showing a tendency to give up breastfeeding. Successful educational strategies and advocacy measures should be urgently developed to promote and sustain breastfeeding in developing countries.

Is unimpeded marketing for breast milk substitutes responsible for the decline in breastfeeding in the Philippines? An exploratory survey and focus group analysis.

Infant mortality and morbidity risk is linked to formula usage. The proportion of Filipino infant formula users rose 6% between 2003 and 2008. It is hypothesized this rise resulted from aggressive formula industry marketing. We conducted a household survey between April and December 2006 and focus groups in April-May 2007 in The Philippines to examine the association between mothers' exposure to advertising and other information sources and formula feeding decisions. Sixteen barangays (communities) were randomly selected from three purposively selected disadvantaged rural, urban and mixed municipalities. A total of 345 households had children under 24-months age: 114, 142 and 89 households from the rural, urban and mixed municipalities, respectively. In addition 38 respondents participated in 3 focus groups of 10-15 participants each, from three selected barangays. After adjusting for education and economic indicators logistic regression analysis showed that, children were more likely to be given formula if their mother recalled advertising messages, or a doctor, or mother or relative recommended it. Those using formula were 6.4 (1.8-23.1) times more likely to stop breastfeeding before 12 months. The focus groups described how television advertisements, doctors and medical representatives enticed them to use formula. We conclude that two factors were strongly associated with the decision to formula feed: self-reported advertising exposure, and physicians' recommendations.

Misperceptions and misuse of Bear Brand coffee creamer as infant food: national cross sectional survey of consumers and paediatricians in Laos.

OBJECTIVE: To investigate the use of Bear Brand coffee creamer as a food for infants and the impact on consumers of the logo of a cartoon baby bear held by its mother in the breastfeeding position. DESIGN: Interviews with paediatricians throughout the country and a national survey of potential consumers regarding their perceptions and use of the Bear Brand coffee creamer. SETTING: 84 randomised villages in south, central, and northern Laos. PARTICIPANTS: 26 Lao paediatricians and 1098 adults in households in a cluster sampling. RESULTS: Of the 26 paediatricians, 24 said that parents "often" or "sometimes" fed this product to infants as a substitute for breast milk. In the capital city, paediatricians said that mothers used the product when they returned to work. In the countryside, they reported that poor families used it when the mother was ill or died. Of 1098 adults surveyed, 96% believed that the can contains milk; 46% believed the Bear Brand logo indicates that the product is formulated for feeding to infants or to replace breast milk; 80% had not read the written warning on the can; and over 18% reported giving the product to their infant at a mean age of 4.7 months (95% confidence interval 4.1 to 5.3). CONCLUSION: The Bear Brand coffee creamer is used as a breast milk substitute in Laos. The cartoon logo influences people's perception of the product that belies the written warning "This product is not to be used as a breast milk substitute." Use of this logo on coffee creamer is misleading to the local population and places the health of infants at risk.