The Competition and Markets Authority (CMA) has today released its long-awaited report on the infant and follow-on formula market, confirming that prices have soared, and that robust interventions are needed to better support families in informed decision making around product choice. The report findings and recommendations are based on updated consumer research as part of the CMA market study, exploring consumers’ experiences in the infant formula market, and aim to deliver better outcomes for parents who depend on infant formula to feed their babies.

As a member of The Baby Feeding Law Group UK, and in partnership with First Steps Nutrition Trust, the iHV has long campaigned for stronger formula regulations and better enforcement around the marketing of infant formula. We welcome the report’s findings and key recommendations to governments for action to improve outcomes for parents by:

  1. Eliminating brand influence in healthcare settings:
    • Timely, clear, accurate and impartial information on nutritional sufficiency of infant formula products in healthcare settings.
    • Standardised infant formula labelling in healthcare settings.
  2. Equipping parents to make strong choices in retail settings:
    • Clear, accurate and impartial information on the nutritional sufficiency of all infant formula products on retail shelves and in online shopping channels.
    • Display all brands of infant formula together on retail shelves and in a separate cluster from all brands of other formula milks.
  3. Strengthening labelling and advertising rules:
    • Clear, accurate and impartial information on the nutritional sufficiency of all infant formula products on product labelling.
    • On-pack messaging – prohibiting intangible and/or non-verifiable messages on infant formula and follow-on formula labels.
    • Extending the restriction on advertising to follow-on formula.
    • Clarify what constitutes advertising.
    • Permit the use of gift cards, vouchers, loyalty points and coupons in lieu of cash to purchase infant formula.
  4. Effective enforcement:
    • Governments to assess whether infant formula and follow-on formula labels are ‘clearly distinct’ and communicate assessment to manufacturers and enforcers.
    • Competent authority to pre-approve product labels.

The report’s authors stress that the UK, Northern Irish, Scottish and Welsh governments must now act swiftly to implement these measures and maintain the momentum for effective reform.


Dr Vicky Sibson
, Director of First Steps Nutrition Trust, said:

“The CMA’s findings reflect the lived experience of many families – infant formula is prohibitively expensive, while families are being manipulated by misleading marketing. Stronger, enforced regulations are needed to protect parents, carers and their babies. We welcome today’s recommendations and urge the UK, Northern Irish, Scottish and Welsh governments to build on this progress by ensuring swift implementation. It is vital that the cost of infant formula is brought down across the board and in the long term.”

The Baby Feeding Law Group UK is disappointed that the CMA has not explicitly acknowledged the need for stronger digital marketing regulations and has failed to recommend price controls. It is essential that UK legislation is updated to protect families from these highly effective and inappropriate marketing practices. Stronger interventions are also needed to ensure families who use formula can afford it and not resort to dangerous feeding practices. We agree with the CMA that if the proposed package of measures does not achieve the desired outcomes within a reasonable timeframe, it will be essential to reconsider the need for more direct price controls for essential formula milks.


Baroness Walmsley
, chair of the House of Lords all party inquiry entitled ‘Recipe for health: a plan to fix our broken food system’ said:

“I welcome the CMA’s report, but the government must now ensure it is implemented. The pre-authorisation must be independent of the industry and parents must have accurate information such as the fact that follow on milks and toddler milks are not needed. Then we need to move on to tackling the advertising of foods for toddlers.” 

Responding to the report, Alison Morton, iHV CEO said,

“Shopping for infant formula in the UK has become a minefield. This welcomed report lays bare the harsh fact that parents are being exploited by misleading advertising. The industry preys on parents’ overriding motivation to do “what is viewed to be best for their baby” – with aggressive corporate marketing tactics motivated by profit, pressurising parents to purchase a higher priced product under the misguided belief that it is better quality.

“Parents and babies deserve better. At a time when more families are living in poverty or struggling to make ends meet, it is vital that all parents have access to clear, accurate and impartial information to make informed choices, and can save money by switching to the cheapest infant formula brands. Implementing stricter guidelines with effective enforcement to end exploitative practices cannot come soon enough. The iHV fully supports all the recommendations in the CMA report”.

The Baby Feeding Law Group UK (BFLG-UK) has developed a briefing note to clarify misconceptions about the UK infant formula marketing laws.

This new briefing document is intended for use by journalists, policy makers, politicians, and health care professionals, including health visitors. It has been produced to clarify the intention of current UK law on the marketing of infant formula and to dispel some misinterpretations that have been seen recently in the media.

The current UK legislation on restricting the marketing of infant formula is informed by the WHO Code of Marketing of Breastmilk Substitutes. However, since the legislation contains only ‘some’ provisions and it is poorly enforced, the reality is that the current UK law provides limited protection for breastfeeding and does not properly enable safe and appropriate formula feeding.

The BFLG-UK briefing highlights how:
“misinformation can do damage, especially with regard to public health and the protection of the most vulnerable groups in the population, including infants and young children. Misinformation is false information that can be spread either by mistake or intentionally and has the potential to cause substantial harm to individuals and society”.

Promote the facts and clarify the misconceptions in your practice:

  1. Fact: Legal restrictions on infant formula marketing exist to protect all babies, no matter how they are fed.
    Misconception: Legal restrictions on infant formula marketing exist to protect and encourage breastfeeding only.
  2. Fact: Restricting inappropriate marketing of infant formula does not limit its accessibility. It is inaccessible when its price is unaffordable.
    Misconception: Legal restrictions on infant formula marketing limits its accessibility.
  3. Fact: Restricting inappropriate marketing of infant formula does not cause high prices. High prices are largely the result of high profit margins and large marketing budgets.
    Misconception: Legal restrictions on infant formula marketing are causing high prices.
  4. Fact: Shoppers need to spend hundreds of pounds to accrue sufficient points to purchase a single tin of infant formula. This is not a means to improve accessibility to families on the lowest incomes.
    Misconception: Not allowing rewards scheme points to buy infant formula is preventing families from accessing it.
  5. Fact: There are no legal restrictions preventing families from using store gifts cards (and equivalents) issued by food banks to buy infant formula.
    Misconception: Legal restrictions prevent families from using foodbank vouchers to buy infant formula.
  6. Fact: Legal restrictions on infant formula marketing exist to safeguard the health of all babies, however they are fed.
    Misconception: Legal restrictions on infant formula marketing are inappropriate.

 

Within the briefing, First Steps Nutrition Trust who are the current Secretariat for the BFLG UK make four specific recommendations, with important actions that the Government could and should be taking now, to ensure that all families using formula to feed their babies can be enabled to do so safely. These are:

  1. Improvement of the Healthy Start scheme.
  2. A public health messaging campaign around the nutritional equivalence of all first infant formula.
  3. Enforcement of existing legislation designed to prevent inappropriate marketing of formula milks and to protect breastfeeding AND safe and appropriate formula feeding and strengthening of this legislation in line with the International Code of Marketing of Breastmilk Substitutes and subsequent World Health Assembly Resolutions.
  4. Government establishment of pricing policies and practices to ensure infant formula is provided at lower prices on a long-term basis (e.g., through a price cap).


What is the Baby Feeding law Group:
The Institute of Health Visiting is a member of the Baby Feeding Law Group UK. The group brings together organisations and individual members who work together to protect infant, young child and maternal health by ending marketing practices that commercialise infant feeding, mislead consumers and threaten breastfeeding.

To read the full briefing and for more information see First Steps Nutrition Press release and Baby Feeding Law Group UK website.

Research published by Swansea University this week finds that, despite their marketing claims, ‘at home formula preparation devices’ often do not deliver water hot enough (i.e. at least 70˚C) to kill bacteria that may be present in powdered infant formula.

Formula-fed infants experience gastrointestinal infections at higher rates than breastfed infants, due in part to bacteria in powdered infant formula (PIF) and bacterial contamination of infant feeding equipment. The United Kingdom National Health Service (UK NHS) has adopted the World Health Organization recommendation that water used to reconstitute PIF is ≥70°C to eliminate bacteria.

The research study used community science methods to co-design an at-home experiment and online questionnaire to explore the safety of PIF preparation compared to UK NHS guidelines. 200 UK-based parents of infants aged ≤12 months were recruited; 151 provided data on PIF preparation, and 143 were included in the analysis of water temperatures used to reconstitute PIF.

Key findings:

  • Only 14.9% of 74 PIF preparation machines produced a water temperature of ≥70°C compared with 78.3% (n = 54) of 69 kettle users.
  • On average, preparation machine temperatures were 9 degrees C lower than when parents used a kettle.
  • Most parents routinely washed and sterilised bottles and teats.
  • Many parents did not always fully follow NHS safer PIF preparation guidance, including 21.8% washing their hands half the time or less, and 14.6% regularly pre-preparing bottles.
  • Most parents did not appear to understand the risks of PIF bacterial contamination.

 Study recommendations:

  • Parents should be advised that many PIF preparation machines will not produce water that meets the minimum temperature needed to kill any bacteria present in PIF, which is not and cannot be made to be sterile.
  • Instead, they should be advised to follow NHS (2019) advice, including heating water in a kettle so that it is >70°C, and, per Losio et al. (2018), ideally >85°C.
  • There is an urgent need for stronger consumer protections with respect to the marketing of PIF and PIF preparation devices to further protect infants from PIF-related bacterial contamination, which can result in serious ill health and even death. This should ensure that PIF labelling is compliant with the WHO (1981) guidance (WHO Europe, 2022).

 Please amplify these safety messages:

  • Use the infographics produced by Swansea University and in partnership with the Food Standards Agency to share these messages widely – use them on social media, as posters, and included in teaching.
  • These infographics, alongside others produced by First Steps Nutrition Trust can be found here.

 Policy response:

  • The Food Standards Agency (responsible for the safety of powdered infant formula) has recommended:
    • All formula-feeding parents should check the temperature of the water they use.
    • If formula machine users find a temperature below 70°C, they should report it to the manufacturer AND their local trading standards/Citizens Advice.
  • Office for Product Safety and Standards (responsible for the regulation of formula preparation machines):
    • Are conducting further testing on PIF preparation machines
    • They will alert the public if any further action needs to be taken
  • DHSC (responsible for content on NHS website, including bottle feeding guidance).
    • No response at this stage