The Institute for Collaboration on Health, Intervention, and Policy (InCHIP) hosted guest speaker Rafael Pérez-Escamilla for their InCHIP lecture series on Thursday, Nov. 14. His presentation, “The Impact of Neocolonialism on Global, Maternal, and Child Health: The Case of the Infant Formula Industry,” described the history of commercially made formula (CMF) and their marketing towards mothers all over the world.
Pérez-Escamilla is a professor of public health, director of the Office of Public Health Practice and the Global Health Concentration, as well as the Maternal Child Health Promotion track at the Yale School of Public Health.
He began by outlining the ways in which the legacy of colonialism benefited the CMF industry.
“As a result of colonialism, massive profits have been generated by exploitative extraction of wealth from the Global South and redistributing it throughout the Global North via routes and systems established during European colonization,” he said.
According to Pérez-Escamilla, multinational and transnational corporations continue to capitalize on these systems in order to maximize profits at the expense of public health. An example he references is Nestlé.
During the turn of the 20th century, nutritional science was integrated into colonial medicine and allowed CMF to become a solution for nutritional deficiencies in infants.
“Medical authority’s increasing influence on infant feeding in Europe was instrumental to the Nestlé S.A. corporation in securing its reputation as a de-facto humanitarian organization to assist colonial health in addressing infant malnutrition and related illnesses,” Pérez-Escamilla said.
This phenomenon led to Nestlé gaining the trust of Swiss physicians and so they promoted their products, which would lead to a bigger boom after World War II, which saw food insecurity and hunger.
Nestlé would continue to market their products around the world, like in Africa, targeting pregnant and lactating women, and encouraging them to abandon breastfeeding altogether and rely on CMFs.
Pérez-Escamilla says the efforts by Nestlé were catastrophic in that they disrupted the lactation period for mothers and subsequently led to millions of infant deaths. There have been many documentations and analyses of the “Nestlé controversy” and subsequent boycotts over its unethical and predatory marketing tactics.
“Global outrage over the Nestlé corporation’s economic and physiological exploitation for profit led to collection action for human rights policy, known as the International Code of Marketing of Breastmilk Substitutes (the WHO Code), adopted in 1981 by the World Health Assembly ,” Pérez-Escamilla said.
This code would essentially regulate the marketing of CMF and is aimed to protect and promote breastfeeding. It also sets standards for the labeling and quality of products ensuring that parents’ choices are based on full and impartial information, rather than misleading or inaccurate marketing claims.
“The only country that voted against the code was the United States,” Pérez-Escamilla said. “They did so based on the principle that the code violated the right to free speech that CMF companies had. In other words, their free speech was equated with the right to free speech.”
Many health professionals emphasize the importance of breastfeeding. Pérez-Escamilla highlights the benefits for both infants and mothers.
“The longer women breastfeed during their lifetime, the lower the risk they have of experiencing high blood pressure, tied to diabetes, cardiovascular disease, breast cancer and ovarian cancer,” he said. “Breastfeeding reduces the risk of respiratory drug infections and ear infections and gastrointestinal infections in infants.”
Pérez-Escamilla proposes that breastfeeding is a complex biopsychosocial system. Meaning it’s a dynamic system based on evolution, the interaction between mother, baby and the environment, and it’s establishing a psycho-emotional bond between the two. To him, CMFs cannot replicate this phenomenon.
From an economic standpoint, it’s also the most cost-effective tool for promoting maternal and child health worldwide, according to Pérez-Escamilla. He says that breastmilk is valued at over $3.5 trillion a year, but due to low investments in breastfeeding, the world loses about $1 billion a day.
There is a push or desire among mothers to breastfeed, but Pérez-Escamilla says there are many structural barriers that prevent this or do nothing to encourage it. A study was done comparing 2,070 women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children program showed that there were great disparities between mothers of different races, and if they reached their intention of only breastfeeding for the first few months with their infants. For the first month, 55.9 percent of white women met their goal, 41.5 percent of Black women met their goal and 42.2 percent of Hispanic women met their goal; the disparities are larger in three months.
Pérez-Escamilla argues that these disparities are “caused mainly by structural barriers permeating through diverse settings to affect infant feeding decisions.” The differences in care for women throughout the U.S. and how mothers are treated bn the workplace can impact their decisions and ability to choose breastfeeding.
When looking at the CMF industry’s marketing strategies, Pérez-Escamilla and other scholars found that the industry uses “unregulated and invasive online advertising, industry-sponsored online mom ‘clubs,’ industry-sponsored counseling and telephone support networks, price promotions at point of sale and unsolicited free gifts of milk formula, and practices aimed at influencing the training of health personnel and the recommendations they make.”
Having a constant flow of contact with pregnant women and nursing mothers is how CMF companies target vulnerable parents. But they also target health professionals through their education and the shaping of science, according to Pérez-Escamilla.
“The companies shaped the narrative by claiming, ‘Yes, breastfeeding is the best, but just in case here are our products which are good as human milk,’” he said. “They deny or erase corporate influence or responsibility, they ship the blame to individual responsibility, ‘it’s a lifestyle choice.’”
“They sound out about science, deploy legal tactics and this is not new. The pharmaceutical industry all uses this approach. What is the difference? It’s just at an incredibly tender stage of life. At which these really, really harmful marketing behaviors are happening,” Pérez-Escamilla said.