On 5 August 2026, experts called on healthcare workers to protect parents from being pressured into feeding children commercial milk formula (CMF), during an online panel discussion.

The discussion was held by the Healthy Living Alliance (Heala) in light of the World Health Organizationâs (WHOâs) World Breastfeeding Week, which took place from 1 to 7 August. This yearâs theme was âBreastfeeding for a sustainable start in life: strengthen what worksâ, and focused on tracking progress, evaluating impact and scaling proven approaches that improve breastfeeding outcomes.

The panellists included Healaâs policy and programme manager Angelika Grimbeek, Dr Catherine Pereira-Kotze who is the senior advisor on infant and young child feeding advocacy programme of the SA Medical Research Council (SAMRC), Gilbert Tshitaudzi, the nutrition manager at the United Nations Childrenâs Fund (Unicef), SAMRC chief specialist scientist Professor Tanya Doherty and chairperson of the Rural Doctors Association of Southern Africa (Rudasa) Asafika Mbangata. The panel was moderated by the SAMRCâs communications manager, Zukiswa Zimela.

The discussion highlighted how it is known that breastfeeding is the best option for feeding infants and young children, yet commercial milk formula gets pushed through healthcare workers to influence parentsâ feeding decisions.

How CMF marketing infiltrates healthcare

As of 2024, 48% of infants under six months old were exclusively breastfed, while in SA this rate was as low as 22%, according to WHO Africa. To Tshitaudzi, this is an indication that there is much work to do in protecting breastfeeding and regulating the marketing of CMF products.

In her presentation, Doherty said that breastfeeding protects children from common infections and diseases, supports healthy development, reduces the risk of childhood obesity and also reduces the motherâs risk of developing breast cancer, ovarian cancer and type 2 diabetes. And considering the benefits of breastfeeding, she argues that families should be guided by their own interests when feeding their children, and not by commercial interests.

âI really want to be clear about what this presentation is about. Itâs not about the existence of products and itâs not about judging the choices made by women and families. The issue is whether parents and health professionals are receiving accurate and impartial information, and further that public interests remain separate from commercial interests,â said Doherty.

Doherty based her presentation on the report, How the marketing of formula milk influences our decisions on infant feeding, by the WHO and Unicef.

This report found that CMF companies not only marketed their products to parents, but actively engaged health professionals too, because they were trusted sources of advice, she said. Health professionals had become critical pathways through which marketing messages reached families.

The report also found that one in five women in SA were advised to formula feed by a health professional, and one in four had received a brand recommendation from a health professional.

According to the report, almost half of health professionals in SA had reported direct contact with company representatives, more than a quarter had attended company-sponsored events, and some professionals indicated that they had recommended products about which they had received marketing information to families, or that their health facility was sponsored by a brand that they had recommended to families, Doherty said.

The study also discovered that the CMF industryâs marketing messages began reflecting in the way healthcare workers described products. Doherty provided an example in her presentation, stating that CMF was inaccurately described as being âclose to breastmilkâ.

CMF was also commonly framed as a solution to problems, which were actually normal newborn behaviours. Marketing messages exploited mothersâ insecurities about their own milk sufficiency and ability to satisfy their babies by offering these milk products as solutions, she said.

âWe all know that parents are understandably concerned when babies cry, when they have colic, regurgitate or seem unsettled, but the marketing messages frame these normal newborn developmental experiences as problems, and that the solutions to these problems have a specific type of formula product,â she said.

Further, companies used scientific language, pseudo-scientific claims and references to ingredients to create an impression of innovation and credibility, Doherty said, citing the report. Products were often presented as an equivalent or superior substitute to breastfeeding, without having evidence.

Pereira-Kotze noted in her presentation that she had found advertisements using scientific claims to promote CMF in a scientific journal.

Health professionals were often directly contacted by CMF companies, too. They could receive promotional emails, health update invitations with continuing professional development (CPD) points attached, and product information. Collectively these tactics created repeated exposure to marketing tactics, and gradually the claims made by CMF companies were normalised, Doherty said.

Many nutrition institutes or foundations of CMF companies that provided educational webinars may claim to be separate from the commercial side of the company, but remained linked to the manufacturer and broader commercial objectives, said Doherty. These educational channels had the potential to shape professional knowledge, priorities and perceptions.

These relationships between healthcare workers and the CMF industry created conflicts of interest among health professionals, where their responsibilities towards women and families intersected with commercial interests, Doherty added. This influenced the information women and families received.

What healthcare workers can do

Doherty cited the WHO and Unicef report for healthcare workersâ opportunities for action.

The first action was that healthcare workers should be more aware of the International Code of Marketing of Breast-Milk Substitutes, and South African regulations.

CMF marketing practices were regulated by Foodstuffs for Infants & Young Children (R991 of 2012) in SA, according to Tshitaudzi. The regulations were informed by the WHOâs International Code of Marketing of Breast-Milk Substitutes, which protected and promoted breastfeeding and aimed to eliminate the aggressive commercial promotion of CMF. Among other provisions, R991 regulated the labelling, composition, packaging, manufacturing measures related to these designated products, promotion of formulas and complementary foods and CMF company financial contributions or sponsorships to healthcare personnel working in infant and young child nutrition, said Tshitaudzi.

Moreover, healthcare settings should explicitly and actively reject CMF marketing, Doherty said. Healthcare professionals must correct and challenge the misconceptions on the equivalence of formula to breastfeeding. Health professionals should be the leading source of evidence-based advice and support for infant feeding. Professional associations, universities and healthcare institutions had the responsibility to adopt and publicise strong conflicts of interests in policies that protected education, research and clinical guidance from commercial influence.

Grimbeek provided an alternative way to address the matter â through the Nourished Truth Programme. The programme was started in 2022 by various academics, experts, national and international organisations, civil society organisations and the University of the Western Cape, she said. Together they created a guide for building an environment that protected womenâs breastfeeding choices from the influence of CMF marketing. The guide focused on educating healthcare workers on the R991 and mobilising them to become aware of the conflicts of interest, commercial determinants of health and all the marketing tactics used by CMF companies, she said.

Mbangata said there needed to be more advocacy for the promotion and support of mothers who were working to enable them to breastfeed in their work environments to preserve the health of their babies.

Education also needed to be shared in healthcare, she said. She provided the example of having televisions in waiting rooms play educational material, such as what to do when a baby was not latching properly or when a mother was not producing enough breastmilk. DM