You're a social media mom who isn't sure if she should breastfeed her baby or if she should continue to breastfeed when she's six months old.
You join an online baby advice group, and before you know it, you're the target of a post about baby formula.
The World Health Organization (WHO) says it is now fighting this type of advertising in a campaign to limit the aggressive marketing of products called "breast milk substitutes", also known as formula.
WHO recommends that babies are exclusively breastfed for the first six months and that governments should provide mothers with the necessary health and social support for breastfeeding.
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After they reach six months, babies should be fed cow's, goat's or other types of milk, WHO recommends.
For more than 40 years, the WHO has been campaigning to increase the number of breastfed babies, which is currently 44 percent.
After a report from the 1970s, which pointed to the malnutrition of formula-fed babies in developing countries, in 1981 the WHO created the International Regulations for manufacturers of infant milk formulas (breast milk substitutes).
Adapted milk for babies under six months and tobacco are the only two products that are subject to international guidelines to prevent advertising to consumers.
Despite this, only 32 countries have fully incorporated this rulebook into their domestic legislation.
At a meeting in Geneva, the WHO Executive Committee discussed ways to limit the digital marketing of these products.
Given the annual value of the formula milk industry, which is 55 billion US dollars, the WHO has taken a firm stand.
'My baby won't get enough milk'
Guy (not her real name), a mother of a newborn from Thailand, says she often sees baby milk ads on her social media accounts, featuring influencers and TV stars promoting several companies' products.
The guy has been feeding her baby with milk formula since birth.
She was afraid that she would not have enough milk, although this was not the case.
Her baby is now three months old.
She still buys the same formula milk, for which she spends US$50 a month.
"I buy milk formula from the same manufacturer because the hospital recommended it to me, and the baby had no allergies or bad reactions," explains Tip.
She is currently breastfeeding her baby, but adds 30 or more milliliters of formula to each meal.
"I'm afraid my baby won't get enough milk, so I supplement her with milk formula."
The ads she sees on social media could influence her decisions in the future, Tip told the BBC.
"I already remembered the ads I saw on my accounts, and they could influence the decision when I will introduce milk for children older than one year instead of milk formula for infants."
Who is responsible?
The WHO says that milk formula manufacturers use marketing strategies that are not considered normal advertising.
Such strategies, says the WHO, include: social media posts, video streaming, games, podcasts, dark posts (producer posts for the targeted user only that do not appear on the producer's social networks), engaging social media influencers, and online baby support and advice forums and groups.
In November 2023, the Geneva-based organization published a guide to combat this type of activity online.
Anyone who creates, publishes and distributes content promoting "breast milk substitutes," the guide says, should be held accountable.
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The WHO has also advised governments to reduce, block, filter, or immediately remove such marketing content.
The WHO Executive Board will consider the guidelines and ways to tighten them at a meeting in January.
But, for now, there is no initiative to apply the guide in all countries, although some support such a step.
'Milk for children over one year old'
The WHO recommends that a baby be introduced to solid food when it reaches the age of six months, and that breastfeeding continue until the second year of life.
However, many mothers stop breastfeeding when their babies are six months old and become the target of advertisements or marketing that recommend feeding their babies 'milk for children over one year old'.
In October 2023, the American Academy of Pediatrics (AAP) published a clinical report stating that formula for babies older than 12 months has no nutritional benefits.
The APP said parents should not immediately believe claims made on product labels for these age groups, such as "stimulating brain development" or "improving immunity".
Additional confusion is introduced by the simultaneous advertising of these products and adapted milk formulas for infants, because they have similar names and packaging, APP added.
"Advertising messages that present these products as the next stage or next step in a child's diet cause confusion and may even discourage breastfeeding or switching to infant formula," the APP warned.
Infant formula is regulated by the US Food and Drug Administration (FDA), but not formula for children over one year of age, which is not subject to certain federal nutrient content regulations.
The AAP also stated that milks for children older than 12 months should be labeled differently from infant formulas and that they should not be placed on store shelves next to formula milks.
Marketing strategies
Last year, the British medical journal The Lancet published a report criticizing international marketing strategies used by manufacturers of infant formula to target parents, health professionals and lawmakers.
The report lists the contents of labels on several packages of infant formula in different countries, among them Enfamil i Aptamil.
For example, Enfamil Neuro Pro, part of a British-Dutch multinational food company Reckitt, claims that their product "strengthens brain function".
Dr. Cecilia Tomori, an associate professor at the Johns Hopkins University School of Nursing and one of the authors of the Lancet report, told the BBC that such claims lead parents to believe that ingredients added to milk formula will stimulate brain development and thus improve the child's cognitive abilities and intelligence.
Tomori, a breastfeeding expert, points out that the use of scientific terminology in advertisements creates the false impression that such claims are supported by strong scientific evidence.
"Some of the claims are expressed verbally, and some with photographs that indicate that the baby will be extremely smart.
"Such texts usually state something about intelligence quotient, strengthening of brain functions, etc.," Tomori points out.
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Advertisements for other products, exemplified in a report in the Lancet, claim that they relieve "irritability, crying, gas, and burping in babies."
All of this can be considered normal for babies, says Dr. Tomori.
In a written statement to the BBC, the company Danone, a global food and beverage manufacturer that makes Aptamil, says they researched infant formula for 50 years before coming up with the advertising message of "formulas that are based on science and backed by clinical research."
"Our marketing policy, which is the world leader in this industry, respects strict regulations on highlighting the health benefits and advertising of our products.
"This ensures that we carry out marketing activities responsibly," the company said Danone in a written statement.
British multinational company Reckitt which makes health, hygiene and nutrition products, had no comment, but referred the BBC to the International Dietetics Industry Association, which represents it.
The Association told the BBC that the entire communication that this industry sector carries out both with consumers and with health professionals is strictly regulated, and is based on scientific evidence and facts.
The health and nutritional benefits claims made by the Association's member companies are based on scientific and medical research, and the products have been approved by the relevant authorities and are in full compliance with applicable local, national and international regulations.
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