Indian 0-3-year olds consume 29,836 tonnes of powdered milk formulas. These products are harmful.
On 21 May, Friday, the global communities celebrated the “World Breastfeeding Protection Day”, the day when the World Health Assembly adopted the “International Code of Marketing for Breastmilk Substitutes” in 1981, exactly 40 years back. On this day, the world officially recognized that marketing of breastmilk substitutes is harmful to health of mothers and children. Even as four decades have passed, the global sales of baby milks for infants and young children are growing and are about US $70 billion annually. Companies spend about 10% of sales on marketing their products to promote and sustain sales growth. This figure of about US$7 billion annually is more than the entire budget of the World Health Organization.
According to reports, Indian infants and young children up to 3 years of age, consume about 29,836 tonnes of powdered milk formula (retail value estimated at Rs 35,660 million retail value on 2020 prices). Follow on formula and growing up formula consumed by the 6-month to 3-year-olds is roughly 2/3 and the standard milk formula for 0-6 months is about 1/3. The consumption has increased from 22,000 tonnes in 2010 and is likely to increase to 31,400 tonnes by 2024.
This consumption may depend on the medically indicated need of the babies. But more often than not it is because of unethical or illegal activities of the food corporations indulging in aggressive marketing opportunities. Both under and over nutrition co-exist in India in the under-5 children. The NFHS-5 survey report from 22 states and UTs shows that only 1 in 2 newborn babies is able to begin breastfeeding within an hour of birth. During 0-6 months, again 2 out of 5 babies are receiving mixed feeding. These situations spur intake of powdered formula or liquid animal milk. Industry pitches powdered milk formula as the answer to enhanced nutrition and convenience for mothers and tends to get aspirational among societies.
REDUCE CONSUMPTION OF POWDERED BABY MILKS
By the nature of production, such foods fall under the category of ultra processed foods (UPFs) and consumption of UPFs is associated with health problems such as obesity, diabetes, heart diseases, breast cancer, asthma, depression, all-cause mortality, renal function decline and colorectal adenoma. This piece explains why. “Industrial processing itself can also be harmful. For example, certain food additives can disrupt our gut bacteria and trigger inflammation, while plasticisers in packaging can interfere with our hormonal system.” When people eat UPFs, they tend to eat more as these are addictive due to taste enhancers.
Yet another inherent risk of the use of powdered infant formula (PIF) is serious illness and even death due to infection with Cronobacter sakazakii and other microorganisms with consumption of reconstituted powdered infant formula. In several outbreak investigations, Cronobacter has been found in powdered infant formula that had been contaminated in the factory. Newborns are more vulnerable and the World Health Organization has developed guidelines for use of powdered infant formulas and calls for an extreme degree of caution for health workers for the safety and health of the newborns. Such instances go unnoticed in India without any investigation.
UPFs are also harmful to the environment in so many ways, including GHG emissions. In a study estimating GHG emissions from such products for infants and young children, authors calculated for production and processing of individual ingredients from cradle to factory gate. They used annual retail sales data for 2012-2017 from Euromonitor International for six purposively selected countries; Australia, South Korea, China, Malaysia, India, Philippines. “Results showed up emissions for milk formula products ranged from 3.95-4.04 kg CO2 eq. Milk formula sold in the six countries in 2012 contributed 2,893,030 tonnes CO2 eq. to global greenhouse gas emissions.”
HOW TO REDUCE
First, the marketing techniques used to promote UPFs for children must be understood. Currently most of the baby food companies promote their milk formulas through the health system in India in spite of the ban on such activity. Baby food companies use many tactics, most common being reaching through health professionals because new parents are extremely vulnerable and sensitive to the recommendations of health professionals. The Infant Milk Substitutes Feeding Bottles, and Infant Foods (Regulation of Production, Supply and Distribution) Act 1992, and Amendment Act 2003 is meant to control marketing under the age 2, however, it needs to be implemented and enforced effectively. Therefore, meetings of baby food company representatives with health professionals need to end.
Secondly, and unfortunately, women don’t get full support or care needed to succeed in breastfeeding within the health facilities where they give birth. The National Family Health Survey 5 (data from 22 states and UTs) shows that Caesarean sections have rapidly increased over past 5 years varying from 5.2% in Nagaland to 60% in Telangana. It is much more likely that breastfeeding is delayed in CS deliveries and milk formulas are used. In a study on the impact of Caesarean section on early breastfeeding, it was concluded, “We found that when controlling for socio-demographic and labor and delivery characteristics, planned C-section is associated with early breastfeeding cessation. Anticipatory guidance around breastfeeding could be provided to women considering a planned C-section…” The World Health Organization prescribes acceptable medical reasons for use of breastmilk substitutes. It does not include C-section. There is a distinct possibility to reduce consumption of UPFs if we acted positively and assisted women delivering by CS. Monitoring the use of milk formulas in hospitals is a way forward. As put up by a mother, could we also introduce a step to record consent of the mother, or her husband before the formula is to be used? Last trimester of pregnancy could be the critical time period to intervene to prepare women towards early breastfeeding and skin-to-skin contact at birth.
The POSHAN Abhiyaan of the Government of India’s flagship programme to improve nutritional outcomes for children, pregnant women and lactating mothers needed to rethink about its strategies to be holistic and lays emphasis on the issues raised and recommendations. Given the scientific reasons above, it is for the policymakers and public health professionals to work towards minimizing consumption of such foods.
To conclude, consumption of UPFs by young children is harmful, slowly increasing, and there are ways to check it. It requires both the will and a plan that looks at food system during the first 3 years and minimises the risks of non-communicable disease in adult life. As young children have no say in deciding about their food, and depend on parents, action must be taken to communicate this fact.
Dr Arun Gupta is Central Coordinator BPNI, and Director.