Infant formula is an adequate substitute for breastfeeding, but it has a chequered history and remains controversial - Emma Hall investigates

All the experts now agree that breastfeeding is the best option for most mothers and babies. But it doesn’t work for everyone and infant formula is steadily improving to provide an adequate substitute. Babies reared on the bottle can be as healthy as their breastfed contemporaries – at least in the hygienic developed world.

Infant formula is now probably the world’s most regulated food, but it remains a controversial product. Improperly used, it can contribute to obesity and tooth decay in children, among other health problems. In the developing world, the effects of choosing bottle over breast can be fatal.

How infant formula began
Henri Nestlé marketed an early breast milk substitute in the US in 1867. By 1873, 500,000 boxes of Nestlé Milk Food were sold all over the world. The quest to find a perfect substitute for breast milk has continued ever since, with annual sales of baby milk in 1998 estimated at US$8 billion.

Formula milk first reached the UK in 1904 and became popular during the Second World War, when National Dried Milk was celebrated for liberating mothers from the constraints of breastfeeding so that they could help with the war effort. But, in 1939, Nestlé was exporting condensed milk to Singapore and Malaysia as ‘ideal for delicate infants’, though it was banned in the UK for causing rickets and blindness.

In a speech that would be just as relevant 60 years later, Dr Cecily Williams said, ‘Misguided propaganda on infant feeding should be punished as the most miserable form of sedition; these deaths should be regarded as murder.’

National Dried remained on sale until 1976, when it was pushed out by the new modern-style baby milks, launched in the UK as a response to a Department of Health report called ‘Present Day Practice in Infant Feeding’.

Until then, infant formula was little more than dried full-cream milk powder with a few vitamin D and C supplements thrown in.

The catalyst for change was a 1966 US Government brochure, which warned of the dangers of improperly used breast milk substitutes and created a global public health controversy.

Exploiting the developing world
The World Health Organisation estimates that more than a million babies still die every year as a result of diarrhoea picked up from unhygienic bottle-feeding, usually from contaminated water or unsterilised equipment.

This appalling death toll is compounded by illegal marketing practices. International regulations forbid providing samples of infant formula to new mothers, but in the Philippines, Nestlé has been exposed for hiring graduate nurses as ‘health educators’ to visit mothers at home and try to convince them to use their products.

Nestlé was also nailed for running Baby World Clubs for pregnant women in Singapore. The company said these were for health education, but campaigners claimed they also helped to promote Nestlé products.

Current regulations
The World Health Resolutions of the World Health Assembly have clarified and amplified the International Code on the marketing of formula.

Baby food companies may not:

• Give free supplies of baby milk to hospitals
• Promote their products to the public or health workers
• Use baby pictures on their baby milk, bottle and teat labels
• Give gifts to mothers or health workers
• Give free samples to parents
• Promote baby foods or drinks for babies under six months old
• Use labels that are not in a language
understood by the mother and that do not include a prominent health warning

Follow-on milk
In the UK, consumer marketing of formulas aimed at infants up to six months is banned. But no such restrictions apply to follow-on milk, which can be freely advertised and conveniently carries the same brand names as the baby formulas.

Market leader SMA, for example, spends £1.5 million a year on television and press ads for their follow-on milk.

Cynics believe that follow-on milk was invented purely for the purpose of raising awareness of these brand names. The World Health Organisation has stated that follow-on milk – which offers little more than a bit of extra iron and vitamin C – is unnecessary.

Parents can take comfort from the fact that all baby milks must comply with the Infant Formula and Follow-on Formula Regulations that control the composition, labelling and marketing of infant formulas in the UK.