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Report outlines how the US interfered with marketing restrictions on formula across the globe

A recent investigative report by ProPublica unmasked the extensive interference by the US government in international regulations concerning the marketing of formula.

The report details how Thailand and other developing countries trying to safeguard the health of children attempted to regulate formula marketing. These efforts were thwarted by the US government, which repeatedly advanced the interests of multinational baby formula companies.

Thailand’s attempt to halt advertising met with lodged criticisms from the US

In 2017, health experts in Thailand attempted to halt aggressive advertising for all types of formula, including toddler formula, the report says, fearing that promotions could mislead parents and convince mothers to forgo breastfeeding – rates that were already among the lowest in the world.

In response to these attempts, officials at the US Department of Agriculture's (USDA) Foreign Agricultural Service (FAS) delivered a letter to Thai authorities asking “pointed” questions about the proposed legislation, according to ProPublica, and lodging criticisms in a bilateral trade meeting with the Thai government and on the floor of the World Trade Organization (WTO).

Despite its concerns about misleading marketing and low breastfeeding rates, ProPublica said the Thai government ultimately relented, banning advertising for infant formula, but allowing marketing for toddler formula.

During an interview for the report, former adviser to Thailand’s health minister, Dr Siriwat Tiptaradol, expressed upset and disappointment in the government's decision to back down. He said: "Our law is really weak, and enforcement is really weak."

Ingredients Network contacted the USDA FAS for its response to the ProPublica report but did not receive any comments in time for publication of this article.

Low breastfeeding rates in Thailand

A July 2023 UNICEF-supported survey found that around 29% of Thai mothers exclusively breastfed their babies during the first six months of life. This is up 14% from 2019 but is still far below the Global Nutrition Target of 50% by 2025.

Breastfeeding is promoted as the best source of nourishment for infants and young children and is one of the most effective ways to ensure a child's health and survival, according to the World Health Organization (WHO).

“Meddling” by the US government uncovered in 2018

The “meddling” by the US government was first exposed in 2018 after officials from the Trump administration were accused of threatening to withhold military aid to Ecuador unless the country dropped its proposed resolution in support of breastfeeding at the WHO.

The ProPublica investigation uncovered decades-long efforts by the US government to undermine public health initiatives in numerous countries while advancing the interests of multinational formula companies. US agencies intervened in around 17 jurisdictions, and this continued under various administrations, impacting countries across the globe.

The meddling often opposed measures that would restrict formula marketing or require additional safety precautions.

Infant formula versus toddler milk

Toddler formula is a processed powdered drink aimed at children between one and three years old. The drink often contains caloric sweeteners and vegetable oil, alongside powdered milk.

Evidence of the deceptive marketing and nutrient-poor formulations has been building for years. The ProPublica report references a 2023 study published by the American Academy of Pediatrics, which concluded that toddler formulas offer no nutritional advantage and are misleadingly promoted as a necessary part of a healthy child’s diet.

A 2024 scoping review of research on consumption, perceptions, and marketing practices of toddler formula found that sales appear to be growing rapidly worldwide, despite health authorities not supporting its use and emerging evidence suggesting that marketing practices may mislead consumers.

In the US, infant formula is regulated by the US Food and Drug Administration (FDA) but toddler formula, on the other hand, is not. Although toddler formula made up only 11% of all formula sales in the US in 2023, global sales were significant, making up more than 37%, according to Euromonitor.

The aggressive marketing of formula, and backlash, is not new. In the late 1970s and early 80s, boycotts of Nestlé took place across the US and Europe after concerns about the company’s marketing of formula arose, particularly in low- and middle-income countries.

VoxDev, a research into policy platform, estimates that Nestlé’s entry into low- and middle-income formula markets, many of which did not have access to clean water, resulted in increased child mortality.

At the peak of the Nestlé controversy in 1981, estimates sat at approximately 212,000 infant deaths per year, and between 1960 and 2015 it has led to around 10.9 million excess infant deaths.