When Vernellia Randall became a mother in 1970s America, she chose to do something radical, something that — at the time — felt like a break with social norms: Randall chose to breastfeed her baby. 

"In the '70s, people, nurses, doctors and all of the ads and stuff made it seem like I wasn't being a good mother by choosing to breastfeed," recalled Randall in an interview with DW. 

Research suggests that in 1971 just 10% of new mothers in the US breastfed their babies past the fourth month. 

Randall, now a retired law professor, was then in nursing college, poor and a single mother. Her decision was straightforward — breast milk was free.

Logic defied in hospital formula approach

A few years later, Randall was working as a nurse. She knew from her training and personal experience that breastfeeding was cheap and effective. But what she saw in the healthcare system seemed to defy logic.

Randall said new mothers were often given a free stash of baby formula upon leaving the hospital. The supply would see them through a few weeks — long enough for them to lose some of their natural ability to produce milk.

Milk supply depends on demand, so if the child isn't feeding on the breast, the body's breast milk production wanes. 

"So, then mothers had no choice but to buy the formula, but because they were poor…they watered it down," said Randall. "What else were they supposed to do?"

Bad formula practice in hospitals across the world

Randall's experiences are far from isolated — reports published in the late '70s and '80s showed that similar practices were happening in health care facilities all over Europe, the US and, most alarmingly, in developing countries where the vast majority of women didn't have access to a steady supply of formula or clean water to prepare it.

Knowledge provided in these reports sparked global boycotts against baby formula company Nestle and the publishing of the WHO's 1981 International Code of Marketing of Breast-milk Substitutes. It was a global health policy framework that sought to end the sorts of practices that Randall had noticed in clinics. 

But the code — to this day — is seldom legally binding. It's mostly viewed as a set of recommendations because in many countries, it hasn't become legislation.   

And in the 40 years since the code was written, the baby formula industry has grown from a value of less than $2 billion to over $55 billion, according to a study published in The Lancet in February 2023.

Some women need to use baby formula

Baby formula was created for a reason. Some women are unable to breastfeed.

There are various reasons for that, but researchers estimate that as many as 10-15% of women are unable to produce enough breast milk to feed their babies. So, there is a legitimate need for baby formula.

The problem, say the researchers in The Lancet, is that formula companies have found a way to exploit women's fear of — and in some cases even induce a fear of — problems such as low breast milk production.

And they say that that pushes some women, who would be better off breastfeeding, to use formula instead.

Breastfeeding is hard and women need help

The WHO recommends that women who can breastfeed should do so for at least the first six months of a baby's life. But it estimates that only about 44% of children under the age of 6 months are exclusively breastfed, globally.

"It is difficult to breastfeed," said Randall. "You need help."

The researchers writing in The Lancet advocate "baby friendly" policies: breastfeeding, they say, should be initiated within the first hour after a baby's birth — the baby should be put to the mother's breast.

Mothers should be shown by trained doctors or nurses how to breastfeed and maintain lactation even when separated from their babies.

Healthy babies should not be given any sort of food or drink other than breast milk. And mother and baby should be kept together. 

These are known as baby friendly methods, but not all hospitals do it that way.

“In some hospitals, they only give the baby back to the mother after 6 or 12 hours,” a pediatrician at a public hospital in Mexico City said in an interview for a 2022 WHO report on formula advertising.

When that happens, milk production can become difficult, making women less likely to want to breastfeed, especially if they don't have support from other women in their lives — a doula, midwife or sister, mother or friend who has been through it before.

How formula companies market today

The WHO report says that formula companies use algorithms to pinpoint and advertise to young mothers, capitalizing on a mother's fear about whether they can produce enough breast milk for their newborn baby.

Those researchers in The Lancet also say that some formula companies frame a person's fears and insecurities as being "pathological", and push their products as answers to problems that, in many cases, don't exist.  

We all leave trails of personal data on the internet. What we post on social media, photos of our newborns, the websites we visit, the amount of time we spend looking at TikTok videos or Instagram Reels, the questions we Google, and the words we use, like "baby crying all night", or the online stores we visit and what we buy from them. 

The advertisers use all that information to feed sophisticated internet algorithms that target new mothers. That's what the researchers say.

Some 50% of the mothers surveyed by the WHO researchers reported exposure to baby formula advertisements, with the highest numbers in China (97%), Viet Nam (92%) and the United Kingdom (84%), but also in African countries. 

“Advertisements will make me buy infant formula,” a mother from Lagos, Nigeria told WHO researchers,  “if I see a beautiful and chubby baby on TV, well fed and smiling and there is a container of milk there with all the nutritional facts on it, detailed.”

Parenting apps exploit a mother's worries

Some companies offer parenting apps, which new mothers can use to keep track of their baby's habits and health and get information and advice.

The WHO report we mentioned earlier in this article says such apps require that women submit a significant amount of personal information — specifically, the problems and worries they are having with feeding — which the companies then use to target more products at them. 

One company, for example, describes its app as being "for mothers to reach other mothers who [are] up all night," so that mothers, who have a newborn baby and are up at 3 a.m. and lonely and bored, can connect with other mothers who are up at the same time and talk about their experiences.

But all of this gives the formula companies and advertisers yet more personal information about new moms and their babies — when they are at their most susceptible.

None of the six companies that make up the largest share of the global formula market — Abbott Nutrition, Danone, Feihe, Freisland Campina, Nestlé, and Reckitt Benckiser  —  responded to DW's requests for comment.  

Edited by: Zulfikar Abbany