Ongoing debate about women’s “choice” to breastfeed masks the ugly reality that trade trumps infant health. Food security and climate change resilience for infants requires political courage to govern industry and commit to breastfeeding, to ensure a safe and nutritious food supply.

Food safety and food access in the first-food system

Dire shortages of infant formula in the US recently led President Joe Biden to approve imported emergency supplies from Australia. Half of US mothers rely on free formula, through an agricultural support and child nutrition program supplied by US formula manufacturers. The crisis was precipitated by infant deaths from bacterial contamination in a US manufacturing plant. The company involved, Abbott, is one of three which dominate the US market for milk formula, and one of five that dominate the global market.

The current situation in the US resembles the global scramble for safe formula products following the melamine contamination scandal in China in 2008, in which 52,000 infants were hospitalised and six died. As long ago as 2007, FAO and WHO experts advised of the intrinsic contamination risks of powdered infant formula, and recommended warnings for consumers that the product is not sterile. Most countries took no action. Such crises have been a windfall for Australian milk formula manufacturers but highlight a deeper issue; the vulnerability of commercially-fed infants to insecure and unsafe food supplies, and the unmet need for public investments in a resilient “first food system.”

Can globalised commercial milk formula markets deliver food security for infants?

Infants relying on milk formula supply chains are food insecure. This can result not only from disrupted supply chains, but also from changes in family income and purchasing power during economic crises. Supply chain disruptions are becoming more common with accelerating climate change and the increased frequency of natural disasters. The dairy industry faces immense challenges due to high methane emissions and rising energy prices, which increase the costs of farming and other inputs throughout the supply chain. During the Black Summer fires, and in recent flood emergencies, Australian governments were  poorly prepared to help infants and young children dependent on formula.

Despite assurances of the Australian formula manufacturers, a global market offers little guarantee of domestic supply. The unchecked export of infant formula from Australian supermarkets to more profitable markets in China has led to local shortages. In contrast, breastfeeding is the shortest supply chain of all infant feeding options and delivers optimal food, and immunological protection for infants.

So what stops governments investing in breastfeeding?

Infant food security is a neglected area in public policy. Debates about women’s “choice” to breastfeed mask an ugly reality: for policymakers, trade trumps health in infant feeding.

Conflicts between trade and health are revealed in growing global evidence of corporate political activity. Commercial influence by the infant formula industry is immense, and directly interferes with public policy objectives for breastfeeding on a globalised scale. This influence seeps deeply into international and national food regulatory forums. In the WHO/FAO Codex Alimentarius Commission, the industry strongly influences international food standards for formula products, with national delegations often dominated by industry stakeholders.

The industry also intervenes to weaken restrictions on marketing of milk formula products to parents and health systems. New evidence shows how US baby food and dairy industry lobby groups have coordinated with other industry lobbyists to mobilise the US government against the WHO. Recent research also clearly documents how ‘Big Formula’ distorts evidence through sponsorship of research, scientific journals, and health professional education.

Australia is a “bad policy actor” both at home and abroad. It joined US efforts to stop Thailand from strengthening its milk formula marketing and breastfeeding protection law. In January the former federal government announced grants totalling $160,000 for industry to “develop market strategies” in SE Asia, Latin America, and the Middle East.

An upcoming conference to be held by the formula industry at Parliament House will promote “networking” and “market access” (ironically titled “Safeguarding the Future”). The Sydney Morning Herald reported that ‘The Infant Nutrition Council is selling tickets to a cocktail event at Parliament House in June, promising access to “government officials” and seeking between $5000 and $10,000 from sponsors.’

Meanwhile Australia’s National Breastfeeding Strategy (ANBS) remains largely unfunded, and its objectives to “protect the community from false and misleading marketing and advertising” of breastmilk substitutes un-actioned. Repeated reviews, including a 2021 assessment by the Australian Consumer and Competition Commission, found that the current industry self-regulatory agreement on marketing fails to manage modern marketing strategies. These include “egregious” digital marketing and rampant promotion of toddler milks, and other poorly evidenced “specialised” milk formula products. Yet another “independent” review is now underway. Previous reviews resulted in no action on toddler milk marketing. Public health motivations for breastfeeding promotion and health system savings, globally and in Asia Pacific countries, are feebly aligned against vast corporate marketing budgets and commercial incentives.

Acute crisis or chronic stress?

Food insecurity makes national targets to increase breastfeeding all the more imperative, to reach  global goals for exclusive breastfeeding of 70 percent. The COVID-19 pandemic and bushfire and flood emergencies have revealed structural weaknesses in maternity care and breastfeeding support. Acute stressors in the health system from COVID-19 compound existing barriers to breastfeeding. Unsurprisingly, rates of exclusive breastfeeding in Australia show a steady decline, starting soon after birth, with around 30 percent of babies fed infant formula even before discharge from hospital.

Action to deliver infant food security: fund breastfeeding policy

Industry interference on infant feeding policy leaves infants vulnerable at home and abroad: food security for infants requires political courage. Governments must fund breastfeeding protection, promotion and support, not formula marketing. Food security is a global imperative, but action starts at home.

First steps towards infant food security in Australia requires the new government to withdraw Ministers and officials from participating at the 23 June industry lobbying event at Parliament House. The Albanese government should also immediately reverse the previous government’s decision to subsidise baby formula promotion in Asia. Additionally, Australia has a comprehensive, multi-pronged, and evidence-based policy waiting for political will and courage. It should be funded, and restraints on marketing made law, not voluntary.

The new Australian government must start prioritising maternal and infant health over trade in its geopolitical partnerships.

Libby Salmon is a PhD candidate at the School of Regulation and Global Governance (RegNet), Australian National University.

Julie Smith is an Honorary Associate Professor at the National Centre for Epidemiology and Population Health, Australian National University.

Phil Baker is a Senior Lecturer in Human Nutrition at the School of Exercise and Nutrition Sciences, Deakin University.

This article is published under a Creative Commons Licence and may be republished with attribution.