Milk and Social Media: Online Communities and the International Code of Marketing of Breast-milk Substitutes

Background: The advent of social networking sites and other online communities presents new opportunities and challenges for the promotion, protection, and support of breastfeeding. This study examines the presence of infant formula marketing on popular US social media sites, using the World Health Organization International Code of Marketing of Breast-milk Substitutes (the Code) as a framework. Methods: We examined to what extent each of 11 infant formula brands that are widely available in the US had established a social media presence in popular social media venues likely to be visited by expectant parents and families with young children. We then examined current marketing practices, using the Code as a basis for ethical marketing. Results: Infant formula manufacturers have established a social media presence primarily through Facebook pages, interactive features on their own Web sites, mobile apps for new and expecting parents, YouTube videos, sponsored reviews on parenting blogs, and other financial relationships with parenting blogs. Violations of the Code as well as promotional practices unforeseen by the Code were identified. These practices included enabling user-generated content that promotes the use of infant formula, financial relationships between manufacturers and bloggers, and creation of mobile apps for use by parents. An additional concern identified for Code enforcement is lack of transparency in social media-based marketing. Conclusion: The use of social media for formula marketing may demand new strategies for monitoring and enforcing the Code in light of emerging challenges, including suggested content for upcoming consideration for World Health Assembly resolutions.