Stephanie Labarta, 31, was six months pregnant when she first noticed the occasional infant formula ad on Instagram and Facebook. Now, a year later, she sees ads three or four times a day, typically for Reckitt Benckiser's Enfamil or Nestle's Gerber Good Start.
"Gerber actually came up this morning on my feed - it started off with a contest to submit your smiling baby and then it trickled into the different types of formulas and what they have available," said Labarta, a senior analyst at a nonprofit in New York.
Soon after the influx of social media ads began, Labarta also received an unexpected care-package from an online registry that included an infant formula sample.
Such marketing represents what the World Health Organisation (WHO) describes in a report released Friday as "inappropriate promotion of breast-milk substitutes" via digital media.
Friday's report builds on WHO research published in February that flagged broader "aggressive" marketing tactics in the industry, which is set to grow to more than US$54 billion in formula sales this year, according to Euromonitor.
"Breast-milk substitutes companies buy direct access to pregnant women and mothers in their most vulnerable moments from social media platforms and influencers," WHO researchers said in the report. "They use apps, babyclubs, advice services and online registrations to collect personal information and send personalized breast-milk substitutes promotions to mothers."
In Western countries, what Labarta experienced is "very common practice", Laurence Grummer-Strawn, one of the report's authors, told Reuters. "They're using digital technology to get addresses of these women; (to) identify that they are pregnant; to get them on the lists and such for that kind of distribution."
The WHO, which has closely monitored marketing practices in the industry since the 1970s and created a non-legally binding code of conduct for companies in 1981, recommends exclusive breastfeeding for newborns, where possible, as the healthier option. To be sure, for many parents breastfeeding is not possible and formula is essential. Companies like Reckitt, Danone and Nestle all encourage parents to breastfeed and have their own strict guidelines detailing what their marketing representatives can or cannot do or say to mothers.
Danone's global head of digital transformation, Mabel Lu, said that while it was true that women are "constantly reached out to by targeted content" online, the problem is largely due to algorithms on social media platforms automatically displaying ads they think are relevant to users.
Reckitt said it provides parents with essential information about the best nutrition for their babies and follows all local regulations on marketing, which are often stricter than the WHO code.
Nestle, the world's biggest food company, has said that it will stop promoting infant formula for babies younger than six months all over the world from the end of 2022. Currently, Nestle does not promote infant formula for babies younger than 12 months in 163 countries. Some, including Nestle, say they cannot control the actions of independent "bad actors".
"Anyone in China can buy infant formula in Australia and sell it back on the internet independently," Marie Chantal Messier, global head of food and industry affairs at Nestle, told Reuters. "Often, people are not aware of the WHO code and therefore it's challenging for us to engage."
"They raise a fair point that there are multiple actors who are involved in this," WHO's Grummer-Strawn said. But it's unfair to "absolve them of responsibility...they pay marketers, they sponsor the various entities that are sharing misinformation," he added.
For Friday's report, the WHO analysed data from 4 million social media posts about infant feeding over a six-month period using a commercial social listening platform. The posts reached 2.47 billion people and generated more than 12 million likes, shares or comments. The 264 breast-milk substitutes brand accounts monitored for the WHO research posted content around 90 times per day and reached 229 million users.
In the United States alone, the amount the infant formula industry spent on advertising on Reddit, Facebook, Instagram and Twitter nearly doubled to US$3.82 million in 2021 versus 2017, according to Nielsen. Companies spent more on using digital marketing to sell infant formula last year than on any other type of advertising, the data showed.
"Where two or three years ago less than 5 percent of their budgets went into influencer marketing, now that could be anywhere from 25 percent to 50 percent of their budget," said Maria Sipka, co-founder of influencer marketing agency Linqia, which has worked on more than 20 campaigns for infant nutrition brands including Nestle's Gerber Good Start #forumlaforhappiness campaign.
Sipka said the true value of an influencer campaign is that it must not "smell like it's a promotion".
In a Linqia client brief seen by Reuters, influencer mothers were told by an unnamed food company that its infant formula is the only one that contains "a probiotic clinically shown to reduce crying by up to 50 percent in colicky breastfed infants" that is "ideal for formula-fed babies."
Mothers were told to "start your blog story by sharing your excitement and enthusiasm for your partnership" with the brand, share their story about how it provided comfort to their baby, and then ask their followers to share their thoughts about the brand.
"I think it's OK to explain that products are scientific and to show healthcare providers with lab coats, provided that doing so meets your code of conduct and that there is real substance to what is being said, that you can actually prove it through the data," a former Reckitt Benckiser executive said.
Some, however, are more skeptical about the ads, saying their increasing frequency is actively turning mothers away from breastfeeding.
"It's rampant on Instagram and on Facebook, it's everywhere on my stories," New York-based lactation consultant Rebecca Four said. "I've noticed the uptick. Does it anger us? Frustrate us? Of course."