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 to protecting and supporting breastfeeding. This study analyzed the presence of infant formula marketing within social media to identify emerging challenges to the maintenance of the International Code of Marketing of Breast-milk Substitutes (Code). Provisions of the Code have been incorporated into the Surgeon General's Call to Action to Support Breastfeeding. Methods: Social media tools, including Facebook, Blogspot, and interactive features on manufacturer web sites, were examined for the presence of infant formula marketing and potential Code violations, including direct-to-consumer marketing, images idealizing formula feeding, and promotional devices such as giveaways. Results: Infant formula manufacturers have established a social media presence primarily through pages on Facebook, “mommy blog” sponsorships, and social media tools on their own sites. Several violations of Article 5 of the voluntary Code were identified within social media outlets, including coupons and giveaways, sponsored reviews, and contact between mothers and company representatives. Examination of marketing content identified challenges to maintaining the Code in an era of social media, including issues unforeseen by the original Code. These include: lack of transparency in marketing, user-generated content like photos and testimonials (allowing manufacturers to solicit content for promotional purposes while staying within the letter of the Code), and potential to perpetuate social norms through creation of online communities. Conclusion: Use of social media for formula marketing may demand new strategies for monitoring and maintaining the International Code, including revision in light of emerging challenges.