Infant feeding in developing countries: Remedying market failure through quality certification

During infancy, normal infant growth requires complementing breastmilk with specialized foods of higher nutrient density and digestibility than the family diet. Inadequate complementary feeding makes the 6-24 month age range the period of most widespread and severe growth faltering in developing countries (C.G. Victora et al., “Worldwide Timing of Growth Faltering”, Pediatrics 2010, vol.125:e473–e480). To facilitate infant feeding, governments and philanthropies have long supported the production and distribution of low-cost complementary foods, but commercial markets in remain dominated by a high-priced global brand: Nestle's Cerelac. Even in the world's poorest countries, Cerelac is heavily advertised, widely available and sold for 4 to 5 times the cost of nutritionally-similar alternatives developed by public health agencies. Generic alternatives to Cerelac are safe and effective for institutional use when procured in bulk under supervision, but when individual consumers rarely buy them at any price. This paper describes theory and evidence explaining that market failure in terms of asymmetric information between sellers and buyers, by which consumers mistrust products that could be worth nothing at all. The only effective remedy for information asymmetry is quality assurance, in which a third party inspects competing products and provides a common label that certifies at least a given level of quality. This paper summarizes the evidence for how quality certification would improve child feeding from market experiments and surveys in Mali, Ghana and Uganda, and thereby improve infant health through more widespread access to lower cost, higher quality infant foods in Africa and Asia.