The Effects of In-store Marketing of Infant Formula and Lactation Support Products Among Stores in Black and White Zip Codes Across Los Angeles County

Abstract

The World Health Organization adopted the International Code of Marketing of Breastmilk Substitutes to prompt governments to regulate the marketing of artificial supplementation. This code was designed to protect the most vulnerable (babies) by ending unethical infant formula marketing. The United States (U.S.) signed on to support this code, yet there is little governance to enforce it. As a result, infant formula marketing continues to disproportionately target Black families and undermine efforts for breastfeeding promotion in the U.S. This is problematic as rates of breastfeeding among Black populations are consistently the lowest compared to other races/ethnicities (with White populations having highest breastfeeding rates). To gain a deeper understanding of the social barriers to breastfeeding among ethnic minority lactating persons, the current study investigates in-store marketing and health claims of infant feeding products across Black and White communities in Los Angeles County. Trained researchers utilized observational methods to explore marketing aspects and health claims of infant formula, follow-on formula, and galactagogues products in June 2019. This was a cross-sectional study that included 47 retail stores in Black (N=24) and White (N=23) communities across 20 zip codes. Findings indicate that stores in majority White zip codes, compared to those in majority Black zip codes, had greater multi-pack discount marketing of infant formula and bottled purified water marketed for mixing infant formula (17.4 percent Black vs. 60.9 percent White, p<0.01). Additionally, stores in majority White zip codes, compared to those in majority Black zip codes, had more infant formula products and galactagogue beverage products with health claims on their label. The results of this study suggest a minimal difference in in-store marketing and use of health claims on labels for infant formula, follow-on formula, and galactagogues products between stores in the communities included in this study. Overall, the findings underscore an opportunity for the marketing and education of safe and quality galactagogue products for persons who may be struggling with initiating and maintaining lactation.