Advertising breast milk substitutes: testing the effectiveness of new legislation

Submitting Institution

University of Leicester

Unit of Assessment

Communication, Cultural and Media Studies, Library and Information Management 

Summary Impact Type


Research Subject Area(s)

Medical and Health Sciences: Public Health and Health Services

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Summary of the impact

The UK infant formula market increased in value from 2005-2013 by 65% to £463m. The Unit's research, funded by the Food Standards Agency and the Department of Health, addressed the concerns of policy makers and breast feeding lobby groups that baby food manufacturers might be circumventing recently introduced restrictions on advertising infant formula (breast milk substitute) products in such a way as to undermine support for, and uptake of, breastfeeding. The research findings underpinned the recommendations on regulatory change made to government by an independent review panel established by the Minister of State for Public Health. Since the panel reported, manufacturers have addressed the issue by removing publicly accessible links to infant formula product information.

Underpinning research

Infant formula products fall into two categories: those that are suitable for infant feeding during the first six months of life (infant formula) and those intended for children older than six months (known as `follow-on formula' in the UK). The labelling, advertising and promotion of these products are subject to government controls. The regulations prohibit, with some exceptions, the advertising of infant formula, but the advertising of follow-on formula is permitted. The UK market for infant formula products is large (c £600m) and has grown by 50% over the last five years. A concern within the health promotion and policy-making community and among lobby groups supporting breastfeeding is that, within this control framework, there is potential for parents, parents-to-be, and carers to mistake advertising that promotes follow-on formula for advertising for infant formula with the possible effect that support for and uptake of breastfeeding are undermined.

Our research, directed by Professor Barrie Gunter and Mr Roger Dickinson, was designed to establish the effect of revised regulations introduced in 2007 controlling the advertising and commercial presentation of infant formula products. The research (see 3.1) was commissioned to assist an independent review panel assembled at the request of the Minister of State for Public Health to assess whether the new controls were meeting their objectives, whether further action was needed, and what future action, if any, would be appropriate. Gunter and Dickinson were the joint grant-holders and principal investigators. The independent review panel's work was concerned with a small though significant element of the very much broader topic of the marketing and advertising of breast milk substitutes. It set out to conduct a review `based on the best available evidence and that this evidence should be robust and able to withstand scrutiny' (5.3). The panel sought to commission academic researchers with proven expertise to collect relevant data using established social scientific methods of high validity and reliability and to analyse and interpret these data in order to provide the panel with firm evidence on which to base its recommendations.

An analysis of the textual and visual content of UK print, television, internet and outdoor advertising for formula products was conducted for two 12-month periods (January to December 2006; March 2008 to February 2009). Data from store displays for formula products in 108 retail sites situated in Belfast, Cardiff, Edinburgh and Leicester between December 2008 and January 2009 were also analysed. Coding schedules were designed to measure variables in the advertisements known to mediate consumers' responses to advertising content.

Our research findings were presented in a report to the review panel in July 2009. They showed that the advertising of infant formula and follow-on formula had changed since the change in regulations in 2007. Prevalence of information about product features increased from 2006 to 2008-09 in print advertisements while there was evidence that TV advertising of follow-on formula and its intended use had become less clear. After the change in regulations, TV advertisements were more likely to use techniques designed to play on the emotions of consumers than print advertisements; the use of emotional triggers becoming more prevalent. The text in print and TV advertisements had become easier to read but techniques that could further improve clarity reported by the research team had not been utilised either before or after the change in regulations. There was evidence that in TV advertising of follow-on formula there had been a decline in the use of images showing age-related factors that may indicate to consumers the suitability of follow-on formula products.

All the data analysis was conducted by researchers at Leicester and was led by Gunter and Dickinson with the assistance of Dr Julian Matthews (Lecturer) and Ms Jennifer Cole (Graduate Research Assistant).

References to the research


(1) October 2008 — July 2009: Gunter, B and Dickinson, R. University of Leicester: A project to establish the nature of infant formula and follow-on formula advertising and presentation. Research grant, Food Standards Agency and Department of Health £177,300.

Key research outputs

(2) Dickinson, R., Gunter, B., Matthews, J. and Cole, J (2013) "The impact of amended controls on the advertising of infant formula in the UK: findings from a before and after study" International Journal of Health Promotion and Education 51 (1) 11-22.


(3) Gunter, B., Dickinson, R., Matthews, J., Cole, J. (2013),"Formula manufacturers' web sites: are they really non-compliant advertisements?" Health Education, 113 (1):18 - 27.


(4) Gunter, B., Dickinson, R., Matthews, J. and Cole, J. (2009) The Nature of Infant Formula and Follow-on Formula Advertising and Presentation: Final Report to the Food Standards Agency/Department of Health.

Previous research relevant to the case study

(5) Dickinson, R (2000) "Food and eating on television: impacts and influences." Nutrition and Food Science. 30 (1) 24 - 30.


(6) Dickinson, R and Leader, S (1996) "The role of television in the food choices of 11-18 year olds." Nutrition and Food Science 6 (5) 14-19.


Research Quality

These articles all appeared in peer-reviewed journals.

Details of the impact

The Minister of State's independent review panel, chaired by Professor Anne Murcott made repeated reference to our research in its final report to the Minister of State and used our key findings to justify its recommendations on the regulation of infant formula advertising (5.2). The panel recommended to the Minister that formula manufacturers should make changes to the advertising of infant formula products that improved text legibility and that the use of imagery in formula advertising should give clearer indications of the age suitability of these products. The changes include clarification of text about the age suitability of infant and follow on formula products and the clarity of pack shots in advertisements (pages 6 and 68 of 5.2). These recommendations derive from the secondary research analysis and primary data collection of the University of Leicester project. Further changes concerning identifiers of the age of any infants shown in follow-on formula advertising were also underpinned by the primary analysis of formula advertising we undertook.

The robustness of our evidence base has been further reinforced by the publication of two peer-reviewed papers. One of these papers went beyond the original brief to highlight the way formula manufacturers were able to circumvent restrictions to their product promotions in regulated advertising by presenting product information for infant formula products alongside that for follow-on formula products on their company web sites that can be readily accessed by consumers. Follow-up research indicated that three years on from the original research, four out of the five major formula product manufacturers had addressed this issue and removed publicly accessible links to infant formula product information.

The research therefore had a direct impact on a government policy-making process; in spite of the change of government in June 2010 and the lack of formal response to the panel's recommendations, the manufacturers have nonetheless acknowledged and responded to our findings.

Current television advertising for follow-on formula adheres to the key recommendations underpinned by Leicester's research. The recommendations were that television advertising should:

  • Provide text relating to age suitability in a box, in bold or underlined.
  • Specify, unambiguously, the age of the child for whom the product is intended in the voiceover of television advertisements.
  • Ensure that the infants shown in follow-on formula advertising are unambiguously aged six months and over: for example by demonstrating features such as good head and arm control; sitting upright; having hair and teeth; showing emotional facial expression; being in an outdoor environment; self-feeding.
  • Increase the size and enhance the clarity of product images (i.e. packshots)

These recommendations can be seen translated into practice in 2013 television commercials by leading formula manufacturers. Advertising by Aptamil, for example, can be viewed here:

Sources to corroborate the impact

(1) Food Standards Agency, UK.

(2) Food Standards Agency (2010) Report of the Independent Review Panel conducting the Independent Review of the Controls on Infant Formula and Follow-on Formula. Available at:

(3) Gunter, B., Dickinson, R., Matthews, J. and Cole, J. (2009) The Nature of Infant Formula and Follow-on Formula Advertising and Presentation: Final Report to the Food Standards Agency/Department of Health.

(4) Contactable: Honorary Professorial Research Associate, Food Studies Centre, Department of Anthropology and Sociology, SOAS, to corroborate changes to the regulations regarding infant formula advertising.