New paper: Digital Marketing Tactics, Non‐Compliance with the International Code of Marketing of Breastmilk Substitutes and Legal Breaches of Code‐Based Legislation by Commercial Milk Formula Industry
In June 2026, Mazariegos and colleagues published this paper documenting digital marketing of commercial milk formula (CMF) and violations of the Code and national legislation in three countries in Central America and the Caribbean.The Dominican Republic and Guatemala are upper-middle-income countries and Panama is a high-income country. All three countries have national legislation that is moderately aligned with the International Code of Marketing of Breastmilk Substitutes and subsequent World Health Assembly (WHA) resolutions (hereafter, the Code), scoring 53 (Guatemala), 64 (Panama) and 70 (the Dominican Republic) out of 100 on the Global Code Status report.
Researchers applied the WHO CLICK monitoring framework which was specifically developed to support Member States in monitoring digital marketing of unhealthy products to children. Over approximately 6 months (November 2023 to May 2024), researchers manually monitored CMF brand websites and official social media accounts to document promotional practices and violations of the Code and national legislation. Growing-up milks (GUM) accounted for 98.4% of promoted products and were often used in cross-promotion with infant formula. The paper describes the various types of marketing strategies used by CMF manufacturers in the 3 countries. The most frequent breaches involved labelling requirements and examples of violations included idealising CMF use, undermining breastfeeding, portraying formula as superior or equivalent to breastmilk, and the omission of mandatory warnings. The main regulatory gaps related to GUMs, cross‐promotion strategies, and health and nutrition claims. The research demonstrated that national legislation is not adequately regulating the active and sophisticated ecosystem of CMF promotion through digital marketing, which remains the dominant marketing channel for CMF in these 3 countries.
This research clearly illustrates how CMF manufacturers are able to continue aggressively marketing all CMF from birth to 36 months, even when national Code-related legislation exists, and demonstrates that when national legislation is only moderately aligned with the Code, CMF marketing remains pervasive, and similar tactics are used by manufacturers across countries and regions. The authors documented the loophole and regulatory gap between national legislation and the Code, which ranges from 21.7% in Panama to 47.1% in Guatemala.
The findings that violations of the Code and national legislation remain widespread are similar to the current situation in the UK, where regulatory gaps allow for evolving marketing tactics that continue to reach parents, caregivers and healthcare professionals.
The recommendations from this research are entirely relevant to the UK, including “the urgent need to adapt regulatory frameworks, enforcement mechanisms, and monitoring systems to protect breastfeeding, safeguard the first food system, and ensure safe and ethical digital environments for parents and children”.
The authors provide 5 policy recommendations which have global relevance:
1. Countries should urgently revise and expand national legislation to fully incorporate all Code provisions and WHA resolutions, explicitly covering all products intended for children under 36 months, nutritional and health claims, and all communication channels, including digital.
2. Enforcement mechanisms must be strengthened. This includes defining sanctions, clarifying mandates across government institutions, and building capacity among regulatory bodies.
3. Investments are needed in real‐time digital surveillance tools to detect non‐compliant marketing practices. Countries like Vietnam, Mexico, and Argentina have begun using artificial intelligence driven monitoring to auto-detect CMF adverts and analyse content, greatly enhancing the reach and speed of monitoring.
4. It is essential to foster coordinated action between health authorities, communication regulators, consumer protection agencies, competition authorities, civil society organizations, and digital platforms. Collaborative approaches can help detect and prevent marketing, while narrowing the gap between the Code and national laws. Strengthening the technical, human, and legal capacity of regulators is critical to ensure effective enforcement. This can include developing digital monitoring protocols and improved legal responses.
5. Governments and regional bodies should establish cooperation mechanisms to address cross‐border digital marketing strategies, including harmonizing legal frameworks between countries in regions, shared digital monitoring systems for content targeting multinational audiences, and formalizing interinstitutional agreements to exchange alerts, evidence, and enforcement actions.