Global trends and patterns of commercial milk-based formula sales: is an unprecedented infant and young child feeding transition underway?

Abstract

Objective: The marketing of infant/child milk-based formulas (MF) contributes to suboptimal breast-feeding and adversely affects child and maternal health outcomes globally. However, little is known about recent changes in MF markets. The present study describes contemporary trends and patterns of MF sales at the global, regional and country levels.

Design: Descriptive statistics of trends and patterns in MF sales volume per infant/child for the years 2008-2013 and projections to 2018, using industry-sourced data.

Setting: Eighty countries categorized by country income bracket, for developing countries by region, and in countries with the largest infant/child populations.

Subjects: MF categories included total (for ages 0-36 months), infant (0-6 months), follow-up (7-12 months), toddler (13-36 months) and special (0-6 months).

Results: In 2008-2013 world total MF sales grew by 40·8 % from 5·5 to 7·8 kg per infant/child/year, a figure predicted to increase to 10·8 kg by 2018. Growth was most rapid in East Asia particularly in China, Indonesia, Thailand and Vietnam and was led by the infant and follow-up formula categories. Sales volume per infant/child was positively associated with country income level although with wide variability between countries.

Conclusions: A global infant and young child feeding (IYCF) transition towards diets higher in MF is underway and is expected to continue apace. The observed increase in MF sales raises serious concern for global child and maternal health, particularly in East Asia, and calls into question the efficacy of current regulatory regimes designed to protect and promote optimal IYCF. The observed changes have not been captured by existing IYCF monitoring systems.

Keywords: Breast-milk substitutes; Formula; Infant and young child feeding; Nutrition transition.

Fig. 1

Total formula retail sales volumes (kg) per infant/child (aged 0–36 months) v. log GDP per capita (PPP, international dollars) in 2013, with fitted values. The fitted line on the graph represents a robust, non-parametric, locally weighted regression describing the smoothed relationship between the variables, generated using the Stata lowess algorithm (set to the default bandwidth of 0·8, n 79); see Table 1 for country abbreviations; data from Euromonitor Passport Global Market Information database^{( 32 )}. *Volume for USA excludes follow-up formula; †volume for JPN excludes toddler formula; HKG was excluded as an outlier with 256.9 kg per infant/child. GDP, gross domestic product per capita at purchasing power parity (PPP) and international dollars to allow for comparability between countries

Fig. 2

Formula sales volumes (kg) per infant/child in 2013 v. 5-year compound annual growth rates (CAGR; %) for 2008–2013, for countries grouped by income category, with weighted markers representing infant/child population sizes: (a) infant formula, L-MIC; (b) infant formula, U-MIC; (c) infant formula, H-IC; (d) follow-up formula, L-MIC; (e) follow-up formula, U-MIC; (f) follow-up formula, H-IC; (g) toddler formula, L-MIC; (h) toddler formula, U-MIC; (i) toddler formula, H-IC. See Table 1 for country abbreviations; data from Euromonitor Passport Global Market Information database^{( 32 )}; population estimates are for infants/children aged 0–6 months for infant formula, 7–12 months for follow-up formula and 13–36 months for toddler formula. Fig. 1(c) excludes JPN and outliers not shown are HKG (269·3 kg, 14·3 %) and FIN (114·8 kg, –0·8 %); Fig. 1(f) outliers not shown are HKG (100·5 kg, 4·9 %) and FIN (72·3 kg, –0·6 %); Fig. 1(g) excludes UZB; Fig. 1(e) excludes MKD and outlier not shown is THA (68·8 kg, 6·3 %); Fig. 1(i) excludes JPN and USA and outliers not shown are HKG (298·7 kg, 10·7 %) and FIN (1·3 kg, 33·0 %). L-MIC, lower–middle income countries; U-MIC, upper–middle income countries; H-IC, high-income countries

Fig. 3

Formula category sales volumes (kg) per infant/child by country income groups, 2008–2013 (, 2008; , 2013) with projections to 2018 (). Data from Euromonitor Passport Global Market Information database^{( 32 )}; population estimates are for infants/children aged 0–6 months for infant formula (IF), 7–12 months for follow-up formula (FUF), 13–36 months for toddler formula (TF), 0–6 months for special formula (SF) and 0–36 months for total milk-based formula (Total MF); countries grouped by World Bank country lending categories; L-MIC, lower–middle income countries; U-MIC, upper–middle income countries; H-IC, high-income countries. Estimates for high-income countries exclude toddler formula in JPN and follow-up formula in the USA

Fig. 4

Formula category sales volumes (kg) per infant/child by region, 2008–2013 (, 2008; , 2013) with projections to 2018 (). Data from Euromonitor Passport Global Market Information database^{( 32 )}; population estimates are for infants/children aged 0–6 months for infant formula (IF), 7–12 months for follow-up formula (FUF), 13–36 months for toddler formula (TF), 0–6 months for special formula (SF) and 0–36 months for total milk-based formula (Total MF). Includes data for lower–middle income countries and upper–middle income countries only (i.e. excludes high-income countries) grouped by World Bank region