Breastfeeding is best but if baby formula is required, should the price be regulated?

Labour Senator and a Rotunda Hospital consultant stress high cost of formula needs to be dealt with urgently

“Parents are facing an unjust burden and it’s our duty to intervene.” So said Labour Senator Rebecca Moynihan, as she wrote to the Competition and Consumer Protection Commission calling for an investigation into rising baby formula prices.

Moynihan is calling for the Government to implement price caps and to “allow general supermarket vouchers” to apply to infant formula. “Treating infant formula the same as alcohol”, in regards to the application of vouchers, “helps no one”, she said.

It is usually not possible to use money-off vouchers for items such as alcohol, cigarettes, lottery tickets and infant formula.

But is Moynihan’s ask as straightforward as it might appear? Or would such actions be in direct conflict with the World Health Organisation (WHO) code on breastfeeding?


The WHO code advocates that “infants be breastfed. If they are not breastfed, the code also advocates that infants be fed safely on the best available nutritional alternative. Breastmilk substitutes should be available when needed, but not promoted.”

Prof Afif El-Khuffash, neonatologist and lactation consultant based at the Rotunda Hospital, says there’s a fine line to be tread “between breaking the code but also being fair on families”.

“What the code goes against is advertising and the promoting of formula, and that’s completely different from advocating to the Government to actually control the prices of formula.”

El-Khuffash has striven to change Irish views about breastfeeding, and he has done that by painting and exhibiting his own artworks as well as his work as a neonatologist.

First formula “is an essential food item for some families, that is necessary and that we will always require. So, we shouldn’t be in a position where we offer promotions on it. It should just be made affordable from the outset, for people that need it.”

“I do think that the prices of formula need to be regulated,” he says. El-Khuffash believes this could happen if formula companies “reinvested some of their profits into making the first formulas affordable”.

“Globally, formula sales amounted to $55 billion last year,” he says.

But while El-Khuffash says he’s all for regulating “the price of formula”, he is “against the advertising that happens. It’s an essential product for some, you shouldn’t need to advertise it. If a baby needs it, a baby needs it. The advertising is a cynical way of trying to entice people to use it more when they may not necessarily need it.”

Strict regulations mean formula companies cannot advertise, or promote first formulas, which, he explains, is “the only formula babies need, and they know this”.

“The only formula baby needs, is the formula they cannot advertise, so they bump up the price,” he says, explaining they invest heavily instead in “advertising their other products”.

“Where they try and promote brand loyalty is advertising for the formulas after six months – the ones that aren’t needed. Because the World Health Organisation and all the physicians recommend that all the babies need, in the first year of age, is the number one standard formula exclusively up until five, six months and then with foods up until a year and then after a year you switch to whole cow’s milk. It’s simple.”

“I have no issues with ethical advertising,” El Khuffash says. “The problem with formula companies is their claims are unsubstantiated. And they do it in a very indolent, underhand way, in that they make you feel that you will help improve their development.

“If you actually look at all the ads, they all have these subliminal messages of ‘if you take formula, if you want to go on a night out you’ll be more free. If you give your baby formula, they will sleep for longer. If you give your baby formula, they’ll be satisfied for longer. They’ll gain weight better. They’ll develop better’. And none of that is true. I’m not saying that formula is harmful, I’m just saying that none of these claims of it improving all these things are actually substantiated. There was a big paper published in the BMJ (British Medical Journal) late last year, demonstrating there is absolutely no evidence base to a lot of the claims that they have, or that they make.”

El-Khuffash feels extending supermarket vouchers to incorporate first formulas “gives the room and the opportunity for formula companies to advertise”. He also says it is “not universal”.

“I really have an issue with it only being available to people who have club points with stores, because that only benefits the stores.”

“There’s nothing stopping the formula companies from cutting the price. And I think the politicians should be putting pressure on the formula companies to lower the prices. By asking for first formulas to be included as part of the voucher scheme, removes the onus away from the formula companies. It absolves them from any responsibility.”

El-Khuffash doesn’t believe reducing the price of formula would lower breastfeeding rates. Rather instead, it would make formula financially accessible to those who need it. Pinning low rates on lower-cost formula absolves the “Government from increasing their supports and their breastfeeding promotion”, he says.

“I don’t accept that lowering the price of formula is going to discourage people that want to breastfeed, from breastfeeding. If you have the proper support for mothers that want to breastfeed, they’re not going to say, ‘gosh it’s a tenner instead of 15 quid. I’m not going to bother with breastfeeding’. We’ve done a study on this: 80 per cent of mums delivering in the Rotunda on their first baby intend to breastfeed.

“However, out of those 80 per cent, the percentage of mums leaving the hospital exclusively breastfeeding is only 40 per cent.”

That huge drop “is to do with the lack of support, the lack of encouragement, the lack of education. And the lack of understanding that breastfeeding is hard, it takes a while to get established. We need a big shift in the mentality of healthcare providers dealing with mums over the first few days after delivery. We also need big investment in increasing staff numbers, because you can have one midwife looking after 10 mother and baby pairs on a ward.”

The high cost of formula needs to be dealt with urgently, El-Khuffash believes. “The prices have gone up exponentially.” He reiterates that “if some of the advertising allocations that formula companies use are diverted to making the number one formula accessible to parents, then that’s what should happen”. “Advertising is regulated, but the pricing isn’t.”

  • Sign up for push alerts and have the best news, analysis and comment delivered directly to your phone
  • Find The Irish Times on WhatsApp and stay up to date
  • Our In The News podcast is now published daily – Find the latest episode here