The threat of social media towards exclusive breastfeeding: The Cambodia perspective

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This is a summary of the following report: World Vision International – Cambodia (2022) Under Social Media Influence: Digital Marketing of Breastmilk Substitutes in Cambodia.

A views piece provides an additional perspective to the findings of this report.

Grana Pu Selvi Gnanaraj is the Technical Lead for integrated nutrition for World Vision International in Cambodia

Carmen Tse is the Senior Nutrition Advisor, World Vision International

Loria Kulathungam is the Knowledge Management and Capability Advisor, World Vision International

In Cambodia, improved internet access and increasing social media use have driven an exponential rise of digital marketing strategies, including for commercial milk formula products. In 2020, 79% of Cambodia’s population used the internet, in contrast to 6% of the population in 2013. Similarly, active social media users in Cambodia have substantially increased from 27% in 2016 to 74% in 2022, with the most popular social media platform being Facebook (with 11.6 million users and an advertisement exposure reach of 68% of users).¹

The International Code of Marketing of Breastmilk Substitutes (or ‘Code’),² as currently implemented in Cambodia within Sub-Decree 133, does not explicitly cover digital marketing strategies employed by commercial milk formula companies as Code violations. It only prohibits the marketing of commercial milk formula products “at the points of sale, in hospitals or health centres or any other places”. Cambodia’s Demographic and Health Surveys indicate that the percentage of children exclusively breastfed for the first six months of life has decreased from 74% in 2010 to 51% in 2021. Given this negative trend, it is concerning that no regulation oversees the wide range of online channels and social media platforms utilised for commercial milk formula promotion, given that the aggressive marketing of commercial milk formula products undermines breastfeeding benefits and norms.

The recent report reviewed in this article documents various case studies on the digital marketing strategies utilised by commercial milk formula companies via a literature search for relevant documents (e.g., published papers, reports and social media posts) and structured interviews with lactating mothers, as well as with government and civil society stakeholders. Strategies identified include targeting commercial milk formula product advertisements to pregnant women and mothers using personal data on social media platforms; using social media influencers to promote various commercial milk formula products (e.g., across various life stages during their pregnancy and new motherhood), often paired with a health professional to add credibility; and hosting online support channels (websites, chats and groups) for advice on childcare and feeding while promoting commercial milk formula products. Digital advertisements also encourage the use of commercial milk formula products through emotional appeal (e.g., showing idealised family relationships of happy families, or mothers and children, in a commercial milk formula product advertisements); cross-promotion of commercial milk formula products with milk products for pregnant women; and discounts, sales or free samples of commercial milk formula products.

The report highlights challenges in monitoring Code violations on these platforms, as well as suggesting methods for improving such monitoring. The authors call for the government to update the legal framework by including a ban on marketing commercial milk formula products on social media and the internet, as well as restrictions on the use of health and nutrition claims to promote commercial milk formula products; to strengthen monitoring via developing appropriate tools for digital marketing and capacity training for government staff and monitors at national and sub-national levels; to state publicly, and enact, significant penalties for Code violations; to formally sensitise commercial milk formula company brand holders and ambassadors (e.g., influencers and health professionals) regarding the ban on marketing commercial milk formula products, and associated risks for violators; and to invest in breastfeeding promotion in digital media.

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