Content analysis of breast milk substitutes marketing on Chinese e‐commerce platforms

Abstract

China has the largest and fastest-growing breast milk substitutes (BMSs) market and a disproportionately low exclusive breastfeeding rate. Many BMS manufacturers have established Chinese e-commerce stores. This marketing is of concern as it is likely to undermine breastfeeding. This study aimed to identify:(1) the marketing themes and strategies used to promote BMSs on the Chinese BMSs e-commerce websites; (2) if and how digital BMSs marketing may deviate from the World Health Organization Code of Marketing of Breast Milk Substitutes (the Code) recommendations. Content analysis was conducted on the flagship websites of 10 BMSs companies on the Chinese e-commerce platform "TMall" in July 2019. The main landing page (n = 10) of the flagship TMall website and the product description page (n = 113) of all individual formulas (Stages 1-3) within each company's TMall website were examined. The content was analysed and coded using an iterative thematic analysis approach. Emphasis on Premiumization and Science & Nutrition was the most commonly used marketing approaches. A total of 27.4% of the product description pages sampled used images of infants (<12 months), 33.6% made favourable comparisons of BMSs to breast milk, and only 34.5% included probreastfeeding statements. Marketing strategies were often inconsistent with the Code, and companies used "creative" ways to target mothers, often circumventing the Code recommendations. Unsubstantiated information was commonplace and of concern, because the e-commerce platform provided easy opportunities for bulk purchases. National regulatory actions are urgently needed to monitor online BMS marketing and the undermining of breastfeeding in China.

Global evidence of persistent violations of the International Code of Marketing of Breast‐milk Substitutes: A systematic scoping review

“…For example, 41% of interviewed mothers in a study from Ethiopia reported that they had seen BMS advertising, and 74% of the violations reported occurring through TV promotions (Laillou et al, 2021). Promotion via parent magazines was highlighted in a study in Taiwan (Chen) and in a Chinese study "premiumization" and "nutrition and science" were the main marketing appeal strategies on the BMS companies' websites and e-commerce platforms studied (Han, 2020) | 7 of 14 about risks from improper use was reported in Uruguay (Alcaire et al, 2020). In a study in Ecuador, more than half of the BMS labels contained texts or images that idealized their use (Caicedo-Borrás et al, 2021).…”

Methodologies for Monitoring the Digital Marketing of Foods and Beverages Aimed at Infants, Children, and Adolescents (ICA): A Scoping Review

“…The highest number of sources was identified in 2020, with six sources within the year ( Figure 2 ) [ 24 , 25 , 26 , 27 , 28 , 29 ]. Among the sources obtained, peer-reviewed papers ( n = 20) [ 25 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ] were the most frequent type, followed by official reports ( n = 4) [ 46 , 47 , 48 , 49 ], narrative review ( n = 1) [ 50 ], comments ( n = 1) [ 24 ], open access theses ( n = 1) [ 26 ] and conference abstracts ( n = 1) [ 51 ]. All of the sources included in this scoping review were published in English.…”

“…Most of the sources included in this scoping review focused on a single country ( n = 23); the rest of the publications considered more than one country, with one of them including up to 53 countries [ 49 ]. Australia was the country with the highest number of studies ( n = 5) [ 31 , 35 , 41 , 45 , 50 ], followed by Canada ( n = 4) [ 24 , 30 , 40 , 42 ], the United Kingdom (UK) ( n = 3) [ 33 , 38 , 49 ], the Philippines ( n = 3) [ 30 , 46 , 48 ], New Zealand ( n = 3) [ 36 , 43 , 44 ], the United States of America (US) ( n = 3) [ 25 , 30 , 34 ], China ( n = 3) [ 26 , 30 , 46 ], Indonesia ( n = 3) [ 30 , 32 , 46 ], Thailand ( n = 3) [ 32 , 39 , 46 ], Mexico ( n = 2) [ 27 , 31 ], India ( n = 2) [ 40 , 46 ], Ireland ( n = 2) [ 47 , 49 ], Myanmar ( n = 2) [ 40 , 42 ], Vietnam ( n = 2) [ 40 , 42 ], and some other countries with only one source ( Figure 3 ). Based on this scoping review, a total of 81 countries have any published documents or reports related to methodologies for the monitoring of the digital marketing of BMS to parents or caregivers ( ...…”

“…On the other hand, a Yale University theses analyzed BMS retail websites on the largest Chinese e-commerce platform (TMall) to characterize the themes and marketing strategies used to target consumers [ 26 ]. After identifying the top five domestic and top five foreign BMS company/brand websites of TMall, the main landing page of each flagship website and the product description page of all unique individual formula products (IF, follow-on formula, and toddler milk) were captured.…”

“…Coding protocols were developed and adapted based on the previous content analysis on the digital marketing of children’s food [ 59 , 60 ]. The 10 main landing pages were coded and separated into two sections (primary and secondary displays) based on the location of the information on the webpage [ 26 ]. This study incorporated a combination of quantitative (describing the frequency of different outcomes: thematic appeals, Code violations, and images used) and qualitative (the extraction of specific texts and language to provide context for each variable and for the appeals and marketing strategies targeted to consumers) research techniques in order to improve the understanding of how BMS digital marketing violates Code recommendations and attempts to normalize and promote IF as an alternative to breastfeeding [ 26 ].…”