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China is the largest market for infant formula. With the increasing use of smartphones, apps have become the latest tool used to promote milk formula. Formula manufacturers and distributors both have seized the popularity of apps as an avenue for marketing.
This study aimed to identify and analyze milk formula ads featured on Chinese pregnancy and parenting apps, to build the first complete picture of app-based milk formula marketing techniques being used by milk formula brand variants on these apps, and to more fully understand the ad content that potentially undermines public health messaging about infant and young child feeding.
We searched for free-to-download Chinese parenting apps in the 360 App Store, the biggest Android app store in China. The final sample consisted of 353 unique formula ads from the 79 apps that met the inclusion criteria. We developed a content analysis coding tool for categorizing the marketing techniques used in ads, which included a total of 22 coding options developed across 4 categories: emotional imagery, marketing elements, claims, and advertising disclosure.
The 353 milk formula ads were distributed across 31 companies, 44 brands, and 79 brand variants. Overall, 15 of 31 corporations were international with the remaining 16 being Chinese owned. An image of a natural pasture was the most commonly used emotional image among the brand variants (16/79). All variants included branding elements, and 75 variants linked directly to e-shops. Special price promotions were promoted by nearly half (n=39) of all variants. A total of 5 variants included a celebrity endorsement in their advertising. A total of 25 of the 79 variants made a product quality claim. Only 14 variants made a direct advertisement disclosure.
The purpose of marketing messages is to widen the use of formula and normalize formula as an appropriate food for all infants and young children, rather than as a specialized food for those unable to breastfeed. Policy makers should take steps to establish an appropriate regulatory framework and provide detailed monitoring and enforcement to ensure that milk formula marketing practices do not undermine breastfeeding norms and behaviors.
Despite the strong health message that
Omnipresent marketing of BMS negatively affects breastfeeding practices [
The International Code of Marketing of Breast Milk Substitutes (the Code), published by the WHO in 1981, is an international health policy framework to regulate the marketing of BMS [
Given that this marketing heavily influences infant and young child feeding preferences and choices [
Android is the most popular smartphone operating system in China, with an almost two-thirds share of the total market [
Ads promoting any type of milk formula were defined as formula ads for this study. Between April and May 2018, we scrolled through the entire app loading page and e-commerce page of each of the included 79 apps to identify and document the formula ads. In addition, as banner ads have been shown to capture audience attention [
Flow chart for milk formula ads collection.
Manufacturers frequently offer different variations of the same branded products known as brand variants [
The formula company, brand, and brand variants featured in each ad were identified. Descriptive statistics were used to assess the range of companies, brands, and variants of milk formula, and the frequency of different milk types and target ages. If a single ad promoted more than one type of formula milk or only promoted a company or a brand itself, then that ad was categorized as brand advertising.
On the basis of previous content analysis studies of infant and toddler food ads in magazines [
Coding categories and options of milk formula ad content.
Coding category and coding options | Definition or examples | |
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Happy child | Image of a smiling baby. |
Parental love | Image of a parent hugging or kissing a baby. | |
Satisfied baby drinking from a milk bottle or holding a formula can | Image of a cute baby drinking milk from a bottle or holding a milk formula can. | |
Relieved mother, pregnant women | Image of a mother or pregnant woman relieved or at ease. | |
Beautiful natural environment, pasture | Image of a mountain pasture, clear sky, and natural landscape. | |
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Branding elements | Any logos, colors, and trademarks. |
Special price promotions | Limited-time offers, discount, or other reduced price. | |
Sampling | Consumers are given some quantity of a product for no charge (either new or established products). | |
Coupons | A document or e-voucher exchanged for financial discount with product purchase. | |
Bonus packs | Special packaging that provides consumers with extra quantities of products at no extra charge. | |
Competitions, prizes, and giveaways | Any contest involving a participant entry, including content about the product or the brand (such as photos and article) created by users. | |
Cartoon characters or spokes characters | Any nonhuman characters that are used to promote a product or a brand—giraffes, sheep, bees, bears, and other cartoon images. | |
Sponsorships and partnerships | Any events that the brand supports or other brands with which the brand partners. | |
Celebrity endorsement | People with an entertainment or media profile. | |
Online shop | The ad is directly linked to the products in e-shop, and app user could buy the product online. | |
Delivery | Products are delivered directly to consumer. | |
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Food safety claim | Purity, no contamination, imported milk source, good quality of milk source, whole package imported, and a long brand history. |
Product quality claim | Organic, goat milk, premium or gold or super package, scientific based or medical evidence based or medical recommendations based or trusted by parents and health professionals. | |
Health claims | Nutritionally balances, and provides good nutrition to, the infant or children, supports healthy growth/better overall health, helps to support digestive system, good for the brain/better brain power, and specialized for allergic baby. | |
Nutrition claims | Contains DHAa or ARAb, Omega 3, or milk fat globule; contains fiber; contains probiotics; contains protein or amino acids; contains lactose; contains vitamin. | |
Claims idealizing the use of milk formula | Texts aim to idealize the use of milk formula, including wording |
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Advertisement disclosure | All advertising has to be identified with the word |
aDHA: docosahexaenonic acid.
bARA: arachidonic acid.
First, any emotional imagery included in the ads was coded. Emotional images were coded to one of the following 5 options: (1) happy child, (2) parental love, (3) satisfied baby drinking from a milk bottle or holding a formula can, (4) relieved mother, pregnant women, and (5) beautiful natural environment, pasture. Any duplicate images that appeared in multiple ads were not assessed. Next for each ad, the presence of any of the 11 marketing element categories was recorded. Marketing element categories included branding, special price promotions, sampling, coupons, bonus pack, contests, prizes and giveaways, sponsorships, spokes characters and celebrity endorsement, and free delivery. The third coding category, claims, was made up of 5 coding options: food safety claims, product quality claims, health claims, nutrition claims, and claims idealizing the use of formula, with several types of claim under each option. Finally, for the last coding category, disclosure, it was noted whether the ad included text identifying that it was advertising content. According to China’s
All content coding was completed by JZ and then tested for accuracy by a research assistant independently coding 40 ads randomly selected from the final sample. Cohen kappa was used to measure intercoder reliability using SPSS version 22.0 statistical software (SPSS Inc, an IBM Company). Kappa value was 0.81. Definitions for infant formula and substitutes is provided in
Breast milk substitutes refer to any food for children (up to 3 years of age) being marketed or otherwise presented as a partial or total replacement for breast milk, whether suitable for that purpose or not [
Milk formula refers to the wider range of milk powders for all ages available on the market [
Infant formula refers to milk formula products intended for infants during the recommended exclusive breastfeeding phase (typically 0-6 months of age) [
Follow-on formula refers to milk formula products intended for older infants, as they begin to receive complementary foods, and young children (typically 6-12 months of age) [
Toddler milk: A fortified milk-based product only suitable for children older than 12 months (12-36 months) [
Child milk: A fortified milk-based product only suitable for children older than 36 months [
In total, 353 unique ads from the 79 apps were collected for analysis. The 353 milk formula ads were distributed across 31 companies, 44 brands, and 79 brand variants. Just over half of the milk formula companies (15/31) were international corporations with the remaining 16 Chinese-owned. Many of the international companies marketed multiple brands and brand variants with the majority of brands (27/44, 61%) and brand variants (49/79, 62%) being produced by international companies. In all, 70 of the 353 ads were distributed across 10 variants from 4 brands manufactured by the Danone Company. This was followed by Nestle, with 52 ads across 11 variants under 4 brands and then Mead Johnson with 34 ads across 7 brand variants under 6 brands.
More than one-thirds of brand variants (n=28) advertised more than one type of milk formula.
An image of a natural pasture was the most commonly used emotional image among all 79 brand variants (n=16). Followed by an image of parental love (n=11), happy child (n=7), relieved mother/pregnant women (n=5), and a baby drinking/holding milk bottle (n=4;
Emotional imagery, marketing elements, and advertisement disclosure presented in 79 milk formula brand variant ads.
Coding category and option | Occurrencea, n (%) | |
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Beautiful natural environment, pasture | 16 (20) |
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Parental love | 11 (14) |
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Happy child | 7 (9) |
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Relieved mother, pregnant women | 5 (6) |
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Satisfied baby drinking milk bottle or holding formula can | 4 (5) |
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Branding elements | 79 (100) |
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Online shop | 75 (95) |
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Special price promotions | 39 (49) |
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Competitions, prizes, and giveaways | 27 (34) |
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Delivery | 23 (29) |
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Coupons | 20 (25) |
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Bonus packs | 17 (22) |
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Cartoon characters/spokes characters | 16 (20) |
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Sampling | 14 (18) |
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Celebrity endorsement | 5 (6) |
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Sponsorships and partnerships | 4 (5) |
Advertisement disclosure | 32 (41) |
aSome brand variants contained more than one emotional imagery or marketing element.
All variants included branding elements, such as logos, trademarks, and brand colors, and linked directly to e-shops. Special price promotions, such as discounts, sales, and limited-time offers, were promoted by nearly half (39/79, 49%) of all brand variants. Competitions, prizes, or giveaways on the condition of supplying contact details were used by 27 variants. A user-generated content (UGC) contest was held by one brand variant (Enfinitas) where consumers were asked to submit a photo of or a story about the milk formula to win a gift. A total of 23 variants offered free delivery service. Coupons, distributed either by the brand or online store, were available in the ads of 20 variants. A total of 17 variants offered a bonus pack and 16 variants included licensed characters to promote their products, such as cartoon giraffes, sheep, bees, and bears. Time-limited product sampling was identified in the ad of 14 variants of both established formulas and new products. A total of 5 variants included a celebrity endorsement in their advertising. These celebrities were all well known in China, included an actress who is a mother and is followed by nearly 30 million fans on the social media site Weibo [
Many brand variant ads contained more than one claim across the 5 coding options. Although some type of claims appeared in more than one ad for a single brand variant, each unique type of claim was counted only once (
Prevalence of 79 milk formula brand variants making claims by type of claim.
Claim type | Brand variant making this claim typea, n | |
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34 | |
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Whole package imported | 20 |
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Good quality of milk source | 9 |
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Long brand history | 8 |
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Imported milk source | 7 |
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Purity, no contamination | 2 |
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25 | |
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Premium, gold package, super | 20 |
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Organic | 7 |
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Scientific based, medical evidence based/medical recommendations based/trusted by parents and health professionals. | 5 |
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Goat milk | 4 |
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24 | |
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Helps to support digestive and absorption system | 8 |
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Specialized for allergic baby | 7 |
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Nutritionally balances and provides good nutrition to infant or children/supports healthy growth/better overall health | 6 |
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Good for the brain/better brain power | 3 |
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24 | |
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Contains DHAb/ARAc, Omega 3, or milk fat globule membrane | 7 |
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Contains sphingomyelin or choline | 5 |
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Contains protein or amino acids | 4 |
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Contains probiotics | 4 |
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Contains lactose | 2 |
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Contains fiber | 1 |
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Contains vitamin | 1 |
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10 | |
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Including |
10 |
aSome brand variants made multiple types of claims under each claim option.
bDHA: docosahexaenonic acid.
cARA: arachidonic acid.
In total, only 14 variants made a direct advertisement disclosure. In addition, a further 18 variants included the Chinese character for “product/commodity” instead of advertisement. A total of 2 variants (NAN Pro and S-26 Promil Ultima) stated
This study identified a total of 79 brand variants that included multiple types of milk formula, with 24 of these brand variants advertising infant milk formula, 30 follow-on formula, and 40 toddler formula. This reflects a full-scale breach of the Code, which applies advertising restrictions to any milk specifically marketed for feeding infants and young children up to the age of 3 years. Since 1986, the WHO has maintained the position that follow-on formula is nutritionally unnecessary, but most countries only apply partial advertising restrictions to infant formula [
In addition, 11 brand variants promoted child (aged >36 months) milk formula, with one brand variant, Enfakid, only promoting child milk formula; the remaining variants advertised more than one type of milk formula. As the Code is only designed to prevent companies from promoting milk formula and food for children up to 3 years of age, these products and promotions skirt advertising regulations. Moreover, China launched new infant milk formula registration measures in 2015 that came into effect on January 1, 2018. This legislation limits the number of brands per manufacturer to 3 for each of the development stages under 3 years of age [
Brand extension and brand-focused advertising help to establish brand awareness, preference, and loyalty to formula from fetus through to early childhood, this includes influencing pregnant women and mothers who are breastfeeding their infants. We found 10 variants of a special type of milk formula marketed as being for breastfeeding/pregnant women. Marketing an increasing range of milk formulas for different age groups weakens the impact of restrictions on infant formula (0-6 months). Sharing a brand that is identified with other life stages of formula is likely to influence infant feeding behavior to the same extent as direct advertising, as consumers are unable to differentiate between the two [
Manufactures use persuasive marketing techniques to reinforce their brand identity, such as special price promotion, coupons, prizes, and giveaways. This is despite the fact that the Code prohibits any point of sale advertising or any promotional technique to induce sales [
Some brand variants advertised with claims of
The 2008 milk product scandal in China has also led to high demand for imported infant formula. Large international companies exploit these product fears to create a premium image of their brands. Meanwhile, domestic companies are attempting to rehabilitate their brand image while also making similar reassuring claims that they use
Heath claims also included the claim of formula with added nutrients and associated benefits. For example, 3 brand variants claimed to contain added ingredients that improve the baby’s intelligence, which may leave some mothers with the impression that their own breast milk is inferior to formula [
The Chinese national government must take responsibility for ensuring the Code is implemented with adequate enforcement measures. Advertising regulations that restrict a broader range of marketing techniques are urgently needed. Monitoring advertisers’ compliance with such restrictions forms a strong basis for regulation and is particularly important for online and digital media. Moreover, a significant monetary penalty should be applied if milk formula companies or other app platforms are found to be breaking laws. Concurrently, when compared with the innovative strategies used by the milk formula industry, a more active approach is needed to promote breastfeeding by public health authorities, rather than the simple message that breast milk is the best. Scaling up health professional advice to breastfeed alongside engaging media campaigns or social mobilization events such as the national breastfeeding day or world breastfeeding week is crucial. Brazil, for example, is widely recognized for implementing a successful National Breastfeeding Program that has made a substantial improvement in breastfeeding exclusivity and duration [
A key strength of the study is that we developed and established a comprehensive coding tool to manually analyze milk formula ad content, including text and images, in a non-English language context. This content analysis also has some limitations. First, this study is only a snapshot of a small number of available free-to-download parenting apps. Second, although the ad collection was not confined to one type of milk formula, we may have missed some milk formula brands or variants, as many products are being continually added and removed from the market. Although a second independent coder was used to test the accuracy of the ad coding and high agreement was achieved, it is possible that ad characteristics could be missed or miscoded.
This is the first study to analyze milk formula ads found on the popular Chinese parenting apps. Products that function as BMS should not be freely advertised [
Distribution of the types of milk formula across brands and brand variants that appeared in the advertisements.
Example of a2 Platium formula advertisement featuring emotional imagery, marketing elements and claims.
Example of NAN Pro formula advertisement featuring emotional imagery, marketing elements and claims.
breast milk substitutes
The International Code of Marketing of Breast Milk Substitutes
user-generated content
World Health Organization
The authors would like to thank Dr Nina Berry for assistance with establishing the ad content coding process. All data generated or analyzed during this study are available within this study and its supplementary information file.
None declared.