Background Breastfeeding makes an important contribution to infant and maternal lifelong health. Marketing and promotion of Breast Milk Substitutes (BMS) is recognised as an important barrier to breastfeeding. Commission Delegated Regulation 2016/127 regarding first infant formulas (FIF) and follow-on formulas (FOF), which supplements the overarching Food for Specific Groups Regulation, regulates labelling and advertising so as not to discourage breastfeeding. BMS must display a statement concerning the superiority of breastmilk and must not use text or images idealising the use of formula or suggesting a product is equivalent to breastmilk. The present study aimed to analyse on-package labelling of BMS to assess use of messaging relating to breastfeeding and compliance with GB regulations.

Methods Formula products available over the counter in GB between April and October 2020 were identified, and pictures of all sides of packs were collated using NVivo 12. The presence and appearance of the mandatory statement concerning the superiority of breastmilk was recorded. Text and images idealising the use of formula were identified using GB legislation and guidance notes, to aid compliance with the legislation, issued by the Department of Health and Social Care (DHSC).

Results In total, 18 FIF, 18 FOF and 16 specialist formulas were identified. All 52 products included the mandatory statement concerning the superiority of breastmilk. Despite DHSC guidance that this statement ‘should be afforded a high degree of prominence’, it was generally in the smallest lettering on the pack and hidden at the back. Based on DHSC guidance notes, text which may idealise the use of formula, and therefore be considered non-permitted, was identified on 6% of FIFs, 22% of FOFs and 6% of specialist formulas. Images which may idealise the use formula were found on 67% of FIFs, 78% of FOFs and 75% of specialist formulas; including images of teddy bears, baby elephants and a stalk.

Conclusion On-package labelling of BMS in GB includes text and images that appear to idealise the use of formula and could be considered non-permitted according to DHSC guidance notes to BMS regulations. However, lack of detail in the legislation makes it difficult to clearly determine compliance. Providing additional detail in the legislation, such as specifying permitted imagery, would aid identification of breaches, facilitate enforcement and provide greater protection of caregivers from BMS promotion.