The Competition Commission of Singapore (CCS) has called for a halt to formula milk companies' aggressive marketing methods - including sponsorships and milk rotation programmes in hospitals - which give major formula milk brands a "first mover advantage".

The commission found that sponsorships and contributions to hospitals have been increasing, with manufacturers paying for pregnancy and parenting talks, training materials for hospital staff, shuttle buses for staff and discharge gift bags.

The manufacturers also have tie-ups with private hospitals for milk rotation programmes, where the hospital offers a brand of formula milk for newborns for a certain period of time before putting them on another, rotating between the various major brands.

The CCS called for these "conflict of interest" deals to be reviewed as it has entrenched brand loyalty and helped increase formula milk prices in Singapore by 120% in the last decade to become one of the highest in the world.

Parents unlikely to change formula brand

After a year-long inquiry into the prices of infant formula, the CCS published an 87-page report on 10 May, which estimated that:

• 59.2% of babies were born in private hospitals as compared to public hospitals in 2014;
• 15% to 60% of newborns drink formula milk in hospitals either as a supplement to breast milk or exclusively; and
• 70% of parents who use formula milk in private hospitals have no preferred brand, and will continue using the default brand on rotation.

This makes hospitals a target for formula milk companies to gain a "first-mover" advantage.

“Given that more babies are delivered in private hospitals, majority of parents who use ready-to-feed formula milk in private hospitals do not have a preferred brand in mind, and a large proportion of parents generally do not switch away from the brand they have used in hospitals, this could become a significant barrier to entry for new brands in term of brand exposure,” said the CCS.

The CCS recommends that such tie-ups should be reviewed.

Public and private hospitals differ in milk rotation programmes

Milk rotation programmes differ in public hospitals where various brands are rotated equally throughout the year, regardless of the amount of sponsorships or contributions received. For instance, KK Women's and Children's Hospital (KKH) invites manufacturers to take part in their milk rotation programme each year, to give different manufacturers equal opportunities.

"At any one time, only one brand of infant formula is made available, and the duration of each rotation is determined by the number of companies that opt to participate in this rotation," said Dr Chua Mei Chien, head and senior consultant at KKH's Department of Neonatology.

Dr Chua stressed that formula milk is only given when a mother is unable to produce breast milk due to other medical complications or conditions.

For private hospitals, the duration depends on the level and quality of support given to the hospitals by the manufacturers. Hospitals also could initiate contact by expressing their needs to manufacturers or manufacturers could approach hospitals and offer to contribute.

Some manufacturers have also paid to be part of the milk rotation programme in private hospitals. Hospitals claim that such payments and sponsorship help defray the cost of running activities and training nurses, allowing them to prepare more parents for parenthood.

Government agencies implement measures to curb price hike of formula milk

The CCS has suggested making formula milk in all hospitals "brand-free" or anonymised, delinking rotation schedules from sponsorship.

The Ministry of Health (MOH) also said that it will "strongly encourage" all hospitals providing maternity services to achieve the Baby-friendly Hospital Initiative (BFHI) certification to prevent conflicts of interest by prohibiting sponsorship arrangements, and actively encourages breastfeeding.

Currently there is no private hospital that is BFHI-certified although Thomson Medical Centre and Mount Alvernia have said they are working towards it.

Other government agencies are also implementing wide-ranging measures to curb misleading advertising and provide consumers with more choices by enhancing public education on nutritional content and requirements of formula milk through a five-year campaign.

"What consumers face... are the aggressive marketing and "premiumisation" messages driven by formula milk manufacturers, which perpetuate consumers' belief that the more expensive and the more ingredients there are in the formula milk, the higher quality it is," said the CCS report.

The Agri-Food and Veterinary Authority (AVA) has said they will tweak import requirements to allow more suppliers into the market and encourage price competition. The Sale of Infant Foods Ethics Committee Singapore will also review existing guidelines that prohibit the sale of formula milk online for infants younger than six months old. MIMS

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