Abstract
Despite recommendations by the International Code of Marketing of Breastmilk Substitutes (the Code), regulatory bodies in the United States continue to permit commercial milk formula (CMF) marketing that threatens public health. The increasing popularity of online shopping highlights the need for more research on virtual CMF product marketing. To assess marketing strategies from the e-customer standpoint, we analyzed a sample of 26 bestselling virtual infant formula (IF) products from three US-based e-commerce giants. All product display content, including visual and audible components, was evaluated according to Code guidelines, analyzed thematically and assessed for theme co-occurrence. No IF labels were compliant with the Code due to widespread health benefit claims and idealization of IF. Furthermore, no US-based products were compliant with critical Code guidelines for powdered IF reconstitution instructions. Thematic analysis of virtual product web pages revealed 17 themes, of which four were novel to public health literature: purity, nature, innovation and eco-friendly. These themes co-occurred in patterned ways to capture consumers. The most popular online IF products in the United States combine Code violations with compelling online materials that idealize IF and shape cultural expectations about infant feeding and care. These practices reinforce the formula industry's well-documented efforts to undermine breastfeeding. A review of US regulations and implementation of the Code is urgently needed to protect public health.