Conflicts of Interest Are Harming Maternal and Child Health: Time for Scientific Journals to End Relationships with Manufacturers of Breast-Milk Substitutes

Correspondence to Ms Catherine PereiraKotze; catherinejanepereira@ gmail. com © Author(s) (or their employer(s)) 2022. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. The promotion and support of breastfeeding globally is thwarted by the USD $57 billion (and growing) formula industry that engages in overt and covert advertising and promotion as well as extensive political activity to foster policy environments conducive to market growth. This includes health professional financing and engagement through courses, elearning platforms, sponsorship of conferences and health professional associations and advertising in medical/health journals. These contribute to the overuse of specialised formulas and inappropriate dissemination of health and nutrition claims. Such ‘medical marketing’ reduces breastfeeding initiation, exclusivity, and duration, irrespective of country context. It also creates a subtle, unconscious bias and conflict of interest, whereby journal publishers may consciously, or unconsciously, favour corporations in ways that undermine scientific integrity and editorial independence—even perceived conflicts of interest may tarnish the reputation of scientists, organisations or corporations. Such conflicts have plagued infant and young child nutrition science for decades. Consequently, the World Health Organization (WHO) and United Nations Office of the High Commissioner for Human Rights recommend measures to avoid conflict of interest in nutrition policy development and service delivery as well as professional education and research. 8 While perceived conflict of interest generally does not involve financial payment, the WHO defined actual conflict of interest as arising “when a vested interest has the potential to unduly influence official or agency judgement/action through the monetary or material benefits it confers on the official or agency.” The public health importance of breastfeeding is undisputed. Creating an Summary box