As breastfeeding deficiency troubles South Africa's kids, Big Formula milk corps cash in

Lethu Nxami’s one-year-old infant weighs 6 kg against paediatricians expectations’ of an average of 10.5 kg at his age. 

‘He’s so tiny; I’m afraid he'll ever grow,’ she says. 

She knows a dozen new mums facing her situation in Joe Slovo Township informal settlement (one of the largest informal settlements in Nelson Mandela Bay), in the Eastern Cape. 

Eastern Cape is South Africa’s poorest province – a place where 78 per cent of kids are said to be living in poverty. A recent study by the University of the Western Cape says South Africa has one of the world’s lowest exclusive breastfeeding rates. Just 22 per cent of mothers do exclusive breastfeeding in 2024, far below the World Health Organisation target of 50 per cent by 2025, the report noted. 

Yet South Africa, the world’s most unequal country among 146 ranked by the World Bank, is peculiar in that even poor mothers prefer formula milk ahead of breastfeeding, Sithembile Nale, an outspoken former nurse at Leratong Hospital, west of Johannesburg City, and pro-breast milk activist, says. This is even so at a time adequate supplies of commercial baby formula costs twice as much as the monthly R536 ($32) child welfare grant paid mostly to 13 million infants from low-income households, she says. 

'We have scarce electricity and clean tap water to heat, wash, and sanitize formula milk bottles in South Africa’s slums, so one would assume poor mothers in South Africa would find breast-feeding not only healthier, but cost beneficial,' says Nale. 

Profit-seeking Big formula Milk agents

While working in maternity wards, Nale says she was disturbed by how commercial formula milk sellers and hospital managers enjoyed cosy and close relations via formula milk samples’ donations’, and ‘sponsorship’ of baby food hampers for poor mothers. 

When she challenged that, her managers considered her ‘troublesome’, she says. ‘Big Milk is in wards; hospital managers are friends with Big Milk,’ she told FairPlanet in January in South Africa during an interview. Poor mothers, especially those from poor urban slums like Nxami, were at the mercy of profit-seeking Big formula Milk agents who target them from early pregnancy to delivery in hospital maternity wards via these covert or direct means, she says. Formula milk brand loyalty is established in the first 48 hours after birth through these profiteering ‘donations,’ Nale added. Overworked paediatricians and nurses in stressed public hospitals have little time to sit down with poor mothers and educate them on the clinical and nutritional importance of breastfeeding. 

‘In the week, we gave birth to our kids – nurses at Dora Nginza Hospital would walk in our ward daily showing us free samples of Danone (brand name) formula milk, tempting us,’ Nxami says of her experience in the maternity ward.

Mothers in Informal Settlements

"For mothers from informal settlements — jobless, with bare cupboards — tempting them away from breastfeeding is simply wrong,’ Nale says. Without nutritious food, breast milk for babies often comes out in little trickles, she adds. 

‘We should rather direct poor mothers to food banks or encourage them to start vegetable gardens at home so that they harvest nutritious, fresh food to cook – and thus empower their bodies to pump lots of breast milk,’ she says.  

Formula milk corporations in South Africa not only pay hundreds of millions of rands to South Africa’s tax purse but wield so much power that their lobbying extends to interactive public media, parroting unscientific claims that their products are the superior solutions to alleviating infant health issues like stunted growth, colic, sleep disorders, and even pump-up high IQ, says Dr Chantell Witten, a nutrition professor at Northwest University who contributed to a 2023 Lancet Journal global paper on breastfeeding. 

‘[They are] creating an enabling environment for mothers to optimally breastfeed their babies,’ she commented, calling for strict government regulation in South Africa to control the commercial marketing of formula milk for children.  

This is not merely a black-and-white case of supposedly big food corporations like ‘Nestle Danone’ pressurising South Africa’s mothers to tilt towards commercial baby milk formula, says Sidumo Dlamini, the former president of the Democratic Nurses Union of South Africa. There is financial poverty and human cost when poor mums of colour are whitewashed into spending their meagre child welfare grant payments on formula milk, he says. 

‘Baby formula milk’s dominance in South Africa flies into the societal dynamics of poverty of a country where ‘hidden hunger’ is high,’ he told FairPlanet during a telephone interview from Durban, South Africa’s third biggest city, in January. 

Big Food corporations in South Africa are also accused of sneaking in ‘too high’ sugar compounds to their baby cereal products that are often used to stretch baby formula milk. This has led to documented malnutrition when baby cereals are used to ‘bulk up’ formula feeds when the tin is empty – according to a 2025 expose by the Swiss investigative non-profit Public Eye. In South Africa, specifically, Cerelac, the most popular baby food cereal manufactured by Nestle, added 4 g of sugar per serving, and 6 g in several other African countries.  In contrast, in the UK, Nestle adds no sugar. 

Critics say Big Food (Nestlé, Danone) has an outsized influence on government health policies and actively works to lobby against pro-breastmilk laws, especially the country’s progressive Regulation R991 law of 2012, which bans Big Food brands selling baby foods from proclaiming their products to be nutritionally superior to rivals or breast milk. South Africa’s government has failed to protect its most vulnerable mothers from predatory marketing by Big Food corps while at the same time failing to guarantee low-cost food and water that makes breastfeeding doable, says Nale, the former nurse. 

‘It’s a vicious cycle,’ she adds, explaining how maternal undernutrition and the stress of food poverty cause the cortisol stress hormone to rise and reduce breast milk lactation, and thus lead mothers again to formula milk substitutes. 

Lethu looks at her son, whose growth is stunted, and considers what the future holds. ‘I wish I were well off enough to feed him breast milk exclusively – he’d be big by now,’ she says, reflecting. She is now introducing her son to starchy traditional porridge, which a community midwife has recommended. It is early days, but she says her son is enthusiastically eating the nutritious traditional porridge - and it costs very little because the meal is made from wheat that her relatives in the countryside grow in their gardens and give her. That’s giving her a glimmer of hope that the baby’s weight can catch up, she says.