Introduction
Breast-milk substitutes (BMS) marketing remains pervasive worldwide, but its public-health impact is most acute where breastfeeding rates are low and online advertising thrives. In China, the largest global BMS market, a UNICEF/WHO field study used a diary method to trace how pregnant women and new mothers encounter BMS online. The findings illuminate the channels, tactics, and themes shaping infant feeding decisions, and they reveal regulatory gaps in an increasingly digital marketplace.
Why a diary study matters
Traditional surveys can miss the real-time, everyday exposures that drive choices. Diaries—where participants capture screenshots or photos of BMS marketing messages over a set period—offer granular, context-rich insights into how digital marketing threads into perinatal life. In China, where online platforms are central to daily information flows, this approach helps identify not just what ads appear, but how they function within mothers’ routines and decision-making processes.
Who was studied and how
The diary sub-study enrolled 20 women from two urban centers, Beijing and Jinan, including 5 pregnant participants and 15 mothers with infants under 18 months. Over one week, each participant recorded BMS exposures, noting platform, date, message type, and content, and provided brief contextual descriptions. The study aimed to map online channels, marketing tactics, and thematic content, then assess how current Chinese regulations align with observed practices.
Exposure channels: online dominance
Across all participants, BMS marketing was ubiquitous, with 100% exposure and an average of at least one encounter per day. A striking 90% of exposure occurred online. Social media, e‑commerce, video platforms, and general web browsing formed the core channels. Offline channels—such as in-store promotions or seminars—were far less represented in the dataset. This online concentration underscores the need for regulatory strategies that address webpage layouts, embedded purchasing links, live streams, and direct-to-consumer interfaces, not just traditional labeling rules.
Core promotional strategies
The study identified four recurring marketing strategies that spanned channels and participant statuses:
- Competition: price, ingredients, and functional claims aimed at outperforming alternatives.
- Health claims: assertions about digestion, immunity, growth, and development.
- Brand-building/endorsements: celebrity associations, brand heritage, and perceived trustworthiness.
- Word-of-mouth: recommendations within families, peer networks, and online mother groups.
When combined in a single exposure, these tactics created potent persuasive cues, often linking product features to infants’ well-being and maternal care.
Thematic content and messaging patterns
Eight recurring themes emerged in the diary entries, including sales promotions, nutrition claims, purported infant-health benefits, claims of suitability for the Chinese population, quality-control assurances, breastfeeding information, appeals to maternal love, and messaging about switching formulas. Nutrition claims—especially those describing ingredients and purported health effects—were the most frequent. Free samples, price discounts, and “easy-to-digest” or “immune-boosting” narratives were common. Several entries highlighted how some messages appeared to rely on scientific-sounding language without transparent evidence, prompting critical scrutiny from mothers.
From exposure to purchase: one-click dynamics
A notable pattern was the rapid transition from seeing an ad to buying the product. Advertisements frequently linked directly to in-app product pages, enabling one-click purchasing. This direct-to-consumer flow intensifies the impact of digital marketing, especially when audiences already trust algorithm-driven recommendations. Current Chinese regulatory focus has emphasized labeling and certain institutional channels, but online purchase flows and embedded promotional links are less clearly regulated, creating gaps for BMS promotion.
Regulatory context and policy implications
China has made strides in labeling standards and restricting in-hospital promotions, yet online advertising and non-clinical channels require stronger governance. The diary findings suggest that:
- Digital advertising formats, influencer promotions, and group-based marketing fall outside many existing provisions.
- Embedded e-commerce links and live-streaming promotions demand explicit rules aligned with the WHO Code and national measures.
- Public-health education and media-literacy support could help mothers critically evaluate marketing claims.
Policymakers should consider channel-inclusive monitoring, clearer responsibilities for platforms, and safeguards against one-click purchase pathways that bypass critical information checks.
Conclusions and forward look
These two cities’ diary data illuminate how BMS marketing penetrates daily life for pregnant women and new mothers in urban China. The online landscape magnifies promotional reach and accelerates decision-making, highlighting the need for comprehensive, Code-consistent regulation that covers digital spaces, direct linking, and consumer education. As China remains a pivotal global BMS market, closing these regulatory gaps will be essential to protect infant health and support informed feeding choices.
