Response to Competition Commission of Singapore's Recommendations on Formula Milk

The Ministry of Health (MOH), Health Promotion Board (HPB) and the Agri-Food & Veterinary Authority of Singapore (AVA) note the findings from Competition Commission of Singapore’s (CCS) market inquiry into the supply of formula milkopens in a new window, and broadly accept CCS’s recommendations.

2. The Government is committed to addressing parents’ concerns about the rising prices of formula milk in Singapore. To this end, we will help parents make more informed decisions regarding the nutritional needs of their children. First, we will adjust our guidelines and regulations pertaining to the advertising, labelling, and import of formula milk to encourage greater price competition. Second, we will strengthen our public education efforts. Third, we will encourage all hospitals to provide stronger support for breastfeeding.

I) Adjust Guidelines and Regulations on Advertising, Labelling and Import of Formula Milk

3. Today, the Sale of Infant Foods Ethics Committee, Singapore (SIFECS)¹ Code of Ethics covers the ethical aspects of marketing and promotion of breast milk substitutes and already restricts advertising, marketing and promotion of infant formula for infants below six months in Singapore. SIFECS will, in the third quarter of 2017, extend the coverage of the Code to all infant formula for infants up to 12 months of age. It is also reviewing its Code in line with international best practices.

4. In addition, AVA will tighten its regulations on labelling and advertising for formula milk to prohibit the use of nutrition/health claims and idealised images.This will also discourage companies from incurring massive costs on aggressive advertising and marketing activities, and passing these costs on to consumers.

5. To encourage more competition, AVA will streamline its importrequirements and procedures to facilitate entry of more suppliers and brands of formula milk, without compromising on food safety.

II) Strengthen Public Education Efforts

6. All infant formula sold in Singapore, regardless of price, meets Singapore’s Food Regulations and the nutritional needs of healthy infants. However some infant formula companies claim that their particular brands of milk powder can do more. The scientific evidence for this is weak. Without better information, parents may rely on claims made by these companies, or be misled into using price as a proxy for the quality of the product.

7. To help parents make informed decisions, HPB will step up public education and embark on a multi-year campaign on the nutritional needs of children. This includes reinforcing messages that:

a. Breast milk is best for babies, especially in the first year of life. Mothers are encouraged to continue breastfeeding their baby until they are 12 months of age, or longer if desired.

b. For children above 12 months of age, cows’ milk, as part of a balanced diet, is adequate to meet their nutritional needs.

c. In cases where exclusive breastfeeding is not possible, the baby will require infant formula. All infant formula sold in Singapore, regardless of price, meets the safety standards and nutritional requirements under Singapore’s Food Regulations, and provides sufficient basic nutrition for infants to grow healthily.

III) Encourage Hospitals to Provide Stronger Support for Breastfeeding

8. Hospitals are an important touch-point for parents, and their actions may shape the behaviour of parents. All hospitals in Singapore, both public and private, encourage and support breastfeeding, and only provide infant formula when needed.

9. MOH will strongly encourage all hospitals providing maternity services to achieve the international Baby-Friendly Hospital Initiative (BFHI)² certification. All BFHI-certified hospitals must actively encourage and support breastfeeding targets. To avoid conflict of interest, BFHI-certified hospitals are also not allowed to enter into sponsorship arrangements with formula milk companies. Currently, all three public hospitals offering maternity services – namely, KK Women’s and Children’s Hospital, National University Hospital and Singapore General Hospital – are BFHI-certified, and account for 42% of births in 2015. However, none of the private hospitals offering maternity services has obtained such certification to date, and we hope that they will see that this is beneficial for their patients and will come on board to support the initiative.

10. MOH will also look into how public hospitals – in cases where breastfeeding is not possible during their hospital stay – can provide infant formula options that can also be found at retail outlets at affordable prices. Specifically, MOH will work with the industry players to make available more affordable infant formula brands in the ready-to-feed form suitable for use in hospitals. As with all formula milk products, these options will only be allowed for sale in Singapore if they meet all of the infant’s nutritional needs.

Conclusion

11. The Government will take comprehensive steps to address parents’ concerns about the rising prices of formula milk in Singapore. With support from public and private hospitals, these measures will enable parents to make more informed decisions, and encourage

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¹ SIFECS was established by MOH in 1979 to guide the marketing practices of the infant food industry, and to promote breastfeeding. SIFECS consists of healthcare professionals and representatives from the major formula milk companies.

² The BFHI is a global initiative by the WHO and UNICEF to protect, promote and support breastfeeding.