Diary-based methods have rarely been applied to BMS marketing. By capturing exposures in real time, marketing diaries provide quantitative counts together with contextual qualitative detail, offering better timeliness and completeness than recall-based approaches. Using this approach, the present study generated evidence on maternal exposure to BMS marketing in two Chinese cities.
This study described where, what, and how participants encountered BMS marketing. By using data from two cities, we were able to show that exposure to BMS marketing persists despite the Code’s prohibition on promotion to the general public. This finding is consistent with previous research [5, 9, 40], yet provides more nuanced and detailed evidence.
Specifically, exposure to BMS marketing was multifaceted, arising from both online and offline channels and encompassing a diverse array of promotional tactics and thematic messages [21, 41]. Marketing appeared to be deeply embedded in women’s daily digital routines, underscoring the need for continued attention to BMS promotion in contemporary media ecosystems. Prior studies have also highlighted the rapid expansion of online BMS marketing as a social phenomenon [42]. In the present study, online channels were predominant across cities, pregnancy status, and feeding pattern—likely reflecting both technological change and the centrality of smartphones in daily life. With respect to the regulatory environment, China’s Advertising Law prohibits mass-media or public-venue advertisements that claim infant formula wholly or partially replaces breastmilk, restricts paid endorsements in specified categories, and—together with product-registration rules—has strengthened labelling requirements. However, many digital promotional practices fall outside label-specific provisions, and broad monitoring of compliance with the Code—particularly online—remains limited in scope within the measures reviewed [19]. Channel-inclusive approaches that address webpage layouts, embedded e-commerce links, live-streaming/push formats, and other direct-to-consumer interfaces may therefore be warranted to complement labelling-focused rules.
Findings also indicated frequent use of celebrity/brand-building appeals and peer-to-peer diffusion (i.e., friends, family, neighbours, and mothers’ groups). While current measures emphasize restrictions within healthcare settings, community and social-media channels are less directly addressed. China’s Breastfeeding Promotion Action Plan (2021–2025) reinforces the importance of health education for women and families across the perinatal period [43]. On the other hand, the guidelines provided by the Food and Drug Administration, the State Health and Family Planning Commission, and the State Administration for Industry and Commerce, strictly prohibit any promotional activities related to BMS in medical institutions [44]. The present diary evidence suggests that non-clinical channels—for example, family networks and mothers’ clubs—played a notable role and merit consideration in future breastfeeding-support and communication strategies. The channels observed in this study were not assessed for legal compliance; rather, they illustrate how marketing can circulate in spaces not specifically targeted by existing provisions.
Moreover, the findings indicate that BMS marketing frequently emphasizes price promotions, nutrition/ingredient claims, purported infant-health benefits (e.g., easy digestion/absorption, immune support, growth and development, cognitive/“comprehensive” development, and reduced inflammation), suitability for the Chinese population, quality-control/technology credentials, breastfeeding-related information, appeals to maternal love, and messaging around formula switching. Consistent with prior research [45]our study found that BMS advertising commonly uses emotive appeals to mothers, such as invoking maternal love. The 2023 Lancet Breastfeeding Series also highlighted how the commercial milk formula industry frequently exploits parental concerns about unsettled infant behaviours and perceived milk insufficiency through unfounded product claims and advertising messages, thereby influencing feeding decisions [7, 46, 47]. The present study adds more detailed, participant-level evidence from Beijing and Jinan, China, regarding the substantive content of such marketing. To effectively protect the health of infants and young children and further regulate the promotions and sales behaviour of BMS, the State Food and Drug Administration, the National Health and Family Planning Commission, and the State Administration for Industry and Commerce issued the “Notice of the State Food and Drug Administration, National Health and Family Planning Commission, and State Administration for Industry and Commerce on Further Regulating the Propaganda and Sales of Breast Milk Substitutes” in 201343. This document stipulates that infant formula labels should prominently display messages on the superiority of breastfeeding, must not include pictures of infants, and must avoid terms such as “human milk-like” or “breast milk-like.” In this study, we found that while such content is restricted from appearing on labels, companies often promote it in advertising outside the label, which may fall outside label-focused provisions. The now-abolished “Administrative Measures for the Sale of Breast Milk Substitutes” stipulated that the sale of BMS cannot use marketing methods such as giving away products or reducing prices [18, 48]. At present, these methods are still the main marketing methods for BMS. The 2023 update to the “Measures for the Administration of Formula Registration of Infant Formula Milk Powder Products” by the State Administration for Market Regulation places new restrictions on labels and instructions [49]. It prohibits claims related to disease prevention, immunity enhancement, and vague terms like ‘imported milk source’. This comprehensive regulation focuses on labels and instructions but does not address other promotional content. The existence of these instruments indicates awareness of deceptive marketing tactics; however, important regulatory loopholes remain. Current provisions focus on labels and instructions and do not explicitly cover digital advertising formats, influencer- or group-based promotion, price promotions or free samples, or one-click purchase links on social media. Closing these loopholes would require extending Code-aligned rules to online environments, defining permissible and prohibited claims irrespective of medium, and assigning clear responsibilities for compliance monitoring by platforms.
Furthermore, as digital marketing has evolved, one-click purchase interfaces have become increasingly common. Although this study delineated exposure patterns by feeding status and first encounter, it did not capture conversion metrics (e.g., click‐through or purchase rates). Live‐streaming platforms and social media frequently embed direct purchase links within BMS advertisements [41], which likely amplify consumer uptake [50]. In offline settings, consumers rely primarily on product labels; by contrast, online decision‐making is influenced by a wider array of page‐level content. Future regulatory frameworks for BMS promotion should therefore extend beyond labelling to encompass webpage layouts, embedded e-commerce functionalities and direct‐to‐consumer interfaces.
Interestingly, some participants demonstrated the ability to critically evaluate BMS marketing messages rather than accepting them unreservedly. Programs that provide professional guidance and access to rigorously reviewed information from public, academic, and clinical sources, with transparent conflict-of-interest statements, may help women evaluate claims and make informed decisions.
Based on the BMS marketing diaries of 20 pregnant women from Beijing and Jinan, this paper attempted to evaluate the specific exposure of this population to BMS. Although the sample size was small, this study collected as complete information as possible on 20 women exposed to BMS marketing. To our knowledge, this is the first study using the diary method to explore BMS marketing to mothers. We can use this information to respond to the marketing of BMS with regulation and policy action to limit what is not scientific and ethical and promote breastfeeding in society as a whole. Compared to the Code, it appears that China has established some degree of standardization in areas such as the labelling of BMS, monitoring of compliance of healthcare institutions, and food safety norms for manufacturers and distributors. However, there might be a need for further enhancement in the promotion of BMS, distribution of samples, and particularly in the regulation of advertisements through online channels that are beyond food labelling [2].
As an exploratory pilot study, several limitations should be noted. First, the self-report diary method may have led to under-capture of fleeting or subconscious exposures to BMS marketing. This limitation also signals a research gap with direct relevance to marketing regulation; methods capable of detecting transient and targeted content are needed to inform enforceable standards. Nevertheless, the entries are likely to reflect the most salient and memorable promotional messages, which are of primary relevance to maternal decision-making. Second, the sample was limited to 20 women in two urban centers (Beijing and Jinan), constraining the generalizability of findings to other regions and demographic groups within China. Despite these constraints, this study offers novel empirical evidence on the channels, tactics and thematic content of BMS marketing as encountered by Chinese pregnant women and new mothers. Given China’s position as the largest global market for BMS, these insights provide a valuable foundation for future large-scale, mixed-methods research and for the development of more effective regulatory and educational interventions.
Future work should integrate these marketing characteristics into strengthened BMS regulations, validate and refine the thematic framework through large-scale quantitative or mixed‐methods studies, assess the credibility and monitoring of compliance of digital BMS content, test the impact of regulatory and media‐literacy interventions, and adopt a coordinated multisectoral approach to bolster breastfeeding promotion and curb online BMS marketing [51, 52].