BREAST might be best but 30 years of product boycotts and regulation has failed to stop big companies promoting infant formula in ways that put babies and small children at risk in developing countries, new research shows.
A report by the aid agency Save the Children has named a clutch of global brands including Nestle, Danone, Mead Johnson, Abbott, Enfamil and Friso as being involved in questionable marketing practices.
It estimates 95 babies could be saved every hour, or 830,000 a year, if new mothers across the world breastfed immediately after giving birth.
When babies receive colostrum - the mother's first milk - within an hour of birth, it kick-starts the child's immune system, making them three times more likely to survive. Babies in developing countries breastfed for six months are up to 15 times less likely to die from diseases such as pneumonia and diarrhoea.
But the report says a lack of education in poor communities, a shortage of health workers in developing countries and inappropriate marketing techniques by some baby milk substitute companies are contributing to declining breastfeeding rates across east Asia and parts of Africa.
There has been a long-running campaign to promote breastfeeding over infant formula, especially in developing countries where a scarcity of clean water can make the use of milk substitutes dangerous.
A global boycott of Nestle was launched in 1977 in a bid to end inappropriate marketing of infant milk formula, especially to poor women. In 1981, the World Health Organisation introduced the International Code of Marketing of Breast Milk Substitutes.
But the Save the Children report concludes that violations of the World Health Organisation code continue and ''many infant formula companies conducting marketing and lobbying practices that, we believe, put children at risk''.
One in five Pakistani health workers surveyed for the report said they received branded gifts from representatives of breast milk substitute companies.
In China, a quarter of mothers surveyed had received gifts from representatives of baby milk substitute companies or health workers and 40 per cent had been given formula samples, often in hospitals.
The report describes one recently terminated program run by a subsidiary of Danone in Indonesia under which midwives and other health workers were given cash gifts and free flights to Mecca in return for selling infant formula.
A 2012 survey cited in the report said one in 10 Pakistani health professionals reported that their health facility had received free samples of breast milk substitutes and ''68 per cent said that the sample had been manufactured by Nestle''.
Nestle Australia said in a statement to Fairfax Media it had the industry's toughest system in place to enforce code compliance and expressed disappointment its comments on a draft of the report were ''only marginally'' taken into account.