Public Health Nutrition Editorial Highlight ‘Informed choice or guessing game? Understanding caregivers’ perceptions and use of infant formula labelling’ Authors Lenka Malek, Hazel Fowler, Gillian Duffy and Lisa Katzer discuss their research below.

Without question, breastmilk is the optimal food for infants. However, for mothers who are either unable or choose not to breastfeed, the only safe and nutritionally suitable alternative to breastmilk is infant formula. Caregivers can select from a wide range of infant formula products across a large price range, which makes purchase decisions all the more complex.

Food Standards Australia New Zealand (FSANZ) is the government agency responsible for regulating the nutritional composition and labelling of infant formula (and general food) products in both Australia and New Zealand (NZ). Importantly, infant formula labels should enable caregivers to make informed choices. Improving labelling to achieve this requires an understanding of how caregivers interpret and use elements of label information when making purchase decisions.

Since 2016, researchers from FSANZ and the University of Adelaide’s Centre for Global Food and Resources have worked together on a series of studies designed to help inform FSANZ’s review of the labelling requirements for infant formula products.
In the first of these studies, we conducted 21 focus group discussions with a total of 136 Australian and NZ caregivers of formula-fed infants. Overall, we showed that caregivers are interested in the nutritional differences between infant formulas, but they experience difficulties using labelling information to identify and understand key differences. Here it is important to note that all infant formula products sold in Australia and NZ are nutritionally complete, providing all required nutrients in the required amounts. Manufacturers can, however, voluntarily add certain nutrients/substances and use a different source of protein (e.g., cow’s/goat’s/soy milk), both of which can contribute to nutritional differences between products.
What’s more, we showed that comparing infant formula products can be a complex task regardless of a caregiver’s education level or ethnicity.

So, what does all this mean and where to from here?

Our findings indicate that caregivers need greater support with understanding the labelling information on infant formula. Our findings further suggest that strategies for improving caregivers’ ability to identify and meaningfully interpret differences between infant formula products should be aimed at all caregivers, rather than specific socio-demographic subgroups.
Further investigations to determine the most effective strategies for meeting information needs of caregivers were carried out in follow-up studies in 2017 and 2018. These studies, which are not yet published, involved online surveys with larger and national samples of Australian and NZ caregivers.
The most recent study:
• tested the effectiveness of various mock-up infant formula labels in enabling caregivers to compare and choose between infant formula products; and
• examined caregivers’ preferences regarding alternative (non-label) information sources (e.g., additional education and/or resources) on the nutritional aspects of infant formula.
The findings from the initial focus group discussions and follow-up investigations will be considered in FSANZ’s review of the labelling requirements for infant formula products.

The full article ‘Informed choice or guessing game? Understanding caregivers’ perceptions and use of infant formula labelling’ published in Public Health Nutrition is available to download for free until 30th April 2019.

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