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Informed choice or guessing game? Understanding caregivers’ perceptions and use of infant formula labelling

  • Lenka Malek (a1), Hazel Fowler (a2), Gillian Duffy (a3) and Lisa Katzer (a4)

Although breast-feeding is the recommended way to feed an infant, a safe and nutritious substitute for breast milk is needed for infants who are not breast-fed. Labelling information on infant formula (IF) products aims to enable caregivers (who have already made the decision to use IF) to make informed product choices. Yet, there is limited data on how caregivers understand and use the information provided on IF packaging. The present study aimed to increase understanding of caregivers’ interpretation and use of the following label elements on IF products: the nutrition information statement; the ingredients list; and statements around nutrition content and health claims.


Qualitative data were obtained from twenty-one focus group discussions. To enable comparison of findings by education level and ethnicity, focus group participants were homogeneous with respect to educational attainment (Australian groups) or ethnic background (New Zealand groups).


Focus groups were conducted in metropolitan and regional areas of Australia and New Zealand.


Caregivers (n 136) of formula-fed infants.


Framework analysis revealed that caregivers commonly experience difficulties when using labelling information, particularly when trying to identify and understand key differences between products. Moreover, comparing products can be a complex task regardless of education level and ethnicity.


Further research is required to determine the most effective strategies for meeting information needs of caregivers and allowing easier identification and understanding of product differences. This is especially important given that the vast range of IF products across large price ranges in the market adds to the complexity of purchase decisions.

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1. Australian Institute of Health and Welfare (2011) 2010 Australian National Infant Feeding Survey: Indicator Results. Canberra: AIHW; available at
3. Organisation for Economic Co-operation and Development (2014) OECD Family Database. CO1.5: Breastfeeding Rates. Paris: OECD.
4. World Health Organization (1981) International Code of Marketing of Breast-Milk Substitutes. Geneva: WHO; available at
5. Food Standards Australia New Zealand (2015) Australia New Zealand Food Standards Code – Standard 2.9.1 – Infant Formula Products. Canberra: Australian Government.
6. Food Standards Australia New Zealand (2014) Australia New Zealand Food Standards Code - Standard 2.9.1 – Infant Formula Products. Canberra: Australian Government.
7. Commonwealth Department of Health and Ageing (2003) Marketing in Australia of Infant Formulas: Manufacturers and Importers Agreement 1992 (MAIF Agreement). (accessed February 2018).
8. Infant Nutrition Council (2014) The Infant Nutrition Council Code of Practice for the Marketing of Infant Formula in New Zealand (INC Code of Practice). (accessed February 2018).
9. Food Standards Australia New Zealand (2016) Labelled composition available on the retail market in Australia and New Zealand. Appendix 1 to Supporting Document 1 – Definitions and nutrient composition – Proposal P1028. Infant Formula. (accessed February 2018).
10. National Health and Medical Research Council (2012) Infant Feeding Guidelines Information for Health Workers. Canberra: Australian Government.
11. Ministry of Health (2014) Code of practice for health workers New Zealand. (accessed February 2018).
12. Battersby, S (2010) An evaluation of midwives’ knowledge of formula feeding and their role in supporting mothers who formula feed their infants. J Fam Health Care 20, 192197.
13. Smith, SA (2010) Information seeking needs of mothers who bottle-feed their young infants: how the information seeking process affects them and what libraries can do to help them. Master’s Thesis, Victoria University of Wellington.
14. Lee, E & Furedi, F (2005) Mothers’ Experience of, and Attitudes to, Using Infant Formula in the Early Months. Canterbury: School of Social Policy, Sociology and Social Research, University of Kent.
15. Yockney, C & Comfort, V (2013) Understanding caregivers’ perceptions and use of follow-up formula and toddler milks in New Zealand and Australia: a qualitative report. Prepared for the Ministry of Primary Industries; MPI Technical Paper no. 2013/44. (accessed December 2017).
16. Smith, J & Blake, M (2013) Infant food marketing strategies undermine effective regulation of breast-milk substitutes: trends in print advertising in Australia, 1950–2010. Aust N Z J Public Health 37, 337344.
17. Tarrant, RC, Sheridan-Pereira, M, McCarthy, RA et al. (2013) Mothers who formula feed: their practices, support needs and factors influencing their infant feeding decision. Child Care Pract 19, 7894.
18. Labiner-Wolfe, J, Fein, SB & Shealy, KR (2008) Infant formula-handling education and safety. Pediatrics 122, Suppl. 2, S85S90.
19. Winstanley, A & Cressey, P (2008) Information Sources and Practices – Preparation of Powdered Infant Formula in New Zealand – Qualitative Research. Prepared as part of a New Zealand Food Safety Authority contract for scientific services. (accessed December 2017).
20. Food Standards Australia New Zealand (2016) Rapid evidence assessment on infant formula preparation, perceptions and label use. Attachment A2.2 to Supporting Document 2 – Safety & Food Technology – Proposal P1028 Infant Formula. (accessed December 2017).
21. Miller, LMS & Cassady, DL (2015) The effects of nutrition knowledge on food label use. A review of the literature. Appetite 92, 207216.
22. Higginson, CS, Kirk, TR, Rayner, M et al. (2002) How do consumers use nutrition label information? Nutr Food Sci 32, 145152.
23. Bialkova, S & van Trijp, H (2010) What determines consumer attention to nutrition labels? Food Qual Prefer 21, 10421051.
24. Jacobs, SA, de Beer, H & Larney, M (2011) Adult consumers’ understanding and use of information on food labels: a study among consumers living in the Potchefstroom and Klerksdorp regions, South Africa. Public Health Nutr 14, 510522.
25. Hawley, KL, Roberto, CA, Bragg, MA et al. (2013) The science on front-of-package food labels. Public Health Nutr 16, 430439.
26. Drichoutis, AC, Lazaridis, P & Nayga, RM Jr (2006) Consumers’ use of nutritional labels: a review of research studies and issues. Acad Market Sci Rev 9, 93118.
27. Cowburn, G & Stockley, L (2005) Consumer understanding and use of nutrition labelling: a systematic review. Public Health Nutr 8, 2128.
28. Grunert, KG, Fernández-Celemín, L, Wills, JM et al. (2010) Use and understanding of nutrition information on food labels in six European countries. J Public Health 18, 261277.
29. Huang, Y, Labiner-Wolfe, J, Huang, H et al. (2013) Association of health profession and direct-to-consumer marketing with infant formula choice and switching. Birth 40, 2431.
30. Berry, NJ, Jones, S & Iverson, D (2010) It’s all formula to me: women’s understandings of toddler milk ads. Breastfeed Rev 18, 2130.
31. Berry, NJ, Jones, SC & Iverson, D (2011) Relax, you’re soaking in it: sources of information about infant formula. Breastfeed Rev 19, 918.
32. Morgan, DL (1998) The Focus Group Guidebook. Thousand Oaks, CA: SAGE Publications, Inc.
33. Krueger, RA (1988) Focus Groups: A Practical Guide for Applied Research. Thousand Oaks, CA: SAGE Publications, Inc.
34. Freeman, T (2006) ‘Best practice’ in focus group research: making sense of different views. J Adv Nurs 56, 491497.
35. Wu, L, Yin, S, Xu, Y et al. (2014) Effectiveness of China’s organic food certification policy: consumer preferences for infant milk formula with different organic certification labels. Can J Agric Econ 62, 545568.
36. Huang, Y, Li, S, Mu, Q et al. (2015) Consumption survey on infant formula in urban and suburb of Hohhot. China Dairy Ind 43, 5358.
37. Tshikovhi, MP, Gericke, GJ & Bekker, PJ (2015) Factors that influenced mothers and/or caregivers in the Tshwane Metropolitan Municipality, South Africa, to purchase infant formula for their infants. S Afr J Clin Nutr 28, 611.
38. Gale, NK, Heath, G, Cameron, E et al. (2013) Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol 13, 117.
39. Ritchie, J & Spencer, L (1994) Qualitative data analysis for applied policy research. In Analysing Qualitative Data, pp. 173194 [A Bryman and RG Burgess, editors]. London: Routledge.
40. Wallace, LS, Rosenstein, PF & Gal, N (2016) Readability and content characteristics of powdered infant formula instructions in the United States. Matern Child Health J 20, 889894.
41. Burton, S & Andrews, JC (1996) Age, product nutrition, and label format effects on consumer perceptions and product evaluations. J Consum Aff 30, 6889.
42. TNS Social Research (2004) Consumer Research on the Need for Consistency in Nutrition Information Panels. A TNS Social Research Report prepared for Food Standards Australia New Zealand. Canberra: FSANZ.
43. Williams, P (2005) Consumer understanding and use of health claims for foods. Nutr Rev 63, 256264.
44. Salaün, Y & Flores, K (2001) Information quality: meeting the needs of the consumer. Int J Inform Manage 21, 2137.
45. Tonkin, E, Webb, T, Coveney, J et al. (2016) Consumer trust in the Australian food system – the everyday erosive impact of food labelling. Appetite 103, 118127.
46. Malek, L, Umberger, W, Makrides, M et al. (2016) Poor adherence to folic acid and iodine supplement recommendations in preconception and pregnancy: a cross-sectional analysis. Aust N Z J Public Health 40, 424429.
47. Bernhardt, JM & Felter, EM (2004) Online pediatric information seeking among mothers of young children: results from a qualitative study using focus groups. J Med Internet Res 6, e7.
48. Bianchi, CM, Huneau, J-F, Le Goff, G et al. (2016) Concerns, attitudes, beliefs and information seeking practices with respect to nutrition-related issues: a qualitative study in French pregnant women. BMC Pregnancy Childbirth 16, 306.
49. Guerra-Reyes, L, Christie, VM, Prabhakar, A et al. (2016) Postpartum health information seeking using mobile phones: experiences of low-income mothers. Matern Child Health J 20, 1321.
50. McVeigh, C (1997) Motherhood experiences from the perspective of first-time mothers. Clin Nurs Res 6, 335348.
51. Moran, CF, Holt, VL & Martin, DP (1997) What do women want to know after childbirth? Birth 24, 2734.
52. Sword, W & Watt, S (2005) Learning needs of postpartum women: does socioeconomic status matter? Birth 32, 8692.
53. Gibson, L & Hanson, VL (2013) Digital motherhood: how does technology help new mothers? In CHI ‘13: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, pp. 313322. New York: Association for Computing Machinery.
54. Jang, J, Dworkin, J & Hessel, H (2015) Mothers’ use of information and communication technologies for information seeking. Cyberpsychol Behav Soc Netw 18, 221227.
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