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BackgroundThe global milk formula market has 'boomed' in recent decades, raising serious concerns for breastfeeding, and child and maternal health. Despite these developments, few studies have investigated the global expansion of the baby food industry, nor the market and political practices corporations have used to grow and sustain their markets. In this paper, our aim is to understand the strategies used by the baby food industry to shape 'first-foods systems' across its diverse markets, and in doing so, drive milk formula consumption on a global scale. We used a theoretically guided synthesis review method, which integrated diverse qualitative and quantitative data sources.ResultsGlobal milk formula sales grew from ~US$1.5 billion in 1978 to US$55.6 billion in 2019. This remarkable expansion has occurred along two main historical axes. First, the widening geographical reach of the baby food industry and its marketing practices, both globally and within countries, as corporations have pursued new growth opportunities, especially in the Global South. Second, the broadening of product ranges beyond infant formula, to include an array of follow-up, toddler and specialized formulas for a wider range of age groups and conditions, thereby widening the scope of mother-child populations subject to commodification. Sophisticated marketing techniques have been used to grow and sustain milk formula consumption, including marketing through health systems, mass-media and digital advertising, and novel product innovations backed by corporate science. To enable and sustain this marketing, the industry has engaged in diverse political practices to foster favourable policy, regulatory and knowledge environments. This has included lobbying international and national policy-makers, generating and deploying favourable science, leveraging global trade rules and adopting corporate policies to counter regulatory action by governments.ConclusionThe baby food industry uses integrated market and political strategies to shape first-foods systems in ways that drive and sustain milk formula market expansion, on a global scale. Such practices are a major impediment to global implementation of the International Code of Marketing of Breastmilk Substitutes, and other policy actions to protect, promote and support breastfeeding. New modalities of public health action are needed to negate the political practices of the industry in particular, and ultimately to constrain corporate power over the mother-child breastfeeding dyad.

Abstract Background The Paris Declaration on Aid Effectiveness, which provides an international agreement on how to deliver aid, has recently been reviewed by the Organization for Economic Co-operation and Development (OECD). Health sector aid effectiveness is important, given the volume of financial aid and the number of mechanisms through which health assistance is provided. Recognizing this, the international community created the International Health Partnership (IHP+), to apply the Paris Declaration to the health sector. This paper, which presents findings from an independent monitoring process (IHP+Results), makes a valuable contribution to the literature in the context of the recent 4th High Level Forum on Aid Effectiveness in Busan, Korea. Methods IHP+Results monitored commitments made under the IHP + using an agreed framework with twelve measures for IHP + Development Partners and ten for IHP + recipient country governments. Data were collected through self-administered survey tools. IHP+Results analyzed these data, using transparent criteria, to produce Scorecards as a means to highlight progress against commitments and thereby strengthen mutual accountability amongst IHP + signatories. Results There have been incremental improvements in the strengthening of national planning processes and principles around mutual accountability. There has also been progress in Development Partners aligning their support with national budgets. But there is a lack of progress in the use of countries’ financial management and procurement systems, and in the integration of duplicative performance reporting frameworks and information systems. Discussion and Conclusions External, independent monitoring is potentially useful for strengthening accountability in health sector aid. While progress in strengthening country ownership, harmonisation and alignment seems evident, there are ongoing challenges. In spite of some useful findings, there are limitations with IHP + monitoring that need to be addressed. This is not surprising given the challenge of rigorously monitoring Development Partners across multiple recipient countries within complex global systems. The findings presented here suggest that the health sector is ahead of the game – in terms of having an established mechanism to promote alignment and harmonisation, and a relatively advanced monitoring framework and methods. But to capitalise on this, IHP + signatories should: a) reaffirm their commitments to the IHP+; b) actively embrace and participate in monitoring and evaluation processes; and c) strengthen in-country capacity notably amongst civil society organizations.