Date of Award


Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Rafael Pérez-Escamilla

Second Advisor

Marney A. White


Background: China has one of the largest and fastest-growing breast milk substitutes (BMS) industries and a disproportionately low exclusive breastfeeding rate. The rapid penetration of technology and the internet, together with convenience-oriented lifestyles, has led to the dominance of the e-commerce industry in China. Many BMS manufacturers have established e-commerce flagship stores and use them as main retail and marketing channels.

Objective: This study aimed to analyze the BMS retail websites on the largest business to consumer (B2C) e-commerce platform TMall, to characterize the marketing themes and strategies used to target consumers. It was specifically designed to improve our understanding of how digital BMS marketing violates recommendations from the WHO Code for Marketing of BMS and seeks to normalize and promote infant formula as an alternative to breastfeeding.

Methods: Content analysis was conducted on the flagship websites of 10 BMS companies on the Chinese B2C e-commerce platform (TMall). Two components of the company websites were examined. First, the main landing page (MLP) of the flagship TMall website; second, the product description page (PDP) of all unique individual formulas (stages 1 to 3) within each company’s TMall website. Variables such as thematic appeals, deviation from the Code articles, and images used were coded and analyzed for all 10 MLP and 113 PDP.

Results: Descriptive results revealed that Premiumization and Science & Nutrition were the most commonly used marketing appeal strategies among both MLP and PDP of companies’ websites. The marketing strategies had low adherence to the Code and national Code of Conduct, only 34.5% included pro-breastfeeding statements. A total of 27.4% of the PDP sampled used images of infants (<12 >months), and 33.6% of PDP samples made favorable comparisons of BMS to breast milk. The detailed content analysis further showed that BMS companies used “creative” ways to target mothers and subverting the Code regulations.

Conclusion: The findings identified a variety of marketing appeals and techniques BMS companies are employing on e-commerce websites. The amount of potentially misleading information provided online was concerning, especially because the e-commerce platform provided a convenient and direct opportunity for bulk purchases. Future research is required to see how online marketing influences the mother's infant feeding behaviors. National regulatory actions are urgently needed to improve the monitoring of online BMS and enforcement of the code in China.

Open Access

This Article is Open Access

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Public Health Commons