South African influencer reach

A total of 62 Instagram posts that were influencer-initiated and met the inclusion criteria were identified for the period of January 2018 to December 2020. As shown in Table 2, the seven influencers included in the analysis had a total number of 6,790,000 followers, representing their total audience. Two were mega-influencers, with well over 1 million followers, while three were macro-influencers and the remaining two were micro-influencers. In addition to the original posts, data were collected on the response and engagement of the followers through the number of likes and the number of comments each post received. Cumulatively, the 62 eligible posts received 918,299 likes and 18,333 comments, which were analysed over a three-month period in 2020.

There were no likes on Ntando Kunene’s video because she posted this on her stories, and posts made on this feature do not have a ‘like’ button. Therefore, it was not possible to establish how many people would potentially react to the video through likes.

Influencer infant feeding focus

Of the total eligible posts by influencers that were analysed, 43% were advertisements promoting products by companies producing BMS (specifically, NUK, Phillips Avent and Ella’s Kitchen) and 57% of the posts promoted breastfeeding. There was no explicit endorsement of formula feeding. However, indirect facilitators of formula, such as feeding bottles were advertised by two of the three companies. Gadgets which are used to facilitate early mixed feeding (under six month of age), for example baby food makers and squeeze stations, were also advertised. Of the posts promoting breastfeeding, 43% were made during breastfeeding week, which is held from the 1st to the 7th of August every year.

As shown in Table 3, four of the influencers posted specifically about BMS, with some potential violations to Regulation 991 recorded. There were six influencers who referred to breastfeeding during the study period and three influencers referred to both BMS and breastfeeding. Among those influencers who posted both BMS and breastfeeding posts, no clear pattern could be established in terms of the number of times they posted the different infant feeding methods. For example, macro-influencer Azwi Rambuda had a total of 23 sponsored IF posts and 9 non-sponsored breastfeeding posts, while another macro-influencer, Nkateko Dinwiddy, had only 1 sponsored BMS post and 19 non-sponsored breastfeeding posts.

Table 3 Types of posts by the influencers and potential Regulation 991 violations

Table 4 indicates the specific type of BMS advertised by the influencers. There were no posts advertising baby formula, and only one post was an advert for complementary food, directed at infants less than six months of age. Most of the advertising was done for gadgets that facilitate the use of BMS. This could be attributed to awareness by the manufacturers of the implications of illegal advertising but still finding ways to advertise that are seemingly less evident.

Table 4 Post by specific type of BMSInfluencer framing of BMS in relation to crying and sleeping

The methods and language used by influencers to describe infant feeding, particularly BMS, was of particular interest in terms of frames related to crying and sleeping. Table 5 highlights the breakdown of the posts in relation to crying or sleeping for those influencers who posted about BMS. Only two influencers linked BMS to these issues. Specifically, Azwi Rambuda discussed complementary feeding to help infants with sleep and to address crying infants, while Jessica Nkosi referred to a pacifier as a solution for a “fussy baby”. The other frames they discussed, for example bottles and teats mimicking the breast are outlined in the qualitative analysis that follows.

1.

“Pacifiers soothe crying babies”

Table 5 Frequency of BMS mentions in relation to crying or sleeping, by influencer

BMS manufacturers used South African influencers to spread the narrative that pacifiers are a solution to a child who cries a lot or is fussy. In the instance highlighted below, an influencer posted an image of a Phillips Avent pacifier and framed it as the best alternative in the market that helps with a child who cries a lot.

The first few weeks of Sedi’s arrival, boy, he’d cry. Pretty much every second, ok, maybe not second, you do catch my drift though. Had to come up with different ways to soothe him, and a Paci was it. Not just any Paci but the smooth Philips Avent Paci. He had it for approximately four months, and in those months he slept peacefully, the crying was reduced and mommy rested too. (Azwi Rambuda)

Jessica Nkosi made the same claims about pacifiers soothing crying or ‘fussy’ babies, advertising a different brand of pacifiers called NUK. Both of these companies market BMS products, namely bottles and teats, which are covered by R991.

2.

“Bottles and pacifiers mimic the breast”

Another pattern in the framing of company-sponsored posts was the use of persuasive language to sway followers into using bottles or pacifiers, through portraying them as equal to the breast. In a Phillips Avent sponsored post, an influencer uploaded an image of a Phillips bottle with a caption describing how breastfeeding is difficult for a working mom, for the baby and the caregiver. The influencer described how the Phillips Avent bottle was the ideal solution because it mimics the breast and is ideal for combination feeding. The post explained that by using the Phillips bottle, there was some comfort guaranteed to the mother and the baby would not be fussy during the day, in this instance marketing the product in relation to crying.

Being a young working mom who is still breastfeeding is quiet challenging... Well, not just for you but also for your little one as well as the person taking care of your little you while you are at work. @philipsaventsa Natural bottle makes it all easy, for these bottles mimic the breast for easier combination feeding. That way you know your little heart is not fussy all day while you are at work. Oh and the very same containers you use to store your expressed milk can easily be turned into a Natural bottle. Easy feeding without pouring and re-pouring, ensuring hygiene for your little heart #breastfeeding #naturalbottles #youngmom #breastmilk #expressmilk #babyboy #babysedi #lesedi #avent #philipsavent #babies #bottles #naturallatch #anticolic #ultrasoft (Azwi Rambuda)

This post promoted combination feeding as a solution for the “challenges” that come with breastfeeding. The fact that the influencer mentioned expressing breastmilk and used the hashtag #expressmilk as opposed to promoting infant formula explicitly does not detract from the frame claiming bottle equivalency to the breast.

The parents and caregivers of children who cry a lot were influenced to use pacifiers and infant formula was subtly advertised through the marketing of bottles. While there was no direct marketing of infant formula, the implication that bottles and pacifiers were as good as breasts since they are “shaped like the breast” undermined the unique benefits of breastfeeding.

‘Do it your way’

In a different post, Mpoomy Ledwaba shared an image of herself breastfeeding, and highlighting the benefits of breastfeeding to her followers. However, this post was sponsored by NUK, a company which produces BMS. In her caption, she directed her followers to the NUK Instagram page and encouraged them to follow the page in order to stand a chance of winning a hamper by NUK.

Antibodies, vitamins, trace elements – and a lot of love: breast milk has everything your child needs for healthy development in the first months” The best breastfeeding advice I can give you is: do it your way and with love. I’m giving away a @nuk_southafricahamper to one amazing mama, all you have to do is follow @nuk_southafricaand share your unique breastfeeding journey and if you are pregnant, what you look forward to. (Mpoomy Ledwaba)

This is an example of marketing of BMS that is not very apparent but may be considered a contravention, as NUK also makes bottle and teats and directing followers to their page may be regarded as promotional practise. In addition, the ‘do it your way’ mention is one often embraced by BMS companies as a way to underplay the hygiene and health risks of using their products.

Exciting (early) milestones

A more apparent advert of BMS was made by Nkateko Dinwiddy, who advertised baby food produced by Ella’s kitchen. The image shared was of a baby being spoon-fed solids and the packaging on the food packet showed that the food was suitable for infants aged four months and beyond. The caption on the image read:

We’ve reached another exciting milestone for Suri as she’s now started her weaning journey. I remember having a lot of fun and making a lot of mess with Sana when she was weaning, but I remember finding it a little daunting too. Knowing when to start, what to start and how to keep it fun! That’s why I’m really happy to announce that I’ve partnered with @ella’skitchenuk to tell you about WEANSURY- a brilliant new online hub filled with lots of helpful information, top tips form the experts, recipes, and so much more to support you on your weaning journey – Nkateko Dinwiddy

In this post, Nkateko Dinwiddy shared that she was weaning her child and had partnered with a BMS company called Ella’s Kitchen. In the post, she directed her followers to the company’s website to get more infant feeding advice. In this image, BMS is marketed targeting infants less than six months, which violates both the Code and R991. The food packets advertised in the image are marked “from 4 months”, implying that the influencer is marketing to mothers or caregivers of infants under six months old. At the time the image was posted, her infant was less than six months old, therefore the image idealised feeding solids to infants under six months of age. Suggesting that introducing semi-solids before six months is an ‘exciting milestone’ directly contradicts WHO EBF guidelines.

Influencer framing of breastfeeding in relation to crying and sleeping

Another aim of this study was to analyse the posts on breastfeeding and how this is framed by the influencers on Instagram. From the posts analysed, 57% were images of influencers breastfeeding their children and the subsequent captions accompanying the posts encouraged their followers to practice the same. Influencers who advocated for breastfeeding highlighted how breastfeeding was ideal to calm a crying baby and to aid with sleep patterns. There was no evidence of sponsorship by companies or breastfeeding promotion organisations, e.g. GrowGreat or La Leche League, in these posts or associated hashtags.

During the annual breastfeeding week, the frequency of posts related to breastfeeding significantly increased by 43% among the influencers. In this period, most posts were about influencers promoting breastfeeding and highlighting its benefits. In the example below, the influencer shared her experience with tandem breastfeeding (nursing two babies at the same time) and the benefits of EBF. The caption on the image read;

One of my favourite things about motherhood is breastfeeding, so I decided I would breastfeed Nuri till she’s 2 and even when I found out that I’m pregnant I was happy when my midwife told me its safe to breastfeed. However, our breastfeeding had reduced to just mornings and evenings but the closer we are to the arrival of our new baby the clingier Nuri has gotten yes I plan on breastfeeding both but it seems missy is super attached now. Moms who’ve breastfed more than one baby did you experience this? Or just clinginess towards the end of your pregnancy? #momtalk #breastfeedingmama #breastfeeding #breastfeedingmom #breastfeedingweek #postpartum #youngmum #breastfeedingbenefits #babies #mom #preggo #newmom #exclusivebreastmilk -Mpoomy Ledwaba

Another example of a post from an influencer encouraging her followers to breastfeed is showcased in an image where the influencer was smiling and publicly breastfeeding and had the following caption:

I breastfeed openly whenever and wherever Suri needs. I’ve learnt to block out the stares or the whispered comments form the non-approvers as I give my baby what she needs. My influence comes from my African upbringing where this approach to feeding babies was normalised by everyone around me. Don’t let anyone make you feel bad for what’s natural and normal. Enjoy your breastfeeding journey #normalisebreastfeeding #breastfeeding #breastfeedingmom – Nkateko Dinwiddy

There were other posts promoting breastfeeding by the influencers and they shared their own personal journeys with breastfeeding. Despite none of the breastfeeding posts being sponsored, we found that posts encouraging breastfeeding accounted for the majority of infant feeding posts that were shared by the selected influencers.

There was little reference to breastfeeding in relation to crying or sleeping. Rather, some benefits to breastfeeding shared by the influencers were being nutritional, bonding between mother and child, and weight loss for the mother. The influencers who shared breastfeeding posts also highlighted some challenges that they encountered with breastfeeding. Some other influencers shared how their support systems did not agree with the concept of EBF and since they relied on them for taking care of their infants while they worked, their children were introduced to solids before turning six months old. Their followers responded sharing their own personal experiences with infant feeding, which is highlighted in the following section.

Follower responses to influencer frames

It is worth noting that from this study, more infant feeding posts promoted breastfeeding (57%) as compared to those that promoted the use of BMS products (43%). However, as reported earlier in Table 1, the posts encouraging the use of BMS got as many likes and comments as the posts that encouraged breastfeeding. The framing of the followers’ responses to the BMS and breastfeeding posts were analysed to explore the degree to which audiences’ frames may align (or not) with Influencers. This is illustrated in Table 6.

Table 6 Follower’s framing of comments relating to posts initiated by the influencersInfluencer vs alternative frames in follower responses

There were examples of influencer posts and subsequent conversations outweighing a follower’s immediate social support system around the use of BMS, pacifiers in particular. As noted below, a follower mentioned that her grandmother was against the use of pacifiers and had advised she throw hers away. However, she was hardly sleeping at night and was reconsidering her decision following the conversations around the issue from the influencer’s post. Responding to Jessica Nkosi’s pacifier post, a follower had the following sentiments to share.

Wow I had to throw the pacifiers in the bin because my son’s paternal granny is so against them and I’m also a neat freak so wouldn’t give my son something dirty. Now at night I hardly sleep cos he eats every 2 hours.

In this case the mother’s sleep took precedence over the infant feeding method that was ideal for the baby. Responses of the followers from the described case and other similar posts indicated that the consensus among the influencers and their followers was that giving babies pacifiers was an effective way to calm a crying baby (and catch up on one’s own sleep).

In a video post, Ntando Kunene probed the opinions of her followers after her mother had suggested giving her four-month-old son solids. She was sceptical of her mother’s advice since she knew guidelines advised initiation of solids after six months of age. Responding to this, a follower mentioned how she had started her child on solids when she was hardly a month old. She gave the logic that the child cried a lot and after initiating solids, the crying decreased. From this comment, other people giving their opinions on the conversation highlighted how they found it helpful to introduce solids to children that had not even reached a month to deal with the excessive crying.

… mine seems a bit crazy but my daughter started solids when she was hardly a month old , because she used to cry a lot even after the bottle so my mom suggested I start the solids. I felt it was waaaaayyy too soon but hey it worked

Another response to the video was:

You waited this long? My grandmother waits for a month and then she starts feeding solids. These kids cry so much when they are hungry and sometimes milk alone doesn't do justice.

Some “experienced” mothers within the comments sections also opined that the recommended six months to introduce solids was unachievable, and that the mother would have lost their mind because of an excessively crying baby.

I’m a mother of three...Start as soon as they start crying from hunger, you would know, 2 months and above but the books are shy to tell the truth ... they’ll be like 6 months ... at which point you would be at a mental institution

A notable finding from this and other influencer-initiated posts was that influencers seldom responded to the questions posed by the followers. In the case of the video, Ntando Kunene did not comment or give feedback to her followers pertaining to the conversation that she had started. Due to this, it is unclear whether her inclination from the responses of her followers was more towards breastfeeding or not. This was not a sponsored post and no BMS product was advertised.

Health frames by professionals on influencers’ posts

Despite regulations from the Code against it, some health professionals used the influencers’ platforms to give infant feeding advice. One such example is from a nurse who recommended the need for a baby to have a pacifier. In the comment, the nurse pointed out that some babies need pacifiers to soothe them even when not hungry, and that the pacifier helps with a good sleep at night. The comment read,

I am a nurse, trust me I thought the same way before the baby arrived but reading more my anxieties were alleviated, some babies NEEEDDD a pacifier as they always want something to suck on even when they are not hungry, and it helps them sleep well at night not to mention prevention of sudden infant death.

In this instance, a pacifier was portrayed as a preventative method against infant death by a health professional.

Despite the popularity of pacifiers among the influencers who posted them and their followers, some other responses to the pacifier posts were against their use, citing them as unsanitary. A follower’s response to a pacifier advert by an influencer highlighted how she was not using one because of the risk they pose on exposing children to diarrheal infections. Another follower responded that on doctor’s advice, she was not going to use a soother because she believed they are unhealthy.

Despite comments like these, the general slant in the responses were more positive towards what the influencers suggested, with some followers thanking the influencers for the suggestions on which pacifier to buy and how the pacifier helped soothe their own babies as seen in this quote: “Just gave birth two weeks back and I'm planning to get one. Thank you @mrslitelu”.

Frames related to sleep and hunger

Belief that a child who is not well fed tends to sleep less and therefore the child’s diet needs to be complemented with BMS was popular among the followers. A follower mentioned that she started her child on solids at three months old, against the advice of health professionals; however it had turned out “great” for her; “Started at 3 months cos she was just not getting full with the milk only… It turned out great though nurses discourage it.”