How the U.S. Waged a Global Campaign Against Baby Formula Regulation

The following story was originally published by ProPublica, written and photographed by the contributors listed below.  I’ve been donating to ProPublica for a number of years and encourage those who read this blog to do so as well.  ProPublica can be followed on social media at BlueSky (@propublica.bsky.social), Mastodon (@ProPublica), and on Twitter (@propublica)


by Heather Vogell, ProPublica, photography by June Watsamon Tri-yasakda, special to ProPublica

ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.

LOPBURI, Thailand — When Gustun Aunlamai arrived at school at age 4, he was so overweight that his teacher worried he’d have trouble breathing during naptime. His arms and legs were thick. His mouth peeked out from two ballooning cheeks. He moved slowly.

Throughout his toddler years, Gustun had regularly asked his parents to refill his bottle with his favorite “milk” — a type of formula made especially for kids his age. And they were happy to oblige. Sumet Aunlamai and Jintana Suksiri, who lived in a rural province north of Bangkok, had carefully chosen the brand.

Like other Thai parents, they’d been bombarded by formula advertising on television, online and in grocery stores, where a rainbow of boxes and canisters of powdered toddler milk featured teddy bears in graduation caps and giveaways like toys or diapers. It cost far more than cow’s milk but promised to make Gustun stronger and smarter.

What Jintana didn’t know, as Gustun chugged the formula and his weight neared 70 pounds, was that her son’s choice drink had sparked an international feud.

In 2017, Thai health experts tried to stop aggressive advertising for all formula — including that made for toddlers. Officials feared company promotions could mislead parents and even persuade mothers to forgo breastfeeding, depriving their children of the vital health benefits that come with it. At the time, Thailand’s breastfeeding rate was already among the lowest in the world.

But the $47 billion formula industry fought back, enlisting the help of a rich and powerful ally: the United States government.

Over 15 months, U.S. trade officials worked closely with formula makers to wage a diplomatic and political pressure campaign to weaken Thailand’s proposed ban on formula marketing, a ProPublica investigation found.

U.S. officials delivered a letter to Bangkok asking pointed questions, including whether the legislation was “more trade restrictive than necessary.” They also lodged criticisms in a bilateral trade meeting with Thai authorities and on the floor of the World Trade Organization, where such complaints can lead to costly legal battles.

Thai officials argued the new regulation would protect mothers and babies. In the end, though, the Thai government backed down. It banned advertising for infant formula but allowed companies to market formula for toddlers like Gustun — one of the industry’s most profitable and dubious products. The final law also slashed penalties for violators.

“Our law is really weak and enforcement is really weak,” said Dr. Siriwat Tiptaradol, who championed the proposed ban as a former adviser to Thailand’s health minister, in an interview in Bangkok. “I was upset and disappointed.”

The U.S. endeavor in Thailand was part of a decadeslong, global effort to protect the United States’ significant formula production and export business. ProPublica reviewed thousands of pages of emails and memos by U.S. officials, letters to foreign ministries, correspondence from industry groups and academic research. We also interviewed health experts and government leaders in nearly two dozen countries, including former U.S. officials.

Together, the reporting shows the U.S. government repeatedly used its muscle to advance the interests of multinational baby formula companies, such as Mead Johnson and Abbott, while thwarting the efforts of Thailand and other developing countries to safeguard the health of their youngest children.

Just last March, at a meeting in Dusseldorf, Germany, U.S. officials opposed a reference to formula advertising bans in a new international food standard for toddler milk. The move came after industry lobbying.

At the center of many efforts was the Office of the United States Trade Representative, which advises the president on trade policy. Emails show its staff in regular contact with formula makers and their industry groups through meetings, calls and position papers — which the industry used to hammer its objections to regulations around the world. “Mead Johnson and other infant formula producers have been very vocal, expressing concerns to the Thai and U.S. governments about what they feel is the imminent passage of this measure,” U.S. officials wrote in 2016 as Thailand considered its formula marketing ban.

Officials with the USTR and other trade-focused agencies, including those within the U.S. Department of Agriculture, then echoed those positions in communications with other countries or in international forums like the WTO, the documents showed.

“The U.S. is highly influential,” said Dr. Robert Boyle, a doctor at Imperial College London who has researched international formula use.

In many places, the lobbying appeared to succeed. Hong Kong, for example, watered down some of its formula regulations after objections from U.S. trade officials, who said in a draft letter that the rules “could result in significant commercial loss for U.S. companies.” And a proposal in Indonesia stalled after questions from the U.S. at the WTO.

Notably, such advocacy has not only hindered local attempts to stop formula marketing that critics say is misleading or even predatory, but it has also undermined the work of U.S. foreign aid and health officials, who have long supported breastfeeding across the globe. They call it “one of the highest returns on investment of any development activity” because of its well-documented benefits for babies’ health and cognitive growth.

“I think it is shocking,” said Jane Badham, an independent nutrition consultant and expert in child feeding who works internationally. “One doesn’t realize how much this kind of interference is happening.”

The meddling broke into public view in 2018, when officials from the Trump administration were accused of threatening to withhold military aid from Ecuador if the country didn’t drop its proposed resolution in support of breastfeeding at the World Health Organization; the U.S. ambassador later denied making threats. But ProPublica’s investigation found that the scope of the interference far exceeded that incident and continues today under the Biden administration. In fact, Ecuador and Thailand were just two stops on a worldwide crusade against regulation that has spanned Republican and Democratic presidential administrations and touched more than a dozen countries, including South Africa, Guatemala and Kenya, as well as Southeast Asian nations such as the Philippines, Malaysia and Vietnam.

Neither Abbott nor Mead Johnson responded to requests for interviews or to detailed questions from ProPublica. The latter’s parent company, Reckitt, also did not respond to our request for comment.

USTR officials declined to be interviewed for this story. In response to written questions, an agency spokesperson said in a statement that under President Joe Biden, the trade agency has emphasized respecting the role of foreign governments in deciding the appropriate regulatory approach, including with respect to infant formula. USTR has been committed “to making sure our trade policy works for people — not blindly advancing the will of corporations,” the statement said.

That has meant moving the office “away from the formerly standard view that too often deemed legitimate regulatory initiatives as trade barriers,” the spokesperson said, adding that the move has “enervated” corporate players who have been used to “getting their way at USTR for decades.”

The spokesperson, however, declined to provide examples of the new approach in relation to formula. She also declined to respond to questions about government documents that show the trade office under Biden working with other federal agencies to pursue the same playbook on formula as prior administrations.

In 2021, for example, officials complained to Filipino trade authorities about stricter formula marketing rules they considered “overkill,” and expressed fears about regulatory “spillover” elsewhere in Southeast Asia. In Kenya, they sought to strike a provision in a proposed formula advertising ban after an industry group sent USTR a paper seeking its deletion.

Public health officials are increasingly raising concerns about toddler milk, especially as companies deploy advertising for products using bold — and, critics say, often unsupported — health claims.

In October, the American Academy of Pediatrics published a new report warning about the marketing for toddler formula. “Products that are advertised as ‘follow-up formulas,’ ‘weaning formulas’ or ‘toddler milks and formulas’ are misleadingly promoted as a necessary part of a healthy child’s diet,” said Dr. George Fuchs III, a lead author of the study. The drinks are worse than infant formula for babies under 1 year, he said, and “offer no benefit over much less expensive cow’s milk in most children older than age 12 months.”

Unlike infant formula, toddler milks are not regulated by the Food and Drug Administration. Nutrition experts have warned about hefty doses of sweeteners and sodium in some brands.

The Infant Nutrition Council of America, a formula industry group, defended toddler drinks, saying they “can contribute to nutritional intake and potentially fill nutrition gaps for children 12 months and older.”

Toddler milk made up just 11% of all formula sales in the United States in 2023, but it was much more popular abroad, according to Euromonitor, which tracks sales data. Worldwide, it made up 37% of sales. In Thailand, it accounted for more than half.

The country is now struggling to address the consequences of the law’s weakening, researchers and officials say. More than 1 in 10 Thai children under 5 years old face what researchers call a “double burden of malnutrition” that leaves some struggling with obesity and others lagging behind growth targets. Increased breastfeeding could help address both problems.

“You go to school and see a lot of kids are overweight,” said Dr. Somsak Lolekha, president of the Royal College of Pediatricians of Thailand and the Pediatric Society of Thailand. “We have a big problem in Thailand.”

Targeting “the Sippy Cups of the World”

Formula is one of only two products with international recommendations to prohibit its marketing. The other is tobacco.

The warning dates to 1981, when the nations that make up the governing body of the WHO passed the International Code of Marketing of Breast-Milk Substitutes. It aimed to stop all promotion of drinks meant to replace breast milk.

The move followed reports in the 1970s that thousands of infants in impoverished countries were falling ill and dying after drinking formula.

Not only were mothers using costly formula to replace breast milk, which would have given their babies better immunity, but the water parents mixed milk powder with was sometimes contaminated, leading to life-threatening bacterial infections and diarrhea. Overdiluted formula was causing severe malnutrition, too. Activists called for a boycott of the world’s biggest formula maker, Nestlé, which had heavily promoted its products in developing countries.

During the height of the controversy, an average 212,000 babies in low- and middle-income countries died preventable deaths linked to formula use annually, an academic paper circulated by the National Bureau of Economic Research estimated last year. (Nestlé disputed the research and said it was the first formula company to incorporate the WHO recommendations into its marketing policy in 1982.)

The United States cast the sole “no” vote against the international code, with the Reagan administration citing First Amendment protections on advertising. The Washington Post quoted a senior federal official who resigned over the decision, saying it would be “seen in the world as a victory for corporate interests.”

To be sure, formula was crucial for babies who didn’t have access to breast milk. But for those who did, public health experts feared aggressive advertising and free samples would derail a critical cycle. Once babies start drinking formula regularly, research shows, their mothers’ breast milk supply can drop.

“The evidence is strong,” a WHO and UNICEF report explains. “Formula milk marketing, not the product itself, disrupts informed decision-making and undermines breastfeeding and child health.”

In the years since the international code was adopted, at least 144 countries have sought to enshrine its voluntary restrictions into laws that bar formula marketing in stores, hospitals and elsewhere. Despite poor enforcement in many places, the laws have had measurable benefits. Studies have shown that countries that adopted marketing bans saw their breastfeeding rates rise, and more breastfeeding is in turn linked to fewer infant deaths. It also reduces mothers’ risk of certain cancers.

Baby formula manufacturers responded to slower growth in infant formula sales by creating products for older babies and toddlers — age groups that fell outside most regulations.

“We have a proven global demand-creation model,” Greg Shewchuk, Mead Johnson’s head of global marketing, told investors in 2013. “Capture baby very early on, often before it’s born, hold onto them through feeding and their feeding challenges and extend them as long as possible.”

Mead, which was based in the United States until a British company bought it in 2017, termed the strategy A-R-E: Acquisition, Retention, Extension.

To make toddler products more attractive to parents, who usually just gave their kids cheaper cow’s milk beginning at age 1, formula makers began adding nutritional supplements like DHA, an omega-3 fatty acid found in fish and algae with purported benefits for brain and eye health.

The claims, however, are unproven. Studies have found no definitive link between babies’ brain and eye development and DHA supplementation, a 2017 meta-analysis of 15 studies found, according to Cochrane, a nonprofit that supports systematic reviews of health research. In fact, breastfed babies perform better on intelligence tests.

Still, formula companies used additives like DHA “as a hook to expand their market share,” said Peter Buzy, CFO and treasurer of Martek Biosciences Corp., which produced DHA, at an analysts’ meeting in 2004. “Really targeting, you know, the sippy cups of the world.”

A spokesperson for the Infant Nutrition Council of America defended the health and nutrition claims, saying they “are based on science and medical research and meet all legal, regulatory and nutritional science requirements.”

The marketing worked. Toddler milk has overtaken infant formula in worldwide sales, according to Euromonitor. Global toddler milk sales have grown by 25% since 2013, to almost $20 billion. A little less than two gallons of toddler milk can cost $30 or more, compared with around $3.94 a gallon for regular milk in the U.S.

For formula manufacturers, the popularity of the product had another benefit: It helped them circumvent local rules against marketing infant formula. By using similar logos, colors or fonts across product lines, legal advertisements for toddler milk effectively promoted baby formula too, even in places where it was subject to a marketing ban. Nutrition experts and advocates called the tactic “cross-promotion.”

During the past decade, sales of regular infant formula grew about 10% worldwide, to $15 billion.

A Focus on Developing Nations

In 2014, Jintana gave birth to the couple’s first child, whom they nicknamed “Captain” after a soccer player.

The family lived in military housing in Lopburi, a rural province two hours north of Bangkok whose capital city is world famous for its flourishing monkey population. With Sumet serving in the Army, Jintana took time off from her job in customer relations to care for the newborn.

She breastfed Captain until it was time to return to work three months later. The couple shopped for formula. Health claims formula makers listed on packages were “very important,” Sumet said through a translator. They settled on a product called Dumex that promised to strengthen Captain’s brain, immunity and eyes. It was made by the French giant, Danone, which boasts that the brand “has happily raised generations of Thais.”

Millions of women like Jintana had been entering the workforce in developing regions such as Southeast Asia. The big six transnational companies that make most of the world’s baby formula saw this as a boon.

For Mead Johnson, the maker of Enfamil, the benefits of developing economies were twofold. “Firstly, in most countries, breastfeeding is incompatible with women participating fully in the workforce,” CEO Kasper Jakobsen said in a 2013 earnings call. “And, secondly, as women participate in the workforce, that creates a rapid increase in the number of dual-income families that can afford more expensive, premium nutrition products.”

By then, Thailand was Mead’s fifth-biggest market worldwide. And Southeast Asia was well on its way to becoming more important to the formula industry than the U.S. and European markets combined.

As business boomed, advocates lambasted the industry for its practices. Mead employees, for example, allegedly bribed health care workers at government hospitals in China so they would recommend the company’s formula to new mothers — charges the company ultimately resolved with a $12 million settlement in 2015; the company did not admit or deny regulators’ findings in the agreement. Danone faced similar allegations from Chinese media related to the brand Captain and Gustun drank, Dumex. Danone said at the time that it accepted responsibility for the lapses and suspended the program involved, according to the BBC.

The industry maintained close relationships with the medical establishment in Thailand, too. One pediatrician and advocate for breastfeeding, Dr. Sutheera Uerpairojkit, told ProPublica that two decades ago, she saw formula companies offer doctors and medical staff trips abroad in exchange for giving patients free samples and collecting their data. Some took the trips. Sutheera did not participate.

Thailand adopted the international code in 1984 — but only as a voluntary measure. Over the years, Siriwat and others pushed for tougher formula marketing restrictions without success. In one meeting, he and colleagues at the Thai health ministry pressed formula companies to comply with the voluntary rules, which they’d routinely broken. The businesses resisted. “One company said, ‘If I do not violate, I cannot compete with other companies,’” Siriwat recalled in September.

“That makes me very angry,” he said, remembering how he stormed out of the room.

By 2014, with Thailand’s breastfeeding rate at only 12%, according to one survey, Siriwat persuaded the health minister to seek legislation to formally ban marketing infant and toddler formula. He wanted the new law to include enforcement and penalties for violators.

The WHO, a United Nations agency promoting health, wanted more countries to pursue such measures. Its staff in 2016 released new recommendations on ending the promotion of formula products for toddlers, as well as infants. In theory, that guidance could help countries like Thailand fend off trade complaints about new marketing bans. And an endorsement by the WHO’s member nations would underscore the recommendations’ importance.

But public health wasn’t the only concern as nations prepared to vote.

U.S. Intervention on a Global Stage

The WHO effort alarmed formula makers, which worried that it would kick off a new round of laws against formula marketing. “That’s what’s at stake by a new measure that’s being proposed by the WHO, without any scientific evidence,” Audrae Erickson, a Mead Johnson lobbyist, told a trade association crowd.

Industry groups scrambled to arrange meetings with high-level officials in Washington. “Clearly, the potential economic and international trade implications from this proposed draft guidance are quite significant,” the pro-industry Infant Nutrition Council of America said in a letter to an FDA official in 2016.

That year, companies and trade groups connected to commercial milk formula, including Abbott Laboratories and Nestlé, spent almost $7 million lobbying U.S. officials about WHO matters, after a decade in which their lobbying disclosures had not mentioned the organization at all, a study found.

The industry’s outreach spanned Washington. The Infant Nutrition Council of America, for instance, lobbied the Senate, House and USTR — as well as the commerce, state, agriculture and health departments, lobbying records show. The efforts attracted the attention of leaders in both parties, including House Speaker Paul Ryan, who called President Barack Obama about the issue, according to records obtained by ProPublica.

Inside the administration, USTR took up the formula industry’s cause. “USTR does not support issuance of the guidance or resolution” on toddler milk, wrote Jennifer Stradtman, a USTR official, in an email to other federal officials. Furthermore, she wrote, her office “will not be able to accept” any resolution that encouraged WHO member countries to convert any of the guidance into law.

It wasn’t the first time the USTR sided with industry despite public health concerns: In 2013, a group of Democratic senators scolded U.S. Trade Representative Michael Froman for a proposal to help tobacco companies use trade law to “subvert” tobacco control measures — a stance the lawmakers called “deplorable and a serious threat to global public health.”

In the debate over toddler milk, officials from Froman’s office repeatedly questioned science, prompting a fight with public health officials, internal documents show.

In one exchange, then-USTR lawyer Sally Laing objected to a sentence from the guidance that said research suggests food preferences are established early in life.

“Unsupported,” Laing wrote.

Health officials pushed back on that, as well as other USTR edits. “MUST NOT DELETE,” the Centers for Disease Control and Prevention protested in all caps, arguing that key language in the resolution was, in fact, backed by scientific evidence. But such concerns appeared to get lost in the debate, as those sentences were ultimately struck from the text.

Meanwhile, as WHO member nations gathered to vote in Geneva, formula lobbyists had U.S. officials “on speed dial” and urged them to weaken the WHO resolution, said Jimmy Kolker, who led the negotiations for the U.S. as an assistant secretary in the Health and Human Services Department.

And the industry’s agents appeared to have inside knowledge. A baby-formula industry association lobbyist cornered Kolker. “From her approach, it was obvious to me that she had been forwarded an internal, very-limited-distribution USG email,” he wrote in an email to other U.S. government officials. “This is unacceptable and makes our job as negotiators significantly more difficult.”

In the end, the United States delegation persuaded WHO nations not to “endorse” their staffs’ own recommendations. Instead, the body voted only that it “welcomes with appreciation” the guidance — language that undercut its utility. The resolution, lacking the weight of an official endorsement, left many nations puzzled over whether it would help neutralize trade complaints.

“That has caused a lot of confusion,” said Laurence Grummer-Strawn, a WHO official who focuses on child feeding and former nutrition chief for the CDC. “What does that really mean?”

Stradtman and Laing could not be reached for comment. Froman did not respond to requests for comment, and a USTR spokesperson declined to comment on the office’s actions during the WHO debate. In a general statement, the spokesperson said that “with regard to infant formula, USTR, in conjunction with others in the interagency, work to uphold and advocate for policy and regulatory decisions that are based on science.”

The practical impact of the resolution’s weakened wording became clear within months, when the U.S. and other dairy producers like Australia and Canada accused Thailand of attempting to obstruct trade with its marketing ban. Thai officials argued their country had a “strong need for a regulation,” saying the “sales promotion” of milk formula for babies and toddlers contributed to the nation’s low rate of breastfeeding. But when it referenced the WHO’s guidance and resolution to support its position at the WTO, the U.S. countered that those measures did not amount to “an international standard.”

When the Thai National Legislative Assembly finally passed its formula marketing measure in April 2017, the provisions that the U.S. and its allies — plus some Thai doctors and industry lobbyists — had complained about most loudly were either watered down or gone entirely. Lawmakers had reduced the maximum criminal penalty for violations from three years in prison to one year in prison and the maximum fine from about $8,730 to $2,910, a USDA document shows.

The law banned the marketing of infant formula and outlawed cross-promotion, but it still allowed advertising on products for 1- to 3-year-olds.

At a June 2017 meeting of the WTO, the U.S. called the changes “a welcome modification.”

“Addicted to the Bottle”

The next year, Sumet and Jintana celebrated the birth of their second child, Gustun. As she had with her firstborn, Jintana breastfed Gustun until he was 3 months old, then started him on formula so she could go back to work.

The couple diligently followed the “stages” prescribed by Dumex, which came in a cheery red package: Stage 1 formula when Gustun was an infant, Stage 2 when he was an older baby and Stage 3 when he became a toddler. He craved formula, and his parents, believing it was healthy, always gave him more. By the time he was 3, he reached his peak weight of about 66 pounds — the same as an average9-year-old. He was drinking six or seven bottles a day, each holding about 12 ounces of toddler milk.

Jintana wasn’t worried at first as Gustun grew pudgy. His brother, Captain, had been big, too — almost 60 pounds — at the same age. But when Gustun started school in person after the pandemic, his teachers were concerned. They had seen others arrive, as one put it, “addicted to the bottle.” The weight slowed Gustun down during movement time, his teacher Tida Rakrukrob said through a translator. “He would move slowly and was less active compared to other children,” she said.

When another teacher posted a video on TikTok showing herself comforting and talking with Gustun one day, it went viral — receiving 732,000 likes and many comments about how cute he was. But his teacher’s concern with his difficulty moving led his parents to bring him to see a doctor, who tested him for a hormone imbalance and checked him for diabetes. The tests came back negative. The parents reduced the fried food, dessert and snacks Gustun ate.

The biggest change the family made, though, was eliminating toddler formula from his diet. His school gave him cow’s milk instead, as it did for other children.

Gustun’s extra weight began to disappear.

Looking back, Jintana said she thinks he gained so much “because of the toddler milk.”

Today at age 6, Gustun is no longer on a restricted diet — he can eat fried food and dessert — and weighs 35 pounds, about half of what he weighed at the peak of his Dumex consumption. He is more outgoing at school, Jintana said, and plays soccer with his older brother every day. Captain lost a similar amount of weight after switching to cow’s milk at school and is now 9 and slim, weighing around 51 pounds.

One Monday in September, the brothers — both in soccer jerseys — kicked a ball back and forth in the driveway of the family’s brightly painted red house. Gustun, who has a lightning bolt shaved into his hairline, chased the ball and tried to get it away from his brother, who darted about quickly, tapping it from foot to foot.

“Now, his movement is perfect,” his mother said.

Danone, the company that makes Dumex, said in a statement that while breast milk offers children the best nutritional start, “50 years of scientific research into nutritional needs in early life underpins our products, and we do not make claims that have not been backed up by scientific research.” The company said that research has shown that toddler milk can provide nutrition and help improve the diet of children age 1 and older, reducing the risk of iron and vitamin D deficiency.

“We encourage parents to follow the guidelines on pack when using our products, which are carefully calibrated so that babies and infants receive the right amount of nutrients they need each day from our products,” the company said.

“The Tactic is ‘I Will Violate Your Law’”

Thailand’s marketing restrictions have done little to curb practices like cross-promotion, said Nisachol Cetthakrikul, who has worked in the Thai health ministry and studied the law.

Indeed, at two supermarkets in Bangkok, shiny walls of powdered formula boxes seven shelves high greeted shoppers on a warm day in September. There were few differences between packages for products intended for babies and those intended for toddlers.

Formula makers and stores offered steep discounts for toddler milk, calling one a “Mommy Fair Shock Deal.” An offer on one shelf told parents if they spent about $87 on Hi-Q1 toddler formula, made by Danone, they could receive a free yellow and blue swing set worth about $27. Other offers included a clay “pizza dough cooking fun set,” a toy keyboard and microphone, and even a pushable “speedcar trolley” that a toddler could sit in.

A 2022 study led by Nisachol found 227 instances of formula marketing that violated the law.

The government has levied fines for violations, but Thailand’s health ministry doesn’t name offenders. “The tactic is ‘I will violate your law,’” Siriwat said, “‘and prepare the budget for the fine.’”

Thai health authorities have tried to fight back by raising parents’ awareness of the benefits of breastfeeding. The health ministry, for example, erected billboards saying “breast milk is medicine” and called doctors to a meeting to urge them to promote breastfeeding among their patients. But these campaigns are no match for the formula companies’ massive spending on marketing, Siriwat said.

While Thailand’s exclusive breastfeeding rate for babies six months or younger rebounded to about 29% in 2022, UNICEF found, it is still far short of the WHO’s target of at least 50% by 2025. The country’s rates of obesity and stunting for children 5 and under are higher today than they were in 2016, the year before the watered-down formula law passed.

Dr. Somsak Lolekha, president of the Thai pediatric society, said formula isn’t the only reason for children’s weight problems. But it plays a big role, he said, because it’s so easy to drink — a point that tracks with studies showing that babies who breastfeed longer are less likely to become obese and develop diabetes than those who drink formula.

Last summer, Thailand joined more than 100 nations at the WHO’s headquarters in Geneva to explore ways to fight unethical formula marketing. Attendees sat at long tables in a sleek, modern auditorium. Like other nations’ representatives, Dr. Titiporn Tuangratananon, an official with Thailand’s health ministry, declared her intentions on brightly colored paper posted at the front of the room: “Fully control” the marketing of formula to young children, and “Increase + expand enforcement.”

In an interview, Titiporn said health officials are trying to update the country’s marketing rules — including making some forms of toddler formula advertising, such as giveaways, discounts and free samples, illegal.

But that could ultimately prove difficult in a country that is now the seventh-largest market in the world for formula.

In fact, according to Titiporn, the government has already been deluged by public comments critical of its regulatory efforts. She suspected the pro-marketing remarks, some of which had been repeatedly copied and pasted, came from representatives of the formula industry.

“We know that it’s not real,” Titiporn said. “It’s not the real mothers.”

Churches Are Breaking the Law by Endorsing in Elections, Experts Say. The IRS Looks the Other Way.

by Jeremy Schwartz and Jessica Priest

ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.

Six days before a local runoff election last year in Frisco, a prosperous and growing suburb of Dallas, Brandon Burden paced the stage of KingdomLife Church. The pastor told congregants that demonic spirits were operating through members of the City Council.

Grasping his Bible with both hands, Burden said God was working through his North Texas congregation to take the country back to its Christian roots. He lamented that he lacked jurisdiction over the state Capitol, where he had gone during the 2021 Texas legislative session to lobby for conservative priorities like expanded gun rights and a ban on abortion.

“But you know what I got jurisdiction over this morning is an election coming up on Saturday,” Burden told parishioners. “I got a candidate that God wants to win. I got a mayor that God wants to unseat. God wants to undo. God wants to shift the balance of power in our city. And I have jurisdiction over that this morning.”

What Burden said that day in May 2021 was a violation of a long-standing federal law barring churches and nonprofits from directly or indirectly participating in political campaigns, tax law experts told ProPublica and The Texas Tribune. Although the provision was mostly uncontroversial for decades after it passed in 1954, it has become a target for both evangelical churches and former President Donald Trump, who vowed to eliminate it.

Burden’s sermon is among those at 18 churches identified by the news organizations over the past two years that appeared to violate the Johnson Amendment, a measure named after its author, former President Lyndon B. Johnson. Some pastors have gone so far as to paint candidates they oppose as demonic.

At one point, churches fretted over losing their tax-exempt status for even unintentional missteps. But the IRS has largely abdicated its enforcement responsibilities as churches have become more brazen. In fact, the number of apparent violations found by ProPublica and the Tribune, and confirmed by three nonprofit tax law experts, are greater than the total number of churches the federal agency has investigated for intervening in political campaigns over the past decade, according to records obtained by the news organizations.

In response to questions, an IRS spokesperson said that the agency “cannot comment on, neither confirm nor deny, investigations in progress, completed in the past nor contemplated.” Asked about enforcement efforts over the past decade, the IRS pointed the news organizations to annual reports that do not contain such information.

Neither Burden nor KingdomLife responded to multiple interview requests or to emailed questions.

Trump’s opposition to the law banning political activity by nonprofits “has given some politically-minded evangelical leaders a sense that the Johnson Amendment just isn’t really an issue anymore, and that they can go ahead and campaign for or against candidates or positions from the pulpit,” said David Brockman, a scholar in religion and public policy at the Baker Institute for Public Policy at Rice University.

Among the violations the newsrooms identified: In January, an Alaska pastor told his congregation that he was voting for a GOP candidate who is aiming to unseat Republican U.S. Sen. Lisa Murkowski, saying the challenger was the “only candidate for Senate that can flat-out preach.” During a May 15 sermon, a pastor in Rocklin, California, asked voters to get behind “a Christian conservative candidate” challenging Gov. Gavin Newsom. And in July, a New Mexico pastor called Democratic Gov. Michelle Lujan Grisham “beyond evil” and “demonic” for supporting abortion access. He urged congregants to “vote her behind right out of office” and challenged the media to call him out for violating the Johnson Amendment.

Andrew Whitehead, a sociologist at the University of Indiana-Purdue, who studies Christian nationalism, said the ramping up of political activity by churches could further polarize the country. “It creates hurdles for a healthy, functioning, pluralistic democratic society,” he said. “It’s really hard to overcome.”

The Johnson Amendment does not prohibit churches from inviting political speakers or discussing positions that may seem partisan nor does it restrict voters from making faith-based decisions on who should represent them. But because donations to churches are tax-deductible and because churches don’t have to file financial disclosures with the IRS, without such a rule donors seeking to influence elections could go undetected, said Andrew Seidel, vice president of strategic communications for the advocacy group Americans United for Separation of Church and State.

“If you pair the ability to wade into partisan politics with a total absence of financial oversight and transparency, you’re essentially creating super PACs that are black holes,” Seidel said.

Churches have long balanced the tightrope of political involvement, and blatant violations have previously been rare. In the 1960s, the IRS investigated complaints that some churches abused their tax-exempt status by distributing literature that was hostile to the election of John F. Kennedy, the country’s first Catholic president. And in 2004, the federal agency audited All Saints Episcopal Church in California after a pastor gave an anti-war speech that imagined Jesus talking to presidential candidates George W. Bush and John Kerry. The pastor did not endorse a candidate but criticized the Iraq war.

Some conservative groups have argued that Black churches are more politically active than their white evangelical counterparts but are not as heavily scrutinized. During the 1984 presidential campaign, Democratic candidate Rev. Jesse L. Jackson was accused of turning Sunday sermons into campaign rallies and using Black churches to raise funds. In response to allegations of illegal campaigning, Jackson said at the time that strict guidelines were followed and denied violating the law.

While some Black churches have crossed the line into political endorsements, the long legacy of political activism in these churches stands in sharp contrast to white evangelical churches, where some pastors argue devout Christians must take control of government positions, said Robert Wuthnow, the former director of the Princeton University Center for the Study of Religion.

Wuthnow said long-standing voter outreach efforts inside Black churches, such as Souls to the Polls, which encourages voting on Sundays after church services, largely stay within the boundaries of the law.

“The Black church has been so keenly aware of its marginalized position,” Wuthnow said. “The Black church, historically, was the one place where Black people could mobilize, could organize, could feel that they had some power at the local level. The white evangelical church has power. It’s in office. It’s always had power.”

At the end of his two-hour sermon that May, Burden asserted that his church had a God-given power to choose lawmakers, and he asked others to join him onstage to “secure the gate over the city.”

Burden and a handful of church members crouched down and held on to a rod, at times speaking in tongues. The pastor said intruders such as the mayor, who was not up for reelection last year but who supported one of the candidates in the race for City Council, would be denied access to the gates of the city.

“Now this is bold, but I’m going to say it because I felt it from the Lord. I felt the Lord say, ‘Revoke the mayor’s keys to this gate,’” Burden said. “No more do you have the key to the city. We revoke your key this morning, Mr. Mayor.

“We shut you out of the place of power,” Burden added. “The place of authority and influence.”

Johnson Amendment’s Cold War Roots

Questions about the political involvement of tax-exempt organizations were swirling when Congress ordered an investigation in April 1952 to determine if some foundations were using their money “for un-American and subversive activities.”

Leading the probe was Rep. Gene Cox, a Georgia Democrat who had accused the Guggenheim and Rockefeller foundations, among others, of helping alleged Communists or Communist fronts. Cox died during the investigation, and the final report cleared the foundations of wrongdoing.

But a Republican member of the committee argued for additional scrutiny, and in July 1953, Congress established the House Committee to Investigate Tax-Exempt Foundations. The committee focused heavily on liberal organizations, but it also investigated nonprofits such as the Facts Forum foundation, which was headed by Texas oilman H.L. Hunt, an ardent supporter of then-Sen. Joseph McCarthy of Wisconsin, a Republican who was best known for holding hearings to investigate suspected Communists.

In July 1954, Johnson, who was then a senator, proposed an amendment to the U.S. tax code that would strip nonprofits of their tax-exempt status for “intervening” in political campaigns. The amendment sailed through Congress with bipartisan support and was signed into law by Republican President Dwight D. Eisenhower.

Johnson never explained his intent. Opponents of the amendment, as well as some academics, say Johnson was motivated by a desire to undercut conservative foundations such as the National Committee to Uphold Constitutional Government, founded by newspaper magnate Frank Gannett, which painted the Democrat as soft on communism and supported his opponent in the primary election. Others have hypothesized that Johnson was hoping to head off a wider crackdown on nonprofit foundations.

Over the next 40 years, the IRS stripped a handful of religious nonprofits of their tax-exempt status. None were churches.

Then, just four days before the 1992 presidential election, Branch Ministries in New York ran two full-page ads in USA Today and The Washington Times urging voters to reject then-Arkansas Gov. Bill Clinton, a Democrat, in his challenge to Republican President George H.W. Bush.

The ads proclaimed: “Christian Beware. Do not put the economy ahead of the Ten Commandments.” They asserted that Clinton violated scripture by supporting “abortion on demand,” homosexuality and the distribution of condoms to teenagers in public schools. Clinton, the ads said, was “openly promoting policies that are in rebellion to God’s laws.”

The IRS revoked the church’s tax-exempt status, leading to a long legal battle that ended with a U.S. appeals court siding with the federal agency.

The case remains the only publicly known example of the IRS revoking the tax-exempt status of a church because of its political activity in nearly 70 years. The Congressional Research Service said in 2012 that a second church had lost its tax-exempt status, but that its identity “is not clear.”

Citing an increase in allegations of church political activity leading up to the 2004 presidential election between incumbent Bush and Kerry, IRS officials created the Political Activities Compliance Initiative to fast-track investigations.

Over the next four years, the committee investigated scores of churches, including 80 for endorsing candidates from the pulpit, according to IRS reports. But it did not revoke the tax-exempt status of any. Instead, the IRS mostly sent warning letters that agency officials said were effective in dissuading churches from continuing their political activity, asserting that there were no repeat offenders in that period.

In some cases, the IRS initiated audits of churches that could have led to financial penalties. It’s unclear how many did.

In January 2009, a federal court dismissed an auditinto alleged financial improprieties at a Minnesota church whose pastor had supported the congressional campaign of former U.S. Rep. Michele Bachmann, a Republican from Minnesota.

The court found that the IRS had not been following its own rules for a decade because it was tasked with notifying churches of their legal rights before any pending audits and was required to have an appropriately high-level official sign off on them. But a 1998 agency reorganization had eliminated the position, leaving lower IRS employees to initiate church investigations.

Following the ruling, the IRS suspended its investigations into church political activity for five years, according to a 2015 Government Accountability Office report.

During the hiatus, a conservative Christian initiative called Pulpit Freedom Sunday flourished. Pastors recorded themselves endorsing candidates or giving political sermons that they believed violated the Johnson Amendment and sent them to the IRS. The goal, according to participants, was to trigger a lawsuit that would lead to the prohibition being ruled unconstitutional by the U.S. Supreme Court.

The IRS never challenged participating churches, and the effort wound down without achieving its aim.

In response to a Freedom of Information Act request from ProPublica and the Tribune last year, the IRS produced a severely redacted spreadsheet indicating the agency had launched inquiries into 16 churches since 2011. IRS officials shielded the results of the probes, and they have declined to answer specific questions.

Despite the agency’s limited enforcement, Trump promised shortly after he took office that he would “totally destroy the Johnson Amendment and allow our representatives of faith to speak freely and without fear of retribution.”

As president, Trump tried unsuccessfully to remove the restrictions on church politicking through a 2017 executive order. The move was largely symbolic because it simply ordered the government not to punish churches differently than it would any other nonprofit, according to a legal filing by the Justice Department.

Eliminating the Johnson Amendment would require congressional or judicial action.

Although the IRS has not discussed its plans, it has taken procedural steps that would enable it to ramp up audits again if it chooses to.

In 2019, more than two decades after eliminating the high-level position needed to sign off on action against churches, the IRS designated the commissioner of the agency’s tax-exempt and government entities division as the “appropriate high-level Treasury official” with the power to initiate a church audit.

But Philip Hackney, a former IRS attorney and University of Pittsburgh tax law professor, said he doesn’t read too much into that. “I don’t see any reason to believe that the operation of the IRS has changed significantly.”

The Pulpit and Politics

There is no uniform way to monitor church sermons across the country. But with the COVID-19 pandemic, many churches now post their services online, and ProPublica and the Tribune reviewed dozens of them. Many readers shared sermons with us. (You can do so here.)

Texas’ large evangelical population and history of activism in Black churches makes the state a focal point for debates over political activity, said Matthew Wilson, a political science professor at Southern Methodist University in Dallas.

“Combine all of that with the increasing competitiveness of Texas elections, and it’s no surprise that more and more Texas churches are taking on a political role,” he said. “Texas is a perfect arena for widespread, religiously motivated political activism.”

The state also has a long history of politically minded pastors, Wuthnow said. Texas evangelical church leaders joined the fight in support of alcohol prohibition a century ago and spearheaded efforts to defeat Democrat Al Smith, the first Catholic to be nominated for president by a major party, in 1928. In the 1940s, evangelical fundamentalism began to grow in the Dallas-Fort Worth area.

Today, North Texas remains home to influential pastors such as Robert Jeffress, who leads the First Baptist megachurch in Dallas. Jeffress was one of Trump’s most fervent supporters, appearing at campaign events, defending him on television news shows and stating that he “absolutely” did not regret supporting the former president after the deadly Jan. 6, 2021, Capitol insurrection.

Burden went a step further, urging followers to stock up on food and keep their guns loaded ahead of President Joe Biden’s inauguration. He told parishioners that “prophetic voices” had told him in 2016 that Trump would have eight consecutive years in office.

The Frisco Conservative Coalition board voted to suspend Burden as chair for 30 days after criticism about his remarks.

Burden called his comments “inartful” but claimed he was unfairly targeted for his views. “The establishment media is coming after me,” he saidat the time. “But it is not just about me. People of faith are under attack in this country.”

Since then, Burden has repeatedly preached that the church has been designated by the Lord to decide who should serve in public office and “take dominion” over Frisco.

As the runoff for the Frisco City Council approached last year, Burden supported Jennifer White, a local veterinarian. White had positioned herself as the conservative candidate in the nonpartisan race against Angelia Pelham, a Black human resources executive who had the backing of the Frisco mayor.

White said she wasn’t in attendance during the May 2021 sermon in which Burden called her the “candidate that God wants to win.” She said she does not believe pastors should endorse candidates from the pulpit, but she welcomed churches becoming more politically active.

“I think that the churches over the years have been a big pretty big disappointment to the candidates in that they won’t take a political stance,” White said in an interview. “So I would love it if churches would go ahead and come out and actually discuss things like morality. Not a specific party, but at least make sure people know where the candidates stand on those issues. And how to vote based on that.”

Pelham’s husband, local pastor Dono Pelham, also made a statement that violated the Johnson Amendment by “indirectly intervening” in the campaign, said Ellen Aprill, an emerita tax law professor at Loyola Marymount Law School in Los Angeles

In May 2021, Pelham told his church that the race for a seat on the City Council had resulted in a runoff. He acknowledged that his church’s tax-exempt status prevented him from supporting candidates from the pulpit. Then, he added, “but you’ll get the message.”

“It’s been declared for the two candidates who received the most votes, one of which is my wife,” Pelham said. “That’s just facts. That’s just facts. That’s just facts. And so a runoff is coming and every vote counts. Be sure to vote.”

Pelham then asked the congregation: “How did I do? I did all right, didn’t I? You know I wanted to go a little further, but I didn’t do it.”

Angelia Pelham, who co-founded Life-Changing Faith Christian Fellowship in 2008 with her husband, said the couple tried to avoid violating the Johnson Amendment. Both disagreed that her husband’s mention of her candidacy was a violation.

“I think church and state should remain separate,” Angelia Pelham said in an interview, adding: “But I think there’s a lot of folks in the religious setting that just completely didn’t even consider the line. They erased it completely and lost sight of the Johnson Amendment.”

She declined to discuss Burden’s endorsement of her opponent.

In his sermon the morning after Pelham defeated his chosen candidate, Burden told parishioners that the church’s political involvement would continue.

“So you’re like, but you lost last night? No, we set the stage for the future,” he said, adding “God is uncovering the demonic structure that is in this region.”

“Demonic” Candidate

Most Americans don’t want pastors making endorsements from the pulpit, according to a 2017 survey by the Program for Public Consultation, which is part of the School of Public Policy at the University of Maryland.

Of the nearly 2,500 registered voters who were surveyed, 79% opposed getting rid of the Johnson Amendment. Only among Republican evangelical voters did a slight majority — 52% — favor loosening restrictions on church political activity.

But such endorsements are taking place across the country, with some pastors calling for a debate about the Johnson Amendment.

After the U.S. Supreme Court overturned Roe v. Wade in June, New Mexico became an island of abortion access for women in Texas and other neighboring states.

The issue raised the stakes in the upcoming Nov. 8 New Mexico governor’s race between incumbent Lujan Grisham, a supporter of abortion rights, and Republican challenger Mark Ronchetti, who advocates limiting access.

“We’re going to fast become the No. 1 abortion place in all of America,” a pastor, Steve Smothermon, said during a July 10 sermon at Legacy Church in Albuquerque, which has an average weekly attendance of more than 10,000 people. Smotherman said the governor was “wicked and evil” and called her “a narcissist.”

“And people think, ‘Why do you say that?’ Because I truly believe it. In fact, she’s beyond evil. It’s demonic,” Smothermon said.

He later added: “Folks, when are we going to get appalled? When are we going to say, ‘Enough is enough’? When are we going to stop saying, ‘Well, you know, it’s a woman’s right to choose’? That’s such a lie.”

Church attendees had a stark choice in the upcoming election, Smothermon said. “We have the Wicked Witch of the North. Or you have Mark Ronchetti.”

The governor’s campaign declined to comment. Neither Legacy Church, Smothermon nor Ronchetti responded to requests for comment.

The sermon was a “clear violation” of the Johnson Amendment, said Sam Brunson, a Loyola University Chicago law professor. But Smothermon showed no fear of IRS enforcement.

Those who thought he crossed the line were “so stupid,” Smothermon said during the sermon. “You have no idea what you’re talking about.”

In another example, pastors at a Fort Worth church named Mercy Culture have repeatedly endorsed candidates for local and statewide offices since its founding in 2019.

“Now, obviously, churches don’t endorse candidates, but my name is Landon and I’m a person before I’m a pastor. And as an individual, I endorse Nate Schatzline,” the lead pastor, Landon Schott, said in a February sermon about a church member who was running to fill an open state representative seat.

Johnson Amendment rules allow pastors to endorse in their individual capacity, as long as they are not at an official church function, which Schott was.

In other services, Schott challenged critics to complain to the IRS about the church’s support of political candidates and said he wasn’t worried about losing the church’s tax-exempt status.

“If you want it that bad, come and take it. And if you think that we will stop preaching the gospel, speaking truth over taxes, you got another thing coming for you,” Schott said in May.

Schatzline, a member of Mercy Culture, received 65% of the vote in a May 24 runoff against the former mayor of the Dallas suburb of Southlake. He works for a separate nonprofit founded by Heather Schott, a pastor at Mercy Culture and the wife of Landon Schott.

Schatzline said in an interview with ProPublica and the Tribune that Landon Schott, not the church, endorsed him. He added that the church sought legal advice on how to ensure that it was complying with the Johnson Amendment.

“I think prayers can manifest into anything that God wants them to, but I would say that the community rallying behind me as individuals definitely manifested into votes,” Schatzline said.

Mercy Culture also supported Tim O’Hare, a Republican running for Tarrant County judge, this year after he came out against the shutdowns during the COVID-19 pandemic. His opponent in the primary had ordered churches and businesses to temporarily close when she was mayor of Fort Worth.

O’Hare came to prominence as the mayor of suburban Farmers Branch, where he championed a city ordinance to prohibit landlords from renting to immigrants without legal status. A federal court declared the ordinance unconstitutional in 2010 after a legal battle that cost the city $6.6 million.

O’Hare has pledged to hire an election integrity officer to oversee voting and “uncover election fraud.”

“The Lord spoke to me and said, ‘Begin to pray for righteous judges in our city,’” Heather Schott said during a Feb. 13 service. “I am believing that Mr. Tim O’Hare is an answered prayer of what we have been petitioning heaven for for the last year and a half.”

Neither Mercy Culture, Landon Schott nor Heather Schott responded to requests for comment. O’Hare also did not respond to a phone call and email seeking comment.

Schott’s comments were a prohibited endorsement, said Aprill, the emerita tax law professor at Loyola Marymount Law School in Los Angeles.

“It doesn’t say ‘vote for him’ but is still an endorsement,” she said. “There’s no other way to understand the statement that O’Hare has answered prayers for righteous judges.”

Two weeks later, O’Hare won his primary. He faces Deborah Peoples, a Democrat, on Nov. 8.

A New Tactic

On April 18, 2021, a day before early voting began for city council and school board elections across Texas, pastors at churches just miles apart flashed the names of candidates on overhead screens. They told their congregations that local church leaders had gathered to discuss upcoming city and school elections and realized that their members were among those seeking office.

“We’re not endorsing a candidate. We’re not doing that. But we just thought because they’re a member of the family of God, that you might want to know if someone in the family and this family of churches is running,” said Robert Morris, who leads the Gateway megachurch in Southlake and served as a member of Trump’s evangelical advisory board.

On the same day, Doug Page gave a similar message less than 5 miles away at First Baptist Grapevine.

“And so what we decided to do is look within our church families and say, ‘Who do we know that’s running for office?’ Now, let me clarify with you. This is not an endorsement by us. We are not endorsing anyone. However, if you’re part of a family, you’d like to know if Uncle Bill is running for office, right? And so that’s all we’re going to do is simply inform you.”

Saying that you are not endorsing a candidate “isn’t like a magic silver bullet that makes it so that you’re not endorsing them,” Brunson said.

The churches’ coordination on messaging across the area is notable, according to University of Notre Dame tax law professor Lloyd Hitoshi Mayer, who said he hadn’t before seen churches organizing to share lists of candidates.

“I do think this strategy is new,” said Mayer, who has studied the Johnson Amendment for more than a decade. “I hadn’t heard of that before. It’s quite a sophisticated tactic.”

Eight of the nine candidates mentioned by the pastors won their races.

Mindy McClure, who ran for reelection to the Grapevine-Colleyville school board, said she thought church involvement contributed to her defeat in a June 5, 2021, runoff by about 4 percentage points. Her opponent campaigned on removing critical race theory from district curriculum, while McClure said students “weren’t being indoctrinated in any way, shape or form.” Critical race theory is a college-level academic theory that racism is embedded in legal systems.

McClure said pastors endorsing from the pulpit creates “divisiveness” in the community.

“Just because you attend a different church doesn’t mean that you’re more connected with God,” she said.

Lawrence Swicegood, executive director of Gateway Media, said this month that the church doesn’t endorse candidates but “inform(s) our church family of other church family members who are seeking office to serve our community.” Page told ProPublica and the Tribune that “these candidates were named for information only.”

Eleven days after responding to ProPublica and the Tribune in October, Morris once again told his church that he was not endorsing any candidates during the last Sunday sermon before early voting. Then, he again displayed the names of specific candidates on a screen and told parishioners to take screenshots with their cellphones.

“We must vote,” he said. “I think we have figured that out in America, that the Christians sat on the sidelines for too long. And then all of a sudden they started teaching our children some pretty mixed up things in the schools. And we had no one to blame but ourselves. So let’s not let that happen. Especially at midterms.”