Milk is milk. But is it?
Minister in the Prime Minister's Office Josephine Teo's recent comment set off a firestorm amid public debate over the high prices of infant formula.
The average price of a 900g tin of infant milk powder has soared 120 per cent over the last decade to $56.06, making it among the highest in the world, along with those in China and Hong Kong.
A baby can go through three or four such tins a month, which means families can easily spend around $200 a month per child on formula alone.
Amid rising unhappiness, Senior Minister of State for Trade and Industry Koh Poh Koon announced in Parliament last month that the Government would be taking steps to ensure access to affordable options. He said all formula sold here, regardless of price, meets food regulations and the nutritional needs of infants to grow healthily, and the scientific evidence that some brands can do more is weak.
"Parents should therefore be careful about relying on the claims made by infant formula companies, or be misled into using price as a proxy for the quality of the product," he said.
Mrs Teo, who oversees population matters, said she had concluded, from her own experience as a mother of three, that "milk is milk, however fancy the marketing", and went for the cheapest option for her kids.
But indignant parents said that it is not always possible to do that and that it is a process of trial and error to find a formula that their babies take to, leaving them stuck with the price of the one junior chooses.
Doctors said that babies have varying tolerance levels to different brands. All ingredients in formula milk are present in breast milk, but the latter also contains antibodies and other protective substances that cannot be replicated in formula.
The World Health Organisation recommends exclusive breastfeeding in the first six months of a child's life, followed by the introduction of semi-solid foods. The Health Promotion Board (HPB) supports continued breastfeeding until one year and beyond due to its benefits for the baby.
But some mums have difficulty producing enough breast milk or need to return to work - either of these can make breastfeeding a challenge. Mums have also pointed out that Stage 1 formula for newborn babies is the costliest.
So, why are prices here so high, especially compared with those in other countries such as Malaysia, where prices can be half that of Singapore's?
Formula companies have attributed the price increases to research and development to improve their products and rising overhead costs. Pricing differs from country to country as factors such as operation costs and taxes vary considerably, some said.
But managing partner at pricing consultancy Simon-Kucher & Partners Jochen Krauss said that while import and other costs account for part of the price differences across countries, firms ultimately fix prices based on the perceived value of their products and consumers' spending power.
Economists said that in the case of infant formula, parents bear with high prices as they see it as an expense for the short term. That, in turn, creates inelastic demand - that is, demand that does not fall when prices go up.
A report by the Competition Commission of Singapore (CCS) released last month found no evidence of price-fixing by the six major manufacturers that make up more than 99 per cent of the fortified milk formula market here.
Instead, it uncovered during its year-long inquiry that the companies were competing not on price, but on building "premium" brand images, driven by consumer demand.
They invest heavily in research and development, constantly introducing new products and ingredients that purport to - among other things - boost mental development and vision.
This is accompanied by more spending on marketing and "aggressive" tactics, such as inducements to private hospitals for participation in their milk rotation programmes, where a brand is set as the default for a given period for infants who need formula.
This helps them to gain a "first-mover" advantage, given that the majority of new parents do not have a preferred brand and tend not to switch brands after leaving the hospital, the report said.
Such practices have entrenched consumer loyalty, creating barriers to entry for new brands, which, coupled with weak price competition, has given manufacturers the market power to increase prices, the study found.
Across Asia, manufacturers increasingly focus on premiumisation to retain margins as rising breastfeeding rates and low birth rates constrain volume growth, the CCS said in its report, citing market research firm Euromonitor International.
According to the HPB, in public hospitals with maternity services, the proportion of mothers who are exclusively breastfeeding at discharge has increased from 76 per cent in 2013 to 86 per cent last year.
A 2015 Global Baby Care report by Nielsen found that price is a dominant driver in Western markets, with more than a third of respondents in North America and Europe citing "good price/value" as the most important factor in buying baby food.
In the Asia-Pacific, only 20 per cent said it was a top factor. Due to a number of food safety incidents in recent years, respondents in the region value safety more than anything else, the report said.
In response to the CCS report, the Government has announced measures to tighten regulations on labelling and advertising, facilitate imports of more formula milk options, strengthen public education and encourage good practices in hospitals.
A task force has been formed to ensure that key measures are in place by the end of the year.
Supermarkets have also said that they are expanding their sourcing to provide more affordable options, while both FairPrice and Cold Storage are looking into creating house brands.
A made-in-Singapore range of infant milk powder, Einmilk, was recently launched with prices of under $40 for an 800g tin.
But more options will not help if there is no demand for them.
An estimated 95 per cent of formula milk sales in 2015 comprised sales of "premium" and speciality milk, with just 5 per cent of sales for "standard" milk - which costs less than half the price.
The CCS report noted that manufacturers and retailers may withdraw brands that do not perform well, such as a pharmacy that discontinued the sale of a formula brand less than a year after it started due to lack of demand.
As Pasir Ris-Punggol GRC MP Sun Xueling pointed out, both the supply and demand sides of the issue must be addressed, with entrenched brand perceptions posing an added challenge.
Regulations address supply, but demand must be served by better breastfeeding support and consumer education.
According to the last National Breastfeeding Survey, the top reasons that mothers cited for stopping breastfeeding were an inability to supply enough breast milk and the need to return to work. Thus, better breastfeeding support, beyond the hospital and in workplaces, should be provided to mothers who choose to breastfeed.
Consumer education is also key.
The two top- selling brands in Singapore last year were the Gain and Pediasure formula ranges, for children a year and above.
While children above 12 months do not require formula as cow's milk together with a balanced diet is adequate, supermarket shelves are stocked with formula for older kids, including for six years and beyond.
Some parents that The Straits Times spoke to said that they were unaware that formula milk can be stopped after one, making it largely an unnecessary expense.
The HPB, which has traditionally focused on promoting breastfeeding, has recognised the lack of awareness around formula milk. It has launched a multi-year programme aimed at educating parents on the nutritional needs of children.
Marketing efforts will cover the nutritional composition of formula milk, to help parents who rely on it to make more informed decisions, as well as weaning at six months.
With the entrance of more affordable options, better consumer education and more support for breastfeeding, prices of formula milk should become more competitive over time.
It is time for consumers to set a ceiling on what they are willing to pay, and send a signal to manufacturers that they cannot milk parents for top dollar.