scholarly journals Marketing Breastfeeding Substitutes: A Discussion Document

2020 ◽  
Vol 17 (24) ◽  
pp. 9239
Author(s):  
Genevieve E Becker
Keyword(s):  
Child Nutrition ◽  
Health Workers ◽  
Long Term Effects ◽  
Policy Makers ◽  
Health And Wellbeing ◽  
Infant And Young Child ◽  
Discussion Document ◽  
Parental Confidence ◽  
Breast Milk Substitutes ◽  
Milk Substitutes

Marketing influences knowledge, attitudes, and decisions related to infant and young child nutrition, safety, development, parental confidence, and other aspects of health and wellbeing of the child. These attitudes and behaviours of parents, health workers, policy makers, and other influencers have short- and long-term effects on the child. There is an International Code of Marketing of Breast-Milk Substitutes. Is it time to have a code of marketing of breastfeeding substitutes?

David Clark: Defender of Human Rights and Breastfeeding

2020 ◽  
Vol 36 (2) ◽  
pp. 221-223
Author(s):  
Laurence M. Grummer-Strawn ◽  
David Lawson Clark
Keyword(s):  
Human Rights ◽  
Infant Feeding ◽  
Child Nutrition ◽  
International Code ◽  
International Trade Agreements ◽  
Training Materials ◽  
Infant And Young Child ◽  
Breast Milk Substitutes ◽  
Milk Substitutes ◽  
Human Rights Based Approach

On September 10, I had the pleasure of interviewing my friend and colleague David Lawson Clark, the legal advisor for infant and young child nutrition and expert on the International Code of Marketing of Breast-milk Substitutes at UNICEF. A native of Scotland, David began his career as an attorney with the Scottish Development Agency and subsequently worked for the United Nations Interregional Crime and Justice Research Institute in Rome, Italy. Since 1995, David has assisted more than 60 countries in drafting legislation to implement the International Code of Marketing of Breastmilk Substitutes and has been instrumental in bringing a human rights-based approach to the protection, promotion, and support of breastfeeding. He has contributed to the development of international policy guidelines in the area of HIV and infant feeding and infant feeding in emergencies, and has provided guidance on issues around international trade agreements and intellectual property rights. David has written and contributed to many articles and publications on health and nutrition policy, developed courses and training materials on the implementation of the International Code and maternity protection, and has facilitated numerous workshops on the issue. (LGS refers to Dr. Laurence Grummer-Strawn and DC are the verbatim responses of David Clark)

scholarly journals What You Don’t Know About the Codex Can Hurt You: How Trade Policy Trumps Global Health Governance in Infant and Young Child Nutrition

2021 ◽  
Author(s):  
Katheryn Russ ◽  
Phillip Baker ◽  
Michaela Byrd ◽  
Manho Kang ◽  
Rizki Nauli Siregar ◽  
...  
Keyword(s):  
Public Health ◽  
Child Nutrition ◽  
Standard Setting ◽  
World Health ◽  
International Code ◽  
Infant And Young Child ◽  
Trade Politics ◽  
Breast Milk Substitutes ◽  
Milk Substitutes ◽  
Health Organization

Background: International food standards set by the Codex Alimentarius Commission (CAC), have become more prominent in international trade politics, since being referenced by various World Trade Organization (WTO) agreements. The new standing of the CAC imposes limits on domestic public health regulation. We show this includes implementation of the World Health Organization (WHO) International Code of Marketing of Breast-milk Substitutes. Methods: Using trade in commercial milk formulas (CMF) as a case study, we collected detailed data on interventions across various WTO bodies between 1995 and 2019. We used language from these interventions to guide data collection on member state and observer positions during the CAC review of the Codex Standard for Follow-up Formula (CSFUF), and during CAC discussions on the relevance of WHO policies and guidelines. Results: Exporting member states made 245 interventions regarding CMFs at the WTO, many citing deviations from standards set by the CAC. These did not occur in formal disputes, but in WTO Committee and Accession processes, toward many countries. In Thailand, complaints are linked to weakened regulation. Exporters also sought to narrow the CSFUF at the CAC in a way that is at odds with recommendations in the International Code. Tensions are growing more broadly within the CAC regarding relevance of WHO recommendations. Countries coordinated during WTO committee processes to advocate for reapportioning core WHO funding to the CAC and in order to further influence standard-setting. Conclusion: The commercial interests of the baby food industry are magnifying inconsistencies between health guidelines set by the WHO, standard-setting at the CAC, and functions of the WTO. This poses serious concerns for countries’ abilities to regulate in the interests of public health, in this case to protect breastfeeding and its benefits for the health of infants, children and mothers.

scholarly journals Implementation of the Code of Marketing of Breast-Milk Substitutes in Vietnam: Marketing Practices by the Industry and Perceptions of Caregivers and Health Workers

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2884
Author(s):  
Tuan T. Nguyen ◽  
Ha T. T. Tran ◽  
Jennifer Cashin ◽  
Van D. C. Nguyen ◽  
Amy Weissman ◽  
...  
Keyword(s):  
Breast Milk ◽  
Pregnant Women ◽  
Health Workers ◽  
Milk Formula ◽  
Cross Sectional ◽  
Policy Makers ◽  
Breast Milk Substitutes ◽  
Milk Substitutes ◽  
Commercial Milk ◽  
Depth Interviews

Background: The promotion of breastmilk substitutes (BMS) is an important barrier to successful breastfeeding. Objective: To examine the enactment and implementation of the Code of Marketing of Breast-Milk Substitutes (the Code) in Vietnam with a focus on marketing practices by the baby food industry and perceptions of caregivers, health workers, and policy makers. Methods: From May to July 2020, we conducted a mixed-method, cross-sectional study including a survey of 268 pregnant women and 726 mothers of infants aged 0–11 months and in-depth interviews with a subset of interviewed women (n = 39), policy makers, media executives, and health workers (n = 31). Results: In the previous 30 days, two mothers (out of 726) participating in the quantitative survey reported that health workers had recommended BMS, at private hospitals in both cases. In-depth interviews with health workers showed that hospitals have internal procedures to prevent the promotion of BMS by health workers. However, companies employed representatives to promote products not covered under the Code (e.g., commercial milk formula for pregnant women) at antenatal care visits and by gaining contact information from women and using this information to promote BMS outside the hospital, often on social media. In the 30 days preceding the survey, one-fifth of pregnant women were exposed to promotions of commercial milk formula for pregnant women and 7.1% to promotions of BMS. Among mothers of infants, 7.3% and 10.7% of respondents with infants aged 0–5 and 6–11 months, respectively, were exposed to some form of BMS promotion in the past 30 days. Around the time of birth, parents commonly brought BMS to maternity facilities (52.5%) or purchased it nearby (35.4%). Conclusions: Although Vietnam has a strong regulatory environment for the protection, promotion, and support of breastfeeding, there are implementation, monitoring, and enforcement gaps. Stronger enforcement of national policies to regulate the presence of BMS industry representatives in health facilities—both public and private—and the promotion of BMS products on digital platforms are needed.

Has Pakistan failed to ban the sale of formula milk?

2021 ◽  
pp. 1-3
Author(s):  
Areeba Nakhuda ◽  
Emaan Amin ◽  
Sakina Abbas
Keyword(s):  
Breast Milk ◽  
Infant Formula ◽  
Support Groups ◽  
Healthcare Workers ◽  
Child Nutrition ◽  
Healthcare Providers ◽  
Formula Milk ◽  
Awareness Campaigns ◽  
Breast Milk Substitutes ◽  
Milk Substitutes

According to a report published by WHO and UNICEF, countries continue to promote infant formula as a substitute for breast milk. (1) Out of 194 countries, 136 have adopted measures from the International Code of Marketing of Breast-milk substitutes while 79 countries have banned the marketing of breast milk substitutes in hospitals. (1) Pakistan introduced a Protection of Breastfeeding and Child Nutrition Ordinance in October 2002 to restrict the promotion of infant formula milk. (2) The Ordinance prohibits the marketing of infant formula as a substitute for mother’s milk. (2) Healthcare workers are prohibited from accepting any gifts or samples from the formula milk companies, and they should promote breastfeeding. (2) Breastmilk improves nutrition and provides antibodies for protection against various diseases. (1) Babies should be exclusively breastfed for the first 6 months after which complementary food should be given along with breastfeeding up to 2 years of age. (1) Undernutrition is responsible for about half of the under 5 deaths as it increases the frequency and severity of common infections. (3) However, in Pakistan, 48% of infants are breastfed exclusively for 0-5 months and the under 5 mortality rate in Pakistan is 67.2 per 1000 live births. (4) Healthcare providers play a pivotal role in encouraging parents’ decision to breastfeed their child by regular counselling where they highlight the benefits and address any misconceptions. During the COVID19 pandemic, there has been a decline in counselling, skilled lactation and other services by healthcare providers to encourage breastfeeding practice. (1) Practices of social distancing have made community counselling and mother support groups for promotion of breastfeeding challenging, leaving a gap for formula milk companies to profit from the crisis and weaken the confidence in nursing. (1) A study in Pakistan revealed that 70.5% of the healthcare workers had no knowledge about the national breastfeeding law. As a result, formula milk companies continued to violate the ban on distributing free samples and gifts to the healthcare staff. (5) This calls for a strict re-enforcement of regulations in hospitals and conducting nationwide awareness campaigns via social media, television, newspapers to counter the marketing of breastmilk substitutes and promote breastfeeding.  Keeping in mind that the benefits of breastfeeding outweigh the risks associated with coronavirus, WHO and UNICEF have encouraged mothers to breastfeed during the COVID-19 pandemic as there is no substantial evidence that the virus can be transmitted via breastmilk. (1) Continuous....

scholarly journals Discourse and breastfeeding practice in urban communities in Indonesia: A Foucauldian perspective

2020 ◽  
Vol 4 (3) ◽  
pp. 597
Author(s):  
Hetti Mulyaningsih ◽  
Bagong Suyanto ◽  
Rahma Sugihartati
Keyword(s):  
Urban Communities ◽  
Critical Discourse Analysis ◽  
Health Workers ◽  
Research Subjects ◽  
Structured Interviews ◽  
Breastfeeding Practices ◽  
Metropolitan Cities ◽  
Breast Milk Substitutes ◽  
Milk Substitutes ◽  
Breastfeeding Practice

Breastfeeding coverage in Indonesia is under government target. Several works of literature illustrate that mothers in Indonesia face three classic problems. First, inadequate regulation to protect breastfeeding practices, second, the massive promotion of infant formula and breast-milk substitutes, and third, discrepancies in health services. This article aimed to explore the experiences of breastfeeding mothers and to relate it to broader discourse. The study was conducted in two metropolitan cities in Indonesia, Jakarta, and Surabaya. Both locations were chosen because the two cities share similar characteristics, namely urban communities with dense, heterogeneous populations and rapid changes. The study is a critical discourse analysis using the Foucauldian perspective to help examine the discourse and the social practices of breastfeeding. Data were collected with semi-structured interviews on 36 research subjects. The results confirmed that all subjects recognised the benefits of breastfeeding discourse. However, the practice of infant feeding was not always related to health recommendations. The study also found three issues concerning breastfeeding practice, namely: discourse on breastmilk and biopower, failed mothers, and mothers’ negotiation. The discourse on breastfeeding is recognised as a biopower discourse which is an extension of affected mothers’ identities. Mothers who fail to breastfeed feel guilt, frustration and shame. They tried to negotiate this condition by asking health workers for help and arguing that the identity of the mother is not only influenced by the practice of breastfeeding. Therefore, a constructive biopower discourse is needed to implement breastfeeding practices and discourses to normalise breastfeeding practices.

scholarly journals Use of social media platforms by manufacturers to market breast-milk substitutes in South Africa

2020 ◽  
Vol 5 (12) ◽  
pp. e003574
Author(s):  
Catherine Pereira-Kotze ◽  
Tanya Doherty ◽  
Elizabeth C Swart
Keyword(s):  
South Africa ◽  
Social Media ◽  
Breast Milk ◽  
Low Income ◽  
Child Nutrition ◽  
Middle Income ◽  
Digital Platforms ◽  
National Legislation ◽  
Breast Milk Substitutes ◽  
Milk Substitutes

In South Africa (SA), exclusive breast feeding remains rare, with breast-milk substitutes (BMS) commonly being used in ways that are detrimental to infant and young child nutrition, health and survival. The use of internet, digital and mobile platforms has increased, including in low-income and middle-income countries, like SA and these platforms are avenues for BMS marketing. SA has national legislation (Regulation R991) to enforce the International Code of Marketing of BMS. This paper aims to provide pertinent examples of how BMS manufacturers in SA use social media to market their products thus violating national regulations. A digital (and social media) ethnography approach was used to study BMS organisations’ activity on Facebook and Instagram. Purposively selected examples of social media posts observed (from 2015 to 2019) were included, and content analysed in terms of national legislation. Several examples of BMS social media marketing are presented and interpreted according to provisions of national regulations that they violate. BMS manufacturers have found ways on social media to market their products in a media space that is complex to regulate, and where it is difficult to enforce national regulations. It is necessary to engage with stakeholders, notably social media companies, to alert them to relevant regulations applicable to their platforms. Monitoring the marketing of products for infants and young children by national governments needs to include online and digital platforms especially social media.

scholarly journals Challenges and responses to infant and young child feeding in rural Rwanda: a qualitative study

2019 ◽  
Vol 38 (1) ◽  
Author(s):  
Jeanine Ahishakiye ◽  
Laura Bouwman ◽  
Inge D. Brouwer ◽  
Eric Matsiko ◽  
Margaret Armar-Klemesu ◽  
...  
Keyword(s):  
Young Child ◽  
Community Health ◽  
Community Health Workers ◽  
Child Nutrition ◽  
Health Workers ◽  
Feeding Practices ◽  
Child Feeding ◽  
Young Child Feeding ◽  
Child Feeding Practices ◽  
Infant And Young Child

Abstract Background Despite different interventions to improve child nutrition conditions, chronic malnutrition is still a public health concern in Rwanda, with a high stunting prevalence of 38% among under 5-year-olds children. In Rwanda, only 18% of children aged 6–23 months are fed in accordance with the recommendations for infant and young child feeding practices. The aim of this study was to explore challenges to infant and young child feeding practices and the responses applied to overcome these challenges in Muhanga District, Southern province of Rwanda. Methods Sixteen (16) focus group discussions were held with mothers, fathers, grandmothers, and community health workers from 4 rural sectors of Muhanga District. The discussions were recorded, transcribed verbatim, and thematically analyzed using qualitative data analysis software, Atlas.ti. Results Two main themes emerged from the data. Firstly, there was a discourse on optimal infant and young child feeding (IYCF) practices that reflects the knowledge and efforts to align with early initiation of breastfeeding, exclusive breastfeeding for the first 6 months, as well as initiation of complementary foods at 6 months recommendations. Secondly, challenging situations against optimal practices and coping responses applied were presented in a discourse on struggling with everyday reality. The challenging situations that emerged as impeding appropriate IYCF practices included perceived lack of breast milk, infant cues, women’s heavy workload, partner relations and living in poverty. Family and social support from community health workers and health facility staff, financial support through casual labor, and mothers saving and lending groups, as well as kitchen gardens, were used to cope with challenges. Conclusion Factors influencing IYCF practices are multifaceted. Hence, intervention strategies to improve child nutrition should acknowledge the socially embedded nature of IYCF and address economic and social environmental constraints and opportunities, in addition and above knowledge only.

RESPONSE BY NESTLE TO THE WHO CODE ON BREAST-MILK SUBSTITUTES

PEDIATRICS ◽  
1982 ◽  
Vol 70 (5) ◽  
pp. 707-707
Author(s):  
Keyword(s):  
Breast Milk ◽  
Infant Formula ◽  
General Public ◽  
Health Workers ◽  
Media Analysis ◽  
International Code ◽  
Written Information ◽  
Who Code ◽  
Breast Milk Substitutes ◽  
Milk Substitutes

The Nestle Group has prepared written instructions (dated February, 1982) for its employees on the implementation of the W.H.O. International Code of Marketing of Breast-milk Substitutes. . . . The instructions appear in parallel with the relevant sections of the code, and the comparisons thus offered raise some doubts about the purity of Nestle's intentions. Article 2 of the international code, for instance, states that it covers all breast-milk substitutes, including complementary foods. Nestle has limited its applicability to infant formula alone, exempting its weaning cereals and canned milks, which are often marketed as early supplements to breast milk. Concerning the circulation of informational and educational material to pregnant women and mothers of young children, Nestle says: "Information intended for mothers. . . may bear corporate and product brand (packshot permitted)." Is this really within the terms of the code? Another requirement of the code disregarded by Nestle, is the inclusion in any such material of a warning of the health hazards of the improper use of infant formula. Article 5 of the W.H.O. code states that "There should be no advertising or other forms of promotion to the general public of products within the scope of this Code." Nestle has written: "Information relating to specific brands of infant formula must not be communicated directly to mothers or to the general public." Conceivably, such a statement could permit generic infant formula advertising in the mass media. Analysis of Nestle's guidelines discloses ways in which they might be used to circumvent various parts of the international code, such as the code's stipulations on free samples to health workers and free supplies to institutions.

scholarly journals Violations of the International Code of Marketing of Breast-milk Substitutes: Indonesia context

2016 ◽  
Vol 20 (1) ◽  
pp. 165-173 ◽  
Author(s):  
Irma Hidayana ◽  
Judhiastuty Februhartanty ◽  
Vida A Parady
Keyword(s):  
Breast Milk ◽  
Breast Feeding ◽  
Health Workers ◽  
Health Facilities ◽  
International Code ◽  
Cross Sectional Survey ◽  
Milk Substitute ◽  
Breast Milk Substitutes ◽  
Milk Substitutes ◽  
Breast Milk Substitute

AbstractObjectivesTo measure compliance with the International Code of Marketing of Breast-milk Substitutes (‘the Code’) in Indonesia.DesignThe study was a cross-sectional survey using the Interagency Group on Breastfeeding Monitoring protocol.SettingPublic and private health facilities in six provinces on Java island in Indonesia.SubjectsA total of 874 women (382 pregnant women and 492 breast-feeding mothers of infants below 6 months) and seventy-seven health workers were recruited from eighteen participating health facilities. The study also analysed a total of forty-four labels of breast-milk substitute products, twenty-seven television commercials for growing-up milk (for children >12 months) of nine brands and thirty-four print advertisements of fourteen brands.ResultsThe study found that 20 % of the women had received advice and information on the use of breast-milk substitutes and 72 % had seen promotional materials for breast-milk substitutes. About 15 % reported receiving free samples and 16 % received gifts. Nearly a quarter of the health workers confirmed receiving visits from representatives of breast-milk substitute companies. Two health workers reported having received gifts from the companies. The most common labelling violations found were statements or visuals that discouraged breast-feeding and the absence of mention about the consideration of local climate in the expiration date.ConclusionsViolations of the Code by health workers, breast-milk substitute companies and their representatives were found in all provinces studied. A regular monitoring system should be in place to ensure improved compliance with and enforcement of the Code.

scholarly journals Media audit reveals inappropriate promotion of products under the scope of the International Code of Marketing of Breast-milk Substitutes in South-East Asia

2017 ◽  
Vol 20 (8) ◽  
pp. 1333-1342 ◽  
Author(s):  
Kristine Hansen Vinje ◽  
Linh Thi Hong Phan ◽  
Tuan Thanh Nguyen ◽  
Sigrun Henjum ◽  
Lovise Omoijuanfo Ribe ◽  
...  
Keyword(s):  
Breast Milk ◽  
East Asia ◽  
Child Nutrition ◽  
Market Size ◽  
Milk Formula ◽  
South East Asia ◽  
International Code ◽  
Editorial Content ◽  
Breast Milk Substitutes ◽  
Milk Substitutes

AbstractObjectiveTo review regulations and to perform a media audit of promotion of products under the scope of the International Code of Marketing of Breast-milk Substitutes (‘the Code’) in South-East Asia.DesignWe reviewed national regulations relating to the Code and 800 clips of editorial content, 387 advertisements and 217 Facebook posts from January 2015 to January 2016. We explored the ecological association between regulations and market size, and between the number of advertisements and market size and growth of milk formula.SettingCambodia, Indonesia, Myanmar, Thailand and Vietnam.ResultsRegulations on the child’s age for inappropriate marketing of products are all below the Code’s updated recommendation of 36 months (i.e. 12 months in Thailand and Indonesia; 24 months in the other three countries) and are voluntary in Thailand. Although the advertisements complied with the national regulations on the age limit, they had content (e.g. stages of milk formula; messages about the benefit; pictures of a child) that confused audiences. Market size and growth of milk formula were positively associated with the number of newborns and the number of advertisements, and were not affected by the current level of implementation of breast-milk substitute laws and regulations.ConclusionsThe present media audit reveals inappropriate promotion and insufficient national regulation of products under the scope of the Code in South-East Asia. Strengthened implementation of regulations aligned with the Code’s updated recommendation should be part of comprehensive strategies to minimize the harmful effects of advertisements of breast-milk substitutes on maternal and child nutrition and health.

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