Evidence of Violations of the International Code of Marketing of Breast-Milk Substitutes since the Adoption by the World Health Assembly in 1981: A Systematic Scoping Review Protocol

This is the protocol for a scoping review that aims to systematically explore and summarise the published evidence of violations of the International Code of Marketing of Breast-milk Substitutes (the Code) and subsequent World Health Assembly Resolutions globally. The planned scoping review will seek to identify what research has been conducted on the topic, examine the geographic spread and nature of violations, and summarise knowledge gaps. The Code was adopted in 1981 by the World Health Assembly to protect infant health, in particular from aggressive and inappropriate marketing of breastmilk substitutes including formula and related products. Non-compliance with the Code or violations are described in reports, however, no existing systematic review of the global research appears to have been conducted that encompasses the varied disciplines including health, economics, and gender. The review will inform international and national decision-makers on the nature of violations and potentially highlight the need for new modalities to regulate this marketing. The proposed scoping review will use the six-step process of Arksey and O’Malley which includes defining the research question; identifying the relevant literature; selecting studies; charting the data; collating, summarising and reporting the findings; and will include a consultative group.

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Recommendations for Adopting the International Code of Marketing of Breast-milk Substitutes Into U.S. Policy

Journal of Human Lactation ◽

10.1177/0890334417703063 ◽

2017 ◽

Vol 33 (3) ◽

pp. 582-587 ◽

Cited By ~ 2

Author(s):

Jessica Soldavini ◽

Lindsey Smith Taillie

Keyword(s):

United States ◽

Breast Milk ◽

World Health Organization ◽

The United States ◽

World Health ◽

International Code ◽

The World ◽

Breast Milk Substitutes ◽

Milk Substitutes ◽

Health Organization

In 1981, the World Health Organization adopted the International Code of Marketing of Breast-milk Substitutes ( International Code), with subsequent resolutions adopted since then. The International Code contributes to the safe and adequate provision of nutrition for infants by protecting and promoting breastfeeding and ensuring that human milk substitutes, when necessary, are used properly through adequate information and appropriate marketing and distribution. Despite the World Health Organization recommendations for all member nations to implement the International Code in its entirety, the United States has yet to take action to translate it into any national measures. In 2012, only 22.3% of infants in the United States met the American Academy of Pediatrics recommendation of at least 6 months of exclusive breastfeeding. Countries adopting legislation reflecting the provisions of the International Code have seen increases in breastfeeding rates. This article discusses recommendations for translating the International Code into U.S. policy. Adopting legislation that implements, monitors, and enforces the International Code in its entirety has the potential to contribute to increased rates of breastfeeding in the United States, which can lead to improved health outcomes in both infants and breastfeeding mothers.

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Old Tricks, New Opportunities: How Companies Violate the International Code of Marketing of Breast-Milk Substitutes and Undermine Maternal and Child Health during the COVID-19 Pandemic

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052381 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2381

Author(s):

Constance Ching ◽

Paul Zambrano ◽

Tuan T. Nguyen ◽

Manisha Tharaney ◽

Maurice Gerald Zafimanjaka ◽

...

Keyword(s):

Breast Milk ◽

Child Health ◽

Maternal And Child Health ◽

Public Awareness ◽

The Philippines ◽

World Health ◽

International Code ◽

Breast Milk Substitutes ◽

Milk Substitutes ◽

And Child Health

Breastfeeding is critical to maternal and child health and survival, and the benefits persist until later in life. Inappropriate marketing of breastmilk substitutes (BMS), feeding bottles, and teats threatens the enabling environment of breastfeeding, and exacerbates child mortality, morbidity, and malnutrition, especially in the context of COVID-19. These tactics also violate the International Code of Marketing of Breast-Milk Substitutes. This study identified marketing tactics of BMS companies since the start of the COVID-19 pandemic by reviewing promotional materials and activities from 9 companies in 14 countries, and the official Code reporting data from the Philippines. Eight qualitative themes emerged that indicate companies are capitalizing on fear related to COVID-19 by using health claims and misinformation about breastfeeding. Other promotional tactics such as donations and services were used to harness the public sentiment of hope and solidarity. Past studies show that these tactics are not new, but the pandemic has provided a new entry point, helped along by the unprecedented boom in digital marketing. There was a sharp increase of reported violations in the Philippines since the pandemic: 291 during the first months of the outbreak compared with 70 in all of 2019, corroborating the thematic findings. A lack of public awareness about the harm of donations and inadequate Code implementation and enforcement have exacerbated these problems. Proposed immediate action includes using monitoring findings to inform World Health Assembly (WHA) actions, targeted enforcement, and addressing misinformation about breastfeeding in the context of COVID-19. Longer-term action includes holding social media platforms accountable, raising public awareness on the Code, and mobilizing community monitoring.

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Marketing breast milk substitutes: problems and perils throughout the world

Archives of Disease in Childhood ◽

10.1136/archdischild-2011-301299 ◽

2012 ◽

Vol 97 (6) ◽

pp. 529-532 ◽

Cited By ~ 59

Author(s):

June Pauline Brady

Keyword(s):

Breast Milk ◽

The World ◽

Breast Milk Substitutes ◽

Milk Substitutes

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Formulation and Adoption of the International Code of Marketing of Breast-milk Substitutes

Holding Corporations Accountable: Corporate Conduct, International Codes and Citizen Action ◽

10.5040/9781350220607.ch-004 ◽

2001 ◽

Keyword(s):

Breast Milk ◽

International Code ◽

Breast Milk Substitutes ◽

Milk Substitutes

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Breastfeeding

10.1093/med/9780198759928.003.0004 ◽

2018 ◽

Author(s):

John Puntis

Keyword(s):

Emotional Support ◽

World Health ◽

Social And Emotional ◽

Maternity Hospitals ◽

The World ◽

Breast Milk Substitutes ◽

Milk Substitutes ◽

Health Organization ◽

Method Of Assessment ◽

Huge Variation

Breastfeeding has many benefits to both mother and infant and the World Health Organization (WHO) recommends exclusive breastfeeding for the first 6 months of life. Correct positioning of the baby at the breast and social and emotional support for the mother are among other factors that are important to successful breastfeeding. The ‘Baby Friendly’ initiative sets out ten steps to successful breastfeeding and encourages maternity hospitals to implement these and become accredited. The WHO ‘International Code of Marketing of Breast Milk Substitutes’ gives clear guidance on acceptable practices to formula manufacturers so that breastfeeding is not undermined. ‘Tongue tie’ has increasingly become regarded as a cause of maternal pain and difficulty latching on during breastfeeds. However, estimates of prevalence show huge variation and there is no agreed standard method of assessment. In addition, the risks of frenotomy need to be balanced against any possible benefit.

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