Violations of the International Code of Marketing of Breast-milk Substitutes in Mexico.

Sonia Hernández‐Cordero,Juan Rivera Dommarco,Teresita González De Cosío,Chessa Lutter,Ana Lilia Lozada‐Tequeanes,Laurence Grummer‐Strawn,Teresa Shamah‐Levy,Pedro Saturno‐Hernández

doi:10.1111/mcn.12682

Abstract

This study estimated the prevalence of violations of the International Code of Marketing of Breast-milk Substitutes (BMS) and subsequent resolutions of the World Health Assembly (Code) at health facilities, points of sale (POS), and on BMS labelling and media in Mexico. We carried out a cross-sectional survey among 693 mothers with children aged less than 24months and 48 health providers at public and private health facilities in two states of Mexico. Observational assessment at 20 POS and the health facilities was conducted as well as an analysis of labels on BMS products for sale. Women attending public and private health facilities reported receiving free BMS samples in the previous 6months (11.1%), and about 80% reported seeing BMS promotion in the mass media. Health providers reported contact with BMS manufacturer representatives in the previous 6months (15.5%), and only 41.6% of the health providers had knowledge of the Code. BMS promotions were identified at nearly all POS. Analysis of 190 BMS labels showed that 30% included pictures/text idealizing the use of BMS, and all labels incorporated health and nutrition claims. Violations of the Code are prevalent within the health services, POS, and labelling of BMS products. The high percentage of health providers with no knowledge of the Code calls for action at national level to better disseminate and comply with the Code. A transparent, free from commercial influence, and continual monitoring system for Code compliance is needed, including a follow-up component on sanctions for contraventions of the Code.

Highlights

The contribution of breastfeeding to survival, health, and development in children as well as to the mother's health and human capital development is well known (Victora et al, 2016)
The International Code of Marketing of Breast‐ milk Substitutes was adopted by the World Health Assembly (WHA) in 1981 in response to a rise in child mortality owing to the promotion of breast milk substitutes (BMS) (World Health Organization [WHO], 1981)
We found that BMS promotion and offering mothers free samples of infant formula occur within as well as outside of health facilities in Mexico

Summary

Introduction

The contribution of breastfeeding to survival, health, and development in children as well as to the mother's health and human capital development is well known (Victora et al, 2016). Breastfeeding practices are influenced by socio‐economic, cultural, and individual factors, as well as by the presence or absence of public policies that support and promote breastfeeding and regulated marketing strategies of breast milk substitutes (BMS). Among these factors, the promotion of manufactured BMS (including infant formula, follow‐up formula, and growing‐up or toddler milks) results in suboptimal breastfeeding practices. The International Code of Marketing of Breast‐ milk Substitutes was adopted by the World Health Assembly (WHA) in 1981 in response to a rise in child mortality owing to the promotion of BMS (World Health Organization [WHO], 1981). The Code outlines the responsibilities of governments, health care systems, and workers, as well as those of the companies that market or manufacture BMS (WHO, 1981)

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