Papers

Monitoring compliance with the International Code of Marketing of Breastmilk Substitutes in west Africa: multisite cross sectional survey in Togo and Burkina Faso

Victor M Aguayo, regional nutrition and child survival adviser for Africa, ^a Jay S Ross, policy coordinator, LINKAGES project, ^b Souleyman Kanon, senior programme officer, ^c Andre N Ouedraogo, regional nutrition adviser. ^d

^a Helen Keller International, Regional Office for Africa, New York, NY 10010, USA, ^b Academy for Educational Development, Washington, DC 20009, USA, ^c International Baby Food Action Network, Regional Office for West Africa, 01 BP 1776 Ouagadougou, Burkina Faso, ^d World Health Organization, Regional Office for Africa, BE-773 Harare, Zimbabwe

Correspondence to: V M Aguayo vaguayo{at}hkimali.org

Objectives: To monitor compliance with the International Code of Marketing of Breastmilk Substitutes in health systems, sales outlets, distribution points, and the news media in Togo and Burkina Faso, west Africa.
Design: Multisite cross sectional survey.
Participants: Staff at 43 health facilities and 66 sales outlets and distribution points, 186 health providers, and 105 mothers of infants aged 5 months in 16 cities.
Results: Six (14%) health facilities had received donations of breast milk substitutes. All donations were being given to mothers free of charge. Health providers in five (12%) health facilities had received free samples of breast milk substitutes for purposes other than professional research or evaluation. Health professionals in five (12%) health facilities had received promotional gifts from manufacturers. Promotional materials of commercial breast milk substitutes were found in seven (16%) health facilities. Special displays to market commercial breast milk substitutes were found in 29 (44%) sales and distribution points. Forty commercial breast milk substitutes violated the labelling standards of the code: 21 were manufactured by Danone, 11 by Nestlé, and eight by other national and international manufacturers. Most (148, 90%) health providers had never heard of the code, and 66 mothers (63%) had never received any counselling on breast feeding by their health providers.
Conclusion: In west Africa manufacturers are violating the code of marketing of breast milk substitutes. Comparable levels of code violations are observed with (Burkina Faso) or without (Togo) regulating legislation. Legislation must be accompanied by effective information, training, and monitoring systems to ensure that healthcare providers and manufacturers comply with evidence based practice and the code.

What is already known on this topic All member states of the World Health Assembly have reaffirmed their support for the International Code of Marketing of Breastmilk Substitutes Violations by manufacturers of breast milk substitutes have been reported in industrialised and developing countries What this study adds Manufacturers of breast milk substitutes are violating the code in Togo and Burkina Faso The levels of code violations are similar in a country with (Burkina Faso) and one without (Togo) legislation on the marketing of breast milk substitutes Legislation must be accompanied by effective information, training, and monitoring systems to ensure compliance with the code