Intended for healthcare professionals


Report warns of continuing violations of code on breast milk substitute marketing

BMJ 2004; 328 doi: (Published 20 May 2004) Cite this as: BMJ 2004;328:1218
  1. Susan Mayor
  1. London

    Many manufacturers of breast milk substitutes continue to violate an international code on marketing, a new report published last week says.

    The report analysed the promotional practices of 16 international baby food companies and 14 bottle and teat companies between January 2002 and April 2004. It was published by the International Baby Food Action Network, a coalition of public interest groups working to reduce infant morbidity and mortality, as part of its ongoing monitoring of compliance with the international code of marketing of breast milk substitutes and relevant resolutions of the World Health Assembly.

    Results showed a growing emphasis on “closeness to breast milk” in advertising materials: manufacturers attribute this closeness to the addition of fatty acids derived from fungi, algae, or fish oil, with claims linking them to increased intelligence.

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    Some mothers believe claims that breast milk substitutes increase intelligence


    The report also found that health facilities remained the preferred way for companies to reach mothers, with donations of formula and free samples to hospitals, especially in countries that had not yet implemented the code or where enforcement measures were inadequate. Gifts from companies to healthcare workers and women remained common, particularly in Thailand.

    Annelies Allain, director of the International Baby Food Action Network's International Code Documentation Centre, based in Penang, Malaysia, said: “We found an increasing problem, with 11 out of the 16 companies studied adding fatty acids to their products and some claiming that this made them closer to breast milk and that they could improve intelligence.

    “Mothers are taken in by this, and many are willing to pay the extra $15 [£8; €12] to $20 per tin that companies charge for these products.”

    The report found that the Switzerland based company Nestlé was responsible for more violations than any other company,

    However, a spokesperson from Nestlé accused IBFAN of judging companies based on their own inaccurate interpretation of guidelines for baby milk marketing and said that the portrayal of their marketing is “simply not true.”


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