Assessing Compliance: Violations of WHO Code in Breast Milk Substitute Marketing, Ecuador.

Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101201025 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1740-8709 (Electronic) Linking ISSN: 17408695 NLM ISO Abbreviation: Matern Child Nutr Subsets: MEDLINE

Publication: Oxford, UK : Wiley-Blackwell
Original Publication: Oxford, UK : Blackwell Pub., c2005-

Marketing*/legislation & jurisprudence ; Marketing*/standards ; Guideline Adherence*/statistics & numerical data ; Milk Substitutes*/economics ; Infant Formula*; Humans ; Ecuador ; World Health Organization ; Cross-Sectional Studies ; Female ; Infant ; Adult ; Advertising ; Mothers ; Milk, Human ; Food Labeling ; Breast Feeding ; Health Personnel

Breast milk substitute (BMS) marketing significantly influences global infant feeding practices. Ecuador, like many countries, seeks to regulate these promotions under the WHO's International Code of Marketing of Breast-Milk Substitutes. This cross-sectional analysis assessed BMS marketing compliance with WHO's Code in Ecuador. Surveys were conducted with mothers (n = 330) and healthcare professionals (n = 66), complemented by observations at health facilities (n = 33) and retail outlets (n = 44). Media monitoring and product labelling evaluations were also conducted. The study revealed widespread exposure to BMS marketing outside health facilities (91.21% of mothers). Promotional activities targeted healthcare professionals, with significant interactions involving free supplies (26.09%) and gifts (21.74%). Retail outlets prominently displayed BMS promotions, often featuring discounts (95%). Compliance with labelling criteria was notably low, particularly concerning nutrition and health claims (39%). TV emerged as the dominant platform for BMS advertising, with 2884 ads aired over 16 h and 24 min, totalling $1,876,915.50 in expenditures. Digital platforms also featured BMS ads, with significant engagement on social media (533,845 interactions). This study reveals widespread violations of the WHO Code in Ecuador, emphasizing the need for stronger regulations and targeted education for healthcare professionals and the public to protect infant health and promote breastfeeding. Despite existing regulations, the pervasive advertising and substantial investment in BMS marketing across various media underscore significant enforcement gaps. To effectively safeguard maternal and child health, Ecuador must fully incorporate and rigorously enforce all Code recommendations within its national legislation.
(© 2024 The Author(s). Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Front Public Health. 2023 Oct 23;11:1176478. (PMID: 37937076)
BMJ Glob Health. 2023 Nov;8(11):. (PMID: 37949499)
Matern Child Nutr. 2019 Jan;15(1):e12682. (PMID: 30168899)
Curr Nutr Rep. 2022 Sep;11(3):416-430. (PMID: 35507274)
Nutrition. 2021 Jul-Aug;87-88:111206. (PMID: 33761442)
Matern Child Nutr. 2022 May;18 Suppl 3:e13335. (PMID: 35313063)
Lancet. 2016 Jan 30;387(10017):475-90. (PMID: 26869575)
Andes Pediatr. 2022 Jun;93(3):327-335. (PMID: 35857003)
Int J Environ Res Public Health. 2021 Mar 01;18(5):. (PMID: 33804481)
Lancet. 2016 Jan 30;387(10017):491-504. (PMID: 26869576)
Rev Paul Pediatr. 2022 Jul 06;41:e2021228. (PMID: 35830162)
BMC Public Health. 2022 Dec 13;22(1):2336. (PMID: 36514038)
J Paediatr Child Health. 2020 Sep;56(9):1438-1447. (PMID: 32790214)
Lancet. 2023 Feb 11;401(10375):486-502. (PMID: 36764314)
BMJ Glob Health. 2023 Mar;8(3):. (PMID: 36918217)

This work was supported by the UNICEF Office for Ecuador.

Keywords: breast feeding; commercial milk formula; infant formula; legislation; marketing; mass media; milk substitutes; nutrition policy

Date Created: 20241213 Date Completed: 20250427 Latest Revision: 20250427

20250428

PMC11956041

10.1111/mcn.13783

39670338