Violations of the International Code of Marketing of Breast-milk Substitutes: Indonesia context

Abstract

Objectives: To measure compliance with the International Code of Marketing of Breast-milk Substitutes ('the Code') in Indonesia. Design: The study was a cross-sectional survey using the Interagency Group on Breastfeeding Monitoring protocol. Setting: Public and private health facilities in six provinces on Java island in Indonesia. Subjects: A total of 874 women (382 pregnant women and 492 breast-feeding mothers of infants below 6 months) and seventy-seven health workers were recruited from eighteen participating health facilities. The study also analysed a total of forty-four labels of breast-milk substitute products, twenty-seven television commercials for growing-up milk (for children >12 months) of nine brands and thirty-four print advertisements of fourteen brands. Results: The study found that 20 % of the women had received advice and information on the use of breast-milk substitutes and 72 % had seen promotional materials for breast-milk substitutes. About 15 % reported receiving free samples and 16 % received gifts. Nearly a quarter of the health workers confirmed receiving visits from representatives of breast-milk substitute companies. Two health workers reported having received gifts from the companies. The most common labelling violations found were statements or visuals that discouraged breastfeeding and the absence of mention about the consideration of local climate in the expiration date. Conclusions: Violations of the Code by health workers, breast-milk substitute companies and their representatives were found in all provinces studied. A regular monitoring system should be in place to ensure improved compliance with and enforcement of the Code.

Discourse and breastfeeding practice in urban communities in Indonesia: A Foucauldian perspective

“…A study found that health workers, breast-milk substitute manufactures, and company representatives were guilty of violations of the WHO CODE and recommended a regular monitoring system to ensure compliance and enforcement of WHO CODE. The same study also confirms that health workers and representatives of breast-milk substitutes companies in Indonesia are working together (Hidayana Et al., 2017). Infant formula and other breast-milk substitutes are latent threats for breast-milk supporters in Indonesia.…”

Progress towards reducing sociodemographic disparities in breastfeeding outcomes in Indonesia: a trend analysis from 2002 to 2017

“…The ease of infant formula access; aggressive marketing in retail outlets and the media; continued provision of formula samples and feeding supplies by health professionals; and lack of comprehensive understandings of optimal infant nutrition and feeding practices, are some of the reasons that families choose to use infant formula [13,24]. Violations of the Code by infant formula companies include incentivizing the provision of infant formula and feeding supplies by health professionals and retail outlets, and producing misleading advertisements and product labelling [25]. In the US, the government formed the National Alliance for Breastfeeding Advocacy (NABA) to monitor compliance with the Code and establish a task force to identify hospitals which have collaborated with infant formula companies [50].…”

“…Thus, no fines nor sanctions can be given to infant formula companies that collaborate with community-based workers. Moreover, Hidayana et al [25] reported that some health workers received gifts from infant formula companies, infant formula labelling contained content that discouraged breastfeeding practice, and free formula samples were being distributed to mothers. In the case of the BFHI, in 2015 just 8% of hospitals in Indonesia had been designated as BFHI [26].…”

Predictors of breast milk substitute feeding among newborns in delivery facilities in urban Cambodia and Nepal

“…Promotion and consumption of these products have increased in step with global sales volume (Kent, 2015). Marketing of BMS within the health care system undermines mothers' confidence in breastfeeding (Parry, Ip, Chau, Wu, & Tarrant, 2013) and has been observed across South and Southeast Asia even when national legislation is in place to limit it (Barennes, Slesak, Goyet, Aaron, & Srour, 2016;Durako, Diallo, Thompson, & Aronson, 2016a;Durako, Diallo, Thompson, & Aronson, 2016b;Hidayana et al, 2016;Sobel et al, 2011). Prior research has shown that early use of BMS for feeding of newborns can increase the likelihood of continued BMS use for infant feeding and contribute to early breastfeeding cessation (Onah et al, 2014;Patil et al, 2015;Raheem, Binns, Chih, & Sauer, 2014).…”