Global Index

India Spotlight Index

Global Index 2016

BMS methodology

Approach to assessment

The 2016 Global Index has significantly strengthened the approach it takes to assessing BMS manufacturers’ compliance with The Code and subsequent WHA resolutions compared to that used in 2013. ATNF recognized that the previous approach was limited; it lacked an assessment of companies’ policies, management systems and disclosure, and that a more extensive assessment of companies marketing within countries was needed. Many stakeholders also expressed this view.

The new approach, undertaken on a pilot basis, evaluates companies’ performance in two ways:

BMS 1. Corporate profile assessment: The ATNI BMS Corporate Profile methodology is designed to evaluate whether the six selected companies have robust BMS marketing policies and management systems, and their level of transparency.

BMS 2. In-country assessments: Two pilot assessments were undertaken in Vietnam and Indonesia to assess the compliance of all BMS companies in each country with The Code and national regulations. (For an explanation of how the two countries were selected see BMS Annex). This research was carried out by specialist statistical survey firm Westat, appointed following a competitive bid process, using the IGBM Protocol. The Protocol was developed between 1998 and 2007 by The Interagency Group on Breastfeeding Monitoring (IGBM) which was a UK-based coalition of international non-government organizations, churches, academic institutions and interested individuals. Its use is now controlled by UNICEF New York.

The companies were not informed of the location or timing of these studies prior to their commencement, but only after they had been finished.

Basis for company assessment

As with all other aspects of the ATNI methodology, the assessment is based on key international guidelines and standards, in this area:

  • The International Code of Marketing of Breast-milk Substitutes (The Code).
  • Subsequent WHA resolutions that make significant additions or provide clarifications to the original Code, referred to throughout this document in appropriate sections.
  • WHO’s statement of 17 July 2013 entitled ‘Information concerning the use and marketing of follow-up formula’.
  • Codex Alimentarius Standards (Codex) for infant formula and formulas for special medical purposes intended for infants (Codex Standard 72 – 1981) and Codex standard for follow-up formula (Codex Standard 156-1987).

In addition, ATNF aimed to learn from and align its approach to the BMS criteria and research methods to those of FTSE4Good.14 The ATNF Expert Group and a wide range of external stakeholders provide extensive, constructive advice in developing the ATNI BMS methodology. These included HKI, WHO, UNICEF, Save The Children, Alive & Thrive, 1000 Days, the World Bank and others. ATNF also occassionally updated the companies and IFM, the International Association of Infant Food Manufacturers, on the discussions. During the consultations, the companies and industry associations indicated that they do not accept the definition of BMS as used by ATNF, based on WHO’s definitions.

Scope of assessment - products

In line with the WHO guidance, ATNI assesses whether companies restrict marketing of the following products, considered to be breast-milk substitutes, in line with the recommendations of The Code and relevant WHA resolutions:

  • Complementary foods and beverages identified as being suitable for infants up to six months of age.
  • Any type of milk-based formula including infant formula (that can satisfy the normal nutritional requirements of infants up to six months of age); follow-on formula, also called follow-up formula (for infants from six months of age) and growing-up milk, also called toddler milk (for infants and young children up to 24 months of age.)
  • Feeding bottles and teats (and any other products encompassed by country regulations, for the in-country assessments) and equipment and materials, as defined by The Code or local regulations.

Note also that The Code does not exclude products for special medical or dietary use; these products were therefore included in the ATNI analysis.

Improving nutrition for all

The Access to Nutrition Index rates food and beverage manufacturers´ nutrition-related policies, practices and disclosures worldwide on a recurring basis.


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