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Global Index 2018

BMS methodology

Methodology structure

The methodology to assess BMS marketing for the 2018 ATNI Global Index retains the same structure as in the 2016 Global Index. It assesses whether BMS manufacturers take a responsible approach to marketing their products using two separate tools:

BMS 1 Corporate Profile assessment: The BMS 1 Corporate Profile methodology is designed to measure the extent to which BMS companies’ marketing policies align to The Code; whether companies have comprehensive, effective procedures and management systems to implement their policies; as well as their level of transparency.

BMS 2 In-country assessments: In-country assessments are designed to measure companies’ compliance with The Code and/or national regulations, whichever is stricter. These assessments cover all forms of marketing, as set out in The Code, by interviewing mothers and healthcare workers, visiting retail stores and online retailers, as well as monitoring traditional and digital media. For the 2018 Global Index, two such studies were undertaken by ATNF. For this Index, the original 2015 edition of the NetCode Protocol was used as it supersedes the IGBM Protocol ATNF used previously. The NetCode Protocol was developed and is supported by the WHO and a wide range of expert organizations including UNICEF, IBFAN, WABA, HKI, Save the Children Foundation and the WHO Collaborating Center at Metropol University. Companies were not informed of the location or timing of these studies prior to their commencement.

Basis for company assessment

As with all elements of the Global Index methodology, this assessment is based on key international guidelines and standards:

  • The International Code of Marketing of Breast-milk Substitutes (The Code).
  • Subsequent World Health Assembly (WHA) resolutions that make significant additions or provide clarifications to the original Code [1]
  • 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).
  • Relevant local regulations in the countries in which ATNF conducts the in-country studies. 

Product scope

The 2018 Global Index assesses whether companies restrict marketing of the following BMS in line with the recommendations of The Code: 

  • Complementary Foods (CF) identified as being suitable for infants up to six months of age.
  • Any type of milk-based formula, including: infant formula (IF) (that can satisfy the normal nutritional requirements of infants up to six months of age); follow-on formula (FOF), also called follow-up formula (for infants from six months of age); and growing-up milk (GUM), also called toddler milk (for young children from 12 to 24 months of age.

BMS 1 also assesses the commitments companies make with respect to feeding bottles and teats, as well as equipment and materials, as defined by The Code or local regulations, although BMS 2 does not. Further, because The Code encompasses products for special medical or dietary use, these products are also assessed in both BMS 1 and BMS 2.

[1] Although the WHA adopted new recommendations in resolution WHA 69.9 in May 2016 which clarify that the scope of The Code extends to formulas for young children up to 36 months of age and include guidance about how CF intended for infants and young children between six and 36 months of age should be marketed, this Index will not assess companies’ compliance with this resolution.

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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