- Regulation, monitoring and enforcement appears to be broadly effective: Local experts noted in consultations prior to this BMS study that the Indian IMS Act is fully aligned with, and in some areas, more demanding than The Code, and that its enforcement by the Indian government was strong. This assessment reinforces that view, at least in the limited area covered by this study (although it may not be the case elsewhere in the city or across India.) Advertising of BMS products monitored appeared to be virtually non-existent in Greater Mumbai on the media assessed. Likewise, no point-of-sale promotions were found in any of the ‘bricks and mortar’ retail establishments visited. Company representatives appear to have little direct contact with women or healthcare workers. There were no incidences of non-compliance found on labels of any products other than one relating to Amulspray and seven relating to parallel imports. This is a credit to the strength of the IMS Act, and to diligent application by healthcare workers and vigilant monitoring by local stakeholders such as BPNI.
- More focus is needed on informational and educational materials: Some printed informational or educational materials were found in healthcare facilities. Companies should ensure that any such materials intended for healthcare workers are not left in common areas.
- Further consideration should be given to wording allowed on product labels: While none of the labels included the specific phrases designed to increase the saleability of products precluded by labeling regulations, many other statements were found on products that seem intended to have this effect.
- Online product promotions are a concern: As Westat noted in its conclusions, three online retailers, of the 12 monitored, offered promotions and price discounts. It is not possible to determine whether these online stores procure the products they sell from the manufacturers directly, or whether they initiate the promotions and discounts themselves, with or without the agreement of the manufacturers. Nevertheless, these findings have been included in the results, logged against each company whose products were being promoted or discounted. How such promotional activity might be curtailed is an area that requires more investigation.
- Marketing websites and online magazines need to be carefully monitored: Various websites aimed at mothers and pregnant women were found to invite mothers to “sign-up” to access information and engage in exchanges with other members. Although Westat did not find any adverts or promotions on such sites, they are, potentially, routes through which brand profile and loyalty could be established which may, in turn, lead to purchases of BMS products.
Insert detailed results
The study also included interviews with women attending the selected healthcare facilities to determine whether they i) recalled seeing adverts or promotions for any BMS products made by particular manufacturers; ii) had been provided with product samples or gifts; iii) any marketing personnel had had contact with them, and; iv) had been advised to use formula and/or a specific product. In total, 61 such instances were identified by Westat. Thirty-three women reported being spoken to by a healthcare worker about using formula, with 23 having been recommended a particular product. It may be beneficial for the Government to remind healthcare workers of their responsibilities under the IMS Act, and when it is and is not appropriate to make product recommendations (i.e. only when an infant has a particular health condition that means it cannot be breastfed).
Similarly, healthcare workers were asked whether: i) any equipment or materials bearing product names had been donated by the companies; ii) they had been offered any material contributions or pecuniary benefits by the companies; iii) any product samples (other than those for professional evaluation or research) or equipment or utensils had been donated to their facilities, and iv) whether company representatives had visited to give product information to healthcare workers. At least one worker at 14 of the 40 facilities (35%) reported that a company representative had visited the facility within the last 6 months. However, none said that the visits were with the intent of talking to women, obtaining their contact information or providing materials to them nor to distribute samples. Twenty-one workers said that the purpose was to give product information to health professionals. These observations are not included in companies’ final scores.
The reasons for not including either type of recall data in the companies’ scores is outlined fully in the Westat report. In short, it is because recall is subjective and can be biased in several ways. The recalled data can, however, be used to corroborate the objective information collected in the study.
BMS chapter is available here and downlaod the Westat report here.