In this, International Breastfeeding week (August 1 – 7th) 2017, the Access to Nutrition Foundation calls on makers of infant formulas and complementary foods to protect and encourage breastfeeding by committing to comply fully with The International Code of Marketing of Breast-milk Substitutes (the Code) in all countries in which they sell their products. In so doing - restricting their marketing as recommended by The Code - companies can help to give babies the best start in life while also contributing to infants’ and mothers’ health over their lifetimes.
The Access to Nutrition Index (ATNI) is founded on the premise that food and beverage manufacturers can and should make a strong contribution to addressing poor nutrition and diet-related diseases around the world. Those companies that make breast-milk substitutes (BMS) have a particular responsibility to ensure that their marketing practices do not undermine breastfeeding.
Why is breastfeeding critical to health?
According to a comprehensive global study published in The Lancet in 2016, if breastfeeding were scaled up to a near universal level, the lives of 823,000 children under 5 could be saved each year worldwide, along with 20,000 deaths or mothers. These levels of breastfeeding would also generate economic savings of US$300 billion. Currently, only 38% of all babies around the world are breastfed exclusively for the first 6 months.
The Lancet’s BREASTFEEDING SERIES found that breastfeeding results in fewer infections, increased intelligence, probable protection against overweight and diabetes, and cancer prevention for mothers.
How should infants and young children be fed?
The World Health Organisation (WHO) recommends that to achieve optimal growth, development and health, babies everywhere are breastfed exclusively for the first six months, at which point safe, appropriate complementary foods should be introduced to meet their evolving nutritional requirements. The code specifically notes that complementary foods should not be used as breast-milk substitutes (BMS), and infants and young children should continue to be breastfed until they are two or older. WHO has a target of increasing the rate of exclusive breastfeeding in the first six months to 50% by 2025.
The International Code of Marketing of Breast-milk Substitutes (The Code) was adopted in 1981. It is a non-binding instrument that sets out ‘a recommended basis for action’ for Member States to regulate and monitor the marketing of breast-milk substitutes. Several WHO Member Health Assembly (WHA) resolutions have subsequently been passed that augment The Code, clarifying and/or extending its scope and application. The Code’s articles relate in some cases to governments, in some cases to BMS manufacturers and in some cases to healthcare systems, workers and others.
To give legal effect to The Code, countries need to enact laws and regulations. However, even in the absence of such instruments, BMS manufacturers should follow The Code so as not to undermine breastfeeding and ensure that give babies get the best start in life.
What are the current levels of breastfeeding around the world?
Breastfeeding is one of the few health-positive behaviors more common in poor countries than rich ones. In low-income countries, most infants are still breastfed at 1 year, compared with less than 20% in many high-income countries and less than 1% in the UK (the LANCET). Rates of breastfeeding are low due to a wide range of factors that combine to make it very difficult for mothers to breastfeed, particularly when they return to work. These low rates cannot be passed off as individuals’ choice and responsibility - the promotion of breastfeeding is a collective societal responsibility and requires a set of coherent policies and practices among employers and across society.
How does the Access to Nutrition Foundation assess BMS companies’ marketing policies and practices?
The Access to Nutrition Indexes, published by ATNF, look at what the world’s largest food and beverage companies do to contribute to good diets and optimal nutrition ‘in the round’ – for all consumers, and in relation both to preventing and addressing obesity as well as undernutrition.
Nutrition during the first 1000 days (from conception to 3 years old) is proven to be absolutely critical for the health of babies and mothers over their lifetime. How BMS companies market those products is very important, because marketing can affect a mothers’ choice not to breastfeed. For example, so as not to interfere with health care professionals’ ability to provide mothers with the best information regarding the nutrition and health of their infants, BMS companies must not use health care professionals and facilities as marketing channels to promote their products.
Baby foods (a category which encompasses both formulas and weaning foods and drinks) is the fastest growing food and beverage segment, with an annual growth rate of 7.8%. Revenues in 2014 had already reached US$50 billion globally. The return on advertising spent across all media is highest for baby foods compared to any other product category (Nielsen Catalina Solutions study, 2016). However, a key question is whether this growth based in large part on marketing practices that undermine breastfeeding and thereby undermine babies’ and mothers’ health? Many health advocates and nutrition experts believe this is the case.
ATNF aims to provide stakeholders with a tool by which to hold BMS companies accountable for their impact on consumers’ nutrition, diets and health and with which to encourage them to improve their practices. In the Global and Spotlight (country-specific) Indexes, BMS manufacturers are assessed on whether their BMS policies align with The Code and their actual marketing practices in key markets.
ATNF’s BMS assessment for the 2016 Global Index found that the performance of all six major BMS producers fell well short of the WHO’s recommendations on marketing. (see ranking below)
India is an example of a country with strict regulations around marketing breast-milk substitutes that align with – and in some cases go beyond - The Code. In a 2016 study for the India Spotlight Index, ATNF found that these regulations appeared to be effective at curtailing BMS marketing, as it found relatively high levels of compliance by BMS companies compared to similar previous ATNF studies in Vietnam and Indonesia in 2015 where marketing regulations are not as strict.
For the forthcoming 2018 Global Index, ATNF will again undertake its BMS assessments. For the sake of children’s and mothers’ health everywhere, we hope that BMS companies’ marketing practices will be found to be increasingly aligned with the recommendations of The Code and WHA resolutions.
All reports regarding breast-milk substitutes and the methodologies used in the Indexes are published on our website www.accesstonutrition.org :
The Access to Nutrition Index rates food and beverage manufacturers´ nutrition-related policies, practices and disclosures worldwide on a recurring basis.
Access to Nutrition Foundation
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