Law matters – assessment of country-level code implementation and sales of breastmilk substitutes in South Asia
ObjectivesThis study examines the status of implementation of the International Code of Marketing of Breast-milk Substitutes of eight countries in the South Asia region (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka), and describes the sales value and volume of com...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-10-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1176478/full |
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| author | Constance Ching Vani Sethi Tuan Thanh Nguyen Zivai Murira Katherine Shats Dhammica Rowel Khadheeja Ahmed Kinley Dorji Indrani Chakma Karan Courtney Haag Phulgendra Prasad Singh Salma Khatoon Uzma Khurram Bukhari Ahmadwali Aminee Sebanti Ghosh Thomas Forissier Kristen Kappos Paul Zambrano Golam Mohiuddin Khan |
| author_facet | Constance Ching Vani Sethi Tuan Thanh Nguyen Zivai Murira Katherine Shats Dhammica Rowel Khadheeja Ahmed Kinley Dorji Indrani Chakma Karan Courtney Haag Phulgendra Prasad Singh Salma Khatoon Uzma Khurram Bukhari Ahmadwali Aminee Sebanti Ghosh Thomas Forissier Kristen Kappos Paul Zambrano Golam Mohiuddin Khan |
| author_sort | Constance Ching |
| collection | DOAJ |
| description | ObjectivesThis study examines the status of implementation of the International Code of Marketing of Breast-milk Substitutes of eight countries in the South Asia region (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka), and describes the sales value and volume of commercial milk formula (CMF) marketed as breastmilk substitutes (BMS) and baby food in four countries (Bangladesh, India, Pakistan, and Sri Lanka).DesignA mix of descriptive methods is used to assess national status of Code implementation, including a desk review of the 2022 WHO/UNICEF/IBFAN Code Status Report, systematic content analysis of national Code measures, and insights generated from the participation of key government and UNICEF/WHO actors in a regional workshop that aimed to identify each country’s barriers, gaps, and the status of Code implementation. Data on the sales value and volume of CMF and baby food between 2007 to 2021 and with the prediction to 2026 in Bangladesh, India, Pakistan, and Sri Lanka were obtained from Global Data.FindingsThere are major gaps in Code implementation in countries even with legal measures considered substantially aligned with the Code, such as the inadequate age range of CMF covered in the scope, insufficient safeguards against conflicts of interest in the health system, lack of warning of risks of intrinsic contamination of powdered milk formula, and an absence of effective monitoring and enforcement mechanisms. Data on CMF sales shows health facilities and pharmacies sustain the highest sales. Lower sales volume of infant formula (including special formula), compared to other CMF such as follow-up formula and growing-up milk, has been observed in three of the four countries (Bangladesh, India, and Sri Lanka). Overall, GUM, followed by baby cereals, accounted for a large portion of CMF and baby foods sales in the same three countries.Recommended actions include(1) Closing the gaps between national measures and the Code, (2) Ensuring effective monitoring and enforcement mechanisms, (3) Strengthening conflicts of interest safeguards in the health system, (4) Tackling digital marketing, and (5) Galvanizing political support and support from in-country public health and women’s rights jurist networks. |
| first_indexed | 2024-03-11T16:41:53Z |
| format | Article |
| id | doaj.art-06df4ba1f1134c609e43ef78018b313a |
| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-03-11T16:41:53Z |
| publishDate | 2023-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj.art-06df4ba1f1134c609e43ef78018b313a2023-10-23T08:30:01ZengFrontiers Media S.A.Frontiers in Public Health2296-25652023-10-011110.3389/fpubh.2023.11764781176478Law matters – assessment of country-level code implementation and sales of breastmilk substitutes in South AsiaConstance Ching0Vani Sethi1Tuan Thanh Nguyen2Zivai Murira3Katherine Shats4Dhammica Rowel5Khadheeja Ahmed6Kinley Dorji7Indrani Chakma8Karan Courtney Haag9Phulgendra Prasad Singh10Salma Khatoon11Uzma Khurram Bukhari12Ahmadwali Aminee13Sebanti Ghosh14Thomas Forissier15Kristen Kappos16Paul Zambrano17Golam Mohiuddin Khan18Alive & Thrive, Global Nutrition, FHI 360, Hanoi, VietnamUNICEF Regional Office for South Asia, Kathmandu, NepalAlive & Thrive, Global Nutrition, FHI 360, Hanoi, VietnamUNICEF Regional Office for South Asia, Kathmandu, NepalUNICEF Headquarters, New York, NY, United StatesUNICEF Sri Lanka Country Office, Colombo, Sri LankaUNICEF Maldives Country Office, Malé, MaldivesUNICEF Bhutan Country Office, Thimphu, BhutanUNICEF Bhutan Country Office, Thimphu, BhutanUNICEF Nepal Country Office, Kathmandu, NepalUNICEF Nepal Country Office, Kathmandu, NepalUNICEF Field Office for Khyber-Pakhtunkhwa, Peshawar, PakistanUNICEF Field Office for Punjab Field Office, Lahore, Pakistan0UNICEF Office for Afghanistan, Kabul, Afghanistan1Alive & Thrive, Global Nutrition, FHI360, New Delhi, India1Alive & Thrive, Global Nutrition, FHI360, New Delhi, India2Alive & Thrive, Global Nutrition, FHI 360, Washington, DC, United States3Alive & Thrive, Global Nutrition, FHI 360, Manila, Philippines4UNICEF Bangladesh Office, Dhaka, BangladeshObjectivesThis study examines the status of implementation of the International Code of Marketing of Breast-milk Substitutes of eight countries in the South Asia region (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka), and describes the sales value and volume of commercial milk formula (CMF) marketed as breastmilk substitutes (BMS) and baby food in four countries (Bangladesh, India, Pakistan, and Sri Lanka).DesignA mix of descriptive methods is used to assess national status of Code implementation, including a desk review of the 2022 WHO/UNICEF/IBFAN Code Status Report, systematic content analysis of national Code measures, and insights generated from the participation of key government and UNICEF/WHO actors in a regional workshop that aimed to identify each country’s barriers, gaps, and the status of Code implementation. Data on the sales value and volume of CMF and baby food between 2007 to 2021 and with the prediction to 2026 in Bangladesh, India, Pakistan, and Sri Lanka were obtained from Global Data.FindingsThere are major gaps in Code implementation in countries even with legal measures considered substantially aligned with the Code, such as the inadequate age range of CMF covered in the scope, insufficient safeguards against conflicts of interest in the health system, lack of warning of risks of intrinsic contamination of powdered milk formula, and an absence of effective monitoring and enforcement mechanisms. Data on CMF sales shows health facilities and pharmacies sustain the highest sales. Lower sales volume of infant formula (including special formula), compared to other CMF such as follow-up formula and growing-up milk, has been observed in three of the four countries (Bangladesh, India, and Sri Lanka). Overall, GUM, followed by baby cereals, accounted for a large portion of CMF and baby foods sales in the same three countries.Recommended actions include(1) Closing the gaps between national measures and the Code, (2) Ensuring effective monitoring and enforcement mechanisms, (3) Strengthening conflicts of interest safeguards in the health system, (4) Tackling digital marketing, and (5) Galvanizing political support and support from in-country public health and women’s rights jurist networks.https://www.frontiersin.org/articles/10.3389/fpubh.2023.1176478/fullbaby foodsbaby milksbreastmilk substitutescommercial milk formulainappropriate marketinglegal measures |
| spellingShingle | Constance Ching Vani Sethi Tuan Thanh Nguyen Zivai Murira Katherine Shats Dhammica Rowel Khadheeja Ahmed Kinley Dorji Indrani Chakma Karan Courtney Haag Phulgendra Prasad Singh Salma Khatoon Uzma Khurram Bukhari Ahmadwali Aminee Sebanti Ghosh Thomas Forissier Kristen Kappos Paul Zambrano Golam Mohiuddin Khan Law matters – assessment of country-level code implementation and sales of breastmilk substitutes in South Asia Frontiers in Public Health baby foods baby milks breastmilk substitutes commercial milk formula inappropriate marketing legal measures |
| title | Law matters – assessment of country-level code implementation and sales of breastmilk substitutes in South Asia |
| title_full | Law matters – assessment of country-level code implementation and sales of breastmilk substitutes in South Asia |
| title_fullStr | Law matters – assessment of country-level code implementation and sales of breastmilk substitutes in South Asia |
| title_full_unstemmed | Law matters – assessment of country-level code implementation and sales of breastmilk substitutes in South Asia |
| title_short | Law matters – assessment of country-level code implementation and sales of breastmilk substitutes in South Asia |
| title_sort | law matters assessment of country level code implementation and sales of breastmilk substitutes in south asia |
| topic | baby foods baby milks breastmilk substitutes commercial milk formula inappropriate marketing legal measures |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1176478/full |
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