Since 1981, the World Health Organization (WHO) has called on countries, health systems and manufacturers to implement the International Code of Marketing of Breast-Milk Substitutes as part of an effort to promote and support breastfeeding around the world. The Code protects infants and young children by laying out a set of restrictions on the marketing activities of breast-milk substitute (BMS) companies. The latest Access to Nutrition Index found that while BMS companies are enacting stronger corporate policies that more closely align with the Code, they are not always putting those policies into practice on the ground.
It is well established that exclusive breastfeeding for the first six months of life gives babies the best possible start. Optimal breastfeeding practices could prevent over 820,000 child deaths around the world, and have been proven to strengthen babies’ immune systems, improve brain development and contribute to increased earnings later in life. Despite the proven benefits, global breastfeeding rates continue to lag – a particularly concerning issue in countries with high rates of child mortality and malnutrition.
Evidence shows that breastfeeding is undermined when companies use inappropriate marketing tactics to promote infant formula, such as providing free samples in hospital discharge packs. The 2018 Global Access to Nutrition Index (ATNI) evaluated the marketing practices of six major baby-food companies – Danone, Nestle, Abbott, FrieslandCampina, RB/Mead Johnson and Kraft Heinz – who own over 50 percent of the global market of breast-milk substitutes. The Index scored companies in two ways: first, by looking at their policies, management systems and transparency; second, by assessing their practices in two high-risk countries based on child mortality and malnutrition rates.
What’s striking about this year’s report is that while all scores remain low, most companies made significant improvements to their “corporate profile” scores. Five out of the six companies improved their corporate profile scores since the 2016 Global Index, indicating that they are making efforts to align their BMS marketing policies with the Code and subsequent World Health Assembly (WHA) resolutions.
However, their scores – ranging from 0-60 percent – indicate two critical issues: First, companies’ policy commitments vary considerably; and second, not a single company has adopted policies and systems that align fully with the Code.
Many countries have adopted the Code as national law, but to varying degrees. While 135 countries have some form of legal measure covering parts of the Code, only 39 countries have comprehensive legislation or other legal measures that reflect all or most of the provisions of Code. Even fewer countries have mechanisms in place to effectively monitor compliance with the Code.
With such a range of national laws and regulations in place – and varying levels of monitoring and enforcement across countries – BMS companies carry a significant responsibility to abide by the Code. The Index shows that despite the notable policy improvements captured in this year’s report, companies appear to be picking and choosing which policies to apply and where. For example, not all companies pledge to follow their own policies in countries with no regulations or weaker ones. Essentially, companies are exploiting the vast differences in national laws and regulations by applying different standards to different countries.
This year’s report included assessments of companies’ activities in two high-risk countries: Thailand and Nigeria. In Thailand, the Access to Nutrition Foundation (ATNF) found over 3,000 violations of the Code in terms of product promotion, while roughly 150 were found in Nigeria. At the time of the study, Nigeria had a stronger regulation in place than Thailand – potentially contributing to the lower number of violations. Companies scored far lower in this assessment than they did in their corporate profile scores, further illustrating the persistent gap between policy and practice.
ATNF’s evaluation of companies’ policies and in-country practices shows just how disparate they have become. Helen Keller International’s Assessment & Research on Child Feeding (ARCH) project has found this to be true in countries where we have conducted research on the availability, promotion and consumption of commercial infant foods. In Cambodia, for example, ARCH found that 86 percent of mothers reported seeing a promotion for breast-milk substitutes despite strong legislation on the marketing of breast-milk substitutes.
Our research, along with ATNF’s latest report and others, demonstrates that the inappropriate marketing of breast-milk substitutes is pervasive, and that both companies and countries must work to keep it in check. In countries where strong regulations don’t exist, companies have an even greater responsibility to act according to the provisions of the Code. And, if more countries passed stronger regulations supported by rigorous monitoring and enforcement, then perhaps more companies would adhere to the very policies they have pledged to follow.
In addition to assessing BMS companies, ATNF also evaluated and ranked the world’s largest food and beverage manufacturers on their nutrition-related commitments, practices and performance globally. While companies have taken steps to improve their commitment to nutrition, their overall average score remains low – averaging 3.3 out of 10. Taking both their evaluation of food and beverage companies as well as BMS companies together, a simple conclusion can be drawn: The private sector must do more.
The views expressed in this article belong to the author and do not necessarily reflect the editorial policy of Malnutrition Deeply.