Most countries lack adequate laws to protect and promote breastfeeding – UN

The 2016 status report, Marketing of breast-milk substitutes: National implementation of the International Code, shows that of the 194 countries analyzed, 135 have in place some form of legal measure related to the International Code of Marketing of Breast-Milk Substitutes (the Code) and subsequent, relevant resolutions adopted by the World Health Assembly.

This is up from 103 in 2011, but only 39 countries have laws that enact all provisions of the Code, a slight increase from 37 in 2011.

The report, by the World Health Organization (WHO), UN Children's Fund (UNICEF), and the International Baby Food Action Network (IBFAN) , reveals that among the countries that have any laws on marketing of breast-milk substitutes, just over half sufficiently prohibit advertising and promotion of breast-milk substitutes, including infant formula, feeding bottles and teats.

“It is encouraging to see more countries pass laws to protect and promote breastfeeding, but there are still far too many places where mothers are inundated with incorrect and biased information through advertising and unsubstantiated health claims,” said, Francesco Branca, Director of WHO's Department of Nutrition for Health and Development, in a joint press release.

“This can distort parents' perceptions and undermine their confidence in breastfeeding, with the result that far too many children miss out on its many benefits,” he adds.

WHO and UNICEF recommend that babies are fed nothing but breast milk for their first 6 months, after which they should continue breastfeeding – as well as eating other safe and nutritionally adequate foods – until two years of age or beyond.

The report says that globally, nearly two out of three infants are not exclusively breastfed for the recommended 6 months – a rate that has not improved in two decades. Breast milk is the ideal food for infants. It is safe, clean and contains antibodies which help protect against many common childhood illnesses.

Breastfed children perform better on intelligence tests, are less likely to be overweight or obese and less prone to diabetes later in life. Women who breastfeed have a reduced risk of breast and ovarian cancers. Inappropriate marketing of breast-milk substitutes continues to undermine efforts to improve breastfeeding rates and duration worldwide, the report warns.

In this context, WHO member States have committed to increase the rate of exclusive breastfeeding in the first 6 months of life to at least 50 per cent by 2025 as one of a set of global nutrition targets.

The Code calls on countries to protect breastfeeding by stopping the inappropriate marketing of breast-milk substitutes, including infant formula, feeding bottles and teats. It bans all forms of promotion of substitutes, including advertising, gifts to health workers and distribution of free samples.

Labels must not 'idealize' infant formula

In addition, labels cannot make nutritional and health claims or include images that idealize infant formula. They must include clear instructions on how to use the product and carry messages about the superiority of breastfeeding over formula and the risks of not breastfeeding.

The breast-milk substitute business is a big one, with annual sales amounting to almost $45 billion worldwide. This is projected to rise by over 55 per cent to $70 billion by 2019.

The breast-milk substitutes industry is strong and growing, and so the battle to increase the rate of exclusive breastfeeding around the world is an uphill one—but it is one that is worth the effort

“The breast-milk substitutes industry is strong and growing, and so the battle to increase the rate of exclusive breastfeeding around the world is an uphill one – but it is one that is worth the effort,” says UNICEF Chief of Nutrition Werner Schultink.

“Mothers deserve a chance to get the correct information: that they have readily available the means to protect the health and wellbeing their children. Clever marketing should not be allowed to fudge the truth that there is no equal substitute for a mother's own milk.”

Overall, richer countries lag behind poorer ones. The proportion of countries with comprehensive legislation in line with the Code is highest in the Southeast Asia Region at 36 per cent, followed by Africa at 30 per cent while Europe has the lowest rate at six per cent.

WHO and UNICEF have recently established a Global Network for Monitoring and Support for Implementation of the Code (NetCode) to help strengthen countries' and civil society capacity to monitor and effectively enforce Code laws.

New analyses have revealed that increasing breastfeeding to near-universal levels could save the lives of more than 820,000 children under the age of five and 20,000 women each year. It could also add an estimated $300 billion into the global economy annually, based on improvements in cognitive ability if every infant was breastfed until at least 6 months of age and their expected increased earnings later in life. Boosting breastfeeding rates would significantly reduce costs to families and governments for treatment of childhood illnesses such as pneumonia, diarrhoea and asthma.

Photo: WHO/SEARO/Anuradha Sarup