Law matters - assessment of country-level code implementation and sales of breastmilk substitutes in South Asia.

This 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). A 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. There 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. (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.

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Copyright © 2023 Ching, Sethi, Nguyen, Murira, Shats, Rowel, Ahmed, Dorji, Chakma, Haag, Singh, Khatoon, Bukhari, Aminee, Ghosh, Forissier, Kappos, Zambrano and Khan.

Déclaration de conflit d'intérêts

4.1.8.Conflicts of interest within the health system and government, such as industry sponsorship of health programs and industry’s participation in policymaking and monitoring, can impede the adoption of strong laws and proper enforcement. This study reveals two main problems. Firstly, for some countries, their law specifies that financial or material inducements are not allowed only if they are used for promoting products covered in the law. This creates situations where financial or materials inducements could arguably be allowed so long as they are not explicitly specified with a purpose to promote designated products. Secondly, the definition of conflicts of interest may not be clear, allowing room for companies to establish ambiguous ‘partnerships’ or ‘corporate social responsibility’ campaigns that are fraught with conflicts of interest. The 2016 WHO Guidance reinforces with clearer conflicts of interest safeguards within the health systems.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.