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2.2 Marketing - the role of the International Code

The evidence is strong. Formula milk marketing, not the product itself, disrupts informed decision-making and undermines breastfeeding and child health. All sectors of governments, including health, labour and trade, health professionals and their associations, investors and those with economic leverage should fulfil their responsibilities and exert their influence to insist on practices that prioritize children and families over commercial interests.

Products covered by the International Code

Despite its importance, the International Code is often misunderstood by the public, health care workers, and even policymakers. The Code concerns itself with the protection of all infants, by eliminating inappropriate commercial influences and requiring high-quality, appropriate products that are labelled for safer use by the consumer. It protects the public and the health care workers.

Products covered by the Code:
• breastmilk substitutes, including infant formula
• other milk products, foods (cereals), and beverages (teas and juices for babies), when marketed or otherwise represented to be suitable for use as a partial or total replacement of human milk up to 36 months of age.
• feeding bottles and teats/artificial nipples, as well as pacifiers ("dummies")

The Code remains as relevant today as it was 40 years ago. In recent years, some marketers of baby foods exploited the COVID-19 pandemic to promote their products by invoking unfounded fears that breastfeeding could transmit COVID-19. WHO and UNICEF guidance is clear: mothers suspected or known to have COVID-19 should continue breastfeeding.

Note the Code violations

Note the Code violations.
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Code Violations

In the images above can you find the Code violations? Look below and you will see.


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Key provisions related to the Code

Key provisions related to The Code

Key provisions related to The Code.
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David Clark discusses the Code and its importance.
© Alive and Thrive

Products covered by the Code must have accurate, clear labelling for use and preparation, without any idealizing imagery or health claims. They must also indicate that breastfeeding is the ideal way to feed an infant.

Country with Code labels in law

Country with Code labels in law.
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Country without Code labels in law

Country without Code labels in law.
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Within health facilities, there should be no distribution of product samples or marketing materials distributed to staff or the public. Necessary products purchased for use within the facility must be purchased at market prices, with donations strictly prohibited.

Case Study

A colleague tells you that the local formula sales rep has a solution for your prenatal breastfeeding class: he has dropped off branded backpacks for each family that include coupons and very helpful information leaflets. Such a gift would likely much improve attendance at your classes. What would you do?

Consider:

  • What impact could these gifts have on your students?
  • What impact could accepting these gifts have on you as a health worker?
  • What policies might apply to this situation?
  • Where could you go for more guidance?

Health care workers and the Code

Health care workers as individuals also have responsibilities under the Code, which include ensuring that parents receive accurate, evidence-based information about breastfeeding and that parents who are breastfeeding receive individual instruction on the use of infant formula and bottles as well as avoiding any conflicts of interest with companies that are covered by the Code.

Marketing is NOT education

Manufacturers and distributors of products covered by the Code should not provide or sponsor education or training to health care providers or the public.

This is a Conflict of Interest!!!

This is a Conflict of Interest!!!

Did you know…?

The value of a gift has little impact on whether it influences the recipient. In fact, some research shows that gifts with a low value, such as pens or chocolates, are more effective at influencing future behaviour than high-value gifts. Gifts from manufacturers and distributors are always marketing and always create conflicts of interest when given to health care providers.

Identify three ways in which the parent entering this room might be harmed because the facility and/or health care provider are not following the Code.


© Michelle Pensa Branco

Health care facilities and individual health care providers have a responsibility to protect the patients that they serve and avoid conflicts of interests that may unduly influence or undermine patient trust in them.

Tip

Ensure that there is a staff member assigned to regularly 'audit' both patient and staff areas for prohibited materials (ie: company coupons, branded resources, product samples) and positive images of breastfeeding and healthy IYCF practices.

Professional and voluntary service organizations should also have specific policies to protect their members and the public from undue influence.

Case Study

You are a pediatrician. You receive a mailing at your office from your national pediatric association. Inside is this flyer.


© Health e-Learning-IIHL

  • Is this kind of contact permissible under the Code?
  • How could this event influence the care and trust of patients?
  • What steps could you take?

What should I remember?

  • The Code is an international document that is implemented through national, local, and organizational regulations and policies: it includes the provisions of the 1981 WHA resolutions and subsequent relevant WHA resolutions.
  • The Code applies to marketing, broadly defined: it does not prevent the manufacture or sale of products.
  • Which products are covered and what your responsibilities are as a healthcare worker or administrator.
  • Failing to meet your obligations as a health care provider can harm the families you are caring for.

If you would like to know more about Code Monitoring (optional)