Basic Info
What is the official name of the Code?
International Code of Marketing of Breast-milk Substitutes
What is one reason that the Baby-Friendly Initiative includes compliance with the Code and subsequent WHA Resolutions?
- Way to protect, promote and support breastfeeding and reduce the inappropriate marketing of products that compete with breastfeeding
- Provides guidelines for health care facilities and health care providers to help them avoid promoting products covered by the Code
- Helps to create an environment that enables mothers/families to make infant feeding decisions based on impartial information and free of commercial influences
What information does the Code allow manufacturers and distributors of infant formula to share with health care providers?
Information that is scientific and factual about their products
Why is the Code important for mothers, families and babies?
Aggressive and predatory marketing by manufacturers and distributors of products covered by the Code can greatly influence the decisions made by mothers and families. Mothers and families need factual and impartial information to make informed decisions.
What is a potential problem when the sales rep for infant formula wants to speak to staff working with perinatal families about a new infant formula?
- Manufacturers and distributors of products covered by the Code like to form alliances with health care providers because health care providers can increase company profits through product endorsement
- The sales rep could use the opportunity to later advertise that the product is supported by staff and used by the facility
What is the purpose of the Code?
The Code provides recommendations to regulate the marketing of breast-milk substitutes, feeding bottles and teats and promotes optimal nutrition for infants by protecting breastfeeding and ensuring the proper use of breast-milk substitutes when they are necessary
Describe one reason why it is important for facilities to purchase all products covered by the Code in the same manner as other pharmaceuticals and food.
- Obtaining infant formula through normal procurement channels makes it less likely that the product will be promoted
- Reduces the risk of companies providing incentives and using other strategies to promote their product and health care providers feeling a sense of indebtedness and conveying a preference for the company/product to patients/clients and the public
Name an infant feeding product not covered by the Code.
Nipple creams, nursing pillows, breast pumps, nursing bras, infant feeding cups etc.
Describe one reason why it is important for representatives of companies covered by the Code to not have access to mothers and families utilizing the services of the health care facility.
- Protection from aggressive, targeted marketing and product promotion
- Company representatives could collect information from mothers and families and contact them later
One of your patients/clients asks why the specific formula used by the facility is the best. How do you respond?
Explain that the facility has a contract with the company because the company won the bid and that is the reason for the particular formula being used. Clarify that the formula is not necessarily the best and provide general information about infant formula and how all infant formula must meet requirements regarding nutrient levels and safety determined by Health Canada.
Name two products covered by the Code.
1. Infant formula including follow-up formulas
2. Any food or beverage promoted to be fed to infants aged 6 months or younger
3. Feeding bottles and teats
Why is it important for a health care facility to not use posters, crib cards, measuring tapes or other materials with the name, logo or other reference to any product under the scope of the Code?
- Form of promotion of the company and their products
- Mothers, families and the public could interpret it to mean endorsement of the company or product by the health care facility
What is the problem with giving free samples or coupons for products covered by the Code to expectant and postnatal women and families?
- Free samples and coupons lead to more babies being fed formula
- Free samples and coupons show endorsement of the product by the health care provider
- The free sample or coupon may not be for the product best suited for the baby who is receiving formula for a medical reason or whose parent has decided to feed infant formula
A mother/birthing parent confides that finances are tight and there is insufficient money to buy the needed amount of formula for the week. The mother/birthing parent asks if you could give them some free samples of formula to help them out. How do you respond?
- No distribution of free samples or coupons for infant formula from the health care facility
- Referral to an appropriate source of support such as social worker
- Contact information for area food bank
A company that sells products covered by the Code provides health care providers who care for perinatal families with model breasts to use when teaching mothers/birthing parents about hand expression. What are the concerns associated with this?
Material inducement (gift) from company could result in health care provider feeling a sense of goodwill toward the company and this could lead to recommendation of the company's products to mothers and families
Has the Code been updated since it was released in 1981?
The Code has not been rewritten but there have been World Health Assembly Resolutions over the years to address gaps and make the scope of the Code more precise. eg. WHA 39.28 clarifies that maternity wards should purchase breastmilk substitutes through normal distribution channels and not receive free or subsidized supplies from companies.
Why is it important for health care facilities to not openly display products such as infant formula, bottles and artificial nipples?
- Promotion of products covered by the Code undermines breastfeeding
- Infant formula, bottles and other products covered by the Code are not needed by most mothers/families and education about them should be done on an individual basis when these products are needed
A company that makes products covered by the Code asks you how they can become Code compliant. If you agree to assist them, is this a violation of the Code?
It is not a Code violation to provide companies covered by the Code with information to help them become Code compliant
Describe one potential problem when a mother/birthing parent joins an online baby club run by a manufacturer of infant formula.
- The manufacturer has contact information for the mother and could send her promotional materials such as discount coupons for infant formula
- Information provided by the baby club may not be entirely evidence based and may undermine breastfeeding by making it sound difficult, tiring, interfering with personal freedom etc.
You are teaching a prenatal class and one of the expectant mothers/birthing parents asks you about formula feeding. The partner of another expectant mother adds that he wants to help with feedings and would like to know about formula and how much to feed a new baby. How do you respond?
- Education about the risks of formula and informed decision making about the use of formula can be provided in group settings
- Some content such as infant stomach size and importance of responsive, cue-based feeding is applicable for breastfed, mixed fed and formula fed babies
- Education about the safe preparation, use and storage of infant formula needs to be done 1:1. Prenatal educator could make arrangements for private consultation after class or at another time.
Describe two topics covered by the Code.
- Information and education on infant feeding
- Promotion of breast-milk substitutes and related products to the general public and mothers/families
- Promotion of breast-milk substitutes and related products to health care providers and in health settings
- Labelling and quality of breast-milk substitutes and related products
- Implementation and monitoring of the Code.
Describe one concern with accepting funds from manufacturers or distributors of products covered by the Code to help offset the costs of staff education?
-Conflict of interest
-Staff may feel indebted to the manufacturer or distributor and promote their products with families
Why are health care providers and health care facilities often targeted by companies and distributors of products that fall under the scope of the Code?
- Health care workers and health care facilities have easy access to prenatal and postnatal families and can encourage use of company products
- Health care workers and health care facilities are usually highly trusted by the public
What is one of the most recent and effective ways companies that manufacture or distribute products covered by the Code use to reach their target audience?
Digital marketing via social media platforms, influencer marketing, search engine marketing, email marketing etc. are being increasingly used by companies that manufacture or distribute products covered by the Code. This method of advertising has been found to have global reach, cost less, and have increased engagement. Companies can use a wide range of smart tools to collect lots of data and make in-depth analyses about their target audience. This makes the marketing increasingly effective.
You are asked to speak about breastfeeding at a conference about infant nutrition. One of the major sponsors is the maker of infant formula and the list of exhibitors includes a few companies that make products covered by the Code. Should you accept this speaking engagement? What are some of the factors to consider?
- Conflict of interest/ethical considerations
- Risk of being used in advertising about the conference and being viewed as a healthcare professional that endorses products and practices of the companies covered by the Code
- Have concerns with sponsorship been shared with event organizers? If so, what was their response?