Introduction
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This report is the compilation of monitoring evidence collected during the year 2000 in 14 countries. The IBFAN Monitoring Project was designed by the International Code Documentation Centre in Malaysia and the LACMAT Foundation in Argentina. Monitoring coordinators received intensive training and did subsequent national training within their groups. Monitors used a new protocol drafted for electronic and digital reporting. They visited maternity wards, clinics and shops in both rural and urban areas. They interviewed hundreds of mothers, doctors, nurses, company representatives and retail managers. Countries were selected on the basis of geographical representation, commercial competition, willingness to increase local capacity for monitoring and potential use of results for national Code advocacy. |
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Participating IBFAN groups were from the following countries: Bolivia, Canada, Côte d’Ivoire, Ghana, Hong Kong, Italy, Malaysia, Mexico, Russia, Togo, the United Arab Emirates, Uruguay and the United States of America. Except for Uruguay, none of the countries had a comprehensive law based on the International Code of Marketing of Breastmilk Substitutes and subsequent Resolutions. One country, Ghana, adopted excellent legislation on 9 May 2000. Italy has enacted the European Union Directive based on the Code but monitoring shows this is not far-reaching or effective enough. The aim of the IBFAN Monitoring Project is to show in which ways the Code continues to be violated. It was not designed to obtain statistical information nor was it meant to provide a comprehensive “grading” of each company. In fact, the relatively narrow base of survey countries means that the overall performance of manufacturers may be under-rated, rather than over-rated. Some companies, Dumex, Humana, Snow and Meiji only market in one or two of the selected countries and thus may have received a better rating than if it had been possible to check their performance in 30 or 60 countries. All data were reviewed, first, by the national coordinators and then by ICDC. Entries not sufficiently substantiated by evidence or corroborating facts were rejected. All efforts were made to verify the accuracy of this report but any errors remain the responsibility of the editors. |
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Background Scientific evidence from hundreds of studies over the past twenty years confirms that breastfeeding including exclusive breastfeeding during the first six months is the optimal way to nourish and nurture infants. Breastmilk contains all the essential nutrients as well as antibodies that counter infection. No infant formula made of cow’s milk, soy or other ingredients can equal its advantages. Human milk decreases risks for a large number of acute and chronic diseases including diarrhoea and respiratory infection. Breastfeeding provides all necessary nutrients and liquids for six months, it supplies half the baby’s nutritional requirements between six and 12 months and up to one third between 12 and 24 months. It helps mothers to space births, stimulates the baby’s intellectual development, is always at the right temperature, clean, free and available in just the amount the baby needs. The amount of breastmilk increases if a mother feeds her baby more frequently; it decreases if formula or other foods are given. For the mother, breastfeeding provides reduced risk of ovarian and pre-menopausal cancer and unequalled bonding with her child. Even in the most affluent conditions, where water is clean and mothers are highly educated, an artificially fed infant is more likely to suffer from respiratory illnesses, gastrointestinal infections, and allergies. The risk of contracting the HIV virus through breastfeeding exists but is often exaggerated. It is about 15%, one in seven, if the infant is breastfed by a mother infected by HIV. In a population with a relatively high HIV prevalence of 20 % among pregnant women, if one hundred breastfeed, about three infants will get HIV through breastfeeding, and ninety-seven will not. Exclusive breastfeeding is known to provide some protection while the worst option is mixed feeding: breast and bottle. In much of the developing world the risk of death for infants who are not breastfed is almost six times greater in the first two months and four times greater between two and four months, than for babies who are breastfed. (Ref.: WHO Collaborative Study, The Lancet 2000; 355:451-55]) The Code is more necessary than ever in areas of high HIV prevalence because it helps mothers to get the objective information they need to make choices about infant feeding, while protecting all mothers as well as all health professionals from promotion of artificial feeding. |
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Violations
by Company
The data about violations are summarised
under the relevant Code provisions. The pictures used represent a fraction
of what was reported. They are marked with the word VIOLATION in order
to reduce their potential promotional effect. Stretching the Rules reports
on products and practices which are not covered by the Code or subsequent
resolutions but which undermine breastfeeding all the same. Violations
from non-database countries are reported in a separate section. At the
end of each company report, there is a score card showing its
overall compliance rating.
On the next two pages is a summary of the Code and relevant Resolutions. The text of the full Code and these Resolutions can be found in http://www.ibfan.org/English/resource/who/fullcode.html |