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Violations of the International Code of Marketing of Breastmilk Substitutes (WHO Code) in two Ecuadorian cities

Abstract:

Objective: The aim of this study was to estimate the prevalence of violations of the International Code of Marketing of Breastmilk Substitutes (World Health Organization [WHO] Code) in Ecuador's two main cities, Quito and Guayaquil. Methods: The WHO Net Code Protocol was applied. It examines compliance with the WHO Code by: (1) Interviews with health professionals and mothers of children <24 mo in randomly selected health facilities (HFs); (2) Surveillance of breastmilk substitutes (BMS) points of sale (POS); (3) Assessment of BMS labels; and (4) Mass media monitoring. Results: Most HFs were contacted by BMS company representatives. BMS promotional materials were found in one of every four HFs. Almost 50% of health personnel knew about the WHO Code. At least 48.5% of mothers received advice on feeding their children BMS. The varied advice came from several sources. Of POS, 68% failed to comply with the WHO Code in several ways (e.g., giving gifts, promotional packaging, and informational materials) and by reducing the price of BMS. More than half of the BMS labels contained texts or images that idealized their use. More than $1 million of BMS advertising expenses were identified in the media. Conclusion: The fact that the WHO Code was violated many times in Quito and Guayaquil strengthens the need for regulatory mechanisms and for the promotion of breastfeeding by multiple sectors.