GLOBAL -The World Health Organization (WHO) has released its 2024 status report on the implementation of the International Code of Marketing of Breast-milk Substitutes (BMS), revealing significant gaps and challenges in the adoption and enforcement of the Code’s provisions worldwide.

This report, which updates the status of the Code’s implementation and the extent of its incorporation into national legal measures, underscores the ongoing efforts and hurdles faced by countries in regulating the marketing of BMS to protect breastfeeding.

As of March 2024, 146 WHO Member States, representing 91% of global annual births, have adopted legal measures to implement at least some provisions of the Code.

Among these, 33 countries have measures substantially aligned with the Code, 40 have moderately aligned measures, 73 have included some provisions, and 48 have no legal measures at all.

Timor-Leste enacted Code-related legislation for the first time in 2023, while Burkina Faso, El Salvador, China, and Paraguay have strengthened their legal measures. In contrast, Ukraine has weakened its protections by repealing earlier legal measures related to the Code.

According to the report, only 38 countries cover the full breadth of BMS up to 36 months of age, with an additional 13 countries covering follow-up formula without specifying an age range.

Prohibitions on advertising and promotional devices at points of sale are more common, with 89 and 115 countries, respectively, having such regulations.

However, only 28 countries prohibit the distribution of informational or educational materials from the industry, and 68 countries prohibit nutrition and health claims on labels.

Protections against conflicts of interest in the health system are weak, with only 34 countries prohibiting gifts and incentives to health workers and 22 prohibiting industry sponsorship of health professional meetings.

Among countries with legal measures, only 59% identify the entities responsible for Code monitoring, and only 24% delineate monitoring procedures.

Additionally, 64% define sanctions for violations, but only 18% specify how these sanctions should be determined and levied. Only 17 countries ensure that monitoring and enforcement are independent, transparent, and free from commercial influence.

The report highlights that countries with more detailed monitoring and enforcement provisions in their legislation see higher rates of exclusive breastfeeding.

Specifically, countries with at least three specified provisions for monitoring and enforcement have an average exclusive breastfeeding rate of 53% for infants aged 0-5 months, compared to 27% in countries lacking these provisions.

Since 2022, WHO, UNICEF and civil society partners have intensified efforts to support countries in restricting BMS marketing. Initiatives include the development of educational tools for decision-makers, regional workshops, and the provision of technical legal assistance.

The 2023 Global Congress on Implementation of the Code facilitated further learning and the development of work plans to strengthen legislation, monitoring, and enforcement.

Despite some progress, the WHO report indicates that significant gaps remain in the legal frameworks of many countries, which allow unethical marketing practices to persist.

“Strengthening the implementation and enforcement of the Code is crucial for protecting the health of infants, children, and mothers, and should be prioritized as a public health imperative by all countries.”

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