Evidence of Violations of the International Code of Marketing of Breast-Milk Substitutes since the Adoption by the World Health Assembly in 1981: A Systematic Scoping Review Protocol

Abstract

This is the protocol for a scoping review that aims to systematically explore and summarise the published evidence of violations of the International Code of Marketing of Breast-milk Substitutes (the Code) and subsequent World Health Assembly Resolutions globally. The planned scoping review will seek to identify what research has been conducted on the topic, examine the geographic spread and nature of violations, and summarise knowledge gaps. The Code was adopted in 1981 by the World Health Assembly to protect infant health, in particular from aggressive and inappropriate marketing of breastmilk substitutes including formula and related products. Non-compliance with the Code or violations are described in reports, however, no existing systematic review of the global research appears to have been conducted that encompasses the varied disciplines including health, economics, and gender. The review will inform international and national decision-makers on the nature of violations and potentially highlight the need for new modalities to regulate this marketing. The proposed scoping review will use the six-step process of Arksey and O’Malley which includes defining the research question; identifying the relevant literature; selecting studies; charting the data; collating, summarising and reporting the findings; and will include a consultative group.

Global evidence of persistent violations of the International Code of Marketing of Breast‐milk Substitutes: A systematic scoping review

“…Marketing of pacifiers was documented in countries where they are covered by the national law, such as Brazil (Bartolini et al, 2009; Lima, 2019; Lopes & Pereira, 2013; Rodrigues et al, 2021) and Vietnam (Durako et al, 2016). Marketing of CMF‐PW can be a channel for cross‐promotion to circumvent the Code (Nguyen et al, 2021; Zhao et al, 2019). Pacifiers and commercial milk formulas for mothers should be included in future guidance on the Code and countries should be encouraged to implement measures to restrict cross‐promotion through the marketing of these products.…”

“…11) and is reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta‐Analysis (PRISMA) extension for Scoping Reviews (Tricco et al, 2018). The six‐step process of Arksey and O'Malley (Arksey & O'Malley, 2005) formed the framework and a protocol was published (Becker et al, 2021). The overall research question was identified as: What is the published evidence of exposure to violations of the International Code of Marketing of Breast‐milk Substitutes ?…”

“…In a study in Ecuador, more than half of the BMS labels contained texts or images that idealized their use (Caicedo-Borrás et al, 2021). Promotion via nutrition and health claims was reported in 66 studies, including statements making claims to benefit child health and development from Cambodia and Nepal (Champeny et al, 2019) and from a multi-country study in Europe (Austria, Bulgaria, Hungary, and Israel; WHO Regional Office for Europe, 2019a), to help with digestion, support for cognitive development and aid to the immune system in an Australian study (Berry & Gribble, 2017).…”

Methodologies for Monitoring the Digital Marketing of Foods and Beverages Aimed at Infants, Children, and Adolescents (ICA): A Scoping Review

“…According to the Code, BMS are all foods and beverages marketed for feeding infants and young children up to three years of age, including infant and follow-up formula, other milk products, bottle-feed complementary foods, feeding bottles, and teats. Since then, the WHA has adopted several subsequent relevant resolutions to clarify and strengthen aspects of the Code [ 10 ]. Up to March 2022, 144 (74.2%) of 194 WHO Member States have adopted legal measures to regulate BMS marketing aligned with the Code [ 11 ].…”