High Rates of International Code Violations: A Cross Sectional Study in one Region of Canada with Low Breastfeeding Rates

Abstract

Background Exposure to marketing and promotion of commercial milk formula is associated with an increased likelihood of formula-feeding. In 1981, the International Code (IC) of Marketing of Breastmilk Substitutes was adopted by the 34th World Health Assembly (WHA) to restrict the promotion, marketing and advertising of commercial milk formulas and to protect breastfeeding. The aim of the current study is to examine mothers’ exposure to violations of the IC in a province of Canada with low breastfeeding rates. Methods A cross-sectional study of 119 participants completed an online survey including questions on IC violations related to marketing, advertising and promotion of commercial milk formula. Data were collected on type, frequency, and location of violation. Results The majority of participants (87.4%, n = 104/119) reported being exposed to at least one IC violation (95% CI 0.82, 0.93). Of the exposed group (n = 104): 94.2% of participants reported receiving coupons or discount codes for the purchase of commercial milk formula; 88.3% reported receiving free samples of commercial milk formula directly from infant formula manufacturers while 78.8% were directly contacted for advertising purposes by infant formula companies via email, text message, mail or phone. Almost one-third (n = 28/104, 27.2%) reported seeing commercial milk formula promotional materials in health care facilities. Doctors’ offices, supermarkets, and pharmacies were the most common place to view branding (79%, 75%, and 71%, respectively). Conclusion Most study participants were exposed to marketing of commercial milk formula. The most frequent violations provide evidence infant formula companies target and directly contact new mothers to provide unsolicited promotions and free samples of commercial milk formula.