Two survey teams monitored compliance with the code, adopted by the World Health Assembly in 1981 to ensure the proper use of breast milk substitutes. The study involved health facilities, sales outlets, distribution points, and the news media in Togo (a country without legislation on the marketing of breast milk substitutes) and Burkina Faso (which has such legislation).
Violations included no statement on superiority of breastfeeding, no instructions for appropriate preparation or storage, no warning against health hazards of inappropriate use, and pictures, drawings, or text idealising use.
The levels of code violations were similar in both countries. Six (14%) health facilities had received donations of breast milk substitutes. All donations were being given to mothers free of charge. Health providers in five (12%) health facilities had received free samples of breast milk substitutes and promotional gifts from manufacturers.
Promotional materials for commercial breast milk substitutes were found in seven (16%) health facilities. Special displays to market commercial breast milk were found in 29 (44%) sales and distribution points.
Forty commercial breast milk substitutes violated the labelling standards of the code: 21 were manufactured by Danone, 11 by Nestle, and eight by other national and international manufacturers. Most health providers (90%) has never heard of the code, and 63% of mothers had never received any counselling on breast feeding by their health providers.
Governments have an obligation to ensure that legislation is accompanied by effective information, training, and monitoring systems to ensure compliance with the code, say the authors. Manufacturers have an obligation to comply with the standards of the code, they conclude.
Protection of breast feeding from commercial exploitation should be among the highest priorities for the international community, write two paediatricians in an accompanying editorial. They discuss how we should monitor compliance with the code, how we should train health workers, and how we should combine support for breast feeding with a recognition of the risk of maternally transmitted HIV infection.