Violations of the International Code of Marketing of Breast-milk Substitutes: Indonesia context

Abstract
Objectives: To measure compliance with the International Code of Marketing of Breast-milk Substitutes ('the Code') in Indonesia.

Design: The study was a cross-sectional survey using the Interagency Group on Breastfeeding Monitoring protocol.

Setting: Public and private health facilities in six provinces on Java island in Indonesia.

Subjects: A total of 874 women (382 pregnant women and 492 breast-feeding mothers of infants below 6 months) and seventy-seven health workers were recruited from eighteen participating health facilities. The study also analysed a total of forty-four labels of breast-milk substitute products, twenty-seven television commercials for growing-up milk (for children >12 months) of nine brands and thirty-four print advertisements of fourteen brands.

Results: The study found that 20 % of the women had received advice and information on the use of breast-milk substitutes and 72 % had seen promotional materials for breast-milk substitutes. About 15 % reported receiving free samples and 16 % received gifts. Nearly a quarter of the health workers confirmed receiving visits from representatives of breast-milk substitute companies. Two health workers reported having received gifts from the companies. The most common labelling violations found were statements or visuals that discouraged breast-feeding and the absence of mention about the consideration of local climate in the expiration date.

Conclusions: Violations of the Code by health workers, breast-milk substitute companies and their representatives were found in all provinces studied. A regular monitoring system should be in place to ensure improved compliance with and enforcement of the Code.