□ Free supplies to hospitals and to individual health professionals □ Small gifts such as pens, prescription pads, growth charts, calendars,
posters and less expensive medical equipment
□ Large gifts such as incubators, machines, fridges, air conditioners, computers
□ Gifts of professional services such as architectural design of hospitals, organisation of events or legal services
□ Personal gifts such as holiday trips, electrical goods, meals, and entertainment
□ Sponsorship of hospitals, clinics or projects, health worker associations
□ Funding of research grants and salaries
□ Support to attend professional events and for professional associations
□ Financial sponsorship of students and the presence of company representatives in health training establishments, which may include actual teaching in infant feeding courses
□ Sponsorship of conferences, seminars and publications
□ Advertisements in journals and similar publications, 'advertorial' articles that look like information but are advertising
□ Research reports that are really promotional materials
□ Friendly relations that encourage health workers to feel well disposed to the company, sending cards, bringing sweets or other food to the staff at work
□ Close relationships with Ministries of Health and their employees □ Visits by company representatives to doctors in private practice,
health institutions and ministries
Ask: What can you do to help protect babies and their families from marketing practices?
What health workers can do:
• Health workers as individuals and as a group can help to protect infants and their mothers from marketing. They can and should:
- Remove posters that advertise formula, teas, juices or baby cereal, as well as any that advertise bottles and teats and refuse any new posters.
- Refuse to accept free gifts from companies.
- Refuse to allow free samples, gifts, or leaflets to be given to mothers.
- Eliminate antenatal group teaching of formula preparation to pregnant women, particularly if company staff provides the teaching.
- Do individual private teaching of formula use if a baby has a need for it. - Report breaches of the Code (and/or local laws) to the appropriate authorities. - Accept only product information from companies for their own information that is
scientific and factual, not marketing materials.
• Hospitals must abide by the International Code and the subsequent resolutions in order to be recognised as baby-friendly.
4. Donations in emergency situations 5 minutes
• In emergencies the basic resources needed for safe artificial feeding, such as clean water and fuel, are scarce or nonexistent. Attempts at artificial feeding in such situations increase the risk of malnutrition, disease, and death. In addition, young children not breastfed miss its protective effects and are far more vulnerable to infection and illness.
• In emergencies, donations of infant formula, foods and feeding bottles may come from many sources, including well-intentioned but poorly informed small groups or individuals. Media coverage may have led these donors to believe that women cannot breastfeed in the crisis.
• These donations should be refused since they can result in:
- Too much infant formula sent, which may result in babies who do not need formula receiving it, as well as problems with storage and disposal of excess formula and disposal of packaging waste.
- Advertising brands, which mothers may then think are recommended brands. - Donations of out of date or unsuitable formula, making them unsafe to use. • Additional problems can arise:
- No instructions in local languages provided for the formula preparation.
- Bottles and teats included though cup feeding is recommended in emergencies.
Additional dangers of unlimited supplies in emergencies
• If supplies of infant formula are widely available and uncontrolled, there may be spillover. Spillover means that mothers who would otherwise breastfeed lose their confidence and needlessly start to give artificial feeds.
• Infants and their families become dependent on infant formula. If the free supply is unreliable, they are put at risk of malnutrition in addition to the health risks of artificial feeding.
• Large donations may come from companies who, by donating formula to the area in crisis, intend to create a new market for later sale of their products to the emergency-affected population or the host population.
• If donations are unavoidable, they should be used to prepare cooked foods or porridges for older children or others, or be used with a relactation device to relactate or induce
5. How to respond to marketing practices 15 minutes
Class discussion
A company representative visits the nutritionists at a nutritional rehabilitation centre to promote the use of a new, improved infant formula. He says that this formula is especially useful for malnourished babies. He offers to provide enough so that every mother may be given two free tins. If the staff is implementing the Code, how can they respond?
- Write responses on the blackboard or flipchart.
- Key points: Staff should refuse the donation. Breastfeeding should be encouraged for these
babies. Two tins would only feed a baby for a short time. What would happen after the two tins were used up?
Wambui runs a private maternity home. Her friend, Wanjike, works for an infant formula company and offers to give the home posters and leaflets on breast and bottle- feeding, and supplies of formula. What can Wambui say to her friend?
- Write responses on the blackboard or flipchart.
- Key points: Wambui can explain to her friend that breastfeeding is important for the health
of the babies and mothers. Posters and free formula undermine the importance of
breastfeeding. If there are any mothers who do not breastfeed, free formula will only last a short time. These mothers need a discussion with an infant feeding counsellor about sustainable ways to feed their baby. The posters and free formula are not needed.
Sam is training to be a paediatrician. He is very interested in infant nutrition. A formula company offers to fund his travel to a free conference that the company is holding and provide him with accommodation at the conference hotel. If Sam accepts this funding, what might happen?
- Write responses on the blackboard or flipchart.
- Key points: Sam needs to think carefully about accepting this funding. At the conference,
will he hear information that is scientific and factual, or information marketing the company’s products? Will there be ‘gifts’ at the conference of pens, prescription pads, posters and other materials marketing the products from that company? Will Sam refuse to accept these ‘gifts’ or will he bring them back to his workplace? Will the company
representatives come to visit Sam after the conference expecting that he will help them to get their products used in the health facility because they helped him to get to the
conference? Article 7 of the Code states that no financial or material inducement to promote products should be offered to health workers or accepted by them. If funding is provided for a conference, the company should disclose this funding to the health facility where the person is employed and the health worker receiving the funding should also inform their supervisor.