Alive & Thrive, Global Nutrition, FHI 360, Hanoi, Vietnam.
UNICEF Regional Office for South Asia, Kathmandu, Nepal.
Front Public Health. 2023 Oct 23;11:1176478. doi: 10.3389/fpubh.2023.1176478. eCollection 2023.
This study examines the status of implementation of the International Code of Marketing of Breast-milk Substitutes of eight countries in the South Asia region (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka), and describes the sales value and volume of commercial milk formula (CMF) marketed as breastmilk substitutes (BMS) and baby food in four countries (Bangladesh, India, Pakistan, and Sri Lanka).
A mix of descriptive methods is used to assess national status of Code implementation, including a desk review of the 2022 WHO/UNICEF/IBFAN Code Status Report, systematic content analysis of national Code measures, and insights generated from the participation of key government and UNICEF/WHO actors in a regional workshop that aimed to identify each country's barriers, gaps, and the status of Code implementation. Data on the sales value and volume of CMF and baby food between 2007 to 2021 and with the prediction to 2026 in Bangladesh, India, Pakistan, and Sri Lanka were obtained from Global Data.
There are major gaps in Code implementation in countries even with legal measures considered substantially aligned with the Code, such as the inadequate age range of CMF covered in the scope, insufficient safeguards against conflicts of interest in the health system, lack of warning of risks of intrinsic contamination of powdered milk formula, and an absence of effective monitoring and enforcement mechanisms. Data on CMF sales shows health facilities and pharmacies sustain the highest sales. Lower sales volume of infant formula (including special formula), compared to other CMF such as follow-up formula and growing-up milk, has been observed in three of the four countries (Bangladesh, India, and Sri Lanka). Overall, GUM, followed by baby cereals, accounted for a large portion of CMF and baby foods sales in the same three countries.
(1) Closing the gaps between national measures and the Code, (2) Ensuring effective monitoring and enforcement mechanisms, (3) Strengthening conflicts of interest safeguards in the health system, (4) Tackling digital marketing, and (5) Galvanizing political support and support from in-country public health and women's rights jurist networks.
本研究考察了南亚地区 8 个国家（阿富汗、孟加拉国、不丹、印度、马尔代夫、尼泊尔、巴基斯坦和斯里兰卡）实施《国际母乳代用品销售守则》的现状，并描述了在孟加拉国、印度、巴基斯坦和斯里兰卡这 4 个国家，以母乳代用品（BMS）和婴儿食品名义销售的商业配方奶（CMF）的销售价值和数量。
采用混合描述方法评估国家实施《守则》的状况，包括对 2022 年世卫组织/儿基会/国际母乳代用品行动联盟《守则》状况报告的案头审查、对国家《守则》措施的系统内容分析，以及从关键政府和儿基会/世卫组织行为体参加区域研讨会中获得的见解，这些行为体旨在确定每个国家的障碍、差距和《守则》实施状况。孟加拉国、印度、巴基斯坦和斯里兰卡 2007 年至 2021 年以及到 2026 年的 CMF 和婴儿食品销售价值和数量的数据来自全球数据。
即使在法律措施被认为与《守则》基本一致的国家，也存在《守则》实施的重大差距，例如 CMF 覆盖的年龄范围不足、卫生系统中的利益冲突防范不足、对粉状配方奶固有污染风险的警告不足，以及缺乏有效的监测和执行机制。CMF 销售数据显示，卫生保健机构和药房保持着最高的销售额。在这 4 个国家中的 3 个（孟加拉国、印度和斯里兰卡），婴儿配方奶粉（包括特殊配方）的销售量低于其他 CMF，如后续配方和成长奶。总体而言，在这 3 个国家中，GUM 紧随婴儿谷类食品，占据了 CMF 和婴儿食品销售的很大一部分。
（1）缩小国家措施与《守则》之间的差距，（2）确保有效的监测和执行机制，（3）加强卫生系统中的利益冲突防范，（4）解决数字营销问题，以及（5）调动政治支持和来自国内公共卫生和妇女权利法律网络的支持。
