Releasing the Breaking the Rules 2001 report to coincide with the 20th anniversary of the Code, IBFAN says it has evidence of world-wide systematic violations of the provisions of the International Code, which prohibits all direct and indirect promotion of baby foods. The World Health Assembly will be discussing progress on the Code this week (follow developments through IBFAN's updates from the WHA).

IBFAN says that it has proof of infractions by 16 baby food companies: Abbott-Ross, Danone, Dumex, Friesland, Gerber, Hipp, Heinz, Humana, Mead Johnson, Meiji, Milupa, Morinaga, Nestlé, Nutricia, Snow Brand and Wyeth. Among the bottles and teats companies, the worst violators were Chicco, Gerber, Evenflo and Playtex.

The report is based on a survey of company compliance with the International Code that was conducted by IBFAN groups in 14 countries - the United States, Canada, Russia, Malaysia, Ghana, Hong Kong, Taiwan, Italy, Côte d'Ivoire, Bolivia, Uruguay, Mexico, Togo and the United Arab Emirates. IBFAN monitoring of the marketing practices of baby food companies has been a regular practice of the network.

IBFAN also monitors Code implementation by governments. To date, 51 countries have incorporated all or most of the Code's provisions into law, according to the State of the Code by Country 2001, a chart IBFAN is releasing today as well.

The Code encourages non-governmental organisations to keep a check on the marketing practices of companies. "Without IBFAN's regular monitoring exercises and reporting, the situation would be far worse", says Annelies Allain, Director of IBFAN's Code Documentation Centre. "Most violations were found in countries where, until now, there were no IBFAN groups, such as Taiwan, Hong Kong and the UAE. It was a 'free-for-all' situation there. No laws and no monitoring."

Subsequent WHA Resolutions on infant feeding and young child nutrition have strengthened the Code and adapted it to new marketing strategies and scientific knowledge. Among other things, these resolutions prohibit donations of breastmilk substitutes to any part of the health care system and recommend complementary feeding from the age of six months. Another resolution clearly states that financial support for professionals should not create conflicts of interest.

In March this year, international health experts settled the long debate about the optimal duration of breastfeeding by recommending that babies receive only breastmilk for the first six months. The recommendation is to be incorporated into a draft WHA Resolution which will be presented next week. The draft Resolution took thirteen long hours of negotiation during WHO`s Executive Board meeting in January to reach its present compromise status (see IBFAN updates from the WHO EB). It is likely that the majority of Member States will resent any move to re-open debate on this draft Resolution whilst a few may try to introduce amendments weakening it. A lively debate is expected for Thursday, 17 May.

According to the IBFAN report, all baby food companies disregard many provisions of the International Code which are meant to ensure optimal breastfeeding and the highest levels of nutrition among infants and young children. In their bid to maximise profits, the companies seek to undermine exclusive breastfeeding for the first six months by promoting many products for use by 3 or 4 months. Suitable complementary foods should start only after 6 months, as recommended by the Code and numerous nutrition experts world-wide. Industry also advertises follow-up milks which discourage continued breastfeeding and in many cases these promote infant formula by having very similar labels.

Brazil has recently shown that strong national laws can bring about changes for the better. Last year, the country introduced a new law which requires companies to remove pictures of babies, bottles or animal toys from formula and baby food labels and put clear warnings about the product not to be used before 6 months. Just last month IBFAN heard that Gerber and Nestlé are the first to have complied with the new law.

The IBFAN report identifies Nestlé, Gerber, Milupa, Wyeth, Heinz, Mead Johnson and Abbott-Ross as companies that employ new approaches to get around marketing curbs. They establish "baby clubs" to contact mothers directly in order to distribute promotional materials, free samples and enticing gifts. Personnel of these and other companies counsel mothers about infant feeding and recommend the company's brands, weakening mothers' confidence in breastfeeding and winning loyal customers who will spend a world-wide average of US$450 per baby per year. Another new avenue to contact mothers directly and in disregard of any national law is via the Internet.

One tactic that has witnessed an alarming resurgence is donations of free supplies of milks, baby foods and feeding bottles to health care facilities. These supplies promote the use of artificial feeding within the facility or are passed on as samples to mothers. A majority of mothers, at least 90 per cent, remain loyal to the brand they are introduced to in the health care system because of the implied medical endorsement of the product.

The network reminds governments that the Code is a minimum measure to be translated into enforceable national legislation. It also stresses that WHO has a clear role as guardian of the Code for the protection of breastfeeding against vested commercial interests.