The International Code and its subsequent WHA Resolutions bans all promotion of bottle feeding and sets out requirements for labelling and information on infant feeding. Any activity which undermines breastfeeding also violates the aim and spirit of the Code. The Code is intended as a minimum requirement in all countries.

The following information is designed to help you to find and report violations of the International Code. As there is quite a lot of text you may want to read it offline.

The Code has provisions which ban all promotion of bottle feeding. All the major baby food companies claim to abide by it, but evidence from around the world shows widespread violation. This evidence is the result of monitoring carried out by individuals, non-governmental organisations and others. The accurate collection and reporting of examples of bottle feeding promotion is essential if we are to end irresponsible and dangerous marketing practices.

Information provided by such monitoring helps international organisations like UNICEF, WHO, aid agencies and IBFAN in their campaigns to protect infant health. You can help by observing the infant feeding situation in your hospitals, clinics, shops and in public. IBFAN 's publication of company tactics has proved to be one of the best ways to force changes. We need your help to keep abreast of promotional tactics and to end dangerous practices. Please e-mail us with what you have seen.

How to be a Code monitor

Monitoring involves investigation, observation and recording of information. Be inquisitive, be persistent and use your imagination. Prepare carefully: familiarise yourself with the main points of the International Code (above) and find out the names of baby milk companies and their brand names in your country (ask in a pharmacy).

Pay close attention to detail: in all your notes, make a careful record of dates, company and brand names, name and address of hospital, clinic, store, etc, name and position of person giving information, descriptions of posters, displays, etc. (take photographs if possible). Protect confidentiality: assure the person giving information that his or her name will not be published or disclosed to a superior.

NB: we are monitoring company practices, not policing hospitals. This work is to support health workers, not to undermine them. Get copies of code violations wherever possible. Get copies of brochures, booklets or labels, or take photocopies or photographs. Label all examples of promotion with as much detail as possible (but do not deface them).

What to bring

  1. Pens
  2. Notepad
  3. If possible, a camera with film. Auto-focus cameras with a built-in flash unit are good because they are small and quick.

Monitoring in hospitals and clinics

Gaining access to information in hospitals depends on your relationship with the institution. If you are a health worker or a mother-to-be it will be easier. Otherwise, it may be best simply to walk in to the maternity ward, introduce yourself and begin to ask questions and look around. Because you are researching the many factors that affect breastfeeding, you may be welcomed. But be prepared for the fact that many hospital officials, doctors and health workers have direct contact with the companies, sometimes depending on them for financial support, and may be unhappy if they feel that you are threatening this. If you request permission from the hospital administrator from the start, there's always the chance that you will be refused and will have to leave with no information.

At the hospital, try to visit the maternity ward, nursery, milk kitchen, paediatric ward, malnutrition ward, rehydration unit and offices of paediatricians, obstetricians, nurses and administrators. Asking the same questions of different people will increase your chances of finding the right information. If a health worker appears sympathetic but uncomfortable giving information, he or she may be happier to talk to you away from the hospital - perhaps leave a card with your phone number and address.

Protect the confidentiality of health workers who give you sensitive information. Ask permission to talk to mothers with newborn babies - it's best to talk to those about to go home since many practices which violate the Code occur close to the time when the mother leaves hospital. Mothers often have a very different view of hospital procedures. You might find information which health workers didn't give you - or you may get ideas of other places to investigate.

Interview techniques

Don't accuse anyone. You will get better answers if you don't assume that a person is guilty. Asking a health worker "when was the last time you got a bribe from a company?" is not likely to get a response. However, saying that you heard that some companies used to give money and presents to doctors and nurses, and asking if the health worker knows if this still goes on, might get an interesting reply.

Lead in: start the interview with questions about breastfeeding rates, number of babies born, etc. When you have begun to build up some rapport with the interviewee, you can begin to ask some of the more direct questions about promotional practices. Listen - don't argue: You want to collect information, not get into a debate. So even if the health worker says something with which you disagree, listen politely. You can go back another time to encourage good breastfeeding practices.

Take accurate notes. But don't start writing when someone is telling you something particularly sensitive - you might make them feel they're going too far.

Direct observation

In hospitals and clinics, look for evidence of milk company influence via:
  1. free tins of baby milk
  2. posters, charts and similar
  3. booklets for mothers or health workers
  4. gifts - any size, from clocks and fridges to pens and pads
  5. company employees

It is important to observe the different rooms of the hospital: you may even be able to see things which contradict some of the information you have been given. Take photographs if possible. Write down all details about such items: eg. does a poster advertise a milk brand or just the company? which brand? which company? does it show a happy baby? a mother? where is the poster? when was it given to the hospital?

Monitoring at the point of sale

Visiting shops, supermarkets, pharmacies and other locations where baby milks and feeding bottles are sold will enable you to check for special displays, leaflets, posters, special prices and other promotion. Interview an employee and ask to see examples of any literature provided by the companies.

Check product labels: buy a tin of any product when labels are severe violations of the code and send us the label. (If the information is printed directly on to the tin, empty the contents and post the tin, or flatten it out and photocopy it.)

In a large supermarket, check the labels first and then interview an employee if possible. In a small shop, where you will be noticed immediately, introduce yourself to the owner and explain that you are researching infant feeding practices and are interested in the milks on sale in the shop. Interview the owner first and then check labels on the shelves. DonÍt arrive at the busiest times or just as the shop is about to close.

Monitoring the media and other direct consumer advertising

Checking the media for advertisements is easy - look particularly in magazines for parents and also check publications imported from other countries. Radio and TV may also broadcast advertisements. We're interested in advertisements for any breastmilk substitutes. Check to see if any products are advertised for use before they are nutritionally necessary: eg. whole milk powder is sometimes promoted for babies from birth or the early months, baby foods and drinks are often advertised for use before the baby is 6 months old.

Looking in relevant trade journals - magazines aimed at the shops and pharmacies which sell baby products - may expose violations. Look for information about breastmilk substitutes or advertisements: they may give details of sales inducements, tie-in sales, special offers, discounts or competitions for shop owners and pharmacists.

Other direct advertising can include advertising hoardings, direct mail to consumers, displays at public events and baby shows. Keep an eye out for bottle feeding promotion at all times.

We want information about any promotion of bottle feeding or undermining of breastfeeding, so please give details of anything relevant, even if you're not sure whether it violates the Code.

Background research

Whilst not essential, providing background information about the area in which you are monitoring will help to place the survey results in context. Any of the following would be useful:

  1. The infant mortality rate
  2. Statistics on breastfeeding rates, duration of breastfeeding, mixed feeding rates, etc
  3. Baby milk marketing controls (this can range from having all or part of the Interna-tional Code as law or as a voluntary measure to having no controls at all or a code written by the industry itself)
  4. The locally spoken language(s)
  5. The percentage of people who can a) read at all & b) read the language in which most baby milk labels are written
  6. The percentage of people who have constant access to clean water
  7. Whether baby milks, foods and feeding bottles are imported or produced locally
  8. The volume of baby milks, foods and feeding bottles a) used b) imported
  9. The value of the different sections of the baby feeding market
  10. The percentage of the market held by each company
  11. The percentage of each company's total turnover which is represented by sales of baby milks, foods and feeding bottles In each case, please send as much detail as possible.

Reporting your findings

UNICEF: Carol Bellamy, Executive Director, UNICEF, 3 United Nations Plaza, New York, NY 10017, USA.
WHO: Dr. James Tulloch, CDD, World Health Organisation, 1211 Geneva 27, Switzerland.
IFM: Andrée Bronner, IFM, 194 rue de Rivoli, 75001 Paris, France. (IFM is funded and controlled by the baby milk industry and rarely supports any complaints.)