# Assessing Compliance: Violations of WHO Code in Breast Milk Substitute Marketing, Ecuador

## TL;DR

This study finds that breast milk substitute marketing in Ecuador violates WHO regulations, with heavy promotion through media and gifts to healthcare workers, threatening breastfeeding practices.

## Contribution

The study provides empirical evidence of widespread non-compliance with the WHO Code in Ecuador's BMS marketing, highlighting enforcement gaps and the rise of digital promotion.

## Key findings

- 91.21% of mothers were exposed to BMS marketing outside health facilities.
- TV is the dominant platform for BMS ads, with over $1.8 million spent on advertising.
- Only 39% compliance with labeling criteria, especially on nutrition and health claims.

## Abstract

Breast milk substitute (BMS) marketing significantly influences global infant feeding practices. Ecuador, like many countries, seeks to regulate these promotions under the WHO's International Code of Marketing of Breast‐Milk Substitutes. This cross‐sectional analysis assessed BMS marketing compliance with WHO's Code in Ecuador. Surveys were conducted with mothers (n = 330) and healthcare professionals (n = 66), complemented by observations at health facilities (n = 33) and retail outlets (n = 44). Media monitoring and product labelling evaluations were also conducted. The study revealed widespread exposure to BMS marketing outside health facilities (91.21% of mothers). Promotional activities targeted healthcare professionals, with significant interactions involving free supplies (26.09%) and gifts (21.74%). Retail outlets prominently displayed BMS promotions, often featuring discounts (95%). Compliance with labelling criteria was notably low, particularly concerning nutrition and health claims (39%). TV emerged as the dominant platform for BMS advertising, with 2884 ads aired over 16 h and 24 min, totalling $1,876,915.50 in expenditures. Digital platforms also featured BMS ads, with significant engagement on social media (533,845 interactions). This study reveals widespread violations of the WHO Code in Ecuador, emphasizing the need for stronger regulations and targeted education for healthcare professionals and the public to protect infant health and promote breastfeeding. Despite existing regulations, the pervasive advertising and substantial investment in BMS marketing across various media underscore significant enforcement gaps. To effectively safeguard maternal and child health, Ecuador must fully incorporate and rigorously enforce all Code recommendations within its national legislation.

This study reveals widespread violations of the WHO Code on breast milk substitute marketing in Ecuador, with significant promotions targeting healthcare professionals and the public. An 80% increase in mass media advertising compared to 5 years ago underscores enforcement gaps and the urgent need for stronger regulations to protect breastfeeding.

The advertising efforts in Ecuador have been ramped up by the industry in the last 10 years, using both conventional mass media and digital marketing to promote formula feeding as opposed to breastfeeding to young women and their families.Insufficient regulations on digital and social media marketing of BMS in Ecuador indicate the need for stronger oversight and comprehensive digital marketing regulations.The study reveals persistent violations of both the IC and Ecuador's national laws, underscoring the difficulties in preventing inappropriate marketing practices by the CMF industry.The findings emphasize the need for Ecuador to strengthen its national legislation to fully adopt and enforce the Code, protecting breastfeeding practices and improving maternal and child health outcomes.Strengthening adherence to BMS marketing regulations is essential for promoting and protecting breastfeeding as a fundamental component of maternal and child health in Ecuador.

The advertising efforts in Ecuador have been ramped up by the industry in the last 10 years, using both conventional mass media and digital marketing to promote formula feeding as opposed to breastfeeding to young women and their families.

Insufficient regulations on digital and social media marketing of BMS in Ecuador indicate the need for stronger oversight and comprehensive digital marketing regulations.

The study reveals persistent violations of both the IC and Ecuador's national laws, underscoring the difficulties in preventing inappropriate marketing practices by the CMF industry.

The findings emphasize the need for Ecuador to strengthen its national legislation to fully adopt and enforce the Code, protecting breastfeeding practices and improving maternal and child health outcomes.

Strengthening adherence to BMS marketing regulations is essential for promoting and protecting breastfeeding as a fundamental component of maternal and child health in Ecuador.