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Confronted with evidence of widespread Code violations that contribute to a low exclusive breastfeeding rate, Cote d’Ivoire launches national training initiative 

May 21 2022
Tags: Cote d'Ivoire, BMS Code, Code, breastfeeding, Baby Friendly Hospitals Initiative

Violations of the International Code of Marketing of Breastmilk Substitutes (BMS Code) is contributing to low rates of exclusive breastfeeding in Cote d’Ivoire. A national initiative to train health workers on the Code, launched with support from Alive & Thrive, seeks to address the problem.

Exclusive breastfeeding rates in Cote d’Ivoire are among the lowest in West and Central Africa. While the prevalence of exclusive breastfeeding in Côte d’Ivoire increased by 10 percentage points from 12% to 23.5% between 2012 and 2016 (Ministere du Plan et du Developpement, UNICEF, & Insitut National de la Statistique, 2017), it remains far below the World Health Assembly global target of 50% by 2025. 

abidjan posters
Posters like these are commonly found in health facilities in Cote d'Ivoire, violating the International Code of Marketing of Breastmilk Substitutes.

A new updated version of our brief guide to the BMS Code is now available.

The pervasive marketing of BMS, as well the promotion of baby bottles and teats, may be an important factor undercutting efforts to improve breastfeeding rates. Indeed, bottle feeding is six times higher in urban areas than in rural areas (Ministere du Plan et du Developpement et al., 2017). 

A study conducted by Alive & Thrive and the Ministry of Health showed that nearly two-thirds of mothers had been exposed to advertising of the products and nearly the same proportion of health workers had been contacted by companies that make the products. 

“Violations of the Code are common in Cote d’Ivoire, particularly in urban areas, where this study was conducted,” said Dr. Francke-Lina Gbogbo, Alive & Thrive’s focal person in Cote d’Ivoire. “The study on violations only concerned health structures, but violations are also very frequent in shops and the media. Fortunately, a study is currently underway concerning the violations in these two entities.”

The study also revealed that virtually no health workers had received training on the Code – and the vast majority – 90% – had never even heard of it. 

In the video below, Dr. Kouamé Oka René, Coordinator of the National Nutrition Program, discusses the national effort to train health care workers on the Code via the Baby Friendly Hospital Initiative.

In the late 1990s, the MOH introduced the Baby Friendly Hospital Initiative (BFHI) to encourage facilities providing delivery services to better support breastfeeding. The National Nutrition Program is scaling up this initiative in all 33 health regions and across 500 health facilities through a World Bank-funded project called SPARK Health as well as with funding from the African Development Bank. Compliance with the International Code of Breastmilk Substitute and the subsequent World Health Assembly Resolutions is a critical component of BFHI. 

An extensive effort to train health workers in Cote d’Ivoire on the International Code of Marketing of Breastmilk Substitutes is now underway as part of the Baby-Friendly Hospital Initiative. Alive & Thrive has played an important role in developing the training module and helping the government to roll it out nationwide.  

regional webinar
In February, regional and international experts on the Code discussed the realities for health workers in West Africa during a webinar co-sponsored by ECOWAS, UNICEF, WHO, HKI, IBFAN and Alive & Thrive. Click the image to learn more.

The study also showed that more than half of mothers surveyed had been advised by health workers to give their infants breastmilk substitutes. BMS company visits to health facilities push health workers to advise mothers to do so, one health worker said.

“It’s a form of corruption,” the health worker said. “If you receive free samples from the company, you’re going to feel bothered if you do not prescribe the product to patients.” 

“The government’s effort is badly needed,” said Manisha Tharaney, Alive & Thrive’s regional director for West Africa. “The evidence is compelling that breastmilk substitute manufacturers in Cote d’Ivoire – as in many countries in the region – put profits ahead of the lives of babies. Without government action, the problem will only get worse.”

Violations of the Code in West Africa are widespread. The regional Stronger With Breastmilk Only initiative conducted a regional webinar on the Code with leading experts in February. Watch here.

Advocates used the Alive & Thrive study to push for greater government action, resulting in the issuing of four “Orders” in 2021 to implement its 2013 Decree on the Code, and then the Code training program to be implemented within the framework of country’s Baby-Friendly Sanitary Structure Initiative (ISSAB).

But much more work remains to be done, Dr. Gbogbo said.

“We are gradually increasing awareness of the Code, which is important,” she said. “But monitoring the implementation of the Code and national legislation remains weak or even non-existent.”

WATCH the Stronger With Breastmilk Only regional webinar on the Code held in February.

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