Marketing of Breast Milk Substitutes 107
2
feeding among children aged 6–23 months (rela-
tive risk: 2.18) [11]. Early initiation of breastfeed-
ing is critical. In a Ghanaian study, neonatal mor-
tality of babies fed after the first 24 h was more
than twice that of those fed within the first hour.
In the developed world, exclusive breastfeeding
has no detectable effect on mortality, but signifi-
cant reductions in both short-term and long-term
morbidity were noted. Failure to breastfeed in-
creases the risk of gastrointestinal disease, acute
otitis media and acute lower respiratory tract in-
fection in infancy. In older children, the likelihood
of obesity, elevated cholesterol levels, hyperten-
sion as well as type 1 and type 2 diabetes is in-
creased. In a recent meta-analysis, negative emo-
tions such as guilt, anger, uncertainty and sense
of failure were found more often in mothers of
bottle-fed babies [12]. Term small-for-gestation-
al-age babies are at risk of obesity and metabolic
problems like hypertension and diabetes. Breast-
feeding is protective by preventing accelerated
growth in these subsets of babies [13].
Situations in Which Breast Milk Substitutes
Can Be Used
Formula feeding is clearly essential in certain cir-
cumstances, such as when the mother is on cyto-
toxic drugs or is unwilling to breastfeed. Since
HIV can be transmitted with breast milk, infected
mothers were advised to use breast milk substi-
tutes in 1985. This practice led to an increase in
infant mortality in resource-poor countries where
safe formula feeding was not feasible. Therefore,
the WHO guidelines of 2010 recommend exclu-
sive breastfeeding for the first 6 months with an-
tiretroviral treatment of the mother unless substi-
tute feeding is acceptable, feasible, affordable,
sustainable and safe [14].Conclusions- Breastfeeding is the best source of nutrition for
infants less than 6 months of age - Formula feeding can lead to increased infant
mortality, especially in developing countries,
due to poor hygiene and sanitation facilities - The risks of short- and long-term morbidities
such as infections, allergies, obesity and life-
style diseases increase with formula feeding - The International Code of Marketing of
Breast-Milk Substitutes must be monitored
and implemented in all countries. Health care
professionals can play a very important role by
explaining the benefits of breastfeeding to
pregnant women and by promoting early ini-
tiation of breastfeeding after birth
6 Taylor A: Violations of the international
code of marketing of breast milk substi-
tutes: prevalence in four countries. BMJ
1998; 316: 1117–1122.
7 Salasibew M, Kiani A, Faragher B, et al:
Awareness and reported violations of
the WHO International Code and Paki-
stan’s national breastfeeding legislation:
a descriptive cross-sectional survey. Int
Breastfeed J 2008; 3: 24.References1 WHO: Infant and young child nutrition.
Geneva, WHO, 1993. EB93/17.
2 Palmer G: The industrial revolution in
Britain: the era of progress? In Palmer G
(ed): The Politics of Breastfeeding. Lon-
don, Pinter & Martin, 2009, pp 205–207.
3 Jelliffe DB, Jelliffe EF: Feeding young
infants in developing countries: com-
ments on the current situation and
future needs. Stud Fam Plann 1978; 9:
227–229.
4 World Health Assembly: Resolutions of
the Executive Board at its sixty-seventh
session and of the thirty-fourth World
Health Assembly on the International
Code of Marketing of Breast-Milk Sub-
stitutes. Resolution EB67.R12 Draft In-
ternational Code of Marketing of Breast-
Milk Substitutes. Geneva, WHO, 1981.
5 Forsyth S: Three decades of the WHO
code and marketing of infant formulas.
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DOI: 10.1159/000360326