Breastfeeding protection in health care facilities of Quebec

Background: With increasing breastfeeding initiation, health organizations bear the responsibility of protecting mothers and avoid undermining their breastfeeding decisions. For 25 years, the International Code of Marketing of Breastmilk Substitutes (Code) has stipulated the conditions under which infant formula, complementary foods and artificial nipples should be marketed, sold and distributed, clearly defining the role of the health care setting and its professionals. Objective: To measure compliance with the Code in 28 health-care facilities in Québec, Canada. Methodology: Three studies in 2001, 2004 and 2005 examined Code compliance by 9 hospitals and 19 community health centers (CHC) in Québec's Montérégie region, using as data sources mothers, staff and external observers. Implementation level of 8 to 19 indicators (depending on the type of facility) as well as a synthetic score were measured. Results: According to head nurses and observers, only one out of 9 hospitals distributed to mothers a gift bag containing ads for pacifiers and cereal. Encouragingly, 88% of hospital mothers and 97% of CHC mothers reported they had not received infant formula samples or supplies to take home. On the other hand, according to external observers, 56% of maternity wards and 42% of CHC presented some form of promotional materials (such as measuring tapes, cans of infant formula and baby food, posters, folders, etc.) from manufacturers of products covered by the Code. Conclusion: Montérégie professionals have used assessment results to detect areas of Code non compliance and introduce changes necessary to help mothers successfully implement their infant feeding decisions.