Formula labeling violations to the WHO Code: a quantitative and qualitative analysis

BACKGROUND: The WHO Code on Marketing of Breastmilk Substitutes is intended to be adopted as a minimum requirement by all governments and aims to protect infant health by preventing inappropriate marketing of breastmilk substitutes. Labels need to have correct and clear dispositions since they frequently are the only source of vital information for consumers regarding the content of the product and its uses. OBJECTIVE: The purpose of this study was to determine violations to the provisions of the International Code Article 9 regarding infant formula labeling existing in Puerto Rico. Methods: A quantitative and qualitative evaluation of 34 labels of infant formula was done. Instrument 4-A of the IBFAN Monitoring Project (IMPIII) and the Standard IBFAN Monitoring (SIM) was utilized. This instrument included 14 criteria that identified violations to the International Code of Breastmilk Substitutes on labeling. Descriptive analysis was used for all variables. The 34 labels evaluated represent 77.3% of infant formula labels of the four companies which market them in the island. RESULTS: All the labels (100%) that were evaluated were found to violate the Code in one or more of its dispositions. Most striking violations include: a statement that breastfeeding is best is lacking in 73.5%, as well as a statement that the product should be used only on the advice of a health worker. None of the labels are written in Spanish, the local language. Text which may idealize the use of infant formula or discourage breastfeeding is present in 97.1% of the samples, and the same percentage has a photo or picture idealizing the use of infant formula. CONCLUSIONS: It is vital to produce legislation that implants the WHO Code in Puerto Rico in order to regulate indiscriminate marketing practices and their subsequent ill effects on children's health and breastfeeding practices.

Exploratory study: breastfeeding knowledge, attitudes towards sexuality and breastfeeding, and disposition towards supporting breastfeeding in future Puerto Rican male parents

Identify the breastfeeding knowledge, the attitudes towards sexuality and breastfeeding and the disposition towards supporting breastfeeding in future fathers were the aims of this study. A non-probabilistic sample (n = 100) of future Puerto Rican male parents was used in this study. A self-administered questionnaire was used consisting of four sections. Descriptive statistics were used for data analysis and t-test to the inferential analysis. 88.8of the participants presented a low level of knowledge. However, 81.6had a positive attitude toward sexuality and breastfeeding. Also, 92.0of the participants indicated much/enough willingness to support their partners in exclusively breastfeeding. Disposition to support the breastfeeding was associated with knowledge towards breastfeeding (p = 0.04) and attitudes toward sexuality and breastfeeding (p = 0.00). The knowledge and the attitudes, in this study, are strongly related with the disposition of the father to supporting the breastfeeding in the future.

Effectiveness in the implantation of law 155 of 2002 ordering the designation of spaces for breastfeeding in government agencies

As part of an effort to promote and protect breastfeeding among working mothers in Puerto Rico, Public Law 427 was passed in December 2000. This law grants a paid breastfeeding daily break for milk extraction in the workplace. In support of this initiative Public Law 155 was passed in 2002 ordering Secretaries, Directors, Presidents and Public Administrators of the government of Puerto Rico to designate breastfeeding spaces in the workplaces. OBJECTIVE: Describe the level of compliance with the dispositions of Law 155 in government agencies. METHODOLOGY: A cross sectional descriptive study was carried out. A sample of 28 government agencies was randomly selected, representing 25of the total number of agencies, and a structured telephone interview was administered using an instrument made up of 6 premises. RSEULTS: All (100) of the agencies had knowledge about the existence of this law, but only 50had set up and equipped the spaces. Of these, all had a table, a chair, and an electric outlet, 43had available running water, and 71provided a refrigerator for milk storage. Fifty three percent of the agencies reported having received followup communications to verify whether they were complying with the law, and 61reported having a written public policy in support of breastfeeding for working mothers. Only 54of the agencies stated they had offered some type of orientation to their women employees regarding their breastfeeding rights. CONCLUSIONS: In spite of over two years since the passing of Law 155, the majority of government agencies in Puerto Rico have not complied with its legal dispositions. It is necessary that the responsible entities watch for the satisfactory compliance with this law since working mothers need a secure and accesible place for milk extraction during the working day.