Protecting breastfeeding in West and Central Africa: over 25 years of implementation of the International Code of Marketing of Breastmilk Substitutes.

Background: In 1981 the World Health Assembly (WHA) adopted the International Code of Marketing of Breastmilk Substitutes out of concern that inappropriate marketing of breastmilk substitutes was contributing to the alarming decline in breastfeeding worldwide and the increase in child malnutrition and mortality, particularly in developing countries.

Objective: To document progress, challenges, and lessons learned in the implementation of the International Code in West and Central Africa.

Methods: Data were obtained by literature review and interviews with key informants.

Results: Twelve of the 24 countries have laws, decrees, or regulations that implement all or most of the provisions of the Code, 6 countries have a draft law or decree that is awaiting government approval or have a government committee that is studying how best to implement the Code, 3 countries have a legal instrument that enacts a few provisions of the Code, and 3 countries have not taken any action to implement the Code. International declarations and initiatives for child nutrition and survival have provided impetus for national implementation of the Code. National action to regulate the marketing of breastmilk substitutes needs to be linked to national priorities for nutrition and child survival. A clearly defined scope is essential for effective implementation of national legislation. Leadership and support by health professionals is essential to endorse and enforce national legislation. Training on Code implementation is instrumental for national action; national implementation of the Code requires provisions and capacity to monitor and enforce the legislative framework and needs to be part of a multipronged strategy to advance national child nutrition and survival goals.

Conclusions: Nations in West and Central Africa have made important progress in implementing the International Code. More than 25 years after its adoption by the WHA, the Code remains as important as ever for child survival and development in West and Central Africa.