Factors associated with non-compliance with the code of marketing breast milk substitutes and/or statutory instrument number 48 of 2006 of the laws of Zambia in Kalinjalinga and Chelstone

Abstract

Non-compliance with the International Code of Marketing Breast Milk Substitutes (ICMBMS) and/or Statutory Instrument (SI) number 48 of 2006 of the Laws of Zambia by manufacturers and distributors is prevalent posing a challenge to successful breast feeding. The World Health Organization (WHO)'s Code of marketing of breast milk substitutes is an important component of the global effort to protect breast feeding. It was developed in 1981, as an international public health framework to promote breastfeeding and ensure safe use of breast milk substitutes when required. Over 84 countries have since enacted this legislation implementing all or part of the provisions. In Zambia it was enacted as Statutory Instrument No.48 on Marketing of Breast Milk Substitutes, Regulations of 2006. Factors associated with non-compliance with the code are unknown in Zambia. To determine factors associated with non-compliance with the Code, a study was conducted in Kalingalinga and Chelstone communities of Lusaka. A Concurrent Triangulation method was applied whereby structured questionnaires were used to collect quantitative data and Focus Group Discussions to generate qualitative data. Interviews were conducted with shop owners (80), health workers (8) and mothers (214). Observations provided data on labels of breast milk substitute and adverts (62). Data were analyzed using Stata and NVIVO softwares respectively. Results revealed that feeding bottle picture on the labels [AOR: 22 (95%CI: 4-131)] and infant formula labels resembling follow up formula [AOR: 18(95%CI: 2-172)] were more likely to cause non-compliance among manufacturers. Manufacturers were also reported to promote BMS with enticing labels and posters. Unsuitable products displayed close to breast milk substitutes [AOR: 22(95%:2-212)] and point of sale advertizing [AOR: 80(95%CI: 6-1019) were more likely to cause non-compliance among distributors. Crying child, working or schooling mother, illness and mother’s lack of milk were some of the reasons for mothers opting for BMS. Others were caesarian section, traditional beliefs and challenges associated with expressed milk storage. Furthermore, friends, relatives and health workers were reported to have an influence on infant feeding. Non-compliance with the Code and/or SI no.48 of 2006 of the Laws of Zambia was prevalent in Kalingalinga and Chelstone after 10 years of enacting the Law on marketing of breast milk substitutes. This study highlighted problems of non-compliance with the code and/or SI no 48 of 2006 of the Laws of Zambia. It provided the evidence to prompt routine law enforcement to control the unethical marketing of breast milk substitutes. Information from the study also demonstrated the need to refocus infant and young child feeding messages in Kalingalinga and Chelstone.