title: Implementation of international code of marketing breast-milk substitutes in China.
abstract: BACKGROUND
  Breastmilk is the best source of nourishment for infants and young children, and breastfeeding is one of the most effective ways to ensure child health and survival. In May 1981, the World Health Assembly adopted the International Code of Marketing Breast-Milk Substitutes. Since then several subsequent resolutions have been adopted by the World Health Assembly, which both update and clarify the articles within the International Code (herein after the term "Code" refers to both the International Code and all subsequent resolutions). The Code is designed to regulate "inappropriate sales promotion" of breastmilk substitutes and instructs signatory governments to ensure the implementation of its aims through legislation. The Chinese Regulations of the Code were adopted by six government sectors in 1995. However, challenges in promotion, protection, and support of breastfeeding remain. This study aimed to monitor the implementation of the Code in China.
  
  
  METHODS
  Six cities were selected with considerable geographic coverage. In each city three hospitals and six stores were surveyed. The International Baby Food Action Network Interview Form was adapted, and direct observations were made. Research assistants administered the questionnaires to a random sample of mothers of infants under 6 months old who were in the outpatient department of the hospitals. In total, 291 mothers of infants, 35 stores, 17 hospitals, and 26 companies were surveyed.
  
  
  RESULTS
  From the whole sample of 291 mothers, the proportion who reported exclusively breastfeeding their infant was 30.9%; 69.1% of mothers reported feeding their infant with commercially available formula. Regarding violations of the Code, 40.2% of the mothers reported receiving free formula samples. Of these, 76.1% received the free samples in or near hospitals. Among the stores surveyed, 45.7% were found promoting products in a way that violates the Code. Also, 69.0% of the labeling on the formula products did not comply with the regulations set out in the Code.
  
  
  CONCLUSIONS
  As the social and economic developments continue, the interactions of more and more factors curb further success in breastfeeding. Support from all sectors of the society is needed in order to create a social environment to enable the promotion of breastfeeding, in addition to the efforts already made by the healthcare system.
authors.affiliation: Department of Integrated Early Childhood Development, Capital Institute of Pediatrics , Beijing, China .
authors.forename: Aihua
authors.initials: A
authors.lastname: Liu
authors.forename: Yaohua
authors.initials: Y
authors.lastname: Dai
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Xie
authors.forename: Li
authors.initials: L
authors.lastname: Chen
mesh_terms: D000329:Advertising / Q000941:ethics / Q000331:legislation & jurisprudence* / Q000592:standards; D001903:Bottle Feeding; D001942:Breast Feeding; D002681:China / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence / Q000331:legislation & jurisprudence; D006293:Health Promotion; D006801:Humans; D007223:Infant; D007225:Infant Food / Q000009:adverse effects; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D008297:Male; D040541:Marketing / Q000941:ethics / Q000331:legislation & jurisprudence* / Q000592:standards; D041941:Milk Substitutes; D009035:Mothers; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011356:Product Labeling / Q000941:ethics / Q000331:legislation & jurisprudence* / Q000592:standards; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires