Thailand Bans Infant Formula Advertising to Encourage Breastfeeding

by Gabrielle Khalife
Part of the Food Policy Snapshot Series

Policy Name:

Control of Marketing of Infant and Young Child Food Act (B.E. 2560)

Location:

Thailand  

Population: 69,183,173 (Worldometers, 2018)

Overview:

To meet international recommendations for breastfeeding, Thailand’s Control of Marketing of Infant and Young Child Food Act bans manufacturers, importers and distributors from marketing and advertising breastmilk substitutes (e.g. infant formula) and complementary foods for infants. The act recognizes that breastmilk is the single best nutrition source for infants and helps prohibit misleading industry claims about products being suitable for infants.

Progress to date:

To promote the importance of breastmilk and the health benefits that result from being breastfed for both infants and young children, in 2007 the Thai FDA proposed a modification of the Ministry of Public Health Notification No. 156 (B.E. 2537 (1994)) requiring producers and importers of infant formula to display the following statements on product labels:

  • The best food for infants is maternal milk owing to its full nutritional content
  • Modified milk for infants should be recommended by a physician, nurse or nutritionist
  • Incorrect preparation or mixture will be hazardous for infants.

However, inappropriate advertising and sale promotions continued.

Therefore, on April 4, 2017, the National Legislative Assembly of Thailand passed the Control of Marketing of Infant and Young Child Food Act to restrict the marketing of food for infants and young children. The law is based on the International Code of Marketing of Breast-milk Substitutes, an international health policy framework for breastfeeding promotion, adopted by the World Health Assembly in 1981, that was developed to recommend marketing restrictions for breastmilk substitutes and ensure that substitutes are used safely if needed.

On September 9, 2017, the Control of Marketing of Infant and Young Child Food Act took effect and Thailand joined 135 other countries around the world that have national laws to protect breastfeeding.

Program/Policy Initiated:

September 9, 2017

Food policy category: Diet & Nutrition

Program goals:

To encourage mothers to breastfeed their infants in accordance with international recommendations.

How it works:

The law controls advertising of breastmilk substitutes and other food products for infants (newborns to 12 months) and children (12 months to 3 years of age). Manufacturers, importers and distributors are prohibited from:

  1. Advertising food products for infants and young children in a way that may cause families to believe they are good or necessary
  2. Claiming any nutritional or health benefits on food labels for infants and young children
  3. Giving discount coupons, tie-in-sales, prizes, product samples or gifts
  4. Offering gifts, money incentives or other benefits to public health personnel
  5. Organizing meetings, trainings or seminars on food products for infants and young children for public health service agencies or their personnel
  6. Donating food for infants or children to public health service agencies or their personnel, except to those who are sick with specific diseases or those with abnormal physical conditions that require supplementation
  7. Demonstrating or sponsoring a demonstration of food products for infants or young children in healthcare facilities or any other venues with the goal of encouraging or promoting the consumption of these products, except when such activities are conducted for medical purposes or for the benefits of treating infants or young children

Penalties exist for violating the advertising components of this Act, including up to one-year imprisonment and fines whose amount is determined by the section of the act that was violated.

Why it is important:

The World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF) both recommend initiation of breastfeeding within the first hour after birth, exclusive breastfeeding for the first 6 months of life, and continued breastfeeding combined with the introduction of complementary foods for up to two years or more. Despite these international recommendations, infant feeding compliance is poorly followed in Thailand, which has one of the world’s lowest breastfeeding rates. According to the 2016 Multiple Indicator Cluster Survey, only 40 percent of newborns in Thailand are breastfed within one hour of birth, only 23 percent of infants are exclusively breastfed for the first six months of life and only 16 percent continue to be breastfed for 2 years.

Lack of breastfeeding has a profound impact on both the economy and infant health. The medical journal, The Lancet, found that optimal breastfeeding alone could prevent more than 800,000 infant deaths each year. Breastfed infants have fewer infections (e.g. diarrhea, ear infections, and pneumonia) and hospitalizations than formula-fed infants. Breastfeeding may also protect infants against autoimmune disorders (e.g. allergies) and chronic diseases (e.g. obesity and diabetes). From an economical viewpoint, costs associated with inadequate breastfeeding include: (1) medical and therapeutic costs for cognitive losses in children not breastfed up to 6 months, (2) health system costs for treatment for diarrhea and pneumonia in children due to inadequate breastfeeding (3) medical and therapeutic costs for breast cancer in mothers who have not breastfed their infants since breastfeeding is protective (4) indirect costs due to travel, caregiver time or uninsured health care costs and (5) cost of formula. In fact, investing in breastfeeding practices could save the Thai healthcare system more than U.S $7.6 million in expenditures to treat diarrhea and pneumonia due to inadequate breastfeeding. Furthermore, for Thai families, the savings with breastfeeding are profound provided that breast milk is free while the cost of formula quickly adds up.

Nutrition within the first 1,000 days of a child’s life, from conception to two years old, is particularly important. Optimal breastfeeding is a crucial element of infant and young child nutrition. Breast milk is beneficial in promoting infant growth, development and productivity. The protective effects of breast milk are attributed to its unique composition of macronutrients, minerals and vitamins necessary for optimal nutrition, growth and development for the newborn infant. Further, breast milk contains several bioactive compounds including IgA antibodies, Human Milk Oligosaccharides (HMOs) — which are found only in human milk and not in infant formulas– beneficial bacteria and long-chain polyunsaturated fatty acids, which support the development of the immune system and aid in the maturation of the infant gut. Higher IQs (average of 3 points) and improved school performance are also associated with children who are breastfed. In addition, mothers who breastfeed have a lower risk of breast cancer, high blood pressure, diabetes and cardiovascular disease.

Advertisements marketing breastmilk substitutes as equal or superior to breastmilk mislead families into thinking that substitutes provide the best nutritional value for their children and undermine optimal infant and young child nutrition, which can be better achieved through breastfeeding. Implementing a standard policy that limits infant formula advertising and marketing is an effective approach to ending the inappropriate promotion of foods for infants and supporting exclusive breastfeeding.

Evaluation:

The Thai Health Department has appointed officials to monitor violations of the Act.

The WHO fully supports the Thai government’s efforts and will provide guidance as needed for setting up mechanisms for effective implementation and monitoring of the Act.

Learn more:

http://www.nationmultimedia.com/detail/national/30324202

Point of Contact:

Nattha Keenapan

UNICEF Thailand

T: 086 616 7555

E: [email protected]

Similar practices:

With the passage of the Control of Marking of Infant and Young Child Food Act, Thailand joins other countries such as the Philippines, India and Nepal in implementing the World Health Assembly’s International Code of Marketing of Breastmilk Substitutes (the Code). As of March 2016, 135 countries have enacted legislation implementing all or many of the provisions of the Code (e.g. all forms of food product advertising and promotion targeted to infants and young children are prohibited, labeling of infant formula must contain a statement of the superiority of breastfeeding, promotion of any breast milk substitute is forbidden in healthcare facilities, health workers are responsible for encouraging breastfeeding, etc). For a list of the 135 countries, see ANNEX 1 & 2.

References:

https://academic.oup.com/heapol/article/31/8/1107/2198223

https://www.unicef.org/thailand/media_22880.html

https://apps.fas.usda.gov/gainfiles/200710/146292602.pdf

https://www.unicef.org/thailand/media_26304.html

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00210-5/fulltext

https://mics-surveys-prod.s3.amazonaws.com/MICS5/East%20Asia%20and%20the%20Pacific/Thailand/2015-2016/Final/Thailand%202015-16%20MICS_English.pdf.pdf

http://englishnews.thaipbs.or.th/law-infant-formula-milk-take-effect-sept-8/

http://www.searo.who.int/thailand/news/infant-and-young-child-food-act/en/

https://www.unicef.org/thailand/media_26304.html

http://www.nationmultimedia.com/news/opinion/30311251

http://apps.who.int/iris/bitstream/handle/10665/206008/9789241565325_eng.pdf;jsessionid=75D69F92D2091A2A8897459ED691F504?sequence=1

http://www.who.int/nutrition/publications/code_english.pdf

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