International Code of Marketing of Breastmilk Substitutes ...

International Code of Marketing of
Breastmilk Substitutes
Implementation and Monitoring Process in Kuwait
Dr Mona AlSumaie , IBCLC
Community Nutrition Promotion Supervisory
Food & Nutrition Administration / MOH/ Kuwait
2012

Area of 17,818 Km²
Capital: Kuwait

Population
(in thousands)
3,566,437
Kuwaitis=1,133,214
(31.8%)
K. Children :

KUWAIT background data
Indicator
Result
1. IMR rate (per 1000 live births)
2. Low birth weight
Low birth weight(per 1000 live births)
3. NMR (per 1000 live births)
4. MMR (Per 100,000 live births)
5. Annual no. of live births
8.7
8%
79.7
5.3
5.2
57,533
Source and date: Kuwait Health Statistics 2010

KUWAIT background data
Indicator
Result
6. Prevalence of anaemia (under-fives)
7. Overweight (under-fives)
Obesity (under-fives)
19.8 %
5.6 %
2.3 %
8. Wasting (under-fives)
1.7 %
9. Stunting (under-fives)
4 %
Source and date: Kuwait Nutrition Surveillance System 2011

Kuwait Hospitals with Maternity Services
4 Government Hospitals 10 Private Hospitals
Al-Adan Hospital
Al- Farwaniya Hospital
Al- Jahra Hospital
Maternity Hospital
54 %
44.7 %
Al-Salam Hospital
New Mowasat Hospital
Al-Seef Hospital
Dar Alshifa Hospital
KOC Hospital
London Hospital
Royal Hayat Hospital
Al-Hadi Hospital
Taiba Hospital
Al-Omooma Hospital
Al-Rashid Hospital

Prevalence and initiation of breastfeeding in
Kuwait (1996 – 2006 - 2010)
%
90
80
70
60
50
40
30
20
10
0
81.1 83
76.6
Ever Breastfed
4.5
18.7
Breastfed
Within one
hour of birth
14.1
51.2
41.8
Breastfed
Within 6+
hours
55.9
15.2
11.9 11.6
exclusive BF
1996
2006
2010

Breastfeeding Promotion Program in
Kuwait since 1997

Kuwait Breastfeeding Promotion & BFHI
Implementation Committee
and sub-committees
• Established Nov. 1997
with 11 members from
Primary Health Care,
Nutrition, Pediatrics,
Gynecology, Nursing,
Medication & Special
foods Supervisory
Asmah
Maternity
H.
Jahra
• 6 sub-committees
represented in the
higher committee.
Ahmadi
Hawally
Farwaniya

Our vision
“an environment that enables mother,
families and other caregivers to make
informed decisions about optimal feeding”.

Achieving this vision requires
• Ensure that all health facilities providing maternity services fully practices the
“Ten steps to successful breastfeeding” set out by WHO/UNICEF
• Implement the International Code of Marketing of Breast milk Substitutes and
subsequent relevant World Health Assembly resolutions.
• Enact and enforce legislations protecting the breastfeeding rights of working
women.

International Code of Marketing of Breastmilk Substitutes implementation in Kuwait
Key dates in the history of the I.
code implementation in Kuwait

Key dates in the history of the I. code
implementation in Kuwait
1997
• Adoption of Local Code of Marketing of Breast
Milk Substitutes.
• A Ministerial circular to ban receiving
milk samples directly by mothers or staff.

1998
• Ministerial Decree No. (642)
It is forbidden to accept free milk samples directly or
indirectly in all PHC and hospitals
It is forbidden to promote materials related to infant
formulas such as milk bottles, teats, posters,
pamphlets and booklets in all health care centers

2002
• Ministerial Resolution No. (632)
Article 1
It is forbidden to accept free milk samples directly or
indirectly in all governmental and private PHC
and hospitals as well as private clinics
Article 2
It is forbidden to promote materials related to infant
formulas such as milk bottles, teats, posters,
pamphlets and booklets in all private health care
centers

2002
• Ministerial Decree No. (532)
Regarding breastmilk substitutes and infant formulas;
1- Classified as Special foods
2- Include infant formulas, follow up milk, canned
infant foods, infant formulas prepared from cereals
and pulses, etc…
• Regulation No. 7 on advertising
It is forbidden to advertise by use of words or picture
or photo or writing in whatever means or tools of
advertising.

Kuwait Breast feeding Promotion
Program Recent Activities (2011-2012)
BFHI& IYCF Training
Courses
WBTi
I. Code training
The First Kuwait IYCF Conference 2011

Poor implementation of the International Code of Marketing of
Breast milk Substitutes in Kuwait

I. Code Monitoring System in Kuwait
• A monitoring system has been established
since 2009.
• A cross sectional survey was conducted on
154 mothers of infants between 6-24 months
attending immunization clinics.
• IBFAN monitoring tool (SIM) was used.

Form 1
Interview with
Mothers
Form 2
Promotion in Shops
Form 3
Hospitals and Clinics
Form 4
Labels of Infant Formula,
other breastmilk substitutes
and bottles and teats
Form 5
Company materials for
health workers and general
public

Survey of marketing breast milk substitutes in Kuwait
2009
Form 1: Interview with mothers
variables 2009
Survey sample 154
Median age (months) 3.2
% babies were consuming any
commercial food
99.4

Kuwait National Survey on Implementation
of International Code for Breast milk substitutes
2009 %
Mothers met companies representatives 48.7%
Mothers given samples 40.9%
At health facility 28.6%

Survey of marketing breast milk substitutes in Kuwait
2012
Form 1: Interview with mothers
variables 2012
Survey sample 143
Median age (months) 4.0
% babies were consuming any
commercial food
91.6

SIM Form 2
Promotion in Shops
2009
• Monitoring promotion in retail outlets was
conducted at 31 shops and pharmacies .
• Infant formula companies (Melupa, Abbot and
Nestle) were giving special offers and gifts.

SIM Form 3
Hospitals and Clinics 2009
• That was the most difficult part of the survey.
• The monitoring was conducted by university
students on 41 doctors and nurses from three
hospitals only.
• 100% said no free samples or gifts distribution at
their facilities.

Lessons learnt
• To ensure information accuracy better to
double check the answers and ask different
workers in different areas.
• Depend on your personal observations.
• You should take photos for the violations you
observed.
• Do not give copies of the forms it might
influence the way they answer your questions.

Conclusion
• The monitoring system of the I. Code in Kuwait needs enforcement
and sustainability.
• Baby food companies are violating the code everywhere in Kuwait
which mandates the issuance of a strict law.
• A policy document about Code implementation has been
formulated and passed to the MOH for issuance soon.
• A committee is formulated to monitor labels of Infant Formulas
and other breastmilk substitutes.

Dr Mona AlSumaie
Head of Community Nutrition Supervisory / FNA / MOH
MB Bch – DCH – Msc H. Nutrition - IBCLC
Kuwait Breastfeeding Promotion & BFHI Programs Coordinator