Violations of the International Code (Code) of Marketing of Breast-milk Substitutes (BMS) in Health Systems of Burkina Faso and Cote d’Ivoire

Abstract Objectives Marketing of BMS continue to undermine breastfeeding globally. The health system is the most frequently used marketing platform in West Africa. In Burkina Faso (BF) and Cote d'Ivoire (CI), we aimed to understand the frequency and type of contacts between representatives of BMS companies and health workers, the presence of educational materials and branded equipment in health facilities, and their overall prevalence in public and private health facilities. Methods In 2021, we used the World Health Organization's NetCode protocol and conducted semi-structured interviews with health workers (130 in BF and 126 in CI) and mothers of children less than 2 years (330 in BF and in CI), and observations of educational materials in most urban facilities (43 in BF and 42 in CI). Contents of materials were analyzed to evaluate their compliance with the Code. Descriptive statistics and chi square tests were used to assess differences by child age and facility type (public vs. Private). Results Health workers in BF (67%) and in CI (63%) were contacted by BMS companies with on-site visits being the most frequently used method. The main reasons given for contact were to provide samples for distribution and to provide incentives/gadgets for health workers and facilities. The overall knowledge of health workers on the Code was very low in both countries; only 8% in CI and 1% in BF had heard of it. 43% of mothers in Cote d'Ivoire and 24% in Burkina Faso were advised to feed their children BMS products in the last six months. Conclusions Strong actions are needed in CI and BF to prevent BMS promotion in the health system, including increasing health workers’ knowledge of the International Code and national regulations, monitoring and sanctions imposed for violations, and reaching mothers and families with infant and young children to promote optimal breastfeeding practices. Funding Sources Bill & Melinda Gates Foundation through Alive & Thrive, managed by FHI Solutions.