This document provides an analysis of the status of national implementation of the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolutions (the Code) in 194 countries. It finds that as of 2018, 136 countries have some form of legal measures relating to the Code, though the comprehensiveness of the measures varies significantly between countries and regions. Few countries adequately address inappropriate marketing of complementary foods. The report recommends that all countries establish robust laws and enforcement mechanisms to eliminate inappropriate marketing practices in line with the Code and WHO guidance.
WHO Pharmaceuticals NEWSLETTER , 2019 No.2.
The WHO Pharmaceuticals Newsletter provides you
with the latest information on the safety of medicines
and legal actions taken by regulatory authorities around
the world. It also provides signals based on information
derived from the WHO global database of individual
case safety reports
The WHO Pharmaceuticals Newsletter provides regulatory updates and safety information on medicines from various national regulatory authorities and WHO. This issue includes regulatory actions and safety warnings issued by authorities in countries such as Japan, Ireland, UK, New Zealand, and others. Warnings included updated risks of non-melanoma skin cancer with hydrochlorothiazide, hypoglycemia with direct-acting antivirals for hepatitis C, tendon damage and neurological effects with fluoroquinolone antibiotics, and thromboembolic events with irinotecan. It also provides signals identified in WHO's global pharmacovigilance database and updates on WHO initiatives in India and Thailand.
WHO model list of essential medicines: 21st list 2019Niraj Bartaula
WHO’s Essential Medicines List and List of Essential Diagnostics are core guidance documents that help countries prioritize critical health products that should be widely available and affordable throughout health systems.
The updated Essential Medicines List adds 28 medicines for adults and 23 for children and specifies new uses for 26 already-listed products, bringing the total to 460 products deemed essential for addressing key public health needs.
A report outlining the differences in the Biosimilar regulatory market betwee...MalavikaSankararaman
The document discusses key differences between the biosimilar markets in the EU and US. The EU approved its first biosimilar, Omnitrope, in 2006 and has since approved over 48 biosimilars, while the US approved its first, Zarxio, in 2015 and has approved only 11. The disparity is due to differences in regulatory pathways, interchangeability standards, and litigation procedures. The EU has a more established pathway under the EMA and allows for interchangeability through physician switching or pharmacist substitution, while the US pathway was only established in 2009 and has stricter interchangeability requirements. Patent litigation is also more complex and drawn out in the US compared to the centralized process in Europe.
The Organic Products Cluster (OPC) was established in 2006 to bring together actors involved in the organic products business in Greece and facilitate the organic products market. It has members from across Greece including manufacturing companies, producers, and certification organizations. The OPC organizes events, seminars, and projects to promote members' products and services, provide industry information and support, and represent members in policy discussions.
This document provides an overview and market analysis of the global contraceptives industry. It includes industry trends, segmentation by product type, profiles of major companies, and research and development activities. The document also discusses the role of organizations like the United Nations in promoting contraceptive use globally. Key product segments covered include oral contraceptives, condoms, implants/injections, and other contraceptive methods. Market data and forecasts are provided for 2007-2015 with a focus on major geographic regions.
To recap the previous month's pharma highlights to Pharma Uptoday members, Monthly magazine Volume 6 has been released with
News Uptoday
New Guidance
New MAPP Release
Audit Findings
483 Observations
- 483 of Impax Laboratories
- 483 of Ipca Labs
- 483 of Bausch & Lomb Inc
- 483 of Alexion
Warning Letters
- Marck Biosciences Ltd.
- The Compounding Shop Inc.
- Zions Rx Formulations Services LLC.
EMA Non-Compliance Reports
- Renown Pharmaceuticals Pvt. Ltd., India
- VETPROM AD, Bulgaria
- SCM PHARMA LIMITED, UK
Guest of the Month
Dr. M Damodharan - Vice President Global Quality & Regulatory
Regulations of the Month
§ 211.180 Subpart J--Records and Reports - General Requirements
§ 211.182 Subpart J--Records and Reports - Equipment cleaning & use log
Pfizer will acquire Hospira for approximately $17 billion in an all-cash deal. The acquisition will enhance Pfizer's global established pharmaceutical business by adding Hospira's injectable drugs and biosimilars portfolio. The combination is expected to generate annual cost savings of $800 million by 2018 and be immediately accretive to Pfizer's earnings per share. The acquisition is subject to regulatory approvals and Hospira shareholder approval.
WHO Pharmaceuticals NEWSLETTER , 2019 No.2.
The WHO Pharmaceuticals Newsletter provides you
with the latest information on the safety of medicines
and legal actions taken by regulatory authorities around
the world. It also provides signals based on information
derived from the WHO global database of individual
case safety reports
The WHO Pharmaceuticals Newsletter provides regulatory updates and safety information on medicines from various national regulatory authorities and WHO. This issue includes regulatory actions and safety warnings issued by authorities in countries such as Japan, Ireland, UK, New Zealand, and others. Warnings included updated risks of non-melanoma skin cancer with hydrochlorothiazide, hypoglycemia with direct-acting antivirals for hepatitis C, tendon damage and neurological effects with fluoroquinolone antibiotics, and thromboembolic events with irinotecan. It also provides signals identified in WHO's global pharmacovigilance database and updates on WHO initiatives in India and Thailand.
WHO model list of essential medicines: 21st list 2019Niraj Bartaula
WHO’s Essential Medicines List and List of Essential Diagnostics are core guidance documents that help countries prioritize critical health products that should be widely available and affordable throughout health systems.
The updated Essential Medicines List adds 28 medicines for adults and 23 for children and specifies new uses for 26 already-listed products, bringing the total to 460 products deemed essential for addressing key public health needs.
A report outlining the differences in the Biosimilar regulatory market betwee...MalavikaSankararaman
The document discusses key differences between the biosimilar markets in the EU and US. The EU approved its first biosimilar, Omnitrope, in 2006 and has since approved over 48 biosimilars, while the US approved its first, Zarxio, in 2015 and has approved only 11. The disparity is due to differences in regulatory pathways, interchangeability standards, and litigation procedures. The EU has a more established pathway under the EMA and allows for interchangeability through physician switching or pharmacist substitution, while the US pathway was only established in 2009 and has stricter interchangeability requirements. Patent litigation is also more complex and drawn out in the US compared to the centralized process in Europe.
The Organic Products Cluster (OPC) was established in 2006 to bring together actors involved in the organic products business in Greece and facilitate the organic products market. It has members from across Greece including manufacturing companies, producers, and certification organizations. The OPC organizes events, seminars, and projects to promote members' products and services, provide industry information and support, and represent members in policy discussions.
This document provides an overview and market analysis of the global contraceptives industry. It includes industry trends, segmentation by product type, profiles of major companies, and research and development activities. The document also discusses the role of organizations like the United Nations in promoting contraceptive use globally. Key product segments covered include oral contraceptives, condoms, implants/injections, and other contraceptive methods. Market data and forecasts are provided for 2007-2015 with a focus on major geographic regions.
To recap the previous month's pharma highlights to Pharma Uptoday members, Monthly magazine Volume 6 has been released with
News Uptoday
New Guidance
New MAPP Release
Audit Findings
483 Observations
- 483 of Impax Laboratories
- 483 of Ipca Labs
- 483 of Bausch & Lomb Inc
- 483 of Alexion
Warning Letters
- Marck Biosciences Ltd.
- The Compounding Shop Inc.
- Zions Rx Formulations Services LLC.
EMA Non-Compliance Reports
- Renown Pharmaceuticals Pvt. Ltd., India
- VETPROM AD, Bulgaria
- SCM PHARMA LIMITED, UK
Guest of the Month
Dr. M Damodharan - Vice President Global Quality & Regulatory
Regulations of the Month
§ 211.180 Subpart J--Records and Reports - General Requirements
§ 211.182 Subpart J--Records and Reports - Equipment cleaning & use log
Pfizer will acquire Hospira for approximately $17 billion in an all-cash deal. The acquisition will enhance Pfizer's global established pharmaceutical business by adding Hospira's injectable drugs and biosimilars portfolio. The combination is expected to generate annual cost savings of $800 million by 2018 and be immediately accretive to Pfizer's earnings per share. The acquisition is subject to regulatory approvals and Hospira shareholder approval.
Marketing of breast milk substitutes: national implementation of the international code, status report 2020.
Este relatório fornece informações atualizadas sobre o status da implementação do Código Internacional de Comercialização de Substitutos do Leite Materno (NBCAL no Brasil) e subsequentes resoluções relevantes da Assembléia Mundial da Saúde (“o Código”) nos países. Apresenta o status legal do Código, incluindo até que ponto suas disposições foram incorporadas nas medidas legais nacionais.
Dado o importante papel dos profissionais de saúde na proteção de mulheres grávidas, mães e seus bebês da promoção inadequada de fórmulas infantis, o relatório de 2020 destaca disposições específicas consideradas particularmente úteis para abordar e eliminar a promoção de substitutos do leite materno, mamadeiras e bicos aos profissionais de saúde e nas unidades de saúde, e fornece uma extensa análise das medidas legais adotadas para proibir a promoção para os profissionais de saúde e nas unidades de saúde.
Neste relatório, um novo algoritmo de pontuação foi usado para classificar a legislação dos países. Os métodos de pontuação permitem a classificação padronizada de países, seguindo os critérios acordados entre a OMS, UNICEF e IBFAN. As medidas legais para todos os países foram analisadas com base em uma lista de verificação padronizada e expandida com um algoritmo para facilitar uma classificação sistemática e objetiva dos países de acordo com o seu alinhamento com o Código. Desde 2018, continua havendo progresso na promoção e proteção do aleitamento materno, globalmente e nos países. Medidas mais robustas para coibir práticas de marketing prejudiciais contínuas por fabricantes e distribuidores de fórmulas infantis foram adotadas em vários países.
Thahira Shireen Mustafa
Departamento de Nutrição e Segurança Alimentar
Organização Mundial da Saúde
Muito bom!
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Promoção comercial dos ditos substitutos do leite materno:
Implementação do Código Internacional -
relatório de situação mundial em 2024
Esta publicação fornece informações atualizadas sobre o estado de implementação do Código Internacional de Comercialização de Substitutos do Leite Materno (de 1981) e subsequentes resoluções da Assembleia Mundial da Saúde (relacionadas com o “Código”) por países. Apresenta o estatuto jurídico do Código, incluindo até que ponto as disposições de recomendação foram incorporadas nas legislações nacionais.
O relatório centra-se na forma como as medidas legais delineiam processos de monitorização e aplicação para garantir a eficácia das disposições incluídas.
Também destaca exemplos importantes de interferência de fabricantes e distribuidores de substitutos do leite materno nos esforços para enfraquecer e atrasar a implementação de proteções contra o marketing antiético.
O Brasil aparece classificado como “substancialmente alinhado com o Código” devido à NBCAL – Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras, que está em constante atualização desde sua primeira versão de 1988.
Esse status no traz esperança de continuar avançando, principalmente contra o marketing digital perpetrado pelas redes sociais e pelas ditas “influenciadoras”.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Relatório apresenta uma análise do estado atual da BFHI - Baby-Friendly Hospital Initiative (No Brasil, IHAC – Iniciativa Hospital Amigo da Criança) em países ao redor do mundo.
Com base na 2 ª revisão da política global de nutrição, implementado pela OMS em 2016-2017, o documento apresenta a implementação da iniciativa, 25 anos após o seu lançamento.
O relatório descreve a cobertura do programa, o atual processo de designação, razões para rescisão em locais onde o programa foi descontinuado, integração dos dez passos para outras normas e políticas globais, e lições aprendidas. Além disso, o relatório fornece informação qualitativa em alguns dos países que enfrentaram desafios na implementação da BFHI.
Excelente publicação – o Brasil é citado várias vezes.
Number of pages: 60
Publication date: 2017
Languages: English
ISBN: 978 92 4 151238 1
The document summarizes the 55th report of the WHO Expert Committee on Specifications for Pharmaceutical Preparations. The report outlines the Committee's discussions and adoption of several new guidelines and standards related to good manufacturing practices, quality control of medicines, international reference materials, and regulatory guidance. Key items adopted include revised GMP guidelines for sterile products and water for pharmaceutical use, as well as new guidelines on data integrity, bioequivalence waivers for essential medicines, and certification schemes for medicine quality.
The document provides guidelines from the World Health Organization (WHO) for malaria prevention and control. It recommends several vector control interventions for large-scale deployment, including pyrethroid-only long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) using a WHO-prequalified insecticide. It conditionally recommends pyrethroid-PBO nets and larviciding as supplementary measures in some settings. It recommends ensuring access to effective vector control through ITNs or IRS at optimal coverage levels for populations at risk of malaria.
Em fevereiro de 2022, o Dr. Tedros Adhanom, Diretor-Geral da OMS, o UNICEF e parceiros lançaram um novo relatório, "Como o marketing do leite artificial influencia nossas decisões sobre alimentação infantil".
Este relatório - o maior de seu tipo até hoje - baseia-se nas experiências de mais de 8.500 mulheres e 300 profissionais de saúde em 8 países. Ele expõe as práticas agressivas de marketing usadas pela indústria do leite em pó e destaca os impactos nas decisões das famílias sobre como alimentar seus bebês e crianças pequenas.
Mais da metade dos pais, mães e mulheres grávidas está exposta ao marketing agressivo de fórmulas infantis.
...
As mensagens que famílias e profissionais de saúde recebem são muitas vezes enganosas, cientificamente infundadas e violam o Código Internacional de Comercialização de Substitutos do Leite Materno (o Código) – um acordo histórico de saúde pública aprovado pela Assembleia Mundial da Saúde em 1981 para proteger as mães de práticas agressivas de marketing por parte da indústria de alimentos para bebês.
...
Ainda em inglês, vale ler e divulgar essa publicação.
Pela proteção à Amamentação.
Prof. Marcus Renato de Carvalho
Finalmente saiu a atualização do manual da OMS sobre PARTO e NASCIMENTO. A 1a. edição foi publicada há mais de 20 anos atrás - 1996!
Desde então, tivemos no ano passado a publicação das diretrizes do Ministério da Saúde, para cesárea e parto normal, um trabalho colaborativo de grande porte, denso, em que muit@s de nós tivemos o privilégio de poder contribuir.
E esta semana saiu! Ainda está apenas em inglês, espero que em breve esteja acessível em outros idiomas. Incluindo o nosso!
Algumas coisas do que dá para perceber lendo o sumário a partir da página 3:
- o foco principal é na redução de intervenções sem indicação precisa
- inova ao incluir como resultado a mulher relatar o parto como uma experiência positiva
- adorei a proposta de um toque vaginal a cada 4h no primeiro estágio, fase latente
- recomenda banho do bebê só depois de 24 horas (afora contato pele-a-pele, amamentação na primeira hora etc)
- inclui cuidados com a mulher no pós-parto imediato
- esta versão integra recomendações provenientes de outros documentos da OMS
Bem - agora é ler, tomar conhecimento e adotar como referência, né?
Muito, muito bom!
Dizem que o ano começa, de verdade, após o carnaval - taí! começou bem!
Cordialmente,
Daphne Rattner
ReHuNa
Recomendações da OMS: Cuidados intra-parto para um
experiência de parto/nascimento positiva (baseada em evidências científicas).
Já se passaram mais de duas décadas desde que a Organização Mundial da Saúde (OMS) emitiu orientação técnica dedicada ao cuidado de gestantes saudáveis e seus bebês - Cuidados no parto normal: um guia prático.
O panorama global dos serviços de maternidade mudou consideravelmente desde que essa orientação foi publicada.
Mais mulheres estão dando à luz em instituições de saúde em muitas partes do mundo e, ainda assim, abaixo do ideal.
A qualidade dos cuidados continua a impedir a obtenção dos resultados desejados. Enquanto em algumas configurações também poucas intervenções estão sendo fornecidas tarde demais para as mulheres, em outros ambientes as mulheres estão recebendo muitas intervenções desnecessárias...
...
A nossa querida Profa. Melania Amorim foi uma das autoras dessa importante publicação.
Prof. Marcus Renato de Carvalho
This document provides guidance on the medical management of abortion, including recommendations for incomplete abortion, intrauterine fetal demise, induced abortion, and post-abortion contraception. It aims to expand access to safe, effective non-surgical abortion services and includes guidance on using mifepristone and misoprostol combinations or misoprostol-only regimens for medical abortion. The recommendations were developed based on a review of the evidence and consideration of human rights, ethics, safety and implementation factors.
The document is a mission report from a Joint External Evaluation of IHR Core Capacities conducted in Pakistan from 27 April to 6 May 2016. The evaluation assessed Pakistan's capabilities across prevention, detection and response domains for health emergencies. Key areas examined included legislation, coordination, laboratories, surveillance, zoonotic diseases, immunization, preparedness and more. Provincial reports on capacities in Sindh, Punjab, Khyber Pakhtunkhwa, Balochistan and other areas are also included. The evaluation provides Pakistan with recommendations and areas for further strengthening its compliance with International Health Regulations.
The document summarizes the 55th report of the WHO Expert Committee on Specifications for Pharmaceutical Preparations. The report adopted several new guidelines and guidance texts related to good manufacturing practices, data integrity, regulatory practices, specifications for medicines including those for COVID-19, and other quality assurance areas. It also recommended texts for inclusion in The International Pharmacopoeia and outlined the Committee's views and recommendations.
Budget matters for health: key formulation and classification issuesHFG Project
This policy brief aims to raise awareness on the role of public budgeting – specifically aspects of budget formulation – for non-PFM specialists working in health. As part of an overall WHO programme of work on Budgeting in Health, it will help clarify the characteristics and implications of various budgeting approaches for the health sector.
Novas diretrizes da OMS e Unicef para maternidades, casas de parto e centros de nascimento:
Protecting, promoting and supporting Breastfeeding in facilities providing maternity and newborn services: the revised
BABY-FRIENDLY HOSPITAL INITIATIVE
OMS e Unicef relançam os 10 passos da IHAC/BFHI leia em http://www.aleitamento.med.br/amamentacao/conteudo.asp?cod=2358
WHO Foresight Approaches in Public Health.pdfWendy Schultz
Suggestions for expanding futures research and foresight capabilities in an organization, with an emphasis on broad participation by stakeholders; includes examples of multiple futures methods and linked processes.
This document discusses frameworks for essential public health functions (EPHFs) developed by the World Health Organization and other organizations. It analyzes existing EPHF frameworks to identify common functions. Key findings include: WHO regions have developed their own EPHF lists; common "horizontal" functions across frameworks include governance, financing, human resources, health information systems, and research. The document aims to develop conceptual clarity around EPHFs and inform a WHO roadmap to guide their application at country and regional levels.
The WHO just released a report that looked at how well countries are preparing for the health effects of climate change, and found that few are making progress. Analyzing data from 101 countries, the report says that half have strategies in place, and many of the countries cited finances as being the major challenge to implementing national plans. Only 12 countries reported having a national curriculum to train its health force on the effects of climate change, while 27 countries have plans in development. At the same time, only a quarter of the countries assessed looked at how their countries would be affected by vector-borne, water-, or food-borne diseases as a result of climate change.
Welcome to the 38th edition of The Authentication Times.
We hope you are doing well, staying healthy, and, most importantly, taking care of
your loved ones. The pandemic COVID-19 is affecting all of us and we can only face it all together. Let’s all work together to remain calm, be positive and fight this outbreak.
Firstly, we request all stakeholders to #Stayhome and practice social distancing. While there are various myths and rumors are spreading, we would suggest adhering to some practices while forwarding these messages at social media. Various other concerns are increasing among the public including the news of getting fake personal protection equipment’s, including sanitizers & masks. Witnessing a scarcity of sanitizers and
face masks since the COVID-19 outbreak, Counterfeiters and profiteers have offered the bogus public treatments and unfounded advice. These are ideal conditions for
criminals to capitalize on people’s fears by advertising falsified therapies and vaccines and spreading rumors of potential cures. In this challenging situation, being vigilant is the most important thing (Please refer our special page on COVID-19 & counterfeiting).
Secondly, referring to current issue, we are highlighting the issue of “Food & Beverages Safety & Quality – An overview on recent regulation, product recall, authentication & traceability”. Apart from it, you will also find various authentication & traceability initiative various countries are adopting in combating illicit trade, smuggling and counterfeiting. This is a positive step and we hope more and more countries will come together in fighting illicit trade.
We hope you will find this issue informative and interesting and as always, we look
forward to receiving your feedback. If you have any news, contributions or comments for the editorial team, please feel free to email us at info@aspaglobal.com
The document discusses international harmonization in the pharmaceutical industry. It defines regulatory harmonization as making technical guidelines uniform across countries. It describes international organizations that work on harmonization, like ICH which brings together regulators from Europe, Japan, US, and others. Harmonization has benefits like faster drug approvals and reduced costs, but also risks like potentially weakening public health protections and limiting competition. The document also discusses pharmaceutical regulation and harmonization challenges in Pakistan, like weak domestic regulation, an emphasis on price controls over quality, and lack of investment in quality and GMP compliance.
This document provides guidelines from the World Health Organization (WHO) on reducing the risk of cognitive decline and dementia. It was developed by an international group of experts and provides evidence-based recommendations in 12 areas, including physical activity, nutrition, social activity, management of hypertension and diabetes, and hearing loss. The guidelines aim to provide a knowledge base for healthcare providers, policymakers, and other stakeholders to reduce dementia risks through public health approaches. Key recommendations can be integrated into existing programs for non-communicable diseases. Implementation of the guidelines may help improve the lives of people with dementia and their families by delaying or slowing the onset and progression of the disease.
A Organização Mundial da Saúde lançou, no dia 30 de março, diretrizes globais inéditas para apoiar mulheres e recém-nascidos no período pós-natal, que considera as primeiras seis semanas após o nascimento.
Segundo a OMS, este é um momento crítico para garantir a sobrevivência do recém-nascido e da mãe e para apoiar o desenvolvimento saudável do bebê, bem como a recuperação e o bem-estar mental e físico geral da mãe.
Atualmente, mais de 3 em cada 10 mulheres e bebês em todo o mundo não recebem cuidados pós-natais nos primeiros dias após o nascimento – o período em que ocorre a maioria das mortes maternas e infantis.
...
As diretrizes incluem orientações sobre #amamentação, #aconselhamento e informações de apoio aos pais no oferecimento de cuidados aos recém-nascidos. No total, as novas diretrizes reúnem mais de 60 recomendações que ajudam a moldar uma experiência pós-natal positiva para mulheres, bebês e famílias.
...
Recomendamos essa publicação (ainda em idioma inglês) que está sensacional e muito útil para orientar nossa atenção baseada em evidências científicas.
Prof. Marcus Renato de Carvalho
www.aleitamento.com
Concepção, gravidez, parto e pós-parto: perspectivas feministas e interseccionais
Livro integra a coleção Temas em Saúde Coletiva
A mais recente publicação do Instituto de SP traça a evolução da política de saúde voltada para as mulheres e pessoas que engravidam no Brasil ao longo dos últimos cinquenta anos.
A publicação se inicia com uma análise aprofundada de dois conceitos fundamentais: gênero e interseccionalidade. Ao abordar questões de saúde da mulher, considera-se o contexto social no qual a mulher está inserida, levando em conta sua classe, raça e gênero. Um dos pontos centrais deste livro é a transformação na assistência ao parto, influenciada significativamente pelos movimentos sociais, que desde a década de 1980 denunciam o uso irracional de tecnologia na assistência.
Essas iniciativas se integraram ao movimento emergente de avaliação tecnológica em saúde e medicina baseada em evidências, resultando em estudos substanciais que impulsionaram mudanças significativas, muitas das quais são discutidas nesta edição. Esta edição tem como objetivo fomentar o debate na área da saúde, contribuindo para a formação de profissionais para o SUS e auxiliando na formulação de políticas públicas por meio de uma discussão abrangente de conceitos e tendências do campo da Saúde Coletiva.
Esta edição amplia a compreensão das diversas facetas envolvidas na garantia de assistência durante o período reprodutivo, promovendo uma abordagem livre de preconceitos, discriminação e opressão, pautada principalmente nos direitos humanos.
Dois capítulos se destacam: ‘“A pulseirinha do papai”: heteronormatividade na assistência à saúde materna prestada a casais de mulheres em São Paulo’, e ‘Políticas Públicas de Gestação, Práticas e Experiências Discursivas de Gravidez Trans masculina’.
Parabéns às autoras e organizadoras!
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
More Related Content
Similar to Código Internacional dos ditos Substitutos do Leite Materno - OMS: relatório sobre a implementação nacional
Marketing of breast milk substitutes: national implementation of the international code, status report 2020.
Este relatório fornece informações atualizadas sobre o status da implementação do Código Internacional de Comercialização de Substitutos do Leite Materno (NBCAL no Brasil) e subsequentes resoluções relevantes da Assembléia Mundial da Saúde (“o Código”) nos países. Apresenta o status legal do Código, incluindo até que ponto suas disposições foram incorporadas nas medidas legais nacionais.
Dado o importante papel dos profissionais de saúde na proteção de mulheres grávidas, mães e seus bebês da promoção inadequada de fórmulas infantis, o relatório de 2020 destaca disposições específicas consideradas particularmente úteis para abordar e eliminar a promoção de substitutos do leite materno, mamadeiras e bicos aos profissionais de saúde e nas unidades de saúde, e fornece uma extensa análise das medidas legais adotadas para proibir a promoção para os profissionais de saúde e nas unidades de saúde.
Neste relatório, um novo algoritmo de pontuação foi usado para classificar a legislação dos países. Os métodos de pontuação permitem a classificação padronizada de países, seguindo os critérios acordados entre a OMS, UNICEF e IBFAN. As medidas legais para todos os países foram analisadas com base em uma lista de verificação padronizada e expandida com um algoritmo para facilitar uma classificação sistemática e objetiva dos países de acordo com o seu alinhamento com o Código. Desde 2018, continua havendo progresso na promoção e proteção do aleitamento materno, globalmente e nos países. Medidas mais robustas para coibir práticas de marketing prejudiciais contínuas por fabricantes e distribuidores de fórmulas infantis foram adotadas em vários países.
Thahira Shireen Mustafa
Departamento de Nutrição e Segurança Alimentar
Organização Mundial da Saúde
Muito bom!
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Promoção comercial dos ditos substitutos do leite materno:
Implementação do Código Internacional -
relatório de situação mundial em 2024
Esta publicação fornece informações atualizadas sobre o estado de implementação do Código Internacional de Comercialização de Substitutos do Leite Materno (de 1981) e subsequentes resoluções da Assembleia Mundial da Saúde (relacionadas com o “Código”) por países. Apresenta o estatuto jurídico do Código, incluindo até que ponto as disposições de recomendação foram incorporadas nas legislações nacionais.
O relatório centra-se na forma como as medidas legais delineiam processos de monitorização e aplicação para garantir a eficácia das disposições incluídas.
Também destaca exemplos importantes de interferência de fabricantes e distribuidores de substitutos do leite materno nos esforços para enfraquecer e atrasar a implementação de proteções contra o marketing antiético.
O Brasil aparece classificado como “substancialmente alinhado com o Código” devido à NBCAL – Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras, que está em constante atualização desde sua primeira versão de 1988.
Esse status no traz esperança de continuar avançando, principalmente contra o marketing digital perpetrado pelas redes sociais e pelas ditas “influenciadoras”.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Relatório apresenta uma análise do estado atual da BFHI - Baby-Friendly Hospital Initiative (No Brasil, IHAC – Iniciativa Hospital Amigo da Criança) em países ao redor do mundo.
Com base na 2 ª revisão da política global de nutrição, implementado pela OMS em 2016-2017, o documento apresenta a implementação da iniciativa, 25 anos após o seu lançamento.
O relatório descreve a cobertura do programa, o atual processo de designação, razões para rescisão em locais onde o programa foi descontinuado, integração dos dez passos para outras normas e políticas globais, e lições aprendidas. Além disso, o relatório fornece informação qualitativa em alguns dos países que enfrentaram desafios na implementação da BFHI.
Excelente publicação – o Brasil é citado várias vezes.
Number of pages: 60
Publication date: 2017
Languages: English
ISBN: 978 92 4 151238 1
The document summarizes the 55th report of the WHO Expert Committee on Specifications for Pharmaceutical Preparations. The report outlines the Committee's discussions and adoption of several new guidelines and standards related to good manufacturing practices, quality control of medicines, international reference materials, and regulatory guidance. Key items adopted include revised GMP guidelines for sterile products and water for pharmaceutical use, as well as new guidelines on data integrity, bioequivalence waivers for essential medicines, and certification schemes for medicine quality.
The document provides guidelines from the World Health Organization (WHO) for malaria prevention and control. It recommends several vector control interventions for large-scale deployment, including pyrethroid-only long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) using a WHO-prequalified insecticide. It conditionally recommends pyrethroid-PBO nets and larviciding as supplementary measures in some settings. It recommends ensuring access to effective vector control through ITNs or IRS at optimal coverage levels for populations at risk of malaria.
Em fevereiro de 2022, o Dr. Tedros Adhanom, Diretor-Geral da OMS, o UNICEF e parceiros lançaram um novo relatório, "Como o marketing do leite artificial influencia nossas decisões sobre alimentação infantil".
Este relatório - o maior de seu tipo até hoje - baseia-se nas experiências de mais de 8.500 mulheres e 300 profissionais de saúde em 8 países. Ele expõe as práticas agressivas de marketing usadas pela indústria do leite em pó e destaca os impactos nas decisões das famílias sobre como alimentar seus bebês e crianças pequenas.
Mais da metade dos pais, mães e mulheres grávidas está exposta ao marketing agressivo de fórmulas infantis.
...
As mensagens que famílias e profissionais de saúde recebem são muitas vezes enganosas, cientificamente infundadas e violam o Código Internacional de Comercialização de Substitutos do Leite Materno (o Código) – um acordo histórico de saúde pública aprovado pela Assembleia Mundial da Saúde em 1981 para proteger as mães de práticas agressivas de marketing por parte da indústria de alimentos para bebês.
...
Ainda em inglês, vale ler e divulgar essa publicação.
Pela proteção à Amamentação.
Prof. Marcus Renato de Carvalho
Finalmente saiu a atualização do manual da OMS sobre PARTO e NASCIMENTO. A 1a. edição foi publicada há mais de 20 anos atrás - 1996!
Desde então, tivemos no ano passado a publicação das diretrizes do Ministério da Saúde, para cesárea e parto normal, um trabalho colaborativo de grande porte, denso, em que muit@s de nós tivemos o privilégio de poder contribuir.
E esta semana saiu! Ainda está apenas em inglês, espero que em breve esteja acessível em outros idiomas. Incluindo o nosso!
Algumas coisas do que dá para perceber lendo o sumário a partir da página 3:
- o foco principal é na redução de intervenções sem indicação precisa
- inova ao incluir como resultado a mulher relatar o parto como uma experiência positiva
- adorei a proposta de um toque vaginal a cada 4h no primeiro estágio, fase latente
- recomenda banho do bebê só depois de 24 horas (afora contato pele-a-pele, amamentação na primeira hora etc)
- inclui cuidados com a mulher no pós-parto imediato
- esta versão integra recomendações provenientes de outros documentos da OMS
Bem - agora é ler, tomar conhecimento e adotar como referência, né?
Muito, muito bom!
Dizem que o ano começa, de verdade, após o carnaval - taí! começou bem!
Cordialmente,
Daphne Rattner
ReHuNa
Recomendações da OMS: Cuidados intra-parto para um
experiência de parto/nascimento positiva (baseada em evidências científicas).
Já se passaram mais de duas décadas desde que a Organização Mundial da Saúde (OMS) emitiu orientação técnica dedicada ao cuidado de gestantes saudáveis e seus bebês - Cuidados no parto normal: um guia prático.
O panorama global dos serviços de maternidade mudou consideravelmente desde que essa orientação foi publicada.
Mais mulheres estão dando à luz em instituições de saúde em muitas partes do mundo e, ainda assim, abaixo do ideal.
A qualidade dos cuidados continua a impedir a obtenção dos resultados desejados. Enquanto em algumas configurações também poucas intervenções estão sendo fornecidas tarde demais para as mulheres, em outros ambientes as mulheres estão recebendo muitas intervenções desnecessárias...
...
A nossa querida Profa. Melania Amorim foi uma das autoras dessa importante publicação.
Prof. Marcus Renato de Carvalho
This document provides guidance on the medical management of abortion, including recommendations for incomplete abortion, intrauterine fetal demise, induced abortion, and post-abortion contraception. It aims to expand access to safe, effective non-surgical abortion services and includes guidance on using mifepristone and misoprostol combinations or misoprostol-only regimens for medical abortion. The recommendations were developed based on a review of the evidence and consideration of human rights, ethics, safety and implementation factors.
The document is a mission report from a Joint External Evaluation of IHR Core Capacities conducted in Pakistan from 27 April to 6 May 2016. The evaluation assessed Pakistan's capabilities across prevention, detection and response domains for health emergencies. Key areas examined included legislation, coordination, laboratories, surveillance, zoonotic diseases, immunization, preparedness and more. Provincial reports on capacities in Sindh, Punjab, Khyber Pakhtunkhwa, Balochistan and other areas are also included. The evaluation provides Pakistan with recommendations and areas for further strengthening its compliance with International Health Regulations.
The document summarizes the 55th report of the WHO Expert Committee on Specifications for Pharmaceutical Preparations. The report adopted several new guidelines and guidance texts related to good manufacturing practices, data integrity, regulatory practices, specifications for medicines including those for COVID-19, and other quality assurance areas. It also recommended texts for inclusion in The International Pharmacopoeia and outlined the Committee's views and recommendations.
Budget matters for health: key formulation and classification issuesHFG Project
This policy brief aims to raise awareness on the role of public budgeting – specifically aspects of budget formulation – for non-PFM specialists working in health. As part of an overall WHO programme of work on Budgeting in Health, it will help clarify the characteristics and implications of various budgeting approaches for the health sector.
Novas diretrizes da OMS e Unicef para maternidades, casas de parto e centros de nascimento:
Protecting, promoting and supporting Breastfeeding in facilities providing maternity and newborn services: the revised
BABY-FRIENDLY HOSPITAL INITIATIVE
OMS e Unicef relançam os 10 passos da IHAC/BFHI leia em http://www.aleitamento.med.br/amamentacao/conteudo.asp?cod=2358
WHO Foresight Approaches in Public Health.pdfWendy Schultz
Suggestions for expanding futures research and foresight capabilities in an organization, with an emphasis on broad participation by stakeholders; includes examples of multiple futures methods and linked processes.
This document discusses frameworks for essential public health functions (EPHFs) developed by the World Health Organization and other organizations. It analyzes existing EPHF frameworks to identify common functions. Key findings include: WHO regions have developed their own EPHF lists; common "horizontal" functions across frameworks include governance, financing, human resources, health information systems, and research. The document aims to develop conceptual clarity around EPHFs and inform a WHO roadmap to guide their application at country and regional levels.
The WHO just released a report that looked at how well countries are preparing for the health effects of climate change, and found that few are making progress. Analyzing data from 101 countries, the report says that half have strategies in place, and many of the countries cited finances as being the major challenge to implementing national plans. Only 12 countries reported having a national curriculum to train its health force on the effects of climate change, while 27 countries have plans in development. At the same time, only a quarter of the countries assessed looked at how their countries would be affected by vector-borne, water-, or food-borne diseases as a result of climate change.
Welcome to the 38th edition of The Authentication Times.
We hope you are doing well, staying healthy, and, most importantly, taking care of
your loved ones. The pandemic COVID-19 is affecting all of us and we can only face it all together. Let’s all work together to remain calm, be positive and fight this outbreak.
Firstly, we request all stakeholders to #Stayhome and practice social distancing. While there are various myths and rumors are spreading, we would suggest adhering to some practices while forwarding these messages at social media. Various other concerns are increasing among the public including the news of getting fake personal protection equipment’s, including sanitizers & masks. Witnessing a scarcity of sanitizers and
face masks since the COVID-19 outbreak, Counterfeiters and profiteers have offered the bogus public treatments and unfounded advice. These are ideal conditions for
criminals to capitalize on people’s fears by advertising falsified therapies and vaccines and spreading rumors of potential cures. In this challenging situation, being vigilant is the most important thing (Please refer our special page on COVID-19 & counterfeiting).
Secondly, referring to current issue, we are highlighting the issue of “Food & Beverages Safety & Quality – An overview on recent regulation, product recall, authentication & traceability”. Apart from it, you will also find various authentication & traceability initiative various countries are adopting in combating illicit trade, smuggling and counterfeiting. This is a positive step and we hope more and more countries will come together in fighting illicit trade.
We hope you will find this issue informative and interesting and as always, we look
forward to receiving your feedback. If you have any news, contributions or comments for the editorial team, please feel free to email us at info@aspaglobal.com
The document discusses international harmonization in the pharmaceutical industry. It defines regulatory harmonization as making technical guidelines uniform across countries. It describes international organizations that work on harmonization, like ICH which brings together regulators from Europe, Japan, US, and others. Harmonization has benefits like faster drug approvals and reduced costs, but also risks like potentially weakening public health protections and limiting competition. The document also discusses pharmaceutical regulation and harmonization challenges in Pakistan, like weak domestic regulation, an emphasis on price controls over quality, and lack of investment in quality and GMP compliance.
This document provides guidelines from the World Health Organization (WHO) on reducing the risk of cognitive decline and dementia. It was developed by an international group of experts and provides evidence-based recommendations in 12 areas, including physical activity, nutrition, social activity, management of hypertension and diabetes, and hearing loss. The guidelines aim to provide a knowledge base for healthcare providers, policymakers, and other stakeholders to reduce dementia risks through public health approaches. Key recommendations can be integrated into existing programs for non-communicable diseases. Implementation of the guidelines may help improve the lives of people with dementia and their families by delaying or slowing the onset and progression of the disease.
A Organização Mundial da Saúde lançou, no dia 30 de março, diretrizes globais inéditas para apoiar mulheres e recém-nascidos no período pós-natal, que considera as primeiras seis semanas após o nascimento.
Segundo a OMS, este é um momento crítico para garantir a sobrevivência do recém-nascido e da mãe e para apoiar o desenvolvimento saudável do bebê, bem como a recuperação e o bem-estar mental e físico geral da mãe.
Atualmente, mais de 3 em cada 10 mulheres e bebês em todo o mundo não recebem cuidados pós-natais nos primeiros dias após o nascimento – o período em que ocorre a maioria das mortes maternas e infantis.
...
As diretrizes incluem orientações sobre #amamentação, #aconselhamento e informações de apoio aos pais no oferecimento de cuidados aos recém-nascidos. No total, as novas diretrizes reúnem mais de 60 recomendações que ajudam a moldar uma experiência pós-natal positiva para mulheres, bebês e famílias.
...
Recomendamos essa publicação (ainda em idioma inglês) que está sensacional e muito útil para orientar nossa atenção baseada em evidências científicas.
Prof. Marcus Renato de Carvalho
www.aleitamento.com
Similar to Código Internacional dos ditos Substitutos do Leite Materno - OMS: relatório sobre a implementação nacional (20)
Concepção, gravidez, parto e pós-parto: perspectivas feministas e interseccionais
Livro integra a coleção Temas em Saúde Coletiva
A mais recente publicação do Instituto de SP traça a evolução da política de saúde voltada para as mulheres e pessoas que engravidam no Brasil ao longo dos últimos cinquenta anos.
A publicação se inicia com uma análise aprofundada de dois conceitos fundamentais: gênero e interseccionalidade. Ao abordar questões de saúde da mulher, considera-se o contexto social no qual a mulher está inserida, levando em conta sua classe, raça e gênero. Um dos pontos centrais deste livro é a transformação na assistência ao parto, influenciada significativamente pelos movimentos sociais, que desde a década de 1980 denunciam o uso irracional de tecnologia na assistência.
Essas iniciativas se integraram ao movimento emergente de avaliação tecnológica em saúde e medicina baseada em evidências, resultando em estudos substanciais que impulsionaram mudanças significativas, muitas das quais são discutidas nesta edição. Esta edição tem como objetivo fomentar o debate na área da saúde, contribuindo para a formação de profissionais para o SUS e auxiliando na formulação de políticas públicas por meio de uma discussão abrangente de conceitos e tendências do campo da Saúde Coletiva.
Esta edição amplia a compreensão das diversas facetas envolvidas na garantia de assistência durante o período reprodutivo, promovendo uma abordagem livre de preconceitos, discriminação e opressão, pautada principalmente nos direitos humanos.
Dois capítulos se destacam: ‘“A pulseirinha do papai”: heteronormatividade na assistência à saúde materna prestada a casais de mulheres em São Paulo’, e ‘Políticas Públicas de Gestação, Práticas e Experiências Discursivas de Gravidez Trans masculina’.
Parabéns às autoras e organizadoras!
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Existem cada vez mais evidências de que os setores de bebidas e alimentos ultra processados, fórmulas infantis, micronutrientes, pesticidas e manipulação genética de alimentos, além de atores associados, frequentemente tentam atrasar, enfraquecer, distorcer e/ou impedir o desenvolvimento de políticas e programas de alimentação e nutrição que possam contribuir efetivamente para sistemas alimentares mais saudáveis e sustentáveis.
Este documento estabelece um roteiro para introduzir e implementar, na Região das Américas, o Projeto de abordagem da OMS para a prevenção e gestão de conflitos de interesse na formulação de políticas e implementação de programas de nutrição no âmbito nacional, publicado pela OMS em dezembro de 2017.
Conflito de interesse segundo a OMS é uma situação em que o interesse primário de uma instituição pode ser indevidamente influenciado pelo interesse de um ator não estatal, de tal forma que afete (ou possa parecer afetar) a independência e objetividade do trabalho do governo no campo da saúde pública.
O projeto de abordagem da OMS é um processo decisório cujo objetivo é ajudar os Estados a identificar, prevenir e gerenciar potenciais conflitos de interesse quando da sua interação com atores não estatais (principalmente comerciais) nas políticas e programas de nutrição.
Considerando a complexidade do projeto de abordagem da OMS, este documento também fornece uma 'ferramenta de triagem' simplificada para apoiar e permitir sua aplicação.
Essa ferramenta de triagem foi desenvolvida pela OPAS, com o apoio de funcionários de ministérios da saúde e de organizações da sociedade civil.
Este roteiro tem como objetivos:
- apresentar os princípios fundamentais da abordagem da OMS aos tomadores de decisão das agências governamentais relevantes;
- adaptar e desenvolver formatos complementares da abordagem da OMS que se encaixem nos processos decisórios existentes em nível nacional;
- e complementar a ferramenta completa da OMS com uma ferramenta de triagem mais curta para aumentar a acessibilidade e possibilitar um envolvimento e uso mais efetivos na tomada de decisões relativas a potenciais interações com atores não estatais.
A publicação explica como esses objetivos podem ser abordados usando um método em 3 estágios. Ela também inclui anexos que cobrem estudos de caso, programas para oficinas e uma ferramenta de triagem para avaliar potenciais interações com atores não estatais: indústrias, comerciantes, empresas... Inclusive, no patrocínio de Congressos, Encontros, Reuniões científicas e apoio as Associações e Sociedades de profissionais de saúde.
Recomendamos!
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Maternidade pública de Salvador lança caderneta específica para acompanhamento da gestação de Homens Trans. A Unidade de saúde da Universidade Federal da Bahia mantém ações de acolhimento à população transexual. Medida visa preencher lacuna do sistema de saúde.
A iniciativa foi idealizada e produzida pela Maternidade Climério de Oliveira da UFBA em Salvador.
“A caderneta tem como objetivo promover inclusão social, visibilidade e pertencimento, além de produzir dados qualitativos e quantitativos sobre gestações transmasculinas. O uso do instrumento pode contribuir na elaboração de políticas públicas que propiciem o acesso, o cuidado seguro e a garantia de direitos, conforme estabelecido nos princípios do SUS (universalidade, equidade e integralidade)”, disse Sinaide Coelho, superintendente da MCO-UFBA.
TRANSGESTA
Trata-se de uma iniciativa voltada às pessoas que se reconhecem e se declaram transexuais, travestis, transgêneras, intersexo e outras denominações que representam formas diversas de vivência e de expressão de identidade de gênero. Desde o início, o programa realizou o acompanhamento de 7 homens trans gestantes, que resultou no nascimento de nove bebês na maternidade.
Parabéns!
Todo o nosso apoio: essa Caderneta será citada no V Seminário online anual preparatório para a SMAM 2024 em www.agostodourado.com
Prof. Marcus Renato de Carvalho
www.aleitamento.com
ALIMENTAÇÃO DE LACTENTES E CRIANÇAS PEQUENAS EM SITUAÇÕES DE EMERGÊNCIA:
manual de orientações para a comunidade, profissionais de saúde e gestores de programas de assistência humanitária.
*Tema da SMAM 2009 e que abordaremos novamente no www.agostodourado.com desse ano.
As calamidades e emergências complexas têm um impacto devastador sobre a vida das pessoas. Repentinamente, elas perdem suas casas e são obrigadas a viver fora de seu local de origem, muitas vezes com a cisão abrupta da unidade familiar. O acesso aos serviços de saúde primários costuma ficar prejudicado ou completamente inviabilizado e os sistemas de saúde podem entrar em colapso. A água potável e os alimentos geralmente se tornam escassos, as condições de segurança precárias. Durante os desastres é preciso enfrentar o desafio de lidar com um grande número de pessoas em choque, muitas delas doentes, feridas ou traumatizadas por suas experiências. As mulheres e crianças são as vítimas que mais necessitam de cuidados. Muitas mulheres perdem seus maridos/companheiras, filhos, pais ou parentes e, mesmo assim, precisam iniciar imediatamente o trabalho de reconstruir seus lares, de organizar o espaço para continuar vivendo e de cuidar dos membros mais frágeis da família. O impacto sobre as mulheres pode ser imenso, tanto físico quanto emocional e social. Atenção extra e cuidados especiais precisam ser oferecidos às mulheres com crianças pequenas, órfãos e gestantes.
A Amamentação cruzada não é recomendada e as lactantes devem receber um acolhimento carinhoso para que possam continuar amamentando ou serem apoiadas para a relactação.
Prof. Marcus Renato de Carvalho
www.aleitamento.com
Você gostaria de saber mais sobre como ter uma amamentação prazerosa?
Tirar as principais dúvidas sobre aleitamento?
Como doar seu leite com segurança e ter apoio de um Bancos de Leite Humano?
Quais medicamentos pode tomar enquanto está amamentando?
Baixe agora o Aleitamento App!
O que você irá encontrar:
- dicas desde a gestação até a volta ao trabalho,
- espaço para crianças com dicas de livros,
- diário do bebê,
- rede de apoio / cuidado paterno e muito mais!
* Estamos sem patrocínio e precisamos do seu apoio para que essa ferramenta continue disponível gratuitamente.
=> Nosso aplicativo é sempre atualizado com informações baseadas em evidências científicas e notícias do universo da saúde materno-infantil.
É grátis e muito fácil baixar:
https://aleitamento.com.br/instalar/
ou acesse pelo celular o Google Play Store e na Apple Store, faça o download de “Aleitamento Lactare”
Programadora: Clara
Watanabe
Divulgação: aleitamento.com
Curadoria de conteúdo: Prof. Marcus Renato de Carvalho @marcus.decarvalho
Amamentação e desenvolvimento sensório psico-motor dos lactentes: “Trilhos anatômicos”, bases neurais da motricidade do sistema estomatognático e suas repercussões sistêmicas.
O lactente é preparado para a amamentação desde a décima segunda semana de gestação, quando inicia o ato reflexo de deglutir o líquido amniótico. A região do encéfalo responsável pela elaboração desses primitivos atos motores é o tronco encefálico. O RN adquire controle motor no sentido céfalo caudal. Isso se dá porque a deposição de mielina obedece à mesma direção. Acrescente-se o fato de o aumento expressivo dos prolongamentos de neurônios ocorrer, principalmente, até os 2 anos de idade. A amamentação, que deve ser mantida pelo menos até que o lactente complete 24 meses de vida, ou mais, funcionaria como uma forma de estimulação perfeita durante esse período crítico do desenvolvimento motor. No lactente, fase em que predominam as ações motoras do orbicular dos lábios e do bucinador (inervados pelo facial), a deglutição é visceral. Entre 7 e 8 meses de idade ocorre a erupção dos dentes incisivos decíduos. O contato inter incisal deflagra a mudança de dominância motora do facial para a do trigêmeo. O padrão de deglutição muda de visceral para somático. Os músculos masseter, pterigoideo medial e temporal (inervados pelo trigêmeo) fazem parte da linha profunda anterior e se comunicam com o occipto frontal (inervado pelo facial), limite cranial da linha superficial posterior. A atuação conjunta dessas duas linhas miofasciais permite que o lactente abandone sua postura flexora com o fortalecimento gradual da musculatura extensora. A amamentação promove, portanto, um adequado sincronismo das ações motoras estimuladas pelos nervos facial e trigêmeo, cujos núcleos se situam no tronco encefálico e estabelecem contato com diversas vias neurais importantes para a organização dos movimentos. Influência o tônus neuromuscular, a postura e o desenvolvimento motor do lactente.
Juliana de Magalhães Faria, Antonio de Padua Ferreira Bueno, Marcus Renato de Carvalho.
Publicado na Revista Fisioterapia Ser • vol. 18 - nº 4 • 2023.
Juliana é Fisioterapeuta em instituições públicas e/ou
privadas há 22 anos, onde adquiriu experiência na área da Saúde e Educação, Pediatria, Fisioterapia em reabilitação de bebês e crianças com problemas neurológicos, estimulação sensório psicomotora, correção postural, reabilitação de pacientes com limitações ortopédicas e neurológicas...
Especialista em Atenção Integral à Saúde Materno-infantil na Maternidade Escola da UFRJ onde iniciou esse artigo que começou com o seu TCC em 2006-7.
Os Princípios de Yogyakarta são um documento sobre direitos humanos nas áreas de orientação sexual e identidade de gênero, publicado em novembro de 2006 como resultado de uma reunião internacional de grupos de direitos humanos na cidade de Joguejacarta (em indonésio: Yogyakarta), na Indonésia.
Os Princípios foram complementados em 2017, expandindo-se para incluir mais formas de expressão de gênero e características sexuais, além de vários novos princípios.
Os Princípios, e sua extensão de 2017, contêm um conjunto de preceitos destinados a aplicar os padrões da lei internacional de direitos humanos ao tratar de situações de violação dos direitos humanos – LGBTQIA+ - de lésbicas, gays, bissexuais, transgêneros, intersexuais e demais expressões de gênero.
São 29 princípios:
1. Direito ao Gozo Universal dos Direitos Humanos
2. Direito à Igualdade e a Não-Discriminação
3. Direito ao Reconhecimento Perante a Lei
4. Direito à Vida
Direito à Segurança Pessoal
6. Direito à Privacidade
7. Direito de Não Sofrer Privação Arbitrária da Liberdade
8. Direito a um Julgamento Justo
9. Direito a Tratamento Humano durante a Detenção
10. Direito de Não Sofrer Tortura e Tratamento ou Castigo Cruel, Desumano e Degradante
11. Direito à Proteção Contra todas as Formas de Exploração, Venda ou Tráfico de Seres Humanos
12. Direito ao Trabalho
13. Direito à Seguridade Social e outras Medidas de Proteção Social
14. Direito a um Padrão de Vida Adequado
15. Direito à Habitação Adequada
16. Direito à Educação
17. Direito ao Padrão mais Alto Alcançável de Saúde
18. Proteção contra Abusos Médicos
19. Direito à Liberdade de Opinião e Expressão
20. Direito à Liberdade de Reunião e Associação Pacíficas
21. Direito à Liberdade de Pensamento, Consciência e Religião
22. Direito à Liberdade de Ir e Vir
23. Direito de Buscar Asilo
24. Direito de Constituir uma Família
25. Direito de Participar da Vida Pública
26. Direito de Participar da Vida Cultural
27. Direito de Promover os Direitos Humanos
28. Direito a Recursos Jurídicos e Medidas Corretivas Eficazes
29. Responsabilização (“Accountability”).
Fonte: Wikipedia + JusBrasil
"Amamentação, sistemas de primeira alimentação
e poder corporativo: um estudo de caso sobre o mercado e as práticas políticas da indústria
transnacional de alimentação infantil no Brasil"
Artigo original: Breastfeeding, first-food systems and corporate power: a case study
on the market and political practices of the transnational baby food industry in Brazil.
Métodos da pesquisa: Usamos um desenho de estudo de caso, extraindo dados de documentos e entrevistas com informantes-chave (N=10).
Resultados: As taxas de amamentação despencaram no Brasil para um mínimo histórico na década de 1970. O ressurgimento da amamentação a partir
de meados da década de 1980 refletiu o fortalecimento do compromisso para a política nacional e uma lei de proteção da amamentação, resultante, por sua vez, de ações coletivas levadas a cabo por coligações de amamentação, defensores e mães. No entanto, mais
recentemente, as melhorias na amamentação estabilizaram no Brasil, enquanto a indústria aumentou as vendas de CMF
( Fórmulas Lácteas Comerciais) no Brasil em 750% entre 2006 e
2020. À medida que as regulamentações se tornaram mais rigorosas, a indústria promoveu de forma mais agressiva os CMF para bebés mais velhos e crianças pequenas, bem como para produtos especializados. fórmulas. A indústria de alimentos para bebés é fortalecida através da associação com grupos industriais poderosos e emprega lobistas com bom acesso aos decisores políticos.
A indústria conquistou a profissão pediátrica no Brasil através de sua associação de longa data com a Sociedade Brasileira de Pediatria.
...
Parabenizamos os autores: Cindy Alejandra Pachón Robles, Mélissa Mialon, Laís Amaral Mais, Daniela Neri, Kimielle Cristina Silva e Phillip
Baker.
Tradução: Moises Chencinski
* Referência: Robles et al. Globalization and Health (2024) 20:12
https://doi.org/10.1186/s12992-024-01016-0
GLOBAL BREASTFEEDING SCORECARD 2023
As taxas de amamentação estão aumentando em todo mundo através da melhoria dos sistemas de promoção, proteção e apoio.
A amamentação é essencial para a sobrevivência e saúde infantil. O leite materno é um produto seguro, natural, nutritivo e sustentável. O padrão ouro para a alimentação dos lactentes. O leite materno contém anticorpos que ajudam a proteger contra muitas doenças infantis, como como diarreia e doenças respiratórias. Estima-se que o desmame precoce seja responsável por 16% das mortes infantis a cada ano.
As crianças amamentadas têm melhor desempenho em testes de inteligência e têm menos probabilidade de ter excesso de peso ou obesidade na vida adulta. As mulheres que amamentam também têm um risco reduzido de câncer e diabetes tipo II.
O “Global Breastfeeding Scorecard” examina as práticas atuais de amamentação em todo o mundo, considerando o momento de iniciação, exclusividade nos primeiros seis meses de vida e continuação até os dois anos de idade.
Além disso, documenta o desempenho nacional em indicadores-chave de como a amamentação é protegida e apoiada. Essa edição 2023 registra o progresso e os desafios na melhoria da amamentação. O relatório destaca histórias de sucesso em vários países que reforçaram as suas políticas e programas de amamentação.
Oito iniciativas fundamentais e seus impactos são analisadas:
1. Assegurar e ampliar o financiamento de políticas para aumentar as taxas de amamentação desde o nascimento até aos dois anos de vida dos lactentes;
2. Implementar integralmente o Código de Comercialização de Substitutos do Leite Materno (NBCAL no Brasil);
3. Garantir legalmente licença parentalidade (licença maternidade e paternidade) remunerada e políticas de apoio à amamentação no local de trabalho;
4. Implementar os Dez Passos para o Sucesso da Amamentação nas maternidades – a IHAC;
5. Melhorar o acesso as capacitações em Aconselhamento em amamentação;
6. Fortalecer os vínculos entre as unidades de saúde e as comunidades;
7. Fortalecer os sistemas de monitoramento que acompanham o progresso das políticas, programas de aleitamento, e o seu financiamento;
8. Apoio IYCF (Infant and Young Child Feeding / Alimentação de lactentes e pré-escolares) em Emergências
...
CONCLUSÃO
O Scorecard demonstra que há progressos na proteção e no apoio à amamentação. Mas, ainda temos desafios significativos no aleitamento materno. São necessários mais investimentos e ações políticas ousadas para melhorar os ambientes propícios à proteção, promoção e apoio à amamentação.
Essa importantíssima publicação é do GLOBAL BREASTFEEDING COLLECTIVE, um conjunto de dezenas de instituições e experts no tema com o apoio do UNICEF.
Tradução livre do Prof. Marcus Renato de Carvalho www.aleitamento.com
Workplace breastfeeding support for working women: A scale
development study
Artigo científico publicado no European Journal of Obstetrics & Gynecology and
Reproductive Biology: X
O objetivo deste estudo foi desenvolver uma escala para avaliar o apoio ao aleitamento materno no local de trabalho.
Métodos
O estudo foi realizado com 490 mulheres trabalhadoras que se inscreveram nos ambulatórios da mulher e da criança de um hospital na Turquia. Os dados do estudo foram coletados por meio de um 'Formulário de Informações Pessoais' e da 'Escala de Apoio à Amamentação no Local de Trabalho para Mulheres Trabalhadoras'. Os dados foram analisados nos softwares SPSS 25 e AMOS 21. No processo de desenvolvimento da escala; Utilizaram-se a validade de conteúdo, a análise fatorial exploratória, os métodos de correlação item escore total e o coeficiente alfa de Cronbach.
Resultados
O índice de validade de conteúdo da escala foi de 0,90 e o valor de alfa de Cronbach foi de 0,93. O valor da escala de Kaiser-Meyer-Olkin foi de 0,91, o teste de Bartlett foi χ2 = 11.573,924 e p < 0,000. De acordo com os resultados da análise fatorial exploratória para a validade de construto da escala, a escala foi composta por 31 itens e 6 fatores.
Conclusões
A escala desenvolvida pode ser utilizada para avaliar o apoio à amamentação no local de trabalho para mulheres trabalhadoras como um instrumento de medida válido e confiável.
Excelente instrumento: tema da SMAM 2023 - Amamentação / Direito da Mulher Trabalhadora.
Profa. Carla Taddei afirma nessa entrevista que a AMAMENTAÇÃO modula a MICROBIOTA, e, portanto, se sobrepõe ao parto normal na transmissão materno infantil de “bactérias do bem”.
E em outra pesquisa mostrou que os prematuros de UTI Neonatal que tomavam leite materno tinham menos tempo de internação, independentemente se receberam leite da própria mãe ou leite humano pasteurizado do Banco de Leite da maternidade.
Está comprovado cientificamente que a Amamentação dá resiliência para a microbiota e, mesmo que a criança precise de antibiótico ou que tenha alguma outra enfermidade, o Aleitamento humano vai garantir a estrutura daquela comunidade microbiana (que antigamente chamávamos de flora intestinal).
Dra. Carla Taddei é Professora Associada do Laboratório de Microbiologia Molecular do HU da USP.
Fonte: Super Saudável, Ano XXIII, número 100 – outubro a dezembro de 2023.
Leia mais sobre esse tema no nosso portal www.aleitamento.com
As bactérias do leite humano - Microbioma do leite materno tem um efeito protetor contra infecções.
Prof. Marcus Renato de Carvalho
A União Europeia está enfrentando desafios sem precedentes devido à pandemia de COVID-19 e à invasão russa da Ucrânia. Isso destacou a necessidade de autonomia estratégica da UE em áreas como energia, defesa e tecnologia digital para garantir sua segurança e prosperidade a longo prazo. A Comissão Europeia propôs novas iniciativas para fortalecer a resiliência econômica e geopolítica do bloco.
Orientação sobre regulamentação de medidas destinadas a restringir o marketing digital de substitutos do leite materno (em tradução livre)
É urgente a proteção da amamentação nas redes sociais
"Guidance on regulatory measures aimed at restricting digital marketing of breast-milk substitutes".
As redes sociais se tornaram rapidamente a fonte predominante de exposição à promoção de substitutos do leite materno a nível mundial. O marketing digital amplifica o alcance e o poder da publicidade e de outras formas de promoção em ambientes digitais, e a exposição a promoção comercial digital aumenta a compra e a utilização dos ditos substitutos do leite materno.
À luz destas evidências, a 75ª. Assembleia Mundial da Saúde solicitou que a OMS desenvolvesse orientações para os Estados-Membros sobre medidas regulamentares destinadas a restringir a comercialização digital de substitutos do leite materno. Esta orientação aplica-se à comercialização de produtos abrangidos pelo Código Internacional de Comercialização de Substitutos do Leite Materno (NBCAL no Brasil), bem como a alimentos para lactentes e crianças pequenas que não sejam substitutos do leite materno.
Parabenizamos o nosso colega e amigo Cristiano Boccolini (Institute of Scientific and Technological Communication—ICICT, Oswaldo Cruz Foundation—Fiocruz, Brazil) um dos autores dessa inédita publicação.
Prof. Marcus Renato de Carvalho
www.aleitamento.com
Este Guia, “Alimentação complementar de bebês e crianças pequenas de 6 a 23 meses de idade”, substitui os Princípios Orientadores para Alimentação Complementar do Lactente Amamentado e princípios orientadores para alimentação crianças não amamentadas de 6 a 24 meses de idade.
A alimentação complementar saudável é definida como o processo de fornecimento de alimentos além do leite materno ou fórmula láctea quando por si só não são mais suficientes para atender necessidades nutricionais. Geralmente começa aos 6 meses de idade e continua até 24 meses de idade, embora a amamentação deve permanecer além deste período.
Essa etapa é um momento crítico para o desenvolvimento para as crianças aprenderem a aceitar alimentos e bebidas saudáveis a longo prazo. Também coincide com o período de pico para o risco de crescimento insuficiente e deficiências nutricionais.
As consequências imediatas, como a desnutrição durante estes anos de formação –
bem como no útero e nos primeiros 6 meses de
vida - incluem crescimento insuficiente significativo, morbidades e mortalidade e atraso motor, retardo do desenvolvimento cognitivo e sócio emocional.
Mais tarde, pode levar a um risco aumentado de doenças não transmissíveis (DNT). No
longo prazo, desnutrição na primeira infância causa redução da capacidade de trabalho e dos rendimentos e, entre as meninas, redução da capacidade reprodutiva. A Alimentação Complementar inadequada com alimentos ultra processados pode resultar em Obesidade, Diabetes tipo 2, hipertensão…
Os primeiros dois anos de vida também são um período crítico para o desenvolvimento do cérebro, a aquisição de linguagem e maturação das vias sensoriais para a visão
e audição, e o desenvolvimento de melhor desempenho das funções cognitivas.
Estas novas diretrizes estão atualizadas com evidências mais sólidas e têm muitos princípios em comum com o que preconiza o “Guia Alimentar para Crianças Brasileiras menores de 2 anos”. (Baixe aqui no nosso SlideShare).
Prof. Marcus Renato de Carvalho
www.aleitamento.com
Apresentamos a Carta do Recife: Por uma política pública de atenção integral aos homens na saúde para promoção da paternidade e do cuidado no Brasil que apresenta uma breve síntese das reflexões e discussões desenvolvidas ao longo do Seminário Nacional e Internacional "Paternidade e Cuidado" que aconteceu em Recife, entre 30 de agosto e 1º de setembro de 2023.
Nesta carta, apresentamos algumas notas e proposições a toda a sociedade brasileira, dialogando especialmente com gestores/as da União, estados e municípios, legisladores/as, órgãos do poder judiciário, empresas, empregadores/as, sindicatos, movimentos sociais, pesquisadores/as, entidades vinculadas ao controle social e à sociedade em geral.
Abraços,
Coordenação de Atenção à Saúde do Homem (COSAH/CGACI/DGCI/SAPS/MS)
Núcleo de Pesquisas Feministas em Gênero e Masculinidades - GEMA/UFPE
Núcleo GenSex/Fiocruz
Núcleo Tramas/UFPA
UFMT
Estivemos presentes e ratificamos essas análises e recomendações.
Prof. Marcus Renato de Carvalho
Representante do Parents in Science / Faculdade de Medicina - UFRJ
www.aleitamento.com
A Federação Internacional de Ginecologia e Obstetrícia (FIGO) reconhece a Amamentação
como uma prática protetora que pode salvar vidas e recomenda que seja iniciada dentro da 1ª hora de vida (conhecida como “hora mágica” ou "hora de ouro").
Através das recomendações do
melhores práticas, a OMS sugere que a amamentação “temprana” e oportuna na sala de parto pode trazer grandes benefícios para ambos – tanto para a mãe quanto para o bebê.
Alguns aspectos importantes da hora mágica, como o contato pele a pele e o início
no início do aleitamento materno, pode prevenir a hemorragia pós-parto, facilita a involução uterina e produz amenorreia lactacional, que é um método contraceptivo (LAM) útil.
A amamentação no início da vida traz benefícios a longo prazo para a mãe e para a criança.
...
Parabéns a FIGO!
Amamentação na primeira hora: proteção sem demora!
Prof. Marcus Renato de Carvalho
www.aleitamento.com
O atendimento ambulatorial de Puericultura é destinado à criança saudável, para a prevenção, e não para o tratamento de doenças. Sendo
assim, diante dos novos conceitos de programming
e epigenética, fica clara a necessidade da assistência à saúde da criança se iniciar antes
mesmo de seu nascimento.
A ANS em 2013, pela Resolução Normativa nº 338, incluiu o procedimento pediátrico “atendimento ambulatorial em puericultura” no rol de consultas, passando a valer desde janeiro de 2014. Uma vez incluído, o procedimento passou a fazer parte da cobertura assistencial mínima
obrigatória pelos planos privados de assistência
à saúde suplementar: operadoras, Unimed...
O atendimento pediátrico a gestantes (terceiro trimestre) foi contemplado pelo Código
nº 1.01.06.04-9 com indicação de remuneração pelo Porte 2B, lembrando aos pediatras a importância do preenchimento correto do código da ANS nas guias de consulta para o devido reembolso desse valor diferenciado.
Vamos incentivar as gestantes a marcarem uma Consulta Pediátrica Pré-Natal?
Prof. Marcus Renato de Carvalho
Este documento apresenta a posição conjunta e a visão de um grupo de trabalho especializado, global e multissetorial sobre a implementação da Metodologia Mãe Canguru (MCC) para todos os bebês prematuros ou com baixo peso ao nascer (BPN), como base para o cuidado de recém-nascidos prematuros e/ou doentes.
O documento resume as informações básicas, as evidências e a justificativa para disponibilizar o MMC para todos os recém-nascidos prematuros ou de BPN e busca mobilizar a comunidade internacional de saúde materna, neonatal e infantil e as famílias para se unirem para apoiar a implementação do MMC para todos os prematuros ou bebês com baixo peso ao nascer para melhorar a saúde e o bem-estar deles e de suas mães e famílias.
Este documento de posição destina-se a ser utilizado por gestores, parceiros de desenvolvimento, lideranças do pessoal de saúde, pediatras neonatologistas, lideranças da sociedade civil (por exemplo, organizações de pais e profissionais) e organizações de pesquisa envolvidos na pesquisa de implementação do MMC.
O MMC é uma intervenção que permite à mãe assumir um papel central em sua própria vida
e os cuidados do seu recém-nascido, revertendo assim a mudança de poder entre a mãe e o responsável pelos cuidados de saúde, prestadores ou sistemas de saúde. Humaniza os cuidados maternos e neonatais, capacitando e envolvendo
aqueles que mais cuidam do RN, em vez de focar predominantemente em soluções tecnológicas.
Assim, o MMC pode servir como ponto de partida para uma reformulação mais ampla do sistema de saúde e para a prestação de serviços,
transformação dos cuidados maternos e neonatais, e um modelo do que pode ser realizado quando
as partes interessadas relevantes têm o poder de desempenhar os papéis que lhes são naturalmente confiados no cuidado dos seus
recém-nascidos.
Esse documento mostra como o Cuidado Mãe-Canguru pode ser revolucionário na atenção neonatal.
Prof. Marcus Renato de Carvalho
www.aleitamento.com
Este "Guia do Pré-Natal do Parceiro para Profissionais
de Saúde" foi originalmente publicado em 2016 para apresentar a Estratégia Pré-Natal do Parceiro (EPNP), que, em linhas gerais, visa orientar
profissionais e gestores(as) do SUS sobre a importância do envolvimento masculino em todo o ciclo gravídico-puerperal.
Mais recentemente, entre 2021 e 2023, este material passou por processo de revisão/atualização
conduzido pela Coordenação de Atenção à Saúde do Homem (Cosah/CGACI/DGCI/Saps/MS), com a participação de pesquisadores/as vinculados/
as a instituições públicas de pesquisa e formação acadêmica (Gema/UFPE; UFPA; UFMT e IFF/Fiocruz).
Esse processo contou também com diálogos e a apreciação de gestores(as), das Coordenações
Estaduais e Municipais de Saúde do Homem, das áreas técnicas da Secretaria de Atenção Primária à Saúde do Ministério da Saúde, além de
trabalhadores(as) da atenção primária à saúde (APS)
e representantes da sociedade civil.
Para ampliarmos a participação dos homens na APS é necessário que trabalhadores(as) e gestores(as) revejam práticas e ideias e estejam mais atentos(as)
às construções socioculturais de gênero e às singularidades das pessoas e dos territórios, a fim
de garantir espaços de reflexão sobre as práticas de cuidado em saúde.
Parabéns ao Ministério da Saúde e parceiros.
Notamos a falta de conteúdo da Amamentação - informações básicas devem ser dadas nessa fase gestacional para que mães e pais se preparem para esse ato de cuidado e proteção da infância.
Prof. Marcus Renato de Carvalho
www.aleitamento.com
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
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3. MARKETING OF BREAST-MILK SUBSTITUTES:
NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
STATUS REPORT 2018
4. P. IV I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
CONTENTS
ACKNOWLEDGEMENTS������������������������������������������������������������������������������������������������������������ V
ABBREVIATIONS���������������������������������������������������������������������������������������������������������������������� VI
EXECUTIVE SUMMARY�����������������������������������������������������������������������������������������������������������VII
INTRODUCTION������������������������������������������������������������������������������������������������������������������������� 2
METHODOLOGY������������������������������������������������������������������������������������������������������������������������ 6
Data collection 6
Analysis of legal provisions for the Code 6
Categorization of legislation 6
Provisions for complementary foods 7
LEGISLATIVE STATUS OF THE CODE������������������������������������������������������������������������������������� 10
Status of national legal measures 10
Categorization of national legal measures 11
Key provisions of national legal measures by region 12
Summary19
STATUS OF LEGAL PROVISIONS RELATED TO COMPLEMENTARY FOOD���������������������������� 22
Based on selected recommendations of the WHO Guidance on Ending
inappropriate promotion of foods for infants and young children 22
Requirements for messages on complementary foods (recommendation 4) 22
Avoidance of conflicts of interest in health-care settings by manufacturers and
distributors of complementary foods (recommendation 6) 23
Cross-promotion (recommendation 5) 25
Summary25
CONCLUSIONS������������������������������������������������������������������������������������������������������������������������ 30
Recommendations for action 31
REFERENCES�������������������������������������������������������������������������������������������������������������������������� 34
ANNEX 1. LEGAL STATUS OF THE INTERNATIONAL CODE OF MARKETING OF
BREAST-MILK SUBSTITUTES IN ALL WORLD HEALTH ORGANIZATION MEMBER
STATES, INCLUDING CATEGORIZATION�������������������������������������������������������������������������������� 38
ANNEX 2. SPECIFIC PROVISIONS COVERED IN THE COUNTRIES THAT HAVE LEGAL
MEASURES IN PLACE������������������������������������������������������������������������������������������������������������� 44
ANNEX 3. SPECIFIC PROVISIONS RELEVANT TO COMPLEMENTARY FOODS FOR
CHILDREN UP TO 36 MONTHS OF AGE IN THE COUNTRIES THAT HAVE LEGAL
MEASURES IN PLACE������������������������������������������������������������������������������������������������������������� 56
5. STATUS REPORT 2018 I P. V
ACKNOWLEDGEMENTS
This report was prepared by Dr Laurence Grummer-Strawn, World Health Organization
(WHO) Department of Nutrition for Health and Development, and Mr Marcus Stahlhofer,
WHO Department of Maternal, Newborn, Child and Adolescent Health, under the supervision
of Dr Francesco Branca, Director, WHO Department of Nutririon for Health and Development.
Technical support was provided by WHO regional advisers for nutrition, Mr David Clark,
Nutrition Specialist (Legal), Programme Division, United Nations Children’s Fund (UNICEF),
Ms Yeong Joo Kean, Legal Adviser, International Code Documentation Centre, International
Baby Food Action network (IBFAN), and Ms Thahira Mustafa, WHO Department of Nutrition
for Health and Development.
Ms Ellen Sokol, independent legal consultant, United States of America, undertook the
analysis and, where deemed necessary, re-examination of available national legal measures.
We extend our thanks to all individuals and organizations involved in the preparation of
this report.
6. P. VI I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
ABBREVIATIONS
the Code International Code of Marketing of Breast-milk Substitutes (4) and subsequent
relevant World Health Assembly resolutions (5)
EU European Union
GINA Global Database on the Implementation of Nutrition Action
the Guidance Guidance on ending inappropriate promotion of foods for infants and young
children (7)
IBFAN International Baby Food Action Network
ICDC International Code Documentation Centre (IBFAN technical office for Code
implementation and monitoring)
NetCode Network for Global Monitoring and Support for Implementation of the
International Code of Marketing of Breast-milk Substitutes and subsequent
relevant WHA resolutions
UNICEF United Nations Children’s Fund
WHA World Health Assembly
WHO World Health Organization
7. STATUS REPORT 2018 I P. VII
EXECUTIVE SUMMARY
This report provides updated information on the status of implementing the International
Code of Marketing of Breast-milk Substitutes1
and subsequent relevant World Health Assembly
resolutions2
(“the Code”) in and by countries.3
It presents the legal status of the Code,including
– where such information is available – the extent to which Code provisions have been
incorporated in national legal measures. While the 2016 report focused on the status and
quality of Code provisions at the global level, this report provides a regional perspective on
the legal status of the Code. It highlights the status of a limited number of specific provisions
that the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF) and
the International Baby Food Action Network (IBFAN) consider to be particularly instrumental
in addressing and eliminating inappropriate marketing of breast-milk substitutes, feeding
bottles and teats. As a baseline assessment of the 2016 Guidance on ending inappropriate
promotion of foods for infants and young children (“the Guidance”),4
WHO, UNICEF and IBFAN
also undertook a preliminary analysis of selected legal provisions in those countries where
complementary foods are listed as designated products in their Code-related legislation.
METHODOLOGY
WHO, UNICEF and IBFAN collected information from country and regional offices on new
or additional legal measures adopted by countries since 2016. In addition, for countries
with missing or incomplete information in 2016, further investigation was conducted on the
status of Code implementation. A re-examination of legal measures was undertaken for all
countries with new information. For those countries that have adopted legal measures since
the 2016 report, the relevant legal documents were obtained through the ministry of health,
and with the assistance of regional and country offices. Documentation was also obtained
from legal databases (LexisNexis5
and FAOLEX6
), national gazettes and internet search
engines. Where needed, additional copies of legislation and translations were acquired from
UNICEF and IBFAN-ICDC (International Code Documentation Centre) files. The documents
received were then reviewed, based on the comprehensiveness of the provisions included
in the national legal measures in all WHO Member States, and categorized as countries with
full, many, few or no provisions in law.
FINDINGS
LEGISLATIVE STATUS OF THE CODE
As of April 2018, 136 out of 194 countries had some form of legal measure in place covering
all, many or few provisions of the Code. In 2017, three countries – Chile, Thailand and
Mongolia – enacted new Code-related legislation, while Albania, Bahrain and Bangladesh
adopted additional legal measures to strengthen their legislative frameworks for Code
implementation. Two countries – Fiji and China – took retrogressive steps by repealing laws
or specific provisions of laws. New information available clarified the legal status of the Code
in 10 countries that were classified as countries with no information in 2016. Seven of these
were subsequently determined to have no legal measures in place, while three were added
to the list of countries with legal measures, based on an analysis indicating that they de facto
1 International Code of Marketing of Breast-milk Substitutes. Geneva: World Health Organization; 1981 (http://www.
who.int/nutrition/publications/code_english.pdf).
2 World Health Organization. Code and subsequent resolutions (http://www.who.int/nutrition/netcode/resolutions/en/).
3 The data presented in this report are for 194 WHO Member States (“countries”), and do not include non-Member
States or territories.
4 Maternal, infant and young child feeding. Guidance on ending the inappropriate promotion of foods for infants
and young children. In: Sixty-ninth World Health Assembly, Geneva, 23–28 May 2016. Provisional agenda item
12.1. Geneva: World Health Organization; 2016 (A69/7 Add 1; http://apps.who.int/gb/ebwha/pdf_files/WHA69/
A69_7Add1-en.pdf?ua=1).
5 LexisNexis (http://www.lexisnexis.co.uk/en-uk/about-us/about-us.page).
6 Food and Agriculture Organization of the United Nations. FAOLEX database (http://www.fao.org/faolex/en/).
8. P. VIII I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
align with the European Union (EU) regulation of 2013.7
In addition, documentation of the
legal measures that was unavailable in 2016 was obtained for five countries, resulting in an
upgrade for two countries and a downgrade for three other countries. Careful re-examination
of information on existing legal measures was undertaken for a total of 12 countries. On this
basis, one country was upgraded and 11 were downgraded.
Thirty-seven years after the adoption of the Code, too few countries have robust measures
in place to eliminate inappropriate promotion of breast-milk substitutes and complementary
foods for infants and young children, including advertising to the general public and various
forms of promotion in health-care settings. A ban on promotion of complementary foods
for infants under 6 months of age is in place in under one third of all countries with Code-
related legislation. In addition, in four out of the six WHO regions, a little over half of the
countries have provisions that explicitly empower government agencies to impose sanctions
on violators of their law. Furthermore, very few countries currently include milk products
labelled for use up to at least 36 months of age as designated products in their legislation.
LEGAL PROVISIONS RELATED TO COMPLEMENTARY FOODS
As the Guidance was approved and launched in 2016, it is unlikely that many countries would
already have adopted legal measures that adequately reflect the various requirements and
prohibitions embedded in the Guidance recommendations. Nevertheless, of the 136 countries
that have legal measures in place, 59 have incorporated complementary foods as designated
products under such measures. Based on the information and analytical methods currently
available to WHO, UNICEF and IBFAN, it appears that a number of countries have made
significant efforts to address inappropriate marketing practices in relation to complementary
foods, by incorporating relevant provisions in their legislation for the Code and infant and
young child nutrition. Some of those countries successfully did so prior to the approval of the
Guidance, while those that adopted new, or improved existing, legislation after 2016 took into
consideration various elements of the Guidance.
Many countries do have detailed requirements and restrictions in relation to messages and
labels on products, including for complementary foods. Nevertheless, there is much room for
further improvement. In particular, prohibition of cross-promotion, and avoidance of conflicts
of interest, by both manufacturers and distributors of complementary foods and health
professionals, are frequently not included within the legal measures. The baseline analysis
undertaken provides a useful, albeit cautious, starting point to assess the extent to which the
current legal and regulatory landscape in countries is supportive of effective implementation
of the recommendations of the Guidance.
7 Regulation (EU) NO. 609/2013 of the European Parliament and of the Council of 12 June 2013 on food intended for
infants and young children, food for special medical purposes, and total diet replacement for weight control and
repealing Council Directive 92/52/EEC, Commission Directives 96/8/EC, 1999/21/EC, 2006/125/EC and 2006/141/
EC, Directive 2009/39/EC of the European Parliament and of the Council and Commission Regulations (EC) No
41/2009 and (EC) No 953/2009. Official Journal of the European Union. 2013;29 June:L 181/35–56 (https://eur-lex.
europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32013R0609from=EN).
9. STATUS REPORT 2018 I P. IX
Recommendations for action
The findings of this report lead to the recommendations listed next.
• Legislators and policy-makers must recognize their obligations, under both international
human rights law and national Code-related or other relevant laws, to promote
and protect breastfeeding, and to eliminate inappropriate marketing practices.
Such obligations must translate into clear statements of support, allocation of adequate
budgets, and creation and application of budget-oversight mechanisms.
• Governments must establish robust and sustainable monitoring and enforcement
mechanisms to implement national laws and regulations aimed at eliminating
inappropriate marketing practices. Such mechanisms need to involve all relevant
government agencies authorized to monitor and enforce various elements of the
Code and Guidance, must be adequately funded and sourced with knowledgable staff,
and should allow for public engagement and scrutiny, including through the periodic
release of implementation reports. To assist countries with the strengthening of
monitoring and enforcement, WHO, in collaboration with partners of the Network for
Global Monitoring and Support for Implementation of the International Code of Marketing
of Breast-milk Substitutes and subsequent relevant World Health Assembly Resolutions
(NetCode),8
has published important monitoring protocols, including practical tools and
guidance for setting up effective monitoring systems.9
• Countries should analyse and address weaknesses or gaps in their existing legislation,
and act accordingly. In particular, countries must strengthen their legal and regulatory
frameworks, to (i) eliminate advertising and other forms of promotion to the general
public and in health-care facilities; (ii) enable authorized government entities to impose
sanctions when violations have been identified and validated; iii) explicitly include milk
products intended and marketed as suitable for feeding young children up to at least 36
months of age; and (iv) enforce a ban on promotion of complementary foods for infants
under 6 monthsof age.
• Countries should also urgently review and analyse their legal and regulatory
frameworks in view of the WHO Guidance on ending inappropriate promotion of foods
for infants and young children. For those countries that do not include complementary
foods as designated products in their relevant legislation, efforts must be made to do
so, aligning additional measures with the recommendations set forth in the Guidance.
Countries that have complementary foods included, should review and amend their
legislation accordingly.
8 World Health Organization. Nutrition. NetCode (http://www.who.int/nutrition/netcode/en/).
9 World Health Organization. Nutrition. NetCode toolkit for ongoing monitoring and periodic assessment of the Code
(http://www.who.int/nutrition/netcode/toolkit/en/).
10. P. X I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
12. P. 2 I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
INTRODUCTION
Despite ample evidence of the benefits of exclusive and continued breastfeeding for children,
women and society (1), far too few children are breastfed as recommended. Globally, three
out of five children under 6 months of age are not exclusively breastfed and only 45% of
children continue breastfeeding for 2 years (2).
A major factor undermining efforts to improve breastfeeding rates is continued and
aggressive marketing of breast-milk substitutes, as well as the promotion of feeding bottles
and teats. In 2014, global sales of breast-milk substitutes totalled US$ 44.8 billion, and this
number is expected to rise to US$ 70.6 billion by 2019 (3).
Inappropriate marketing of food products that compete with breastfeeding often negatively
affects the mother’s choice to breastfeed her child optimally. Given the special vulnerability
of infants and the risks involved in inappropriate feeding practices, usual marketing practices
are unsuitable for these products. Yet, the prevalence of inappropriate marketing practices is
persistent in many countries, and these practices increasingly target new and non-traditional
settings, including social media channels and internet sites.
The International Code of Marketing of Breast-milk Substitutes (4) and subsequent relevant
World Health Assembly (WHA) resolutions (5) (“the Code”) remain crucial tools in efforts to
reduce and eliminate inappropriate marketing practices, and ensure the effective promotion
and protection of breastfeeding.
In addition, there is increasing promotion of breast-milk substitutes for older infants and
young children – those between 6 and 36 months of age – including follow-up formula
and “growing-up” milks. These products undermine sustained breastfeeding up to 2 years
or beyond.
Inappropriate promotion of commercial complementary foods can mislead and confuse
caregivers about their nutrition- and health-related qualities, and their age-appropriate and
safe use. Promotion can be used to convince caregivers that family foods are inadequate,
and create a dependency on expensive commercial products. In addition, caregivers often
do not understand the distinctions between milk products promoted for children of different
ages. Cross-promotion of such foods, through use of colours, mascots and wording on
the labelling, is frequently used to promote a company’s breast-milk substitute products.
Because the packaging and marketing of these products often resemble those of infant
formula, mothers may also decide to use them in the first 6 months of life.
Responding to these growing concerns, in 2010, the WHA urged all Member States to end
inappropriate promotion of food for infants and young children (6) and in 2012, the WHA
requested the World Health Organization (WHO) to develop clarification and guidance on the
inappropriate promotion of foods for infants and young children.
The Guidance on ending inappropriate promotion of foods for infants and young children (“the
Guidance”) was approved and welcomed by the WHA in 2016 (7). It pertains to foods and
drinks marketed for children aged 6–36 months, and includes seven recommendations.
It further clarifies the scope of the Code and extends some provisions to the marketing
of complementary foods. The Guidance also states that no complementary foods should
be promoted for use before 6 months of age. The promotion of complementary foods for
infants aged less than 6 months is also prohibited under resolution WHA39.28, which states
that “any food or drink given before complementary feeding is nutritionally required may
interfere with the initiation or maintenance of breastfeeding and therefore should neither be
promoted nor encouraged for use by infants during this period” (8).
In recent years, an increasing number of global initiatives have articulated a renewed
emphasis on the importance of the Code and Guidance as key instruments for ensuring
optimal infant and young child nutrition. The Comprehensive implementation plan on maternal
infant and young child nutrition called upon Member States to “develop or where necessary
Globally, three out
of five children
under 6 months
of age are not
exclusively
breastfed and
only 45% of
children continue
breastfeeding for
2 years
There is increasing
promotion of
breast-milk
substitutes for
older infants and
young children
– those between
6 and 36 months
of age – including
follow-up formula
and “growing-up”
milks.
13. STATUS REPORT 2018 I P. 3
strengthen legislative, regulatory and/or other effective measures to control the marketing
of breast-milk substitutes, ]feeding bottles and teats] in order to ensure implementation
of the International Code of Marketing of Breast-milk Substitutes and relevant resolutions
adopted by the [World] Health Assembly” (9). The 2014 Second International Conference on
Nutrition Framework for Action (10), which forms the underpinnings of the United Nations
Decade for Action on Nutrition (11), similarly called on countries to implement the Code and
subsequent relevant WHA resolutions. Various United Nations human rights mechanisms
issued a joint statement in 2016 (12), explicitly referring to the obligation of countries under
relevant international human rights treaties to implement the Code.
Within the last year, a number of reports have documented the inappropriate promotion of
breast-milk substitutes and related matters. The International Baby Food Action Network
(IBFAN) published its 2017 Breaking the rules, stretching the rules report, providing
information on Code violations by 28 companies in 79 countries (13). Apart from violations
by manaufacturers of major Code provisions involving a whole spectrum of products covered
by the scope of the Code, the report shows how unfounded health and nutrition claims
continue to be a prime marketing tool and how, across the globe, technological advances
are becoming effective marketing tools over conventional media. The report also reveals
new trends in promotion, involving the artful combination of marketing initiatives with public
health campaigns that give rise to conflicts of interest. The report indicates the clear need
for enforceable laws that are properly monitored and enforced, to level the playing field
in support of breastfeeding. In 2017, the Changing Markets Foundation published a report
entitled Milking it: how milk formula companies are putting profits before science, in which they
describe a series of unsubstantiated nutrition and health claims for infant milk products
for babies under 12 months of age (14). In addition, in 2018, Save The Children, released
the Don’t push it report,1
which highlights how misleading and inaccurate marketing of
breast-milk substitutes is jeopardizing infants’ health and development by undermining
breastfeeding and preventing families from receiving clear, evidence-based information
about infant feeding (15).
This 2018 WHO/United Nations Children’s Fund (UNICEF)/IBFAN report provides updated
information on the status of implementation of the Code in and by countries. It describes
the extent to which Code provisions have been incorporated in national legal measures.
The 2018 report builds upon the 2016 Code status report (16).
As with the Code, robust and enforceable legislation should also be at the core of a
comprehensive response to end inappropriate promotion of foods for older infants and
young children. In many countries, legislation aimed at implementation of the Code may
already include many of the products identified for designation, and may have provisions
that address the requirements and prohibitions reflected in relevant recommendations of
the Guidance. To this end, this report also provides a baseline analysis of the extent to which
the legal measures enacted for the Code address some of the recommendations contained
in the WHO Guidance (7).
1 The report was endorsed by a a collective of organizations, including Action Contre la Faim, BRAC, FHI 360, Helen
Keller International and the SUN Movement in Pakistan.
No complementary
foods should be
promoted for use
before 6 months
of age.
Robust and
enforceable
legislation should
also be at the core
of a comprehensive
response to end
inappropriate
promotion of foods
for older infants
and young children
14. P. 4 I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
16. P. 6 I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
METHODOLOGY
WHO, UNICEF and IBFAN collected information from country and regional offices on new
or additional legal measures adopted by countries since 2016. In addition, for countries
with missing or incomplete information in 2016, further investigation was conducted on the
status of Code implementation. A re-examination of legal measures was undertaken for all
countries with new information.
DATA COLLECTION
For those countries that have adopted legal measures since the 2016 report, the relevant
legal documents were obtained through the ministry of health, and with the assistance
of regional and country offices. Documentation was also obtained from legal databases
(LexisNexis (17) and FAOLEX (18)), national gazettes and internet search engines. Where
needed, additional copies of legislation and translations were acquired from UNICEF and
IBFAN-ICDC (International Code Documentation Centre) files. New legal measures were
entered into the WHO Global database on the Implementation of Nutrition Action (GINA) (19),
and into the databases of IBFAN-ICDC and UNICEF.
ANALYSIS OF LEGAL PROVISIONS FOR THE CODE
New legal measures adopted since 2016 for which documentation was available,
were analysed by using a standard checklist on the scope and content of national legal
measures. This included countries with no previous legislation and those with existing
legislation for which additional measures had been adopted or amendments made. For those
countries with existing legal measures, but which had adopted additional measures or
amendments, resulting modifications of legal provisions were reviewed and discussed,
and agreement was reached on subsequent re-categorization, where needed.
For 15 countries,new information was obtained on legal measures beyond what was available
in 2016, in some cases demonstrating that no legal measures exist and in other cases
documenting the measures that do exist. For another two countries, while information from
WHO, UNICEF and IBFAN offices indicated that legal measures were in place, relevant legal
documentation could not be obtained during the preparation of this report. It was agreed to
classify these countries as having few measures in place, even though the specific provisions
covered are not clear. Continued efforts will be made to obtain relevant information, in order
to update the status and information on these countries in the next report.
Additionally, based on clearly identified discrepancies between a country’s previous
categorization (full, many or few provisions in law) and the scope and content of its legal
measures in the 2016 report (16), a re-examination and clarification of provisions covered by
existing legal measures was undertaken for 12 countries. As a result, the categorization of
several countries was modified accordingly.
CATEGORIZATION OF LEGISLATION
Based on the documents reviewed, the national legal measures in all WHO Member States
were categorized as follows:
• full law: countries have enacted legislation or adopted regulations, decrees or other
legally binding measures encompassing all or nearly all provisions of the Code and
subsequent WHA resolutions (4, 5);
• many provisions in law: countries have enacted legislation or adopted regulations,
decrees or other legally binding measures encompassing many provisions of the Code
and subsequent WHA resolutions (4, 5);
• few provisions in law:1
countries have enacted legislation or adopted regulations,
1 The 2018 IBFAN-ICDC State of the Code by country (20) add the category “Some provisions in other laws or guidelines
applicable to the health sector” for countries without dedicated Code legislation, but with Code-related provisions
incorporated in other legal measures. However, for the purpose of this report, it was agreed that countries with
no dedicated Code legislation, but with Code provisions incorporated in other legal measures, are included in the
category “Few provisions in law”. These countries will be annotated in the detailed list in annex 1 of the report.
17. STATUS REPORT 2018 I P. 7
directives, decrees or other legally binding measures covering only few of the provisions
of the Code or subsequent WHA resolutions (4, 5);
• no legal measures:2
countries have taken no action or have implemented the Code only
through voluntary agreements or other non-legal measures (includes countries that
have drafted legislation but not enacted it).
PROVISIONS FOR COMPLEMENTARY FOODS
As a baseline assessment of the Guidance, WHO, UNICEF and IBFAN also undertook a
preliminary analysis of the specific legal provisions in those countries that list complementary
foods as designated products in their Code-related legislation. It was not an in-depth
assessment of all provisions in the Guidance recommendations and this report does not
necessarily include all legal measures adopted by countries to incorporate requirements
and prohibitions. Analysis focused on provisions that address the following elements of the
Guidance recommendations:
• requirements for messages on labels for complementary foods;
• avoidance of conflicts of interest in health-care settings by manufacturers and
distributors of complementary foods;
• cross-promotion.
2 The IBFAN-ICDC State of the Code by country (20) includes separate categories for non-legal measures, such as
voluntary codes and policies.
18. P. 8 I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
20. P. 10 I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
LEGISLATIVE STATUS OF THE CODE
Implementation of the Code, through enactment and enforcement of robust national legal
measures, is essential to ensure that parents and other caregivers are protected from
inappropriate and misleading information.
Under Article 11.1 of the Code (4), countries are requested to “take action to give effect to
the principles and aim of this Code, as appropriate to their social and legislative framework,
including the adoption of national legislation, regulation or other suitable measures”.
In resolution WHA34.22 (1981), in which the Code is adopted (21), the WHA stresses that
adoption of and adherence to the Code is a minimum requirement for all countries, and urges
all countries to implement it “in its entirety”.
STATUS OF NATIONAL LEGAL MEASURES
As of April 2018, 136 out of 194 countries had some form of legal measure in place covering
all, many or few provisions of the Code (see Fig. 1 and Annex 1). The specific provisions
covered in the countries that have legal measures are documented in Annex 2.
Full provisions in law Many provisions in law
Few provisions in law No legal measures
FIG. 1. STATUS OF NATIONAL LEGAL MEASURES IN COUNTRIES, 2018
In 2017, three countries – Chile, Thailand and Mongolia – adopted new Code-related
legislation. The Thai legislation has been classified as having many provisions for Code
implementation. Chile introduced a decree to modiy existing food regulations in order to
restrict the advertising of formula products. The current Mongolian legislation is a distinct
improvement over its predecessor from 2005. It introduces many elements that were missing
in the 2005 law. However, not all important elements of the Code are incorporated into the
new law. In three countries – Albania, Bahrain and Bangladesh – additional legal measures
were adopted to strengthen their legislative frameworks for Code implementation, including
adding specific requirements for the content of educational and informational materials,
and additional labelling provisions. Albania issued a ministerial order, which closed a
gap regarding information and education in its existing law, while in 2017, Bangladesh
complemented its 2014 law with a set of additional rules. Two countries – Fiji and China
– took retrogressive steps. In 2016, Fiji repealed the chapter on labelling in its law, while
136 out of
194 countries
report having legal
measures in place
related to the Code
21. STATUS REPORT 2018 I P. 11
China repealed its legal measure in 2016, without any replacement, thus weakening legal
protection from inappropriate promotion of breast-milk substitutes.
Clarification of the legal status of the Code was provided by WHO regional offices for
10 countries for which no information was available in 2016. Central African Republic,
Equatorial New Guinea, Federated States of Micronesia, Montenegro, Nauru, Niue and Tonga
were determined to have no legal measures in place. Three European countries, Andorra,
Monaco and San Marino were added to the list of countries with legal measures, based on
an analysis indicating that they de facto align with the European Union (EU) directive on
marketing of breast-milk substitutes.
In addition, documentation of the legal measures that was unavailable in 2016 was obtained
for five countries. Analysis of the newly obtained documents from Rwanda allowed this
country to be upgraded from few provisions to many provisions for the Code in law. Ethiopia,
which was previously listed as having no legal measures, was upgraded to having few
provisions in law, owing to its analysis of its legislation. New information on Canada and
Qatar indicated that no specific Code provisions were incorporated in law, placing these
countries in the category of “no legal measures in place”, a downgrade from 2016. Similarly,
a translation of available documentation from Israel revealed that the country does not have
legal measures in place, thus re-classifying the country from few measures to having no
measures in place.
New information obtained on Cuba and Ukraine indicated that both countries had some Code
provisions incorporated in other legal measures, although relevant legal documentation
could not be obtained during the preparation of this report. These countries were therefore
classified as having few measures in place but were not added to Annex 2. In addition,
new information also revealed that Guinea does not have legal measures in place.
Careful re-examination of information on existing legal measures was undertaken for a
total of 12 countries: Argentina, Cameroon, Colombia, Costa Rica, Guatemala, Iran, Kenya,
Nicaragua, Niger, Oman, Senegal and Uruguay. Information in Annex 2 for these countries
was reviewed against their 2016 classification. Re-examination was further guided by
ongoing discussions and emerging agreement between WHO, UNICEF and IBFAN on the
development of an algorithm for joint systematic examination and classification of legal
measures in countries. On this basis, one country was upgraded and 11 were downgraded.
CATEGORIZATION OF NATIONAL LEGAL MEASURES
The total number of countries for each of the four different categories has changed, based
on the new information available, new or additional measures adopted, existing measures
repealed or existing measures re-examined and classified.
As of 2018, a total of 35 countries have full Code provisions covered in law, while 31 have legal
measures with many Code provisions in place, and 70 have legal measures incorporating few
Code provisions in law. Fifty-eight countries have no legal measures in place (see Table 1).
As of 2018, a total
of 35 countries have
full Code provisions
covered in law,
while 31 have
legal measures
with many Code
provisions in
place, and 70 have
legal measures
incorporating few
Code provisions
in law. Fifty-eight
countries have no
legal measures in
place
22. P. 12 I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
TABLE 1. LEGAL STATUS OF THE INTERNATIONAL CODE OF MARKETING OF BREAST-MILK SUBSTITUTES (4) IN
WORLD HEALTH ORGANIZATION REGIONS IN 2018
1 Cuba and Ukraine are not included in the analyses, as relevant legal documentation could not be obtained during the
preparation of this report.
Law categories
WHO Region
African
The
Americas
Eastern
Mediterranean
European
South-
East Asia
Western
Pacific
Total
Full provisions
in law
12 6 6 3 5 3 35
Many provisions
in law
12 5 4 4 3 3 31
Few provisions
in law
6 9 7 43 — 5 70
No legal
measures
17 15 4 3 3 16 58
Total 47 35 21 53 11 27 194
As can be seen in Table 1, the proportion of countries with comprehensive legislation on
the Code (full provisions in law) is highest in the South-East Asian Region (45%: 5 out of
11 countries), followed by the Eastern Mediterranean Region (29%: 6 out of 21 countries)
and the African Region (26%: 12 out of 47 countries). The Region of the Americas, and the
Western Pacific Region and European Region have the lowest proportion of countries with
comprehensive legislation (17%: 6 out of 35 countries; 11%: 3 out of 27 countries; and 6%:
3 out of 53 countries, respectively).
It should be noted that the European Region consistently records the lowest proportion of
countries for each of the provisions, since a significant number of countries are subject to
EU regulation no. 609/2013 of 12 June 2013 (22), which contains few specific provisions on
the marketing of designated products under the Code. While the EU regulation allows for
adoption of European Commission directives on specific provisions, none have been issued
by the European Commission to date.
KEY PROVISIONS OF NATIONAL LEGAL MEASURES BY REGION
Further information on the substance and quality of specific provisions contained in national
legal measures allows for a more comprehensive understanding of the extent to which such
measures include all, many or few of the provisions of the Code and recommendations of
subsequent relevant WHA resolutions (4, 5). Annex 2 of this report provides detailed and
updated information on all provisions covered by national legal measures in 134 countries
(out of a total of 136 countries with legal measures in place).1
While the 2016 report (16) focused on the status and quality of Code provisions at the global
level, this report provides a regional perspective on the legal status of the Code.
Table 2 shows the percentage of countries in each WHO region that have covered key
provisions of the Code in their national legal measures. The text here highlights the status of
a subset of these provisions that WHO, UNICEF and IBFAN consider to be particularly critical
in addressing and eliminating inappropriate marketing of breast-milk substitutes, feeding
bottles and teats.
23. STATUS REPORT 2018 I P. 13
TABLE 2. PERCENTAGE OF COUNTRIES INCLUDING KEY PROVISIONS OF THE INTERNATIONAL CODE OF MARKETING
OF BREAST-MILK SUBSTITUTES (4) WITHIN LEGAL MEASURES, BY WORLD HEALTH ORGANIZATION REGION
Provisions within legal
measures
Region, percentage
Global
(n = 134)
African
(n = 30)
The Americas
(n = 19)
Eastern
Mediterranean
(n = 17)
European
(n = 50)
South-East
Asia (n = 8)
Western
Pacific
(n = 10)
Products covered
Infant formula 99 100 100 100 100 100 90
Follow-up formula 90 90 95 76 92 100 90
Complementary foods 44 53 47 76 18 88 50
Feeding bottles, teats and/
or pacifiers
54 87 63 65 20 88 70
Milk for mothers 2 3 5 0 0 13 0
Other designated products 43 77 53 47 12 75 40
Milk products up to
36 months
16 27 5 18 10 25 30
Informational/educational
materials
83 83 84 71 86 100 70
Required information for informational/educational materials
Benefits and superiority of
breastfeeding
50 70 79 65 14 88 60
Maternal nutrition
and preparation for
and maintenance of
breastfeeding
43 63 58 59 14 75 50
Negative effect on
breastfeeding of bottle
feeding
43 63 58 53 14 75 60
Difficulty reversing
decision not to breastfeed
32 50 42 35 12 63 30
Proper use of infant
formula
34 50 42 47 16 25 50
Required information for materials on breast-milk substitutes
Social and financial
implications
31 47 26 29 12 75 50
Health hazards of
inappropriate feeding
41 57 53 59 14 75 50
Health hazards of
inappropriate use
43 60 53 65 14 75 50
Prohibition of pictures/
text idealizing breast-milk
substitutes
39 57 63 47 14 50 40
Approval required for
donation of company
materials
32 60 42 41 10 25 30
Prohibition of promotion to the general public
Advertising 57 83 63 76 22 100 80
Sales devices 51 83 53 65 18 100 60
Samples and gifts 58 87 63 88 20 100 70
Contact with mothers 34 57 53 41 8 88 10
24. P. 14 I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
Provisions within legal
measures
Region, percentage
Global
(n = 134)
African
(n = 30)
The Americas
(n = 19)
Eastern
Mediterranean
(n = 17)
European
(n = 50)
South-East
Asia (n = 8)
Western
Pacific
(n = 10)
Prohibition of promotion to health workers/facilities
Provision of free/low-cost
supplies
43 63 42 76 14 75 40
Materials and gifts 48 83 58 59 14 88 40
Required information on labels of breast-milk substitutes
Recommended age of
introduction
35 60 58 29 16 25 30
Message on superiority of
breastfeeding
59 80 89 82 24 75 60
Only to be used on advice
of health worker
39 50 53 59 16 50 50
Preparation instructions 57 83 84 71 22 75 60
Bans of pictures/text
idealizing infant formula
79 77 89 59 90 75 50
Warning on pathogenic
microorganisms
8 10 11 12 2 25 10
Ban on nutrition and health
claims
39 13 16 18 72 38 30
Mandates monitoring
mechanism
71 67 74 76 44 100 90
Criteria for monitoring mechanism
Independent and
transparent
7 7 0 18 6 0 10
Free from commercial
influence
12 13 5 24 6 13 10
Empowered to investigate
Code violations
52 53 32 65 19 100 80
Empowered to impose
sanctions
65 60 63 82 38 88 80
25. STATUS REPORT 2018 I P. 15
In this context, the provisions selected for this report are the following:
1. coverage of milk products up to 36 months of age;
2. prohibition of advertising to the general public;
3. prohibition of donation of samples and gifts to the general public;
4. prohibition of donation of materials and gifts to health workers;
5. prohibition of promotion of complementary foods for infants aged 0–6 months;
6. empowered to impose sanctions.
It is important to note that these provisions were selected to highlight persistent challenges
witnessed in many countries, and do not in any way diminish the importance of other Code
provisions. Indeed, as emphasized in resolution WHA34.22 (21), adoption of and adherence to
the Code is a minimum requirement for all countries, and the Code should be implemented
“in its entirety”.
In addition, a preliminary analysis of provisions prohibiting promotion of complementary
foods was added, in light of growing concerns about the impact of inappropriate promotion
of such products on breastfeeding.
COVERAGE OF MILK PRODUCTS UP TO 36 MONTHS OF AGE
The Codex Alimentarius Guidelines on formulated complementary foods for older infants and
young children (23) define young children as those up to 3 years of age. WHO recommends
breastfeeding for 2 years or beyond, and protection of continued breastfeeding beyond
2 years against inappropriate promotion is essential. However, promotion of breast-
milk substitutes for older infants and young children between 6 and 36 months of age is
increasing. These products, including follow-up formula and “growing-up” milks, undermine
sustained breastfeeding up to 2 years or beyond.
The Guidance (7) clearly states that products that function as breast-milk substitutes
should not be promoted and defines breast-milk substitutes as “any milks (or products that
could be used to replace milk, such as fortified soy milk), in either liquid or powdered form,
that are specifically marketed for feeding infants and young children up to the age of 3 years
(including follow-up formula and growing-up milks)”. It also states that implementation of
the Code covers all these products. “Follow-on” milks (or follow-up formula) and “growing-
up” milks are thus covered by the scope of the Code.
Fig. 2 shows the proportion of countries, by WHO region, that specifically cover milk
products labelled for use up to at least 36 months of age in their legislation. Only 22 of the
134 countries (16%) with available legal measures have designated this age range. In the
Western Pacific Region, 30% of countries have such provisions in place, followed by 27% of
countries in the African region (3 out of 10 countries and 8 out of 30 countries, respectively);
25% of countries in the South-East Asia Region cover milk products up to at least 36 months
(2 out of 8 countries) and 18% of countries in the Eastern Mediterranean region (3 out of
22 countries), whereas 10% of countries in the European Region (5 out of 50 countries) do so.
The Region of the Americas has the lowest proportion of countries covering such products,
only 5% (1 out of 19 countries).
A further 25% of countries do not specify a maximum age for designated products covered
under the scope of their national legal measures. This could be due to the fact that until the
issuance of the Guidance (7), there was little clarity as to the age limit for products covered
by the scope of the Code (4).
26. P. 16 I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
PROHIBITION OF ADVERTISING TO THE GENERAL PUBLIC
Prohibition of advertising to the general public is fundamental to the protection of optimal
infant and young child feeding. Article 5.1 of the Code states that “there should be no
advertising or other form of promotion to the general public of products within the scope of
the Code” (4). Article 5.3 states that “there should be no point-of-sale advertising, giving of
samples, or any other promotion device to induce sales directly to the customer at the retail
level, such as special displays, discount coupons, premiums, special sales, loss-leaders and
tie-in sales, for products within the scope of this Code” (4).
Fig. 2 shows the proportion of countries, by WHO region, that have legal provisions prohibiting
the advertising of designated products to the general public. Around 57% of the countries
with available legal measures (77 out of 134 countries) appear to have such provisions
incorporated. All countries in the South-East Asia Region prohibit advertising (100%: 8 out of
8 countries), closely followed by countries in the African Region (83%: 25 out of 30 countries).
A significant proportion of countries in both the Eastern Mediterranean Region and the
Western Pacific Region have legal provisions on advertising (76%: 13 out of 17 countries,
and 80%: 8 out of 10 countries, respectively). The lowest proportion of countries prohibiting
advertising is in the Region of the Americas (63%: 12 out of 19 countries) and the European
Region (22%: 11 out of 50 countries).
PROHIBITION OF DONATION OF SAMPLES AND GIFTS TO THE GENERAL PUBLIC
Article 5.2 of the Code states that “manufacturers and distributors should not provide,
directly or indirectly, to pregnant women, mothers or members of their families, samples of
products within the scope of this Code” (4).
Fig. 2 shows the proportion of countries, by WHO region, that have legal provisions
prohibiting donation of samples and gifts to the general public. Fifty-eight per cent of the
countries with available legal measures (78 out of 134 countries) prohibit samples and
gifts. As with prohibition of advertising, the proportion of countries in individual regions that
prohibit such practices is generally high, as many have comprehensive provisions covering
various forms of advertising and promotion to the general public (with the exception of
the European Region, where only 40% of the countries [20 out of 50 countries] have have
comprehensive provisions). All countries in the South-East Asia Region prohibit samples and
gifts (100%: 8 out of 8 countries), closely followed by countries in the African Region (87%:
26 out of 30 countries) and the Eastern Mediterranean Region (88%: 15 out of 17 countries).
TheWestern Pacific Region and the Region of the Americas follow,with around three-quarters
of their countries prohibiting samples and gifts (80%: 7 out of 10 countries; and 63%: 12 out
of 19 countries, respectively).
PROHIBITION OF DONATIONS OF MATERIALS AND GIFTS TO HEALTH WORKERS
The health system has been used as a conduit for promoting products falling under the
scope of the Code. Traditional target audiences, for example pregnant women and mothers
of infants, as well as their family members, can easily be reached, and health facilities and
personnel have often been targeted through the provision of materials and equipment that
may lead to a direct or indirect endorsement of a company’s products.
Article 7.3 of the Code states that “no financial or material inducements to promote products
within the scope of this Code should be offered by manufacturers or distributors to health
workers or members of their families, nor should these be accepted by health workers or
members of their families” (4).
Promotion in health facilities remains persistent in many countries. Fig. 2 shows the
proportion of countries, by WHO region, that have legal provisions prohibiting donation of
materials and gifts to health workers.Of the 134 countries with available legal measures,47%
prohibit samples and gifts to health workers (64 out of 134 countries). Almost all countries in
the South-East Asia Region prohibit samples and gifts (88%: 7 out of 8 countries), followed by
Promotion of
breast‑milk
substitutes for
older infants and
young children
between 6 and
36 months of age
is increasing
Of the
134 countries with
available legal
measures, 47%
prohibit samples
and gifts to health
workers (64 out of
134 countries
27. STATUS REPORT 2018 I P. 17
countries in the African Region (83%: 25 out of 30 countries) and the Eastern Mediterranean
Region (59%: 10 out of 17 countries). The Region of the Americas and the Western Pacific
Region follow, with around three-quarters of their countries prohibiting samples and gifts
(58%: 11 out of 19 countries; and 40%: 4 out of 10 countries, respectively). Fourteen per
cent of countries in the European Region (7 out of 50 countries) prohibit promotion to
health workers.
PROHIBITIONOFPROMOTIONOFCOMPLEMENTARYFOODSFORINFANTSAGED0–6MONTHS
The scope of the Code clearly includes complementary foods that are marketed as a partial
replacement of breast milk. In addition, resolution WHA49.15 urges countries to “ensure that
complementary foods are not marketed for or used in ways that undermine exlusive and
sustained breastfeeding” (24). Since WHO recommends exclusive breastfeeding for the first
6 months of life, any promotion of complementary foods for infants less than 6 months of
age is prohibited by the Code.
A ban on promotion of complementary foods for infants under 6 monthsof age is included in
the legal measures of the Code in 29% of countries (39 out of 134 countries). This analysis did
not distinguish between promotion to the public and in health-care facilities. In a significant
number of these countries (34), the provisions call for a blanket ban on promotion of all
designated products under their laws or regulations, including complementary foods. While
WHO does not call for a ban on promotion of all complementary foods, resolution WHA69.9
states “that Member States could take additional actions to end inappropriate promotion
of foods for infants and young children” (6). A smaller number of countries (5) prohibit
promotion of complementary foods below the age of 6 months only.
While the Guidance only pertains to foods and drinks marketed for children aged 6–36 months,
it does clarify that no complementary foods should be promoted for use before 6 months of
age. For the purpose of this report, the prohibition of promotion of complementary foods upto
36 months is comprehensively presented.
EMPOWERED TO IMPOSE SANCTIONS
For national Code legislation or regulations to be effective, responsible government agencies
must be empowered to monitor compliance with national legal measures, identify Code
violations and take corrective action when violations are identified, through administrative,
legal or other sanctions. Therefore, legal measures must include clear provisions that enable
and empower authorized agencies to take the corrective action needed.
The evaluation of this provision excludes all EU countries, because enforcement of the EU
regulation of 2013 is the responsibility of specific Member States and it was not possible to
obtain information on which EU members have established enforcement mechanisms.
Fig. 2 shows the proportion of countries, by WHO region, that have legal provisions
empowering authorized agencies to impose sanctions where violations have occurred and
have been identified. Sixty-five per cent of the countries with legal measures in place (65 out
of 100 countries) incorporate provisions authorizing the use of sanctions. The South East Asia
Region and the Western Pacific Region have the highest proportion of countries with such
provisions in place (88%: 7 out of 8 countries and 80%: 8 out of 10 countries, respectively).
A total of 82% of countries in the Eastern Mediterranean Region (14 out of 17 countries)
empower government agencies to impose sanctions, followed by 63% and 60% in the Region
of the Americas (12 out of 19 countries) and the African Region (18 out of 30 countries),
respectively. In the European Region (excluding EU members), 38% of countries have such
provisions in place (6 out of 16 countries).
Around57%ofthe
134countireswith
availablelegal
measuresappearto
havelegalprovisions
prohibitingthe
advertisingof
designatedproducts
tothegeneralpublic
Fifty-eight per cent
of the countries
with available legal
measures (78 out
of 134 countries)
prohibit samples
and gifts
28. P. 18 I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
0
10
20
30
40
50
60
70
80
90
100
Global
(n=134)
AfricanRegion
(n=30)
Regionof
theAmericas
(n=19)
Eastern
MediterraneanRegion
(n=17)
EuropeanRegion
(n=50)
South-East
AsiaRegion
(n=8)
WesternPacificRegion
(n=10)
Milkproductscoveredupto36monthsAdvertisingtogeneralpublicprohibitedDonationofsamplesandgiftstogeneralpublicprohibited
Donationofsamplesandgifts
tohealthworkersprohibited
Empoweredtoimposesanctions
Percentage(%)
FIG. 2. KEY PROVISIONS BY WORLD HEALTH ORGANIZATION REGION
29. STATUS REPORT 2018 I P. 19
SUMMARY
While inappropriate promotion of breast-milk substitutes, feeding bottles and teats
occurs in various forms and settings, some of the most persistent Code violations
continue to take place in health-care settings, and via advertising in the public domain.
Among the countries that have any laws on marketing of breast-milk substitutes,
globally just over half sufficiently prohibit advertising and other forms of promotion
to the general public. In addition, a little over half prohibit gifts to health workers or
members of their families. Furthermore, as already highlighted in the 2016 report
(16), not all countries with legal measures in place include robust provisions that
authorize relevant government entities to impose sanctions when violations have
been identified and validated.
A brief analysis of the regional patterns reveals that the South-East Asia Region most
consistently implements the Code, while the European Region consistently covers
the fewest Code provisions. Other regions show less consistency in their provisions.
For instance, while most countries in the African Region prohibit various forms
of promotion to the general public and health workers, fewer of those countries
have provisions in place to impose sanctions in case of violations. This highlights
an important gap in Code implementation, which needs to be addressed through
adoption of robust monitoring and enforcement measures. Countries in the Western
Pacific Region and in the Eastern Mediterranean Region typically prohibit promotion
to the general public, and include provisions that empower governments to enforce
laws and regulations. However, fewer countries in these two regions prohibit
promotion to health workers, again revealing an important shortcoming in efforts to
reduce and eliminate inappropriate promotion of breast-milk substitutes. Countries
in the Region of the Americas generally tend to fall behind in ensuring proper legal
responses to inappropriate promotion, with the proportion of countries prohibiting
promotion in public and health-care settings, and facilitating the imposition of
sanctions, at around 60%.
In addition to the need for more robust measures to curb inappropriate promotion
of breast-milk substitutues in both health-care facilities and public settings, urgent
efforts should be made to ensure that countries strengthen their legal measures to
explicitly include milk products intended and marketed as suitable for feeding young
children up to 36 months of age. Currently, only 22 countries have such measures
in place.
Some of the most
persistent Code
violations continue
to take place
in health-care
settings, and via
advertising in the
public domain
Abanonpromotion
ofcomplementary
foodsforinfants
under6monthsof
ageisincludedin
thelegalmeasures
oftheCodein29%
ofcountries(39out
of134 countries).
30. P. 20 I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
31. STATUS REPORT 2018 I P. 21
STATUSOFLEGALPROVISIONS
RELATEDTOCOMPLEMENTARYFOOD
32. P. 22 I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
STATUS OF LEGAL PROVISIONS RELATED TO
COMPLEMENTARYFOOD
BASEDONSELECTEDRECOMMENDATIONSOFTHEWHOGUIDANCEONENDING
INAPPROPRIATEPROMOTIONOFFOODSFORINFANTSANDYOUNGCHILDREN
Evidence from numerous countries indicates that promotion of commercial foods for infants
and young children increasingly undermines efforts to ensure optimal infant and young child
feeding (25–27).1
Studies show that complementary foods are being sold as suitable for
introduction before 6 months of age; breast-milk substitutes are being indirectly promoted
through association with complementary foods; and inaccurate and misleading claims are
being made that products will, for instance, improve a child’s health or improve intellectual
performance. Such inappropriate promotion of complementary foods can mislead and
confuse mothers and other caregivers about the nutrition- and health-related qualities
of these foods, and about their age-appropriate and safe use, and can lead caregivers to
believe that family foods are inadequate, and create a dependence on expensive commercial
products. For these reasons, the regulation of inappropriate promotion of complementary
foods is crucial in promoting and protecting optimal infant and young child nutrition.
Ofthe136 countriesthathavelegalmeasuresinplace,43%haveincorporatedcomplementary
foods as a designated product within their measures (59 out of 136 countries). The brief
analysis that follows focuses only on those 59 countries.
REQUIREMENTSFORMESSAGESONCOMPLEMENTARYFOODS(RECOMMENDATION4)
Even for products that are considered appropriate for consumption by infants and young children,
messaging and labelling must be accurate and detailed and contain full and honest information
to inform caregivers on optimal nutrition, and to enable them to make informed decisions.
Recommendation 4 of the Guidance (7) spells out the requirements for ensuring that
messages and labels support optimal feeding and are not misleading or inappropriate
in any way.
Such messages and labels must include (i) a statement on the importance of continued
breastfeeding for up to two years or beyond; (ii) a statement on the importance of not
introducing complementary feeding before 6 months of age; and (iii) the appropriate age
of introduction of the food (this must not be less than 6 months).
Messages and labels should not include (i) any image, text or other representation
that might suggest use for infants under the age of 6 months (including references to
milestones and stages); and (ii) any image, text or other representation that is likely to
undermine or discourage breastfeeding, that makes a comparison to breast milk, or that
suggests that the product is nearly equivalent or superior to breast milk. They should also
not recommend or promote bottle feeding, or convey an endorsement or anything that
may be construed as an endorsement by a professional or other body, unless this has been
specifically approved by relevant national, regional or international regulatory authorities.
Analysis of legal measures of the 59 countries that include complementary foods as
a designated product shows that only one country has provisions that cover all of the
requirement of recommendation 4 of the Guidance (7).
Fig. 3 presents the number of countries with legal measures specifying requirements for
messages in product materials and on labels.
1 Reference (25) includes studies conducted in Cambodia, Indonesia Nepal, Senegal, and Tanzania.
Of the
136 countries
that have legal
measures in
place, 43% have
incorporated
complementary
foods as a
designated product
within their
measures (59 out of
136 countries).
Countriesshould
ensurethat
complementary
foodsarenot
marketedforor
usedinwaysthat
undermineexlusive
andsustained
breastfeeding
33. STATUS REPORT 2018 I P. 23
0 5 10 15 20 25 30 35
Required statement on the importance of continued
breastfeeding for up to 2 years or beyond
Required statement on the importance of not
introducing complementary feeding before 6 months
Required statement on the appropriate age of
introduction of food (should not be less than 6 months)
Prohibition of image, text or other representation
that might suggest use for infants under the age
of 6 months
Prohibition image, text or other representation
undermining/discouraging breastfeeding, that makes
a comparison to breastmilk, or that suggests that
the product is nearly equivalent or superior
to breastmilk
Prohibition of recommendation or promotion
of bottle feeding
Prohibition of endorsement by professional or
other body unless approved by relevant national,
regional or international regulatory authorities
2 For the purpose of this report, all countries that require messages on the importance of “optimal infant and young
child feeding” are included here.
FIG. 3. NUMBER OF COUNTRIES WITH LEGAL MEASURES SPECIFYING REQUIREMENTS FOR MESSAGES IN
PRODUCT MATERIALS AND ON LABELS
Twenty-nine countries require messages and labels for complementary foods to include a
statement on the importance of continued breastfeeding for up to 2 years or beyond,2
while
23 require mention of the importance of not introducing complementary feeding before 6
months of age. Indication in messages and on labels of the appropriate age of introduction of
the food is required in 25 countries.
Prohibitions of any image, text or other representation that might suggest use for infants
under the age of 6 months (including references to milestones and stages) are in place
in 13 countries, while 27 prohibit any image, text or other representation that is likely to
undermine or discourage breastfeeding, that makes a comparison to breast milk, or that
suggests that the product is nearly equivalent or superior to breast milk. A mere seven
countries prohibit messages that recommend or promote bottle feeding. Finally, avoidance
of messages that convey an endorsement or anything that may be construed as an
endorsement by a professional or other body (unless this has been specifically approved
by relevant national, regional or international regulatory authorities), is required in only
three countries.
AVOIDANCEOFCONFLICTSOFINTERESTINHEALTH-CARESETTINGSBYMANUFACTURERS
ANDDISTRIBUTORSOFCOMPLEMENTARYFOODS(RECOMMENDATION6)
Inappropriate promotion of foods for infants and young children often occurs in health-care
settings, where manufacturers and distributors of baby and complementary foods have
direct access to those providing services to pregnant women and mothers. The Guidance (7)
clearly states that manufacturers and distributors of complementary foods must not create
possible conflicts of interest in health facilities or throughout health systems.
Twenty-nine
countries out of 59
require messages
and labels for
complementary
foods to include
a statement on
the importance
of continued
breastfeeding
for up to 2 years
or beyond, while
23 require mention
of the importance
of not introducing
complementary
feeding before
6 months of age
34. P. 24 I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
Recommendation 6 of the Guidance (7) highlights the types of actions by manufacturers
and distributors that would constitute a conflict of interest.
These include donation of materials and equipment to health facilities, gifts and incentives
to health personnel, gifts to caregivers and their families, sponsorship of meetings and
events, and provision of direct education to caregivers, among other conflicts of interest.
Recommendation 6 also lays down the responsibilities of health workers, facilities and
health professional associations to avoid situations of conflict of interest.
For the purpose of this report, preliminary analysis of recommendation 6 focuses on the
specific requirements of manufacturers and distributors to avoid conflicts of interest.
Such detailed information is not provided in relation to the responsibilities of health workers,
facilities and health professional associations, although the report does include information
on whether countries generally have provisions that address avoidance of conflicts of
interest for these entities. More detailed analysis will be provided in the next report.
Fig. 4 shows the number of countries with legal measures specifying prohibition of activities
that could lead to a conflict of interest in health-care settings.
0 5 10 15 20 25 30 35 40 45
Prohibition of sponsorships of
meetings by manufacturers and
distributors of complementary
foods/avoidance of conflict of interest
Prohibition of free products, samples
or reduced-price foods for infants and
young children through health
workers/facilities
Prohibition of donation or
distribution of equipement or services
to health facilities
Prohibition of gifts or incentives
to health-care staff
Prohibition of use of health
facilities to host events, contests or campaigns
Prohibition of gifts or coupons to
parents, caregivers and families
Prohibition of direct or indirect
provision of education to parents and
other caregivers in health facilities
Prohibition on provision of
information for health workers which
is not scientific and factual
FIG. 4. NUMBER OF COUNTRIES WITH LEGAL MEASURES SPECIFYING PROHIBITION OF ACTIVITIES THAT COULD
LEAD TO A CONFLICT OF INTEREST IN HEALTH-CARE SETTINGS
Thirty-seven countries prohibit manufacturers and distributors from sponsoring meetings
of health professionals and scientific meetings, but in only 14 countries are manufacturers
and distributors prohibited from using health facilities to host events, contests or campaigns.
Provision of free products, samples or reduced-price foods for infants or young children to
Thirty-seven
countries out
of 59 prohibit
manufacturers
and distributors
from sponsoring
meetings of health
professionals
and scientific
meetings, but in
only 14 countries
are manufacturers
and distributors
prohibited from
using health
facilities to host
events, contests or
campaigns
35. STATUS REPORT 2018 I P. 25
families through health workers or health facilities (except as supplies distributed through
officially sanctioned health programmes) is not allowed in 41 countries, and equipment or
services are not permitted to be donated or distributed to health facilities in 23 countries.
The provision of gifts or incentives to health-care staff is prohibited in 39 countries, while
providing gifts or coupons to parents, caregivers and families is not allowed in 26 countries.
Provisions prohibiting the direct or indirect provision of education by manufacturers and
distributors to parents and other caregivers on infant and young child feeding in health
facilities exist in 21 countries. Finally, the distribution of any information for health workers
that is not scientific and factual is not allowed in 25 countries.
Only four countries have provisions covering all eight conflict-of-interest practices described
in this section.
CROSS-PROMOTION (RECOMMENDATION 5)
It is important to address cross-promotion, as it has been demonstrated that promotional
elements of a company’s complementary food products, such as labelling, branding and
use of mascots, can appear very similar to those related to the company’s range of breast-
milk substitute products, effectively promoting the latter. Brand cross-overs can mislead
and confuse caregivers about the nutrition- and health-related qualities of commercial
complementary foods, and age-appropriate and safe use of these products.
Recommendation 5 of the Guidance (7) calls upon companies to refrain from cross-
promotion to promote breast-milk substitutes indirectly via the promotion of foods for
infants and young children.
Companies must ensure that packaging design, labelling and materials used for
the promotion of complementary foods are distinct from those used for breast-milk
substitutes (e.g. different colour schemes, designs, names, slogans and mascots other
than the company name and logo).
Companies must also refrain from engaging in the direct or indirect promotion of their
other food products for infants and young children by establishing relationships with
parents and other caregivers (e.g. through baby clubs, social media groups, childcare
classes and contests).
In spite of the importance of avoiding cross-promotion, only three of the 59 countries ban
such promotional practices.
SUMMARY
The analysis undertaken provides a starting point to assess the extent to which the current
legal and regulatory landscape in countries is supportive of effective implementation of
the Guidance recommendations (7). A number of countries have made significant efforts
to address inappropriate marketing practices in relation to complementary foods by
incorporating relevant provisions in their legislation for the Code and infant and young
child nutrition. Some of those countries successfully did so prior to the approval of the
Guidance, while those that adopted new, or improved existing, legislation after 2016 took
into consideration various elements of the Guidance. Nevertheless, there is much room for
further improvement.
Analysis of the requirements for messages and labelling under recommendation 4 of the
Guidance (7) indicates that most countries where complementary foods are included as
designatedproductsinrelevantlegalmeasuresdonotsufficientlyincludetheserequirements.
While nearly half of all 59 countries do require a message related to the importance of
breastfeeding, many include a general statement about the importance of “optimal infant
and young children feeding”. Some, but not all these countries define what optimal feeding
The provision of
gifts or incentives
to health-care
staff is prohibited
in 39 out of
59 countries, while
providing gifts
or coupons to
parents, caregivers
and families is
not allowed in
26 countries
Only four countries
have provisions
covering all eight
conflict-of-interest
practices described
36. P. 26 I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
entails, and so there is risk of varying levels of interpretation, which needs to be analysed
further in the future. In 48 countries, either inclusion of information on the age of introduction
of the food or a warning about early introduction is required, but only around one quarter
of all countries require inclusion of both messages. In addition, few countries prohibit
any presentation that suggests use of the product for infants under the age of 6 months.
The omission of these messages and the risk of inappropriate presentation may lead to
confusion among mothers and other caregivers as to the proper age of introduction for
the product. Finally, almost no country prohibits messages that convey real or perceived
endorsement of the product by health professionals.
Conflicts of interest in health-care settings due to the behaviour and practices of
manufacturers and distributors continues to be a major challenge in many countries. Robust
legal measures prohibiting practices that constitute a conflict of interest are key in any
strategy to address the conduct of the private sector. Analysis shows that very few countries
have legal provisons in place that comprehensively address all of the conflicts of interest
dicussed in the Guidance (7), thereby leaving loopholes to be exploited. While a significant
number of countries include measures that prohibit, to a certain extent, manufacturers and
distributors from directly using health personnel as a conduit for promotion, fewer prohibit
practices that allow more direct access to pregnant women, mothers and other caregivers
in health facilities. Such practices would include providing gifts or coupons to parents,
caregivers and families (not allowed in 26 countries), and directly or indirectly providing
education on infant and young child feeding in health facilities, by manufacturers and
distributors, to parents and other caregivers (prohibited in only 21 countries).
Only three out of the 59 countries that cover complementary foods as designated products
under their legislation prohibit cross-promotion. More efforts must be made to ensure that
cross-promotion is not allowed, and this, inter alia, may require a more in-depth analysis
of broader legislative frameworks in countries, to identify existing prohibitions on cross-
promotion more generally.
A number of
countries have
made significant
efforts to address
inappropriate
marketing practices
in relation to
complementary
foods by
incorporating
relevant provisions
in their legislation
for the Code and
infant and young
child nutrition
Few countries
prohibit any
presentation that
suggests use of the
product for infants
under the age of
6 months
37. STATUS REPORT 2018 I P. 27
Conflicts of interest
in health-care
settings due to
the behaviour
and practices of
manufacturers
and distributors
continues to be a
major challenge in
many countries.
Only three out of
the 59 countries
that cover
complementary
foods as designated
products under
their legislation
prohibit cross-
promotion
38. P. 28 I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
40. P. 30 I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
CONCLUSIONS
Since 2016, some progress has been made, both globally and in individual countries,
in advocating for the promotion and protection of breastfeeding, and for the need to protect
mothers and their children from the harm done by inappropriate promotion of breast-milk
substitutes and other foods for infants and young children.
This report documents the adoption of new legislation implementing the Code (4) in a few
countries, and formulation of additional measures to strengthen existing legislation in others.
Capacity-building activities have increased in regions and countries.
Nevertheless, most countries continue to lack an effective and sustained response to the
persistent marketing practices of manufacturers and distributors of breast-milk substitutes
and other foods for infants and young children.
Thirty-seven years after the adoption of the Code (4), too few countries have robust measures
in place to eliminate inappropriate promotion of breast-milk substitutes and complementary
foods for infants and young children, including advertising to the general public and various
forms of promotion in health-care settings. A ban on promotion of complementary foods
for infants under 6 months of age is in place in under one third of all countries with Code-
related legislation. In addition, in four out of the six WHO regions, a little over half of the
countries have provisions that explicitly empower government agencies to impose sanctions
on violators of their law. Furthermore, very few countries currently include milk products
labelled for use up to at least 36 months of age as designated products in their legislation.
The baseline analysis of the specific legal provisions in countries that have complementary
foods listed as designated products in their Code-related legislation also revealed important
gaps, in spite of significant efforts made by some countries to legally curb inappropriate
marketing practices in relation to such products. In most countries, full coverage
of the requirements for messages and labels on complementary foods, as listed in
recommendation 4 of the Guidance (7), is currently inadequate. In addition, few countries
have legal provisons that comprehensively address all forms of conflicts of interest,
as reflected in recommendation 6 of the Guidance (7), thus creating loopholes for expoitation
by manufacturers and distributors. Further, only a handful of countries have legal provisions
in place that ban cross-promotion.
Other, more general challenges persist in many countries. These were discussed at length in
the 2016 report (16), but remain important challenges to address.
These include absence of sustained, high-level political will and accountability; lack of
operational monitoring and enforcement processes and mechanisms; limited understanding
and capacity among actors responsible for monitoring Code-related activities; and insufficient
human and financial resources (or in many cases, inadequate management and use of
available resources).
Many of these broader challenges can be effectively addressed, as legal/technical assistance
and operational tools become increasingly available to countries.
This report has highlighted both recent progress and continuing challenges in countries
related to effective regulation of inappropriate promotion of breast-milk substitutes and
complementary foods for infants and young children. The prevalence of inappropriate
marketing of such products remains high in many countries and continues to undermine
efforts to improve breastfeeding rates. Many types of inappropriate promotion continue
without sanction, in spite of the ample evidence that the protection, promotion and support of
breastfeeding rank among the most effective interventions to improve child survival, and are
beneficial to the health of mothers.
There should be no doubt that the Code remains as relevant and important as when it was
adopted in 1981 (4), if not more so. The Code, and the 2016 Guidance (7), are an essential
A ban on promotion
of complementary
foods for infants
under 6 months
of age is in place
in under one third
of all countries
with Code-related
legislation.
Infouroutofthe
sixWHO regions,a
littleoverhalfof
thecountrieshave
provisionsthat
explicitlyempower
government
agenciestoimpose
sanctionson
violatorsoftheirlaw
41. STATUS REPORT 2018 I P. 31
part of creating an overall environment that enables mothers to make the best possible
feeding choice, based on impartial information and free of commercial influences, and to be
fully supported in doing so. As such, protecting the health of children and their mothers from
continued misleading marketing practices should be seen by countries as a public health
priority and human rights obligation.
Recommendations for action
The findings of this report lead to the recommendations listed next.
• Legislators and policy-makers must recognize their obligations, under both international
human rights law and national Code-related or other relevant laws, to promote
and protect breastfeeding, and to eliminate inappropriate marketing practices.
Such obligations must translate into clear statements of support, allocation of adequate
budgets, and creation and application of budget-oversight mechanisms.
• Governments must establish robust and sustainable monitoring and enforcement
mechanisms to implement national laws and regulations aimed at eliminating
inappropriate marketing practices. Such mechanisms need to involve all relevant
government agencies authorized to monitor and enforce various elements of the Code
(4) and Guidance (7), must be adequately funded and sourced with knowledgable staff,
and should allow for public engagement and scrutiny, including through the periodic
release of implementation reports. To assist countries with the strengthening of
monitoring and enforcement, WHO, in collaboration with partners of the Network for
Global Monitoring and Support for Implementation of the International Code of Marketing
of Breast-milk Substitutes and Subsequent relevant World Health Assembly Resolutions
(NetCode) (28), has published important monitoring protocols, including practical tools
and guidance for setting up effective monitoring systems (29).
• Countries should analyse and address weaknesses or gaps in their existing legislation,
and act accordingly. In particular, countries must strengthen their legal and regulatory
frameworks, to (i) eliminate advertising and other forms of promotion to the general
public and in health-care facilities; (ii) enable authorized government entities to impose
sanctions when violations have been identified and validated; (iii) explicitly include milk
products intended and marketed as suitable for feeding young children up to at least 36
months of age; and (iv) enforce a ban on promotion of complementary foods for infants
under 6 monthsof age.
• Countries should also urgently review and analyse their legal and regulatory frameworks
in view of the WHO Guidance on ending inappropriate promotion of foods for infants
and young children (7). For those countries that do not include complementary foods
as designated products in their relevant legislation, efforts must be made to do so,
aligning additional measures with the recommendations set forth in the Guidance.
Countries that have complementary foods included, should review and amend their
legislation accordingly.
Protecting the
health of children
and their mothers
from continued
misleading
marketing practices
should be seen
by countries as
a public health
priority and human
rights obligation
42. P. 32 I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
44. P. 34 I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
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48. P. 38 I NATIONAL IMPLEMENTATION OF THE INTERNATIONAL CODE
Annex 1. Legal status of the International Code of Marketing of Breast-
milk Substitutes in all World Health Organization Member States,
includingcategorization
Country Region Year of most recent legal measure Legal status of the Code
Afghanistan Eastern Mediterranean 2009 Full provisions in law
Albania European 2017 Full provisions in law
Algeria* African 2012 Few provisions in law
Andorra European 2013 Few provisions in law
Angola African No legal measures
Antigua and Barbuda the Americas No legal measures
Argentina* the Americas 2007 Few provisions in law
Armenia European 2014 Full provisions in law
Australia Western Pacific No legal measures
Austria European 2013 Few provisions in law
Azerbaijan European 2003 Many provisions in law
Bahamas the Americas No legal measures
Bahrain Eastern Mediterranean 1995 Full provisions in law
Bangladesh South-East Asia 2017 Full provisions in law
Barbados the Americas No legal measures
Belarus European No legal measures
Belgium European 2013 Few provisions in law
Belize the Americas No legal measures
Benin African 1998 Full provisions in law
Bhutan South-East Asia No legal measures
Bolivia (Plurinational State of) the Americas 2009 Full provisions in law
Bosnia and Herzegovina European 2000 Few provisions in law
Botswana African 2005 Full provisions in law
Brazil the Americas 2015 Full provisions in law
Brunei Darussalam Western Pacific No legal measures
Bulgaria European 2013 Few provisions in law
Burkina Faso African 1993 Many provisions in law
Burundi African 2013 Many provisions in law
Cabo Verde African 2005 Full provisions in law
Cambodia Western Pacific 2005 Many provisions in law
Cameroon African 2005 Many provisions in law
Canada the Americas No legal measures
Central African Republic African No legal measures
Chad African No legal measures
49. STATUS REPORT 2018 I P. 39
Country Region Year of most recent legal measure Legal status of the Code
Chile* the Americas 2015 Few provisions in law
China* Western Pacific 1995 Few provisions in law
Colombia the Americas 1992 Many provisions in law
Comoros African 2014 Many provisions in law
Congo African No legal measures
Cook Islands Western Pacific No legal measures
Costa Rica the Americas 1994 Many provisions in law
Côte d'Ivoire African 2013 Many provisions in law
Croatia European 2013 Few provisions in law
Cuba** the Americas Few provisions in law
Cyprus European 2013 Few provisions in law
Czech Republic European 2013 Few provisions in law
Democratic People's Republic of
Korea
South-East Asia No legal measures
Democratic Republic of the Congo African 2006 Many provisions in law
Denmark European 2013 Few provisions in law
Djibouti Eastern Mediterranean 2010 Few provisions in law
Dominica the Americas No legal measures
Dominican Republic the Americas 1996 Full provisions in law
Ecuador the Americas 1999 Few provisions in law
Egypt Eastern Mediterranean 2010 Many provisions in law
El Salvador the Americas 2013 Many provisions in law
Equatorial Guinea African No legal measures
Eritrea African No legal measures
Estonia European 2013 Few provisions in law
Ethiopia African 2014 Few provisions in law
Fiji Western Pacific 2016 Many provisions in law
Finland European 2013 Few provisions in law
France European 2013 Few provisions in law
Gabon African 2004 Full provisions in law
Gambia African 2006 Full provisions in law
Georgia European 1999 Full provisions in law
Germany European 2013 Few provisions in law
Ghana African 2000 Full provisions in law