Senior Scientist & Chairperson Bangladesh Breastfeeding Foundation Best Practices on The Breastmilk Substitutes, Infant Foods, Commercially Manufactured Complementary Food and the Accessories thereof (Regulation of Marketing) Act. 2013 Dr. S K Roy Senior Scientist & Chairperson Bangladesh Breastfeeding Foundation

Establishment of BMS Act Monitoring System in Bangladesh Activities 1 Establishment of BMS Act Monitoring System in Bangladesh

Background Based on the findings of worldwide scientific researches WHO recommends to breastfeed exclusively for the first 6 months of life and to introduce local, nutrient rich complementary foods thereafter with continued breastfeeding up to 2 years of age. To ensure adequate nutrition for infants, by the protection and promotion of breast-feeding, and by ensuring the proper use of breast-milk substitutes, when these are necessary the International Code of Marketing Breast Milk Substitutes was adopted by World Health Organization on 21 May 1981 d Resolution Number 34.22, with 118 votes

BMS Act 1984: Government of republic of Bangladesh developed Act on marketing of breast milk substitutes in 1984 Ordinance no. (XXXIII), which was amended in 1990 Government of Bangladesh preceded and won three cases against Dauphin Ubique Trade Limited in 1999, Lalmai Limited in 1997, Urmi Enterprise Pvt. Limited in 2000.

BMS act 2013: The BMS Act, 1984 ordinance was weak. According to the declaration of Prime Minister, Government along with BBF & other organizations developed a new law which was passed by the Parliament on 22th September, 2013. The by-law of new BMS act 2013 is almost final now.

Objectives of the project: General objective: The main objective of the project was to establish the Breast milk Substitute (BMS) Act monitoring system in Bangladesh. Specific objectives: To increase awareness among stakeholders and general population. To support IPHN in monitoring and taking actions on Act violations. To create an environment of continuous monitoring of the compliance of Act .

Flow Diagram of the Project: Send report & Follow up action BBF Collect data from 64 districts and 128 upazila Detect Violation and collate evidence Documentation & Reporting Website update Sharing meeting Awareness creation & information sharing Orientation Meetings Reactivate National level Advisory Committee on BMS Act committee Form District level committee Take Legal /non-legal actions IPHN Civil Surgeon UH&FPO

Implementation of the project: To perform the project activities One hundred twenty eight pre-selected upazilas of sixty four district were visited three times from May, 2013 to May 2014. Target group: Place of visit Target group Household Mother of under 2 years children Market and shop Shopkeepers/retailers: Staffs/owner of the shops Hospital/Clinic Doctor, senior staff nurse, medical officer Doctor’s chamber Doctor Media Observe advertisements of Billboard, Televisions, Radio, local and national newspapers

BMS Act monitoring committee has been formulated BMS Act monitoring committee has been formulated in all sixty four districts Structure of the monitoring Committee: Chairperson: Civil surgeon Members: UH&FPOs of the Upazila Health Education Officer, Sanitary Inspector

BMS Act monitoring activities Shops and Market: With assistance of the sanitary Inspectors, shops were visited to detect violations during marketing of BMS. It was observed that BMS products were displayed in all the shops. Almost 80 Products (Annex) of Ten manufacturing companies were found in different shops of one twenty upazila of the country. Shopkeepers said that BMS companies give 200-700 (USD 10) taka per month for displaying their products

Name of the company Company Registration number was not found on some products- Some products were found without registration number which is the violation of BMS act 2013 clause 5. Name of the company Company Brand Name Nestle Bangladesh Ltd Nido 2+ Nido 3+ Baby and Me Abul khair consumer Ltd Mother’s smile Lacto Fix Mother’s Smile Cereal and fruits Mother’s Smile Cereal Rice & milk Mother’s Smile Wheat & milk Fasska) Fassmil Junior Baby nutrition care Eldo milk 1+ Eldo milk 2+

BMS displayed in a shelf tagged Nutrition Hygiene corner A monitoring officer of BBF monitoring a shop

Hospital and Clinics Representative of BMS Manufacturing companies visit the hospital and private clinics and give their leaflets to nurses for distribution which is the violation of BMS act 2013 clause 4 (2-ka). Representative of BMS Manufacturing companies visit the hospital and private clinics and offer gifts i.e. pen, pad, paper weight, literature, shampoo, container etc. to the nurses of the clinic which is the violation of BMS Act 2013 clause (2-kha).

Picture: Pen of baby nutrition care limited (Collected from private Clinic)

interviewing Senior Staff Nurse, Munshiganj General hospital A monitoring Officer, interviewing Senior Staff Nurse, Munshiganj General hospital

Doctor’s Chamber: Representative of BMS manufacturing companies visited doctors chambers and offered gifts which was violation of BMS Act 2013 clause (2-kha). BMS companies organized seminar with the health professionals (i.e. Doctors, Nurse, Pharmacists etc) which was violation of BMS Act 2013 clause (2-kha:AA).

Leaflets distributed by the representatives of the company

Media: Advertisement of Breastmilk Substitutes was not observed in local and national newspapers Some BMS companies were promoting BMS through facebook fan pages as it is one of the most popular social networking website which indicates violation of clause 4 (1) of BMS act 2013. For those advertisements they used picture of healthy babies.

Advertisement in the facebook

Home level: Households were visited to detect BMS Act violation Home level: Households were visited to detect BMS Act violation. Mothers were asked for breastfeeding practice, complementary feeding practice, use of BMS, promotional activities of the BMS manufacturing companies, knowledge on BMS law etc , Monitoring Officer, BBF interviewing a mother in her home in Mohalchari

Action taken by BBF: S/N Violation Action taken by BBF Action taken by IPHN/civil surgeon Outcome 1. BMS Manufacturing companies distributed leaflets of their products in hospitals and clinics. Monitoring officers of BBS inform to the civil surgeon and requested to take action. In some upazila Civil surgeon give notice to the hospitals and clinics to avoid the activities related to BMS act violation i Hospital management became aware about BMS Act and representative of the companies were refused for visit. 2. BMS Manufacturing companies offer gifts such as pen, pad, paper weight, literature, shampoo, containers, crookeries etc. to the nurses and the Doctors in hospitals and clinics

Action taken by BBF: S/N Violation Action taken by BBF Action taken by IPHN/civil surgeon Outcome 3. BMS products were displayed in all the shops. BMS companies give 200-700 taka per month for displaying their products Monitoring officers of BBS informed the civil surgeon and requested to take action. According to the consent of the Civil Sergeon, Sanitary Inspectors made the shopkeepers aware of BMS act violation. Display of BMS product has been reduced in some districts 4. Registration number was not found on many containers of BMS. BBF sent letter to IPHN to take legal action IPHN sent letters to Nestle Bangladesh Ltd, Baby Nutrition Ltd. Those companies also replied to IPHN.

Action taken by BBF: S/N Violation Action taken by BBF Action taken by IPHN/civil surgeon Outcome 5. Nestle Bangladesh Limited and Abul Khayer Consumer Product Limited organized seminars with the shopkeepers in some districts in February and March, 2014 to promote their products. BBF sent letter to IPHN to take legal action. IPHN with help of Civil Sergeon stopped a seminar in chittagong. IPHN send letter to the president of BPMPA to stop Quiz compitition in collboration with BMS manufacturing companies.

Awareness programs

Round table discussion With Media Personnel Two round table discussion were held to create awareness among the stakeholders and, media personnel on BMS Act violations. Round Table Discussion with Kaler Kontho and Prothom Alo

Orientation with Manufacturers and Shop keepers: Country wide twenty one orientation seminars were conducted with the shopkeepers, retailers and representatives of the BMS manufacturer companies during September 2013 to May 2014 Monitoring officer, BBF giving lecture on BMS Act in Orientation with the Shopkeepers’ at Hobiganj Civil Surgeon Office

Orientations with Manufacturers and Shopkeepers:

Orientations with Media Personnel Twenty one orientations were organized with Media Personnel in twenty one districts. Editors, Reporters and journalists of local and national newspaper participated on those orientations.

Orientation Workshop of media personnel To create awareness about new BMS act two “Orientation Workshop of media personnel” was organized by IPHN Orientation Workshop with Media Personnel on 12th May, 2014 at IPHN conference room

Orientations in the school and College Twenty one orientations were organized in Higher Secondary school on benefits of Breastmilk and hazards of BMS. 150-250 students participated in each orientation programs. A student Norail Govt. Girls’ High School sharing her experience after completion of the orientation on hazards of BMS

District level BMS Act monitoring Committee has been Activated Activities 2 District level BMS Act monitoring Committee has been Activated

Activities of the BMS Act monitoring Committee Sends notice to the hospital and Clinic to avoid BMS Act Violation Regularly monitors BMS Act Violation in the market Takes legal action Takes legal action against Violations Included agenda on BMS act monitoring in the monthly meeting Sends the meeting minutes to the IPHN and BBF.

Activities 3 Dissemination of BMS Breastmilk Substitutes, Infant Foods, Commercially Manufactured Complementary Food and the Accessories Thereof (Regulation of Marketing) Act. 2013 in Divisional Level

Ten Divisional Workshop on BMS Act, 2013 has been Organized in five Divisions Two Divisional workshops in Khulna Two Divisional workshops in Chittagong Two Divisional workshops in Rajshahi Two Divisional workshops in Barisal Two Divisional workshops in Rangpur

Resource person of the workshop

Participants of the workshop

Divisional workshops in Khulna

Six Divisional Workshop on BMS Act, 2013 has been Organized in Six Division by BBF and BRAC One Divisional workshop in Barisal One Divisional workshop in Sylhet One Divisional workshop in Khulna One Divisional workshop in Rajshahi One Divisional workshop in Rangpur One Divisional workshop in Chittagong

Recommendations Divisional Commissioner recommended organizing dissemination of BMS law in the all districts and upazila of Rajshahi. Need to spread the BMs law quickly among people by campaign and promotion of law. Counseling should be done to the pregnant mother about hazard of BMS product and benefits of breastfeeding. BMS act should be disseminated among all level of health professionals. 

Cont... Benefits of breastfeeding and complimentary feeding should be included in the Medical Curriculum.   More action should be taken against the violators of the BMS act, 2013 Effective counseling needed in case of insufficient breast milk. Counseling should be done among mothers about the benefits of breastfeeding, hazards of BMS at the community level.

Thank you