1. Supporting Legislation to Enforce the International Code of Marketing of Breast-milk Substitutes Presentation: Board of Health Meeting April 17, 2014

2. Breastfeeding A Public Health Priority  Contributes to maternal and infant health outcomes  Mediates effects of Social Determinants of Health and helps reduce health inequities  Reduces health costs in short and long term

3. How are we doing in HKPR? Canadian Maternity Experiences Survey 2009 HKPR Breastfeeding Survey (October 2012 – Sept 2013) Of breastfeeding mothers surveyed  90% initiated breastfeeding  9.8% continued until 5 months  8.9% exclusively breastfeeding at 5 months  90.3% initiate breastfeeding  53.9% continue until 6 months  14.4% exclusively breastfeeding at 6 months

4. Successful Breastfeeding Experience Cultural Factors Social and Emotional Factors Compliance with Code and resolutions Knowledge and skills Family Support Support from Health Care System Community and Environmental Support Factors influencing breastfeeding success

5. The International Code of Marketing of Breast-milk Substitutes  Promotes ethical marketing practices  Supports informed decision making based on information that is impartial and free of commercial influences  Endorsed by Baby Friendly Initiative

6. 1.No advertising breastmilk substitutes directly to public. 2.No free samples to mothers. 3.No promotion of products in health care facilities. 4.No company representatives to advise mothers. 5.No gifts or personal samples to health care workers. 6.No words or pictures idealizing artificial feeding. 7.Information to health care workers should be scientific and factual. 8.Information on artificial feeding, including labels should explain the benefits of breastfeeding and costs and hazards associated with artificial feeding. 9.Unsuitable products, such as condensed milk should not be promoted for babies 10.Products should be of high quality and take into account climatic and storage conditions of country where used. WHO Code Recommendations

7. Why legislation? 1.Babies and Mothers are vulnerable 2.Companies are breaking the rules 3.Allow public health messaging to have greater impact 4.Supportive of BFI

8.  Formula ≠ Breastmilk  Unethical marketing practices are being used at a time when mothers are at a critical and vulnerable stage of childrearing  Marketing targets their fears and erodes confidence  Pressures families to use formula when not required  Low income and young families are at greatest risk Babies and Mothers are Vulnerable

9. Companies are breaking the rules Breaking the Rules, Stretching the Rules 2010 (2007-2010)  Summarizes violations of WHO Code  Examines 22 Companies  Legally accurate 1.Misleading or exaggerated claims 2.Sponsorship of health care workers 3.Unethical use of social marketing

10. Advertising works Nestle- 100% Healthy Nutrition for Baby

11. Social media providing access to mothers

12. Google “Breastfeeding Support”

13. Baby Clubs

15. A Good Time to Take Action  “No Time to Wait”  OPHA Position Paper  Growing concern in our own community  BFI expanding into hospitals and community

16. 1.Support Peterborough County-City Health Unit’s position in urging federal government to enact legislation 2.Send letter of support to Prime Minister of Canada and relevant Ministers 3.CC Ontario Boards of Health and other Provincial and Canadian Organizations 4.Present an alPHa Resolution Recommendations

17. Thank you! Questions, Discussion