National Implementation of the International Code of Marketing of Breastmilk Substitutes in CameroonTitle of Decree : Decree N° 2005 /5168/ PM of 01 December 2005 regulating the marketing of substitutes of breastmilk
Analysis and comments by ICDC By virtue of Article 20, Decree No. 2005/5168/PM of 1 December 2005 (the 2005 Decree) supercedes the Inter-ministerial Decree No 040 on the Control of Marketing of Breastmilk Substitutes of 1993 (the 1993 Decree). The 2005 Decree retains the overall format and sequence of the 1993 Decree but the parts on enforcement and sanctions are missing from the new Decree. This is worrisome.
This analysis evaluates the 2005 Decree by comparing it with the 1993 Decree and the International Code of Marketing of Breastmilk Substitutes (the Code). It also highlights the changes made to a few substantive provisions and explains why they are positive or negative developments.
A. Scope and Terminology of the DecreeThe scope of the 2005 Decree is wider than both the 1993 Decree and the Code, covering as it does, additional products such as dummies and pacifiers. The definition section in Article 2 of the 2005 Decree is longer compared to the 1993 Decree and departs substantially from Code definitions.
There is a concerted effort to incorporate the global recommendation of exclusive breastfeeding for 6 months into the various definitions under Article 2 of the 2005 Decree.
The 2005 Decree also raises the upper age limit for infants from 12 months in the 1993 Decree to 30 months in Article 2(d). By extending the upper age limit of “infant”, Cameroon is able to protect a bigger category of babies. This means that toddler milks which hitherto are not included in the scope of the Code are now covered by the 2005 Decree. Though innovative, Article 2(d) does set the country apart from international health and trade standards which refer to babies older than 12 to 36 months as “young children.” Since many products covered by the Decree are imported, the question here is whether there are difficulties in aligning international trade practices to the requirements of the Decree. Other countries will benefit from Cameroon’s experience and feedback would be welcome in this respect.
On a less positive note, the presence of two overlapping terms “designated product” and “breastmilk substitute” gives rise to ambiguity.
“Breastmilk substitute” is defined under in Article 2(a) as “any solid or liquid food sold, used or presented in any other way as partial or total replacement of breast milk...”
“Designated product” is defined under Article 2(j) as “a milk for infants (infant formula, first age milk) or any other product sold as food for infants, follow-up or 2nd age milk, feeding bottles, teats, dummies …..”.
Due to the global controversy surrounding the interpretation of “breastmilk substitute”, ICDC coined the term “designated product” and advocated for its use at the national level. The latter term is meant to replace and subsume the former; not to be used interchangeably or as mutually exclusive concepts the way it is done in the 2005 Decree.
ICDC advocates for the use of the term “designated product” to enable countries to list products by their commercial names so there is no uncertainty on the scope of a law. This is a useful mechanism which enables countries to analyse current marketing practices and extend above the minimum standard set in 1981 by the International Code. It is indeed necessary to cover more products so that a wider group of infants and young children are protected from commercial influence today.
Unfortunately, these objectives are not fully realised by amendments in the 2005 decree. Reiterating the position in 1993, Article 1(3) of the 2005 Decree expressly excludes complementary foods (from 6 months) and circumscribes the potential of Article 2(j). This exclusion cuts out a whole range of products which would otherwise be included if reliance were to be placed solely on the interpretation of “designated product” or “breastmilk substitute”.
B. Prohibitions Like the 1993 Decree, the 2005 Decree maintains a unique anti-dumping clause not found elsewhere. This is an excellent provision.
In relation to the Code, the 2005 Decree repeats the lacuna of the 1993 Decree by leaving out prohibitions relating to promotion in shops, gifts to parents and contact by marketing personnel. Focussing just on advertising and not the wider aspects of promotion is a very narrow approach to overcome the mischief of unethical marketing which undermines breastfeeding.
Article 11 uses the term “breastmilk substitute”. To be consistent with other provisions in the 2005 Decree, it should be replaced by “designated product”.
Typo errors are found in Articles 4 and 7 which respectively reads “Any form of advertising of teats designated products...”and “...or par for costs of attendance of health professionals...”.
C. Labelling, Information and EducationIn an improvement over the 1993 Decree, Article 15 of the 2005 Decree disallows manufacturers and distributors from participating in public information and education campaigns on breastfeeding without prior authorisation of the Ministry of the Public Health. This positive development will restrict the possibility of manufacturers and distributors promoting their products under the guise of information and education.
In regressive mode, the labelling provisions in the 2005 Decree are less comprehensive than both the Code and article 13 of the 1993 Decree. Unless there are other laws which govern this area, the following are missing –
i) Ban on use of pictures or text which may idealise the use of infant formula;
ii) A statement that the product should only be used on the advice of a health worker as to the need for its use and the proper method of use; and
iii) Instructions for appropriate preparation and warning against health hazards of inappropriate preparation.
D. Enforcement Enforcement and penalty provisions in the 1993 Decree are omitted from the 2005 Decree. Unless there are other regulations or laws in Cameroon covering this area, this omission is a major concern and could render the 2005 Decree ineffective.
Conclusion The improvements made in the 2005 Decree vis-à-vis scope, age range and information do not outweigh the emasculation of vital parts of the 1993 Decree, to wit, the parts of labelling, enforcement and sanctions. The opportunity to fill existing lacunas on promotion seems to have been missed. Should the occasion arise for another review of the Cameroon Decree, ICDC suggests the following:
a) a recast of the term “designated product” to cover all breastmilk substitutes including complementary foods marketed as suitable for use below 6 months;
b) more comprehensive labelling provisions for the different categories of designated products;
c) new prohibitions on promotion at the retail level and practices such as gifts and contact with mothers; and
d) a reinstatement of enforcement and penalty provisions.
ICDC’s Model Law is a useful precedent for the drafting of relevant provisions. The Model Law is available upon request from ICDC.
Yeong Joo Kean
Legal Advisor
IBFAN-ICDC Penang
Malaysia
