Development of code into a national legislation in Bangladesh M Q K Talukder, S K Roy, Khurshid Jahan Bangladesh Breastfeeding Foundation One Asia Forum-11, 2 nd November 2015 Kuala Lumpur

1984: BMS Code first promulgated as an ordinance The code stopped open advertisements of infant formula but extensive violation by the milk companies continued Doctors continued to prescribe infant formula For two decades the exclusive breastfeeding rate remained stagnant around 45% The code was weak; did not meet some important WHO code provisions and fell into category 2 as assessed by ICDC

The Prime Minister promotes, protects and supports breastfeeding Inaugurates World Breastfeeding weeks in 2009, 2010 and 2014 Gives directives at the 2009 and 2010 inauguration of WBW to strictly enforce Regulation on marketing of BMS

BBF united the professional bodies to strengthen the code  Institute of Public Health and Nutrition (IPHN)  Bangladesh Medical Association (BMA)  Bangladesh Paediatric Association (BPA)  Bangladesh Neonatal Forum (BNF)  Bangladesh Private Medical Practitioners Association (BPMPA)  Obstetrical and Gynaecological Society of Bangladesh (OGSB)  Bangladesh Perinatal Society (BPS)

International partners International Baby Food Action Network (IBFAN) International Code Documentation Centre (ICDC) Breastfeeding Promotion Network of India (BPNI) World Health Organization (WHO) UNICEF

Processes involved in the preparation of the new law MOHFW and BBF initiated the preparation BBF had the major responsibility of drafting Members of the professional bodies and civil societies joined Relevant Ministries were sent copies of the draft for comment Inter-ministerial Meeting discussed the draft Final draft was sent to Cabinet meeting for approval

Processes involved in the preparation of the new law MOHFW and BBF initiated the preparation BBF had the major responsibility of drafting Members of the professional bodies and civil societies joined Relevant Ministries were sent copies of the draft for comment Inter-ministerial Meeting discussed the draft Final draft was sent to Cabinet meeting for approval

The code in major crisis  The cabinet considered that there can be advertisement and promotion of BMS with prior permission of the Government  The above decision was sent for vetting to the Ministry of Law and Parliamentary affairs

Overcoming the code crisis Frequently visited the Ministry of Law and MOHFW along with VC of BSMMU, BPA President and Secretary Met key Ministers and the cabinet Secretary UNICEF and WHO chiefs met key Ministers and the Cabinet Secretary Prime Minister was briefed

Overcoming the code crisis Arun Gupta 5/23/13 to Patti, Annelies, Lida, Ina, me Dear all, Please see the note below from Dr Talukder requesting us to intervene with BD Health Minister. Attachments area Preview attachment Bangladesh BMS code in crisis.doc Bangladesh BMS code in crisis.doc

Annelies and Patti met Bangladesh Health Minister at WHA in 2013 Dear Professor Talukder, Both Patti and I saw the Minister and his private secretary and urged him to take a strong stand on the Law. He is a politician and said he would of course but I do believe he was sincere. He said he will follow your advice as always. All the best, Annelies

Final steps to legislation by Parliament Ministry of Law in discussion with Ministry of Health resubmitted the draft to the Cabinet disallowing the advertisement of the BMS products Cabinet approved the new Law and sent it to the Parliamentary Committee of Health, which approved with some more stringent provisions Bangladesh Parliament passed the Law in September 2013 and got approval of the President

The Law: 24 clauses 1.Short title and commencement 2.Definitions: 14 3.Overriding effect of the Act 4.Restrictions on the matters relating to BMS, infant foods, commercially manufactured complementary foods and accessories thereof 5.Provisions relating to import, local production, sale 6.Information relating to receptacle and label 7.Education or other information 8.Formation of National Advisory Committee 9.Functions of the committee 10.Registration of Infant formula and others 11.Suspension and cancellation of Registration

12.Penalty 13.Penalty for repetition of offence 14.Offence committed by company 15.Forfeiture of goods, equipments associated with offence 16.Power of entry 17.Application of thr criminal code 18.Application of Act No. 59 of Special provision to impose fine 20.Offences to be cognizable and Non-bailable 21.Power to make rules 22.Removal of difficulties 23.Publication of authentic English text 24.Repeal and saving The Law: 24 clauses

Title of the Law Breast milk substitutes, Infant foods, commercially manufactured complementary Foods and the accessories thereof (Regulation of Marketing) Act, 2013

The Law covers 1.Breast milk substitutes, 2.Infant foods, 3.Commercially manufactured complementary Foods 4.Accessories thereof (Regulation of Marketing) Act, 2013

Restrictions No advertisement in any form of designated products No prescription by health care providers No distribution of leaflets No gift by manufacturing restrictions to health care providers No free sample distribution Not to give financial or any other incentives by manufacturing industries to anybody, officers and staff of health centre or health workers for attending or participating in seminar, conference, symposium, workshop, training, scientific meeting or education tour

Restrictions cont. Not to provide any financial incentives to attend international conferences organised and sponsored by manufacturers Not to provide any funds by manufacturers to attend any higher education or engaging in any research Not to offer financial incentives or any other gifts to any health professionals or any family member thereof

Punishment for violation of the Law Contravention of any provision shall be an offence and shall be punished with imprisonment of maximum 3 years and/or fine up to US$ 6,410 If a child becomes ill or dies from use of any infant formula, complementary infant foods manufactured commercially and any accessories shall be an offence and shall be punishable by 10 years imprisonment and/or with a fine of US$ 64,100