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View Point Indian Pediatrics 2003; 743-746 |
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The IMS Act 1992: Need for More Amendments and Publicity |
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Pushpa Chaturvedi From BPNI, Amravati Branch and MGIMS, Sewagram, Wardha. Correspondence to: Dr. Satish Tiwari, Yashodanagar No.
2, Amravati 444 606, India.
"Breastfeeding was the best, is the best & will remain the best" as far as infant feeding is concerned. Breastfeeding (BF) has been a part of our culture since ancient times. But with modernization, breastfeeding practices have gradually declined. This has resulted in activities for increasing awareness and promotion of BF. Unfortunately, this act has not received the recognition, which it deserved. It has been observed that very few Pediatricians and Obstetricians are aware of this act. This is really a disheartening situation. The effect of mass scale commercial propaganda by baby food companies had resulted in very disheartening and gloomy situation as far as infant health is concerned. The question was who should take the initiative towards improving this situation, the parents, the health workers or the government and policy makers. In this background, the World Health Assembly (WHA) took the initiative by formulating the International code regarding infant feeding in the year 1981(1). The International code is mainly regulatory in nature. It regulates the promotion, sale & marketing of teats, bottles, milk substitutes and baby foods. The code enforces that companies should provide scientific, unbiased and factual information regarding infant feeding. It doesn’t prescribe any punishment to the offenders but gives power to individual state government to frame their own specific rules to tackle the menace of artificial feeding. Based on the recommendations of WHA; Indian government enacted "The infant milk substitutes, feeding bottles and infant foods (Regulation of promotion, supply and distribution) Act, 1992" (IMS Act), that came in force since August 1, 1993. Limitations of the Act (i) The rules and regulations regarding infant food advertisements have many loopholes as compared to that for infant milk substitutes and feeding bottles. It seems that more emphasis was laid over in restricting the use of milk substitutes and feeding bottles rather than on the commercial, artificial baby food products. (ii) There are no stringent rules to tackle the issue of sponsoring of scientific sessions, inducements and other gifts by infant food manufacturers. (iii) Though there are restrictions for infant food companies and health workers, the chemists have been exempted from many provisions of the Act. Thus the chemists continue to advertise and promote the baby food products through their shops. (iv) Since its enactment, there has not been any major amendment to detect and plug the loopholes or to make it more effective. How to Make the Act Work The Government has enacted and passed the act. However, things are not working out as they were supposed to be. There are always some excuses or loopholes in the law, which are used by the manufacturers for their benefit to defeat the aim of the act. The warnings regarding artificial feeding (AF) on television appear hardly for a fraction of second. The print is so small and color so faint that it is difficult to read the warnings, while the pictures of the products or a healthy child are very prominent. Section 6 of the Act prohibits any pictures or graphics, which will increase the saleability of the product. The pictures are removed from the label or container of the product but advertisements very prominently depict the pictures of healthy, smiling children. Most of our viewers and readers are uneducated and can’t read the warnings but they can easily see the picture of products, child and mother. We must monitor and report the violations of the Act committed by IMS industry(2). Role of Parents The parents have a very vital role in making the act work. The parents should know (a) Is milk essential? And if yes, (b) which milk is essential? Exclusive breastfeeding till 6 months is must for each and every child; in-fact it is the right of every child. After 6 months, if the child is weaned properly and accepting cereals, pulses, vegetables, fruits etc., then cow’s milk or artificial food is not at all essential. Breastfeeding the baby is women’s right and not her plight. Activists of women liberation movement must emphasize that breast is not only a sex organ but one of its use is for feeding the infant. Each and every relative (including the husband) must help the mother in breastfeeding the child. Role of Voluntary Organizations Various voluntary organizations like Breastfeeding Promotion Network of India (BPNI) and Association for Consumer Action on Safety and Health (ACASH) have already taken up the cause of fighting the menace of commercial foods by filing criminal cases against companies violating the IMS Act. After the enactment of the IMS Act, ACASH, a voluntary organization filed a case against Johnson & Johnson for violating the Act. In 1994, ACASH also filed a criminal prosecution against Nestle for violating the Act. In 1996, Johnson & Johnson decided to stop marketing feeding bottles in India. At the same time these organizations are also counseling and educating the public regarding advantages of breastfeeding and hazards of artificial feeding. These organizations are authorized by Government of India to make complaint in writing for any violation of the Act. Role of Health Workers The health workers along with relatives must counsel and motivate the mother and build her confidence in removing various misconceptions related to breastfeeding. In the battle against the bottle, we must be able to counter the propaganda and onslaught of media and companies. It is our right to receive information regarding IMS Act(3). Health education regarding advantages of breast-feeding and disadvantages of commercial food must be imparted to the mother and her relatives. Human Lactation Management Training workshops and Baby Friendly Hospital Initiative (BFHI) movement may help in such education. All of us who are working for betterment of the child’s health must take a pledge to protect, support and promote breastfeeding. Role of Government The role of the government and policy makers does not end with the enactment of the law. They should take some bold steps to implement the policies and provisions of the act. The Health Ministry, Women & Child Development Department, Human Resource Development Department should start promoting and supporting breastfeeding through TV and radio channels. We see clippings and advertisements on Pulse Polio, ORS, smoking hazards, HIV etc., but we do not see any regular promotion of breastfeeding through these government media. According to a study conducted by BPNI Delhi, even after a decade of enactment of this Act only about 61.7% of doctors, 28.1% of nurses and 25.6% of chemists are aware of provisions of this act (Personal communication). It is time now for us to publicize this Act more vigorously so that more number of doctors and health workers become aware of this Act. Need for More Amendments There has not been any major amendment in the IMS Act since its implementation. But the government has taken steps to ban the biased and unscientific advertisements of infant food and milk substitutes. In September 2000, The Cable, Television Networks (regulation) Act 1995 was amended. According to Section 6 & 7 of this Act "no advertisement shall be permitted which is not in conformity with prescribed advertising code and which promotes directly or indirectly production, sale or consumption of infant milk substitute, feeding bottles or infant foods", through a cable service. Section 16 of the Act provides the following punishment for contravening the provisions of this act (a) for the first offence, imprisonment up to 2 years or a fine of Rs. 1000/- or both, and (b) for every subsequent offence, imprisonment up-to five years or a fine of Rs. 5000/-. After this amendment we do not see advertisement of baby foods on National Doordarshan channels. Similar amendments are needed to restrict the biased and unscientific advertisement on other channels, Websites, magazines and newspapers. What to do? To make this act work and to improve the health of the child we must initiate BF within ½ hour of birth. Continue exclusive breastfeeding for six months, and promote, support and protect breastfeeding whenever opportunity arises. Give unequivocal support for breastfeeding(4). Baby Friendly Hospital Initiative (BFHI) is one of the well-accepted movements to achieve this goal. We should now plan for Baby Friendly Medical Store Initiative (BFSI). Under this movement we may appreciate those medical shop owners who will (i) have posters and write-ups highlighting benefits of breastfeeding in their shop, and (ii) not promote sale of bottles, milk substitutes and baby foods in their shops. We should also resist commercial promotion of baby foods, refuse growth charts with brand names and logos, and refuse free gifts, samples, sponsorships from infant milk and baby food companies. Use of artificial feeding should be restricted to orphanages. The Indian Academy of Pediatrics executive body (1994) and Indian Medical Association in 1995 decided not to take any aid, advertisement or sponsorship from manufacturers of infant food. Acknowledgement We are highly thankful to Dr. K.Y. Vilhekar and Dr. Hemant Murkey, Member National Task Force of BPNI for constant encouragement, guidance and help given by them in writing this article. We are also thankful to Dr. Janki N. Borkar for her help in drafting this article. Contributors: ST reviewed the literature, designed and drafted the article. PC assisted, guided and critically evaluated the manuscript. Funding: None. Competing interests: None stated. |
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