A critical analysis of the labels of processed complementary foods for infants and young children in South Africa against international marketing guidelines
Motivation - Processed complementary food labels should protect and promote optimal breastfeeding and complementary feeding practices, important determinants of child survival, growth and development, and provide information regarding safe and appropriate use. However, there is a lack of formal guidelines from international normative bodies on the appropriate marketing of complementary foods. In recognition of the need for interim guidance, the Maternal, Infant and Young Child Working Group developed the Draft Guide for Marketing Complementary Foods, which provides practical guidance on how the marketing (including labelling) of processed complementary foods and supplements can be informed by the principles of the International Code of Marketing of Breast-milk Substitutes (the Code) and subsequent relevant World Health Assembly (WHA) resolutions in a way that supports optimal infant and young child feeding. Aim - The aim of this study was to describe the extent to which the labelling practices (as a sub-set of marketing practices) of processed complementary food sold in South Africa comply with international guidance on the marketing of complementary foods that is fully aligned with the principles of the Code and subsequent relevant WHA resolutions (the Draft Guide for Marketing Complementary Foods). Methods - Employing a cross-sectional study design, products were purchased from a sample of 17 retail grocery stores, three wholesale grocery stores, three retail pharmacies and three baby chain stores in the Gauteng, Western Cape and KwaZulu-Natal provinces from June to August 2011. Purchased products were then compared with a master list of complementary food products compiled through desk research, and missing products were identified and purchased. Label information was captured, then blinded and the order of products randomised. The Draft Guide for Marketing Complementary Foods was used to create a checklist with pre-set answers and accompanying criteria against which the captured labelling practices were then analysed. Results - One hundred and sixty product labels of 35 manufacturers were analysed, none of which complied with all checklist criteria. Fifty-six (35%) labels did not provide an appropriate age of introduction, while 32 (20%) labels used phrases implying that the product was suitable for use before six months of age. Thirty-seven (23%) labels used images of infants appearing to be younger than six months. Only 20 (13%) labels carried a message regarding the importance of exclusive breastfeeding for the first six months of life, and none provided a message on the importance of the addition of complementary foods from six months together with continued breastfeeding to two years or beyond. Eight (5%) labels recommended feeding the product in a bottle and two labels (1%) used an image of a feeding bottle. Nineteen (12%) labels suggested a daily ration too large for a breastfed child, and 32 (20%) potentially promote the manufacturer’s infant formula. All labels provided label information in an appropriate language, but 102 (64%) labels relegated required label information to small text and were thus not easy to read. Only six (4%) labels failed to provide instructions for safe and appropriate use, while 44 (28%) did not include safety messages in their preparation and use instructions. Ten (6%) labels did not provide storage instructions, and 27 (17%) labels did not provide necessary warnings. Nutrient content claims, nutrient comparative claims, nutrient function/other function claims and reduction of disease risk claims were found on 126 (79%), eight (5%), 117 (73%) and 10 (6%) labels, respectively. Conclusion - The labelling practices of processed complementary food labels in South Africa do not fully comply with international guidance on the marketing of complementary foods (the Draft Guide for Marketing Complementary Foods) and so do not sufficiently protect and promote optimal infant and young child feeding practices, revealing much room for improvement. Such guidance must be refined and formalised by international normative bodies and adopted into national legislation to assist manufacturers in ensuring that their complementary food labels meet an accepted standard and contribute towards the safe and appropriate use of processed complementary foods.
- Health Sciences