The impact of the international code of marketing of breast-milk substitutes in Ghana and Tanzania

BACKGROUND: Measures that promote and protect breastfeeding have a major impact on child survival rates, as it was estimated that increasing breastfeeding rates can reduce child mortality by 13% in Africa. The International Code of Marketing of Breast-Milk Substitutes is an important measure to protect and promote breastfeeding and the safe use of commercial milk formulas. Ghana and Tanzania adopted measures that are substantially aligned with the Code into national legislation in 2000 and 1994, respectively. METHODS: In this study, we estimate the effects of the Code implementation through national laws on child mortality in Ghana and Tanzania by using the synthetic control group method and performing placebo tests to assess statistical inference. The main outcome is the effect of the national laws on overall child mortality and secondary outcomes are the effect of the laws on child mortality by lower respiratory infections and diarrhea in both countries. RESULTS: Two-sided inference tests showed a statistically significant treatment effect for deaths by lower respiratory infections in Ghana (p = 0.0476; LTE = - 0.8423) and one-sided inference tests showed statistically significant treatment effects for deaths by lower respiratory infections in Ghana (p = 0.0476; LTE = -0.8423) and Tanzania (p = 0.0476; LTE = - 5.1627), and for diarrhea in Tanzania (p = 0.0476; LTE = - 8.1694). To corroborate our results, we also performed the analysis for two major causes of child mortality that are not affected by the intervention, namely congenital diseases and birth asphyxia and trauma birth, for which we did not find significant treatment effects. CONCLUSIONS: The results demonstrate that the Code had a potentially beneficial impact on child mortality in Ghana and Tanzania and corroborate previous research that the Code is a necessary but insufficient step to alone improve child health outcomes. KEY MESSAGES: • The results show that the implementation of the Code had a potentially beneficial impact on child mortality in Ghana and Tanzania. • Policymakers should consider implementing or strengthening the Code within countries in order to improve child and health outcomes.