More than 3,000 women were interviewed in Bangladesh, Poland, South Africa and Thailand to see whether the international code of marketing substitutes for breast milk was being adhered to.
The World Health Organisation estimates that 1.5m deaths a year could be prevented by effective breast feeding protection. Failure to breast feed increases the risk of childhood diseases, impairs child development and may increase the risk of adult disease.
In some cases, as many as 50 per cent of health facilities had received free samples which were not being used for research or professional evaluation and as many as one in five health workers had received free gifts from the companies involved in manufacturing or distributing the breast milk substitutes. Bangladesh was the only country studied which had laws governing the marketing of breast milk substitutes and had the smallest number of free samples - one out of 385 mothers said they had received free samples compared with 97 out of 370 mothers in Bangkok. In Warsaw, 56 per cent of facilities surveyed were found to have information given to health workers in contravention of the code.
The BMJ said the frequency of the violations shows that 16 years after the code was adopted "its requirements are still unmet", and "there is little to suggest that the situation would be different in many other countries".
The BMJ called for governments to incorporate the code into legislation and that monitoring for overt violations should be more systematic. There should also be more emphasis on a positive attitude to breast feeding, to counter "company propaganda...a challenge largely unfulfilled by health workers and professional bodies".