Infant formula donations and code violations during earthquake relief efforts in Türkiye in 2023: an observational study

Abstract

Background: On 6 February 2023, an Mw 7.8 earthquake struck southern and central Türkiye and north-western Syria, affecting the lives of 4.6 and 2.5 million children, respectively. In such crises, infants who are dependent on commercial milk formula (CMF) face increased vulnerability to diseases and malnutrition as safe preparation of CMF becomes difficult and sometimes impossible. The Operational Guidance on Infant and Young Child Feeding in Emergencies (OG-IFE) provides guidance on protecting and supporting recommended infant and young child feeding and minimizing the risks that come with CMF feeding. In addition, the International Code of Marketing of Breastmilk Substitutes (the Code) ensures adequate nutrition for infants by protecting and promoting breastfeeding and ensuring the proper usage of CMF. This study aims to document violations of the Code and the OG-IFE during the earthquake relief efforts to help strengthen infant and young child feeding emergency responses and inform future disaster relief policies.

Methods: Data was collected from 6 February to 10 March 2023 through Internet sources. Social media, news websites, and the Emergency Nutrition Network forum were used for data collection. Turkish content was translated into English for analysis, with a focus on donation-related information and Code violations related to baby food and infant feeding.

Results: A total of 40 reports on CMF, complementary food, and feeding equipment donations were collected. Three main types of violations of the OG-IFE and the Code were identified, with the majority of them being incidences of individuals, humanitarian organizations, and government agencies seeking or accepting donations. Infant formula companies continued to violate the Code by donating large quantities of CMF and feeding equipment to the Turkish Red Crescent, government agencies, and disaster relief infant and young child feeding (IYCF) coordination authorities.

Conclusions: These incidents reflected a systematic violation of the Code and non-compliance with the OG-IFE. Globally accepted IYCF standards and recommendations were not consistently followed due to fragmented early responses. There is a critical need to step up efforts to ensure appropriate and safe IYCF practice protecting and supporting breastfed and non-breastfed infants in emergencies.

Keywords: Breastfeeding; Commercial milk formula; Emergency preparedness; Infant and young child feeding; Infant formula marketing; Türkiye earthquake.

Fig. 1

A flowchart visualizing the data collection, translation and review process

Fig. 2

A screenshot of donation appeal posted by the Turkish Canadian Society of Edmonton, Canada

Fig. 3

A photo of a delivery truck with donations from Turkish Canadian Society of Edmonton, CTV News website

Fig. 4

Screenshots of Izmir Health Worker Union and Academic Dietetic Association’s Instagram posts

Fig. 5

A screenshot of Turkish Red Crescent’s website with a list of donation requests

Fig. 6

Screenshots of Aptamil’s Instagram post offering online classes, with English translations in pink

Fig. 7

Screenshots of Instagram posts by Danone Türkiye and Nestle Türkiye stating their donation efforts

Fig. 8

Screenshots of Instagram post by Philips and Weebaby describing their donation efforts