International Code Monitoring Form

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Breastfeeding logoCODE Monitoring Form

 


Let INFACT Canada know who's playing by the rules and who's not.

Give us as much detailed information as you can - dates, places, company or brand names. If possible, send photos or actual examples of anything you think may be a Code violation (labels, pamphlets, ads, posters, note pads).


ARE MAGAZINES STILL ADVERTISING BREASTMILK SUBSTITUTES, BOTTLES OR NIPPLES?

YesNo

Example:

 

ARE MOTHERS RECEIVING PROMOTIONAL PAMPHLETS OR BOOKLETS FROM HOSPITALS, STORES OR BY DIRECT MAIL?

YesNo

Brand:

Received from:

 

DO PRODUCT LABELS SHOW PICTURES OF BABIES?

YesNo

Brand/Company:

Where seen:

 

DOES LABEL HAVE HAZARD WARNINGS AND CLEAR INSTRUCTIONS?

YesNo

 

ARE MOTHERS STILL GETTING FREE FORMULA SAMPLES?

YesNo

Brand/Company:

Where given:

How given:

 

DO HOSPITAL PRACTICES DISCOURAGE BREASTFEEDING?

  • Strict schedules
  • Unnecessary separation of mother and baby
  • Routine use of water or formula supplements
  • Staff use of brand-name gifts such as pads, calendars, pens, posters

     

  • Anything else?

    Name/address of hospital/clinic:

    IS BREASTFEEDING ACTIVELY SUPPORTED IN YOUR REGION?

  • Posters
  • Booklets
  • Films
  • Public and workplace facilities for breastfeeding mothers
  • Anything else?

     


    We need your Name and Email address: Keep confidential?YesNo

     

    Your Name:

    Your Email:

    Voice Numbers:
     

    Other comments:



     

     


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