Aims To investigate the extent of breast milk substitute (BMS) advertising in high impact medical journals and assess its content for compliance with the International Code of Marketing of Breast-milk Substitutes (the Code).

Methods A retrospective analysis of the number and content of BMS advertisements in high impact paediatric and general medical journals published in hard copy from 2003–2012. 12 journals were drawn from the 20 highest ranking journals by impact factor (Thompson Reuters 2011) in the categories ‘Paediatrics’ and ‘Medicine, General and Internal.’ For each journal we quantified the prevalence and type of BMS advertising. Two investigators independently assessed the content of the 2012 advertisements for compliance with article 7.2 of the Code.

Results 63,167 journal pages were hand searched. 5462 pages were advertising of which 91 (1.7%) were for BMS. Five journals out of twelve contained BMS advertising, 1 general and 4 paediatric journals. In some paediatric journals BMS advertising was more prominent, 7 out of 29 pages of advertising (24%) for one journal in 2012. One publishing group was responsible for almost 75% of all BMS advertising across the sample, albeit spread between different journals. Five different BMS products for infants under six months were advertised. No single product had a clear majority over the timeframe. General first milks, allergy or intolerance milks, and preterm milks each represented 20 – 30% of BMS advertising. None of the 2012 advertisements contained all the information stipulated by the Code.

Conclusions BMS advertising is uncommon overall, but varies greatly between different publishers and journals. Advertisement compliance with the Code is poor, raising questions about the value of information presented. Further research is needed on whether this adversely affects breastfeeding and other infant feeding advice provided by healthcare professionals. Although attempts could be made to improve the quality of BMS advertisements, we believe that a far better option is to invest in more independent sources of BMS information. In the short term, since most publishers avoid BMS adverts entirely, we question whether any should carry BMS advertising. This would be a certain way of avoiding any misunderstandings and potential risks.