F.1 - Section 5.1

Section 5.1.1

Table 19: Strengths of the MAIF Agreement identified by targeted stakeholders

StrengthsAPMAIF membersGovernment organisationsIndustry signatoriesNon-signatoriesHealth professionals/ organisationsConsumer groups
Existence of the MAIF Agreement: Australia has developed and implemented a formal Agreement that is signed by manufacturers of infant formula and implements elements of the WHO Code. Low PriorityLow PriorityLow PriorityHigh Priority
Self-regulation: Regulation through consensus by industry partners creates a stronger sense of ownership, engagement and responsibility amongst manufacturers for the MAIF Agreement. Co-regulation between government and industry also supports cooperation and consultation between stakeholders.High PriorityLow PriorityHigh Priority
Adaptable to environment: The MAIF Agreement has been developed separately to the WHO Code and tailored appropriately to the Australian context. It has been demonstrated that the MAIF Agreement is robust enough to adapt to environmental changes. Low PriorityLow PriorityLow Priority
Aim of the MAIF Agreement: The aim of the MAIF Agreement is clear and provides an effective framework for monitoring marketing in Australia. The two parts of the aim- promotion of breastfeeding and ensuring proper use of breast-milk substitutes- enable the MAIF Agreement to be well-balanced. High PriorityHigh PriorityLow Priority
Scope to 12 months: The MAIF Agreement covers infants up to the age of 12 months, extending beyond the WHO Code which only covers up to six months.Low PriorityLow Priority
Complaints: Current arrangements include a complaints process, which provides the APMAIF with the ability to hear complaints. The process is clear with a good level of transparency. Low PriorityLow PriorityLow Priority
Interpretations/ guidelines: MAIF Agreement is effective in supporting health services in the development of clear policies and guidelines regarding the use of infant formula. The MAIF Agreement clearly demonstrates how the WHO Code has been interpreted. Low PriorityLow Priority

Table 20: Weaknesses of the MAIF Agreement identified by targeted stakeholders

WeaknessesAPMAIF membersGovernment organisationsIndustry signatoriesNon-signatoriesHealth professionals/ organisationsConsumer groups
Scope- Toddler milk drinks: Scope of the MAIF Agreement does not extend to 24 months or include toddler milk drinks. This is a concern due to the proliferation of toddler milk drinks with packaging resembling that of infant formulas. Additionally, the WHO recommends breastfeeding up to two years of age. Low PriorityHigh PriorityLow PriorityHigh Priority
Scope - Retailers and pharmacy: MAIF Agreement currently does not cover retailers or pharmacies, despite the WHO Code prohibiting point of sale advertising. Pharmacies should be covered due to the emergence of private label products. High PriorityHigh PriorityLow PriorityHigh Priority
Scope - Electronic marketing: MAIF Agreement was developed prior to the emergence of social media (e.g. facebook, twitter) and online advertising and promotion. These are currently not covered under the MAIF Agreement. Low PriorityLow PriorityLow PriorityLow Priority
Scope – other products: The current scope of the MAIF Agreement does not cover bottles, teats or dummies. High PriorityHigh Priority
Powers of enforcement: The ‘name and shame’ approach is not a strong enough disincentive, particularly since manufacturers operate as commercial entities and will try and exploit loopholes and push the boundaries. Some suggested the MAIF Agreement should be legally enforceableLow PriorityHigh PriorityLow PriorityHigh Priority
Disparity with WHO Code: The MAIF Agreement does not cover all aspects under the WHO Code, limiting its effectiveness. There is some confusion regarding the alignment and appropriate application of the WHO Code and MAIF Agreement. Low PriorityLow PriorityHigh Priority
Non-signatories: Not all industry members are signatories to the MAIF Agreement, creating an uneven playing field. Low PriorityHigh Priority
Interpretation/ guidelines: The broad nature of the MAIF Agreement means interpretations are difficult and may vary depending on the situation. Clearer guidelines of appropriate interpretations are required. Low PriorityLow PriorityHigh Priority
Suitability to environment: MAIF Agreement needs to be considered within the broader context, with regular reviews to account for changes in the environment (e.g. social media, new avenues for consumers to access information). Whilst the MAIF Agreement is out-dated, in practice it is difficult for any changes to be made due to the high levels of stakeholder consultation required. Low PriorityLow PriorityLow Priority
Awareness: There is a lack of consistency in the understanding of the MAIF Agreement by healthcare professionals. Low PriorityLow PriorityLow Priority
Aim of Agreement: MAIF Agreement prevents parents from obtaining balanced information regarding infant feeding; promotes a sense of guilt and disconnect amongst mothers who either cannot or choose not to breastfeedLow Priority
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Section 5.1.3

Figure 10: Survey question: “The MAIF Agreement responds to the needs of the community appropriately” – results for targeted survey (n=17)
Survey results shows that 24% Strongly disagree, 35% Disagree , 35% Agree and 6% Strongly Agree
Figure 10 is a chart depicting the results of a statement tested in the survey. The main points of interest in relation to the results of this survey question are outlined below. In relation to the statement “The MAIF Agreement responds to the needs of the community appropriately” 6% Strongly agreed, 35% Agreed, 35% Disagreed, and 24% Strongly disagreed.

Section 5.1.6

Figure 11: Survey question: "The MAIF Agreement does not include ambiguous, inconsistent, unclear or out of date wording” – results for general survey (n=516)
Survey question: "The MAIF Agreement does not include ambiguous, inconsistent, unclear or out of date wording” – results for general survey (n=516). For description of this image please refer to the text below the image.
Figure 11 is a chart depicting the results of a statement tested in the survey across a range of stakeholder groups including Consumers, Consumer Groups, Health Professionals/organisations and ‘Other’. In relation to the statement "The MAIF Agreement does not include ambiguous, inconsistent, unclear or out of date wording” overall, most stakeholder groups had similar levels of agreement or disagreement in relation to the statement. The difference between the results for each group were not considered significant for the Review.

Section 5.1.6

Figure 12: Survey question: “The scope of the MAIF Agreement is appropriate” – results from targeted survey (n=17)
Chart depicting the results of a statement tested in the survey. For detailed description of the image please refer to the text below the image.
Figure 12 is a chart depicting the results of a statement tested in the survey. The main points of interest in relation to the results of this survey question are outlined below. In relation to the statement “The scope of the MAIF Agreement is appropriate” 12% Strongly agreed, 29% Agreed, 18% Disagreed, and 41% Strongly disagreed.

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F.2 Section 5.2

Section 5.2.1

Table 21: Strengths of the APMAIF’s operations identified by targeted stakeholders

StrengthsAPMAIF membersGovernment organisationsIndustry signatoriesConsumer Groups
Complaints process: The current process for effective complaints investigation places Australia ahead of other countries. Complaints process is accessible to complainants (e.g. complaints can be accessed online). Low PriorityHigh PriorityLow Priority
Industry compliance: Industry members are aware of the MAIF Agreement and it is in their best interest to work effectively with the APMAIF; Signatories take their responsibilities seriously and commit significant resources to ensure compliance; Industry recognises the impact of a breach upon global branding. Low PriorityLow PriorityLow Priority
Collegiate approach: Strong relationship exists between the APMAIF and Industry (meet once per year and have a representative on the APMAIF); Capacity for the APMAIF to be informed about industry; good consultation with Industry about complaints. Complaints process includes an education/ negotiation strategy which provides companies with the opportunity to respond to breaches. Low PriorityLow PriorityHigh PriorityLow Priority
Independence/ objectivity: The APMAIF is an independent body to the Government and investigates complaints objectively. Low PriorityLow PriorityLow Priority
APMAIF functioning: Governance, processes and functioning of the APMAIF work well. Low PriorityHigh Priority
APMAIF composition: There is good representation of stakeholder on the APMAIF and appropriate mix of knowledge and skills. The variety of expertise enables an accurate assessment of complaints to be made and appropriate responses developed. Low PriorityHigh Priority
Transparency: Annual reports are accessible, comprehensive and enable an open and transparent process. Low Priority

Table 22: Weaknesses of the APMAIF’s operations identified by targeted stakeholders

WeaknessesAPMAIF membersGovernment organisationsIndustry signatoriesNon-signatoriesHealth professionals/ organisationsConsumer Groups
Consumer representative: Consumer representative on the APMAIF is inappropriate as there is no representation by formula-feeding mothers. This hinders the ability of the aim in achieving its aim of providing adequate information regarding the proper use of breast-milk substitutes. Low PriorityLow Priority
Out-of-scope complaints: Many complaints are considered out-of-scope however the APMAIF has no power to address these issues. A process for dealing with these complaints needs to be determined so people do not lose faith in the complaints process. Low PriorityLow Priority
APMAIF views: Ideological difference between APMAIF members creates conflict. APMAIF members should be aware of their collective responsibility and work towards the aim of the MAIF Agreement and Terms of Reference. The role of the industry representative on the APMAIF needs to be clarified due to potential conflicts of interest and concerns that the influence of industry may be too strong. High PriorityLow PriorityLow PriorityHigh PriorityLow Priority
Enforcement: The MAIF Agreement cannot be enforced and there are no significant consequences for breaches. The APMAIF does not have any power to censure those in breach except for naming in the annual report. Low PriorityHigh PriorityLow Priority
Timeliness: Many processes take a long time – there are long time period between meetings; development of guidelines is a slow process and the collegiate approach adopted takes a long time. Low PriorityLow PriorityLow PriorityLow PriorityHigh Priority
Monitoring – The APMAIF does not take a pro-active role in the monitoring of industry and breaches, relying on individuals to report breaches to be investigated. Mechanisms for active monitoring may include surveys or audits. High PriorityLow PriorityLow Priority
Transparency of complaints handling process – Concerns regarding the transparency of the decision-making process. Reports are not made public on a regular basis and information on the APMAIF website is dated. Lack of accountability enables the APMAIF to determine the interpretation of the MAIF Agreement. High PriorityHigh Priority
Complexity of the complaints handling process: The complaints process is very complex for many consumers and the requirement to submit evidence of complaints can be difficult and discourage lodgement. Low Priority
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Section 5.2.3

Figure 13: APMAIF complaints handling process - results from targeted survey (n=7)
Figure 13: APMAIF complaints handling process - results from targeted survey (n=7). For detailed description of the image please refer to the descriptive link next to the image. Description of the Image

Figure 14: APMAIF complaints handling process- results from general survey (n=102)
Figure 14: APMAIF complaints handling process- results from general survey (n=102). For detailed description of the image please refer to the descriptive link next to the image. Description of the Image