{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T09:46:24Z","timestamp":1792057584735,"version":"4.4.0"},"reference-count":23,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Maternal &amp;amp; Child Nutrition"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Digital marketing has become the dominant channel for the promotion of commercial milk formula (CMF), accounting for most consumer exposure in many settings. This study characterized the digital CMF marketing landscape in Guatemala, Panama, and the Dominican Republic, identified prevalent promotional tactics, and assessed non\u2010compliance with the International Code of Marketing of Breastmilk Substitutes (the Code) and breaches of national Code\u2010based legislation. We applied the World Health Organization's CLICK monitoring framework, including mapping the digital ecosystem and analyzing active marketing campaigns. From November 2023 to May 2024, we manually monitored CMF brand websites and official social media accounts to document promotional practices and assess Code non\u2010compliance and legal breaches. A total of 355 digital advertisements were identified, with growing\u2010up milks accounting for 98.3% of promoted products. On average, each advertisement employed 13 marketing tactics and contained 7.5 instances of Code non\u2010compliance. Overall, 2 797 instances of Code non\u2010compliance were documented, of which 1 480 constituted legal breaches in Guatemala, 2 189 in Panama, and 2 160 in the Dominican Republic. The most frequent breaches involved labeling requirements. Major regulatory gaps were identified, particularly regarding growing\u2010up milks, cross\u2010promotion strategies, and health and nutritional claims. These findings reveal a highly sophisticated and insufficiently regulated digital marketing environment for CMF in Central America and the Caribbean, underscoring the need to strengthen and update Code\u2010based legislation to explicitly address digital environments.<\/jats:p>","DOI":"10.1111\/mcn.70212","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T10:36:27Z","timestamp":1781692587000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Digital Marketing Tactics, Non\u2010Compliance With the International Code of Marketing of Breastmilk Substitutes and Legal Breaches of Code\u2010Based Legislation by the Commercial Milk Formula Industry in Central America and the Caribbean"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2250-3683","authenticated-orcid":false,"given":"M\u00f3nica","family":"Mazariegos","sequence":"first","affiliation":[{"name":"INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP) Guatemala City Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda","family":"Paz","sequence":"additional","affiliation":[{"name":"INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP) Guatemala City Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lila","family":"\u00c1lvarez","sequence":"additional","affiliation":[{"name":"INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP) Guatemala City Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Ren\u00e1n","family":"De Le\u00f3n","sequence":"additional","affiliation":[{"name":"Secretar\u00eda Ejecutiva del Consejo de Ministros de Salud de Centroam\u00e9rica y Rep\u00fablica Dominicana (SE\u2010COMISCA) San Salvador El Salvador"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13680"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13335"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.18294\/sc.2024.4776"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2022-011150"},{"key":"e_1_2_9_6_1","unstructured":"Fundaci\u00f3n SANAR.2025. Detecciones con Inteligencia Artificial y reportes ciudadanos en ObservaMaS. Primer informe \u2013 Mayo 2025."},{"key":"e_1_2_9_7_1","volume-title":"Decreto Ley 66\u201083","author":"Gobierno de Guatemala","year":"1983"},{"key":"e_1_2_9_8_1","volume-title":"Acuerdo Gubernativo 841\u201087","author":"Gobierno de Guatemala","year":"1987"},{"key":"e_1_2_9_9_1","volume-title":"Ley 8\u201095 que declara como prioridad nacional la promoci\u00f3n y fomento de la lactancia materna","author":"Gobierno de la Rep\u00fablica Dominicana","year":"1995"},{"key":"e_1_2_9_10_1","volume-title":"Decreto 142\u201018 que establece el Reglamento para la aplicaci\u00f3n de la Ley sobre promoci\u00f3n, ense\u00f1anza y difusi\u00f3n para la pr\u00e1ctica de la lactancia materna","author":"Gobierno de la Rep\u00fablica Dominicana","year":"2018"},{"key":"e_1_2_9_11_1","volume-title":"Ley No. 50 del 23 de noviembre de 1995 por la cual se protege y fomenta la lactancia materna","author":"Gobierno de Panam\u00e1","year":"1995"},{"key":"e_1_2_9_12_1","volume-title":"Decreto Ejecutivo No. 1457 (de 30 de octubre de 2012) que reglamenta la Ley No. 50","author":"Gobierno de Panam\u00e1","year":"2012"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13006-022-00455-y"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13668-022-00414-3"},{"key":"e_1_2_9_15_1","unstructured":"Ministerio de Salud de Panam\u00e1 OPS INCAP.2019. Segundo monitoreo del cumplimiento del C\u00f3digo Internacional de Comercializaci\u00f3n de Suced\u00e1neos de la Leche Materna en la Rep\u00fablica de Panam\u00e1. Informe final. Panam\u00e1."},{"key":"e_1_2_9_16_1","unstructured":"Ministerio de Salud P\u00fablica Rep\u00fablica Dominicana Programa Nacional de Lactancia Materna INCAP.2021. Informe de monitoreo peri\u00f3dico de la Ley 08\u201395 y del C\u00f3digo de Comercializaci\u00f3n de Suced\u00e1neos de la Leche Materna. Santo Domingo."},{"key":"e_1_2_9_17_1","volume-title":"Direcci\u00f3n de Atenci\u00f3n y Asistencia al Consumidor (DIACO); Cruz Roja Guatemalteca. IV informe de monitoreo de cumplimiento de la Ley de Comercializaci\u00f3n de los Suced\u00e1neos de la Leche Materna (Decreto 66\u201083) y su Reglamento (Acuerdo Gubernativo 841\u201087)","author":"Ministerio de Salud P\u00fablica y Asistencia Social (MSPAS), Organizaci\u00f3n Panamericana de la Salud (OPS), Organizaci\u00f3n Mundial de la Salud, Regi\u00f3n de las Am\u00e9ricas (OMS\/AMRO), International Baby Food Action Network (IBFAN), Instituto de Nutrici\u00f3n de Centroam\u00e9rica y Panam\u00e1 (INCAP)","year":"2018"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/0379572115602174"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13006-024-00676-3"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2022-009904"},{"key":"e_1_2_9_21_1","unstructured":"We are Social Meltwater.2024. \u201cGlobal Overview Report: The Essential Guide to the World's Connected Behaviours.\u201d"},{"key":"e_1_2_9_22_1","volume-title":"International Code of Marketing of Breastmilk Substitutes","author":"World Health Organization","year":"1981"},{"key":"e_1_2_9_23_1","unstructured":"World Health Organization.2023. \u201cGuidance on Regulatory Measures Aimed at Restricting Digital Marketing of Breastmilk Substitutes.\u201d Geneva. Licence: CC BY\u2010NC\u2010SA 3.0 IGO."},{"key":"e_1_2_9_24_1","unstructured":"World Health Organization Regional Office for Europe.2018. \u201cMonitoring and Restricting Digital Marketing of Unhealthy Products to Children and Adolescents: Report Based on the Expert Meeting on Monitoring of Digital Marketing of Unhealthy Products to Children and Adolescents.\u201d"}],"container-title":["Maternal &amp; Child Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/mcn.70212","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/mcn.70212","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/mcn.70212","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T09:00:50Z","timestamp":1792054850000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/mcn.70212"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,17]]},"references-count":23,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1111\/mcn.70212"],"URL":"https:\/\/doi.org\/10.1111\/mcn.70212","archive":["Portico"],"relation":{},"ISSN":["1740-8695","1740-8709"],"issn-type":[{"value":"1740-8695","type":"print"},{"value":"1740-8709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,17]]},"assertion":[{"value":"2026-01-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70212"}}