Digital Marketing Tactics, Non-Compliance With the International Code of Marketing of Breastmilk Substitutes and Legal Breaches of Code-Based Legislation by the Commercial Milk Formula Industry in Central America and the Caribbean.

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-compliance with the International Code of Marketing of Breastmilk Substitutes (the Code) and breaches of national Code-based 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-compliance and legal breaches. A total of 355 digital advertisements were identified, with growing-up milks accounting for 98.3% of promoted products. On average, each advertisement employed 13 marketing tactics and contained 7.5 instances of Code non-compliance. Overall, 2 797 instances of Code non-compliance 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-up milks, cross-promotion 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-based legislation to explicitly address digital environments.