Summary of WHO's international code for the marketing of breast milk substitutes
The World Health Organization and UNICEF have emphasised the importance of maintaining the practice of breastfeeding, and of reviving the practice where it is in decline, as a way to improve the health and nutrition of infants and young children.
The World Health Assembly adopted the international code of marketing of breast milk substitutes in 1981. According to the code, every Member State of the World Health Organization shall take measures for the promotion of breast feeding and control of the marketing of breast milk substitutes as referred to in the Code. The code applies to health care professionals and all the operators who manufacture or distribute breast milk substitutes and comparable products as well as to accessories (bottles and teats) required in the feeding of a breast milk substitute, or who provide information about them or advice for their use.
Breast feeding is an unequalled way of providing ideal food for the healthy growth and development of infants. Breast feeding forms a unique biological and emotional basis for the health of both mother and child. Moreover, the anti-infective properties of breast milk help to protect infants against disease. When a mother does not breast feed for some reason, or only does so partially, there is a legitimate market for infant formulae, but they shall not be marketed or distributed in ways that may interfere with the protection and promotion of breast feeding.
The principles for action recommended by the Code are outlined as follows:
Article 1. Aim of the Code
The aim of this Code is to contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion of breast feeding, and by ensuring the proper use of breast milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution.
Article 2. Scope of the Code
The Code applies to the marketing, and practices related thereto, of the following products: breast milk substitutes, including infant formula; other milk products, foods and beverages, including bottle fed complementary foods, when marketed or otherwise represented to be suitable, with or without modification, for use as a partial or total replacement of breast milk; feeding bottles and teats. The Code applies to their quality and availability, and to information concerning their use.
Article 3. Definitions
This Article defines the terms used in the Code.
Article 4. Information and education
Authorities should have the responsibility to ensure that objective and consistent information is provided on infant and young child feeding for use by families and those involved in the field of infant and young child nutrition. Informational and educational materials should include clear information on all the following points:
- the benefits and superiority of breast feeding,
- maternal nutrition, and the preparation for and maintenance of breast feeding,
- the negative effect on breast feeding of introducing partial bottle-feeding,
- the difficulty of reversing the decision not to breast feed,
- where needed, the proper use of infant formula, whether manufactured industrially or home-prepared.
Informational and educational materials should not use any pictures or text which may idealize the use of breast milk substitutes.
Article 5. The general public and mothers
There should be no advertising or other form of promotion to the general public of products within the scope of this Code. Marketing personnel, in their business capacity, should not seek direct or indirect contact of any kind with pregnant women or with mothers of infants and young children
Article 6. Health care systems
Facilities of health care systems should not be used for the promotion of breast milk substitutes or other products within the scope of this Code, through e.g. display of products, placards or posters, or for the distribution of material provided by a manufacturer or distributor other than at the specific request of the health care authorities.
Feeding with infant formula should be demonstrated only by health care workers and only to the mothers or family members who need to use it. The information given should include a clear explanation of the hazards of improper use.
Article 7. Health care workers
Health care workers should encourage and protect breast feeding. Those who are concerned in particular with maternal and infant nutrition should make themselves familiar with their responsibilities under this Code.
No financial or material inducements to promote products within the scope of this Code should be offered by manufacturers or distributors to health care workers or members of their families, nor should these be accepted by health care workers or members of their families.
Health care workers should not give samples of infant formula to pregnant women, mothers of infants and young children, or members of their families.
Article 8. Persons employed by manufacturers and distributors
In systems of sales incentives for marketing personnel, the volume of sales of products within the scope of this Code should not be included in the calculation of bonuses. Nor should quotas be set specifically for sales of these products.
Article 9. Labelling
Labels should be designed to provide the necessary information about the appropriate use of the product, and so as not to discourage breast feeding.
The labelling shall present the following messages in a clear and easily readable manner:
- a statement of the superiority of breast feeding
- a statement that the product should be used only on the advice of a health care worker as to the need for its use and the proper method of use, and
- instructions for appropriate preparation, and a warning against the health hazards of inappropriate preparation.
Neither the container nor the label should have pictures of infants, nor should they have other pictures or text which may idealise the use of infant formula.
Article 10. Quality
The quality of the products should be of a high recognised standard and meet applicable standards recommended by the Codex Alimentarius Commission.
Article 11. Implementation and monitoring
In every country, the government should take action to give effect to the principles and aim of this Code, and to monitor the application of this Code.
Independently of any other measures taken for implementation of this Code, manufacturers and distributors of products within the scope of this Code should regard themselves as responsible for monitoring their marketing practices according to the principles and aim of this Code, and for taking steps to ensure that their conduct at every level conforms to them.
Source: Ministry of Social Affairs and Health: Child, family and food. Nutritional recommendations for infants and young children as well as pregnant and breast feeding mothers. Publications 2004:11 (Working Group memorandum 1985:24 of Ministry of Social Affairs and Health. Memorandum of Working Group appointed to review the implementation of the International Code of Marketing of Breast Milk Substitutes in Finland, Helsinki.)