International Code of Marketing of Breast-milk Substitutes
Encyclopedia
The International Code of Marketing of Breastmilk Substitutes is an international health policy framework for breastfeeding promotion
adopted by the World Health Assembly
(WHA) of the World Health Organization
(WHO) in 1981. The Code was developed as a global public health
strategy and recommends restrictions on the marketing
of breastmilk substitutes, such as infant formula
, to ensure that mothers are not discouraged from breastfeeding
and that substitutes are used safely if needed. The Code also covers ethical considerations and regulations for the marketing of feeding bottles and teats. A number of subsequent WHA resolutions have further clarified or extended certain provisions of the Code.
Since 1981, 65 countries have enacted legislation implementing all or many of the provisions of the Code and subsequent relevant WHA resolutions.
s, health workers
and health care system
s. The Code and resolutions also contain specific provisions and recommendations relating to labelling of infant formula and other breastmilk substitutes.
i. Mothers
ii. Health workers
iii. Health care systems
iv. Labelling
In line with the recommendation for exclusive breastfeeding in WHA resolution 54.2 [2001], all complementary foods must be labeled as suitable for use by infants from six months and not earlier.
industry has been the subject of pointed criticism from non-governmental organization
s, international agencies and campaign groups for failing to abide by the Code. One of the largest food and beverage manufacturers in the world, the Swiss giant Nestlé
, has been the subject of an international boycott campaign since 1977 for its milk-substitute marketing practices prior to the development of the Code (see Nestlé boycott
).
On its own, the International Code is not legally enforceable. Companies are only subject to legal sanctions for failing to abide by the Code where it has been incorporated into the legislature of a nation state. Many countries have fully or partially adopted the Code as law. Other countries have no legislation on baby food marketing at all.
Code violations by baby food manufacturers are still widespread, especially (but not exclusively) in countries that have not implemented the Code as a national measure or where monitoring and enforcement is weak. The WHO
, International Baby Food Action Network
(IBFAN), UNICEF and other international organizations perform monitoring of implementation of the Code across the world both independently and with governments.
Breastfeeding promotion
Breastfeeding promotion refers to coordinated activities and policies to promote health among women, newborns and infants through breastfeeding....
adopted by the World Health Assembly
World Health Assembly
The World Health Assembly is the forum through which the World Health Organization is governed by its 194 member states. It is the world's highest health policy setting body and is composed of health ministers from member states....
(WHA) of the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
(WHO) in 1981. The Code was developed as a global public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
strategy and recommends restrictions on the marketing
Marketing
Marketing is the process used to determine what products or services may be of interest to customers, and the strategy to use in sales, communications and business development. It generates the strategy that underlies sales techniques, business communication, and business developments...
of breastmilk substitutes, such as infant formula
Infant formula
Infant formula is a manufactured food designed and marketed for feeding to babies and infants under 12 months of age, usually prepared for bottle-feeding or cup-feeding from powder or liquid . The U.S...
, to ensure that mothers are not discouraged from breastfeeding
Breastfeeding
Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or...
and that substitutes are used safely if needed. The Code also covers ethical considerations and regulations for the marketing of feeding bottles and teats. A number of subsequent WHA resolutions have further clarified or extended certain provisions of the Code.
Since 1981, 65 countries have enacted legislation implementing all or many of the provisions of the Code and subsequent relevant WHA resolutions.
Provisions of the Code
The Code aims to shield breastfeeding from commercial promotion that affects motherMother
A mother, mum, mom, momma, or mama is a woman who has raised a child, given birth to a child, and/or supplied the ovum that grew into a child. Because of the complexity and differences of a mother's social, cultural, and religious definitions and roles, it is challenging to specify a universally...
s, health workers
Health Human Resources
Health human resources — also known as “human resources for health” or “health workforce” — is defined as “all people engaged in actions whose primary intent is to enhance health”, according to the World Health Organization's World Health Report 2006. Human resources for health are identified as...
and health care system
Health care system
A health care system is the organization of people, institutions, and resources to deliver health care services to meet the health needs of target populations....
s. The Code and resolutions also contain specific provisions and recommendations relating to labelling of infant formula and other breastmilk substitutes.
i. Mothers
- Information and educational materials on infant and young child feeding should be objective and consistent and emphasize the importance of breastfeeding. In no case should such materials refer to a brand name of a product.
- All forms of product advertising and promotion are prohibited.
- Mothers should not be given free product samples.
- Promotional devices such as discounts and special displays at the retail level are prohibited.
- Company representatives may not initiate direct or indirect contact with mothers.
- Health risks to infants who are artificially fed or who are not exclusively breastfed should be highlighted through appropriate labeling and warnings.
ii. Health workers
- The Code gives health workersHealth care providerA health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities....
the responsibility to encourage and protect breastfeeding. - Materials regarding products given to health professionals by manufacturers and distributors should be limited to ‘scientific and factual’ matters. They should not be tools to promote the use of products.
- Product samples may be given only when necessary for professional evaluation or researchResearchResearch can be defined as the scientific search for knowledge, or as any systematic investigation, to establish novel facts, solve new or existing problems, prove new ideas, or develop new theories, usually using a scientific method...
at the institutional level. In no case should these samples be passed on to mothers. - In order to prevent conflicts of interestConflict of interestA conflict of interest occurs when an individual or organization is involved in multiple interests, one of which could possibly corrupt the motivation for an act in the other....
, manufacturers and distributors should not give material or financial inducements to health workers. Three WHA resolutions on infant and young child nutrition subsequent to the adoption of the Code specifically cautioned against conflicts of interest. A 1996 resolution (WHA resolution 49.15) called for caution in accepting financial support for health professionals working in infant and young child health which may create conflicts of interest. The need to avoid conflicts of interest was expanded in 2005 (WHA resolution 58.32) to cover programmes in infant and young child health and reiterated in 2008 (WHA resolution 61.20).
iii. Health care systems
- Promotion of any product is forbidden in a health care facilityHealth care providerA health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities....
. This includes the display of products, placards and posters concerning such products and distribution of materials provided by manufacturers and distributors. - Formula feeding should be demonstrated only to those mothers or family members who need to use it and the information given should include a clear explanation of the risks of formula feeding and hazards of improper use of products.
- Donated equipment and materials should not refer to brand names of products.
- Free Supplies: Two subsequent resolutions (WHA 39.28 [1986] and WHA 47.5 [1994]) effectively call for an end to all free or low-cost supplies to any part of the health care system. Manufacturers and distributors are therefore prohibited from providing products to health care facilities for free or at low cost. (According to guidelines under the Baby Friendly Hospital InitiativeBaby Friendly Hospital InitiativeThe Baby Friendly Hospital Initiative , also known as “Baby Friendly Initiative” , is a worldwide programme of the World Health Organization and UNICEF, launched in 1991 following the adoption of the Innocenti Declaration on breastfeeding promotion in 1990...
, ‘low cost’ means less than 80% of the retail price.)
iv. Labelling
- Information on labelsLabellingLabelling or labeling is describing someone or something in a word or short phrase. For example, describing someone who has broken a law as a criminal. Labelling theory is a theory in sociology which ascribes labelling of people to control and identification of deviant behavior.It has been argued...
for infant formula must be in simple and easy to understand terms in an appropriate language. - Labels of infant formula must contain a statement on the superiority of breastfeeding and that the product should only be used after consultation with health professionals.
- Pictures or text which may idealize the use of infant formula and certain wordings, such as 'humanized” or “materialized” or similar terms should not be used.
- Nutrition and health claims on labels for breastmilk substitutes should not be permitted unless allowed by national legislation (WHA resolution 58.32 [2005]).
- Labels must contain explicit warnings on labels to inform consumers about the risks of contamination of powdered formula with pathogenic microorganismMicroorganismA microorganism or microbe is a microscopic organism that comprises either a single cell , cell clusters, or no cell at all...
s (WHA resolution 58.32 [2005]). - Labels must conform with WHO/FAOFãoFão is a town in Esposende Municipality in Portugal....
guidelines on safe preparation, storage and handling of powdered infant formula (WHA resolution 61.20 [2008]).
In line with the recommendation for exclusive breastfeeding in WHA resolution 54.2 [2001], all complementary foods must be labeled as suitable for use by infants from six months and not earlier.
Implementation of the Code
The baby foodBaby food
Baby food is any food, other than breastmilk or infant formula, that is made specifically for infants, roughly between the ages of four to six months to 2 years. The food comes in multiple varieties and tastes, can be produced by many manufacturers, or may be table food that the rest of the family...
industry has been the subject of pointed criticism from non-governmental organization
Non-governmental organization
A non-governmental organization is a legally constituted organization created by natural or legal persons that operates independently from any government. The term originated from the United Nations , and is normally used to refer to organizations that do not form part of the government and are...
s, international agencies and campaign groups for failing to abide by the Code. One of the largest food and beverage manufacturers in the world, the Swiss giant Nestlé
Nestlé
Nestlé S.A. is the world's largest food and nutrition company. Founded and headquartered in Vevey, Switzerland, Nestlé originated in a 1905 merger of the Anglo-Swiss Milk Company, established in 1867 by brothers George Page and Charles Page, and Farine Lactée Henri Nestlé, founded in 1866 by Henri...
, has been the subject of an international boycott campaign since 1977 for its milk-substitute marketing practices prior to the development of the Code (see Nestlé boycott
Nestlé boycott
The Nestlé boycott is a boycott launched on July 7, 1977, in the United States against the Swiss-based Nestlé corporation. It spread quickly throughout the United States, and expanded into Europe in the early 1980s. In Canada, the controversy lasted from 1978 to 1984...
).
On its own, the International Code is not legally enforceable. Companies are only subject to legal sanctions for failing to abide by the Code where it has been incorporated into the legislature of a nation state. Many countries have fully or partially adopted the Code as law. Other countries have no legislation on baby food marketing at all.
Code violations by baby food manufacturers are still widespread, especially (but not exclusively) in countries that have not implemented the Code as a national measure or where monitoring and enforcement is weak. The WHO
Who
Who may refer to:* Who , an English-language pronoun* who , a Unix command* Who?, one of the Five Ws in journalism- Art and entertainment :* Who? , a 1958 novel by Algis Budrys...
, International Baby Food Action Network
International Baby Food Action Network
The International Baby Food Action Network, IBFAN, consists of public interest groups working around the world to reduce infant and young child morbidity and mortality. IBFAN aims to improve the health and well-being of babies and young children, their mothers and their families through the...
(IBFAN), UNICEF and other international organizations perform monitoring of implementation of the Code across the world both independently and with governments.
See also
- Baby Friendly Hospital InitiativeBaby Friendly Hospital InitiativeThe Baby Friendly Hospital Initiative , also known as “Baby Friendly Initiative” , is a worldwide programme of the World Health Organization and UNICEF, launched in 1991 following the adoption of the Innocenti Declaration on breastfeeding promotion in 1990...
- Breastfeeding promotionBreastfeeding promotionBreastfeeding promotion refers to coordinated activities and policies to promote health among women, newborns and infants through breastfeeding....
- Infant formulaInfant formulaInfant formula is a manufactured food designed and marketed for feeding to babies and infants under 12 months of age, usually prepared for bottle-feeding or cup-feeding from powder or liquid . The U.S...
- Infant mortalityInfant mortalityInfant mortality is defined as the number of infant deaths per 1000 live births. Traditionally, the most common cause worldwide was dehydration from diarrhea. However, the spreading information about Oral Re-hydration Solution to mothers around the world has decreased the rate of children dying...
- Nestlé boycottNestlé boycottThe Nestlé boycott is a boycott launched on July 7, 1977, in the United States against the Swiss-based Nestlé corporation. It spread quickly throughout the United States, and expanded into Europe in the early 1980s. In Canada, the controversy lasted from 1978 to 1984...
- World Health OrganizationWorld Health OrganizationThe World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
External links
- Full Code in English (PDF)
- International Baby Food Action Network
- Baby Milk Action (Great Britain)
- Baby Nahrung (Germany)
- Breaking the Rules, Stretching the Rules, International Baby Food Action Network, 2004 and 2007
- ibfan (Spanish)