The International Code of Marketing of Breastmilk Substitutes
The Member States of the World Health Organisation:
Affirming the right of every child and every pregnant and lactating woman to be
adequately nourished as a means of attaining and maintaining health;
Recognising that infant malnutrition is part of the wider problems of lack of
education, poverty, and social injustice;
Recognising that the health of infants and young children cannot be isolated from the
health and nutrition of women, their socio-economic status and their roles as mothers;
Conscious that breastfeeding is an unequalled way of providing ideal food for the
healthy growth and development of infants; that it forms a unique biological and emotional
basis for the health of both mother and child; that the anti-infective properties of
breast milk help to protect infants against disease; and that there is an important
relationship between breastfeeding and child spacing;
Recognising that the encouragement and protection of breastfeeding is an important part
of the health, nutrition and other social measures required to promote healthy growth and
development of infants and young children; and that breastfeeding is an important aspect
of primary health care;
Considering that when mothers do not breastfeed, or only do so partially, there is a
legitimate market for infant formula and for suitable ingredients from which to prepare
it; that all these products should accordingly be made accessible to those who need them
through commercial or noncommercial distribution systems; and that they should not be
marketed or distributed in ways that may interfere with the protection and promotion of
breastfeeding;
Recognising further that inappropriate feeding practices lead to infant malnutrition,
morbidity and mortality in all countries, and that improper practices in the marketing of
breastmilk substitutes and related products can contribute to these major public health
problems;
Convinced that it is important for infants to receive appropriate complementary foods,
usually when the infant reaches four to six months of age, and that every effort should be
made to use locally available foods; and convinced, nevertheless, that such complementary
foods should not be used as breastmilk substitutes;
Appreciating that there are a number of social and economic factors affecting
breastfeeding, and that, accordingly, governments should develop social support systems to
protect, facilitate and encourage it, and that they should create an environment that
fosters breastfeeding, provides appropriate family and community support, and protects
mothers from factors that inhibit breastfeeding;
Affirming that health care systems, and the health professionals and other health
workers serving in them, have an essential role to play in guiding infant feeding
practices, encouraging and facilitating breastfeeding, and providing objective and
consistent advice to mothers and families about the superior value of breastfeeding, or,
where needed, on the proper use of infant formula, whether manufactured industrially or
home prepared;
Affirming further that educational systems and other social services should be involved
in the protection and promotion of breastfeeding, and in the appropriate use of
complementary foods;
Aware that families, communities, women's organisations and other nongovernmental
organisations have a special role to play in the protection and promotion of breastfeeding
and in ensuring the support needed by pregnant women and mothers of infants and young
children, whether breastfeeding or not;
Affirming the need for governments, organisations of the United Nations system,
nongovernmental organisations, experts in various related disciplines, consumer groups and
industry to cooperate in activities aimed at the improvement of maternal, infant and young
child health and nutrition;
Recognising that governments should undertake a variety of health, nutrition and other
social measures to promote healthy growth and development of infants and young children,
and that this Code concerns only one aspect of these measures;
Considering that manufacturers and distributors of breastmilk substitutes have an
important and constructive role to play in relation to infant feeding, and in the
promotion of the aim of this Code and its proper implementation;
Affirming that governments are called upon to take action appropriate to their social
and legislative framework and their overall development objectives to give effect to the
principles and aim of this Code, including the enactment of legislation, regulations or
other suitable measures;
Believing that, in the light of the foregoing considerations, and in view of the
vulnerability of infants in the early months of life and the risks involved in
inappropriate feeding practices, including the unnecessary and improper use of breastmilk
substitutes, the marketing of breastmilk substitutes requires special treatment, which
makes usual marketing practices unsuitable for these products;
THEREFORE:
The Member States hereby agree the following articles which are recommended as a basis
for action.
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 breastfeeding, and by ensuring the proper
use of breastmilk substitutes, when these are necessary, on the basis of adequate
information and through appropriate marketing and distribution.
The Code applies to the marketing, and practices related thereto, of the following
products: breastmilk 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. It also applies to their quality
and availability, and to information concerning their use.
"Breastmilk substitute" means any food being marketed or otherwise
represented as a partial or total replacement for breast milk, whether or not suitable for
that purpose.
"Complementary food" means any food, whether manufactured or locally
prepared, suitable as a complement to breast milk or to infant formula, when either
becomes insufficient to satisfy the nutritional requirements of the infant. Such food is
also commonly called "weaning food" or "breastmilk supplement".
"Container" means any form of packaging of products for sale as a normal
retail unit, including wrappers.
"Distributor" means a person, corporation or any other entity in the public
or private sector engaged in the business (whether directly or indirectly) of marketing at
the wholesale or retail level a product within the scope of this Code. A "primary
distributor" is a manufacturer's sales agent, representative, national distributor or
broker.
"Health care system" means governmental, nongovernmental or private
institutions or organisations engaged, directly or indirectly, in health care for mothers,
infants and pregnant women; and nurseries or childcare institutions. It also includes
health workers in private practice. For the purposes of this Code, the health care system
does not include pharmacies or other established sales outlets.
"Health worker" means a person working in a component of such a health care
system, whether professional or nonprofessional, including voluntary, unpaid workers.
"Infant formula" means a breastmilk substitute formulated industrially in
accordance with applicable Codex Alimentarius standards, to satisfy the normal nutritional
requirements of infants up to between four and six months of age, and adapted to their
physiological characteristics. Infant formula may also be prepared at home, in which case
it is described as "home prepared".
"Label" means any tag, brand, mark, pictorial or other descriptive matter,
written, printed, stencilled, marked, embossed or impressed on, or attached to, a
container (see above) of any products within the scope of this Code.
"Manufacturer" means a corporation or other entity in the public or private
sector engaged in the business or function (whether directly or through an agent or
through an entity controlled by or under contract with it) of manufacturing a product
within the scope of this Code.
"Marketing" means product promotion, distribution, selling, advertising,
product public relations, and information services.
"Marketing personnel" means any persons whose functions involve the marketing
of a product or products coming within the scope of this Code.
"Samples" means single or small quantities of a product provided without
cost.
"Supplies" means quantities of a product provided for use over an extended
period, free or at a low price, for social purposes, including those provided to families
in need.
4.1 Governments 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. This
responsibility should cover either the planning, provision, design and dissemination of
information, or their control.
4.2 Informational and educational materials, whether written, audio,
or visual, dealing with the feeding of infants and intended to reach pregnant women and
mothers of infants and young children, should include clear information on all the
following points:
the benefits and superiority of breastfeeding;
maternal nutrition, and the preparation for and maintenance of breastfeeding;
the negative effect on breastfeeding of introducing partial bottle feeding;
the difficulty of reversing the decision not to breastfeed; and
where needed, the proper use of infant formula, whether manufactured industrially or
home prepared.
When such materials contain information about the use of infant formula, they should
include the social and financial implications of its use; the health hazards of
inappropriate foods or feeding methods; and, in particular, the health hazards of
unnecessary or improper use of infant formula and other breastmilk substitutes. Such
materials should not use any pictures or text which may idealise the use of breastmilk
substitutes.
4.3 Donations of informational or educational equipment or materials
by manufacturers or distributors should be made only at the request and with the written
approval of the appropriate government authority or within guidelines given by governments
for this purpose. Such equipment or materials may bear the donating company's name or
logo, but should not refer to a proprietary product that is within the scope of this Code,
and should be distributed only through the health care system.
5.2 Manufacturers and distributors should not provide, directly or
indirectly, to pregnant women, mothers or members of their families, samples of products
within the scope of this Code.
5.3 In conformity with paragraphs 1 and 2 of this Article, there
should be no point-of-sale advertising, giving of samples, or any other promotion device
to induce sales directly to the consumer at the retail level, such as special displays,
discount coupons, premiums, special sales, loss leaders and tie-in sales, for products
within the scope of this Code. This provision should not restrict the establishment of
pricing policies and practices intended to provide products at lower prices on a long-term
basis.
5.4 Manufacturers and distributors should not distribute to pregnant
women or mothers of infants and young children any gifts of articles or utensils which may
promote the use of breastmilk substitutes or bottle feeding.
5.5 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.
6.1 The health authorities in Member States should take appropriate
measures to encourage and protect breastfeeding and promote the principles of this Code,
and should give appropriate information and advice to health workers in regard to their
responsibilities, including the information specified in Article 4.2.
6.2 No facility of a health care system should be used for the purpose
of promoting infant formula or other products within the scope of this Code. This Code
does not, however, preclude the dissemination of information to health professionals as
provided in Article 7.2.
6.3 Facilities of health care systems should not be used for the
display of products within the scope of this Code, for placards or posters concerning such
products, or for the distribution of material provided by a manufacturer or distributor
other than that specified in Article 4.
6.4 The use by the health care system of "professional service
representatives", "mothercraft nurses" or similar personnel, provided or
paid for by manufacturers or distributors, should not be permitted.
6.5 Feeding with infant formula, whether manufactured or home
prepared, should be demonstrated only by health workers, or other community workers if
necessary; and only to the mothers or family members who need to use it; and the
information given should include a clear explanation of the hazards of improper use.
6.6 Donations or low-price sales to institutions or organisations of
supplies of infant formula or other products within the scope of this Code, whether for
use in the institutions or for distribution outside them, may be made. Such supplies
should only be used or distributed for infants who have to be fed on breastmilk
substitutes. If these supplies are distributed for use outside the institutions, this
should be done only by the institutions or organisations concerned. Such donations or
low-price sales should not be used by manufacturers or distributors as a sales inducement.
6.7 Where donated supplies of infant formula or other products within
the scope of this Code are distributed outside an institution, the institution or
organisation should take steps to ensure that supplies can be continued as long as the
infants concerned need them. Donors, as well as institutions or organisations concerned,
should bear in mind this responsibility.
6.8 Equipment and materials, in addition to those referred to in
Article 4.3, donated to a health care system may bear a company's name or logo, but should
not refer to any proprietary product within the scope of this Code.
7.1 Health workers should encourage and protect breastfeeding; and
those who are concerned in particular with maternal and infant nutrition should make
themselves familiar with their responsibilities under this Code, including the information
specified in Article 4.2.
7.2 Information provided by manufacturers and distributors to health
professionals regarding products within the scope of this Code should be restricted to
scientific and factual matters, and such information should not imply or create a belief
that bottle feeding is equivalent or superior to breastfeeding. It should also include the
information specified in Article 4.2.
7.3 No financial or material inducements to promote products within
the scope of this Code should be offered by manufacturers or distributors to health
workers or members of their families, nor should these be accepted by health workers or
members of their families.
7.4 Samples of infant formula or other products within the scope of
this Code., or of equipment or utensils for their preparation or use, should not be
provided to health workers except when necessary for the purpose of professional
evaluation or research at the institutional level. Health workers should not give samples
of infant formula to pregnant women, mothers of infants and young children, or members of
their families.
7.5 Manufacturers and distributors of products within the scope of
this Code should disclose to the institution to which a recipient health worker is
affiliated any contribution made to him or on his behalf for fellowships, study tours,
research grants, attendance at professional conferences, or the like. Similar disclosures
should be made by the recipient.
8.1 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.
This should not be understood to prevent the payment of bonuses based on the overall sales
by a company of other products marketed by it.
8.2 Personnel employed in marketing products within the scope of this
Code should not, as part of their job responsibilities, perform educational functions in
relation to pregnant women or mothers of infants and young children. This should not be
understood as preventing such personnel from being used for other functions by the health
care system at the request and with the written approval of the appropriate authority of
the government concerned.
9.1 Labels should be designed to provide the necessary information
about the appropriate use of the product, and so as not to discourage breastfeeding.
9.2 Manufacturers and distributors of infant formula should ensure
that each container has a clear, conspicuous, and easily readable and understandable
message printed on it, or on a label which cannot readily become separated from it, in an
appropriate language, which includes all the following points:
the words "Important Notice" or their equivalent;
a statement of the superiority of breastfeeding;
a statement that the product should be used only on the advice of a health worker as to
the need for its use and the proper method of use;
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. They may,
however, have graphics for easy identification of the product as a breastmilk substitute
and for illustrating methods of preparation. The terms "humanised",
"maternalised" or similar terms should not be used. Inserts giving additional
information about the product and its proper use, subject to the above conditions, may be
included in the package or retail unit. When labels give instructions for modifying a
product into infant formula, the above should apply.
9.3 Food products within the scope of this Code, marketed for infant
feeding, which do not meet all the requirements of an infant formula, but which can be
modified to do so, Should carry on the label a warning that the unmodified product should
not be the sole source of nourishment of an infant. Since sweetened condensed milk is not
Suitable for infant feeding, nor for use as a main ingredient of infant formula, its label
should not contain purported instructions on how to modify it for that purpose.
9.4 The label of food products within the scope of this Code should
also state all the following points:
the ingredients used;
the composition/analysis of the product;
the storage conditions required; and
the batch number and the date before which the product is to be consumed, taking into
account the climatic and storage conditions of the country concerned.
10.1 The quality of products is an essential element for the
protection of the health of infants and therefore should be of a high recognised standard.
10.2 Food products within the scope of this Code should, when sold or
otherwise distributed, meet applicable standards recommended by the Codex Alimentarius
Commission and also the Codex Code of Hygienic Practice for Foods for Infants and
Children.
11.1 Governments should take action to give effect to the principles
and aim of this Code, as appropriate to their social and legislative framework, including
the adoption of national legislation, regulations or other suitable measures. For this
purpose, governments should seek, when necessary, the cooperation of WHO, UNICEF and other
agencies of the United Nations system. National policies and measures, including laws and
regulations, which are adopted to give effect to the principles and aim of this Code
should be publicly stated, and should apply on the same basis to all those involved in the
manufacture and marketing of products within the scope of this Code.
11.2 Monitoring the application of this Code lies with governments
acting individually, and collectively through the World Health Organisation as provided in
paragraphs 6 and 7 of this Article. The manufacturers and distributors of products within
the scope of this Code, and appropriate nongovernmental organisations, professional
groups, and consumer organisations should collaborate with governments to this end.
11.3 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.
11.4 Nongovernmental organisations, professional groups,
institutions, and individuals concerned should have the responsibility of drawing the
attention of manufacturers or distributors to activities which are incompatible with the
principles and aim of this Code, so that appropriate action can be taken. The appropriate
governmental authority should also be informed.
11.5 Manufacturers and primary distributors of products within the
scope of this Code should apprise each member of their marketing personnel of the Code and
of their responsibilities under it.
11.6 In accordance with Article 62 of the Constitution of the World
Health Organisation, Member States shall communicate annually to the Director General
information on action taken to give effect to the principles and aim of this Code.
11.7 The Director General shall report in even years to the World
Health Assembly on the status of implementation of the Code; and shall, on request,
provide technical support to Member States preparing national legislation or regulations,
or taking other appropriate measures in implementation and furtherance of the principles
and aim of this Code.
The WHO/UNICEF International Code of Marketing of Breastmilk Substitutes
has been revised several times since its adoption in 1981, making it stronger and sealing
over some loopholes in the origninal code. These revisions can be found at Baby Milk Action.
The
