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Summary of the International Code of Marketing of Breast-milk Substitutes and all relevant subsequent WHA Resolutions

Aim

To contribute to the provision of safe and adequate nutrition for infants by the protection and promotion of breastfeeding and the proper use of breastmilk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution.

Scope

Breastmilk substitutes* 1 or any food being marketed or otherwise represented as a partial or total replacement for breastmilk, including: 

  • Infant formula 

  • Follow-up formula (also referred to as follow-on formula or Stage 2 milk)* 

  • Growing-up milk (also referred to as toddler milk or Stage 3 milk)* 

  • Any other milk marketed for children 0 < 36 months* 

  • Any other food or liquid (such as cereal, jarred food, infant tea, juice and mineral water) that is represented as suitable to be fed to infants less than six months of age.* 

  • Feeding bottles and teats.

Promotion

No advertising or promotion of above products to the public. No nutrition or health claims on products.* ^ 2

Samples

No free samples to mothers, their families or health care workers.

Health care facility

No promotion of products, i.e. no product displays, posters, calendars or distribution of promotional materials. No mothercraft nurses or similar corporation- paid personnel.

Health care workers

No gifts or samples to health care workers. Financial support and incentives should not create conflicts of interest. ^ 3

Supplies

No free or low-cost supplies of breastmilk substitutes to any part of the health care system. ^ 4

Information

Information and education materials must explain the benefits of breastfeeding, the health hazards associated with bottle-feeding and the costs of using infant formula. Product information must be factual and scientific. Governments to avoid conflicts of interest so materials under infant and young child programs should not be sponsored by manufacturers and distributors.^ 5

Labels

Product labels must clearly state the superiority of breastfeeding, the need for the advice of a health care worker and a warning about health hazards. No pictures of infants, other pictures, or text idealizing the use of infant formula. Labels must contain the warning that powdered infant formula may contain pathogenic microorganisms and must be prepared and used appropriately.^ 5 Labels on complementary foods should not cross-promote breastmilk substitutes, should not promote bottle-feeding, and should state the importance of continued breastfeeding.^ 6

Quality

Unsuitable products, such as sweetened condensed milk, should not be promoted for babies. All products should be of a high quality (Codex Alimentarius Standards) and take account of the climatic and storage conditions of the country where they are used.

*Clarified and extended by the WHO Guidance on ending the inappropriate promotion of foods for infants and young children Guidance in WHA Resolution 69.9 [2016].

^ Code provisions have been clarified and extended by subsequent World Health Assembly Resolutions.
1 WHA49.15 [1996], WHA54.2 [2001] & WHA63.23 [2010]

2 WHA58.32 [2005] & WHA63.23 [2010]

3 WHA49.15 [1996] & WHA58.32 [2005]

4 WHA47.5 [1994] v. WHA58.32 [2005]

5 WHA58.32 [2005]

6 WHA69.9

Relevant World Health Assembly Resolutions 1981-2022

Decision WHA 67(9)

Key points

Through this Decision, the World Health Assembly: 

  • Approved a first set of outcome indicators to monitor the Comprehensive Implementation Plan on MIYCN and its global targets approved in WHA 65.60 [2012]. One of the global targets of the MIYCN Plan is to increase the rate of exclusive breastfeeding in the first six months to at least 50% by 2025. 

  • Called for a working group to table a final set of indicators for a global monitoring framework for the MIYCN Plan in 2015. This includes policy and capacity indicators. The indicator for regulation of marketing is the number of countries with legislation or regulations fully implementing the International Code of Marketing of Breastmilk Substitutes and subsequent relevant WHA resolutions. 

  • Requested for informal consultations on risk assessment and management tools for conflicts of interest in nutrition actions. WHO’s Department of Nutrition responded by establishing a work stream on conflicts of interest that focuses on potential problems with the implementation of the MIYCN Plan, especially in cases for engagement with non-State actors. 

  • Requested work on providing clarification and guidance on inappropriate promotion of food for infants and young children (see WHA 63.23 [2010] and WHA 65.60 [2012]).

2014

Resolution WHA 69.7

Key points

This Resolution includes the WHO Guidance on ending the inappropriate promotion of foods for infants and young children (the 2016 Guidance) which: 

  • clarifies that follow-up milks and growing up milks are covered by the scope of the Code 

  • ensures labelling, packaging, and messages of foods for infants and young children are not undermining exclusive and continued breastfeeding and that products in this category are not marketed as suitable for under 6 months 

  • requires a statement on the importance of not introducing complementary feeding before 6 months of age 

  • prohibits any image, text or other representation that is likely to undermine or discourage breastfeeding, makes a comparison to breastmilk, suggests that the product is nearly equivalent or superior to breastmilk, or promotes bottle-feeding 

  • bans messages that convey an endorsement or anything that may be construed as an endorsement by a professional or other body 

  • prohibits cross-promotion between foods for infants and young children and breastmilk substitutes 

  • provides safeguards to prevent conflicts of interest in health facilities or throughout health systems by outlining what health workers, health systems, health professional associations and nongovernmental organizations should not do

2016

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Technical documents

Code and Relevant WHA Resolutions

International Code of Marketing of Breast-Milk Substitutes | 1981

 

WHA34.22 - International Code of Marketing of Breast-milk Substitutes | 1981

 

WHA35.26 - International Code of Marketing of Breast-milk Substitutes | 1982

 

WHA37.30 - Infant and young child nutrition | 1984

 

WHA39.28 - Infant and young child feeding | 1986

 

WHA41.11 - Infant and young child nutrition | 1988

 

WHA43.3 - Protecting promoting and supporting breast-feeding | 1990

 

WHA45.34 - Infant and young child nutrition and status of implementation of the International Code of Marketing of Breast-milk Substitutes | 1992

 

WHA47.5 - Infant and young child nutrition | 1994

 

WHA49.15 - Infant and young child nutrition | 1996

 

WHA54.2 - Infant and young child nutrition | 2001

 

WHA55.25 - Infant and young child nutrition | 2002

 

WHA58.32 - Infant and young child nutrition | 2005

 

WHA59.11 – Infant and young child nutrition and HIV | 2006

 

WHA59.21 - Infant and young child nutrition | 2006

 

WHA61.20 - Infant and young child nutrition: biennial progress report | 2008

 

WHA63.23 - Infant and young child nutrition | 2010

 

WHA65/6 - Comprehensive implementation plan on maternal, infant and young child nutrition | 2012

 

A67/DIV3 - Decision and list of resolutions: WHA67(9) Maternal, infant and young child nutrition | 2014 

 

A69/7 Add. 1 - Maternal, infant and young child nutrition - Report by the Secretariat
Guidance on ending the inappropriate promotion of foods for infants and young children Provisional agenda item 12.1
| 2016

 

WHA69.7 - Ending inappropriate promotion of foods for infants and young children
Agenda item 12.1
| 2016

 

WHA71.9 - Infant nutrition and breastfeeding Agenda item 12.6 | 2018

 

WHA73.26 - Maternal, infant and young child nutrition Agenda item 15.2 | 2020

 

WHA75.21 - Maternal, infant and young child nutrition Agenda item 18.1 | 2022

Other technical documents

Other resources

AI for Code monitoring in public healthcare

Video

Beliefs and norms associated with the use of ultra-processed commercial milk formulas for pregnant women in Viet Nam

Journal Article, Video

Timeline of the International Code of the Marketing of Breastmilk Substitutes

Brief

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