The International Code of Marketing of
Breastmilk Substitutes and Subsequent Resolutions
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.
Article 2. Scope of the Code
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.
Article 3. Definitions
For the purposes of this Code: "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.
Article 4. Information and education
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.
Article 5. The general public and mothers
5.1 There should be no advertising or other form of promotion to the
general public of products within the scope of this Code.
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.
Article 6. Health care systems
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.
Article 7. Health workers
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.
Article 8. Persons employed by manufacturers and distributors
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.
Article 9. Labelling
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:
