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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:
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Infant formula
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Follow-up formula (also referred to as follow-on formula or Stage 2 milk)*
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Growing-up milk (also referred to as toddler milk or Stage 3 milk)*
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Any other milk marketed for children 0 < 36 months*
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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 facilities
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
Key points
World Health Assembly adopted the International Code of Marketing of Breast-milk Substitutes (together with subsequent relevant WHA resolutions known as the Code). Member States are urged to implement the Code as a minimum requirement into legal measures. See Summary of the Code.
WHA 34.22
Resolution
1981
Key points
Recognizes that commercial promotion of breastmilk substitutes contributes to increased artificial feeding and calls for renewed attention to implement and monitor the Code at national and international levels.
WHA 35.26
Resolution
1982
Key points
Requests that the Director General work with Member States to implement and monitor the Code and to examine the promotion and use of foods unsuitable for infant and young child feeding.
WHA 37.30
Resolution
1984
Key points
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Urges Member States to ensure breastmilk substitutes needed for a minority of infants are made available through normal procurement channels and not through free or subsidized supplies.
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Any food or drink given before complementary feeding is nutritionally required interferes with breastfeeding and therefore should neither be promoted nor encouraged for use.
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The practice of providing infants with follow up milks is not necessary.
WHA 39.28
Resolution
1986
Key points
Requests the Director General to provide legal and technical assistance to Member States in drafting the Code into national measures.
WHA 41.11
Resolution
1988
Innocenti Declaration on protection, promotion and support of breastfeeding
1990
Key points
Highlights the importance of protection, promotion and support of breastfeeding. Calls for obstacles to breastfeeding within the health system, the workplace and the community be eliminated. National authorities are urged to integrate their breastfeeding policies into their overall health and development policies, with support from international organisations in implementing, monitoring, and evaluating. The Declaration was endorsed by the UNICEF Executive Board and by Resolution WHA45.34.
Key points
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Highlights the special role of maternity services on protecting, promoting and supporting breastfeeding, which led to the Baby-Friendly Hospital Initiative in 1992.
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Urges Member States to ensure the principles and aim of the Code are given full expression in national health and nutrition policy and action.
WHA 43.3
Resolution
1990
Key points
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Calls for an end to free and low-cost supplies as a step towards full implementation of the International Code.
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Welcomes the Baby-Friendly Hospital Initiative and the operational targets of the Innocenti Declaration.
WHA45.34
Resolution
1992
Key points
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Extends ban on “free or low cost supplies” to all parts of the health care system (reiterates earlier calls in 1986, 1990 and 1992).
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Provides guidelines on donation of breastmilk substitutes in emergencies.
WHA 47.5
Resolution
1994
Key points
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Complementary foods are not to be marketed for or used to undermine exclusive and sustained breastfeeding.
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Financial support to health professionals should not create conflicts of interests.
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Code monitoring must be carried out in an independent, transparent manner free from commercial interest.
WHA 49.15
Resolution
1996
Key points
Sets global recommendation on exclusive breastfeeding as 6 months, with safe and appropriate complementary foods and continued breastfeeding for up to two years or beyond.
WHA 54.2
Resolution
2001
Key points
The Global Strategy on Infant and Young Child Feeding sets out “additional operational targets” and the roles of all “sectors of society”.
For the baby food companies, paragraph 44 spells out that their role is confined to:
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Ensuring quality of their products and,
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Compliance with the Code and subsequent resolutions, as well as to national measures implementing these.
Global Strategy on Infant and Young Child Feeding
2002
Key points
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Endorses the Global Strategy on Infant and Young Child Feeding which confines the baby food companies’ role to ensuring quality of their products; and complying with the Code and subsequent WHA resolutions, as well as national measures.
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Recognizes the role of optimal infant feeding to reduce the risk of obesity.
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Alerts that micronutrient interventions should not undermine exclusive breastfeeding.
WHA 55.25
Resolution
2002
Key points
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Nutrition and health claims for breastmilk substitutes should not be permitted unless national/regional legislation allows.
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The risks of intrinsic contamination of powdered infant formulas should be conveyed through label warnings.
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Financial support and other incentives for programmes and health professionals working in infant and young child health should not create conflicts of interest.
WHA 58.32
Resolution
2005
Key points
Member States to make sure the response to the HIV pandemic does not include non-Code compliant donations of breastmilk substitutes or the promotion thereof.
WHA 59.11
Resolution
2006
Key points
Welcomes the 2005 Innocenti Declaration and requests WHO to mobilize technical support for Code implementation and monitoring.
WHA 59.21
Resolution
2006
Key points
Scale up efforts to monitor and enforce national measures and to avoid conflicts of interest. Investigate the safe use of donor milk through human milk banks for vulnerable infants, mindful of national laws, cultural and religious beliefs.
WHA 61.20
Resolution
2008
Key points
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Member States need to strengthen implementation of the Code and resolutions, the Global Strategy on Infant and Young Child Feeding, the Baby-Friendly Hospital Initiative, the Operational Guidance for Emergency Relief Staff.
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End all forms of inappropriate promotion of foods for infants and young children, nutrition and health claims should not be permitted on these foods.
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Urges corporations to comply fully with responsibilities under the Code and resolutions.
WHA 63.23
Resolution
2010
Key points
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Member States need to put into practice the comprehensive implementation plan on maternal, infant and young child nutrition, including developing or strengthening legislative, regulatory or other measures to control the marketing of breastmilk substitutes; establishing adequate mechanisms to safeguard against potential conflicts of interest in nutrition action.
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Requests the Director General to provide clarification and guidance on the inappropriate promotion of foods for infants and young children as mentioned in WHA63.23; develop processes and tools to safeguard against possible conflicts of interest in policy development and implementation of nutrition programs.
WHA 65.6
Resolution
2012
Key points
Through this Decision, the World Health Assembly:
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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.
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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.
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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.
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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]).
WHA 67(9)
Decision
2014
Key points
This Resolution includes the WHO Guidance on ending the inappropriate promotion of foods for infants and young children (the 2016 Guidance) which:
WHA 69.7
Resolution
2016
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clarifies that follow-up milks and growing up milks are covered by the scope of the Code
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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
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requires a statement on the importance of not introducing complementary feeding before 6 months of age
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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
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bans messages that convey an endorsement or anything that may be construed as an endorsement by a professional or other body
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prohibits cross-promotion between foods for infants and young children and breastmilk substitutes
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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
Key points
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Urges governments to implement all provisions of the International Code and relevant resolutions as a minimum requirement, and to establish sustainable enforcement mechanisms.
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Manufacturers and distributors must ensure full compliance with all provisions of the International Code and relevant resolutions in all countries.
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Non-governmental organizations should draw attention to activities which are incompatible with the Code's principles and aim so that violations can be effectively addressed.
Innocenti Declaration on Infant and Young Child Feeding
2005
Key points
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Calls for the Baby-friendly Hospital Initiative to be reinvigorated, and full integration of the revised 10 Steps to Successful Breastfeeding, which incorporates Code compliance in Step 1.
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With exclusion of baby food and related industries, adopt multisectoral approaches with regard to “laws, policies and programmes aimed at protection, promotion, including education and support of breastfeeding”.
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Highlights governments’ obligation to implement the 2016 WHO Guidance and industry’s obligations to adhere to it, as set forth in WHA resolution 69.9.
WHA 71.9
Resolution
2018
Key points
Requests the Director-General to review current evidence and prepare a comprehensive report on the scope and impact of digital marketing strategies for the promotion of breast-milk substitutes to the 75th World Health Assembly in 2022.
WHA 73.26
Decision
2020
Key points
Requests the Director-General to develop guidance for Member States on regulatory measures to restrict the digital marketing of breastmilk substitutes, to ensure existing and new regulations designed to implement the International Code of Marketing Breast-milk Substitutes and relevant WHA resolutions adequately address digital marketing practices, and report progress in the 77th WHA 2024.
WHA 75.21
Decision
2022
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
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
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
Innocenti Declaration on the Promotion and Support of Breastfeeding | 1990
Global Strategy for Infant and Young Child Feeding | 2003
Innocenti Declaration 2005 on Infant and Young Child Feeding | 2005
Guideline: Updates on HIV and Infant Feeding | 2016
The International Code of Marketing of Breast-milk Substitutes: Frequently Asked Questions | 2017
Operational Guidance on Infant Feeding in Emergencies (OG-IFE) v3 | 2017
Implementation Guidance: The Revised Baby-friendly Hospital Initiative | 2018
Quick Guide Summarizing the Code and Relevant Resolutions of the World Health Assembly (Alive &Thrive) | 2021
Conflicts of Interest and Undue Influence associated with the Baby Food Industry: A Repository | 2022
CATCH CHATS
Our CATCH CHATS series feature David Clark, former UNICEF Legal Specialist and currently a Public Health and Human Rights Law Specialist, and Katherine Shats, UNICEF Legal Specialist.
These two global Code experts are joined by Constance Ching, Social Change Innovator and Code Consultant, for a deep-dive on Code implementation, monitoring, and ways to tackle digital marketing.
JOURNAL PAPER
VIOLATIONS OF VIETNAMESE LAWS RELATED TO THE ONLINE MARKETING OF BREASTMILK SUBSTITUTES: DETECTIONS USING A VIRTUAL VIOLATIONS DETECTOR
Key messages
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We present the first ever artificial intelligence-enabled system for improving the implementation of national laws related to the digital marketing of commercial milk formulas (CMF).
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Using Vietnam to apply the system, we detected more than 3000 online advertisements that violated or contradicted the intent of current Vietnamese laws over a 12-month period.
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Our findings demonstrate the need to strengthen the design, monitoring and enforcement of existing Vietnamese laws to eliminate mothers' exposure to the exploitative digital marketing of CMF.
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These findings should be considered by the Vietnamese Government as they review Advertising and Food Safety Laws.
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The virtual violations detector can be applied worldwide to help governments hold the industry accountable for the inappropriate digital marketing of CMF.
VIRTUAL VIOLATIONS DETECTOR (VIVID)
FINDINGS BRIEF: AUSTRALIA
September 2023