Marketing of Breast Milk Substitutes 105
2
in developing countries, mortality from malnu-
trition, diarrhea and pneumonia increased sig-
nificantly [3].
The International Code
On May 21, 1981, the 34th meeting of the World
Health Assembly adopted the fourth draft of the
International Code of Marketing of Breast-Milk
Substitutes as a minimum requirement to pro-
tect and promote appropriate feeding of infants
and young children [4]. This code was developed
by the WHO and the UNICEF in partnership
with governments, nongovernmental organiza-
tions and the infant food industry. It was devel-
oped to protect mothers and health workers
from commercial pressure by manufacturers of
breast milk substitutes. It forbids provision of
free samples to mothers or health facilities (ex-
cept for professional research), because of their
negative impact on breastfeeding. It also forbids
inducements to health workers, because recipi-
ents are more likely to promote a particular
product and remain passive in promoting breast-
feeding ( table 1 ). The code was passed by 118
votes to 1 (USA); 3 countries abstained (Argen-
tina, Japan and Korea). By the 1996 World
Health Assembly meeting, all 191 member states
had affirmed their support for the code, its im-
plementation and the implementation of rele-
vant resolutions. By 1997, 17 countries had ad-
opted all or substantially all of the code’s provi-
sions as legal requirements. Adoption of the
Ta b l e 1. International Code of Marketing of Breast-Milk Substitutes [4]
Summary of articles
- There should be no advertising or other forms of promotion of the products
- Manufacturers or distributors should not provide free product samples to mothers
- Manufacturers or distributors should not distribute any gifts or articles to mothers
- Marketing personnel should not seek direct or indirect contact with mothers
- Facilities of the health care system should not be used for display of products
- No health care services should use professional service representatives provided or paid by
manufacturers or distributors - Health workers should encourage and protect breastfeeding
- Health professionals should be provided with scientific and factual information about the
product - No information to health workers should imply or create a belief that bottle feeding is
superior to breastfeeding - No material or financial inducements to promote products should be offered to health
workers or members of their families - Health workers should not give samples of infant formula to mothers or members of their
families - Labels should provide the necessary information about a product
- Labels should state the superiority of breastfeeding and provide information on appropriate
preparation of a product - Labels or the container should not have any picture or text that idealizes the use of infant
formulae - Labels should indicate the ingredients used, the composition, storage conditions required,
batch number and date before which the product is to be consumed - Monitoring the application of the code lies with the government, acting individually and
collectively through the WHO
Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 104–108
DOI: 10.1159/000360326