Pediatric Nutrition in Practice

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