The World Health Organization Code of Marketing of Breastmilk Substitutes (The WHO Code)

What is The WHO Code?

The International Code of Marketing of Breastmilk Substitutes is an international health policy framework for breastfeeding promotion adopted by the World Health Assembly (WHA) of the World Health Organization (WHO) in 1981. Developed as a global public health strategy, The Code works to encourage exclusive breastfeeding for the first six months, and continued breastfeeding for 24 months or as long as the mother and baby desire. If supplementation is necessary, it also promotes safe preparation and storage of breastmilk substitutes (infant formula). Ethical issues are also covered by The Code, which regulates the direct marketing of infant formula, feeding bottles and artificial nipples to mothers, health care workers, and health care systems.

Since its 1981 inception, 84 countries around the globe have signed the document and enacted legislation which implementing most or all of the provisions and subsequent relevant WHA resolutions of The Code. Sadly, the United States was one of only two countries to NOT sign the document in 1981, (click here for article); in 2010 the U.S. signed, but refused to enact legislation.

Wikipedia states: “The baby food industry has been the subject of pointed criticism from non-governmental organizations, international agencies and campaign groups for failing to abide by the Code. One of the largest food and beverage manufacturers in the world, the Swiss giant Nestlé, has been the subject of an international boycott campaign since 1977 for its milk-substitute marketing practices prior to and since the development of the Code (see Nestlé boycott here: Nestlé boycott ).

On its own, the International Code is not legally enforceable. Companies are only subject to legal sanctions for failing to abide by the Code where it has been incorporated into the legislature of a nation state. Many countries have fully or partially adopted the Code as law. Other countries have no legislation on baby food marketing at all.

Code violations by baby food manufacturers are still widespread, especially (but not exclusively) in countries that have not implemented the Code as a national measure or where monitoring and enforcement is weak. The WHOInternational Baby Food Action Network (IBFAN), UNICEFSave the Children and other international organizations perform monitoring of implementation of the Code across the world both independently and with governments.”

Here is what The Code covers:

  1. No advertising of breast-milk substitutes to families
  2. No free samples or supplies in the health care system.
  3. No promotion of products through health care facilities, including no free or low-cost formula.
  4. No contact between marketing personnel and mothers.
  5. No gifts or personal samples to health workers.
  6. No words or pictures idealizing artificial feeding, including pictures of infants, on the labels or product.
  7. Information to health workers should be scientific and factual only.
  8. All information on artificial feeding, including labels, should explain the benefits of breastfeeding and the costs and hazards associated with artificial feeding.
  9. Unsuitable products should not be promoted for babies.
  10. All products should be of high quality and take account of the climate and storage conditions of the country where they are used.

The Code and all subsequent relevant resolutions contain specific provisions and recommendations relating to labeling of infant formula and other breastmilk substitutes.

For Mothers

  • Information and educational materials on infant and young child feeding should be objective and consistent and emphasize the importance of breastfeeding, and should not refer to any brand names.
  • All forms of product advertising and promotion are prohibited.
  • Mothers should not be given free product samples.
  • Promotional devices such as discounts and special displays at the retail level are prohibited.
  • Company representatives may not initiate direct or indirect contact with mothers.
  • Health risks to infants who are artificially fed or who are not exclusively breastfed should be highlighted through appropriate labeling and warnings.

For Health workers

  • The Code gives health workers the responsibility to encourage and protect breastfeeding.
  • Materials regarding products given to health professionals by manufacturers and distributors should be limited to ‘scientific and factual’ matters. They should not be tools to promote the use of products.
  • Product samples may be given only when necessary for professional evaluation or research at the institutional level, with no samples be passed on to mothers.
  • In order to prevent conflicts of interest, manufacturers and distributors should not give material or financial inducements to health workers. Three WHA resolutions on infant and young child nutrition subsequent to the adoption of the Code specifically cautioned against conflicts of interest.  A 1996 resolution called for caution in accepting financial support for health professionals working in infant and young child health which may create conflicts of interest. The need to avoid conflicts of interest was expanded in 2005 to cover programs in infant and young child health and reiterated in 2008.

For Health care systems

  • Promotion of any product is forbidden in a health care facility. This includes the display of products, placards and posters concerning such products and distribution of materials provided by manufacturers and distributors.
  • Formula feeding should be demonstrated only to those mothers or family members who need to use it and the information given should include a clear explanation of the risks of formula feeding and hazards of improper use of products.
  • Donated equipment and materials should not refer to brand names of products.
  • Free Supplies: Two subsequent resolutions (WHA 39.28 [1986] and WHA 47.5 [1994]) effectively call for an end to all free or low-cost supplies to any part of the health care system. Manufacturers and distributors are therefore prohibited from providing products to health care facilities for free or at low cost.

All Formula Labeling

  • Information on labels for infant formula must be in simple and easy to understand terms in an appropriate language.
  • Labels of infant formula must contain a statement on the superiority of breastfeeding and that the product should only be used after consultation with health professionals.
  • Pictures or text which may idealize the use of infant formula and certain wordings, such as ‘humanized” or “materialized” or similar terms should not be used.
  • Nutrition and health claims on labels for breastmilk substitutes should not be permitted unless allowed by national legislation.
  • Labels must contain explicit warnings on labels to inform consumers about the risks of contamination of powdered formula with pathogenic microorganisms
  • Labels must conform with WHO/FAO guidelines on safe preparation, storage and handling of powdered infant formula.

Want to learn more? Here are some links to various pieces of information.

International Code monitoring
Code monitoring in the United States
Who are violators of The WHO Code?
Do you see unethical promotion and marketing of formula, bottles or nipples?
Best For Babes has an excellent article on the promotion of artificial infant milks to mothers

The Nestle Boycott: 

Here is a great BBC radio report on the beginnings of the Nestle Boycott

Nestle is the largest food company in the world. Here is a list of their products as of 2016:

 Nescafé including:

Alta Rica
Black Gold
Blend 37
Cap Colombie
Cappuccino
Caro
Decaff
Expresso
Fine Blend
Gold Blend
Kenjara
Nescafé Ice
Nespresso coffee and machines
Organic
Partners Blend

Dairy products

Carnation
Coffee-Mate
Extreme Viennois
Fussells
Ideal
LC1
Munch Bunch yoghurts
*Rachel’s Dairy
Rowntree yoghurts and ice creams
Simply Double
Ski yogurts
Sveltesse yogurts
Tip-Top

Processed meals

Buitoni pasta & canned foods
Herta
Jenny Craig
Maggi
*Osem/Tivall
*Rowntrees Jellies

Pet Foods

Arthur’s
Bakers
BETA
Bonio
Felix
Friskies
Go-Cat
Go-dog
Gourmet
One
Pro Plan
Purina
Spiller’s
Vital Balance
Winalot

Confectionery & snacks

Aero
After Eights
Animal Bar
Baci Chocolate
Black Magic
Blue Riband
Breakaway
Caramac
Chocolate Cuisine
*Colgate Dental Gum
Dairy Box
Dairy Crunch
Double Cream
Drifter
Fab
Fruit Pastilles
Heaven
Henri Nestlé Collection
Jellytots
Kit Kat
Kit Kat Chunky
Kit Kat – Fairtrade
Lion Bar
*Lyons Maid Ice Cream
Matchmakers
Maxibon
Milky Bar
Munchies
*Nestlé Ice Cream
Polo
Quality Street
Rolo
Rowntrees Fruit Gums
Smarties
Toffee Crisp
Toffo
Tooty Frooties
Walnut Whip
Willy Wonka
Yorkie

Mineral/bottled water

Aqua Panna
Aquarel
Buxton
Contrex
Perrier
Pow-wow
San Pellegrino
Santa Maria
Valvert
Vittel

Other drinks

Build-up
Milo
Nesquik
Nestea

*Cereals

Cheerios & Honey Nut Cheerios
Cinnamon and Golden Grahams
Clusters
Cookie Crisp
Shreddies
Fibre 1
Fitnesse
Force Flakes
Fruitful
Golden Nuggets
Nesquik cereal
Shredded Wheat including: Bitesize, Fruitful, Honey Nut
Shreddies: Coco and frosted

*Cosmetics

Biotherm
Body Shop
Cosmence
Garnier
Helena Rubenstein
Innéov
La Roche-Posay
Lancome
L’Oreal
Matrix
Maybelline
Metamorphosis
Plénitude
Redken