The World Health Organization (WHO) International Code of Marketing of Breast Milk Substitutes (the Code) was adopted in 1981 by the World Health Assembly. [1,2] It was designed to protect and promote breastfeeding and to ensure the proper use of breast milk substitutes when they are necessary. The Code provides recommendations to regulate the marketing of breast milk substitutes, artificial nipples, and feeding bottles. Its purpose is to prevent aggressive marketing of these products, which could interfere with a mom’s decision to breastfeed her baby.
The WHO promotes breastfeeding as the ideal source of nutrition for babies. The WHO recommends that all babies should start breastfeeding within 1 hour of birth and should be exclusively breastfed for 6 months. [1,3] Exclusive breastfeeding for all babies is recommended during the first 6 months, except in some cases where the mom may be taking certain medications or have certain medical conditions. After your baby has reached 6 months of age, the WHO recommends that you start adding foods to your baby’s diet and continue breastfeeding until your baby reaches 2 years of age. You can learn more about how to decide between breastfeeding and formula feeding here.
What products does the Code cover?
The Code applies to the marketing of breast milk substitutes, feeding bottles, and artificial nipples. Breast milk substitutes include infant formulas and any milks or milk-replacement products that are promoted for feeding babies and young children up to the age of 3 years old. This includes growing-up milks and follow-up formulas. The Code also provides recommendations for the marketing of foods and drinks that are intended for babies during their first 6 months of life, including waters, juices, and baby teas.
Why is the Code important to expecting moms?
The Code encourages governments and healthcare workers to provide moms with information about feeding their babies without inappropriate advertising that can interfere with their decision about whether to breastfeed or which formula to choose. It is important because it allows you and your pediatrician to make an informed decision about feeding that will provide the most benefit to both you and your baby.
What are some of the main points of the Code?
The Code encourages governments to implement policies that ensure its recommendations are carried out. The following are some of the recommendations from the Code:
- Advertising to the general public should not be allowed for specific brands of breast milk substitutes and other products covered under the Code.
- Manufacturers and companies should not provide expecting moms or family members with samples of breast milk substitutes or other products covered under the Code.
- Companies and manufacturers should not contact or make recommendations to expecting moms about feeding their babies.
- Gifts and samples should not be provided to healthcare workers.
- Expecting moms should be provided with educational materials about feeding babies and young children. These materials should include a discussion about the benefits of breastfeeding, the negative consequences of using breast milk substitutes unnecessarily or improperly, and instructions regarding the appropriate use of infant formulas.
- Products that are not an appropriate food source for your baby, such as sweetened condensed milk, should not be promoted for use in babies.
- Infant formulas and products covered under the Code should not display pictures of babies or have any picture or text that would promote infant formulas as an ideal replacement for breastfeeding.
- Labels for breast milk substitutes should explain the benefits of breastfeeding and the risks of using infant formula improperly. They should also include appropriate directions for use.
- Baby foods should have a warning that they should not be fed to babies before 6 months of age.
What are the effects of the Code?
Despite the recommendations from the Code, inappropriate marketing and advertising for breast milk substitutes still continues in many areas throughout the world. The popularity of the internet and social media makes it easier for manufacturers to advertise to expecting moms. The sale of breast milk substitutes also continues to rise. In 2014, sales of breast milk substitutes across the world reached over $44.8 billion dollars and is expected to increase to $70.6 billion by 2019.  Although the sale of breast milk substitutes has been increasing, the percentage of moms who breastfeed their baby at birth in the U.S. has also increased. The CDC reported that more than 8 out of 10 women in the U.S. started breastfeeding their babies since birth in 2016.  This is great news that more moms in the U.S. are choosing to breastfeed. Unfortunately, many moms stop breastfeeding earlier than the recommended time, with only about half still breastfeeding by the time their baby reaches 6 months of age.
The Code provides standards that help moms around the world make informed decisions about their baby’s feeding habits. It also provides recommendations to prevent inappropriate advertising that could encourage the unnecessary use of breast milk substitutes.
- World Health Organization. The International Code of Marketing of Breast-milk Substitutes: Frequently Asked Questions. Published 2017.
- World Health Organization. Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care. Compliance with the International Code of Marketing of Breast-milk substitutes. Published 2009.
- World Health Organization. International Code of Marketing of Breast-milk Substitutes. Published 1981.
- Centers for Disease Control and Prevention. Breastfeeding Rates Continue to Rise. Published August 22, 2016.