It is 25 years since the World Health Assembly adopted the International Code of Marketing of Breastmilk Substitutes in 1981.

This code was adopted as a minimum requirement for the protection of infant health and was to be implemented by each nation in its entirety. Such implementation was and remains a requirement for full compliance with the Convention of the Rights of the Child.

The aim of the code is “to contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of breastmilk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution“.

It applies to the marketing of all breastmilk substitutes – including any kind of milk, food or drink that is marketed or otherwise represented as suitable for use either with or instead of breastmilk – as well as feeding bottles and teats. It also regulates quality, availability and labelling. A detailed summary of the main requirements is given at the end of this post.

Nestle is the biggest offender when it comes to breaches of this code. Breaches are frequent and global, and babies die as a result. This is why they are one of the most boycotted firms on the planet. Today, Baby Milk Action staged its annual Nestle protest outside the UK headquarters in Croydon.

Take the Nestle Challenge

Outside the Nestlé (UK) Croydon HQ members of the public were invited to ‘Take the Nestlé Challenge’. Genuine Nestlé promotional materials were used to show how the company idealizes its products and undermines breastfeeding.The challenge is to mix up a bottle under the conditions experienced by mothers living in poor conditions – having to fetch water from a distance in a bucket, gather firewood and follow instructions in the wrong language.

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  • Governments and health workers must promote and enourage breastfeeding and must ensure that health workers are familiar with their responsibilities under the code.
  • Governments must ensure that objective, consistent information on infant feeding is provided for families and those who care for infants. This information must include details of (among other things) the benefits of breastfeeding, the risk of introducing partial bottle feeding and the difficulty of changing your mind if you decide not to breastfeed. Where information is given about formula, it should include information about the social, financial and health implications and should not idealise the use of breastmilk substitues in any way
  • Formula companies may donate informational materials but only on request, only with written government approval, and only for distribution through the health care system (which includes childcare institutions, but not pharmacies). Such materials – like any equipment or other items donated to health care institutions – may bear the donating company’s name or logo, but should not refer to any regulated products.
  • No formula company, retailer or health worker may promote regulated products (to mothers or to the general public) or provide – directly or indirectly – to mothers or pregnant women, or members of their family either free samples or any other item that might promote the use of breastmilk substitutes or bottle feeding. This means that there should be no point-of-sale advertising, discount offers or other promotions. Long term reductions in price are acceptable, but not special offers. Nor may those who market formula seek any direct or indirect contact with pregnant women or mothers of infants.
  • The health care system may not be used to promote any regulated products or display any products or marketing material. No representative of a formula company may be employed in the health care system to advise mothers or pregnant women on the use of infant formula. Health workers themselves may only demonstrate the use of formula to those who need to use it – and must clearly explain the hazards of improper use.
  • Formula companies may provide supplies of formula at no or low cost to institutions or organisations but such supplies (1) should only be used or distributed for infants who have to be fed on breastmilk substitutes (2) should only be so used of distributed by the receiving organisation (3) should not be provided as a sales inducement and (4) if donated for use outside the institution, should continue to be available for as long as the infants concerned need them.
  • Product information provided by formula companies to health professionals must be restricted to scientific and factual matters, and should not imply or create a belief that bottle feeding is equivalent or superior to breastfeeding. Health workers should not be given samples, equipment or utensils except for the purposes of professional evalualtion or (at institutional level) for research. No inducements may be given to or accepted by health workers or their familes for the promotion of any regulated products. If a formula company makes a research grant, contributes to a fellowship, study tour or the like for a health worker, this must be disclosed to the employing institution by both the company and the recipient.
  • Sales volumes should not be relevant to the remuneration or evaluation of marketing personnel employed by formula companies.
  • Labels may provide necessary information about the product, and must not discourage breastfeeding. The label must include a clear notice in the appropriate language stating, among other things, the superiority of breastfeeding, the need for advice from a health worker as to the product’s necessity and proper use and instructions for use. The label may not include any picture of an infant, or any pictures or text idealising formula. Terms such as “humanised” or “maternalised” are forbidden.
  • Governments must implement the code, including by legislation if necessary, and must monitor compliance with it. Formula companies must co-operate with government monitoring. Moreover, independently of whether and how the code has been implemented by any specific government, formula companies are themselves responsible for monitoring their own marketing practices so as to ensure that their conduct at every level conforms to the principles and aims of the code.
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