The International Code of Marketing
of Breastmilk Substitutes
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The Member
States of the World Health Organisation:
Affirming the right of every
child and every pregnant and lactating woman to
be adequately nourished as a means of attaining
and maintaining health;
Recognising that infant malnutrition
is part of the wider problems of lack of education,
poverty, and social injustice;
Recognising that the health
of infants and young children cannot be isolated
from the health and nutrition of women, their
socio-economic status and their roles as mothers;
Conscious that breastfeeding
is an unequalled way of providing ideal food for
the healthy growth and development of infants;
that it forms a unique biological and emotional
basis for the health of both mother and child;
that the anti-infective properties of breast milk
help to protect infants against disease; and that
there is an important relationship between breastfeeding
and child spacing;
Recognising that the encouragement
and protection of breastfeeding is an important
part of the health, nutrition and other social
measures required to promote healthy growth and
development of infants and young children; and
that breastfeeding is an important aspect of primary
health care;
Considering that when mothers
do not breastfeed, or only do so partially, there
is a legitimate market for infant formula and
for suitable ingredients from which to prepare
it; that all these products should accordingly
be made accessible to those who need them through
commercial or noncommercial distribution systems;
and that they should not be marketed or distributed
in ways that may interfere with the protection
and promotion of breastfeeding;
Recognising further that inappropriate
feeding practices lead to infant malnutrition,
morbidity and mortality in all countries, and
that improper practices in the marketing of breastmilk
substitutes and related products can contribute
to these major public health problems;
Convinced that it is important
for infants to receive appropriate complementary
foods, usually when the infant reaches four to
six months of age, and that every effort should
be made to use locally available foods; and convinced,
nevertheless, that such complementary foods should
not be used as breastmilk substitutes;
Appreciating that there are
a number of social and economic factors affecting
breastfeeding, and that, accordingly, governments
should develop social support systems to protect,
facilitate and encourage it, and that they should
create an environment that fosters breastfeeding,
provides appropriate family and community support,
and protects mothers from factors that inhibit
breastfeeding;
Affirming that health care
systems, and the health professionals and other
health workers serving in them, have an essential
role to play in guiding infant feeding practices,
encouraging and facilitating breastfeeding, and
providing objective and consistent advice to mothers
and families about the superior value of breastfeeding,
or, where needed, on the proper use of infant
formula, whether manufactured industrially or
home prepared;
Affirming further that educational
systems and other social services should be involved
in the protection and promotion of breastfeeding,
and in the appropriate use of complementary foods;
Aware that families, communities,
women's organisations and other nongovernmental
organisations have a special role to play in the
protection and promotion of breastfeeding and
in ensuring the support needed by pregnant women
and mothers of infants and young children, whether
breastfeeding or not;
Affirming the need for governments,
organisations of the United Nations system, nongovernmental
organisations, experts in various related disciplines,
consumer groups and industry to cooperate in activities
aimed at the improvement of maternal, infant and
young child health and nutrition;
Recognising that governments
should undertake a variety of health, nutrition
and other social measures to promote healthy growth
and development of infants and young children,
and that this Code concerns only one aspect of
these measures;
Considering that manufacturers
and distributors of breastmilk substitutes have
an important and constructive role to play in
relation to infant feeding, and in the promotion
of the aim of this Code and its proper implementation;
Affirming that governments
are called upon to take action appropriate to
their social and legislative framework and their
overall development objectives to give effect
to the principles and aim of this Code, including
the enactment of legislation, regulations or other
suitable measures;
Believing that, in the light
of the foregoing considerations, and in view of
the vulnerability of infants in the early months
of life and the risks involved in inappropriate
feeding practices, including the unnecessary and
improper use of breastmilk substitutes, the marketing
of breastmilk substitutes requires special treatment,
which makes usual marketing practices unsuitable
for these products;
THEREFORE:
The Member States hereby agree
the following articles which are recommended as
a basis for action.
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Article
1. Aim of the Code
The aim of this 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.
Article
2. Scope of the Code
The Code applies to the marketing,
and practices related thereto, of the following
products: breastmilk substitutes, including infant
formula; other milk products, foods and beverages,
including bottle-fed complementary foods, when
marketed or otherwise represented to be suitable,
with or without modification, for use as a partial
or total replacement of breast-milk; feeding bottles
and teats. It also applies to their quality and
availability, and to information concerning their
use.
Article
3. Definitions
For the purposes of this
Code:
"Breastmilk substitute"
means any food being marketed or otherwise represented
as a partial or total replacement for breast milk,
whether or not suitable for that purpose.
"Complementary food"
means any food, whether manufactured or locally
prepared, suitable as a complement to breast milk
or to infant formula, when either becomes insufficient
to satisfy the nutritional requirements of the
infant. Such food is also commonly called "weaning
food" or "breastmilk supplement".
"Container"
means any form of packaging of products for sale
as a normal retail unit, including wrappers.
"Distributor"
means a person, corporation or any other entity
in the public or private sector engaged in the
business (whether directly or indirectly) of marketing
at the wholesale or retail level a product within
the scope of this Code. A "primary distributor"
is a manufacturer's sales agent, representative,
national distributor or broker.
"Health care system"
means governmental, nongovernmental or private
institutions or organisations engaged, directly
or indirectly, in health care for mothers, infants
and pregnant women; and nurseries or childcare
institutions. It also includes health workers
in private practice. For the purposes of this
Code, the health care system does not include
pharmacies or other established sales outlets.
"Health worker"
means a person working in a component of such
a health care system, whether professional or
nonprofessional, including voluntary, unpaid workers.
"Infant formula"
means a breastmilk substitute formulated industrially
in accordance with applicable Codex Alimentarius
standards, to satisfy the normal nutritional requirements
of infants up to between four and six months of
age, and adapted to their physiological characteristics.
Infant formula may also be prepared at home, in
which case it is described as "home prepared".
"Label" means
any tag, brand, mark, pictorial or other descriptive
matter, written, printed, stencilled, marked,
embossed or impressed on, or attached to, a container
(see above) of any products within the scope of
this Code.
"Manufacturer"
means a corporation or other entity in the public
or private sector engaged in the business or function
(whether directly or through an agent or through
an entity controlled by or under contract with
it) of manufacturing a product within the scope
of this Code.
"Marketing"
means product promotion, distribution, selling,
advertising, product public relations, and information
services.
"Marketing personnel"
means any persons whose functions involve the
marketing of a product or products coming within
the scope of this Code.
"Samples"
means single or small quantities of a product
provided without cost.
"Supplies"
means quantities of a product provided for use
over an extended period, free or at a low price,
for social purposes, including those provided
to families in need.
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Article
4. Information and education
4.1 Governments
should have the responsibility to ensure that
objective and consistent information is provided
on infant and young child feeding for use by families
and those involved in the field of infant and
young child nutrition. This responsibility should
cover either the planning, provision, design and
dissemination of information, or their control.
4.2 Informational
and educational materials, whether written, audio,
or visual, dealing with the feeding of infants
and intended to reach pregnant women and mothers
of infants and young children, should include
clear information on all the following points:
1. the benefits and superiority
of breastfeeding;
2. maternal nutrition, and
the preparation for and maintenance of breastfeeding;
3. the negative effect on
breastfeeding of introducing partial bottle
feeding;
4. the difficulty of reversing
the decision not to breastfeed; and
5. where needed, the proper
use of infant formula, whether manufactured
industrially or home prepared.
When such materials contain
information about the use of infant formula, they
should include the social and financial implications
of its use; the health hazards of inappropriate
foods or feeding methods; and, in particular,
the health hazards of unnecessary or improper
use of infant formula and other breastmilk substitutes.
Such materials should not use any pictures or
text which may idealise the use of breastmilk
substitutes.
4.3 Donations
of informational or educational equipment or materials
by manufacturers or distributors should be made
only at the request and with the written approval
of the appropriate government authority or within
guidelines given by governments for this purpose.
Such equipment or materials may bear the donating
company's name or logo, but should not refer to
a proprietary product that is within the scope
of this Code, and should be distributed only through
the health care system.
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Article
5. The general public and mothers
5.1 There
should be no advertising or other
form of promotion to the general public of products
within the scope of this Code.
5.2 Manufacturers
and distributors should not provide, directly
or indirectly, to pregnant women, mothers or members
of their families, samples of products within
the scope of this Code.
5.3 In conformity
with paragraphs 1 and 2 of this Article, there
should be no point-of-sale advertising, giving
of samples, or any other promotion device to induce
sales directly to the consumer at the retail level,
such as special displays, discount coupons, premiums,
special sales, loss leaders and tie-in sales,
for products within the scope of this Code. This
provision should not restrict the establishment
of pricing policies and practices intended to
provide products at lower prices on a long-term
basis.
5.4 Manufacturers
and distributors should not distribute to pregnant
women or mothers of infants and young children
any gifts of articles or utensils which may promote
the use of breastmilk substitutes or bottle feeding.
5.5 Marketing
personnel, in their business capacity, should
not seek direct or indirect contact of any kind
with pregnant women or with mothers of infants
and young children.
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Article
6. Health care systems
6.1 The health
authorities in Member States should take appropriate
measures to encourage and protect breastfeeding
and promote the principles of this Code, and should
give appropriate information and advice to health
workers in regard to their responsibilities, including
the information specified in Article
4.2.
6.2 No facility
of a health care system should be used for the
purpose of promoting infant formula or other products
within the scope of this Code. This Code does
not, however, preclude the dissemination of information
to health professionals as provided in Article
7.2.
6.3 Facilities
of health care systems should not be used for
the display of products within the scope of this
Code, for placards or posters concerning such
products, or for the distribution of material
provided by a manufacturer or distributor other
than that specified in Article 4.
6.4 The use
by the health care system of "professional
service representatives", "mothercraft
nurses" or similar personnel, provided or
paid for by manufacturers or distributors, should
not be permitted.
6.5 Feeding
with infant formula, whether manufactured or home
prepared, should be demonstrated only by health
workers, or other community workers if necessary;
and only to the mothers or family members who
need to use it; and the information given should
include a clear explanation of the hazards of
improper use.
6.6 Donations
or low-price sales to institutions or organisations
of supplies of infant formula or other products
within the scope of this Code, whether for use
in the institutions or for distribution outside
them, may be made. Such supplies should only be
used or distributed for infants who have to be
fed on breastmilk substitutes. If these supplies
are distributed for use outside the institutions,
this should be done only by the institutions or
organisations concerned. Such donations or low-price
sales should not be used by manufacturers or distributors
as a sales inducement.
6.7 Where
donated supplies of infant formula or other products
within the scope of this Code are distributed
outside an institution, the institution or organisation
should take steps to ensure that supplies can
be continued as long as the infants concerned
need them. Donors, as well as institutions or
organisations concerned, should bear in mind this
responsibility.
6.8 Equipment
and materials, in addition to those referred to
in Article 4.3, donated to a health care system
may bear a company's name or logo, but should
not refer to any proprietary product within the
scope of this Code.
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Article
7. Health workers
7.1 Health
workers should encourage and protect breastfeeding;
and those who are concerned in particular with
maternal and infant nutrition should make themselves
familiar with their responsibilities under this
Code, including the information specified in Article
4.2.
7.2 Information
provided by manufacturers and distributors to
health professionals regarding products within
the scope of this Code should be restricted to
scientific and factual matters, and such information
should not imply or create a belief that bottle
feeding is equivalent or superior to breastfeeding.
It should also include the information specified
in Article 4.2.
7.3 No financial
or material inducements to promote products within
the scope of this Code should be offered by manufacturers
or distributors to health workers or members of
their families, nor should these be accepted by
health workers or members of their families.
7.4 Samples
of infant formula or other products within the
scope of this Code., or of equipment or utensils
for their preparation or use, should not be provided
to health workers except when necessary for the
purpose of professional evaluation or research
at the institutional level. Health workers should
not give samples of infant formula to pregnant
women, mothers of infants and young children,
or members of their families.
7.5 Manufacturers
and distributors of products within the scope
of this Code should disclose to the institution
to which a recipient health worker is affiliated
any contribution made to him or on his behalf
for fellowships, study tours, research grants,
attendance at professional conferences, or the
like. Similar disclosures should be made by the
recipient.
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Article
8. Persons employed by manufacturers and distributors
8.1 In systems
of sales incentives for marketing personnel, the
volume of sales of products within the scope of
this Code should not be included in the calculation
of bonuses, nor should quotas be set specifically
for sales of these products. This should not be
understood to prevent the payment of bonuses based
on the overall sales by a company of other products
marketed by it.
8.2 Personnel
employed in marketing products within the scope
of this Code should not, as part of their job
responsibilities, perform educational functions
in relation to pregnant women or mothers of infants
and young children. This should not be understood
as preventing such personnel from being used for
other functions by the health care system at the
request and with the written approval of the appropriate
authority of the government concerned.
Article
9. Labelling
9.1 Labels
should be designed to provide the necessary information
about the appropriate use of the product, and
so as not to discourage breastfeeding.
9.2 Manufacturers
and distributors of infant formula should ensure
that each container has a clear, conspicuous,
and easily readable and understandable message
printed on it, or on a label which cannot readily
become separated from it, in an appropriate language,
which includes all the following points:
1. the words "Important
Notice" or their equivalent;
2. a statement of the superiority
of breastfeeding;
3. a statement that the
product should be used only on the advice of
a health worker as to the need for its use and
the proper method of use;
4. instructions for appropriate
preparation, and a warning against the health
hazards of inappropriate preparation.
Neither the container nor
the label should have pictures of infants, nor
should they have other pictures or text which
may idealise the use of infant formula. They may,
however, have graphics for easy identification
of the product as a breastmilk substitute and
for illustrating methods of preparation. The terms
"humanised", "maternalised"
or similar terms should not be used. Inserts giving
additional information about the product and its
proper use, subject to the above conditions, may
be included in the package or retail unit. When
labels give instructions for modifying a product
into infant formula, the above should apply.
9.3 Food
products within the scope of this Code, marketed
for infant feeding, which do not meet all the
requirements of an infant formula, but which can
be modified to do so, Should carry on the label
a warning that the unmodified product should not
be the sole source of nourishment of an infant.
Since sweetened condensed milk is not Suitable
for infant feeding, nor for use as a main ingredient
of infant formula, its label should not contain
purported instructions on how to modify it for
that purpose.
9.4 The label
of food products within the scope of this Code
should also state all the following points:
1. the ingredients used;
2. the composition/analysis
of the product;
2. the storage conditions
required; and
3. the batch number and
the date before which the product is to be consumed,
taking into account the climatic and storage
conditions of the country concerned.
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Article
10. Quality
10.1 The
quality of products is an essential element for
the protection of the health of infants and therefore
should be of a high recognised standard.
10.2 Food
products within the scope of this Code should,
when sold or otherwise distributed, meet applicable
standards recommended by the Codex Alimentarius
Commission and also the Codex Code of Hygienic
Practice for Foods for Infants and Children.
Article
11. Implementation and monitoring
11.1 Governments
should take action to give effect to the principles
and aim of this Code, as appropriate to their
social and legislative framework, including the
adoption of national legislation, regulations
or other suitable measures. For this purpose,
governments should seek, when necessary, the cooperation
of WHO, UNICEF and other agencies of the United
Nations system. National policies and measures,
including laws and regulations, which are adopted
to give effect to the principles and aim of this
Code should be publicly stated, and should apply
on the same basis to all those involved in the
manufacture and marketing of products within the
scope of this Code.
11.2 Monitoring
the application of this Code lies with governments
acting individually, and collectively through
the World Health Organisation as provided in paragraphs
6 and 7 of this Article. The manufacturers and
distributors of products within the scope of this
Code, and appropriate nongovernmental organisations,
professional groups, and consumer organisations
should collaborate with governments to this end.
11.3 Independently
of any other measures taken for implementation
of this Code, manufacturers and distributors of
products within the scope of this Code should
regard themselves as responsible for monitoring
their marketing practices according to the principles
and aim of this Code, and for taking steps to
ensure that their conduct at every level conforms
to them.
11.4 Nongovernmental
organisations, professional groups, institutions,
and individuals concerned should have the responsibility
of drawing the attention of manufacturers or distributors
to activities which are incompatible with the
principles and aim of this Code, so that appropriate
action can be taken. The appropriate governmental
authority should also be informed.
11.5 Manufacturers
and primary distributors of products within the
scope of this Code should apprise each member
of their marketing personnel of the Code and of
their responsibilities under it.
11.6 In
accordance with Article 62 of the Constitution
of the World Health Organisation, Member States
shall communicate annually to the Director General
information on action taken to give effect to
the principles and aim of this Code.
11.7 The
Director General shall report in even years to
the World Health Assembly on the status of implementation
of the Code; and shall, on request, provide technical
support to Member States preparing national legislation
or regulations, or taking other appropriate measures
in implementation and furtherance of the principles
and aim of this Code.
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