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The WHO Code (International Code of Marketing of Breastmilk Substitutes)

Families deserve to make informed decisions about infant and young child feeding based on objective factual information free from aggressive and confusing marketing.

The International Code of Marketing Breastmilk Substitutes was adopted by the World Health Organisation in 1981 and aims to stop the inappropriate marketing of breastmilk substitutes, feeding bottles and teats 

The Australian Breastfeeding Association calls on the Australian Government to legislate the International Code of Marketing Breastmilk Substitutes and the subsequent World Health Assembly resolutions (the WHO Code) in full.

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Why is the WHO Code important?

What's in the WHO Code?

• Scope: what products does the WHO Code cover?
• Providing objective and consistent information and education on infant feeding
• Preventing the promotion of breastmilk substitutes and related products to the general public and mothers
• Preventing the promotion of breastmilk substitutes and related products in healthcare settings
• Eliminating conflicts of interest for healthcare workers
• Conduct of employees of manufacturers of breastmilk substitutes, feeding bottles and teats
• Implementing responsible labelling
• Ensuring quality products
• Implementation, monitoring and enforcement of the WHO Code

FAQs

• What is Australia doing about the WHO Code?
• What does the Australian National Breastfeeding Strategy say about the WHO Code?
• Is the WHO Code anti-formula?
• What are my obligations under the WHO Code as a health professional?
• ABA normally uses mother-to-mother language. Why is this campaign focusing on families? 
• How does marketing affect feeding decisions? 

WHO Code and ABA in the media 

Why is the WHO Code important?

The WHO Code aims to stop the aggressive and inappropriate marketing of breastmilk substitutes, feeding bottles and teats.

Mothers and babies are particularly vulnerable and because of the risks involved in inappropriate feeding practices, usual marketing practices shouldn't be used for these products.

Implementation of the WHO Code ensures all families can make informed decisions about infant and young child feeding based on objective factual information free from the influence of aggressive and confusing marketing.

What's in the WHO Code?

1. Scope: what products does the WHO Code cover?
2. Information and education on infant and young child feeding
3. Promotion of breastmilk substitutes and related products to the general public and mothers
4. Promotion of breastmilk substitutes and related products in healthcare settings
5. Engagement with healthcare workers and systems
6. Conduct of employees of manufacturers of breastmilk substitutes, feeding bottles and teats
7. Labelling of breastmilk substitutes and related products
8. Quality of breastmilk substitutes and related products
9. Implementation, monitoring and enforcement of the Code

This represents the International Code of Marketing Breastmilk Substitutes. As mentioned above, the WHO Code also includes a number of World Health Assembly Resolutions, which provided further clarity and expanded some provisions.

Let's take a closer look at the main areas.

Scope: what products does the WHO Code cover?

The WHO Code primarily covers breastmilk substitutes, feeding bottles and teats.

Breastmilk substitutes include any milks (or products that could be used to replace milk such of fortified soy milk), which are specifically marketed for feeding children up to the age of 3 years, including follow-up formula and growing-up milks.

The WHO Code also seeks to prevent inappropriate promotion of foods and drinks as being suitable for feeding a baby during the first 6 months of life when exclusive breastfeeding is recommended.

Providing objective and consistent information and education on infant feeding

The Code states that governments are responsible for ensuring objective and consistent information is provided on infant and young child feeding, both to families and others involved in infant and young child feeding.

Materials should clearly state the importance of breastfeeding as well as the risks and costs of formula feeding.

Limits are also placed on donations of information and education materials by manufacturers of breastmilk substitutes, feeding bottles and teats.

Preventing the promotion of breastmilk substitutes and related products to the general public and mothers

The WHO Code explicitly states that breastmilk substitutes, feeding bottles and teats should be available but not promoted. This includes any type of advertising, discount promotions, special displays, samples, gifts and sponsorship of parenting clubs.

Companies should have no direct or indirect contact with pregnant women and mothers of babies and young children.

The WHO Code covers all promotion by manufacturers, distributors and retailers (e.g. supermarkets and pharmacies).

Preventing the promotion of breastmilk substitutes and related products in healthcare settings

The WHO Code prohibits promotion of breastmilk substitutes, feeding bottles and teats through healthcare services. Health services should not have displays, posters or other promotions for breastmilk substitutes, feeding bottles and teats. Manufacturers of breastmilk substitutes, feeding bottles and teats should not provide parent education through health services.

Information and education on the proper use of infant formula should only be provided to those who require it – there should be no general education classes provided on infant formula.

Eliminating conflicts of interest for healthcare workers

The WHO Code prohibits financial inducements given to healthcare workers to explicitly promote products covered by the Code. The Code also prohibits the distribution of samples by healthcare workers to the general public.

The WHO Code prohibits sponsorship and other financial or in-kind inducements which may present a conflict of interest for healthcare workers.

More information on healthcare workers' obligations can be found here.

Conduct of employees of manufacturers of breastmilk substitutes, feeding bottles and teats

The WHO Code prohibits the calculation of bonuses from sales of breastmilk substitutes, feeding bottles and teats. The Code also prohibits employees of manufacturers of breastmilk substitutes, feeding bottles and teats from providing education to pregnant women or mothers.

Implementing responsible labelling

The WHO Code restricts labelling to factual information only. It prohibits nutrition or health claims and images which may idealise the product.

The WHO Code also requires that all breastmilk substitute labels include a statement on the superiority of breastfeeding, that the product should only be used on health advice, and instructions on appropriate preparation.

Warnings outlining the risks of inappropriate preparation and the risk of breastmilk substitutes containing pathogens are also required.

Ensuring quality products

The WHO Code acknowledges the quality of products is vital to the health of infants and products should meet standards set by the Codex Alimentarius Commission.

Implementation, monitoring and enforcement of the WHO Code

The WHO Code outlines that it is the responsibility of governments to take action to ensure the WHO Code is implemented through suitable measures and applies to all manufacturers and distributors.

The WHO Code also outlines the responsibilities of others in upholding the Code, including non-governmental organisations, professional groups and individuals.

FAQs

What is Australia doing about the WHO Code?

The Marketing in Australia of Infant Formulas (MAIF) Agreement is Australia's response to the WHO Code. The MAIF Agreement is a self-regulatory agreement between infant formula manufacturers and importers who are signatories to the Agreement. The Agreement is overseen by the Department of Health and Ageing.

The MAIF Agreement has a much narrower scope than the WHO Code. For example, it doesn't cover bottles or teats, retailers or pharmacists and it only covers infant formula for babies under 12 months.

In addition, the MAIF Agreement is not legally binding, and any sanctions can only be applied to signatories that breach the Agreement.

Thus, the widespread advertising and marketing of many breastmilk substitutes, including toddler formulas, solids, bottles and teats, can legitimately continue under the MAIF Agreement.

There are also some labelling regulations covered by Food Standards Australia and New Zealand.

The Australian Breastfeeding Association calls on the Australian Government to replace the MAIF Agreement with legislation implementing the WHO Code in full.

What does the Australian National Breastfeeding Strategy say about the WHO Code?

The recently launched Australian National Breastfeeding Strategy (ANBS) 2019 has as one of its main principles to:

'Ensure that governments and health care and education institutions protect the community from false and misleading marketing and advertising of breastmilk substitutes that fall within the WHO Code and subsequent WHA resolutions.' (p 29)

In Action Area 1.2 of the Strategy, it is stated that the Commonwealth will undertake a review of 'regulatory arrangements for restricting the marketing of breastmilk substitutes' and 'raise awareness of the MAIF Agreement in the community' (p34).

The Australian Breastfeeding Association asks the Australian Government to progress this further by replacing the MAIF Agreement with the full implementation of the WHO Code. Australian mothers, babies and families deserve supportive environments to enable the optimal nourishment of their children.

Is the WHO Code anti-formula?

The WHO Code explicitly states that breastmilk substitutes, feeding bottles and teats should be available when needed, but should not be promoted. The WHO Code focuses on regulating the marketing of breastmilk substitutes, feeding bottles and teats.

All families deserve to make informed decisions about feeding their baby based on objective factual information free from aggressive and confusing marketing.

What are my obligations under the WHO Code as a health professional?

There are many resources which can help you understand your obligations as a health professional under the WHO Code. Most importantly you should avoid conflicts of interest regarding infant and young child feeding; not accept gifts from manufacturers of breastmilk substitutes, feeding bottles and teats; and only provide information on formula one-on-one to those who need it.

ABA Professional Members have access to an easy-to-read factsheet and a free training course on WHO Code obligations. Click here to join today.

The World Health Organisation also has a frequently asked questions page which can provide guidance. 

ABA normally uses mother-to-mother language. Why is this campaign focusing on families?

Supporting breastfeeding is the responsibility of everyone in the community but its mothers who should receive that support. Breastfeeding is a mother’s right. That’s why when providing support on breastfeeding ABA speaks mostly to mothers, they are the ones who are breastfeeding their babies.

When it comes to the WHO Code, ABA acknowledge that it often isn’t the mother who makes the sometimes-urgent trip to make the first purchase. Other family members, including partners, fathers and grandparents, are often involved in purchasing breastmilk substitutes, feeding bottles and teats. Breastmilk substitutes, feeding bottles and teats are also used by a variety of families in diverse circumstances where breastfeeding and breastmilk may not be available including adoptive families, foster families, families who have had a surrogate and rainbow families.

ABA believe that regardless of the situation, all families deserve to make informed decisions about infant and young child feeding based on objective factual information free from aggressive and confusing marketing.

How does marketing affect feeding decisions?  

Formula milk is a $55 billion industry, and its marketing efforts aim to maximise profit rather than improve public health or empower parents.  

Formula milk advertising is insidious and one of the biggest issues is that the tactics used are so discrete that you might not even be aware you are the target of marketing. From sponsorship of health professional events and research, to setting up online mums’ groups, marketing is highly personalised and aims to exploit the anxieties of parents. 

Formula milk marketing uses misleading scientific claims to positioning formula as close to, equivalent as or superior to breast milk. However, growing evidence demonstrates that breast milk and breastfeeding have unique properties that cannot be replicated by artificial formula. 

You can read more about the impact of formula milk marketing on feeding decisions in the joint report from WHO and UNICEF here

WHO Code and ABA in the media 

© Australian Breastfeeding Association February 2022