REPORT FROM THE BOARD
The WHO Code-A Primer for Leaders
LLLI Board of Directors
From: LEAVEN, Vol. 35 No. 2, April-May 1999, p. 26
History of the Code
Breastfeeding has long been promoted as a simple, low-cost, essential maternal and child health measure. However this century has witnessed an increasing reliance on infant formula and a decline in the practice of breastfeeding. There were many reasons for this, but the end result was a belief that modern women could not produce enough milk to satisfy their babies.
Following a joint World Health Organization (WHO) and UNICEF meeting on Infant and Young Child Feeding in Geneva in October 1979, a recommendation was made that "there should be an international code of marketing of infant formula and other products used as breast milk substitutes." In May 1980 the 33rd World Health Assembly (WHA, the governing body of WHO) made particular mention of this recommendation and requested the Director-General of WHO to prepare such a code "in close consultation with Member States and with all other parties concerned."
On May 21, 1981, the World Health Assembly adopted the International Code of Marketing of Breast Milk Substitutes, as a set of rules to protect breastfeeding from unethical marketing practices. The Preamble to the Code explains that "the marketing of breast milk substitutes requires special treatment, which makes usual marketing practices unsuitable for these products." Since then, the WHA has passed resolutions that "clarified and strengthened" certain provisions of the Code, particularly Article 2, Scope of the Code, and Article 6, Health Care Systems, which deals with free and low-cost supplies of substitutes for breast milk.
The aim of the International Code of Marketing of Breast Milk Substitutes is "to contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding and by the proper use of breast milk substitutes, when they are necessary, on the basis of adequate information and through appropriate marketing and distribution." The Code does not restrict the availability of substitutes for breast milk, nor prevent mothers from deciding to use them. When properly implemented, the Code will protect breastfeeding and non-breastfeeding families, as well as health workers, from unethical marketing practices.
Main Points of the WHO Code
In summary, the primary issues addressed by the Code include:
- Breast milk substitutes or products used to deliver breast milk substitutes to infants (such as bottles and teats) are not advertised to the public;
- Free samples of breast milk substitutes or other products are not distributed to mothers;
- Breast milk substitutes or other products are not permitted in the health care system;
- Company personnel do not advise mothers on infant feeding practices;
- Gifts or personal samples of breast milk substitutes or other supporting products are not distributed to health care workers;
- Pictures of infants or other pictures idealizing artificial infant feeding products do not appear on labels;
- All information to health care workers should be scientific and factual;
- All information on artificial feeding, including labels, should explain the benefits of breastfeeding and the costs and dangers associated with artificial feeding;
- Unsuitable products, such as sweetened condensed milk, are not promoted for use with babies.
When you read these points you can see that everything LLL does, as well as what an individual Leader does when she represents LLL, is fully in accord with the Code.
The International Code of Marketing of Breast Milk Substitutes is
. . . a code of marketing, not a code of ethics. The Code is a set of rules for industry, health workers and governments designed to regulate marketing. Marketing is much more than advertising. It includes all promotional activities including labeling, shelf space, gifts to health workers, special displays in shops, discount coupons, direct contact with mothers through phone help advice lines and Internet sites, and specifically relations with health workers and their associations.
The Code is also strengthened when the formula marketing companies within each country work with their government establish a self-regulatory code of practice.
. . . about breast milk substitutes, not just infant formula. The Code covers other milk products, cereals, teas and juices, bottles and teats. LLL Leaders know that six months of exclusive breastfeeding is recommended. Any other food or drink introduced during that time will replace breast milk, therefore the marketing of cereals, teas, juices or water for children under six months can be interpreted intending to replace breast milk and undermine breastfeeding.
. . . a compromise, not the ideal. The Code is the result of negotiations. Therefore national measures could be stronger and adapted to include new products and changing marketing practices. It is very important that the Code is put into effect at a national level through legislation or enforceable regulations. If this step is not taken, the Code will lack teeth.
. . . a tool, not an end in itself. When properly implemented, the Code will regulate marketing practices and will protect all mothers against the promotion of breast milk substitutes. This will make the work of LLL Leaders in their mother-to-mother support role easier and more effective.
International Code of Marketing of Breast Milk Substitutes
LLLI fully supports the WHO International Code of Marketing of Breast Milk Substitutes and reaffirms the stand taken by the LLLI Board of Directors in 1981 and 1988. LLLI Policies and Standing Rules 1981, 1988; revised Oct 1993
See additional article, "Leaders and the WHO Code."