In 1981 the World Health Assembly adopted the World Health Organization's International Code of Marketing of Breast-milk Substitutes. The aim of the WHO Code is to to contribute to the promotion and protection of breastfeeding and by ensuring the proper use of breastmilk substitutes, when they are necessary, on the basis of adequate information and through appropriate marketing and dsitribution. To achieve this it recommends, as the basis of action, various requirements and restrictions in relation to marketing and distributing breast-milk substitutes. The New Zealand Minister of Health adopted the Code in its entirety in 1983, ' through consensus and discussion rather than through legislation'.
The Code is to be implemented in all countries within their existing social and legislative context. In New Zealand, advertising restrictions on infant formula may contravene the Commerce Act, although Article 5 of the WHO Code specifies that there should be no advertising of products within the scope of the WHO Code. However the benefits to an infant of receiving breast-milk for the first six months of life are so widely accepted that the infant formula companies comprising the New Zealand Infant Formula Marketers' Association (NZIFMA) choose not to advertise infant formula to the general public.
Source: Ministry of Health Infant Feeding Publication 'Guidelines for New Zealand
Health Workers based on the World Health Organization's Code of Marketing Breast-milk
Substitutes' (1997)
This version of the Code only includes the core text of the Code
itself. It should be read in association with the various Annexes. The full
version of the Code can be obtained at:
http://www.who.int/nut/documents/code_english.PDF.
Introduction
The Member States
of the World Health Organization:
Affirming the
right of every child and every pregnant and lactating woman to be adequately
nourished, as a means of attaining and maintaining health;
Recognizing that
infant malnutrition is part of the wider problems of lack of education, poverty,
and social injustice;
Recognizing that
the health of infants and young children cannot be isolated from the health
and nutrition of women, their socioeconomic status and their roles as mothers;
Conscious that
breast-feeding 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 breast-feeding and child-spacing;
Recognizing that
the encouragement and protection of breast-feeding 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 breast-feeding is an
important aspect of primary health care;
Considering that,
when mothers do not breast-feed, 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 non-commercial distribution systems; and that
they should not be marketed or distributed in ways that may interfere with the
protection and promotion of breast-feeding;
Recognizing further
that inappropriate feeding practices lead to infant malnutrition, morbidity
and mortality in all countries, and that improper practices in the marketing
of breast-milk 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 they reach 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 breast-milk
substitutes;
Appreciating that
there are a number of social and economic factors affecting breast-feeding,
and that, accordingly, governments should develop social support systems to
protect, facilitate and encourage it, and that they should create an environment
that fosters breast-feeding, provides appropriate family and community support,
and protects mothers from factors that inhibit breast-feeding;
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 breast-feeding, and providing objective and consistent
advice to mothers and families about the superior value of breast-feeding, 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 organizations and other
nongovernmental organizations have a special role to play in the protection
and promotion of breast-feeding and in ensuring the support needed by pregnant
women and mothers of infants and young children, whether breast-feeding or not;
Affirming the
need for governments, organizations of the United Nations system, nongovernmental
organizations, 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;
Recognizing 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 breast-milk 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 breast-milk
substitutes, the marketing of breast-milk 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.
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 breast-feeding, and by ensuring the proper use of breast-milk 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: breast-milk substitutes, including infant formula; other milk products, foods and beverages, including bottlefed 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 teasts. It also applies to their quality and availability, and to information concerning their use.
Article
3. Definitions
For the purposes
of this Code:
"Breast-milk substitute" means any food being marketed or otherwise
presented 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 become insufficient
to satisfy the nutritional requirements of the infant.
Such food is also commonly called "weaning food" or breast-milk
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
organizations engaged, directly or indirectly, in health care for mothers, infants
and pregnant women; and nurseries or child-care 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 non-professional, including voluntary unpaid workers.
"Infant formula"
means a breast-milk 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, marks, 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 of 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.
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: (a) the benefits and superiority of breast-feeding; (b)
maternal nutrition, and the preparation for and maintenance of breast-feeding;
(c) the negative effect on breast-feeding of introducing partial bottle-feeding;
(d) the difficulty of reversing the decision not to breast-feed; and (e) 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
breast-milk substitutes. Such materials should not use any pictures or text
which may idealize the use of breast-milk 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.
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
or infants and young children any gifts of articles or utensils which may promote
the use of breast-milk 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.
Article
6. Health care systems
6.1
The health authorities in Member States should take appropriate measures to
encourage and protect breast-feeding 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 4.3.
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 organizations 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
breast-milk substitutes. If these supplies are distributed for use outside the
institutions, this should be done only by the institutions or organizations
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 organization
should take steps to ensure that supplies can be continued as long as the infants
concerned need them. Donors, as well as institutions or organizations 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.
Article
7. Health workers
7.1
Health workers should encourage and protect breast-feeding; 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 breast-feeding. 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.
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 breast-feeding.
9.2
Manufacturers and distributors of infant formula should ensure that each container
as 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: (a) the words "Important
Notice" or their equivalent; (b) a statement of the superiority of breast-feeding;
(c) 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; (d) 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 idealize the use of infant
formula.
They may, however,
have graphics for easy identification of the product as a breast-milk substitute
and for illustrating methods of preparation. The terms "humanized",
"materialized" 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: (a) the ingredients used; (b) the composition/analysis
of the product; (c) the storage conditions required; and (d) 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.
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 recognized 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 Organization 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 organizations,
professional groups, and consumer organizations 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 organizations, 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
Organization, 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.