International Code of Marketing of Breast-Milk Subsitutes

 ISBN 92 4 154160 1

World Health Organization 1981

Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention.   For rights of reproduction or translation of WHO publications, in part or in toto, application should be made to the Office of Publications, World Health Organization, Geneva, Switzerland.    The World Health Organization welcomes such applications.

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city of area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

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Contents

Introduction

International Code of Marketing of Breast-milk Substitutes

Annex 1.         Resolutions of the Executive Board at its sixty-seventh session and of

the Thirty-fourth World Health Assembly on the on the International Code of Marketing of Breast-milk Substitutes

Annex 2.         Resolution of the Thirty-third World Health Assembly on infant and

young child feeding

Annex 3.         Excerpts from the introductory statement by the Representative of the

Executive Board to the Thirty-fourth World Health Assembly on the subject of the draft international code of marketing of breast-milk
substitutes

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Introduction

THE WORLD HEALTH ORGANIZATION (WHO) and the United Nations
Children's  Fund (UNICEF)  have  for  many  years  emphasized  the  importance  of

maintaining the practice of breast-feeding—and of reviving the practice where it is in decline—as a way to improve the health and nutrition of infants and young children. Efforts to promote breast-feeding and to overcome problems that might discourage it are a part of the overall nutrition and maternal and child health programmes of both organizations and are a key element of primary health care as a means of achieving health for all by the year 2000.

A variety of factors influence the prevalence and duration of breast-feeding.
The Twenty-seventh World Health Assembly, in 1974, noted the general decline in
breast-feeding in many parts of the world, related to sociocultural and other factors
including the promotion of manufactured breast-milk substitutes, and urged "Member
countries to review sales promotion activities on baby foods to introduce appropriate
remedial measures, including advertisement codes and legislation where necessary".¹

The issue was taken up again by the Thirty-first World Health Assembly in May  1978.    Among  its  recommendations  were  that  Member  States  should  give priority  to  preventing  malnutrition  in  infants  and  young  children  by,  inter  alia, supporting  and  promoting  breast-feeding,  taking  legislative  and  social  action  to facilitate  breast-feeding  by  working  mothers,  and  "regulating  inappropriate  sales promotion of infant foods that can be used to replace breast milk".²

Interest in the problems connected with infant and young child feeding and emphasis on the importance of breast-feeding in helping to overcome them have, of course, extended well beyond WHO and UNICEF. Governments, nongovernmental organizations, professional associations, scientists, and manufacturers of infant foods have also called for action to be taken on a world scale as one step towards improving the health of infants and young children.

In the latter part of  1978,WHO and UNICEF announced their intention of
organizing jointly a meeting on infant and young child feeding, within their existing
programmes, to try to make the most effective use of this groundswell of opinion.
After thorough consideration on how to ensure the fullest participation, the meeting
was convened in Geneva from 9 to 12 October 1979 and was attended by some 150
representatives of governments, organizations of the United Nations system and other
intergovernmental bodies, nongovernmental organizations, the infant-food industry,
and experts in related disciplines.    The discussions were organized on five main
themes: the encouragement and support of breast-feeding; the promotion and support
of appropriate and timely complementary feeding (weaning) practices with the use of

¹ Resolution WHA27.43 (Handbook of Resolutions and Decisions of the World Health Assembly and the Executive Board, Volume II, 4^th ed., Geneva, 1981, p.58).

² Resolution WHA31.47 (Handbook of Resolutions and Decisions….  Volume II, 4 ^th ed., p.62).

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local food resources; the strengthening of education, training and information on infant and young child feeding; the promotion of the health and social status of women in relation to infant and young child health and feeding; and the appropriate marketing and distribution of breast-milk substitutes.

The Thirty-third World Health Assembly, in May  1980, endorsed in their
entirety  the  statement  and  recommendations  agreed  by  consensus  at  this  joint
WHO/UNICEF meeting and made particular mention of the recommendation that
"there should be an international code of marketing of infant formula and other
products used as breast-milk substitutes", requesting the Director-General to prepare
such a code "in close consultation with Member States and with all other parties
concerned".³

To develop an international code of marketing of breast-milk substitutes in
accordance with the Health Assembly's request, numerous and lengthy consultations
were  held  with  all  interested  parties.     Member  States  of  the  World  Health
Organization and groups and individuals who had been represented at the October
1979 meeting were requested to comment on successive drafts of the code, and
further  meetings  were  held  in  February  and  March  and  again  in  August  and
September in  1980.   WHO and UNICEF placed themselves at the disposal of all
groups in an effort to foster a continuing dialogue on both the form and the content of
the draft code and to maintain as a basic minimum content those points which had
been agreed upon by consensus at the meeting in October 1979.

In January 1981, the Executive Board of the World Health Organization at its
sixty-seventh  session,  considered  the  fourth  draft  of  the  code,  endorsed  it,  and
unanimously recommended⁴ to the Thirty-fourth World Health Assembly the text of a
resolution by which it would adopt the code in the form of a recommendation rather
than as a regulation.⁵   In May 1981, the Health Assembly debated the issue after it
had been introduced by the representative of the Executive Board.⁶   It adopted the
code, as proposed, on 21 May by 118 votes in favour to 1 against, with 3 abstentions.⁷

³ See resolution WHA33.32, reproduced in Annex 2.

⁴ See resolution EB67.R12, reproduced in Annex 1.

⁵ The legal implications of the adoption of the code as a recommendation or as a regulation are

discussed in a report on the code by the Director-General of WHO to the Thirty-fourth World Health Assembly; this report is contained in document WHA34/1981/REC/1, Annex 3.

⁶ See Annex 3 for excerpts from the introductory statement by the representative of the Executive Board.

⁷ See Annex 1 for the text of resolution WHA34.22, by which the code was adopted.  For the

verbatim record of the discussion at the fifteenth plenary meeting, on 21 May 1981, see document WHA34/1981/REC/2.

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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 breastfeeding 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

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feeding practices, encouraging and facilitating breast-feeding, 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  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.

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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  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

"Complementary food"           means

"Container"                             means

"Distributor"                           means

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any  food  being  marketed  or  otherwise

presented as a partial or total replacement for breast milk, whether or not suitable for that purpose.

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".

any  form  of  packaging  of  products  for sale  as  a  normal  retail  unit,  including wrappers.

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

"Health worker"                      means

"Infant formula"                     means

"Label"                                    means

"Manufacturer"                       means

"Marketing"                            means

"Marketing personnel"            means

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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.

a person working in a component of such a health care system, whether professional or  non-professional,  including  voluntary unpaid workers.

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".

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.

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.

product  promotion,  distribution,  selling, advertising, product public relations, and information services.

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.

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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 specific it 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.

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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 bottlefeeding  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

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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 breastmilk 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.

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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 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.

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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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Annex 1

Resolutions of the Executive Board at its Sixty-seventh Session and of
the Thirty-fourth World Health Assembly on the International Code of

Marketing of Breast-milk Substitutes

Resolution EB67.R12

Draft International Code of Marketing of Breast-milk Substitutes

The Executive Board,

Having  considered  the  report  by  the  Director-General  on  the  Draft International Code of Marketing of Breast-milk Substitutes;

1.         ENDORSES  in  its  entirety  the  Draft  International  Code  prepared  by  the

Director-General;

2.         FORWARDS the Draft International Code to the Thirty-fourth World Health

Assembly;

3.         RECOMMENDS to the Thirty-fourth World Health Assembly the adoption of

the following resolution:

28 January 1981

[The text recommended by the Executive Board was adopted by the Thirty-fourth World Health Assembly, on  21 May  1981, as resolution WHA34.22, reproduced overleaf.]

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Resolution WHA34.22

International Code of Marketing of Breast-milk Substitutes

The Thirty-fourth World Health Assembly,

Recognizing the importance of sound infant and young child nutrition for the future health and development of the child and adult;

Recalling that breast-feeding is the only natural method of infant feeding and that it must be actively protected and promoted in all countries;

Convinced that governments of Member States have important responsibilities and a prime role to play in the protection and promotion of breast-feeding as a means of improving infant and young child health;

Aware of the direct and indirect effects of marketing practices for breast-milk substitutes on infant feeding practices;

Convinced that the protection and promotion of infant feeding, including the regulation of the marketing of breast-milk substitutes, affect infant and young child health directly and profoundly, and are a problem of direct concern to WHO;

Having considered the draft International Code of Marketing of Breast-milk
Substitutes prepared by the Director-general and forwarded to it by the Executive
Board;

Expressing its gratitude to the Director-General and to the Executive Director of the United Nations Children's Fund for the steps they have taken in ensuring close consultation with Member States and with all other parties concerned in the process of preparing the draft International Code;

Having considered the recommendation made thereon by the Executive Board at its sixty-seventh session;

Confirming resolution WHA33.32, including the endorsement in their entirety of the statement and recommendations made by the joint WHO/UNICEF Meeting on Infant and Young Child Feeding held from 9 to 12 October 1979;

Stressing that the adoption of and adherence to the International Code of Marketing of Breast-milk Substitutes is a minimum requirement and only one of several important actions required in order to protect health practices of infant and young child feeding;

1.         ADOPTS, in the sense of Article 23 of the Constitution, the International Code
of Marketing of Breast-milk Substitutes annexed to the present resolution;

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2.         URGES all Member States:

(1)        to  give  full  and  unanimous  support  to  the  implementation  of  the

recommendations made by the joint WHO/UNICEF Meeting on Infant and Young Child Feeding and of the provisions of the International Code in its entirety as an expression of the collective will of the membership of the World Health Organization;

(2)        to translate the International Code into national legislation, regulations

or other suitable measures;

(3)        to involve all concerned social and economic sectors and all other

concerned parties in the implementation of the International Code and in the

observance of the provisions thereof:

(4)        to monitor the compliance with the Code;

3.         DECIDES that the follow-up to and review of the implementation of this

resolution shall be undertaken by regional committees, the Executive Board and the

Health Assembly in the spirit of resolution WHA33.17.

4.         REQUESTS the FAO/WHO Codex Alimentarius Commission to give full

consideration, within the framework of its operational mandate, to action it might take

to improve the quality standards of infant foods, and to support and promote the

implementation of the International Code;

5.         REQUESTS the Director-General:

(1)        to give all possible support to Member States, as and when requested,

for the implementation of the International Code, and in particular in the
preparation of national legislation and other measures related thereto in
accordance with operative subparagraph 6(6) of resolution WHA33.32;

(2)        to use his good offices for the continued cooperation with all parties
concerned in the implementation and monitoring of the International Code at
country, regional and global levels;

(3)        to report to the Thirty-sixth World health Assembly on the status of
compliance with and implementation of the Code at country, regional and
global levels;

(4)        based on the conclusions of the status report, to make proposals, if
necessary, for revision of the text of the Code and for the measures needed for
its effective application.

21 May 1981

18

Annex 2

Resolution of the Thirty-third World Health Assembly on Infant and

Young Child Feeding

Resolution WHA 33.32    Infant and young child feeding

The Thirty-third World Health Assembly,

Recalling  resolutions  WHA27.43  and  WHA31.47  which  in  particular
reaffirmed that breast-feeding is ideal for the harmonious physical and psychosocial
development of the child, that urgent action is called for by governments and the
Director-General in order to intensity activities for the promotion of breast-feeding
and development of actions related to the preparation and use of weaning foods based
on local products, and that there is an urgent need for countries to review sales
promotion activities on baby foods and to introduce appropriate remedial measures,
including  advertisement  codes  and  legislation,  as  well  as  to  take  appropriate
supportive social measures for mothers working away from their homes during the
lactation period;

Recalling   further   resolutions   WHA31.55   and   WHA32.42   which emphasized maternal and child health as an essential component of primary health care, vital to the attainment of health for all by the year 2000;

Recognizing that there is a close interrelationship between infant and young
child  feeding  and  social  and  economic  development,  and  that  urgent  action  by
governments is required to promote the health and nutrition of infants, young children
and mothers, inter alia through education, training and information in this field;

Noting that a joint WHO/UNICEF Meeting on Infant and Young Child
Feeding was held from 9 to 12 October 1979, and was attended by representatives of
governments, the United Nations system and technical agencies, nongovernmental
organizations active in the area, the infant-food industry and other scientists working
in this field;

1.         ENDORSES in their entirety the statement and recommendations made by the
joint WHO/UNICEF meeting, namely on the encouragement and support of breast-
feeding;  the  promotion  and  support  of  appropriate  weaning  practices;  the
strengthening of education, training and information; the promotion of the health and
social  status  of  women  in  relation  to  infant  and  young  child  feeding;  and  the
appropriate marketing and distribution of breast-milk substitutes.   This statement and
these recommendations also make clear the responsibility in this field incumbent on
the  health  services,  health  personnel,  national  authorities,  women's  and  other
nongovernmental  organizations,  the  United  Nations  agencies  and  the  infant-food
industry, and stress the importance for countries to have a coherent food and nutrition
policy and the need for pregnant and lactacting women to be adequately nourished;
the joint Meeting also recommended that "There should be an international code of
marketing of infant formula and other products used as breast-milk substitutes.   This
should be supported by both exporting and importing countries and observed by all

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manufacturers. WHO and UNICEF are requested to organize the process for its preparation,  with  the  involvement  of  all  concerned  parties,  in  order  to  reach  a conclusion as soon as possible";

2.         RECOGNIZES the important work already carried out by the World Health
Organization and UNICEF with a view to implementing these recommendations and
the  preparatory  work  done  on  the  formulation  of  a  draft  international  code  of marketing of breast-milk substitutes;

3.         URGES countries which have not already done so to review and implement

resolutions WHA27.43 and WHA32.42;

4.         URGES   women's   organizations   to   organize   extensive   information

dissemination campaigns in support of breast-feeding and healthy habits;

5.         REQUESTS the Director-General ;

(1)        to cooperate with Member States on request in supervising or arranging

for the supervision of the quality of infant foods during their production in the country concerned, as well as during their importation and marketing;

(2)        to  promote  and  support  the  exchange  of  information  on  laws,
regulations,  and  other  measures  concerning  marketing  of  breast-milk
substitutes;

6.         FURTHER REQUESTS the Director-General to intensity his activities for
promoting  the  application  of  the  recommendations  of  the  joint  WHO/UNICEF
Meeting and, in particular:

(1)        to  continue  efforts  to  promote  breast-feeding  as  well  as  sound
supplementary feeding and weaning practices as a prerequisite to healthy child
growth and development;

(2)        to intensify coordination with other international and bilateral agencies
for the mobilization of the necessary resources for the promotion and support
of  activities  related  to  the  preparation  of  weaning  foods  based  on  local products in countries in need of such support and to collate and disseminate information  on  methods  of  supplementary  feeding  and  weaning  practices successfully used in different cultural settings;

(3)        to intensify activities in the field of health education, training and
information  on  infant  and  young  child  feeding,  in  particular  through  the
preparation of training and other manuals for primary health care workers in different regions and countries;

(4)        to prepare an international code on marketing of breast-milk substitutes
in close consultation with Member States and with all other parties concerned
including  such  scientific  and  other  experts  whose  collaboration  may  be deemed appropriate, bearing in mind that:

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(a)        the  marketing  of  breast-milk  substitutes  and  weaning  foods

must be viewed within the framework of the problems of infant and young child feeding as a whole;

(b)        the aim of the code should be to contribute to the provision of
safe  and  adequate  nutrition  of  infants  and  young  children,  and  in
particular  to  promote  breast-feeding  and  ensure,  on  the  basis  of
adequate  information,  the  proper  use  of  breast-milk  substitutes,  if
necessary;

(c)        the  code  should  be  based  on  existing  knowledge  of  infant

nutrition;

(d)       the  code  should  be  governed  inter  alia  by  the  following

principles:

(i)         the  production,  storage  and  distribution,  as  well  as
advertising,  of  infant  feeding  products  should  be  subject  to
national  legislation  or  regulations,  or  other  measures  as appropriate to the country concerned;

(ii)        relevant  information  on  infant  feeding  should  be
provided by the health care system of the country in which the
product is consumed;

(iii)       products should meet international standards of quality
and presentation, in particular those developed by the Codex
Alimentarius  Commission,  and  their  labels  should  clearly inform the public of the superiority of breast-feeding;

(5)        to submit the code to the Executive Board for consideration at its sixty-
seventh session and for forwarding with its recommendations to the Thirty-
fourth  World  Health  Assembly,  together  with  proposals  regarding  its promotion and implementation, either as a regulation in the sense of Articles 21  and  22 of the Constitution of the World Health Organization or as a recommendation in the sense of Article  23, outlining the legal and other implications of each choice;

(6)        to review the existing legislation in different countries for enabling and
supporting breast-feeding, especially by working mothers, and to strengthen
the Organization's capacity to cooperate on the request of Member States in

developing such legislation;

(7)        to submit to the Thirty-fourth World Health Assembly, in 1981, and
thereafter in even years, a report on the steps taken by WHO to promote
breast-feeding and to improve infant and young child feeding, together with an
evaluation of the effect of all measures taken by WHO and its Member States.

23 May 1980

21

Annex 3

Excerpts from the Introductory Statement by the Representative of the

Executive Board to the Thirty-fourth World Health Assembly on the Subject of
        the Draft International Code of Marketing of Breast-milk Substitute1

The topic "infant and young child feeding" was extensively reviewed and discussed in May 1980 at the Thirty-third World Health Assembly, and it has also been extensively discussed this morning.    Delegates will recall last year's Health Assembly's resolution WHA33.32 to this effect, which was adopted unanimously and which among other things requested the Director-General "to prepare an international code of marketing of breast-milk substitutes in close consultation with Member States and with other parties concerned".   The need for such a code and the principles on which it should be developed were thus unanimously agreed upon at last year's Health Assembly.²   It should therefore not be necessary in our deliberations today to repeat this review and these discussions.

There are two issues before the Committee today: firstly, the content of the code;  and  secondly,  the  question  of  whether  the  code  should  be  adopted  as  a regulation in the sense of Articles  21 and  22 of the WHO Constitution or as a recommendation in the sense of Article 23.

The proposal now before the Committee in document A34/8 is the fourth distinct draft of the code; it is the result of a long process of consultations carried out with Member States and other parties concerned, in close cooperation with UNICEF. Few, if any, issues before the Executive Board and the Health Assembly have been the object of such extensive consultations as has the draft code.

During the Executive Board's discussion on this item at its sixty-seventh
session, in January 1981, many members addressed themselves to the aim and the
principles  of  the  code  and  stressed  that,  as  presently  drafted,  it  constituted  the
minimum  acceptable  requirements  concerning  the  marketing  of  breast-milk
substitutes.   Since even at this late date, as reflect in recent newspaper articles, some
uncertainty persists with respect to the content of the code, particularly its scope, I
believe it would be useful to make some remarks on this point.   I hasten to remind
delegates, however, that the scope of the code was not the source of difficulty during
the Board's discussion.

¹ This statement by Dr Torbjørn Mork (Director-General of Health Services, Norway), representative of the Executive Board, was delivered before Committee A on 20 May 1981.  The summary records of the discussion of this topic at the thirteenth, fourteenth and fifteenth meetings of Committee A are contained in document WHA34/1981/REC/3.

² See document WHA33/1980/REC/1, Annex 6; document WHA33/1980/REC/2, page 327; and document WHA33/1980/REC/3, pages 67-95 and 200-204.

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The scope of the draft code is defined in Article 2.   During the first four to six months of life, breast milk alone is usually adequate to sustain the normal infant's nutritional requirements.   Breast milk may be replaced (substituted for) during this period by bona fide breast-milk substitutes, including infant formula.  Any other food, such as cow's milk, fruit juices, cereals, vegetables, or any other fluid, solid or semisolid food intended for infants and given after this initial period, can no longer be considered as a replacement for breast milk (or as its bona fide substitute).   Such foods only complement breast milk or breast-milk substitutes, and are thus referred to in the draft code as complementary foods.   They are also commonly called weaning foods or breast-milk supplements.

Products other than bona fide breast-milk substitutes, including infant formula,
are covered by the code only when they are "marketed or otherwise represented to be
suitable . . . . for use as a partial or total replacement of breastmilk".   Thus the code's
references to products used as partial or total replacements for breast milk are not
intended to apply to complementary foods unless these foods are actually marketed
æ as breast-milk substitutes, including infant formula, are marketed  æ as being
suitable  for  the  partial  or  total  replacement  of  breast  milk.    So  long  as  the
manufacturers and distributors of the products do not promote them as being suitable
for  use  as  partial  or  total  replacements  for  breast  milk,  the  code's  provisions
concerning limitations on advertising and other promotional activities do not apply to
these products.

The Executive Board examined the draft code very carefully.³   Several Board
members  indicated  that  they  considered  introducing  amendments  in  order  to
strengthen it and to make it still more precise.   The Board considered, however, that
the adoption of the code by the Thirty-fourth World Health Assembly was a matter of
great urgency in view of the serious situation prevailing, particularly in developing
countries, and that amendments introduced at the present stage might lead to a
postponement  of  the  adoption  of  the  code.    The  Board  therefore  unanimously
recommended to this Thirty-fourth World Health Assembly the adoption of the code
as presently drafted, realizing that it might be desirable or even necessary to revise the
code at an early date in the light of the experience obtained in the implementation of
its  various  provisions.     This  is  reflected  in  operative  paragraph 5(4)  of  the

recommended resolution contained in resolution EB67.R12.

The second mina questions before the Executive Board was whether it should recommend the adoption of the code as a recommendation or as a regulation.   Some Board members expressed a clear preference for its adoption as a regulation in the sense of Articles 21 and 22 of the WHO Constitution.   It became clear, however, that, although there had not been a single dissenting voice in the Board with regard either to the need for an international code or to its scope or content, opinion was divided on the question of a recommendation versus a regulation.

³ The summary record of the Board's discussions is contained in document EB67/1981/REC/2, pages 306-322.

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It was stressed that any decision concerning the form the code should take
should be based on an appreciation of which alternative had the better chance of
fulfilling the purpose of the code — that is, to contribute to improved infant and child
nutrition  and  health.    The  Board  agreed  that  the  moral  force  of  a  unanimous
recommendation could be such that it would be more persuasive than a regulation that
had gained less then unanimous support from Member States.   It was considered,
however, that the implementation of the code should be closely monitored according
to the existing WHO constitutional procedures; that future Assemblies should assess
the situation in the light of reports from Member States; and that the Assembly should
take any measures it judged necessary for its effective application

After carefully weighing the different points raised during its discussion, the Board unanimously adopted resolution EB67.R12, which contains the draft resolution recommended for adoption by the World Health Assembly.   In this connexion I wish to draw the Committee's particular attention to the responsibilities outlined in the draft resolution: those of Member States, the regional committees, the Director-General, the Executive Board, and the Health Assembly itself for appropriate follow-up action once the code has been adopted.

In carrying out their responsibilities, Member States should make full use of their Organization  — at global, regional and country levels  — by requesting its technical  support  in  the  preparation  of  national  legislation,  regulations  or  other appropriate measures, and in the monitoring of the application of the code.

I think that I can best reflect the sentiments of the Board by closing my introduction with a please for consensus on the resolution as it was unanimously recommended to the World Health Assembly by the Board.  We are not today dealing with an economic issue of particular importance only to one or a few Member States. We are dealing with a health issue of essential importance to all Member States, and particularly to developing countries, and of importance to the children of the world and thus to all future generations.