Marketing of breast-milk substitutes: National implementation of the International Code – Status report 2016

A recent comprehensive report by the World Health Organisation, UNICEF, and the International Baby Food Action Network (IBFAN), has revealed the status of national laws to protect and promote breastfeeding in 194 countries.[1] The World Health Organisation issued a media release on May 9th and commented that richer countries lag behind poorer ones in their implementation of the International Code. [2]

135 countries, out of the 194 analysed, have in place some form of legal measure related to the International Code of Marketing Breast-Milk Substitutes, [3] and subsequent, relevant World Health Assembly resolutions,[4] [5] and this number has increased by 35 since the last analysis which was carried out in 2011. The International Code had a birthday this year and is now 35 years old, so it is disappointing to note that only 39 countries out of the 194 reviewed have laws that enact all International Code provisions. The International Code, and the essential updates in the form of the World Health Assembly resolutions, are designed to not only protect breastfeeding by stopping inappropriate and misleading marketing of breast-milk substitutes, bottles and teats, but to also protect infants fed on breast-milk substitutes. All parents should have access to unbiased, commercial-free, information about infant feeding, and health professionals also need a source of unbiased, scientific and factual information.

To compile the Status Report 2016, countries were invited to respond to a questionnaire on Code implementation, and additionally IBFAN, the International Code Documentation Centre (ICDC), and UNICEF, reviewed and updated categorisation of information received about country practices and legal measures.

In the report New Zealand is one of the countries with no legal measures (Annex 1, p. 50) and although it is recorded that the Ministry of Health has formal mechanisms for monitoring the Code in place, which is noted to be transparent, independent, budgeted, empowered to take action, sustainable and monitored monthly to annually, the report states that it is not free of commercial influence (Annex 3, p. 62). Additionally the NZ monitoring mandate does not include retail shops or pharmacies and the report notes that although violations were recorded no sanctions were imposed (Annex 3, p. 63). As stated in the WHO media release, monitoring is essential to detect violations but it is important that these measures are fully operational and results should be published. Meaningful sanctions are also essential to reduce violations.

It seems timely to refer back to the recent Lancet Series on breastfeeding which contained the economic argument for breastfeeding, and the need for protection of breastfeeding and infant feeding, via the International Code of Marketing of Breast-Milk Substitutes. McFadden et al, called for a coordinated global action to combat inappropriate and misleading marketing. [6] WHO/UNICEF and IBFAN urge countries who have not yet adopted legal measures to do so. With the aggressive and misleading marketing of breast-milk substitutes continuing largely unabated, and a global sales revenue of US$44.8 billion, which is expected to rise to US$70.6 billion by 2019, this Status Report highlights the need for urgent action by governments now.

[1] World Health Organisation/UNICEF/International Baby Food Action Network. (2016). Marketing of breast-milk substitutes: National implementation of the International Code – Status report 2016. Geneva, WHO.

[2] World Health Organisation. (2016). Laws to protect breastfeeding inadequate in most countries. Geneva. WHO Media Centre.

[3] World Health Organisation. (1981.) International Code of Marketing of Breast-Milk Substitutes. Geneva, WHO.

[4] World Health Organisation. World Health Assembly resolutions and documents: Infant and young child nutrition.

[5] International Baby Food Action Network. The Full Code. WHA Resolutions.

[6] McFadden, A., Mason, F., Baker, J., Begin, F., Dykes, F., Grummer-Strawn, L., Kenney-Muir, N., Whitford, H., Zehner, E., & Renfrew, M. (2016). Spotlight on infant formula: Coordinated global action needed. The Lancet, 387:433-435.


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