International Code on Marketing of Breast-milk Substitutes: Legal status of the Code

What does this indicator tell us?

This indicates whether a government has adopted legislation to monitor and enforce the International Code of Marketing of Breast-milk Substitutes (the Code) - an international health policy framework that was adopted by the World Health Assembly in 1981 - and its subsequent related resolutions. The Code is a set of recommendations to regulate the marketing of breast-milk substitutes, feeding bottles and teats. The Code aims to contribute "to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, 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 1).

The number of countries with legislation or regulations that fully implement the Code, and the subsequent relevant resolutions adopted by the Health Assembly, is included as a policy environment and capacity indicator in the Global Nutrition Monitoring Framework. It is also included as an additional indicator in the WHO Global reference list of 100 core health indicators.

How is it defined?

This indicator is defined on the basis of whether a government has adopted legislation covering few, many or full provisions of the Code.

What are the consequences and implications?

Improper marketing and promotion of food products that compete with breastfeeding often negatively affect the choice and ability of a mother to breastfeed her infant optimally. The Code was formulated in response to the realization that such marketing resulted in poor infant feeding practices, which negatively affect the growth, health and development of children and are a major cause of mortality in infants and young children.

Breastfeeding practices worldwide are not yet optimal, in both developing and developed countries, especially for exclusive breastfeeding under 6 months of age. In addition to the risks posed by the lack of the protective qualities of breast milk, breast-milk substitutes and feeding bottles are associated with a high risk for contamination that can lead to life-threatening infections in young infants. Infant formula is not a sterile product, and it may carry germs that can cause fatal illnesses. Artificial feeding is expensive, requires clean water, the ability of the mother or caregiver to read and comply with mixing instructions and a minimum standard of overall household hygiene. These factors are not present in many households in the world.

Source of data

WHO, UNICEF, International Baby Food Action Network (IBFAN). Marketing of breast-milk substitutes: national implementation of the international code: status report 2018. Geneva: World Health Organization; 2018 (http://covid.comesa.int/nutrition/publications/infantfeeding/code_report2018/en/).

Further reading

WHO, UNICEF, IBFAN. Marketing of breast-milk substitutes: national implementation of the international code: status report 2016. Geneva: World Health Organization; 2016 (http://covid.comesa.int/nutrition/publications/infantfeeding/code_report2016/en/).

WHO. The International Code of Marketing of Breast-milk Substitutes: frequently asked questions, 2017 update. Geneva: World Health Organization; 2018 (http://who.int/nutrition/publications/infantfeeding/breastmilk-substitutes-FAQ2017/en/).

WHO, UNICEF. Global Nutrition Monitoring Framework: operational guidance for tracking progress in meeting targets for 2025. Geneva: World Health Organization; 2017 (http://covid.comesa.int/nutrition/publications/operational-guidance-GNMF-indicators/en/).

WHO. Global reference list of 100 core health indicators (plus health-related SDGs). Geneva: World Health Organization; 2018 (https://covid.comesa.int/healthinfo/indicators/2018/en/).

Internet resources

WHO. e-Library of Evidence for Nutrition Actions (eLENA). Regulation of marketing breast-milk substitutes. (http://covid.comesa.int/elena/titles/regulation_breast-milk_substitutes/en/).