Introduction

Breastfeeding helps infants and young children survive and thrive, and is good economics:

  • Breastfed children perform better on intelligence tests, are less likely to be overweight or obese, and less prone to diabetes later in life;
  • Increasing breastfeeding to near-universal levels could save the lives of more than 820 000 children under the age of five each year;
  • Breast milk is safe, clean and contains antibodies which help protect against many common childhood illnesses;
  • Boosting rates of exclusive breastfeeding for infants less than 6 months of age would significantly reduce costs for treatment of childhood illnesses such as pneumonia, diarrhoea and asthma.

In addition, mothers who breastfeed also reduce their risk of developing breast and ovarian cancers. At current breastfeeding rates, an estimated 20 000 deaths from breast cancer are prevented; this could be doubled if rates improved. Furthermore, breastfeeding delays early return of fertility in the mother, and reduces her risk of postpartum haemorrhage.

In spite of clear messages on the importance and advantages of breastfeeding, promotion and sales of breast-milk substitutes, such as infant formula, follow-up formula and other products intended to partially or fully replace breast-milk continues unabated. Global sales of breast-milk substitutes currently total US$ 44.8 billion, and are expected to rise to US$ 70.6 billion by 2019. Inappropriate marketing of food products that compete with breastfeeding is an important factor that often negatively affects the choice of a mother to breastfeed her infant optimally. Given the special vulnerability of infants and the risks involved in inappropriate feeding practices, usual marketing practices are therefore unsuitable for these products. Various studies showing the prevalence of inappropriate marketing of breast-milk substitutes demonstrate that these practices are persistent in many countries, and continues to undermine efforts to improve breastfeeding rates. Marketing practices are increasingly targeted beyond traditional settings such as retail outlets and health facilities. The rise in, and popularity of, social media channels, as well as internet sites dedicated to pregnant women and mothers, often provide manufacturers and distributors with new and unregulated entry points to market their products.

 The International Code of Marketing of Breast-milk Substitutes, adopted by the World Health Assembly in 1981, and subsequent relevant WHA resolutions adopted since then (the “Code”) are an important part of creating an overall environment that enables mothers to make the best possible feeding choice, based on impartial information and free of commercial influences, and to be fully supported in doing so. The Code, adopted as a minimum requirement to protect and promote appropriate infant and young child feeding, is a set of recommendations to regulate the marketing of breast-milk substitutes, feeding bottles and teats.

 The Code:

  • aims to (1) stop the aggressive and inappropriate marketing of breast-milk substitutes; and (2) 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);
  • advocates that babies be breastfed. If babies are not breastfed, for whatever reason, the Code also advocates that they be fed safely on the best available nutritional alternative. Breast-milk substitutes should be available when needed, but not be promoted;
  • represents an expression of the collective will of governments to ensure the protection and promotion of optimal feeding for infants and young children.

 Code implementation is just as important today as it was when it was adopted back in 1981. 2016 kicked off the 2030 Agenda for Sustainable Development, which proposed 17 Sustainable Development Goals to reach by 2030. Throughout these goals are themes directly and indirectly related to maternal and child health through breastfeeding. For example, the first goal is to “end poverty in all its forms everywhere,” and Goal 12 is to “ensure sustainable consumption and production patterns.” Breastfeeding is an integral part of ending poverty, as the purchase of breast-milk substitute can be expensive and unsustainable, and also contributes to reducing waste, because breast-milk does not require packaging like breast-milk substitutes do. More directly related are Goals 2 and 3, which aim to ensure the end  of hunger, achieve food security, improve nutrition, and promote healthy lifestyles and well-being at all ages. Breastfeeding is directly linked to all of these and so much more. At this time, the world needs Code implementation and people who can help achieve it.

 Target audience for the course:

Translating the Code into effective national legal, regulatory and other suitable measures, and ensuring their proper implementation requires a good understanding of the Code’s intent, content and requirements. Given the complexities of Code implementation and monitoring, and hence the need for policy makers, legislators, health practitioners, relevant UN agency staff and civil society partners staff to be adequately informed of Code matters, WHO and UNICEF have joined hands to develop and make accessible this introductory e-course on the Code. Whatever capacity you will be involved in with respect to the Code, it is important to be familiar with the actual articles of the Code, as well as how it has been applied not only by the government, but especially by the manufacturers and distributors as well as the health workers who are subject to its provisions.  You may be called on for advice by government counterparts about how best the articles can be made more effective at a local level.  Or you might find yourself in the position of assisting the development of national legislation or other measures to implement the articles of the Code.  Or, you might become involved in monitoring compliance or assisting others to do so.  Any and all of these roles will require a good understanding of the text as well as how it has been applied in real situations.

 Aim and structure of the course:

This comprehensive e-learning course and resource package has been prepared in order to reach as many people as possible in a cost-effective and sustained manner.  It is intended to provide a comprehensive introduction to the Code, its contents, and ways in which it can be implemented and monitored. It does not, however, provide an in-depth training on development of national Code laws and regulations (e.g. legal drafting), or establishing ongoing monitoring and enforcement mechanisms and processes. For such in-depth training, WHO, UNICEF and other partners, including IBFAN (through the NetCode network), have developed tools and training.

 The course contains 8 Units, each divided in READ, SEE, REVIEW and TEST sections:

  1. The International Code and Infant and Young Child Feeding
  2. Development of the International Code
  3. Aim and Scope of the International Code
  4. Promotion to the Public
  5. Promotion in the Health Care System
  6. Labelling
  7. The Code and infant feeding in exceptionally difficult circumstances
  8. Implementation and Monitoring

Learning Objectives:

 This training course and resource package was developed to strengthen understanding on:

  • The importance of breastfeeding and appropriate complementary feeding for the health, development and survival of children;
  • International recommendations for optimal feeding of infants and young children;
  • What is the International Code and the role it plays in the achievement of optimal feeding of infants and young children including breastfeeding and appropriate complementary feeding;
  • The content of the International Code and other WHA resolutions that relate to the marketing of breast-milk substitutes, feeding bottles and teats.
  • Implementation of the International Code at the national level and its place among international human rights and other legal instruments.
  • How compliance with the International Code and national implementation measures can be monitored and enforced.

 Contact details of developers and/or responsible officers:

David Clark
Legal Specialist, Nutrition Section
UNICEF NYHQ

Tel. +12123267376
E-mail: dclark@unicef.org 

Marcus Stahlhofer
Technical Officer, Child Rights and Child Health & Regulation of Marketing of Foods for Infants and Young Children
Department of Maternal, Newborn, Child and Adolescent Health
Cluster for Family, Women’s and Children’s Health

Department of Nutrition for Health and Development
Cluster for Noncommunicable Diseases and Mental Health

World Health Organization
20 Avenue Appia
1211 Geneva 27
Switzerland

Tel.:  +41 22 791 2909
Fax:  +41 22 791 4853
E-mail:  stahlhoferm@who.int

Web:
www.who.int/maternal_child_adolescent
www.who.int/nutrition