The first step on the road towards healthy nutrition is protecting, supporting and promoting breastfeeding. A key vehicle for that effort is the International Code of Marketing of Breast-milk Substitutes. Adopted by the World Health Assembly in 1981, it calls on all countries to regulate marketing of breastmilk substitutes to prevent breastfeeding from being undermined.  

How countries enforce the Code

The International Code of Marketing of Breast-milk Substitutes aims to promote infant nutrition by protecting breastfeeding from inappropriate marketing of infant formula and other breastmilk substitutes. It is a minimum standard, enforceable through “national legislation, regulations or other suitable measures.” Only countries that have adopted legally enforceable measures implementing the Code in its entirety are listed in category 1. Just 16 countries fall into this category—a disappointing showing considering that the Code is a minimum standard. 

Countries in category 2 have enacted only some of the Code’s provisions. For example, the member States of the European Union, based on an EU Directive, have adopted legislation that is weaker than the Code. It provided that legislation only apply to infant formulas (and not to the wider category of breastmilk substitutes, bottles and teats) and that advertising be allowed in baby care and scientific publications. 

Category 3 includes countries that have developed voluntary agreements with manufacturers providing no means of enforcement. In Australia this approach has proved reasonably successful. But the widespread violations reported in South Africa and Thailand (see Commentary) show the shakiness of such arrangements. Also in category 3 are countries that have drafted measures or are still examining how best to implement the Code. Many are from Central and Eastern Europe and the Commonwealth of Independent States, where the distribution of breastmilk substitutes was formerly centrally controlled.


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