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| International Code of Marketing of Breast-milk Substitutes | |
|---|---|
| Name | International Code of Marketing of Breast-milk Substitutes |
| Type | World Health Organization policy |
| Location signed | World Health Assembly |
| Date signed | 1981 |
| Parties | World Health Organization member states |
International Code of Marketing of Breast-milk Substitutes is a global public health policy adopted by the World Health Assembly in 1981 to regulate the marketing of infant formula and related products. It was developed through negotiations involving World Health Organization, United Nations Children's Fund, national delegations such as United Kingdom, United States, India, and advocacy from organizations including International Baby Food Action Network and Save the Children. The Code aims to protect breastfeeding and ensure appropriate use of breast-milk substitutes in contexts such as hospitals and retail settings influenced by corporations like Nestlé, Abbott Laboratories, and Danone.
The Code emerged amid global debates involving actors such as World Health Organization, United Nations Children's Fund, International Baby Food Action Network, and national delegations from Norway, Ghana, Japan, and Brazil following public campaigns against marketing practices by companies like Nestlé and Wyeth. Historical antecedents include international health initiatives like Alma-Ata Declaration and policy forums such as United Nations General Assembly sessions where infant and maternal health topics featured alongside programs from United Nations Development Programme and United Nations Population Fund. The Code was adopted at the Thirty-fourth World Health Assembly in 1981 after consultations with experts from institutions like Harvard University, London School of Hygiene & Tropical Medicine, and Johns Hopkins University.
The Code contains provisions addressing promotion, labeling, and information for products covered, with language influenced by actors such as World Health Organization experts and legal inputs from International Labour Organization advisers. It applies to products marketed as breast-milk substitutes including formulas from companies like Nestlé, Abbott Laboratories, and Mead Johnson, and extends to commercial practices in settings overseen by ministries such as Ministry of Health (United Kingdom), Ministry of Health and Family Welfare (India), and Ministry of Health (Brazil). Specific provisions prohibit advertising in mass media as seen in regulatory models from United States Food and Drug Administration, restrict distribution of free samples in hospitals similar to policies in Cuba and Norway, and require labeling standards comparable to regulations from European Union directives.
Implementation has varied across countries with examples of national laws influenced by the Code in United Kingdom, South Africa, Philippines, Brazil, and Thailand. Legislative instruments range from comprehensive statutes modeled on WHO recommendations to partial measures shaped by trade considerations involving World Trade Organization negotiations and advice from legal bodies such as the International Law Commission. National actors implementing the Code have included ministries like Ministry of Health (Philippines), regulatory agencies like Food and Drug Administration (United States), and parliaments such as the Parliament of India and National Assembly of South Africa.
Monitoring mechanisms encompass government agencies, civil society organizations like International Baby Food Action Network and Oxfam, and independent watchdogs supported by research institutions such as London School of Hygiene & Tropical Medicine and Harvard School of Public Health. Compliance efforts have engaged multilateral institutions including World Health Organization regional offices, country offices of United Nations Children's Fund, and technical partners like WHO Collaborating Centres. Enforcement has been pursued through administrative sanctions in jurisdictions such as Brazil and Philippines, litigation in courts like Supreme Court of the Philippines, and through publicity campaigns by NGOs drawing on tactics used by groups like Greenpeace.
Studies by universities including University of Oxford, Johns Hopkins University, University of Copenhagen, and agencies such as World Health Organization and United Nations Children's Fund indicate that Code-based policies are associated with higher breastfeeding rates in settings like Sweden, Norway, and Sri Lanka. Public health outcomes linked to increased breastfeeding include reductions in infant morbidity metrics tracked by Global Burden of Disease Study analysts and improvements in child nutrition targets reflected in Millennium Development Goals and later Sustainable Development Goals. Programmatic initiatives integrating the Code have been coordinated with maternal services in hospitals modeled on Baby-Friendly Hospital Initiative standards and training curricula at institutions like University of the Philippines and John Hopkins Bloomberg School of Public Health.
Critiques have come from multinational corporations such as Nestlé and trade groups, from scholars at Harvard Business School, and from policymakers concerned about rights asserted in forums like World Trade Organization. Debates have involved conflicts between public health objectives championed by World Health Organization and commercial freedom arguments presented by industry lobbyists active in capitals such as Washington, D.C., Brussels, and Geneva. Controversies include enforcement challenges highlighted in reports by Human Rights Watch and contested interpretations of scope debated at World Health Assembly sessions and in legal proceedings before national courts such as the Constitutional Court (South Africa).
Since 1981, the World Health Assembly has adopted subsequent resolutions clarifying and extending the Code's application, including directives in resolutions from 1986, 1994, and 2005, and technical guidance produced by World Health Organization and United Nations Children's Fund. Complementary initiatives include the Baby-Friendly Hospital Initiative, WHO guidance on marketing of complementary foods, and policy briefs prepared in collaboration with World Bank and United Nations Children's Fund. Ongoing global governance dialogues occur within forums such as Global Breastfeeding Collective and during meetings of the World Health Organization Executive Board.