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The WHO Code

August 2018

Step 1 of the Ten Steps to Successful Breastfeeding begins with, "Comply fully with the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions”, (2018).  There are many misconceptions about what the WHO Code does and does not cover.  Are breast pumps included?  What about online stores?  Or local grocery stores?  Or pacifiers?  Or specialized formula?  The questions are endless, so let's try to define exactly what The Code says.


The Code describes the following on page 8:

"Article 1. Aim of the Code: The aim of this Code is to contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion of breast-feeding, 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 2. Scope of the Code: The Code applies to the marketing, and practices related thereto, of the following products: breast-milk substitutes, including infant formula; other milk products, foods and beverages, including bottle-fed complementary foods, when marketed or otherwise represented to be suitable, with or without modification, for use as a partial or total replacement of breast milk; feeding bottles and teats. It also applies to their quality and availability, and to information concerning their use” (1981).

One important component is the marketing itself. The website for Baby-friendly USA gives us insight into the various types of marketing ploys that we need to be aware of.

One of the tenets of the Baby-friendly Hospital Initiative is that the marketing of breast-milk substitutes, including infant formula, discourages mothers from initiating and/or exclusively breastfeeding their infants. The International Code of Marketing of Breast-Milk Substitutes, adopted by the WHO in 1981, recommends restrictions on the marketing of breast-milk substitutes, infant feeding bottles, and teats. Hospitals and birthing centers wishing to attain Baby-friendly designation must abide by the provisions of the International Code of Marketing of Breast-Milk Substitutes.

Significant provisions of this code prevent hospitals and birthing centers from accepting free or low-cost infant formula, providing free samples of infant formula to families, or advertising breast-milk substitutes. Provisions of the International Code of Marketing of Breast-Milk Substitutes require:

1.No advertising of breast-milk substitutes to families.

2.No free samples or supplies in the health care system.

3.No promotion of products through health care facilities, including no free or low-cost formula.

4.No contact between marketing personnel and mothers.

5.No gifts or personal samples to health workers.

6.No words or pictures idealizing artificial feeding, including pictures of infants, on the labels or product.

7.Information to health workers should be scientific and factual only.

8.All information on artificial feeding, including labels, should explain the benefits of breastfeeding and the costs and hazards associated with artificial feeding.

9.Unsuitable products should not be promoted for babies.

10.All products should be of high quality and take account of the climate and storage conditions of the country where they are used.

Various aspects of marketing can include pens, lanyards, clocks, posters, informational handouts imprinted with logos of that company, as well as "free” meals with continuing education units from formula companies. Take a peak at this CBS News article from 2009 describing health care workers as "part of the marketing arm” for the infant formula industry https://www.cbsnews.com/news/ap-baby-formula-illegally-marketed-abroad/ Free for the staff often means increased sales for the industry, reduced breastfeeding, reduced exclusivity, and poorer health outcomes for the infants! We should all think about these ploys while working in our facilities on the journey to Baby-friendly Hospital designation.


Kathy Parkes, MSN-Ed, RN, IBCLC, FILCA

Professional Development Educator



Baby-Friendly USA. (2018). The code of marketing of breast-milk substitutes. Retrieved on 8/16/18 from https://www.babyfriendlyusa.org/about-us/10-steps-and-international-code

World Health Organization. (1981). The code of marketing of breast-milk substitutes. Retrieved on 8/16/18 from http://www.who.int/nutrition/publications/code_english.pdf

World Health Organization. (2018). The ten steps to successful breastfeeding. Retrieved on 8/1/18 from http://www.who.int/nutrition/bfhi/ten-steps/en/

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