What’s the Big Deal with the International Code of Marketing of Breast-Milk Substitutes

Let’s just start with this: infant formula, formula feeding, and breast-milk substitutes are not “bad” – and the WHO Code does not imply that they are. Infant formula offers a nutritionally complete food source for infants whose mothers cannot or choose not to breastfeed if a clean water source is available to prepare the formula with and the mother can afford to purchase the necessary formula for the foreseeable future. In the United States and globally there are areas with little or no access to a clean, safe water supply. There are populations of people who cannot afford the cost of infant formula. For these infants, breastfeeding is a life-or-death situation. Preparing infant formula inappropriately or with unsafe water can lead to illness or death. Protecting and supporting the mother to breastfeed can prevent illness and death. This is the purpose of the WHO Code.

What is the WHO Code?

The WHO Code, more formally know as the “International Code of Marketing of Breast-Milk Substitutes”, was created in 1981 by the World Health Organization.

The Code was created as a response to a global decline in breastfeeding. The decline in breastfeeding was partially due to the creation and promotion of breast-milk substitutes.

What is a breast-milk substitute?

Breast-milk substitutes include infant formulas, bottle-fed complementary foods, feeding bottles & teats, or any other product to be used as a partial or total replacement to direct breastfeeding.

What does the WHO Code do?

The WHO Code protects and promotes breastfeeding by offering guidelines to ensure appropriate use of breast-milk substitutes. The WHO Code also offers guidelines for appropriate marketing and distribution of breast-milk substitutes. It is the choice of national governments whether they want to follow or enforce the WHO Code in their respective countries. Irrespective of government enforcement, individual organizations can (and should) choose to follow the WHO Code.

Why is the WHO Code important?

1. Infant formula (and other breast-milk substitute) companies are driven off of profit – not off of infant health. For this reason, formula companies have an inherent conflict of interest. To protect the health of all babies, external oversight of marketing and promotion of their products is necessary.

2. There many individuals for which cost is a barrier to accessing a regular supply of infant formula. There are many places that access to clean water is a barrier to safe formula preparation. In these situations, marketing, disbursement, and use of breast-milk substitutes needs to be controlled to protect the mothers milk supply to ensure a constant food supply for the infant.

3. Breastfeeding offers benefits beyond nutrition – immunity, microbiome-stimulating components, ease of digestibility, maternal health benefits – that cannot be replicated by infant formula. For these reasons, unless there is medical indication, breastfeeding should be promoted and support given to mothers to allow for successful breastfeeding to be achieved.

Simply put, the International Code of Marketing of Breast-Milk Substitutes Code does not forbid the use of breast-milk substitutes, it offers ethical guidelines for organizations manufacturing and distributing breast-milk substitutes so that they are not undermining breastfeeding.

Women DO NOT NEED free formula samples, women need breastfeeding support. Women need paid maternity leave so that they can navigate the new responsibility of motherhood. Women need supportive healthcare providers who are knowledgeable about breastfeeding and can troubleshoot issues. Women need to be supported in their decision to breastfeed a child into toddlerhood (and beyond if desired!).

And when it is medically necessary or it is the mother’s choice – free from the influence of marketing or healthcare provider pressure – breast-milk substitutes should be introduced with proper education about preparation, feeding, and storage.

Read the full WHO Code here.