Research tells us that the overwhelming majority of mothers want to breastfeed, but they don’t always reach their breastfeeding goals. Less than half of newborns begin breastfeeding in the first hour of life, and only 44% of infants are exclusively breastfed at six months.1 One of the most significant challenges to improving breastfeeding rates worldwide is the exploitative marketing of commercial milk formulas.
Around the globe, mothers and other parents experience barriers to lactation, from a lack of skilled support to inadequate workplace provisions. Formula companies are at the ready to exploit these wide gaps. Formula companies’ marketing efforts are aggressive, well funded, and come at families from every angle, including influencing health care providers at sponsoring events and providing branded educational materials, making false claims about the product, providing free samples to hook families (who often can’t afford to continue to purchase the expensive product), and exploiting parents’ desires to do what is best for their children.
The solution to these aggressive marketing tactics exists: the Code.
The aim of the International Code of Marketing of Breast-milk Substitutes and all subsequent relevant World Health Assembly resolutions (which together make up the 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.”2
The Code covers four product areas: breastmilk substitutes, which includes all commercial milk formulas (including follow-on formulas and growing up milks), marketed as appropriate for children up to 36 months of age; any other food or beverage marketed as appropriate for children up to 6 months of age; and feeding bottles and teats.
It is important to understand that the Code applies to the marketing of these products, their quality, and information about their use, but does not limit sales of these products, recognizing that they may be necessary in some situations. The Code specifies no promotion of these products to the public in any form, including no samples of the products to families or health workers, no gifts or other financial inducements to families or health workers, no promotion in healthcare facilities or to health workers, no promotion of complementary foods before 6 months, no sponsorships of meetings of health professionals, and adequate and appropriate labeling. The Code states that companies have a responsibility to follow the Code independent of any legal measures to implement the Code.
The market for commercial milk formulas is huge, estimated at US$70.6 billion in 20193, with an estimated US$16 billion in profits.4 What these companies spend on formula marketing FAR outpaces what countries spend on breastfeeding support: One analysis of just the six largest commercial milk formula companies estimated they spent US$7 billion on marketing in 2015 (US$17 billion if spending on sales staff and administrations is included).5 This spending dwarfs the estimated $653 million annual cost to scale up breastfeeding counselling interventions in 34 countries to meet breastfeeding goals, which would save the lives of 820,000 children and add US$300 billion to the economy annually.6
However, the existence of the Code is not enough. It must be implemented with legal measures, including steps for monitoring and enforcement in every country. As of April 2020, 136 of 194 countries had enacted legal measures with provisions to implement the Code but only 25 of these countries had measures substantially aligned with the Code; 58 countries still have no legal measures at all.7
As we celebrate the 40th anniversary of the enactment of the Code, we are reflecting both upon the gains the Code has made possible, but also upon the work yet to be accomplished by this important protection.
This is why ILCA:
- Calls on governments to enact, enforce, and monitor the Code, or strengthen legal measures already in place.
- Supports existing efforts, like NetCode, to provide resources and support for monitoring and enactment of the Code.
- Calls on all ILCA members to fulfill their obligations under the Code, and supports members with education and information to do so.
- Calls on other health care professional organizations to honor and uphold the Code, including educating health workers and ending the practice of allowing Code-violating corporations to sponsor events.
- Continues to follow the Code in evaluating advertising and sponsorship in the Journal of Human Lactation and at our annual conference, serving as a model to other health care professional organizations.
These efforts are critical to ensuring that formula companies do not continue to put profits before the health of mothers, infants, and young children.
1: SEVENTY-FOURTH WORLD HEALTH ASSEMBLY A74/14 Provisional agenda item 16 Committing to implementation of the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030), Report by the Director-General. (2021). https://apps.who.int/gb/ebwha/pdf_files/WHA74/A74_14-en.pdf
2: International Code of Marketing of Breast-milk Substitutes. (n.d.). https://www.who.int/nutrition/publications/code_english.pdf
3, 6: Rollins, N. C., Bhandari, N., Hajeebhoy, N., Horton, S., Lutter, C. K., Martines, J. C., Piwoz, E. G., Richter, L. M., & Victora, C. G. (2016). Why invest, and what it will take to improve breastfeeding practices? The Lancet, 387(10017), 491–504. https://doi.org/10.1016/s0140-6736(15)01044-2
4, 5: Don’t Push It: Why the formula milk industry must clean up its act. (2018). Resource Centre. https://resourcecentre.savethechildren.net/node/13218/pdf/dont-push-it.pdf
7: Marketing of breast milk substitutes: national implementation of the international code, status report 2020. (2020). Www.who.int. https://www.who.int/publications/i/item/9789240006010
Image credit: UNICEF