ADVOCACY BRIEF

BREASTFEEDING AND THE

INTERNATIONAL CODE OF MARKETING
OF BREASTMILK SUBSTITUTES
GLOBAL BREASTFEEDING COLLECTIVE
Breastfeeding gives all children the healthiest start in life. Breastmilk stimulates brain development and acts as a baby’s first
vaccine. Breastfeeding lowers health-care costs, creating healthier families and a smarter workforce. It also protects maternal
health. When mothers breastfeed, everyone benefits.

Still, worldwide, only 40 per cent of children younger than six months are exclusively fed breastmilk. By age two, only 45 per cent
receive any breastmilk at all.

UNICEF and the World Health Organization (WHO) are leading a global Global Breastfeeding Collective to increase the political
commitment for breastfeeding, which is one of the smartest investments a country can make.

The Global Breastfeeding Collective seeks to join forces with partners who are also working to realize the Sustainable
Development Goals’ vision of a better world. Our aim is to integrate agendas, messages, and advocacy, so we can maximize
our collective influence.

Together, we will go further than any of us could alone.

“Breastmilk substitutes (BMS) include all milk products—such as

infant formula, follow-up formula, and growing up milks—
marketed for use by infants and children up to 36-months old.”
CODE IMPLEMENTATION ENABLES
INFORMED CHOICE
PROMOTION OF BREASTMILK PROTECTING BABIES
SUBSTITUTES UNDERMINES AND PARENTS
BREASTFEEDING In 1981, the International Code of Marketing of Breast-milk
The aggressive marketing of breastmilk substitutes creates Substitutes (the Code) was adopted to protect families from
a major barrier to breastfeeding. Studies show that these the industry’s aggressive marketing tactics. The Code seeks
tactics reduce breastfeeding rates, putting both children’s to prohibit all advertising and other forms of promotion of
and mothers’ health at risk. Consequently, countering this BMS, bottles, and teats, either to health-care systems or to
industry’s marketing practices and promoting the benefits the broader public.
of breastfeeding are top advocacy priorities.
Since its adoption, the Code has been regularly updated by
Breastmilk substitutes (BMS) include all milk products—such World Health Assembly resolutions, which have addressed
as infant formula, follow-up formula, and growing up milks— new scientific evidence on breastfeeding and the BMS
marketed for use by infants and children up to 36-months old. industry’s new products and promotional tactics. When the
Inappropriate and unnecessary use of BMS is associated with Code is successfully implemented, it protects families from
an increase in the risk of respiratory and diarrhoeal diseases, the misinformation and commercial pressures that can
as well as an increase in deaths in children under five. dissuade women from breastfeeding.

Despite the World Health Assembly’s prohibition on all BMS Repeatedly, the World Health Assembly has called on
promotion, manufacturers still make unsubstantiated governments to give effect to the provisions in the Code
claims about the health benefits of their products. BMS through national, legally-binding regulations. Unfortunately,
manufacturers spend millions of dollars annually to promote the Code has not been uniformly implemented. And
their products. These efforts are highly successful, and the monitoring efforts have highlighted consistent violations in
sales of BMS are projected to increase from US$45 billion in many countries. These violations include:
2014 to US$71 billion in 2019.
 Using advertising and social media to promote BMS,
The widespread promotion of BMS leads to the circulation bottles, and teats to the general public and to
of misinformation about breastfeeding which influences the health-care systems.
decisions that families make about feeding their infants and  Distributing free samples to mothers.
young children. Aggressive marketing of BMS products
 Enticing customers to buy BMS products using sales
influences nutritional decisions thatimpact children
inducements such as special offers or price reductions.
throughout their lives. This is why BMS products cannot safely
be marketed in the same way as other food or dairy products.  Publicizing health claims on labels or other BMS
materials.

 Idealizing BMS products in text or images.

 Providing free supplies of BMS, bottles, or teats to

health facilities.

 Sponsoring the education and meetings of health

workers.

2 | BREASTFEEDING ADVOCACY BRIEF | The healthiest start in life

 © UNICEF/UNI182998/Quintos

KEY FACTS
 With US$45 billion in global sales in 2014, the BMS protecting families from the commercial pressures of the
industry exerts considerable influence on infant and BMS industry. Together, we must:
young child feeding.
 Disseminate accurate information about the value of
 Reports by BMS companies and Euromonitor International
breastfeeding and its importance as a powerful tool for
suggest that implementing the International Code of
early childhood development, brain development and
Marketing of Breastmilk Substitutes impacts BMS sales.
healthy families.
 Regulating BMS marketing impacts child feeding:
 Increase investments in breastfeeding and include
A 2000 study found that as the frequency of funding to implement the Code through national, legally-
advertisements for BMS in a parenting magazine enforceable regulations with independent monitoring
increased, breastfeeding rates reported the following mechanisms and deterrent sanctions.
generally declined.
 Advocate for the adoption of or strengthening of
Numerous studies have found that mothers who legislation to fully implement the Code and subsequent
receive free formula samples when discharged from relevant World Health Assembly resolutions, including
the hospital breastfeed less. advocating for legislation that covers all breastmilk

 Currently, 135 countries have implemented legal substitutes including infant formula, follow-up formula,

measures related to the Code. This number increased and toddler and growing-up milks for children up to

from 103 in 2011. Still, only 39 countries have enacted all 36-months-old in accordance with the Code and

provisions, a slight increase from 37 in 2011. WHO guidelines.

 Become a monitor of the International Code of

 Only 32 countries have the monitoring and enforcement
Marketing of Breastmilk Substitutes and report
mechanisms to ensure compliance with regulations, and
violations to the relevant authorities.
even fewer report that their mechanisms are functional.
 Advocate with the medical profession and other
CALL TO ACTION professional associations to increase dissemination of
the Code and improve capacity development so all
Countries have shown that breastfeeding rates can be
health workers know their obligations and avoid being
dramatically improved within a short time period. Actions,
used to promote products made by the BMS industry.
policies, and programmes that support mothers at health
facilities, home and work have been shown to significantly
increase breastfeeding. We invite partners to join us in

UNICEF | WORLD HEALTH ORGANIZATION | 3

RESOURCES CITED:
Foss, Katherine A., and Brian G. Southwell, “Infant feeding
and the media: The relationship between Parents’ Magazine
content and breastfeeding, 1972–2000,” International
Breastfeeding Journal, vol. 1, no. 1, 30 April 2006.

The Lancet breastfeeding series, 29 January 2016.

© UNICEF Indonesia Communication Unit
http://www.thelancet.com/series/breastfeeding
(accessed 2 February 2017).

Piwoz, Ellen G., and Sandra L. Huffman, “The Impact of

Marketing of Breast-milk Substitutes on WHO-recommended
Breastfeeding Practices,” Food and Nutrition Bulletin, vol. 36,
FOR MORE INFORMATION
no. 4, 2015. http://fnb.sagepub.com/content/36/4/373.full.
AND TO JOIN THE COLLECTIVE:
pdf+html (accessed 2 February 2017).
breastfeeding@unicef.org
United Nations Children’s Fund, Tracking Progress on Child unicef.org/breastfeeding
and Maternal Nutrition: A survival and development priority,
UNICEF, New York, 2009. http://www.unicef.org/
Global Breastfeeding Collective Partners: 1000 Days |
publications/index_51656.html (accessed 2 February 2017).
Academy of Breastfeeding Medicine | Action Against
United States Government Accountability Office, Report to Hunger | Alive and Thrive | Bill and Melinda Gates
Congressional Addressees, February 2006, GAO-06-282. Foundation | Carolina Global Breastfeeding Institute |
Centers for Disease Control and Prevention | Concern
Yeong, J. K., “Breaking the Rules, Stretching the Rules 2014—
Worldwide | Helen Keller International | International
Evidence of violations of the International Code of Marketing
Baby Food Action Network | International Lactation
of Breastmilk Substitutes from January 2011 to December
2013”, IBFAN-ICDC Penang. See also http://www.ibfan-icdc. Consultant Association | Nutrition International |
org/index.php/monitoriz (accessed 2 February 2017). New Partnership for Africa’s Development | PATH |
Save the Children | UNICEF | United States Agency
WHO, UNICEF, IBFAN , Marketing of Breast-milk Substitutes: for International Development | WHO | World Alliance
National implementation of the International Code, Status for Breastfeeding Action | World Bank | World Vision
Report 2016, WHO, UNICEF and IBFAN, Geneva, 2016.
International
http://www.who.int/nutrition/publications/infantfeeding/
code_report2016/en/ (accessed 2 February 2017).

World Health Organization (WHO) United Nations Children’s Fund (UNICEF) unicef.org/breastfeeding
Avenue Appia 20 3 United Nations Plaza
1202 Geneva, Switzerland New York, NY 10017, USA
www.who.int/en www.unicef.org

Permission is required to reproduce any part of this publication. © United Nations Children’s Fund (UNICEF)
Permissions will be freely granted to educational or non-profit organizations. © World Health Organization (WHO)
April 2018
© UNICEF/NYHQ2010-3063/Pirozzi: Cover Photo

4 | BREASTFEEDING ADVOCACY BRIEF | The healthiest start in life