by Dr Louise Santhanam, General Practitioner
This section is intended for GPs and healthcare professionals who wish to understand more about the legal and ethical issues surrounding infant feeding.
The Code implicitly recognised that health workers, women and families are susceptible to direct and indirect marketing strategies.
Rollins N.C. 2016 Lancet Breastfeeding Series
The WHO International Code of Marketing of Breastmilk Substitutes (The Code) and subsequent World Health Assembly resolutions are global agreements aim to “contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of breastmilk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution”. Nations can pass legislation to uphold the resolutions, but are not penalised if they do not do so.
A Quick Guide to the International (WHO) Code by Helen Gray IBCLC Leader Today succinctly summarises the purpose and scope of The Code.
The UK has not fully adopted The Code into law, and currently the advertising of ‘Follow On Formula’ and advertising to healthcare professionals is not prohibited (correct as of April 2017).
In order to be awarded Unicef Baby Friendly Accreditation, a healthcare setting must restrict the influence of commercial interests related to infant feeding, preventing advertising of formula milk, bottles, teats or solid food for babies under six months old to mothers and their families. The provision of factual information about formula and bottle feeding and the introduction of solid foods is not restricted in a Baby Friendly setting.
The International Code of Marketing of Breastmilk Substitutes (The Code)
The World Health Organisation (WHO) Code of Marketing of Breastmilk Substitutes Adopted by the World Health Assembly in 1981
The Unicef Baby Friendly Initiative: Working within the International Code of Marketing of Breast-milk Substitutes A Guide for Health Workers Covers The Code, UK Law, professional codes of conduct and sponsorship of educational events and materials.
First Steps Nutrition Trust: Working within the WHO Code of Marketing of Breastmilk Substitutes A collection of resources to support healthcare professionals wishing to work within The Code and subsequent World Health Assembly resolutions (a requirement of Unicef Baby Friendly Accreditation). Includes an evidence-based information leaflet with advice for families on infant formula milk choices.
The Conflicts of Interest Coalition Statement The Conflicts of Interest Coalition comprises civil society organisations with a common objective of safeguarding public health policy-making against commercial conflicts of interest. The Coalition Statement focuses on this issue with regards to the prevention and control of non-communicable diseases (NCDs). The RCGP is a Signatory to the Statement.
Independent Information on Infant Milks
First Steps Nutrition Trust An independent public health nutrition charity providing information and resources to support eating well from pre-conception to five years.
First Steps Nutrition Trust: Scientific and Factual A resource examining recent adverts for infant milks in healthcare professional magazines, illustrating the need to exercise vigilance regarding the claims and information provided.
Local Infant Feeding Information Board (LIFIB) Multidisciplinary group of healthcare professionals based in the northwest of England who critically appraise information and research on infant feeding issues, producing factual evidence-based summaries for healthcare professionals.
Sponsorship and Conflicts of Interest
Organisations Supporting Implementation of The Code
The Baby Feeding Law Group A group of UK Health Professional organisations and Mother Support organisations working to strengthen UK baby feeding laws in line with the UN recommendations. Members include the RCPCH, the RCM and the RCN.
Baby Milk Action The UK arm of IBFAN (see below) which works to stop misleading marketing by the baby feeding industry, with the aim of protecting breastfeeding and babies fed on formula. Baby Milk Action can provide support on understanding formula marketing rules (both UK Regulations and International Standards), investigate reports of regulatory violations and take action where necessary. This link can be used to report suspected violations.
The International Baby Food Action Network (IBFAN) An international organisation aspiring to promote, protect and support breastfeeding and infant feeding. It monitors compliance with the The Code and highlights conflict of interests in policies and programmes both globally and nationally.
World Alliance for Breastfeeding Action (WABA) Global network of organisations and individuals who believe breastfeeding is the right of all children and mothers and who dedicate to protecting, promoting and support the right of all children and mothers to breastfeed. WABA works in close liaison with Unicef.