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The Member States of the World Health
Organisation:
Affirming the right of every child and every pregnant and
lactating woman to be adequately nourished as a means of attaining and
maintaining health;
Recognising that infant malnutrition is part of the wider
problems of lack of education, poverty, and social injustice;
Recognising that the health of infants and young children
cannot be isolated from the health and nutrition of women, their socio-economic
status and their roles as mothers;
Conscious that breastfeeding is an unequalled way of
providing ideal food for the healthy growth and development of infants; that it
forms a unique biological and emotional basis for the health of both mother and
child; that the anti-infective properties of breast milk help to protect infants
against disease; and that there is an important relationship between
breastfeeding and child spacing;
Recognising that the encouragement and protection of
breastfeeding is an important part of the health, nutrition and other social
measures required to promote healthy growth and development of infants and young
children; and that breastfeeding is an important aspect of primary health
care;
Considering that when mothers do not breastfeed, or only do
so partially, there is a legitimate market for infant formula and for suitable
ingredients from which to prepare it; that all these products should accordingly
be made accessible to those who need them through commercial or noncommercial
distribution systems; and that they should not be marketed or distributed in
ways that may interfere with the protection and promotion of
breastfeeding;
Recognising further that inappropriate feeding practices
lead to infant malnutrition, morbidity and mortality in all countries, and that
improper practices in the marketing of breastmilk substitutes and related
products can contribute to these major public health problems;
Convinced that it is important for infants to receive
appropriate complementary foods, usually when the infant reaches four to six
months of age, and that every effort should be made to use locally available
foods; and convinced, nevertheless, that such complementary foods should not be
used as breastmilk substitutes;
Appreciating that there are a number of social and economic
factors affecting breastfeeding, and that, accordingly, governments should
develop social support systems to protect, facilitate and encourage it, and that
they should create an environment that fosters breastfeeding, provides
appropriate family and community support, and protects mothers from factors that
inhibit breastfeeding;
Affirming that health care systems, and the health
professionals and other health workers serving in them, have an essential role
to play in guiding infant feeding practices, encouraging and facilitating
breastfeeding, and providing objective and consistent advice to mothers and
families about the superior value of breastfeeding, or, where needed, on the
proper use of infant formula, whether manufactured industrially or home
prepared;
Affirming further that educational systems and other social
services should be involved in the protection and promotion of breastfeeding,
and in the appropriate use of complementary foods;
Aware that families, communities, women's organisations and
other nongovernmental organisations have a special role to play in the
protection and promotion of breastfeeding and in ensuring the support needed by
pregnant women and mothers of infants and young children, whether breastfeeding
or not;
Affirming the need for governments, organisations of the
United Nations system, nongovernmental organisations, experts in various related
disciplines, consumer groups and industry to cooperate in activities aimed at
the improvement of maternal, infant and young child health and
nutrition;
Recognising that governments should undertake a variety of
health, nutrition and other social measures to promote healthy growth and
development of infants and young children, and that this Code concerns only one
aspect of these measures;
Considering that manufacturers and distributors of
breastmilk substitutes have an important and constructive role to play in
relation to infant feeding, and in the promotion of the aim of this Code and its
proper implementation;
Affirming that governments are called upon to take action
appropriate to their social and legislative framework and their overall
development objectives to give effect to the principles and aim of this Code,
including the enactment of legislation, regulations or other suitable
measures;
Believing that, in the light of the foregoing
considerations, and in view of the vulnerability of infants in the early months
of life and the risks involved in inappropriate feeding practices, including the
unnecessary and improper use of breastmilk substitutes, the marketing of
breastmilk substitutes requires special treatment, which makes usual marketing
practices unsuitable for these products;
THEREFORE:
The Member States hereby agree the following articles which
are recommended as a basis for action.
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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
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.
Article 2. Scope of the
Code
The Code applies to the marketing, and practices related
thereto, of the following products: breastmilk 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.
Article 3.
Definitions
For the purposes of this Code:
"Breastmilk substitute" means any food being marketed
or otherwise represented as a partial or total replacement for breast milk,
whether or not suitable for that purpose.
"Complementary food" means any food, whether
manufactured or locally prepared, suitable as a complement to breast milk or to
infant formula, when either becomes insufficient to satisfy the nutritional
requirements of the infant. Such food is also commonly called "weaning food" or
"breastmilk supplement".
"Container" means any form of packaging of products
for sale as a normal retail unit, including wrappers.
"Distributor" means a person, corporation or any
other entity in the public or private sector engaged in the business (whether
directly or indirectly) of marketing at the wholesale or retail level a product
within the scope of this Code. A "primary distributor" is a manufacturer's sales
agent, representative, national distributor or broker.
"Health care system" means governmental,
nongovernmental or private institutions or organisations engaged, directly or
indirectly, in health care for mothers, infants and pregnant women; and
nurseries or childcare institutions. It also includes health workers in private
practice. For the purposes of this Code, the health care system does not include
pharmacies or other established sales outlets.
"Health worker" means a person working in a component
of such a health care system, whether professional or nonprofessional, including
voluntary, unpaid workers.
"Infant formula" means a breastmilk substitute
formulated industrially in accordance with applicable Codex Alimentarius
standards, to satisfy the normal nutritional requirements of infants up to
between four and six months of age, and adapted to their physiological
characteristics. Infant formula may also be prepared at home, in which case it
is described as "home prepared".
"Label" means any tag, brand, mark, pictorial or
other descriptive matter, written, printed, stencilled, marked, embossed or
impressed on, or attached to, a container (see above) of any products within the
scope of this Code.
"Manufacturer" means a corporation or other entity in
the public or private sector engaged in the business or function (whether
directly or through an agent or through an entity controlled by or under
contract with it) of manufacturing a product within the scope of this
Code.
"Marketing" means product promotion, distribution,
selling, advertising, product public relations, and information
services.
"Marketing personnel" means any persons whose
functions involve the marketing of a product or products coming within the scope
of this Code.
"Samples" means single or small quantities of a
product provided without cost.
"Supplies" means quantities of a product provided for
use over an extended period, free or at a low price, for social purposes,
including those provided to families in need.
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Article 4. Information and
education
4.1 Governments should have the
responsibility to ensure that objective and consistent information is provided
on infant and young child feeding for use by families and those involved in the
field of infant and young child nutrition. This responsibility should cover
either the planning, provision, design and dissemination of information, or
their control.
4.2 Informational and educational materials,
whether written, audio, or visual, dealing with the feeding of infants and
intended to reach pregnant women and mothers of infants and young children,
should include clear information on all the following points:
1. the benefits and superiority of breastfeeding;
2. maternal nutrition, and the preparation for and
maintenance of breastfeeding;
3. the negative effect on breastfeeding of introducing
partial bottle feeding;
4. the difficulty of reversing the decision not to
breastfeed; and
5. where needed, the proper use of infant formula, whether
manufactured industrially or home prepared.
When such materials contain information about the use of
infant formula, they should include the social and financial implications of its
use; the health hazards of inappropriate foods or feeding methods; and, in
particular, the health hazards of unnecessary or improper use of infant formula
and other breastmilk substitutes. Such materials should not use any pictures or
text which may idealise the use of breastmilk substitutes.
4.3 Donations of informational or educational
equipment or materials by manufacturers or distributors should be made only at
the request and with the written approval of the appropriate government
authority or within guidelines given by governments for this purpose. Such
equipment or materials may bear the donating company's name or logo, but should
not refer to a proprietary product that is within the scope of this Code, and
should be distributed only through the health care system.
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Article 5. The general public
and mothers
5.1 There should be no advertising or other form of promotion to
the general public of products within the scope of this Code.
5.2 Manufacturers and distributors should not
provide, directly or indirectly, to pregnant women, mothers or members of their
families, samples of products within the scope of this Code.
5.3 In conformity with paragraphs 1 and 2 of
this Article, there should be no point-of-sale advertising, giving of samples,
or any other promotion device to induce sales directly to the consumer at the
retail level, such as special displays, discount coupons, premiums, special
sales, loss leaders and tie-in sales, for products within the scope of this
Code. This provision should not restrict the establishment of pricing policies
and practices intended to provide products at lower prices on a long-term
basis.
5.4 Manufacturers and distributors should not
distribute to pregnant women or mothers of infants and young children any gifts
of articles or utensils which may promote the use of breastmilk substitutes or
bottle feeding.
5.5 Marketing personnel, in their business
capacity, should not seek direct or indirect contact of any kind with pregnant
women or with mothers of infants and young children.
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Article 6. Health care
systems
6.1 The health authorities in Member States
should take appropriate measures to encourage and protect breastfeeding and
promote the principles of this Code, and should give appropriate information and
advice to health workers in regard to their responsibilities, including the
information specified in Article 4.2.
6.2 No facility of a health care system
should be used for the purpose of promoting infant formula or other products
within the scope of this Code. This Code does not, however, preclude the
dissemination of information to health professionals as provided in Article 7.2.
6.3 Facilities of health care systems should
not be used for the display of products within the scope of this Code, for
placards or posters concerning such products, or for the distribution of
material provided by a manufacturer or distributor other than that specified in
Article 4.
6.4 The use by the health care system of
"professional service representatives", "mothercraft nurses" or similar
personnel, provided or paid for by manufacturers or distributors, should not be
permitted.
6.5 Feeding with infant formula, whether
manufactured or home prepared, should be demonstrated only by health workers, or
other community workers if necessary; and only to the mothers or family members
who need to use it; and the information given should include a clear explanation
of the hazards of improper use.
6.6 Donations or low-price sales to
institutions or organisations of supplies of infant formula or other products
within the scope of this Code, whether for use in the institutions or for
distribution outside them, may be made. Such supplies should only be used or
distributed for infants who have to be fed on breastmilk substitutes. If these
supplies are distributed for use outside the institutions, this should be done
only by the institutions or organisations concerned. Such donations or low-price
sales should not be used by manufacturers or distributors as a sales
inducement.
6.7 Where donated supplies of infant formula
or other products within the scope of this Code are distributed outside an
institution, the institution or organisation should take steps to ensure that
supplies can be continued as long as the infants concerned need them. Donors, as
well as institutions or organisations concerned, should bear in mind this
responsibility.
6.8 Equipment and materials, in addition to
those referred to in Article 4.3, donated to a health care system may bear a
company's name or logo, but should not refer to any proprietary product within
the scope of this Code.
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Article 7. Health
workers
7.1 Health workers should encourage and
protect breastfeeding; and those who are concerned in particular with maternal
and infant nutrition should make themselves familiar with their responsibilities
under this Code, including the information specified in Article
4.2.
7.2 Information provided by manufacturers and
distributors to health professionals regarding products within the scope of this
Code should be restricted to scientific and factual matters, and such
information should not imply or create a belief that bottle feeding is
equivalent or superior to breastfeeding. It should also include the information
specified in Article 4.2.
7.3 No financial or material inducements to
promote products within the scope of this Code should be offered by
manufacturers or distributors to health workers or members of their families,
nor should these be accepted by health workers or members of their
families.
7.4 Samples of infant formula or other
products within the scope of this Code., or of equipment or utensils for their
preparation or use, should not be provided to health workers except when
necessary for the purpose of professional evaluation or research at the
institutional level. Health workers should not give samples of infant formula to
pregnant women, mothers of infants and young children, or members of their
families.
7.5 Manufacturers and distributors of
products within the scope of this Code should disclose to the institution to
which a recipient health worker is affiliated any contribution made to him or on
his behalf for fellowships, study tours, research grants, attendance at
professional conferences, or the like. Similar disclosures should be made by the
recipient.
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Article 8. Persons employed
by manufacturers and distributors
8.1 In systems of sales incentives for
marketing personnel, the volume of sales of products within the scope of this
Code should not be included in the calculation of bonuses, nor should quotas be
set specifically for sales of these products. This should not be understood to
prevent the payment of bonuses based on the overall sales by a company of other
products marketed by it.
8.2 Personnel employed in marketing products
within the scope of this Code should not, as part of their job responsibilities,
perform educational functions in relation to pregnant women or mothers of
infants and young children. This should not be understood as preventing such
personnel from being used for other functions by the health care system at the
request and with the written approval of the appropriate authority of the
government concerned.
Article 9.
Labelling
9.1 Labels should be designed to provide the
necessary information about the appropriate use of the product, and so as not to
discourage breastfeeding.
9.2 Manufacturers and distributors of infant
formula should ensure that each container has a clear, conspicuous, and easily
readable and understandable message printed on it, or on a label which cannot
readily become separated from it, in an appropriate language, which includes all
the following points:
1. the words "Important Notice" or their
equivalent;
2. a statement of the superiority of
breastfeeding;
3. a statement that the product should be used only on the
advice of a health worker as to the need for its use and the proper method of
use;
4. instructions for appropriate preparation, and a warning
against the health hazards of inappropriate preparation.
Neither the container nor the label should have pictures of
infants, nor should they have other pictures or text which may idealise the use
of infant formula. They may, however, have graphics for easy identification of
the product as a breastmilk substitute and for illustrating methods of
preparation. The terms "humanised", "maternalised" or similar terms should not
be used. Inserts giving additional information about the product and its proper
use, subject to the above conditions, may be included in the package or retail
unit. When labels give instructions for modifying a product into infant formula,
the above should apply.
9.3 Food products within the scope of this
Code, marketed for infant feeding, which do not meet all the requirements of an
infant formula, but which can be modified to do so, Should carry on the label a
warning that the unmodified product should not be the sole source of nourishment
of an infant. Since sweetened condensed milk is not Suitable for infant feeding,
nor for use as a main ingredient of infant formula, its label should not contain
purported instructions on how to modify it for that purpose.
9.4 The label of food products within the
scope of this Code should also state all the following points:
1. the ingredients used;
2. the composition/analysis of the product;
2. the storage conditions required; and
3. the batch number and the date before which the product is
to be consumed, taking into account the climatic and storage conditions of the
country concerned.
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Article 10.
Quality
10.1 The quality of products is an essential
element for the protection of the health of infants and therefore should be of a
high recognised standard.
10.2 Food products within the scope of this
Code should, when sold or otherwise distributed, meet applicable standards
recommended by the Codex Alimentarius Commission and also the Codex Code of
Hygienic Practice for Foods for Infants and Children.
Article 11. Implementation
and monitoring
11.1 Governments should take action to give
effect to the principles and aim of this Code, as appropriate to their social
and legislative framework, including the adoption of national legislation,
regulations or other suitable measures. For this purpose, governments should
seek, when necessary, the cooperation of WHO, UNICEF and other agencies of the
United Nations system. National policies and measures, including laws and
regulations, which are adopted to give effect to the principles and aim of this
Code should be publicly stated, and should apply on the same basis to all those
involved in the manufacture and marketing of products within the scope of this
Code.
11.2 Monitoring the application of this Code
lies with governments acting individually, and collectively through the World
Health Organisation as provided in paragraphs 6 and 7 of this Article. The
manufacturers and distributors of products within the scope of this Code, and
appropriate nongovernmental organisations, professional groups, and consumer
organisations should collaborate with governments to this end.
11.3 Independently of any other measures
taken for implementation of this Code, manufacturers and distributors of
products within the scope of this Code should regard themselves as responsible
for monitoring their marketing practices according to the principles and aim of
this Code, and for taking steps to ensure that their conduct at every level
conforms to them.
11.4 Nongovernmental organisations,
professional groups, institutions, and individuals concerned should have the
responsibility of drawing the attention of manufacturers or distributors to
activities which are incompatible with the principles and aim of this Code, so
that appropriate action can be taken. The appropriate governmental authority
should also be informed.
11.5 Manufacturers and primary distributors
of products within the scope of this Code should apprise each member of their
marketing personnel of the Code and of their responsibilities under
it.
11.6 In accordance with Article 62 of the
Constitution of the World Health Organisation, Member States shall communicate
annually to the Director General information on action taken to give effect to
the principles and aim of this Code.
11.7 The Director General shall report in
even years to the World Health Assembly on the status of implementation of the
Code; and shall, on request, provide technical support to Member States
preparing national legislation or regulations, or taking other appropriate
measures in implementation and furtherance of the principles and aim of this
Code.
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