Infant Feeding Issues

The WHO/UNICEF International Code

What is the International Code?

The WHO/UNICEF International Code of Marketing of Breastmilk Substitutes was adopted by a Resolution (WHA34.22) of the World Health Assembly in 1981.

The International Code prohibits all promotion of baby foods and feeding bottles and that sets out requirements for labelling and information on infant feeding. Any activity which undermines breastfeeding also violates the aim and spirit of the Code. The Code and its subsequent World Health Assembly Resolutions are intended as a minimum requirement in all countries.

What is covered?

All breastmilk substitutes. These are products which are marketed in a way which suggests they should replace breastfeeding, even if the product is not suitable for that purpose. They may include:

  • infant formula
  • follow-on formula
  • baby foods
  • gruels
  • teas and juices
  • bottles
  • teats/nipples and related equipment.



    • Key points:

    Baby food companies may not:

    IBFAN advocates breastfeeding above milk substitutes

    When the International Code was adopted by the World Health Assembly in 1981 (see Resolution WHA34.22) it was recognised that it may require clarification or even revision. Accordingly Resolutions have been adopted every 2 years since 1982. The subsequent Resolutions have equal status to the International Code and close many of the loopholes exploited by the baby food industry.

    The following resolutions are available on the IBFAN web site.

     

    All IBFAN groups the world over are urged to strengthen monitoring to ensure companies comply.

    Infant feeding in emergency situations:

    Health care in emergency situation is a concern for families and  programmes that aim to improve the health of women and children. In emergency and relief situations breastfeeding is of critical importance because it save babies' lives. Most of the African countries are under political or civil strife. The diversity of target groups and the complexity of the humanitarian aid places women and children at a greater risk. IBFAN groups need to develop counseling skills on breastfeeding and emergency issues to respond adequately to emergencies. It is during these situations that baby milk companies may take the opportunity to build their image by providing free formula which are very dangerous under the emergency conditions. IBFAN members need to be watchful to see that companies comply with the conditions and spirit of the international Code of Marketing of Breastmilk Substitutes and Subsequent relevant Resolutions. IBFAN links its activities with those of the Interagency Group coordinated by GIFA. IBFAN Africa trains field workers using training modules developed by WHO, UNICEF, and IBFAN. 

    Baby Friendly Hospital Initiatives (BFHI):

    Launched jointly by UNICEF and WHO in 1991, aims at giving babies the best start in life by creating an environment in which breastfeeding is the norm, beginning with a friendly and conducive atmosphere. The initiative is based on Ten steps to Successful Breastfeeding which focuses on maternity services with the idea of protecting, supporting and promoting exclusive breastfeeding for the first six months, and encouraging continued breastfeeding for at least 2 years of the infant's life with adequate nutrition complements from locally available foods.

    Baby Friendly Hospital Initiatives create a friendly atmosphere which is conducive to breastfeeding

    Maternity wards and hospitals which comply with global criteria for applying the set standards after being assessed are designated baby friendly. Through BFHI early initiation of breastfeeding as well as exclusive breastfeeding can be achieved. So far, at least 25% of all maternity facilities are baby friendly in Africa.

    Community Support:

    This is an extension of the BFHI to the communities by implementing the 10th step of the  Ten Steps to Successful Breastfeeding. It is a way in which breastfeeding programmes are incorporated into community activities. There is an extension of actions initiated by health workers in maternity wards and hospitals. Mother to mother support systems are formed by local NGO's. Through these mother-to-mother support systems which are normally composed of mothers who have successfully breastfed, experiences are shared on exclusive breastfeeding and appropriate introduction of complementary feeding. This is one way in which BFHI is encouraged and sustained within communities. IBFAN Africa developed a Community based manual as a teaching Aid for health workers in communities in Africa.

    The Rights of Working Women to Maternity Protection

    : The recommended practice for breastfeeding is to breastfeed exclusively for six months. However this is sometimes seen as impossible for working mothers who have to return to work shortly after delivery. Most African countries have varied maternity leave and its entitlement for their women workforce. Mothers also need time to recover after delivery. The goal is to advocate for extended maternity leave where possible, of up to six months. There is also need to introduce Paternity leave so that parents can share the care of infants in the early life of the baby. IBFAN continues advocacy for improved women rights including longer maternity leave, the right to be paid when on leave and the right to keep her job. These includes all the other maternity benefits in the new ILO Convention 183, 2000 on Maternity Protection, and recommendation 191

    Working Women should be allowed the right to breastfeed their babies
    From the 1998 Calendar of National Food & Nutrition Commission of Zambia

    Codex Alimentarius:

    The food Code was created to protect consumer's health, to ensure fair food trade practices and to facilitate international trade.

    Codex Alimentarius (CA) is a worldwide food code that guarantees:

    The Codex Alimentarius Commission, the Joint Food and Agriculture Organisation (FAO) and the World Health Organisation (WHO) foods standards Programme, deal with different commodity standards, some of these relate to infant and young child foods. Examples of these are the standards for processed Cereal-Based Foods for Infants and Young Children, and the Standard for Infant Formula. The two standards are very important for the fact that they are both linked to the Protection of breastfeeding.

    The benefits of breastfeeding are many and applicable to both rich and the poor. It provides optimal nutrition and health for infants and young children. Further more, breastfeeding has both short term and long term benefits which include of the mother, financial gains on society by reducing health care costs as well as the cost of formula to replace the breast, and finally it is the basis for a healthier society.

    Secondly, the two standards are very important to the infant and young child nutrition as artificially-fed infants need consumer protection.

    The health risks of artificial feeding are many and should therefore be minimised as much as possible by making available the best attainable product. These products should be based on scientific evidence and on the best technology available.

    The promotions of artificial feeding products are misleading and seduce parents to artificially feed their infants unnecessarily. Artificial feeding products should be only for infants that truly need them. The manufacture and marketing of artificial infant feeding products must comply with the International Code.

    Thirdly, the issue of consumer protection is also involved. Infants and young children cannot make decisions about feeding for themselves. They constitute a vulnerable group of consumers who need special protection. Parents are entitled to unbiased information about infant feeding products.

    The Standard for Processed Cereal-based Foods for Infants Young Children, which sets the criteria for cereal-based complementary food products, and standard for infant formula are major standards of interest to IBFAN groups contains a number of areas for concern to IBFAN groups.

    IBFAN wants to see changes in the definitions under scope, which defines the food products covered by the standard in generic terms.

    Under Essential Composition and Quality Factors, IBFAN members would like improvement on various areas such as:

    HIV and Infant feeding:

    Of critical importance is the HIV/AIDS issue as it affects Infant feeding. Africa is the continent most affected and with the industry waiting to cash on this misfortune. IBFAN is contributing to the prevention and reduction of Mother to Child Transmission of HIV/AIDS (MTCT) by guiding appropriate actions. For example IBFAN has developed position statements and policy guidelines on infant feeding in the context of HIV and now supports countries initiatives in developing suitable policies. Information is disseminated on MTCT of HIV and IBFAN supports WHO and UNICEF to train national groups on counseling on HIV and infant feeding. There is also advocacy for independent research on HIV/AIDS and infant feeding issues. See the following reports:

    1. Protection, Support and Promotion of Breastfeeding in HIV: policy guidelines, 2000, Pretoria, South Africa.
    2. Protection of Breastfeeding in HIV/AIDS: A Report of Proceedings of the IBFAN Africa Regional Workshop to Develop Policy Guidelines for Infant Feeding in HIV, Pretoria, South Africa, August 1999
    3. IBFAN Africa Position Statement on HIV and Infant Feeding 1997 and 1999

    IBFAN Africa has also developed a web page on Youth Reproductive Health and Development.