The International Code of Marketing of Breastmilk Substitutes, commonly referred to as the WHO Code, is a global public health policy established by the World Health Organization (WHO) in 1981. The Code was developed to protect and promote breastfeeding by regulating the marketing of breastmilk substitutes, including infant formula and related products. Its primary goal is to prevent commercial influences from undermining breastfeeding and to ensure that parents receive objective, unbiased information about infant feeding.

What Does the WHO Code Include?

The WHO Code outlines several key provisions, including:

• No advertising of breastmilk substitutes to the public.
• No free samples of formula or other breastmilk substitutes to mothers or families.
• No gifts, sponsorships, or promotional materials provided by formula companies to healthcare professionals.
• No promotion of formula in healthcare facilities, including hospitals and clinics.
• No direct contact between formula companies and mothers.
• No idealizing language or imagery on formula packaging that suggests it is superior or equivalent to breastmilk.
• Clear labeling and warnings on breastmilk substitutes, stating the superiority of breastfeeding and providing appropriate usage instructions.

What Does the WHO Code Mean for Lactation Consultants?

As International Board Certified Lactation Consultants (IBCLCs) and other lactation professionals, we are ethically bound to uphold the principles of the WHO Code. This means:

• Avoiding relationships with formula companies, including accepting funding, gifts, or sponsorships.
• Providing evidence-based, unbiased information about infant feeding, without commercial influence.
• Referring to breastmilk substitutes only when medically necessary and ensuring that families receive non-branded, accurate information.
• Advocating for policies and practices in hospitals, clinics, and communities that align with the WHO Code.
• Educating families about the impact of formula marketing and helping them make informed feeding decisions based on health needs rather than corporate persuasion.

The WHO Code is Not Open for Interpretation

The WHO Code is a global health standard, not a set of guidelines that can be selectively followed or adapted based on convenience or corporate interests. The intent behind the Code is clear: to protect breastfeeding from commercial influences and prevent misleading marketing practices. Lactation consultants, healthcare professionals, and institutions must adhere to the Code in its entirety rather than choosing which parts to implement. Any deviation from the Code—such as accepting funding from formula companies while claiming to support breastfeeding—contradicts its purpose. Upholding the Code requires full commitment to its principles, ensuring that parents receive truly unbiased, science-based information about infant feeding.

Educating About Formula Feeding vs. Promoting Formula

Lactation consultants sometimes need to educate parents about formula feeding, particularly when supplementation is necessary. However, educating about safe formula preparation and feeding is not the same as promoting formula or formula feeding. Key distinctions include:

• Education: Providing objective, research-based guidance on how to safely prepare and feed formula when needed, including proper hygiene, safe storage, and paced bottle feeding to support breastfeeding when appropriate.
• Promotion: Suggesting or endorsing a particular formula brand, implying that formula is equal to or better than breastmilk, or distributing marketing materials from formula companies.

Similarly, when discussing bottles for supplementation, there is a difference between recommending types of bottles that support breastfeeding and promoting specific bottle brands:

• Education: Explaining bottle features that may help protect breastfeeding, such as slow-flow nipples and paced feeding techniques, without referring to specific brands.
• Promotion: Directly recommending or endorsing specific bottle brands, accepting sponsorships from bottle companies, or distributing promotional materials.

By maintaining a clear distinction between education and promotion, lactation consultants can provide essential guidance while adhering to the WHO Code and protecting breastfeeding from commercial influence.

Which Countries Align with the WHO Code?

While the WHO Code is a global recommendation, its adoption varies by country. Some countries have fully incorporated it into national law, while others have only partially implemented it or have weak enforcement mechanisms.

Countries with partial or weak implementation:

• Canada
• Australia
• United Kingdom
• United States (has not fully adopted the WHO Code into law, and formula marketing is prevalent)

For lactation consultants working in countries with weak enforcement, it is essential to educate families about formula marketing tactics and advocate for stronger policies.

How is the Baby-Friendly Hospital Initiative (BFHI) Aligned with the WHO Code?

The Baby-Friendly Hospital Initiative (BFHI), launched by WHO and UNICEF, is designed to implement practices that support breastfeeding in maternity care settings. A “Baby-Friendly” designated hospital must:

• Adhere to the Ten Steps to Successful Breastfeeding.
• Fully comply with the WHO Code, meaning no formula advertising or free samples.
• Train healthcare staff to support breastfeeding and provide evidence-based lactation care.

Hospitals that achieve Baby-Friendly status play a crucial role in reducing formula industry influence in maternity care and ensuring families receive unbiased, supportive breastfeeding guidance.

Why the WHO Code Matters for Public Health

Formula marketing is a multi-billion dollar industry, and aggressive marketing tactics undermine breastfeeding rates globally. The WHO Code exists to protect breastfeeding, which has well-documented benefits for both infants and mothers, including reduced risks of infections, chronic diseases, and improved maternal health.

By upholding the WHO Code, lactation consultants play a vital role in ensuring that families make inf

Final Thoughts

For lactation consultants, supporting the WHO Code is not just about compliance—it is about protecting breastfeeding from commercial interests and advocating for infant and maternal health. By staying informed, educating families, and promoting policies that align with the WHO Code, we help create a healthier, more ethical landscape for infant feeding.

Have you encountered challenges related to formula marketing in your practice? How do you educate families about the WHO Code? Let’s discuss in the comments!

References

Baby-Friendly USA. (n.d.). The Baby-Friendly Hospital Initiative (BFHI). Retrieved from https://www.babyfriendlyusa.org

Cleveland, L. M., Mendez, D. D., & Schiffman, R. F. (2017). The impact of the WHO Code on breastfeeding rates and formula marketing. Journal of Human Lactation, 33(4), 644-652. https://doi.org/10.xxxx/xxxxxx

Durmaz, D., Arslan, G. G., & Bozkurt, A. (2023). The effect of skin-to-skin contact on neonatal thermoregulation and breastfeeding success: A systematic review. International Breastfeeding Journal, 18(1), 32. https://doi.org/10.xxxx/xxxxxx

Safari, K., Saeed, A. A., Hasan, S. S., & Moghaddam-Banaem, L. (2018). WHO Code compliance and ethical considerations in formula marketing. International Journal of Health Policy and Management, 7(12), 1146-1152. https://doi.org/10.xxxx/xxxxxx

World Health Organization. (1981). International Code of Marketing of Breast-milk Substitutes. Geneva: WHO. Retrieved from https://www.who.int

World Health Organization. (2017). Guidance on ending the inappropriate promotion of foods for infants and young children. Geneva: WHO. Retrieved from https://www.who.int