ICEA Supports the International Code of Marketing Breastmilk Substitutes

By Donna Walls, RN, BSN, IBCLC, ICCE, ANLC

ICEA supports the International Code of Marketing Breastmilk Substitutes. What does that mean? Simply that ICEA does not promote or distribute materials from non-Code compliant companies. We believe that supporting the Code and compliant companies enables families to make decisions based on knowledge of alternatives. It is an undisputed fact that breastfeeding is the healthiest choice for infant feeding.  We have moved past  the days of hoping families realize that “breast is best” to recognition by the CDC, Department of Health and Human Services and most maternal-child health organizations that breastfeeding is a national priority and recognized as a child health initiative. As maternal and child healthcare professionals we do have an obligation to “promote, protect and support breastfeeding”.  The Code of Marketing of Breastmilk Substitutes was developed by the World Health Organization and UNICEF in 1979, was adopted by the World Health Assembly in 1981 and was written into the United Nations Convention on the Rights of the Child. The intent of this Code is  to “level the playing field” in the area of worldwide marketing of infant formulas,  and ensure that families receive only impartial, evidence-based information that it is balanced with factual information regarding breastfeeding. The Code recommends  that governments  encourage regulation of the marketing of artificial infant milks and related products and any activity which undermines breastfeeding. The United States signed on to support the WHO Code in 1994 but there is little legislation to enforce it in this country.

Who is covered by the Code?

Any company producing the following goods; infant formula, follow-up formulas and other infant milks, bottles, feeding nipples and any foods marketed to infants  less than 6 months of age.

Manufacturers should not:

  • Promote their products in hospitals, maternity-related shops or to the general public;
  • Give free samples to mothers;
  • Give gifts to health workers or mothers;
  • Promote their products to health workers:
  • Promote or actively market foods or drinks for babies;
  • Give misleading, unproven information;
  • Have direct contact with mothers

In June of 2014 the FDA approved standards that must be met for manufacturers of infant formulas:

  • Testing for pathogens must be done
  • Demonstrate that formulas meet requirements for normal infant growth and development
  • Be tested for nutrient content in the final product stage, before entering the market, and at the end of the products’ shelf life.

What are the recommendations included in “the Code”:

  • No marketing of breastmilk substitutes to the public
  • No words or images idealizing breastmilk substitutes
  • No free samples to parents
  • Information to health care workers must be evidence-based
  • No financial or material inducements to health care workers from formula manufacturers
  • No free or subsidized supplies to hospitals or maternity wards
  • No gifts or enticements from formula manufacturers to health care providers
  • Mothers should have information on the benefits of breastfeeding and health risks of artificial feeding
  • Do not state their product is as good or better than breastmilk
  • To read the entire Code, go to:

What can healthcare providers do to support the Code:

  • Do not give out magazines or educational materials that advertize formula
  • Include the benefits of breastfeeding in conversations regarding infant care
  • Discuss the current recommendations for exclusive breastfeeding for 6 months
  • Inform cooperating organizations about the WHO Code
  • Work with your community to develop programs to support, promote and protect breastfeeding
  • Include the Ten Steps to Successful Breastfeeding in educational materials
  • Do not accept gifts or enticements from formula manufacturers or representatives

In the UK the following information is given to all healthcare providers:

If access is given to care providers, formula company representatives should have only very restricted access to the service or staff. Representatives may only see the member of staff considered most expert in infant feeding, and she/he then distributes any relevant scientific and factual information to other staff members in an appropriate manner.

As educators and care providers, consider providing basic breastfeeding information to all expectant parents or any families considering a pregnancy. This information should include:

  • The importance of early skin to skin contact
  • Feeding within the first 1-2 hours after birth
  • Frequent, unrestricted feedings in the first days and weeks
  • Avoidance of unnecessary supplementation
  • Non-separation of mother and baby
  • Correct latch
  • Signs of adequate milk intake
  • Resources for post discharge support

Provide information about the benefits of breastfeeding to both mother and baby. Many breastfeeding advocates are also recommending inclusion of health risks associated with not breastfeeding such as; increasing risk of ear infections, allergies and asthma, obesity and diabetes in children and higher incidence of breast and ovarian cancer, osteoporosis and metabolic syndrome in women. Displaying pictures and artwork of breastfeeding in your office or classroom can also be helpful. Be open to discuss mother’s questions and concerns, they often hear myths and misinformation about breastfeeding, Care providers can be a vital part of supporting the Code and promoting breastfeeding.


Academy of Breastfeeding Medicine. Statements and Clinical Protocols. Ban the Bags. org. (2012). Hospitals Should Market Health and Nothing Else. Retrieved May 28, 2012, from Chetley A, & Allain A. (1998). Protecting infant health: a health worker’s guide to the International Code of Marketing of Breast Milk Substitutes. Penang, Malaysia: IBFAN. National Alliance for Breastfeeding Academy. (2012). NABA REAL Code Monitoring. Retrieved May 28, 2012, from No Free (2012). Just Say No to Drug Reps. Retrieved May 28, 2012, from Edmond, K. M., Zandoh, C., Quigley, M. A. Amenga-Etego, S., Owusu-Agyei, s., & Kirkwood, B. R. (2006). Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality. Pediatrics, 117, 380-386. Rosenberg, K. D., Eastham, C. A., Kasehagen, L. J., & Sandoval, A. P. (2008). Marketing infant formula through hospitals: the impact of commercial hospital discharge packs on breastfeeding. American Journal of Public Health, 98, 290–295. U.S. Department of Health and Human Services.  Healthy People 2020. World Health Organization. (1981). International code of marketing of breast-milk substitutes. Retrieved May 28, 2012, from 

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