The WHO Code

Raise Your Voice For The Code In Canada

 

 

Health Canada will soon be revising acts and regulations to prevent formula shortages in Canada and modernizing the regulations so they are in line with other developed countries. Learn more

 

 

How Can You Make A Difference?

Download the Code Action To Do List:
Take these actions before February 20th, 2024
to make sure your voice is heard by the time the extended consultation period ends February 26, 2024

 

 

CODE ACTION TO DO LIST: ⊗ Add your voice by filling in a brief survey in support of implementing the Code in Canada ⊗ Tell your MP you expect the revised Canadian regulations to protect families from aggressive & inappropriate marketing and labeling practices. Download our template letter. ⊗ Respond to the call for consultation by February 6, 2023. Read our Q&A document or briefing notes and use our template letter ⊗ Report Code violations that you find using the Code Tracker tool ⊗ Connect and be informed: Keen On The Code Facebook Page BCC Website

The WHO International Code of Marketing of Breastmilk Substitutes, approved by the member states participating at the World Health Assembly (except the US), was approved in 1981 to protect breastfeeding by ensuring the ethical marketing of breastmilk substitutes by industry. 

Read The WHO Code Here


The Code includes these ten important provisions: 

  • No advertising of products under the scope of the Code to the public.
  • No free samples to mothers.
  • No promotion of products in health care facilities, including the distribution of free or low cost supplies.
  • No company representatives to advise mothers.
  • No gifts or personal samples to health workers.
  • No words or pictures idealizing artificial feeding, including pictures of infants on the labels of products.
  • Information to health workers should be scientific and factual.
  • All information on use of breastmilk substitutes, including the labels, should explain the benefits of breastfeeding and all costs and hazards associated with artificial feeding.
  • Unsuitable products such as sweetened condensed milk should not be promoted for babies.
  • Products should be of a high quality and take into account the climatic and storage conditions of the country where they are used.

Resources for Facilities:


The International Code of Marketing of Breastmilk Substitutes (WHO Code) and relevant World Health Assembly (WHA) Resolutions 

The Breastfeeding Committee for Canada’s Baby-Friendly Initiative Implementation Guideline and BFI Guideline Checklist provide information about implementation of the Code.

Implementing the WHO Code through the BFI in Canada:  

Many facilities find that one of the most difficult areas of BFI implementation is the application of the International Code of Marketing of Breastmilk Substitutes and subsequent relevant WHA Resolutions (WHO Code). In Canada the WHO Code is not legislated but there are some Canadian regulations which support a few of the tenets, for example, the Food and Drugs Act.  

Multinational companies have a longstanding influence within our health care system and this historic relationship, together with the many loop holes within the Code itself, create much confusion and varying degrees of difficulty for facilities – particularly hospitals – to implement the BFI.  By working through the BFI to inform individuals about the WHO Code and create institutional change with the focus being infant feeding best practices, much progress has been made since 1998 when BFI was launched in Canada and only one hospital in our country was paying for the infant formula used in the Facility.  

Implementation of the WHO Code through the BFI lens requires a working knowledge of the requirements outlined in the BFI Implementation Guideline and BFI Guideline Checklist and the realization that these are minimum requirements.  The WHO Code, from an activism perspective with its broad-based political meaning, does not fall into the scope of BFI designation.  There are grey areas and many scenarios where things meet BFI criteria for designation but strong recommendations or even requirements may be made to the Facility to affect change around a document or situation. In this way, greater understanding of the meaning and importance of the WHO Code is brought about.  


International Code of Marketing of Breastmilk Substitutes (WHO Code) and the Baby-Friendly Initiative:

The goal of the WHO Code and subsequent relevant World Health Assembly (WHA) Resolutions is to reduce the influence of commercial pressure on infant feeding decisions. 

WHO Code ContentVery Clear Implementation  Remain vigilant   Areas for Improvement  Education is needed Major Code Violations  Action plan is essential 
 
No advertising of breast-milk substitutes and other products covered by the Code to the public  All information is scientific and factual and has no company branding   Company logo on donated equipment    Magazines in a waiting area contain Code violations   Written or audio-visual instructional materials, advertising, posters etc. visible or distributed  
No donations of breast-milk substitutes and feeding supplies to facilitiesFacility pays for formula and related infant feeding products Other unrelated products are donated by the company e.g., adult nutritional products, vaccines Discharge packages/gift bags given to families containing products, samples, or coupons for items covered by the CODE.  
No free samples to mothers/parentsFamilies are not given product samples or coupons     Equipment recommended and utilized in specific circumstances on a 1:1 basis e.g., pacifiers, bottles, nipple shields etc.  Brands of pump or bottles/teats etc. are promoted occasionally Formula or other products openly displayed and available or given to mothers/families to take home   
No promotion in the health servicesAppointed staff such as dietician or clinical educator receives product info – scientific and factual, and in turn educates staff Company representative talks with general staff about unrelated products (e.g., family planning methods)    Some product literature or samples are available in a partner organization e.g. Early years programmes run out of community facilities Free lunches from company    Seminars or educational offerings or product info is given to general staff    Staff and students accept tokens, food, funding, equipment etc. from companies manufacturing or distributing products covered by the Code   
No company personnel to advise mothers/parentsHealth workers and students do not facilitate contact between clients and company reps. & distributors Company representative deals with the mother at mothers’ request Company representatives have access to general staff, clients/patients,  staff or client identifying information  Facility accepts funding and value adds with conditions attached to promote brand/products   
No gifts or samples to health workersHealth workers and students decline all incentives from companies manufacturing or distributing products covered by the Code Hospital Foundation receives donations from a variety of private and commercial sources including some industries covered by the Code, but the money is without condition  

Learning Resources For The Code:

The following are links to jeopardy games based on the International Code of Marketing of Breastmilk Substitutes and the Baby-Friendly Initiative. 

If you wish to revise the games, please create your own jeopardy game so that you will not alter the game found via the provided link. 

BFI WHO Code Jeopardy Game for direct care providers is available at https://jeopardylabs.com/play/who-code 

BFI WHO Code Jeopardy Game for indirect care providers is available at https://jeopardylabs.com/play/step-2-education-for-indirect-providers  


WHO / UNICEF Resources:

Title   Content Organization 
What I Should Know About ‘the Code’  A guide to implementation, compliance and identifying violations  https://www.globalbreastfeedingcollective.org/what-i-should-know-about-code       Packed with clear, accessible information, this 20-page guide consolidates the provisions of the Code, WHA resolutions, and the Guidance in one place. UNICEF 
 
Publication date 
2023   
Code Essentials Series  https://www.globalbreastfeedingcollective.org/ibfan-code-essentials-series               This series of booklets supports countries in developing and strengthening measures to control the marketing of breastmilk substitutes. The materials are designed for government officials, health educators, and Code advocates.    IBFAN   Publication date 2018 
Code Implementation Toolkit  https://www.globalbreastfeedingcollective.org/code-implementation-toolkit   Resources for Implementing the International Code of Marketing of Breast-Milk Substitutes.   WHO/UNICEF 
NetCode toolkit: monitoring the marketing of breast-milk substitutes  https://www.globalbreastfeedingcollective.org/netcode-toolkit-monitoring-marketing-breast-milk-substitutes   This protocol for periodic assessment provides procedures, processes, and tools to help countries assess the level of adherence to the Code and/or national laws in different settings. WHO/UNICEF   Publication date 2017 
International Code of Marketing of Breast-Milk Substitutes and Subsequent Resolutions  Recommendations for member states of the World Health Organization  https://www.globalbreastfeedingcollective.org/international-code-marketing-breast-milk-substitutes-and-subsequent-resolutions The Code is a set of recommendations to regulate the marketing of breastmilk substitutes, feeding bottles, and teats, which aims to stop the aggressive and inappropriate marketing of breast-milk substitutes, adopted by the 34th session of the World Health Assembly (WHA) in 1981 as a minimum requirement to protect and promote appropriate infant and young child feeding. Several WHA resolutions adopted since 1981 clarify or extend issues covered in the Code. WHO/WHA 1981 and relevant Resolutions                                     
Sponsorship of Health Professional and Scientific Meetings by Companies that Market Foods for Infants  Information Note   https://www.globalbreastfeedingcollective.org/sponsorship-health-professional-and-scientific-meetings-companies-market-foods-infant This information note clarifies what WHO and UNICEF consider to be sponsorship with respect to associations, organizations, companies, and health care providers that organise meetings, conferences, or other events, including trainings for health care professionals.   WHO/UNICEF  Publication date 2022 
Frequently asked questions on the roles and responsibilities of health workers in the Code  The international code of marketing of breast-milk substitutes: FAQ for health workers  https://www.globalbreastfeedingcollective.org/frequently-asked-questions-roles-and-responsibilities-health-workers-code   This frequently asked questions document aims to provide health workers with information on their specific roles and responsibilities in protecting breastfeeding practices against the inappropriate promotion of breast-milk substitutes by baby food companies.   WHO  Publication date 2020 
National Implementation of the International Code: Status Report 2020    https://www.globalbreastfeedingcollective.org/national-implementation-international-code-status-report-2020   This report provides updated information on the status of implementing the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly (WHA) resolutions (“the Code”) in countries.   WHO/UNICEF and IBFAN  Publication date 2020 
How the Marketing of Formula Milk Influences Our Decisions on Infant Feeding  Marketing the $55 billion formula milk industry  https://www.globalbreastfeedingcollective.org/how-marketing-formula-milk-influences-our-decisions-infant-feeding   This report – the largest of its kind to date – draws on the experiences of over 8,500 women and 300 health professionals across eight countries. It exposes the aggressive marketing practices used by the formula milk industry, and highlights impacts on families’ decisions about how to feed their babies and young children. WHO/UNICEF   Publication date 2022 

The Global Breastfeeding Collective        https://www.globalbreastfeedingcollective.org 

The Breastfeeding Committee for Canada’s Baby-Friendly Initiative Implementation Guideline and BFI Guideline Checklist provide information about implementation of the Code.