International Code of Marketing of Breast-milk Substitutes Abdulwahab Telmesani FRCPC,FAAP Faculty of Medicine and Medical Science Umm Al-Qura University

Breast feeding Protect against chronic illnesses e.g. D.M, Celiac disease, Cancers, Obesity, SID syndrome, etc. Breastfeeding; The Essential Principles L Chandran and P Gelfer PREPS 2006

AN EXTENSIVE REVIEW BY AN EXPERT GROUP In infants, breast-feeding with avoidance of solid food and cow’s milk for at least 4-6 months is the most effective preventive regimen (for atopic diseases). Section on Pediatrics, European Academy of Allergology and Immunology Muraro et al Pediatr. Allergy Immunol 2004

International Code of Marketing of Breast-milk Substitutes World Health Organization Geneva 1981

الميثاق الدولى لتسويق بدائل الرضاعة الطبيعية International Code of Marketing of Breast-milk Substitutes

WHO Assembly 1974

Decline in breast-feeding.

WHO Assembly 1974 Decline in breast-feeding. Related to Socio-cultural and other factors.

WHO Assembly 1974 Decline in breast-feeding. Related to Socio-cultural and other factors. Promotion of manufactured breast-milk Substitutes.

WHO Assembly 1981 THEREFORE: The Member States hereby agree the following articles which are recommended as a basis for action (The Code).

11 Articles

Article 1. Aim of the Code

The protection and promotion of breastfeeding, and Ensuring the proper use of breast-milk substitutes, when necessary.

Article 2. Scope of the Code

The Code applies to the marketing, and practices related thereto, of the following products: breast-milk substitutes, including infant formula; other milk products, foods and beverages, including bottlefed 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 teasts. It also applies to their quality and availability, and to information concerning their use.

Article 3. Definitions

"Breast-milk substitute" means; any food being marketed or otherwise presented as a partial or total replacement for breast milk, whether or not suitable for that purpose.

Article 4. Information and education

4.1 Governments responsibility

Article 4. Information and education 4.2 Enforce the scope

Article 4. Information and education 4.3 Donations…………... at the request and with the written approval of the appropriate government authority………………………….. company's name or logo, but should not refer to a proprietary product

Breast Milk is the Best

Article 5. The general public and mothers

5.1 no advertising

Article 5. The general public and mothers 5.1 no advertising 5.2 samples of products

Article 5. The general public and mothers 5.1 no advertising 5.2 samples of products 5.3 promotion device, special displays…

Article 5. The general public and mothers 5.1 no advertising 5.2 samples of products 5.3 promotion device, special displays… 5.4 gifts of articles or utensils

Article 5. The general public and mothers 5.1 no advertising 5.2 samples of products 5.3 promotion device, special displays… 5.4 gifts of articles or utensils 5.5 Marketing personnel contact …..

Article 6. Health care systems

6.1 promote the principles of this Code..

Article 6. Health care systems 6.1 promote the principles of this Code no facility of a health …promoting formula

Article 6. Health care systems 6.1 promote the principles of this Code no facility of a health …promoting formula 6.3 display of products

Article 6. Health care systems 6.1 promote the principles of this Code no facility of a health …promoting formula 6.3 display of products 6.4 professional paid for by manufacturers or distributors

Article 6. Health care systems 6.5 demo of infant formula feeding, only by health workers,

Article 6. Health care systems 6.5 demo of infant formula feeding, only by health workers, 6.6 Donations or low-price sales only for infants need it

Article 6. Health care systems 6.5 demo of infant formula feeding, only by health workers, 6.6 Donations or low-price sales only for infants need it 6.7 supplies should be continued

Article 6. Health care systems 6.5 demo of infant formula feeding, only by health workers, 6.6 Donations or low-price sales only for infants need it 6.7 supplies should be continued 6.8 Equipment and materials..name or logo

Breast Milk is the Best

Article 7. Health workers

7.1 encourage and protect breast-feeding;

Article 7. Health workers 7.1 encourage and protect breast-feeding, 7.2 Information.. restricted to scientific,

Article 7. Health workers 7.1 encourage and protect breast-feeding; 7.2 Information.. restricted to scientific 7.3 No financial or material inducements to promote ……

Article 7. Health workers 7.1 encourage and protect breast-feeding; 7.2 Information.. restricted to scientific 7.3 No financial or material inducements 7.4 Samples… should not be provided,

Article 7. Health workers 7.1 encourage and protect breast-feeding; 7.2 Information.. restricted to scientific 7.3 No financial or material inducements 7.4 Samples… should not be provided 7.5 should disclose contributions.

Article 8. Persons employed by manufacturers and distributors

8.1 sales incentives for marketing personnel, ………..bonuses based on the overall sales.

Article 8. Persons employed by manufacturers and distributors 8.1 sales incentives for marketing personnel ………..bonuses based on the overall sales, 8.2 should not perform educational functions to pregnant women…… can be used for other functions by the health care system.

Article 9. Labeling

9.1 not to discourage breast-feeding.

Article 9. Labeling 9.1 not to discourage breast-feeding. 9.2 "Important Notice"

Important Notice: Breast milk is best babies. If direct breast feeding is impossible, a mother should be encouraged to express her breast milk to feed her low Birth weight baby. If breast milk is not available or must be supplemented, a special formula adapted to the specific needs of low Birth weight infants should be used under strict medical control.

Article 9. Labeling 9.1 not to discourage breast-feeding. 9.2 "Important Notice" 9.3 warning.. unmodified product..

Article 9. Labeling 9.1 not to discourage breast-feeding. 9.2 "Important Notice" 9.3 warning.. unmodified product label of food products…state all (a) ingredients used; (b) composition/analysis (c) the storage conditions (d) the batch number and the exp. date

Article 10. Quality

10.1 of a high recognized standard Food products…. meet applicable standards recommended

Article 11. Implementation and monitoring

11.1 Governments should take action 11.2 through the World Health Organization

Article 11. Implementation and monitoring 11.1 Governments should take action 11.2 Monitoring by gov. and through the World Health Organization 11.3 Manufacturers and distributors 11.4 Nongovernmental organizations,

Article 11. Implementation and monitoring 11.5 apprise each member of their personnel 11.6 Member States shall communicate annually to the Director-General of WHO

Article 11. Implementation and monitoring 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 to Member States

Saudi Action Saudi Code for breast-milk substitutes. Approved by the ministers counsel.

Summary of the main points of the International Code No advertising of breast-milk substitutes and other products to the public No donations of breast-milk substitutes and supplies to maternity hospitals No free samples to mothers

Summary of the main points of the International Code No promotion in the health services No company personnel to advise mothers No gifts or personal samples to health workers

Summary of the main points of the International Code No use of space, equipment or education materials sponsored or produced by companies when teaching mothers about infant feeding. No pictures of infants, or other pictures idealizing artificial feeding on the labels of the products.

Summary of the main points of the International Code Information by health workers should be scientific and factual. Information on artificial feeding, including that on labels, should explain the benefits of breastfeeding and the costs and dangers associated with artificial feeding.

Summary of the main points of the International Code Unsuitable products, such as sweetened condensed milk, should not be promoted for babies.

ADA supports exclusive breast- feeding for 6 months Exclusive breast-feeding is an important public health strategy and provides optimal nutrition and health protection in the first six months of life, the American Dietetic Association said in an updated position statement. The group said breast-feeding combined with complementary foods is ideal for children ages 6 months to at least 1 year.

Supply ______________Demand

Public Physicians Manufacturers

Promoting Breastfeeding is a moral and ethical responsibility of the health care workers