What is the WHO Code?
The WHO Code was adopted in 1981 by the World Health Assembly (WHA) and is the International Code of Marketing of Breastmilk Substitutes. The establishment of this code was a collective decision at international level to tackle global health problems and to combat unethical marketing strategies by the manufacturers of breastmilk substitutes (more commonly known as 'formula'). Member States of the World Health Organisation (WHO), including Australia, adopted this code with the aim to protect, promote and support appropriate infant and young child feeding practices.
What is the WHO Code?
The WHO Code is a set of marketing rules for breastmilk substitutes (most often known as 'formula') designed to protect:
- babies (both breastfed and artificially fed)
- parents or anyone caring for a baby
- health professionals
How does the Code affect me?
The Code prohibits manufacturers of 'formula' for babies under the age of 1 from advertising these products, offering free samples to parents, idealising artificial feeding and comparing products with breastmilk. It is also about ensuring that those mothers who bottlefeed are protected from false advertising and misleading claims about the manufacturers' products.
Unfortunately, a number of infant formula manufacturers violate the Code.
An example of the kind of misleading and false marketing tactics used by some infant formula companies is an advertisement for Brand S by manufacturer X in a (non-Australian) parent magazine. It states: "Brand S - The Smart Formula for Smart Babies" with a picture of a cute baby at a computer. A coupon offers parents a free sample of infant formula. The advert compares the product with breastmilk and states that "the addition of fatty acids will improve intelligence and eyesight".
Parents are actually being misled by this advertisement. There is no proper scientific evidence to back up these claims. Moreover, the advertisement does not tell parents that scientific research actually demonstrates that bottle-fed babies are generally not as smart as their breastfed counterparts, and that brain growth is superior in breastfed infants. If you would like more details on this type of misleading advertising refer to the World Alliance for Breastfeeding Action (WABA) website.
What is the ideal for my baby?
For most babies, exclusive breastfeeding for six months followed by continued breastfeeding, together with nutritious complementary foods, for two years or beyond, is the key to long term, whole of life, health.
Nearly all women can breastfeed if they are supported to be confident and aware of good techniques. Promotional practices by infant formula companies can undermine these skills through subtle marketing tricks and misinformation to health professionals, mothers and their families. That is why the WHO Code is important. It protects, promotes and supports breastfeeding in Australia and around the world.
How does the Code apply in Australia?
After the Code was adopted by the World Health Assembly in 1981, the Commonwealth Government took a series of steps to implement the Code in Australia.
A voluntary industry code of practice was negotiated between the Australian Government and infant formula manufacturers. It is called the Marketing in Australia of Infant Formula Agreement (MAIF Agreement) and has been signed by most of the infant formula manufacturers who market their products in this country. The Australian Government appointed a panel to regulate the MAIF Agreement and deal with reported breaches. The Panel includes consumer representatives, as well as government and industry. It is by a voluntary agreement with formula manufacturers.
A working party was also convened to examine the WHO Code and its implementation in Australia's health care system. The working party made recommendations in its 1985 report that set the standard for the care of mothers and babies and the promotion and protection of breastfeeding in Australia. Twenty five years later, many of the recommendations have been acted upon. However, there is still much to do.
These are some of the recommendations from that report.
Hospital care of the normal, full term newborn infant should:
- encourage rooming-in as the norm for all healthy newborn infants
- encourage mothers to put their infants to the breast within the first hour after birth, providing the condition of mother and infant are satisfactory
- allowing for frequent and flexible feeding patterns based upon individual needs of infants and not on hospital schedules
- avoid routine use of pre-lacteal feedings of any kind (during the colostrum phase, until the mature milk comes in)
- exclude routine use of complementary feedings (of formula) of any kind
provide specially trained personnel to assist mothers in techniques of breastfeeding
- discourage health professionals from using unnecessary medication before, during or after delivery
- discontinue the practice of providing routine discharge packs including infant formula to mothers leaving the hospital after the birth of their infant
- demonstrate bottle feeding techniques only to those mothers who have clearly indicated that they will not be breastfeeding their infants
- provide information about appropriate contraception, emphasing practical advice on the timing and choice of contraceptive methods which do not reduce milk yields
At the time of discharge from hospital, a care plan should be available which includes information about the following:
- expectations regarding demand feeding - mothers should be aware that not all babies establish or maintain a feeding routine
- expectations regarding night feeds - mothers should be aware that babies will differ in their requirements for night feeds
- supply problems - mothers should be aware of the importance of frequent feeds and the negative effect of complements/supplements of any kind on breast-milk supply
- weight gain of the infant as an indicator of adequate supply - mothers should be aware of the normal variation which exists between infants
- drug use during lactation - mothers should be aware that many substances ingested by them may be transferred to the infant by way of breast-milk and information should stress that no drugs should be taken by lactating women without medical advice
- relationship of breastfeeding to food allergies - at risk infants (infants born into families prone to allergies and food sensitivities) may be protected from allergies by prolonging breastfeeding and delaying the introduction of other foods
- timing of weaning and appropriate weaning foods - mothers should be aware that, generally speaking, and provided supply is adequate there is no need to introduce additional foods to the milk diet before infants are six months of age; education about appropriate weaning foods should emphasise that suitably prepared foods from the family table are less costly than commercially prepared infant foods
What progress has been made?
In the years since the WHO Code was first introduced, other World Health Assembly resolutions have reinforced and added to the Code. As well, much progress has been made in implementing the principles of the Code throughout the world. Some of these key outcomes are:
- Baby-Friendly Hospitals
The Baby-friendly Hospitals Initiative (BFHI) launched in 1991 by UNICEF and WHO provides special accreditation to hospitals that have worked to bring in practices that support the Code. These practices are aimed at supporting mothers to breastfeed their babies and protect them from inappropriate commercial influences to bottlefeed. In Australia, Baby-Friendly Hospitals are gradually gaining momentum as more hospitals work to achieve the standards required for Baby-Friendly Hospital accreditation. (Editors note: Bub Hub will be working to indicate which maternity hospitals are part of the BFHI on our maternity hospital listings.)
- Lactation Consultants
The recognition of the need for a stand alone profession with an international accreditation for health professionals and lay breastfeeding support volunteers to achieve qualifications and training as lactation consultants. This would enable the new profession to assist women who wish to breastfeed. From 1985, organisations were set up around the world to introduce and train members of this new profession to work with mothers and health authorities on lactation issues. Uniform standards of care and knowledge were established and the body of knowledge on this subject continues to grow. Thousands of internationally accredited lactation consultants are now employed around the world in hospitals and health facilities and in private practice. Contact local lactation consultants in Australia.
- Milk Banking
The need for emergency supplies of breastmilk has been recognised as a life saving strategy for babies who are very ill, or for mothers who for some reason are unable to breastfeed for a period of time. In Australia, work is being done in Queensland and Western Australia to establish these banks along similar lines to the Red Cross Blood Banks. The Australian Federal Government through the Therapeutic Goods and Administration Act (TGA) has give approval for an Australian human milk bank to be established. Find your nearest Breast Milk Bank.