UNICEF statement to the European Parliament Development and Co-operation Committee - Special meeting on standard setting by European enterprises in developing countries. The International Code of Marketing of Breastmilk Substitutes and Subsequent Resolutions of the World Health Assembly   Imagine that the world had invented a new "dream product" to feed and immunise everyone born on Earth. Imagine also that it was available everywhere, required no storage or delivery - and helped mothers to plan their families and reduce the risk of cancer. Then imagine that the world refused to use it. At the end of a century of unprecedented discovery and invention, even as scientists discover the origins of life itself, this scenario is not, alas, a fiction. The "dream product" is breastmilk, available to us all at birth, and yet we are not using it (ref 1).   In 1981 the World Health Assembly adopted the International Code of Marketing of Breastmilk Substitutes (ref 2) to address the serious concerns that had arisen over the effects of marketing of artificial feeding on the health of infants and young children. Since then the Assembly has adopted eight subsequent Resolutions clarifying the Code and attempting to close loopholes in the original text. Since the Code itself was adopted as a resolution, these subsequent resolutions have the same legal status as the Code itself and should be read along with it. In the preamble to the Code, the Member States of the World Health Organisation recognised that: "inappropriate feeding practices lead to infant malnutrition, morbidity and mortality in all countries, and that improper practices in the marketing of breast-milk substitutes and related products can contribute to these major public health problems;" This statement contains two of the major elements underlying the Code: FIRST: The Code applies in ALL COUNTRIES. As its name suggests, the Code is INTERNATIONAL and applies globally (ref 3). The drafters never contemplated that it should apply only to developing countries. Parents of infants in Europe and North America have the same right to protection from inappropriate marketing as parents in Asia, Africa and South America. SECOND: The Code applies to ALL BREASTMILK SUBSTITUTES and related products, which include feeding bottles and teats. The Code is not limited to basic infant formula intended for healthy babies born after nine months of gestation and with adequate weight and length for age as many companies would argue. The Code covers special formulae such as those for premature infants, hypoallergenic formulae, lactose free formulae and follow-on formulae (ref 4). It also covers waters, juices, teas, and foods if marketed or in any other way represented as a partial or total replacement for breastmilk. These two principles, universality and the scope including all breastmilk substitutes, cannot be overemphasised given the tendency of the infant feeding industry to attempt to limit the application of the Code. The Code does not, of course, try to lessen the availability of breastmilk substitutes. It seeks to regulate the way in which they are promoted. According to the World Health Assembly: "...in view of the vulnerability of infants in the early months of life and the risks involved in inappropriate feeding practices, including the unnecessary and improper use of breast-milk substitutes, the marketing of breast-milk substitutes requires special treatment, which makes usual marketing practices unsuitable for thes products." (ref 5). A THIRD key principle is contained in Article 11.3 of the Code (ref 6). This Article states that manufacturers and distributors of products covered by the Code must make sure that they comply with the Code irrespective of measures that have, or have not been taken by others to implement it. (ref 7). Thus even if no action has been taken in a country to give effect to the Code and subsequent relevant Resolutions, all companies must still comply. Many people have questioned the continued relevance of the Code in the context of mother-to-child transmission of HIV through breastfeeding. Let me assure you that there is an even greater need to ensure Code compliance in areas of high HIV prevalence. The Code protects artificially fed children as well as those mothers who decide to breastfeed. One of its aims, as specified in Article 1, is to ensure the proper use of breastmilk substitutes when these are necessary. If incorrectly prepared, infant formula can be lethal. Over-dilution, the result of unsuitable availability of formula, leads to malnutrition. Under-dilution can cause serious health problems such as kidney failure. This is without discussing whether sanitation and access to clean water, fuel, and adequate skills permit safe preparation. The Code ensures that labels contain suitable warnings, and clear and understandable preparation instructions. The decision to feed an infant artificially and the choice of brand should be made on the basis of full information provided through counselling by an independent health worker, and not influenced by commercial interests. The Code, when implemented and monitored, also helps prevent spillover of artificial feeding to the majority of infants in the world who would benefit from breastfeeding, and whose lives, in many cases, depend on it. Given the fundamental importance of Code implementation to infant health, survival and development, it is hardly surprising that UNICEF expects every company to fulfill its obligations under this instrument in every country in the world. Every child has the right to the highest attainable standard of health. The Convention on the Rights of the Child, an international treaty ratified by all but two nations, recognises this right. Moreover, the CRC recognises the fundamental role that breastfeeding plays in fulfilling the child's right to health, and the importance of ensuring that parents receive full and unbiased information on the benefits of breastfeeding. The promotion of artificial feeding undermines a mother's right to make an informed decision about how to feed her infant. Implementation of the Code protects against misinformation that will interfere with the rights of infants and their caregivers. In conclusion, the 5 key points that UNICEF would like to leave in your minds are: The Code and subsequent relevant resolutions are global, not limited to developing nations. The Code and resolutions aim to regulate the marketing of all breastmilk substitutes, feeding bottles and teats. The scope is not limited to infant formula. Manufacturers and distributors of breastmilk substitutes, feeding bottles and teats must comply with the Code and resolutions irrespective of action taken by national authorities to translate them into domestic law. The Code and resolutions protect both breastfed and artificially fed children. Its implementation becomes even more important in the context of the HIV pandemic. Implementation of the Code and resolutions is an important component in protecting the right of every child to the highest attainable standard of health under the Convention on the Rights of the Child. References 1. Slightly reworded from Take the Baby-Friendly Initiative! A global effort with hospitals, health services and parents to breastfeed babies for the best start in life. UNICEF, New York 2. International Code of Marketing of Breast-milk Substitutes, WHO, Geneva 1981 3. World Health Assembly Resolution 34.22 which adopted the Code in 1981 "URGES all Member States: (2) to translate the International Code into national legislation, regulations or other suitable measures;". 4. In discussing the definition of infant formula, Sami Schubber, the former Senior Legal Officer of WHO states that "The wording of the definition contains nothing to suggest a distinction between a certain type of infant formula and another, or between a certain infant and another." Shubber, S., The International Code of Marketing of Breast-milk Substitutes: an international measure to protect and promote breastfeeding. The Hague: Kluwer Law International, 1998. 5. Preamble, International Code of Marketing of Breast-milk Substitutes, WHO, Geneva 1981 6. Article 11.3 states "Independently of any other measures taken for implementation of this Code, manufacturers and distributors of products within the scope of this Code should regard themselves as responsible for monitoring their marketing practices according to the principles and aim of this Code, and for taking steps to ensure that their conduct at every level conforms to them". 7. There is support for the proposition that the obligation placed on companies under Article 11.3 is a legal one and not just a moral one. See Shubber, op.cit., p.262 Note from Baby Milk Action Asked if Nestlé correctly interpreted the International Code and Resolutions, UNICEF commented that the titles of the Code and Nestlé's "Charter" gave an indication of how accurately Nestlé interpreted the Code. The International Code of Marketing of Breastmilk Substitutes is international (applying to all countries) and covers all breastmilk substitutes. On the other hand Nestlé infant formula policy in developing countries (its "Charter") applies only to a very narrow classification of breastmilk substitutes and does not apply to all countries.