The Forty-fifth World Health Assembly,

Having considered the report by the Director-General on infant and young child nutrition;

Recalling resolutions WHA33.32, WHA34.22, WHA35.26, WHA37.30, WHA39.28, WHA41.11 and WHA43.3 on infant and young child feeding and nutrition, appropriate feeding practices and related questions;

Reaffirming that the International Code of Marketing of Breastmilk Substitutes is a minimum requirement and only one of several important actions required in order to protect healthy practices in respect of infant and young child feeding;

Recalling that products that may be promoted as a partial or total replacement for breastmilk, esecially when these are presented as suitable for bottle feeding, are subject to the provisions of the International Code;

Reaffirming that during the first four to six months of life no food or liquid other than breastmilk, not even water, is required to meet the normal infant's nutritional requirements, and that from the age of about six months infants should begin to receive a variety of locally available and safely prepared foods rich in energy, in addition to breastmilk, to meet their changing nutritional requirements;

Welcoming the leadership of the Executive Heads of WHO and UNICEF in organizing the "baby-friendly" hospital initiative, with its simultaneous focus on the role of health services in protecting, promoting and supporting breastfeeding and on the use of breastfeeding as a means of strengthening the contribution of health services to safe motherhood, child survival, and primary health care in general, and endorsing this initiative as a most promising means of increasing the prevalence and duration of breastfeeding;

Expressing once again its concern about the need to protect and support women in the workplace, for their own sakes but also in the light of their multiple roles as mothers and care-providers, inter alia, by applying existing legislation fully for maternity protection, expanding it to cover any women at present excluded or, where appropriate, adopting new measures to protect breastfeeding;

Encouraged by the steps being taken by infant-food manufacturers towards ending the donation or low-price sale of supplies of infant formula to maternity wards and hospitals, which would constitute a step towards full implementation of the International Code;

Being convinced that charitable and other donor agencies should exert great care in initiating, or responding to, requests for free supplies of infant foods;

Noting that the advertising and promotion of infant formula and the presentation of other products as breastmilk substitutes, as well as feeding-bottles and teats, may compete unfairly with breastfeeding which is the safest and lowest-cost method of nourishing an infant, and may exacerbate such competition and favour uninformed decision-making by interfering with the advice and guidance to be provided by the mother's physician or health worker;

Welcoming the generous financial and other contributions from a number of Member States that enabled WHO to provide technical support to countries wishing to review and evaluate their own experiences in giving effect to the International Code;

1. THANKS the Director-General for his report;

2. URGES Member States:

(1) to give full expression at national level to the operational targets contained in the Innocenti Declaration, namely:

(a) by appointing a national breastfeeding coordinator and establishing a multisectoral breastfeeding committee;

(b) by ensuring that every facility providing maternity services applies the principles laid down in the joint WHO/UNICEF statement on the role of maternity services in protecting, promoting and supporting breastfeeding;

(c) by taking action to give effect to the principles and aim of the International Code of Marketing of Breastmilk Substitutes and subsequent relevant Health Assembly resolutions in their entirety;

(d) by enacting legislation and adopting means for its enforcement to protect the breastfeeding rights of working women;

(2) to encourage and support all public and private health facilities providing maternity services so that they become "baby-friendly":

(a) by providing the necessary training in the application of the principles laid down in the joint WHO/UNICEF statement;

(b) by encouraging the collaboration of professional associations, women's organizations, consumer and other nongovernmental groups, the food industry, and other competent sectors in this endeavour;

(3) to take measures appropriate to national circumstances aimed at ending the donation or low-priced sale of supplies of breastmilk substitutes to health-care facilities providing maternity services;

(4) to use the common breastfeeding indicators developed by WHO, with the collaboration of UNICEF and other interested organizations and agencies, in evaluating the progress of their breastfeeding programmes;

(5) to draw upon the experiences of other Member States in giving effect to the International Code;

3. REQUESTS the Director-General:

(1) to continue WHO's productive collaboration with its traditional international partners, in particular UNICEF, as well as other concerned parties including professional associations, women's organizations, consumer groups and other nongovernmental organizations and the food industry, with a view to attaining the Organization's goals and objectives in infant and young child nutrition;

(2) to strengthen the Organization's network of collaborating centres, institutions and organizations in support of appropriate national action;

(3) to support Member States, on request, in elaborating and adapting guidelines on infant nutrition, including complementary feeding practices that are timely, nutritionally appropriate and biologically safe and in devising suitable measures to give effect to the International Code;

(4) to draw the attention of Member States and other intergovernmental organizations to new developments that have an important bearing on infant and young child feeding and nutrition;

(5) to consider, in collaboration with the International Labour Organization, the options available to the health sector and other interested sectors for reinforcing the protection of women in the workplace in view of their maternal responsibilities, and to report to a future Health Assembly in this regard;

(6) to mobilize additional technical and financial resources for intensified support to Member States.

14 May 1992

(1) Document WHA43/1990/REC/1, p.35

(2) Protecting, promoting and supporting breastfeeding: the special role of maternity services. A joint WHO/UNICEF statement, Geneva, World Health Organization, 1989

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