The WHO Code

Ethnic Hispanic Mother breastfeeding her sonOn May 21, 1981 the Code of the Marketing of Breast-milk Substitutes was adopted by the World Health Organization. While many in the US want to dismiss breastfeeding as a lifestyle choice, in fact, lack of breastfeeding results in 4000 infant deaths a day worldwide. Just 39% of babies worldwide are exclusively breastfed for the first six months even though an exclusively breastfed child is 14 times less likely to die in the first six months than a non-breastfed child.

According to a paper published in the Lancet in 2013, of all preventative interventions, breastfeeding of infants under two years of age has the greatest potential impact on child survival. In fact, it has the potential to prevent 13% of all deaths in children under five in the developing world.

We think we can dismiss the health benefits of breastfeeding in developed countries because we have access to clean water and sanitation, but non-breastfed children in developed countries are also at higher risk of dying. According to UNICEF, a recent study of post-neonatal mortality in the United States found a 25% increase in mortality among non-breastfed infants.



The WHO Code prohibits advertising or promotion of the following products:

  • breast-milk substitutes, including infant formula
  • milk products, foods or beverages, including bottle-fed complementary foods, used as a partial or total replacement for breast milk.
  • feeding bottles and nipples

The Code is very specific in regards to the responsibility of health care facilities and health workers.

  • 6.2 No facility of a health care system should be used for the purpose of promoting infant formula or other products within the scope of this Code.
  • 7.4 Samples of infant formula or other products within the scope of this Code, or of equipment or utensils for their preparation or use, should not be provided to health workers except when necessary for the purpose of professional evaluation or research at the institutional level. Health workers should not give samples of infant formula to pregnant women, mothers of infants and young children, or members of their families.

Since 1981, 84 countries have enacted legislation implementing all or many of the provisions of the Code and 14 others have laws in progress. Just six countries have taken no action at all to implement this important health directive:

  • Central African Republic
  • Chad
  • Iceland
  • Kazakstan
  • Somalia
  • Untied States


iStock_000005680488SmallBreastfeeding advocates in the US have worked to bring awareness to the important health benefits of breastfeeding and to encourage voluntary adoption of the Code. They have helped to decrease direct advertising to mothers in magazines, on websites and in other media by boycotting outlets that take formula advertising and they have worked to get rid of formula sample distribution in US hospitals by organizing consumer campaigns like Ban the Bags.

It has been difficult to impact formula advertising to mothers because of its pervasiveness and because the breastfeeding advocates can always be outspent by formula companies; they consider the WHO Code restraint of trade.

The US Department of Health and Human Services Office of Women’s Health launched a National Breastfeeding Campaign in 2004. The campaign was selected for official sponsorship by the Advertising Council and the Ad Council helped to implement it. The media campaign for this effort cost $20 million, but the formula companies spent $50 million that year on advertising in the US.

This cost is nothing to an $8 billion a year industry. Infant formula added $5 billion in sales in 2013 and is the fastest growing healthy and functional food drink category of all, growing faster than energy drinks, probiotics or bottled water, especially in Asia which accounts for 53% of overall sales.


iStock_000001969212SmallBecause of the steep decline in breastfeeding in the Philippines—only 16% breastfeed exclusively  for six months—the Philippine Health Department expanded regulations to prevent formula companies from targeting children under two with advertising. In 2006, the breastmilk-substitute industry spent $100 million advertising formula in the Philippines to undermine these regulations. This amount equals nearly half of the Philippine Health Department’s annual budget of $239 million.

These new rules, which call for stricter labeling, more accurate health claims, and sanctions for failure to comply, were to become effective in July 2006. In response, the Pharmaceutical and Healthcare Association of the Philippines (PHAP)—representing the US formula companies Abbott-Ross, Mead Johnson, Wyeth, and Gerber—sued the Philippine Health Department to prevent the new rules from being enacted.

In July 2006, the Philippine Supreme Court denied the formula companies a restraining order, but a few weeks later, on August 15th, the court overturned its earlier decision and granted the restraining order to PHAP. This reversal occurred just four days after Thomas Donohue, president of the US Chamber of Commerce, wrote a letter to Philippine President Gloria Arroyo threatening the Philippines with loss of international investment.


Baby breastfeedingOne place where there is good news for breastfeeding babies is in the area of formula promotion in health care facilities. Over the past decade, hospitals have been steadily trending toward ending formula promotion. According to the Centers for Disease Control and Prevention (CDC) Maternity Practices in Infant Nutrition and Care (mPINC) survey:

  • 27.4% of hospitals had discontinued the formula discharge bags in 2007.
  • 45.5% of hospitals had ended the practice by 2011.

According to a new report by Public Citizen, “Top Hospitals’ Formula for Success: No Marketing of Infant Formula”—co-released by the Ban the Bags campaign—the vast majority of the nation’s most reputable hospitals are acting ethically and thwarting pressure from formula companies to aggressively market their harmful products.

  • 82% (14 out of 17) of US News’ Honor Roll of overall best hospitals, reported having a policy or practice against distributing formula company-sponsored discharge bags or other promotional materials
  • 67% of top hospitals in gynecology (30 out of 45) reported not distributing formula company sponsored discharge bags, formula samples or other formula company promotional materials to mothers in their maternity units.

The number of Baby Friendly designated hospitals, which must prohibit formula marketing to receive that designation, is increasing. Further, all hospitals in Massachusetts and Rhode Island have voluntarily banned discharge bags, while others, including Maryland, North Carolina, Oklahoma and New York, are progressively moving in that direction. Here’s a list of bag-free US hospitals.


On May 21, 2014,  the 33rd anniversary of the adoption of the WHO Code, Public Citizen delivered a petition with 17,000 signatures to the Chicago headquarters of formula manufacturer, Mead Johnson. The petition calls for the end of formula marketing in health care facilities.


PEGGY-headshotPeggy O’Mara is the editor and publisher of  She was the editor and publisher of Mothering Magazine from 1980 to 2011 and founded in 1995. The author of Having a Baby Naturally; Natural Family Living; The Way Back Home; and A Quiet Place, Peggy has conducted workshops at Omega Institute, Esalen, La Leche League, and Bioneers. She is the mother of four and grandmother of three.

Share this post.

Peggy O'Mara

About Peggy O'Mara

Editor and Publisher of Longtime natural living advocate, award winning writer, and independent thinker.

One thought on “The WHO Code

Leave a Reply

Your email address will not be published. Required fields are marked *