WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTÉ
THIRTY-FOURTH WORLD H E A L T H A S S E M B L Y Agenda item 23.2
A 3 4 / 1 N F . D O C . / 1 I 20 M a y 1981
INDEX以
DRAFT INTERNATIONAL CODE OF M A R K E T I N G OF B R E A S T M I L K SUBSTITUTES
The Director-General has the honour to transmit to the Thirty-fourth World Health A s s e m b l y , for its information, communications1 received from the United Nations and other
intergovernmental organizations w i t h w h i c h the Organization has established effective relations and from nongovernmental organizations in official relations w i t h W H O .
«
L
� M “ ¡¡jai . LlB^
A n n e x e d .
THE W O R L D B A N K
2 A p r i l 1981
D r H a If dan M a h l e r D i r e c t o r - G e n e r a l
W o r l d H e a l t h O r g a n i z a t i o n 1211 G e n e v a 27
S w i t z e r l a n d
D e a r D r M a h l e r ,
I a m writing in support of your efforts to a s s u r e the a d o p t i o n of the p r o p o s e d
i n t e r n a t i o n a l code for breast m i l k substitutes ^ l i c h w i l l be p r e s e n t e d to the W o r l d H e a l t h A s s e m b l y in M a y . The code w i l l be a n important contribution to the efforts of developing c o u n t r i e s to improve n u t r i t i o n of infants and c h i l d r e n , efforts w h i c h w e , along w i t h other a g e n c i e s , are supporting.
T h e r e can be little doubt about the dangers resulting from current infant feeding p r a c t i c e s w h i c h h a v e b e e n h e a v i l y influenced b y c o m m e r c i a l p r o m o t i o n a l e f f o r t s . T h e statement adopted by a l l parties at the 1979 W H o / U N I C E F M e e t i n g on Infant and Young C h i l d F e e d i n g n o t e d that poor infant feeding practices are "to a g r e a t extent a m a n - m a d e p r o b l e m
(and) it m u s t be considered a reproach to our science a n d technology a n d our social a n d e c o n o m i c structures, a n d a blot o n our so-called development achievements.1 1 It w o u l d seem that w e a l l h a v e a m o r a l responsibility to bring a b o u t constructive changes in current p r a c t i c e s . ,
A d o p t i o n and i m p l e m e n t a t i o n of the proposed i n t e r n a t i o n a l c o d e , i n c o m b i n a t i o n with other steps n e e d e d to promote b r e a s t feeding and secure adequate n u t r i t i o n for p r e g n a n t and
lactating w o m e n , w i l l be important steps in saving lives of infants and preventing or m i t i g a t i n g significant m a l n u t r i t i o n . W e h o p e , in addition to p r o m p t a d o p t i o n of the code as a m i n i m u m basis for n a t i o n a l action, that WHO in conjunction w i t h UNICEF a n d other agencies can p r o v i d e n a t i o n a l governments with the n e c e s s a r y technical a s s i s t a n c e to translate the c o d e into a set of p r a c t i c a l functional guidelines at n a t i o n a l and local l e v e l s .
Sincerely y o u r s ,
J o h n R . E v a n s Director
P o p u l a t i o n , H e a l t h and N u t r i t i o n D e p a r t m e n t
W H O T E L E G R A M
U N I T E D N A T I O N S / A D M I N I S T R A T I V E C O M M I T T E E ON C O O R D I N A T I O N S U B C O M M I T T E E ON N U T R I T I O N
for d i r e c t o r g e n e r a l , w h o . the f o l l o w i n g i n f o r m a t i o n is p r o v i d e d for t r a n s m i s s i o n to the p r e s i d e n t of the 34th w o r l d h e a l t h a s s e m b l y in r e l a t i o n to a g e n d a item 2 3 .
s i r , y o u m a y w i s h to d r a w the a t t e n t i o n of the m e m b e r s of t h e w o r l d h e a l t h a s s e m b l y to the o p i n i o n s of the c o n s u l t a t i v e g r o u p of e x p e r t s on m a t e r n a l and y o u n g child n u t r i t i o n as e x p r e s s e d in their r e p o r t s o v e r the p a s t three y e a r s . this g r o u p a d v i s e s the un/асс
s u b c o m m i t t e e on n u t r i t i o n (which c o n s i s t s of 14 u n a g e n c i e s , i n d e p e n d e n t e x p e r t s and
a s s o c i a t e d b i l a t e r a l a g e n c i e s ) . these o p i n i o n s a r e i l l u s t r a t e d b y the f o l l o w i n g q u o t a t i o n s f r o m the r e p o r t s
- " t h e first y e a r p a r t i c u l a r l y the first s i x m o n t h s , is the m o s t c r i t i c a l p e r i o d in a child's life •“ b r e a s t m i l k should b e the p r i m a r y food s o u r c e d u r i n g this t i m e1 1.
- " e a r l y c o m p l e m e n t a r y feeding h a s d e f i n i t e h a z a r d s for the i n f a n t e s p e c i a l l y in p o o r e n v i r o n m e n t s ••• h a s economic and s o c i a l costs that may b e c r i t i c a l to m a r g i n a l families m a y also h a v e a n e g a t i v e e f f e c t on the s u c c e s s f u l m a i n t e n a n c e of l a c t a t i o n " .
- " i n g e n e r a l it should n o t b e n e c e s s a r y and i n d e e d m a y b e h a z a r d o u s to i n t r o d u c e c o m p l e m e n t a r y foods to e x c l u s i v e l y b r e a s t fed i n f a n t s b e f o r e four m o n t h s " .
- " a t the g l o b a l level there is a n e e d to d e v e l o p u n i v e r s a l l y a c c e p t a b l e codes of e t h i c s for the q u a l i t y , m a r k e t i n g and p r o m o t i o n of i n f a n t f o o d s " .
- " c o n s i d e r a t i o n s h o u l d b e g i v e n a t the c o u n t r y level to l e g i s l a t i o n that w i l l p r e v e n t the i n t r o d u c t i o n of u n d e s i r a b l e f e e d i n g p r a c t i c e s " .
m e m b e r s of t h e w o r l d h e a l t h a s s e m b l y can r e f e r to these r e p o r t s at the n u t r i t i o n u n i t of w h o . the c o n s u l t a t i v e g r o u p is c o m p o s e d of:
- p r o f p e soysa (chairperson) d e p t of p e d i a t r i c s , u n i v e r s i t y of s r i lanka - p r o f i d o g r a m a c i , d i r e c t o r , i n s t i t u t e of child h e a l t h , ankara
- p r o f d h a b t e，d e p t of p e d i a t r i c s , u n i v e r s i t y of a d d i s ababa
- p r o f j к h a r f o u c h e，m a t e r n a l and child h e a l t h , a m e r i c a n u n i v e r s i t y of b e i r u t - p r o f y h o p v a n d e r , d e p t of p e d i a t r i c s , u n i v e r s i t y h o s p i t a l , u p p s a l a , Sweden - dr f b m o n c k e b e r g，C h i l e a n n u t r i t i o n f o u n d a t i o n , s a n t i a g o
- p r o f o rarisome-kuti, i n s t i t u t e of child h e a l t h , u n i v e r s i t y of lagos
- p r o f s p e r e i r a , d e p t of child h e a l t h and n u t r i t i o n , c h r i s t i a n m e d i c a l c o l l e g e , v e l l o r e , india
- d r b u n d e r w o o d , d e p t of n u t r i t i o n and food s c i e n c e , m a s s a c h u s e t t s i n s t i t u t e of t e c h n o l o g y , u s a .
yours f a i t h f u l l y , j o h n r evans c h a i r m a n u n / a c c s u b c o m m i t t e e on n u t r i t i o n
W O R L D F E D E R A T I O N OF PUBLIC H E A L T H A S S O C I A T I O N S
W F P H A R E S O L U T I O N N 0 , 8 1 - 1
" M a r k e t i n g of B r e a s t m i l k S u b s t i t u t e s "
T h e W o r l d F e d e r a t i o n of Public H e a l t h A s s o c i a t i o n s，
R e c o g n i z i n g the s a n i t a r y , n u t r i t i o n a l , a n d i m m u n o l o g i c a l b e n e f i t s of b r e a s t f e e d i n g for the h e a l t h of h u m a n i n f a n t s , and
R e a l i z i n g that in c e r t a i n c i r c u m s t a n c e s b r e a s t f e e d i n g m a y n o t b e p o s s i b l e or a d e q u a t e , a n d that infant h e a l t h in such c i r c u m s t a n c e s m a y d e m a n d s u b s t i t u t i o n a r y or s u p p l e m e n t a l n u t r i t i o n , b u t
B e l i e v i n g that m a s s p r o m o t i o n a n d a g g r e s s i v e c o m m e r c i a l d i s t r i b u t i o n of b r e a s t m i l k substitutes can b e m i s l e a d i n g a n d d e l e t e r i o u s to m a t e r n a l a n d child h e a l t h , a n d
C o n s i d e r i n g the a c t i v e r o l e of the W o r l d H e a l t h O r g a n i z a t i o n in o r g a n i z i n g e x t e n s i v e c o n s u l t a t i o n s a m o n g p a r t i c i p a t i n g r e p r e s e n t a t i v e s of i n d u s t r y g r o u p s , s c i e n t i f i c i n s t i t u t i o n s , p r o f e s s i o n a l s o c i e t i e s , g o v e r n m e n t s a n d n o n - g o v e r n m e n t a l o r g a n i z a t i o n s c o n c e r n e d w i t h these i m p o r t a n t matters； therefore
A F F I R M S the e x c e l l e n c e of b r e a s t f e e d i n g in infant n u t r i t i o n a n d h e a l t h , and
A D V O C A T E S h u m a n m i l k f r o m a h e a l t h y m o t h e r a s the food of choice for the w o r l d1 s i n f a n t s , a n d
A C K N O W L E D G E S the d e m a n d for a v a i l a b i l i t y of s u b s t i t u t i o n a r y infant f e e d i n g p r o d u c t s that m e e t e s t a b l i s h e d n u t r i t i o n a l r e q u i r e m e n t s of i n f a n t s , b u t
A S S E R T S the n e e d for d e t a i l e d guidelines on the i n t e r n a t i o n a l m a r k e t i n g of b r e a s t m i l k substitutes w h i c h c l e a r l y p r o t e c t the interests of the p u b l i c h e a l t h , and
U R G E S the 34th W o r l d H e a l t h A s s e m b l y to a d o p t an i n t e r n a t i o n a l code on the m a r k e t i n g of b r e a s t m i l k substitutes w h i c h m e m b e r states can u s e as g u i d a n c e in the f o r m u l a t i o n of such
l e g i s l a t i o n or r e g u l a t i o n as is a p p r o p r i a t e to local e c o n o m i c , s o c i a l , a n d c u l t u r a l c o n d i t i o n s , a n d
COMMITS the e f f o r t s of our m e m b e r n a t i o n a l p u b l i c h e a l t h a s s o c i a t i o n s to w o r k w i t h their r e s p e c t i v e g o v e r n m e n t s in i m p l e m e n t i n g ail i n t e r n a t i o n a l code in the spirit of this r e s o l u t i o n .
c o n s i d e r e d a n d u n a n i m o u s l y a d o p t e d b y the W F P H A m e m b e r r e p r e s e n t a t i v e s a s s e m b l e d in a n n u a l b u s i n e s s s e s s i o n a t Geneva oil 7 M a y 1 9 8 1 .
INTERNATIONAL ORGANIZATION F O R COOPERATION IN H E A L T H CARE (MEDICUS M U N D I I N T E R N A T I O N A L I S )
N i j m e g e n , M a y 8th 1981
"Medicus M u n d i Internationalis (m.M.Int.) is an o r g a n i s a t i o n involved in c o o p e r a t i o n in Health C a r e , among other activities responsible for r e c r u i t m e n t , a p p o i n t m e n t s , e t c . of expatriate m e d i c a l personnel at a l l levels to strengthen Health Services and Private H o s p i t a l s in their efforts in countries of the Third W o r l d , especially A f r i c a .
A t present some 600 - 700 doctors and other h e a l t h - w o r k e r s of M . M . I n t . are in the f i e l d . M a n y of them are involved in the h e a l t h conflicts caused b y the aggressive m a r k e t i n g
techniques of the importers of b r e a s t m i l k substitutes (foreign baby f o o d s ) .
Therefore MEDICUS M U N D I INTERNATIONALIS strongly w a n t s to support the proposed W.H.0.-ct>de on this subject and begs W . H . O . to continue its efforts in combating this form of m a n - m a d e disease resulting from present practices.1 1
P . D . M . S l e i j f f e r s , acting general secretary
International Council of Nurses
Dr M e r o p i V i o l a k i - P a r a s k e v a President of the 34th W o r l d
Health Assembly Geneva
18 M a y 1981 D e a r M a d a m P r e s i d e n t ,
The d i s c u s s i o n a b o u t the draft International Code of Marketing of B r e a s t M i l k
S u b s t i t u t e s h a s b r o u g h t out repeatedly the role played by some nurses in promoting the use of such substitutes in inappropriate c i r c u m s t a n c e s .
For the record w e do w a n t it noted t h a t the I n t e r n a t i o n a l Council of N u r s e s supports and encourages the a d o p t i o n of the W H O C o d e . We are w o r k i n g w i t h our m e m b e r n a t i o n a l nurses a s s o c i a t i o n s to encourage c a r e f u l scrutiny by a l l of us of our activities relative to this C o d e . W e w i l l encourage the n a t i o n a l n u r s e s associations to m a k e nurses in their countries a w a r e of their r e s p o n s i b i l i t i e s and to increase their sensitivity to m a r k e t i n g techniques a n d their i m p l i c a t i o n s .
A s n u r s e s we k n o w there are very appropriate uses of commercial infant formula and w e are also acutely aware of the dangers of inappropriate u s e s .
W e request that our comments be shared with the delegates of the 34th A s s e m b l y , and offer our assistance at any t i m e .
Y o u r s s i n c e r e l y ,
Constance H o l l e r a n E x e c u t i v e D i r e c t o r
CHRISTIAN M E D I C A L COMMISSION
Geneva 19 M a y 1981
Dr M e r o p i V i o l a k i - P a r a s k e v a
P r e s i d e n t of the 34th W o r l d H e a l t h A s s e m b l y
Dear M a d a m P r e s i d e n t ,
As a n o n - g o v e r n m e n t a l o r g a n i z a t i o n in official relations w i t h the W o r l d Health
O r g a n i z a t i o n , w e h a v e been strongly supportive of its programme for the p r o m o t i o n of breast- feeding and good feeding practices for infants and young c h i l d r e n . The Assembly n o w h a s before it the d r a f t International Code of M a r k e t i n g of B r e a s t m i l k Substitutes and the r e s o l u t i o n of the E x e c u t i v e Board (EB67/R,12) w i t h regard to that C o d e . This represents a p r o d u c t of m o r e than two y e a r s of h e a r i n g s and w o r k w i t h all parties c o n c e r n e d .
M y o r g a n i z a t i o n , w i t h its constituency of church-related health programmes in o v e r 110 c o u n t r i e s , w i s h e s to indicate its support for the Executive Board resolution ( E B 6 7 / R . 1 2 ) in its present f o r m . The proposed International Code sets out the m i n i m u m in recommendations on m a r k e t i n g p r a c t i c e s , and it has b e e n suggested that it come in for review of its compliance and implementation at the 36th W o r l d Health A s s e m b l y . W e w o u l d strongly urge the d e l e g a t e s to this A s s e m b l y to endorse the r e s o l u t i o n and the d r a f t C o d e . The h e a l t h concern w h i c h under- lies this initiative is b y now c l e a r , and the evidence w h i c h points to the need for such a code is beyond d i s p u t e .
W i t h thanks for y o u r c o n s i d e r a t i o n , M a d a m P r e s i d e n t , and m y b e s t w i s h e s to you in your role as P r e s i d e n t of the W o r l d Health A s s e m b l y , I r e m a i n ,
sincerely y o u r s ,
Stuart J . K i n g m a , M . D . Director
Christian M e d i c a l C o m m i s s i o n
LEAGUE OF RED CROSS SOCIETIES
19 May 1981
Dr M e r o p i V i o l a k i - P a r a s k e v a President
World H e a l t h Asembly Geneva
Dear M a d a m e President,
The League of Red Cross S o c i e t i e s , through its members in N a t i o n a l Red Cross and Red C r e s c e n t Societies throughout the w o r l d , h a s a commitment to w o r k for the p r o t e c t i o n of h e a l t h and life w i t h p a r t i c u l a r c o n c e r n for those w h o are unable to p r o t e c t t h e m s e l v e s . A m o n g these are infants and y o u n g children w h o s e vulnerability in m a n y countries can be
seen by their unacceptably high rates of disease and d e a t h .
In our daily w o r k in the field of child h e a l t h the Red C r o s s / C r e s c e n t is becoming increasingly involved in activities aimed at improving infant feeding through the promotion of breastfeeding and better w e a n i n g p r a c t i c e s .
The League of Red Cross Societies feels strongly that the proposed " I n t e r n a t i o n a l Code of M a r k e t i n g of Breast M i l k Substitutes1 1 if adopted by this Assembly w i l l be an important and realistic step towards p r o m o t i o n of breastfeeding and thereby r e d u c t i o n in disease, m a l n u t r i t i o n and deaths a m o n g infants and y o u n g c h i l d r e n .
A l l of us gathered h e r e at the 34th W o r l d concern for improving health for all p e o p l e s . be s u p p o r t e d .
M a d a m e President, w e would be grateful if of the W o r l d Health Assembly and w e w o u l d like cooperation in this and other fields of h e a l t h
Health Assembly h a v e a common interest and It is our sincere h o p e that the "Code" w i l l
you would share our v i e w s w i t h the delegates to assure y o u of our full support and
p r o m o t i o n .
Yours faithfully,
Olof Stroh
Head of Operations Sector
