WORLD HEALTH ASSEMBLY RESOLUTION

ON THE INAPPROPRIATE PROMOTION OF FOODS

Breastfeeding is a cornerstone of children’s survival, develop stronger national policies that protect
nutrition and early development.1 Optimal infant and children under the age of 36 months from marketing
young child feeding practices have the potential practices that could be detrimental to their health.
to protect children against non-communicable
diseases and common illnesses, improve academic
performance and boost productivity. In May 2016, Optimal infant and young child feeding:
Member States adopted a new World Health
Assembly (WHA) resolution that calls on countries WHO/UNICEF recommend exclusive breastfeeding
to implement the World Health Organization’s (WHO) during the first six months of life, with continued
Guidance on Ending the Inappropriate Promotion breastfeeding until two years of age or beyond,
of Foods for Infants and Young Children to further along with nutritionally adequate and safe
protect breastfeeding, prevent obesity and chronic complementary foods from the age of six months.
disease, and promote a healthy diet. In addition,
the guidance aims to ensure that caregivers receive
clear and accurate information on feeding.2 Background
In May 1981, the World Health Assembly adopted
The WHO developed the guidance as a response the International Code of Marketing of Breast-milk
to a growing body of evidence which shows that Substitutes, which applies to the marketing of
the promotion of breastmilk substitutes (BMS) and breastmilk substitutes, including infant formula,
some commercial foods for infants and young other milk products, foods and beverages, including
children undermines progress on optimal infant bottle-fed complementary foods, when marketed
and young child feeding.3 The guidance serves as or otherwise represented to be suitable as a
a complement to existing tools, such as the partial or total replacement of breastmilk. It also
International Code of Marketing of Breast-milk applies to the marketing of feeding bottles and
Substitutes and subsequent relevant WHA resolutions,4 teats.6 The Code has been updated regularly by
as well as the Global Strategy on Infant and Young subsequent WHA resolutions that provide further
Child Feeding.5 It encourages Member States to clarification and guidance, particularly regarding

1 United Nations International Children’s Emergency Fund, World Health Organization. (2015). Breastfeeding Advocacy Initiative. Retrieved
from http://apps.who.int/iris/bitstream/10665/152891/1/WHO_NMH_NHD_15.1_eng.pdf?ua=1
2 World Health Organization. (2016, May 13). Maternal, infant and young child nutrition: Guidance on ending the inappropriate promotion of
foods for infants and young children. Retrieved from http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_7Add1-en.pdf
3 Ibid
4 World Health Organization. (1981). International Code of Marketing of Breast-milk Substitutes. Retrieved from
http://www.who.int/nutrition/publications/code_english.pdf
5 World Health Organization, United Nations International Children’s Emergency Fund. (2003). Global Strategy for Infant and Young Child
Feeding. Retrieved from http://www.who.int/nutrition/publications/infantfeeding/9241562218/en/
6 World Health Organization. (2014, April 11). Maternal, infant and young child nutrition. Retrieved from
http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_15-en.pdf

IBFAN
new marketing tactics and products. Together, the
Code and subsequent relevant WHA resolutions Marketing means product promotion,
aim to protect breastfeeding from commercial distribution, selling, advertising, product public
influences and ensure the appropriate marketing relations and information services.
and distribution of breastmilk substitutes when they
Promotion includes the communication of
are necessary.
messages that are designed to persuade or
encourage the purchase or consumption of a
Since the adoption of the Code, BMS manufacturers product or raise awareness of a brand.
have created new categories of breastmilk
substitutes in addition to the traditional “infant Cross-promotion is a form of marketing where
formula,” including “follow-on formulas” and customers of one product or service are
“growing-up milks,” with packaging and labeling that targeted with promotion of a related product.
look like infant formula and are cross-promoted as
such. Commercially processed milks and foods Guidance on Ending the Inappropriate Promotion of
designed for children older than six months of Foods for Infants and Young Children: Background on
process and scientific evidence
age are frequently labeled like infant formula and
widely promoted, a marketing practice that can lead
to misuse and have potentially dangerous conse- In response, the WHO convened a Scientific and
quences for a child’s long-term health and well-being. Technical Advisory Group (STAG) to define what
constitutes inappropriate promotion of foods for
Evidence from numerous countries has shown that: infants and young children,10 and draft guidance to
• Some commercial complementary foods are help achieve the goal of ending the inappropriate
promotion of foods for infants and young children.11
being sold as suitable for introduction before six
months of age; Further consultations and revisions resulted in the
final report, which was presented to the sixty-ninth
• Breastmilk substitutes are being indirectly World Health Assembly and provides guidance on
promoted through association with commercial the inappropriate promotion of foods for infants and
complementary foods; and young children.12 The resolution, adopted by all 194
countries, welcomes the guidance as a means to
• Misleading claims are being made that products further strengthen the Code and to protect optimal
will improve a child’s health or intellectual infant and young child feeding practices.
performance.7,8
The Guidance on Ending the Inappropriate
In May 2012, resolution WHA 65.6 requested Promotion of Foods for Infants and Young Children
the Director-General “to provide clarification and The following recommendations from the guidance
guidance on the inappropriate promotion of foods are applicable to government programs, non-profit
for infants and young children cited in resolution organizations and private enterprises.
WHA 63.23, taking into consideration the ongoing
work of the Codex Alimentarius Commission.”9

7 Zehner E & Champeny M (Eds.). (2016, April). Availability, Promotion and Consumption of Commercial Infant Foods. Maternal & Child
Nutrition, 12. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/mcn.2016.12.issue-S2/issuetoc
8 Euromonitor International. (2015, June). Baby food trends in Brazil and Norway. A custom report compiled by Euromonitor International
Consulting for World Health Organization. Retrieved from
http://www.who.int/nutrition/topics/CF_babyfood_trends_brazilandnorway_euromonitor.pdf
9 The Codex Alimentarius was established by FAO and WHO to develop harmonized international food standards, which protect consumer
health and promote fair practices in food trade.
10 World Health Organization. (2013). Scientific and Technical Advisory Group (STAG) on Inappropriate Promotion of Foods for Infants and
Young Children. Retrieved from http://www.who.int/nutrition/events/2013_STAG_meeting_24to25June_recommendations.pdf?ua=1
11 World Health Organization. (2015). Discussion paper: Clarification and guidance on inappropriate promotion of foods for infants and
young children. Retrieved from http://www.who.int/nutrition/events/draft-inappropriate-promotion-infant-foods-en.pdf?ua=1
12 World Health Organization. (2016, May 13). Maternal, infant and young child nutrition: Guidance on ending the inappropriate promotion
of foods for infants and young children. Retrieved from http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_7Add1-en.pdf

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Recommendations
Promotion of foods for infants and young chil-
1. Optimal infant and young child feeding should dren is inappropriate if it:
be promoted.13,14 Emphasis should be placed on
the use of suitable, nutrient-rich, home-prepared, • undermines recommended breastfeeding
and locally available foods that are prepared and practices;
fed safely.15
• contributes to childhood obesity and non-
communicable diseases;
2. Products that function as breastmilk substitutes
should not be promoted. A breastmilk substitute • does not make an appropriate contribution
should be understood to include any milks (or to infant and young child nutrition in the
products that could be used to replace milk, such country;
as fortified soy milk), in either liquid or powdered
form, that are specifically marketed for feeding
• undermines the use of suitable home-
prepared and/or local foods; and
infants and young children up to the age of 36 months
(including follow-up formula and growing-up milks). • is misleading, confusing, or could lead to
inappropriate use.
3. Foods for infants and young children that are not Discussion paper: Clarification and Guidance on Inappropriate
products that function as breastmilk substitutes Promotion of Foods for Infants and Young Children
may be promoted only if they meet all the
relevant national, regional and global standards
and are in line with national dietary guidelines. must be different from those used for breastmilk
Nutrient profile models should be developed and substitutes.
utilized to guide decisions on which foods are 6. Companies that market foods for infants and
inappropriate for promotion.16 young children should not create conflicts of
4. The messages used to market foods for infants interest in health facilities or throughout health
and young children should support optimal systems. Such companies should not provide free
feeding. Messages should include a statement products to families through health workers or
on the importance of continued breastfeeding for health facilities, give gifts or incentives to health
up to two years or beyond and should specify care staff, give any gifts or coupons to parents,
the appropriate age of introduction of the food provide education to parents in health facilities,
(not less than 6 months). Messages should provide any information for health workers other
not suggest use for infants under the age of than that which is scientific and factual, or
6 months, make a comparison to breastmilk, sponsor meetings of health professionals and
recommend or promote bottle feeding, or convey scientific meetings.
an endorsement.
7. The WHO set of recommendations on the
5. There should be no cross-promotion to promote marketing of foods and nonalcoholic beverages
breastmilk substitutes indirectly via the to children17 should be fully implemented. A range
promotion of foods for infants and young children. of strategies should be implemented to limit the
The packaging design, labelling and materials consumption by infants and young children of
used for the promotion of complementary foods foods that are unsuitable for them.

13 Pan American Health Organization. (2003). Guiding principles for complementary feeding of the breastfed child. Retrieved from
http://www.who.int/maternal_child_adolescent/documents/a85622/en/
14 Pan American Health Organization. (2003). Guiding principles for complementary feeding of the breastfed child. Retrieved from
http://www.who.int/maternal_child_adolescent/documents/a85622/en/
15 World Health Organization. (2003). Global Strategy for Infant and Young Child Feeding. Retrieved from
http://apps.who.int/iris/bitstream/10665/42590/1/9241562218.pdf?ua=1&ua=1
16 Codex Guidelines on formulated complementary foods for older infants and young children (CAC/GL-8-1991, revised in 2013); Codex
standard for processed cereal-based foods for infants and young children (Codex/STAN 074-1981, revised in 2006); Codex standard
for canned baby foods (Codex/STAN 73-1981, revised in 1989); Codex advisory list of vitamin components for use in foods for infants
and children (CAC/GL 10-1979, revised in 2009).
17 World Health Organization. (2010). Set of recommendations on the marketing of foods and non-alcoholic beverages to children.
Retrieved from http://www.who.int/dietphysicalactivity/publications/recsmarketing/en/
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Moving to Action: Implementing the Guidance public health to end the inappropriate promotion
Resolution WHA 69.9 welcomes WHO’s evidence- of foods for infants and young children,
based guidelines designed to protect breastfeeding including, in particular, implementation of the
guidance recommendations while taking into
and optimal complementary feeding and outlines
account existing legislation and policies, as well
measures that Member States, manufacturers and
as international obligations;
distributors of foods for infants and young children,
health care professionals, media and civil society
need to take to align their policies, practices and
• Establish a system for monitoring and
evaluation of the implementation of the
programs in accordance with the recommendations guidance recommendations;
provided in the guidance.
• Continue to implement the International Code of
This resolution has the potential to support Marketing of Breast-milk Substitutes and WHO
improved infant and young child feeding practices recommendations on the marketing of foods
and improve the lives of millions of children. It and non-alcoholic beverages to children.
is now the responsibility of Member States to
Member States will be required to report on the
implement the guidance.
implementation of the guidance recommendations
The resolution specifically urges Member States, as part of the report on progress in implementing
in accordance with national context, to: the comprehensive implementation plan on
maternal, infant and young child nutrition18 to
• Incorporate the guidance into national laws: the seventy-first and seventy-third World Health
take all necessary measures in the interest of Assemblies, in 2018 and 2020.

Need for action:

• In 2014, global sales of breastmilk substitutes were US$44.8 billion, and sales are projected to
increase to US$71 billion by 2019.19

• Toddler milk, designed for children 13 months and up, is the fastest growing category of breastmilk
substitutes, with 8.6% growth per year.20

• Data from Brazil found that many baby food products do not specify age of use. 21

• Research conducted by Helen Keller International found that labels for commercially produced
complementary foods with recommended introduction earlier than six months were common in
Senegal (20%), Nepal (13%), and Tanzania (12%).22

18 World Health Organization. (2014). Comprehensive implementation plan on maternal, infant and young child nutrition. Retrieved from
http://apps.who.int/iris/bitstream/10665/113048/1/WHO_NMH_NHD_14.1_eng.pdf?ua=1
19 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series
Group. (2016). Why invest, and what it will take to improve breastfeeding practices? Lancet. 387:491-504. Retrieved from
http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)01044-2.pdf
20 Ibid
21 Euromonitor International. (2015, June). Baby food trends in Brazil and Norway. A custom report compiled by Euromonitor International
Consulting for World Health Organization. Retrieved from
http://www.who.int/nutrition/topics/CF_babyfood_trends_brazilandnorway_euromonitor.pdf
22 Zehner E & Champeny M (Eds.). (2016, April). Availability, Promotion and Consumption of Commercial Infant Foods. Maternal & Child
Nutrition, 12. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/mcn.2016.12.issue-S2/issuetoc