Angela Evans, author of an independent assessment of the WHO Code of Marketing of Breast-milk Substitutes, presents her findings and major recommendations to the Breastfeeding Innovations Team, March 28th, 2018. The report suggests ways in which the Code can be strengthened as an effective public policy instrument in the service of the Sustainable Development Goals relating to child health and nutrition.

1. Food forThought
Key findings from an independent
assessment of the International Code of
Marketing of Breast-milk Substitutes
ANGELA EVANS
Breastfeeding Innovations Team Webinar Launch
Wednesday 28 March 2018
Photo: Russell Watkins/UK DFID

2. I. The Code’s Provisions

3. The International Code of Marketing of
Breast-milk Substitutes (1981)
• Recommendation (Article 23, WHO Constitution) adopted in 1981 by the World
Health Assembly (WHA)
• Article 1 of the Code: “the provision of safe and adequate nutrition for infants,
by the protection and promotion of breast-feeding, and by ensuring the proper
use of breast-milk substitutes, when these are necessary, on the basis of
adequate information and through appropriate marketing and distribution.”
I. THE CODE’S PROVISIONS

4. Key provisions
• products: labelling and quality requirements
• marketing: ban on certain forms of advertising, free samples, gifts, contact with marketing
personnel
• marketing personnel: restrictions on sales incentives and responsibilities for marketing
personnel
• health care: health care facilities and health workers
• information and education: informational and educational materials
I. THE CODE’S PROVISIONS

5. Challenges
• What are the rules?
– subsequent WHA resolutions
• What do they mean?
– scope of the Code
– how do we understand “idealizing the use of infant formula”?
• Are the rules what they should be?
– inclusion of feeding bottles and teats
• How do we decide?
– no designated dispute settlement architecture
I. THE CODE’S PROVISIONS

6. II. National implementation

7. Understanding national implementation
• 39 countries have “comprehensive legislation”
• 135 countries have “at least some form” of legal measure reflecting parts of the
Code
• Code implementation and its impact on child and infant feeding in high-burden
country contexts e.g. India, China, Nigeria, Indonesia, Pakistan
II. NATIONAL IMPLEMENTATION

8. III. The Code and Corporate Conduct

9. Introducing the TECI Framework
III. THE CODE AND CORPORATE CONDUCT

10. Traction: a blueprint for responsible
business
• A blueprint for responsible business
• The increasing importance of international “soft law” instruments
• High notoriety, though varying levels of commitment by industry actors
• FTSE4Good BMS Criteria: facilitator or competitor?
III. THE CODE AND CORPORATE CONDUCT

11. Traction: Code compliance as a business
and human rights issue
• Article 24, UN Convention on the Rights of the Child (1989)
– the right to the “enjoyment of the highest attainable standard of health”
• UN Guiding Principles on Business and Human Rights (2011)
– corporate responsibility to respect internationally-recognized human rights
• Committee on the Rights of the Child, General Comment No. 15 (2013)
– responsibilities of non-state actors to adhere to the Code
III. THE CODE AND CORPORATE CONDUCT

12. Extraction: developing a common
understanding of the Code
• Article 11.3 of the Code: “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.”
• Leading market actors have closely linked policies, albeit with notable deviations:
– two-tiered geographical application
– scope
– other deviations on promotional activities, sales bonus calculations etc.
• Interpretation or renegotiation?
III. THE CODE AND CORPORATE CONDUCT

13. Corporate Action: mechanisms for
monitoring Code compliance
• NGO watchdogs: IBFAN-ICDC, Helen Keller International, Save the Children
• Corporate responsibility indexing: Access to Nutrition Index, FTSE4Good Index
• NetCode: initiative developed in 2014, WHO in consultation with UNICEF
• Company audits
• Goal: legitimate, comprehensive, coordinated, and accessible monitoring
III. THE CODE AND CORPORATE CONDUCT

14. Interaction: the status quo
• Deeply-rooted mistrust and hostility towards private sector actors
• Lack of regular, productive, open channels for dialogue
• Tense, adversarial, and highly politicized culture of interaction
III. THE CODE AND CORPORATE CONDUCT

15. Interaction: key civil society concerns
Conflict of interest
• concern: profit-seeking motive incompatible with public health objectives
• consider: the complexity of how companies conceive long-term profitability
III. THE CODE AND CORPORATE CONDUCT

16. Interaction: key civil society concerns
Image transfer
• concern: the blue-washing phenomenon
• consider: an opportunity to mobilize, rather than dilute the UN’s brand and
legitimacy
III. THE CODE AND CORPORATE CONDUCT

17. Interaction: key civil society concerns
Loss of leverage
• concern: diminishes impact of pressure tactics e.g. boycotts and protests
• consider: a “critical friends” approach to advocacy and engagement
III. THE CODE AND CORPORATE CONDUCT

18. Interaction: key civil society concerns
Futility
• concern: waste of time and resources
• consider: the costs of failing to change the status quo
III. THE CODE AND CORPORATE CONDUCT

19. Conclusions
CONCLUSIONS
• The Code needs clarity and to retain a
connection to reality
• The Code as a business and human
rights obligation
• Case for more productive dialogue and
engagement with private sector
• Importance of the core objective: wider
nutrition and infant and child health
Photo: Pippa Ranger/DFID