US infant formula hospital stance 'confuses' domestic law and WHO Code: UNICEF, PAHO


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US infant formula hospital stance 'confuses' domestic law and WHO Code

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The International Formula Council (IFC) "confuses" US law and the WHO Code when defending the practice of supplying free infant formula samples for hospital discharge bags, the Pan American Health Organization (PAHO) and UNICEF claim.

In a statement sent to, UNICEF and the PAHO - the World Health Organization's (WHO) regional office for the Americas - said that "as its name suggests"​ the WHO International Code of Marketing of Breast-milk Substitutes "lays down standards of behavior that are intended to apply internationally​."

Earlier this month, IFC dismissed claims made in a Public Citizen petition - delivered in May to Mead Johnson Nutrition, Abbott Laboratories, and Nestlé USA - that the US practice of providing free hospital discharge bags containing infant formula samples is a violation of the WHO Code.

Speaking on behalf of Mead Johnson, Abbott, and Nestlé USA, Mardi Mountford, executive vice president, IFC, argued that while it and its members support the “aims and principles”​ of the WHO Code, it has never been incorporated into US law.

“…the voluntary Code is inconsistent with US law and policy, and was therefore not adopted in the US. Thus, US hospitals who distribute formula samples are not in violation of the WHO Code,”​ she said.

In their joint statement, PAHO and UNICEF said that in this conclusion “IFC confuses two distinct concepts; marketing practices that do not violate domestic law and those that are clearly in violation of the International Code.”

“While providing mothers with samples of infant formula or other types of breast-milk substitutes may not violate US domestic law, it does clearly violate the International Code,” ​said the statement.

"Agreed to respect it"

The International Code of Marketing of Breast-milk Substitutes was first drafted by WHO in 1981 to ensure the “protection and promotion of breast-feeding."

Countries that adopt all the Code's recommendations prohibit the advertising of breast-milk substitutes, and outlaw sales promotions for and free samples of infant formula.

A 2013 WHO report​ said that while many countries have incorporated aspects of the Code into national legislation, the US government had taken ‘No Action’ – meaning it has made no effort to slot the principles into law.

Infant formula manufacturers and distributors did agree in 1981, however, to “comply with the Code at all levels, irrespective of other measures taken to implement it," ​said the UNICEF, PAHO statement.

“In other words, the industry agreed to respect the Code irrespective of whether governments have taken legislative action for its implementation."

Weighing in, Marsha Walker, executive director, National Alliance for Breastfeeding Advocacy, labelled IFC’s earlier claims a “diversionary response…designed to shift responsibility from the formula manufacturers.”

“The Code was passed in 1981 by the global health community. This was 33 years ago and it is unconscionable that the infant formula and related industries are still systematically violating its recommendations and continuing to put infant and maternal health at risk,” ​Walker told

"Parents should be trusted"

Citing the Centers for Disease Control and Prevention (CDC), Public Citizen claims that more than half of all US hospitals distribute infant formula firm-sponsored discharge bags that include infant formula product samples.

By supplying samples to distribute to parents, Mead Johnson, Abbott, and Nestlé USA have failed to adhere to the principles of the WHO Code, Public Citizen claimed in its 18,000 signature-strong petition. 

Article 5.2 (“Manufacturers and distributors should not provide, directly or indirectly, to pregnant women, mothers or members of their families, sample of products”​) and Article 6.2 (“No facility of a health care system should be used for the purpose of promoting infant formula”)​ were highlighted by the US consumer group.

While agreeing "that more can be done to support and encourage breastfeeding"​ IFC has long-held the opinion that "parents should be trusted to make the best feeding choices for their babies according to their life circumstances and the needs of their families.”

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