Nancy E. Wight MD, IBCLC, FABM, FAAP

World Breastfeeding Week is celebrated around the world either the first week of August or during October each year. This year, the theme is "Code Watch: 25 Years of Protecting Breastfeeding", which provides an opportunity to celebrate the progress that has been made worldwide to protect breastfeeding, but also serves to remind us that many countries (including the US) have done little to nothing to enforce the Code of Marketing of Breastmilk Substitutes (WHO Code). The Code was adopted 25 years ago by the World Health Assembly to protect mothers and babies. It has been, and continues to be one of the most unexpectedly controversial international recommendations ever.
There are a myriad of ways in which companies persuade mothers to use commercial products to feed their infants rather than the natural way through breastfeeding. Companies spend millions of dollars promoting their products because it works! In the US, free formula, hospital discharge marketing bags, and "free" dollars to hospitals for "education" all ensure that the artificial milk an infant goes home with, is the artificial milk the mother uses when breastfeeding problems are encountered. Millions of infant lives could be saved if marketing companies followed the rules.

The Code forbids promotional practices such as advertising, inaccurate labeling, the giving of samples, posters, calendars, and gifts to mothers, nurses and doctors. Countries are expected to turn these rules into national legislation and other measures to protect mothers and babies from being bombarded with unethical marketing practices. The Code does not forbid the sale of products, it only asks for a halt of product promotion so that families get objective information upon which to make an informed choice.¹
The basic principles common to all advertising and promotion are instructive in the context of artificial milk advertising. All producers competing in the marketplace do so for two reasons:
- to expand the market for a given class of product; and
- to expand their share of the market - present and future - over that of competitors.
To achieve these ends, simultaneously or consecutively, the marketing of infant formula presupposes a market increasing in size as more infants are fed artificially.
Advertising of infant formula is not without consequences. During the last 25 years, evidence for the health disadvantages of NOT breastfeeding, and recommendations for the evidence-based practice of breastfeeding support have continued to increase. We

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