Summary of Company Responses
In June 2020, the World Health Organization (WHO), UNICEF and leading NGOs issued a global Call to Action to all companies that manufacture breast-milk substitutes (BMS) globally and was sent directly to the CEOs of 21 companies. It called on BMS manufacturers to make strong, measurable commitments to align their marketing policies and practices with the International Code of Marketing of Breast-milk Substitutes and subsequent World Health Assembly resolutions (together referred to as the Code).
The Code was adopted 40 years ago by the World Health Assembly (WHA), comprised of 194 national governments, as a minimum requirement to protect and promote appropriate infant and young child feeding. Given that companies have had 40 years to adopt policies and practices in compliance with the Code across their global operations, but have failed to do so, the Call to Action asked companies to publicly commit to achieve full Code compliance by 2030 at the latest, and submit a clear implementation roadmap by the end of 2020 detailing how Code compliance will be achieved.
Seventeen companies submitted responses. Only two companies, KraftHeinz and Meiji, committed to market their BMS in full compliance with the Code. The commitment by these two companies – which represent less than 1% of the global BMS market – is an important step forward, but further details are needed on how they plan to implement their pledge.
Of the six largest BMS companies representing 60% of the global market, Danone and Nestlé pledged to make some modifications to their policies to address selected aspects of the Code, while still falling short of a commitment to align their marketing policies and practices with the Code fully. Abbott, Feihe, FrieslandCampina, and RB submitted responses to the Call to Action that failed to make any commitments to improve their marketing policies and practices to bring them more closely into line with the Code. FrieslandCampina did however commit to sharing a roadmap to outline the steps it is willing to take over the next decade, as did Ausnutria, Danone, Kraft Heinz, Meiji, Morinaga, and Nestle.
KraftHeinz and PepsiCo made a first step towards Code compliance by publishing policies that set out their commitments in relation to marketing BMS products for infants aged 0-12 months in all countries. Ausnutria stated that it has adopted a policy covering formulas for infants from birth to 12 months of age but does not appear to have published this policy. Fonterra published a policy covering these products, and Lactalis committed to do so by the end of 2021. Further analysis is needed to determine whether these companies’ policies are fully aligned with the Code. While breastfeeding needs to be protected beyond just the first year of life, policies and practices covering the 0-12 month period are an important step to protecting young children around the world.
In addition to Ausnutria and Lactalis, four companies – Asahi, HiPP, H&H, and Morinaga – committed to develop or publish a first-ever policy on BMS marketing.
Four companies did not respond to the Call to Action: Yili Group, Mengniu, Progress JSC, and Waja Nutritionals (Nutrilatt). Vinamilk submitted a response but did not make any commitments to improve its marketing policies and practices.
All company responses were reviewed and assessed by the signatories of the Call to Action and by the Access to Nutrition Initiative (ATNI), an independent monitoring body that evaluates food and beverage manufacturers’ policies, practices, and disclosures on addressing all forms of malnutrition. The individual company responses and the assessments can be found here.
Statements from the signatories can be found here.
Clarifications on Points in the Code
In addition to the individual assessments linked below, the signatories would like to clarify a number of issues raised in the responses from companies.
The Code as implemented in national regulations. In their responses to the Call to Action, many companies tout their compliance with local laws and regulations. In some cases, they have qualified their commitment to the Code by saying that they support it only “as implemented in national laws”. We wish to be very clear that compliance with law does not constitute compliance with the Code. While a majority of countries have enacted some legislation to give effect to the Code, most national legislation does not fully cover all provisions of the Code. The Code itself makes it clear that companies are responsible for adherence to the Code even where national legislation is weak or non-existent: “Independently of any other measures taken for implementation of this Code, manufacturers and distributors of products within the scope of this Code should regard themselves as responsible for … ensuring that their conduct at every level conforms to [the Code]” (Article 11.3).
Global Health Policy. Many of the responses state that the companies support the overall goal of the Code, but then identify certain elements of the Code that they disagree with. Global health policy is established by international organizations such as WHO, operating under the mandate of the World Health Assembly. The Code and subsequent relevant resolutions have been adopted by the World Health Assembly and have the imprimatur of essentially all national governments. Individual companies cannot simply pick and choose which elements of global health policy they wish to follow and which ones that they will disregard.
Women’s rights to choose. Some company responses imply that the Code somehow interferes with women’s rights to choose how to feed their children. This is not true. The Code in no way restricts choices. The Code does not limit access to breast-milk substitutes for families that need or want to use them. It also does not restrict access to unbiased information about feeding options. However, the Code does limit the kinds of information that manufacturers and distributors of breast-milk substitutes can disseminate because information from these companies is likely to be biased by commercial interests and is often promotional in nature.
Health professional education. Several companies highlighted their active education of health care professionals as being vital for child health. It is important to clarify that the Code does not prevent manufacturers of breast-milk substitutes from sharing factual and scientific information about their products. However, it is not the role of BMS manufacturers to provide general education on infant and young child feeding. These companies have a clear commercial interest in promoting their products, and thus general information on feeding cannot be seen as unbiased. Education of health care professionals on infant and young child feeding needs to be provided by governments, medical schools, peer review publications, and non-governmental organizations, not manufacturers selling products. Such companies are prohibited from sponsoring meetings of health professionals because of the conflicts of interest that this creates. Similarly, they are not allowed to donate gifts or services, including education services, to health care professionals because of these conflicts of interest.
Milks for children 12-35 months old. Most of the company responses only refer to products marketed for infants, implicitly or explicitly exempting their milk products for children 12-35 months old from any types of marketing restrictions. In 2016, the WHO published guidance to clarify that the Code includes any milks that are specifically marketed for children up to the age of 3 years (including follow-up formula and growing-up milks) within its scope. As described in a WHO Information Note, this clarification was based on the long-standing WHO recommendation for continued breastfeeding for at least 2 years and the recognition that artificial milk feedings replace the intake of breast milk rather than add to it. The World Health Assembly welcomed this guidance and called upon manufacturers and distributors of these milks to abide by it (WHA resolution 69.9).