Company Commitments and Signatory Assessments
The Call to Action applies to all breastmilk substitutes (BMS) companies. All companies need to comply with the International Code of Marketing of Breast-milk Substitutes and its relevant, subsequent resolutions (the Code) to better ensure the health of women and children around the world.
Please see below for a list of companies that have responded to the Call to Action, as well as those that have not responded. Select the links below to view company letters and the signatories’ assessments of company responses.
A statement from the signatories reflecting on the responses to the Call to Action is forthcoming.
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).
All BMS companies worldwide are invited to respond to the Call to Action for compliance with the International Code of Marketing of Breast-milk Substitutes. Of the over 20 largest BMS manufacturers who were contacted directly, those that did not respond are named below. Companies that have responded to date are also shown below, along with links to their responses and the signatories’ assessments of company responses.
Inner Mongolia Yili Industrial Group
Waja Nutritionals (Nutrilatt)
Initial responses to the Call to Action were requested by September 2020, followed by the submission of a detailed implementation roadmap by December 2020. The status of the responses will be updated on an ongoing basis.
Assessing the Responses to the Call to Action
Once a company submits its response, the Call to Action signatories and Access to Nutrition Index (ATNI) review to assess its alignment with the Call to Action. Companies are given the option of either:
Having their response posted immediately while the signatories and ATNI review or
Waiting for feedback from the signatories and ATNI and be given the opportunity to strengthen their response before it be made public. Upon resubmission, that response would be published.
Companies that choose to have their responses published before receiving feedback will still be able to revise their statements upon receiving feedback.
Upon finalization of each response, signatories and ATNI shared a brief assessment, linked above.
In accordance with the Call to Action, companies are then expected to submit concrete plans detailing how they will implement their commitments. These roadmaps will be assessed by ATNI via a qualitative assessment.