Review of the NZ Interpretation of the World Health Organization's International Code of Marketing of Breast-milk Substitutes

Published online: 
01 September 2004

Eleven action points which will provide a framework for refining and strengthening New Zealand's interpretation of the World Health Organization's International Code of Marketing of Breast-milk Substitutes, have been agreed by the Ministry of Health.

The action points are the result of a lengthy review of the New Zealand interpretation of the WHO Code, which aims to protect the nutritional wellbeing of infants by encouraging breastfeeding and discouraging practices which undermine its position as the normal method of feeding infants.

The WHO Code was adopted by the World Health Organization (WHO), in conjunction with the United Nations Children's Fund, in 1981 and by New Zealand as a member country in 1983.

The Ministry review looked at whether two self-regulatory codes of practice, introduced here in 1997 as part of New Zealand's interpretation of the code, were still relevant and were continuing to meet its objectives within a changing social and commercial environment. The two codes are the Code of Practice for the Marketing of Infant Formula (NZIMFA 1997) and the Infant Feeding Guidelines for New Zealand Health Workers (Ministry of Health 1997).

Background Information

Why has the review of the New Zealand Interpretation of the WHO Code taken so long?

The Ministry needed to ensure that the views of all stakeholderswere sought and considered.

Why is there a New Zealand interpretation of the Code?

The articles of the WHO Code are recommended as a basis for action to be adopted to suit the social and legislative needs of individual countries. This review has taken account of the New Zealand social and legislative environment.

How will this revised interpretation differ from the one currently in place?

The two code documents will be combined and it is hoped that this will make the New Zealand interpretation of the WHO Code easier to understand, access and promote. The complaints process will be revised and efforts made to ensure it is better understood, more effective and better promoted. Changes to the Compliance Panel will be considered, including its access to specific cultural and technical expertise.

The revised interpretation will enable the marketing of follow on formula to be monitored by the complaints process to ensure it is not marketed as breast-milk substitute. Concerns have arisen that follow-on formula is often perceived and used as a breast-milk substitute and therefore its marketing should be more closely monitored.

How will the Ministry publicise the WHO Code?

The Ministry will develop a process for raising awareness of the New Zealand interpretation of the WHO Code.

Why has the Ministry created a series of 'actions' that it should be undertaking as a matter of course?

The actions ensure that all policy is consistent, integrated, and makes the best use of resources to create the best possible outcome.

The actions provide a way forward for the New Zealand interpretation of the WHO Code in protecting and promoting breastfeeding. They also signal a level of shared intent and goodwill between the industry and health sectors, consumers and other key stakeholders in improving the nutritional status of infants.

How will the revised interpretation protect and promote breastfeeding?

The review is one of several actions in Breastfeeding:A Guide to Action (Ministry of Health 2002) which is the Ministry's plan of action for improving initiation and maintenance of breastfeeding. The interpretation aims to contribute to a supportive environment that regards breastfeeding as a societal norm by restricting the marketing of breast-milk substitutes.

What is the Ministry's recommendation regarding breastfeeding?

The Ministry recommends that infants be fed exclusively on breast milk from birth to between four and six months. Preferably, breastfeeding should continue until at least the age of one year, with the introduction of appropriate complementary foods. Unmodified cows milk is not recommended as a drinkbefore the age of one year.

Is there an acceptable alternative to breastmilk?

The key public health message is that 'breast is best' until the infant is aged one year, however formula is the best alternative. Unmodified cows milk should not be given as a drink before the infant is aged one year.

How do infant formula and follow-on formula differ?

Infant formula is designed to meet the nutritional needs of an infant aged 0-6 months, and follow on formula is designed to meet the nutritional needs of an infant aged over six months when used in combination with appropriate complementary foods.

Why has the Ministry not addressed the issue of the optimal duration of exclusive breastfeeding in this review?

While this is related, this issue is dealt with in Food and Nutrition Guidelines for Healthy Infants and Toddlers (Aged 0-2): A Background paper (Ministry of Health 2000). The New Zealand interpretation of the WHO Code will automatically fall into line with any changed or new Ministry policy on the optimal duration of exclusive breastfeeding.

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