International Code of Marketing of Breastmilk Substitutes (The Code)
Breastfeeding Policies that Impact Public Health International Code of Marketing of Breastmilk Substitutes (The Code)

The International Code of Marketing of Breastmilk1. Substitutes was adopted in 1981 by the World Health Assembly (WHA) as a means of preventing the formula industry from decreasing breastfeeding rates thru their marketing practices.

The Code stipulates that there should be no promotion of breastmilk substitutes, bottles, or nipples directly to the public. Further, health facilities and health professionals should NOT partake in promoting breastmilk substitutes. Specifically, free samples should not be given to families. The WHA recommended that all countries pass legislation to enforce this code of ethics regarding the sales and marketing of artificial baby milk. The United States has never enforced The Code. The provision of free hospital discharge bags containing formula or coupons is one marketing strategy proven to undermine breastfeeding success. The bags are known to decrease the duration of breastfeeding, thus putting infants at higher risk for morbidity and mortality, in addition to increasing the risk of maternal illnesses among mothers who do not breastfeed. Many states have passed legislation banning the distribution of free formula gift bags. For more information, see

The United States Joint Commission’s Pregnancy and Related Conditions hospital core measure set was revised in 2010 to include Exclusive Breastmilk Feeding2. This has served to motivate hospitals to improve breastfeeding support, in order to decrease formula supplementation of infants during the postpartum stay.




  1. World Health Organization The International Code of Marketing of Breast-milk Substitutes (accessed 1/18/20)
  2. US Joint Commission Perinatal Care Core Measure Set (accessed 12/9/19)