Arch Dis Child 97:529-532 doi:10.1136/archdischild-2011-301299
  • Reviews

Marketing breast milk substitutes: problems and perils throughout the world

Open Access
  1. June Pauline Brady1,2
  1. 1Department of Pediatrics, San Francisco General Hospital, San Francisco, California, USA
  2. 2Department of Pediatrics, University of California School of Medicine, San Francisco, California, USA
  1. Correspondence to June Pauline Brady, 87 Teralynn Court, Oakland, California 94619, USA; june.brady{at}
  1. Contributors JPB is a Clinical Professor of Pediatrics at the University of California, San Francisco. She is a retired neonatologist with major interests in the use of human milk in the intensive care nursery and in the control of ventilation in the newborn infant. She spent 11 years in Africa teaching paediatrics at the University of Nairobi and the University of Zimbabwe.

  • Received 30 October 2011
  • Accepted 13 January 2012
  • Published Online First 14 March 2012


On 21 May 1981 the WHO International Code of Marketing Breast Milk Substitutes (hereafter referred to as the Code) was passed by 118 votes to 1, the US casting the sole negative vote. The Code arose out of concern that the dramatic increase in mortality, malnutrition and diarrhoea in very young infants in the developing world was associated with aggressive marketing of formula. The Code prohibited any advertising of baby formula, bottles or teats and gifts to mothers or ‘bribery’ of health workers. Despite successes, it has been weakened over the years by the seemingly inexhaustible resources of the global pharmaceutical industry. This article reviews the long and tortuous history of the Code through the Convention on the Rights of the Child, the HIV pandemic and the rare instances when substitute feeding is clearly essential. Currently, suboptimal breastfeeding is associated with over a million deaths each year and 10% of the global disease burden in children. All health workers need to recognise inappropriate advertising of formula, to report violations of the Code and to support efforts to promote breastfeeding: the most effective way of preventing child mortality throughout the world.


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No unpublished data.

This paper is freely available online under the BMJ Journals unlocked scheme, see