The Code covers breast milk substitutes, including “infant formula, other milk products, foods and beverages for use as a partial or total replacement for breast milk, feeding bottles and teats”. It was adopted in 1981 at the WHA by the majority of Member States to stem the aggressive marketing of formula milk and the resultant rise in infant mortality. Subsequent WHA Resolutions have updated the Code as necessary, to take account of new scientific knowledge and commercial product marketing trends. These Resolutions have the same status as the Code, as reaffirmed by a technical endorsement from the WHO secretariat (WHO, 2006h).

The main provisions of the Code and subsequent WHA Resolutions are:

1. Governments have the responsibility to provide information on infant feeding. Donations of informational materials by manufacturers or distributors should only be made at the request and with the written approval of the appropriate government authority.
2. No advertising of breast milk substitutes to the public.
3. No direct or indirect free samples or gifts to mothers or their relatives.
4. No company sales representatives to contact mothers directly or indirectly.
5. No gifts or personal samples to health workers. Samples provided are to be for professional evaluation or research at institutional level. Health workers should not give samples to pregnant women or mothers of infants and young children.
6. Information to health workers should be scientific and factual.
7. Financial support to health professionals should not create conflicts of interest.
8. All information to mothers should include the benefits of breastfeeding and the costs and hazards of artificial feeding.
9. No promotion of products covered by the Code in health care facilities including no free supplies.
10. No words like “humanized”, “maternalized”, or similar terms, pictures and text idealising artificial feeding on labels.
11. Nutritional and health claims are not permitted for breast milk substitutes, except where specifically provided for in national legislation.

Successful implementation of the Code depends on countries incorporating and enforcing its provisions into their national/regional legislation. The Code, however, states that irrespective of such incorporation, industries should monitor their own practice and conform to the principles and aims of the Code itself. Although sponsorship of health programmes and health professionals, including training, is not prohibited by the Code, the 1996 and 2005 WHA Resolutions cautioned against conflicts of interest. Health professionals may feel they are immune to commercial promotional activities. Social science studies have concluded otherwise: even “small gifts” have an effect (Dana & Loewenstein, 2003).

The EU first transposed the Code into a Directive of the European Commission (EC) in 1991 (Directive 91/321/EEC). This Directive applied only to infant and follow-on formulae and limited their marketing only to infants less than four months of age. In December 2006 the EC issued Directive 2006/141/EC to update and replace the 1991 Directive. The 2006/141/EC Directive extends the marketing limitations to infants up to six months.

Almost at the same time, the EC issued Directive 2006/125/EC on processed cereal-based foods and baby foods for infants and young children. Article 8.1.a of this Directive says that the label of these products must bear a statement as to the appropriate age from which the product may be used; it adds that “the stated age shall not be less than four months”, thus contradicting many national recommendations for exclusive breastfeeding up to six months and the standard set by the Codex Alimentarius. The Directives of the EC are to be transposed into national laws or regulations in all Member States.