The WHO Code: what it means for families and healthcare professionals

The International Code of Marketing of Breast-milk Substitutes, usually called the WHO Code, was introduced to protect infant and young child health by addressing the way breast-milk substitutes and related products are marketed. It recognises that commercial promotion can influence feeding decisions and that families need accurate, independent information to make informed choices about how they feed their babies (WHO, 1981).

Although the Code was adopted more than four decades ago, inappropriate marketing remains a public-health concern. Understanding why it was created, how marketing has changed and what it means for healthcare professionals helps explain why the Code remains relevant today.

Why the Code was introduced

Breastfeeding has long been recognised as important for infant health, but the expansion of commercial infant formula marketing during the twentieth century changed the environment in which families made feeding decisions. As manufactured milk products became more widely available, companies increasingly promoted them as modern, convenient or desirable alternatives to breastfeeding.

These developments took place alongside wider social changes. Changing expectations around household hygiene, the convenience of feeding and the growth of manufactured milk products all influenced infant-care practices. Commercial promotion contributed to the perception that manufactured products could offer a straightforward alternative to breastfeeding. However, access to clean water, adequate sanitation and reliable supplies was not universal, creating particular risks where formula was prepared in unsafe conditions.

Concerns grew about marketing practices in lower-income countries, where advertising could encourage families to use products that were expensive and potentially difficult to prepare safely. Breastfeeding advocates, healthcare professionals and public-health campaigners challenged manufacturers' promotional practices and raised concerns about the consequences for infant health.

The Nestlé boycott became an important part of this history. Campaigners in the United States initiated a boycott of Nestlé products in 1977, drawing attention to the marketing of infant formula in countries where families could face significant barriers to its safe use. The controversy helped bring international attention to the influence of commercial promotion on infant-feeding decisions. The campaign was part of a wider movement involving many organisations and advocates; it was not the sole cause of the WHO Code.

In 1979, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) convened an international meeting on infant and young child feeding. The meeting called for the development of an international code to regulate the marketing of breast-milk substitutes. Following further work, the International Code of Marketing of Breast-milk Substitutes was adopted by the World Health Assembly on 21 May 1981, with 118 votes in favour (WHO, 1981).

The Code established an international framework intended to protect breastfeeding and ensure that breast-milk substitutes, when necessary, were used appropriately and on the basis of adequate information. It also recognised that marketing should not undermine breastfeeding or exploit the trust families place in healthcare professionals.

What the Code covers

The Code addresses the marketing of breast-milk substitutes, including infant formula, as well as feeding bottles and teats. Its scope also includes products marketed or represented as suitable to replace breast milk, depending on their intended use and the relevant provisions of the Code and subsequent World Health Assembly resolutions.

The Code is not limited to the wording of an advertisement. It considers the wider methods through which products are promoted, including free samples, gifts, sponsorship, promotional materials, contact with healthcare workers and the use of healthcare settings to market products.

The Code also sits within a wider framework of subsequent World Health Assembly resolutions, which clarify and strengthen aspects of its implementation as marketing practices and infant-feeding products have changed.

The underlying principle is that commercial interests should not interfere with families' access to impartial infant-feeding information or with the protection, promotion and support of breastfeeding (WHO, 1981; WHO, 2008).

How the Code is undermined today

Although the WHO Code was adopted in 1981, inappropriate marketing of breast-milk substitutes remains a global public-health concern. Reports continue to document practices that conflict with the Code, including misleading claims, promotion through healthcare professionals, digital advertising and the use of branding to build consumer recognition and loyalty (WHO and UNICEF, 2022; WHO and UNICEF, 2024; WHO, 2026).

The problem is not simply that individual advertisements occasionally cross a line. Establishing brand recognition and loyalty can have commercial value beyond a single purchase. When a brand becomes familiar during pregnancy, is associated with professional education or appears repeatedly in parenting content, that familiarity may influence later purchasing decisions.

The effectiveness of restrictions depends on the strength of legislation, monitoring, enforcement and penalties. Where fines are outweighed by the commercial benefits of continued marketing, including the long-term value of brand recognition and consumer loyalty, penalties may do little to deter repeat practices. This creates a concerning incentive for companies to continue marketing in ways that undermine the Code, particularly where enforcement is inconsistent (WHO and UNICEF, 2024; WHO, 2026).

Marketing has also become less straightforward to recognise. It may appear through social media influencers, sponsored parenting content, online feeding advice, professional publications, educational events and brand-linked resources. Some content is overtly promotional; other material may appear independent while directing attention towards a particular manufacturer or product. This can blur the boundary between education and advertising (WHO, 2022a; WHO and UNICEF, 2022; First Steps Nutrition Trust, 2019; First Steps Nutrition Trust, 2025).

Less transparent or underhand marketing can use educational content, professional endorsements, influencer recommendations, sponsored events or apparently independent advice to create favourable associations with a brand. These practices raise questions about transparency, commercial interests and whether families can distinguish independent information from promotion.

The Code is therefore relevant beyond obvious advertisements. A product does not need to be directly recommended for commercial influence to affect how it is perceived. Repeated exposure to a logo, branded product or company-associated message can make a manufacturer seem familiar, trustworthy or professionally endorsed.

The UK legal position

The WHO Code is an international public-health standard. It is not, by itself, a single piece of UK legislation that makes every provision directly enforceable in the same way. The UK has introduced legislation that gives effect to some, but not all, of the Code's provisions and subsequent resolutions.

The relevant legal framework includes regulations governing infant formula and follow-on formula, with related provisions for foods for special medical purposes. The broad regulatory approach is similar across the UK, but the legal instruments and administrative arrangements are not identical. Infant formula legislation is devolved: England, Scotland and Wales have their respective arrangements, while EU nutrition legislation continues to apply in Northern Ireland under the Windsor Framework (Department of Health and Social Care, 2024).

UK law does not implement every aspect of the WHO Code. Some forms of marketing and advertising that are inconsistent with the Code's wider recommendations may still be permitted under UK regulations. The Baby Feeding Law Group UK and First Steps Nutrition Trust have highlighted gaps between the Code and the UK regulatory position, including concerns about the marketing of particular infant milk products (Baby Feeding Law Group UK, 2004; Baby Feeding Law Group UK, 2022; First Steps Nutrition Trust, 2024; Institute of Health Visiting, 2024).

The distinction matters: a marketing practice may be inconsistent with the WHO Code without necessarily constituting a breach of UK law. Equally, compliance with the minimum legal requirements does not automatically mean that a practice meets the wider professional responsibilities associated with working within the Code.

Healthcare professionals should understand the law relevant to their work, alongside their professional standards, employer policies and any additional requirements associated with their service or accreditation.

What the Code means for professionals

The WHO Code is not simply a voluntary marketing preference for professionals to consider when convenient. It establishes an international public-health standard, and the WHO has published specific guidance explaining the responsibilities of health workers in protecting families from inappropriate promotion of breast-milk substitutes (WHO, 2020).

The Code and relevant subsequent World Health Assembly resolutions should inform professional practice, including decisions about educational resources, commercial relationships, public-facing content and the products displayed in healthcare environments. Professionals should understand both the Code's principles and the legal requirements that apply to their work.

For midwives and nurses registered with the Nursing and Midwifery Council (NMC), the NMC Code requires professionals to practise with integrity, use the best available evidence, preserve safety and promote trust in the profession. These duties are relevant when considering commercial influence, conflicts of interest and the information shared with families (NMC, 2018).

For International Board Certified Lactation Consultants (IBCLCs), the Code of Professional Conduct explicitly requires adherence to the principles and aims of the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolutions. This makes the relationship between the WHO Code and professional conduct particularly direct for IBCLCs (IBLCE, 2023).

Professionals working in UNICEF UK Baby Friendly-accredited services are also expected to work within the Code and subsequent resolutions as part of the standards underpinning accreditation. The UNICEF UK Baby Friendly Initiative provides guidance to help health workers apply the Code in day-to-day practice (UNICEF UK Baby Friendly Initiative, 2025). Other professional bodies, employers and organisations may have additional policies that apply to their members or staff.

Healthcare professionals and the Code

The WHO Code is relevant to all health workers who have contact with babies and families, not only those who specialise in infant feeding. This includes health visitors, midwives, nurses, IBCLCs, doctors, dietitians, pharmacists and other professionals involved in supporting infant feeding (WHO, 2020; UNICEF UK Baby Friendly Initiative, 2025).

The Lactation Consultants of Great Britain’s Who’s Who in Breastfeeding Support and Lactation in the UK resource explains the differences between breastfeeding support roles. For a further overview of the work of an infant-feeding specialist, see What does an infant feeding specialist do?.

Health visitors have a particularly important role because they often provide ongoing support to families in the community, including discussions about feeding, growth, milk supply and the introduction of formula. The information they share, the resources they distribute and the products displayed or recommended in their working environments can influence family decisions.

For health visitors who are registered nurses or midwives, the NMC Code sets professional expectations around evidence-based practice, integrity and maintaining public trust (NMC, 2018). Services working towards or maintaining UNICEF UK Baby Friendly accreditation also have specific expectations for implementing the WHO Code in health visiting and community settings (UNICEF UK Baby Friendly Initiative, 2025).

IBCLCs have an explicit professional obligation: the IBCLC Code of Professional Conduct requires adherence to the principles and aims of the WHO Code and relevant subsequent World Health Assembly resolutions (IBLCE, 2023).

In everyday practice, healthcare professionals should:

• Provide accurate, evidence-based and impartial infant-feeding information, without allowing commercial interests to influence their advice.

• Avoid displaying or distributing promotional materials for breast-milk substitutes, feeding bottles, teats or other products covered by the Code.

• Scrutinise manufacturer-funded education, sponsored events, gifts, free products and other commercial relationships for conflicts of interest or the appearance of endorsement.

• Use appropriately referenced educational materials and consider whether branded images, logos or product placement introduce unnecessary commercial promotion.

• Challenge misleading claims and seek advice from their employer, professional body or relevant service lead when unsure how to respond to a potential breach.

These responsibilities do not mean withholding information about formula or judging families who use it. Families need practical, compassionate support whatever their feeding circumstances. The professional duty is to provide that support without inappropriate commercial influence and to protect families' ability to make informed decisions.

Imagery, branding and endorsement

The Code restricts advertising and promotion of products within its scope to the public. For professionals, applying its principles means looking carefully at how products are represented in clinical and educational settings.

A branded feeding bottle, teat, formula container or manufacturer's logo in a public-facing photograph may give a product or company additional visibility. A professional's photograph beside a product, a testimonial, a recommendation or the display of a manufacturer's materials may also be interpreted as an endorsement, even when no explicit endorsement was intended.

The context matters. A branded image used to explain safe bottle-feeding technique is not necessarily equivalent to a branded promotional image. An unbranded image used to demonstrate safe bottle-feeding can communicate the practical information without giving additional visibility to a commercial product.

Professionals must be able to provide practical, factual information about bottle feeding and formula use without turning that information into advertising. The aim is not to make formula feeding invisible or to make families feel judged. It is to separate necessary, balanced information from avoidable brand promotion.

The same scrutiny applies to presentations, websites, leaflets, study days and social media. Professionals should consider whether an image is necessary, whether it introduces avoidable brand exposure, whether the information is balanced and whether the content could influence families through commercial associations rather than evidence.

The UNICEF UK Baby Friendly Initiative's guide for health workers and First Steps Nutrition Trust's reports on marketing to healthcare professionals provide practical guidance for identifying these issues (UNICEF UK Baby Friendly Initiative, 2025; First Steps Nutrition Trust, 2019).

Sponsorship, gifts and commercial relationships

Commercial relationships can influence professional environments in ways that are not always immediately obvious. Sponsorship of education, provision of free products, gifts, promotional resources and manufacturer-funded events can create a connection between a company and the professional or service receiving the benefit.

Even where a professional believes that a gift or sponsorship has not influenced their judgement, it may create a perception of endorsement. It can also give a company access to professional networks or opportunities to present its products as familiar, trusted or associated with clinical expertise.

Working within the Code means critically evaluating these relationships. Professionals should avoid accepting gifts, free samples or benefits that conflict with the Code or applicable professional standards, and should not allow manufacturers to use professional roles, credentials or healthcare settings to promote products inappropriately.

Educational content funded by manufacturers should be assessed carefully for accuracy, balance, transparency and commercial influence. Information described as scientific or factual should be scrutinised rather than accepted simply because it is presented in a professional setting (First Steps Nutrition Trust, 2019).

Professional independence requires more than disclosing a commercial relationship after it has occurred. It requires considering whether the relationship is appropriate in the first place and whether it could undermine trust in the advice provided.

Professional duty and independence

Working within the WHO Code should be understood as part of professional responsibility, not merely an optional organisational preference. Professionals have a duty to maintain public trust, use independent evidence and protect families from inappropriate commercial influence. Where a professional code explicitly incorporates the WHO Code, adherence is also a requirement of that professional standard.

For further information about the professional role and scope of an IBCLC, see Roles of an IBCLC.

This means critically evaluating manufacturer-funded education, declining arrangements that compromise independence, using appropriately referenced information and challenging misleading or inappropriate marketing when it is identified. It also means ensuring that families who use formula receive accurate preparation advice, practical feeding support and compassionate care without being exposed to unnecessary promotion.

The Code does not mean that professionals must withhold information about formula, nor does it prevent clinically appropriate discussion of products. It requires a distinction between providing the information families need and promoting commercial interests.

Ultimately, professional independence is not demonstrated simply by believing that a particular brand has not influenced one's judgement. It requires active consideration of how sponsorship, branding, gifts, repeated exposure and commercial relationships might influence professional behaviour or public perception. The responsibility is to ensure that infant-feeding advice remains grounded in evidence, the needs of the baby and the circumstances of the family.

Supporting families without judgement

Protecting families from inappropriate marketing must go hand in hand with providing compassionate, practical infant-feeding support. Families may breastfeed, use formula or combine feeding methods for a range of personal, medical and practical reasons. They should be able to access accurate information and skilled support without judgement.

Working within the Code does not mean withholding information about formula, making assumptions about a family's feeding decisions or suggesting that families who use breast-milk substitutes have done something wrong. It means ensuring that information is provided because it meets the family's needs, rather than because it benefits a manufacturer.

Families need reliable information about feeding options, safe preparation, responsive feeding and how to recognise when further support is needed. That information should be evidence-based, clearly referenced and free from inappropriate commercial influence.

The WHO Code remains relevant because the way products are marketed can shape the information families encounter before they ever speak to a healthcare professional. Upholding the Code is therefore a shared responsibility across healthcare, public health, professional education and the wider infant-feeding environment.

References

Baby Feeding Law Group UK (2004) Clarifying misconceptions about the UK law on the marketing of infant formula: BFLG UK briefing document. Available at: https://www.bflg-uk.org/our-work#reports

Baby Feeding Law Group UK (2022) Infant milks marketed as foods for special medical purposes (FSMP): The case for regulatory reform to protect infant health. Available at: https://www.bflg-uk.org/our-work#guidance

Department of Health and Social Care (2024) Nutrition legislation information sheet. Available at: https://www.gov.uk/government/publications/nutrition-legislation-information-sources/nutrition-legislation-information-sheet--2

First Steps Nutrition Trust (2019) Scientific and factual? A further review of breastmilk substitute advertising to healthcare professionals. London: First Steps Nutrition Trust. Available at: https://www.firststepsnutrition.org/reviews-of-claims

First Steps Nutrition Trust (2024) Regulations for infant formula marketed in the UK. June 2024. Available at: https://infantmilkinfo.org/wp-content/uploads/2024/06/RegulationsinfantformulaJune2024.pdf

First Steps Nutrition Trust (2025) Current formula marketing practices in the UK: Why stronger rules are needed. Published 17 July 2025. London: First Steps Nutrition Trust. Information available at: https://www.firststepsnutrition.org/august-2025

Institute of Health Visiting (2024) ‘Baby Feeding Law Group UK: Misconceptions about the UK law on the marketing of infant formula’, 26 January. Available at: https://ihv.org.uk/news-and-views/news/baby-feeding-law-group-uk-misconceptions-about-the-uk-law-on-the-marketing-of-infant-formula/

International Board of Lactation Consultant Examiners (IBLCE) (2023) Code of Professional Conduct for IBCLCs. Updated 1 May 2023. Available at: https://ibclc-commission.org/wp-content/uploads/2023/05/2023May1Code-of-Professional-ConductFINAL.pdf

Nursing and Midwifery Council (NMC) (2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. London: NMC. Available at: https://www.nmc.org.uk/standards/code/

UNICEF UK Baby Friendly Initiative (2025) The International Code of Marketing of Breastmilk Substitutes: A guide for health workers. Updated November 2025. Available at: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/international-code-marketing-breastmilk-substitutes-resources/guide-to-working-within-the-code/

World Health Organization (WHO) (1981) International Code of Marketing of Breast-milk Substitutes. Geneva: WHO. Available at: https://iris.who.int/bitstream/handle/10665/40382/9241541601.pdf?sequence=1

World Health Organization (WHO) (2008) The International Code of Marketing of Breast-milk Substitutes: Frequently asked questions—updated version 2008. Geneva: WHO. Available at: https://www.who.int/publications/i/item/9789241594295

World Health Organization (WHO) (2020) The International Code of Marketing of Breast-milk Substitutes: Frequently asked questions on the roles and responsibilities of health workers. Geneva: WHO. Available at: https://www.who.int/publications/i/item/9789240005990

World Health Organization (WHO) (2022a) Scope and impact of digital marketing strategies for promoting breast-milk substitutes. Geneva: WHO. Available at: https://www.who.int/publications/i/item/9789240046085

World Health Organization (WHO) and UNICEF (2022) How the marketing of formula milk influences our decisions on infant feeding. Geneva: WHO and UNICEF. Available at: https://www.who.int/publications/i/item/9789240044609

World Health Organization (WHO) and UNICEF (2024) Marketing of breast-milk substitutes: national implementation of the International Code, status report 2024. Geneva: WHO and UNICEF. Available at: https://www.who.int/publications/i/item/9789240094482

World Health Organization (WHO) (2026) Marketing of breast-milk substitutes: national implementation of the International Code, status report 2026. Geneva: WHO. Available at: https://www.who.int/publications/i/item/9789240122758