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Applying the Code of Marketing of BMS for IYCF with feeding difficulties

This question was posted the Infant and young child feeding interventions forum area and has 6 replies.

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director, global nutrition programs

Normal user

22 Dec 2022, 12:24

Dear all:

I am overseeing the nutrition programs for a large cleft NGO and I am looking for support with drafting an internal document aimed at the NGO staff and all the partner hospitals across LMICs providing sponsored cleft care. Children with cleft in LMICs are more than twice as likely to become malnourished as their peers without cleft, primarily because mothers are not provided with immediate assistance to overcome the challenges related to breastfeeding their newborns with cleft. Indeed, babies with cleft are more likely to face feeding difficulties because the presence of a cleft in their mouth affects their ability to suck. Modifying positions to breastfeed can be helpful, but in many cases, there is also the need to teach mothers how to express breastmilk and feed their baby with a cup.

There is poor awareness of WHO Code of Marketing of BMS and a need to guide the NGO staff and partners regarding best practices to ensure that breastfeeding/feeding with breastmilk is not overlooked in babies with feeding difficulties.

I am looking for technical guidance and support related to applying the Code specifically when the target population is made of children with feeding difficulties/disability. There may already be existing resources and I am grateful to be directed to them,

Many thanks in advance.

Barbara Delage

Elham Monsesf

Normal user

24 Dec 2022, 07:11

Hi Barbara, 

Dr. Mianne Silvestre, a pediatrician, is the global expert in cleft care and infant feeding. You can contact her via or her linkin account.

Kind regards,


IFE Core Group Coordinator

Technical expert

4 Jan 2023, 00:06

Hello, Barbara, I have a clarifying question. Are you looking for information to help NGO staff and partners are clear on whether special medical products or "specialty feeders" are covered by the Code? 


director, global nutrition programs

Normal user

14 Mar 2024, 12:58

Dear Dima - I only see your question now. I am trying to make a case that bottles are indeed covered by the WHO Code (It would make it easier if bottles and teats were systematically named along with breastmilk substitutes in the document) and that the Code applies to every child. Some children with feeding difficulties may benefit from the use of a normal or special bottle, but this is not the point I am trying to address. Rather I am looking at guidance for child foundations and NGOs, which the Code does not name specifically, but are stakeholders that should align with the Code. 

Could someone point to resources that discuss and/or make a case for Code alignment by NGOs or other stakeholders supporting vulnerable infants/infants with feeding difficulties in poor-resource settings?

Thank you in advance.


Senior Emergency Nutrition Adviser

Normal user

14 Mar 2024, 13:19

Dear all,

I am not sure what is the question anymore...but Bottles and Teats are products covered by the Code. 

The Code is a set of recommendations to regulate the marketing of breast-milk substitutes, feeding bottles and teats. The Code aims to stop the aggressive and inappropriate marketing of breast-milk substitutes.  

Article 2 of the Code clearly states that ....bottles and teats are included.

the Code applies in all context and at all times. So I  hope we have no confusion or doubts on that....but please if I did not understand the question please feel free to clarify.



Maryse Arendt

Lactation consultant IBCLC , BLL Luxembourg

Normal user

14 Mar 2024, 22:24

Hello Barbara 

Explanations about the Code have been provided in the other answers. If you are looking for more information on breastfeeding infants with a cleft, this is trated here Identifying and supporting infants under 6-months with feeding difficulties and disabilities: an overview of resources and evidence | ENN (

Biruk Tadesse

Ethiopian Public Health Institute

Normal user

15 Mar 2024, 02:44

Dear @Barbara,

Thank you for bringing intersting topic on how to apply the Code of Marketing of BMS for IYCF with feeding difficulties

My Name is Biruk Tadesse (National Nutrition Specialist (NiE)

In my view 

Exclusive breastfeeding, one of the best natural resources, needs protection and promotion. The International Code of Marketing of Breast-milk Substitutes (the Code), which aims to prevent the undermining of breastfeeding by formula advertising, faces implementation challenges in LMIC particularly in in poor-resource settings.

Successful holistic approaches that have strengthened the Code need to be scaled up. Community-based actions and peer-to-peer promotions have proved successful. Legislation without stringent enforcement and sufficient penalties is ineffective. The public needs education about the benefits and ways and means to support breastfeeding. It is crucial to combine strong political commitment and leadership with strict national regulations, definitions, and enforcement.  

Penalizing violators is crucial. Managers of multinational companies must be held accountable for international violations, and international legislative enforcement needs to be established. Further measures should include improved regulations to protect the breastfeeding mother: large-scale education campaigns; strong penalties for Code violators; exclusion of the formula industry from nutrition, education, and policy roles; supportive legal networks; and independent research of interventions supporting breastfeeding.

In Ethiopia manufacturers are violating the code of marketing of breast milk substitutes. Legislation must be accompanied by effective information, training, and monitoring systems to ensure that healthcare providers and manufacturers comply with evidence-based practice and the code.

There might be obliging situations for artificial feeding with due attention, monitoring and evaluation for example when:

  • The mother has died or is absent for an unavoidable reason
  • The infant has been rejected by the mother due to having experienced rape or psychosocial trauma
  • Acceptable maternal or infant medical reasons for use of breastmilk substitutes
  • The infant was dependent on artificial feeding when emergency occurred
  • During relactation or whilst moving from mixed feeding to exclusive breastfeeding

For further reference find the following links

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