Caffeinated and sugar-sweetened drinks
10. Interpretation of the Who Code for health Workers in Australia
10.1 The WHO Code
the wHo code9 was formulated in response to concerns over the effects on infant health of unfettered promotion
of infant formula throughout the world. the drive for the wHo code came from recognition of the increased risks of morbidity and mortality in infants who are not breastfed.
the aim of the wHo code is to contribute to the provision of safe and adequate nutrition for infants by protecting and promoting breastfeeding and by ensuring the correct use of breast-milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution.
the wHo code itself, as approved by the wHA, is not legally binding unless individual nations enact specific legislation. the wHo code has not been updated, but a number of supplementary resolutions have been passed by the wHA.565 As recently as may 2010 the wHA passed a resolution urging countries to strengthen their
commitments to the wHo code and the companion BFHI.566
10.1.1 Australia’s Implementation of the WHO Code
Under the wHo code:
• governments have the responsibility to ensure that objective and consistent information is provided on infant and young child feeding for use by families and those involved in the field of infant and young child nutrition • feeding with infant formula should be demonstrated only by health workers, or other community workers if
necessary, and only to the mothers or family members who need to use it.
those aspects of the wHo code that are appropriate to Australia’s social, legal and economic environment are implemented through:
• the Marketing in Australia of Infant Formulas Agreement: Manufacturers’ and Importers Agreement 1992 (mAIF Agreement) (see section 10.2)
• food labelling laws (standard 2.9.1 of the Australia new Zealand Food standards code) (see sections 8.1 and 8.2) • the nHmRc Infant Feeding Guidelines, which were developed as a part of the Australian response to the
wHo code and stated ‘the guidelines aim to help all health workers understand how the wHo code and mAIF Agreement affect their work in both breastfeeding and using infant formula.’25
10.1.2 Health workers’ role
All health workers in Australia have an important role in promoting and supporting breastfeeding. some aspects of the wHo code are the responsibility of other parties, such as government or industry, but it is important that health workers are able to support and understand the objectives of the wHo code as appropriate to Australian conditions.
In keeping with the aims of the wHo code, and its application in Australia, all health workers should: • promote optimal infant nutrition by promoting breastfeeding
• provide information about infant formula when required and support families who are using infant formula • understand the intent of the mAIF Agreement in limiting the marketing of infant formula, particularly in regard
Advice for health workers
• continue to implement the wHo code and be aware of health professional obligations under the mAIF Agreement.
10.2 The Marketing in Australia of Infant Formulas Agreement
the mAIF Agreement is a voluntary, self-regulatory code of conduct between manufacturers and importers of infant formula in Australia. It was developed in 1992 as an arrangement authorised under the then Trade Practices Act 1974.
the aim of the mAIF Agreement is to contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding and by ensuring the proper use of breast-milk substitutes, when they are necessary, on the basis of adequate information and through appropriate marketing and distribution (as per Article 11.1 of the wHo code). A copy of the mAIF Agreement is provided in Appendix l.
10.2.1 Application
the mAIF agreement applies to the marketing and promotion of formulas for infants up to 12 months of age by Australian manufacturers and importers of infant formula who are signatories. As at 2011, the six signatories to the mAIF Agreement represented most of the infant formula market in Australia:
• Abbott Australasia Pty ltd • Bayer Australia ltd
• HJ Heinz company Australia ltd • nestlé Australia ltd
• nutricia Australia Pty ltd • Pfizer nutrition.
the marketing activities of distributors and retailers including pharmacies and supermarkets are outside the scope of the mAIF Agreement. Health workers do not have obligations under the mAIF.
In relation to the products, the mAIF Agreement applies to:
• infant formula i.e. formula that is suitable for babies from birth (e.g starter, stage 1 or All Ages infant formulas) • follow-on formula i.e. formula that is suitable for babies from 6 months.
the mAIF Agreement does not apply to:
• toddler milk drinks suitable from 12 months (sometimes called growing Up milks) • complementary foods (i.e. baby cereal and packaged baby foods)
• feeding bottles and teats.
10.2.2 Advisory Panel on the Marketing in Australia of Infant Formula
the Advisory Panel on the marketing in Australia of Infant Formula (APmAIF) monitors compliance with, and advises the government on, the mAIF Agreement. the APmAIF assesses complaints, which may be submitted by the public (including industry participants or other interested stakeholders) and determines whether a breach of the mAIF Agreement has occurred.
membership of the APmAIF comprises an independent chair, an industry representative, a community and consumer representative, a public health and nutrition expert and a legal expert. members are appointed by the Parliamentary secretary for Health and Ageing. the department of Health and Ageing acts as official observer and provides secretariat services.
terms of reference of the APmAIF are to:
• receive and investigate complaints regarding the marketing in Australia of infant formulas • act as a liaison point for issues relating to the marketing in Australia of infant formulas • develop guidelines on the interpretation and application of the mAIF Agreement
• provide advice on the operation of the mAIF Agreement to the Australian government minister for Health and Ageing.
the APmAIF has no statutory or formal regulatory powers, either to obtain information from industry participants or other parties or to enforce the mAIF Agreement. Reliance is placed upon the cooperation of the industry participants and other stakeholders to provide information, and on the commitment of industry participants to implement any changes to marketing practices that are requested by the APmAIF.
while there are no financial or legal sanctions associated with breaches of the mAIF Agreement, if the APmAIF determines that a breach of the mAIF Agreement has occurred, the minister (or Parliamentary secretary) is informed and details of the breach are published in the APmAIF’s annual report. the annual report is normally tabled in Parliament and copies made available to stakeholders. Reports are also available from the APmAIF website.567
In accordance with its terms of reference, the APmAIF occasionally develops guidelines on the interpretation and application of the mAIF Agreement. these guidelines are made available on the APmAIF website as a reference source for stakeholders.
10.3 Differences between the MAIF Agreement and the WHO Code
the mAIF Agreement only operates in Australia and does not implement all aspects of the wHo code. It is part of Australia’s response to becoming a signatory to the wHo code. It applies only to manufacturers and importers of infant formulas and does not include other milk products, foods, beverages or feeding bottles and teats. only manufacturers and importers are signatories to the mAIF agreement, which therefore excludes retail activities. due to the need to cover a wider range of social and economic circumstances, the wHo code applies to all marketing and related practices of the following products: breast-milk substitutes including infant formula, other milk products, feeding bottles and teats and foods and beverages - including bottle fed complementary foods, when marketed to be suitable for use as a partial or total replacement of breast milk. It also applies to their quality and availability and to information concerning their use.It should also be noted that the wHo code applies to ‘health workers’ who may or may not have a professional qualification whereas the mAIF Agreement refers to ‘health care professionals’. For this reason the mAIF Agreement differs from the wHo code in that it allows for the distribution of samples for professional evaluation and research purposes, through health care professionals including pharmacists.