IN.F.ACT. USA presents at the World Public Health Nutrition Congress 2024

Ellie Mulpeter, Program Coordinator for IN.F.ACT. USA, presented at the WPHN 2024 Congress in June alongside several members of the international research team working on a project that uses a novel approach to monitoring violations of the World Health Organization’s (WHO) International Code of Marketing of Breastmilk Substitutes (“The Code”).

From left to right: Ellie Mulpeter (IN.F.ACT. USA); Dr. Anna Blair (Healthy Children Project, Inc.); Betty Sterken (IBFAN Canada); Barbara O’Connor (Healthy Children Project, Inc.)

The presentation was included in a panel discussion on the evidence supporting food marketing regulations. The WPHN Congress’s focus was: “Questioning the Solutions: Has the Decade of Nutrition delivered?” Researchers presented their projects on topics ranging from food insecurity, to infant feeding, to corporate capture and conflicts of interest in the private sector – all of which are, of course, related.

The research of IN.F.ACT. USA and team members in Australia, Canada and the UK continues in its enrollment currently. Interested parties can learn more at:


WHO 154th Executive Board Meeting, Geneva, 22 January – 27 January 2024

Ellie Mulpeter of INFACT USA will be heading to Geneva later this month alongside her global colleagues of IBFAN to advocate for a resolution to protect families and babies from predatory digital marketing practices of breastmilk substitute (BMS) companies.

As summarized by colleague Patti Rundall of IBFAN on her blog,

“2024 is a reporting year for  Maternal, Infant and Young Child Nutrition so Digital Marketing will be discussed under the “Healthier Populations” agenda item.   

Digital marketing is fast becoming the predominant source of exposure to promotion of baby feeding products globally. In 2022, WHO’s report on digital marketing of breast-milk substitutes  described its cross border extent and power. It is now totally out of control and parents and carers everywhere are targeted by paid  ‘influencers’ and other deceptive schemes with information that undermines WHO and national health recommendations and disempowers parents.

A WHA Resolution supporting the  WHO Guidance on digital marketing of breast-milk substitutes  would  send a  clear message to all WHO Member States that there is a political expectation to implement it.  Implementation of this Guidance will have zero cost to governments, yet the lowering of healthcare costs and stronger, more able workforces will benefit national and family economies.”

A proposed WHA Resolution would read as follows:


It is estimated that over 800,000 child deaths occur each year due to inadequate breastfeeding. Breastfeeding is considered to be one of the most important interventions that exists to protect the health of infants and young children. Unfortunately, the active promotion of breast-milk substitutes worldwide leads to unnecessary and improper use of these products and dissuade families from breastfeeding.

While implementation of the Code of marketing of breast-milk substitutes has limited certain types of promotions, new digital marketing strategies, including targeted ads appearing on pregnant mothers’ cell phones, clandestine participation in online baby clubs, or coaxing mothers to market formula to one another, were not possible when the Code was written. WHO highlighted the widespread exposure and power of these digital tools in 2022 (, noting that digital marketing is the dominant form of marketing in many countries and that new approaches to regulate and enforce the Code are needed.

The Seventy-fifth World Health Assembly, in decision WHA75(21) on maternal, infant and young child nutrition, requested that WHO develop guidance for Member States on regulatory measures aimed at restricting the digital marketing of breast-milk substitutes. WHO published draft guidance on 30 August and will be publishing the final guidance in early November.

It is important that the World Health Assembly takes action on this guidance and calls upon all Member States to take immediate action to address this growing challenge to breastfeeding. The collective weight of the Assembly is needed to ensure that the guidance not become just another set of recommendations from the secretariat. The nature
of digital marketing is inherently transnational and requires urgent collective action.

Xxxxx proposes to lead a Member States in developing a resolution to be adopted at the Seventy-seventh WHA in May 2024. Such a resolution would endorse the WHO guidance and call for various implementation steps to give immediate effect to the recommendations made. An initial draft of the resolution is below.


CODEX to decide on global trade of ultra-processed baby drinks

REPOST: Baby Milk Action Policy Blog – P.Rundall


CCNFSDU43 March 7-10, 2023

IBFAN, alongside ENCA,  ILCA, HKI, WHO and UNICEF  are attending the Codex Nutrition Committee once again where the Review of the Standard for follow-up formula (CXS 156-1987) is expected be finalised this week. 

Background: The lack of marketing safeguards in the original 1987 Standard for Follow-up Formula (FUF) undermined breastfeeding globally and boosted the growth of a $ multi-billion market for unnecessary, denatured, ultra-processed, sweet-tasting, additive laden and flavoured products for older babies – products deliberately invented to get round the marketing recommendations applying to infant formula.

These totally unnecessary and risky products have damaged child health, fuelled the obesity epidemic and added to the environmental burden. (IBFAN Cop26)

The 2023 Lancet Series on Breastfeeding, highlighted baby food industry and powerful exporting states use weak Codex standards in their attempts to stop governments bringing in strong marketing controls, wrongly claiming that Codex standards are a ‘regulatory ceiling’ for trade purposes.  Such challenges have a chilling effect on governments.

IBFAN will be once again calling on Governments to use this opportunity to safeguard the most vulnerable members of society.

SUMMARY OF IBFAN’s CONCERNS:  There are still many unresolved issues on the standard including:   sodium levels,  sweetness; flavourings an  inadequate safeguards to prevent Cross Promotion. Most importantly, a Preamble is needed to ensure that Member States are not challenged when adopting legislation in line with WHO recommendations to halt promotion of these products – ideally before they are placed on the market.


One good thing: after complaining for many years about the lack of transparency in this Codex Committee, this meeting will be broadcast live here.

The Agenda and background papers are HERE. 


This Standard is divided into two sections. Section A refers to Follow-up Formula for Older Infants, and Section B deals with REVERSE ORDER: Drink for Young Children, or Product for Young Children, or alternatively Drink for Young Children with Added Nutrients, or Product for Young Children with Added Nutrients.

The application of this Standard should be consistent with national health and nutrition policies and relevant national/regional legislation and take into account the recommendations made in the International Code of Marketing of Breast-milk Substitutes, DELETE: as per the national context], relevant World Health Organization (WHO) guidelines and policies and World Health Assembly (WHA) resolutions that were considered in the development of this Standard and DELETE may provide further guidance to countries in ending the inappropriate promotion of these products and misleading practice of cross-promotion.

ADD: Follow-up Formula and Drinks for Young Children are not necessary. Energy and nutrient dense family foods with continued breastfeeding for young children can provide the essential complementary feeding to meet the nutrient requirements for older infants and young children.

SWEETNESS:  At the last meeting in November 2021, New Zealand, Australia, the US and the baby food industry (ISDI) called for the deletion of this key sentence: “for products based on non milk protein, carbohydrate sources that have no contribution to sweet taste should be preferred and in no case sweeter than lactose.   Norway, Uruguay, Mexico, Brazil, EU, Chile, Switzerland, WHO, NHF, IBFAN and ENCA all supported its retention. EU and Switzerland now have a new statement calling for extra safeguards: EU/CH CRD16

FLAVOURSAt the last meeting  flavourings were banned for follow-up formulas for older infants. Many countries, WHO, UNICEF and NGOs also strongly opposed for fruit extracts and vanilla flavourings for the drinks 12-36 months. The EU (representing 27 countries) saw no technological need for flavours and questioned the safety of fruit extracts as flavouring agents in that many contain additional compounds.  The US, Canada, Australia and New Zealand and the industry friendly European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) argued that a prohibition of flavours would put the baby drinks at a disadvantage to ‘less good’ products that don’t meet Codex standards. A compromise sentence was added: National or regional authorities may restrict or prohibit the use of the listed flavourings.


Comments in reply to CL 2022/24/OCS-NFSDU

Prepared by New Zealand. Agenda Item 4.  CRD 2. NFSDU43_CRD02e

CRD3: REVIEW OF THE STANDARD FOR FOLLOW-UP FORMULA Prepared by New Zealand. Consideration of relevant concepts and technical guidance in WHO/WHA documents for the labelling and other provisions in the draft standard for follow-up formula


(2)  Russ K, Baker P, Byrd M, et al. What you don’t know about the Codex can hurt you: how trade policy trumps global health governance in infant and young child nutrition. International Journal of Health Policy and Management 2021; 10(12): 983-97.  Baker et al. Globalization and Health (2021) 17:58. Advocacy at Work During the Codex Committee on Food Labelling Meeting


Agenda Item 6


Comments of Brazil, Canada, Chile, Colombia, Cuba, European Union, Iran, Iraq, Japan, New Zealand, Paraguay, Peru, Philippines, Republic of Korea, Saudi Arabia, South Africa, Syrian Arab Republic, United States of America and European Network of Childbirth Associations (ENCA), International Food Additives Council (IFAC), International Baby Food Action Network (IBFAN), International Special Dietary Food Industries (I

IBFAN comments on Additives

IBFAN comments in response to the requests in the circular letter CL 2022/80/OCS-NFSDU regarding the technological justification for the use of certain food additives in food complying with The Standard for Infant Formula and Formulas for Special Medical Purposes (CXS 72-1981).



  1. In the discussion on the adoption of the Guidelines for Ready-to-Use Therapeutic Foods (RUTF) at Step 8:
    •   Many Members intervened in support of final adoption and commended the leadership of the working group in completing the Guidelines.
    •   One Member and an Observer noted the level of carbohydrates, specifically sugar, exceeded WHO recommendations. This issue was discussed extensively at CCNFSDU including current constrains on product formulation and it was also highlighted that RUTF were meant for short term use.
    •   Observer organizations expressed the view that the level of magnesium was too low; stressed the need to guard against inappropriate promotion of the products; underlined the need to ensure the availability of potable water; expressed the view that the preamble should further address the need for appropriately designed programmes to support continued breastfeeding and re-lactation; and that the use of RUTF should not preclude the use of culturally appropriate home-based foods.Conclusion
  2. CAC45 adopted the Guidelines for Ready-to-Use Therapeutic Foods (RUTF) at Step 8 with the editorial amendments as proposed by WHO on the definition for Severe Acute Malnutrition and by EU in CX/CAC 22/45/4 Add. 1.

Codex Alimentarius: Upcoming CCNFSDU43 Meeting

The 43rd Session of the Committee on Nutrition and Foods for Special Dietary Uses will be held in Duesseldorf, Germany on 7 – 10 March 2023. The report adoption will be held virtually on 15 March 2023 at 11:00 – 16:00 (CET).

INFACT USA will be supporting the broader International Baby Food Action Network (IBFAN) comments submitted to the committee on relevant agenda items. Unfortunately, IBFAN’s comments are not in line with the U.S. CODEX office’s comments.

Patti Rundall, the Global Advocacy Spokesperson for IBFAN, notes: “Agenda Item 4  on the revised standard for Follow-up Formulas may well be concluded during this session.  IBFAN considers that the standard has too many unresolved areas so should not be approved at this session.” IBFAN comments can be found here.