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:

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ProPublica releases records and interviews revealing U.S. government favoring formula industry marketing

On March 21, 2024, ProPublica published a scathing story about the U.S. interference of the protection, support and promotion of breastfeeding and of the WHO Code of Marketing of Breastmilk Substitutes.

Government documents obtained by ProPublica show a stark rift between trade and health officials over international efforts to regulate toddler milk. The records provide a rare, candid glimpse into U.S. policymaking around children’s health.

The full story can be read here.

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Baby Food Manufacturer Held Accountable in $60M Lawsuit

The jury found formula manufacturing giant Mead Johnson liable and awarded the plaintiffs $60 million — $35 million more than plaintiff’s attorneys were asking. 

The company was accused of not doing enough to warn parents about the increased risk of a deadly disease in premature babies given their formula called Necrotizing Enterocolotis, or NEC for short.

The trial involving a Fairview Heights mother who lost one of her twin premature babies is the first of hundreds of similar case cases that are part of multidistrict litigation. The I-Team found more than 330 lawsuits filed nationally on the topic.

Source article can be found here:,are%20fed%20in%20NICUs%20nationwide.


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.

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New AAP Report on Misleading Marketing of Toddler Milks

According to the American Academy of Pediatrics (AAP), toddler “formulas” that are promoted as nutritious drinks for the older infant or preschooler are generally unnecessary and nutritionally incomplete, and the marketing practices that promote them are questionable.

The AAP has published a new clinical report, “Older Infant-Young Child ‘Formulas,'” that reviews the growing array of drinks aimed at children ages 6-36 months and observes that they lack standardization or regulatory oversight.

It is not new information that marketing efforts of breastmilk substitutes are consistently predatory and create a lot of confusion for the general public, along with undermining breastfeeding efforts of parents. However, this report, coming from an organization such as the AAP, highlights a corner of the market that is not often in the limelight – that of toddler milks and ‘follow-up’ formula.

The new report from the AAP concludes by recommending the following:

  • For infants younger than 12 months, the liquid portion of the diet should be provided by human milk or standard infant formula that has been reviewed by the FDA based on the Infant Formula Act.
  • For toddlers (children 12 months and older), caregivers should provide a varied diet with fortified foods to optimize nutritional intake. OIYCFs can safely be used as part of a varied diet for children but do not provide a nutritional advantage in most children over a well-balanced diet that includes human milk (preferred) and/or cow milk, and these products should not be promoted as such. OIYCFs have no specific role in routine care of healthy children and are more expensive than cow milk.
  • Marketing of OIYCFs should make the clear and unambiguous distinction from standard infant formula in promotional materials, logos, product names, and packaging. OIYCF product name should not be linked in any way to infant formula (numerical, steps, sequential name) and should be labeled as something other than formula—for example, follow-on or toddler “drink” or “beverage” rather than follow-on or toddler “formula.” Product placement in store shelves of OIYCFs should not be alongside standard infant formulas.
  • Education of families about OIYCFs by health care teams as part of well-child visits is encouraged.
  • Medical providers and care teams should complete a focused nutritional assessment, with consideration of mineral- and iron-rich solid food consumption and offer adjustment of solid food intake and/or vitamin supplementation as needed.

The full report can be found here:

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Global Congress on Implementation of the International Code of Marketing of Breast-milk Substitutes – WHO/UNICEF

Geneva, Switzerland; June 20-22, 2023

Large group of IBFAN representatives from around the world

Last month, INFACT USA joined the many other global representatives of the Infant Baby Food Action Network (IBFAN) and participated in the WHO/UNICEF first ever Code Congress.

More than 400 people came together at the WHO headquarters with a shared goal – to protect every mother and pregnant woman against predatory marketing practices of infant and young child feeding products, including infant formula. Throughout the three day congress, the same message was emphasized again and again: “The best way to support these women is to enact, monitor and enforce the International Code of Marketing of Breast-milk Substitutes.”

The World Health Assembly (WHA) in 1981 adopted the International Code of Marketing of Breast-milk Substitutes. Forty-two years later, formula milk manufacturing companies continue to violate these established principles and place commercial interests before children’s and families’ health. Subsequent WHA resolutions have repeatedly called upon national governments to enact, monitor and enforce the provisions of the Code.

“Over 70% of Member States have enacted legislation that puts in place at least some of the provisions of the Code,” said Dr Francesco Branca, Director of Nutrition and Food Safety at WHO. “But industries are still expanding to push an ever-increasing range of formula milk products on families, using insidious tactics to access their networks and influence their choices. Parents have the right to impartial information on infant feeding, which is actively undermined by exploitative industry marketing.”

WHO and UNICEF notably excluded commercial companies from participation at the Code Congress, much to the annoyance of the International Special Dietary Foods Industries (ISDI), who issued this Statement just one day after the start of the Congress in Geneva.

Here in the United States, there is an incredible amount of work to be done to advance the WHO Code and its subsequent resolutions. To date, the U.S. is one of three countries in the world that did not sign onto the Code back in 1981. While that step may never come for the U.S., there are other options and avenues to implement protections against predatory marketing practices of these commercial baby-food product companies.


After 10 years of struggle, Codex puts child health before trade at last.

REPOST: Baby Milk Action Policy Blog – P.Rundall


7th March, 2023,  Dusseldorf

IBFAN, WHO, UNICEF and partners breathed a sigh of relief today at the Codex Nutrition Committee in Dusseldorf.  After 10 years of tortured discussions in a Committee dominated by food corporations and powerful exporting countries, the main text of the revision of the 1987 Codex Standard for Follow-Up Formula was finalised with the addition of some important safeguards at the last minute. (1) The fact that the meeting was  webcast for the first time (private recording was banned previously) might have contributed to the good outcome.

Despite 8 countries saying that a preamble was not necessary and reservations from the USA about trade, the new standard  (2) will be sent to the Codex Alimentarius Commission for adoption in July and WILL refer to the International Code of Marketing of Breastmilk Substitutes and subsequent WHA Resolutions (the International Code).

While the standard has also improved its requirements for ingredients (the 1987 standard set no upper limits for sugar!),  banned health and nutrition claims and included many other labelling restrictions,  there are still unresolved problems. (3)

IBFAN urges governments to waste no time before bringing in strong marketing controls for all products up to 36 months in line with the International Code and Resolutions. If not, the ‘improved’ new Standard will lead to renewed commercial promotion and a slew of new ultra-processed products for young children with all their attendant risks.(4)  IBFAN, WHO and UNICEF are ready to help governments achieve this, ideally before these products are allowed on markets.

Governments have the sovereign right to adopt any legislation they consider necessary to protect child health as long as it does not violate international trade principles. The newly added references to the International Code and Resolutions in the Preamble will make it less likely that Code-aligned laws trigger costly, time-consuming WTO discussions or other challenges that have a chilling effect on policy-making. (5)

What happened this week

In a skilfully managed debate, the Chair, Dr Anja Brönstrup,  allowed plenty of time – two days – for debate on the final crucial aspects that had been left to the very end of the revision. In the 2019 meeting, the debate was curtailed, resulting in a bad decision on whether Cross Promotion should be forbidden.(6)

The industry notion that there should be two separate standards was quickly rejected, as many countries called for ONE standard with two parts.  Many also called for a Preamble that would protect breastfeeding and help governments position the products correctly in their regulatory frameworks. With such strong arguments and a clear majority, Canada, Switzerland, Australia and the EU changed their positions and indicated that they could support or at least ‘live with’ the compromise Preamble proposed by the New Zealand.  (7). The 9 reservations will be specified in the report but will not stop the Standard going forward for adoption by the Commission in July.

Some of the statements and written comments from country delegates:

John Oppong-Ottoo, for the African Union:

Gry Hay,  for Norway“Norway appreciates the proposed preamble text provided by the New Zealand chairs. Although we would have preferred a more comprehensive wording  [its] referral to key WHO and WHA documents, as well as a reference to subsequent WHA resolutions concerning infant and young child feeding ….provides context for understanding and implementing the standard. This will be of great importance for many countries in order to facilitate coherence with global policies to protect breastfeeding … WHO and UNICEF have documented how parents and pregnant women globally are exposed to aggressive marketing for baby formula milk and how marketing of formula milk influences decisions on infant feeding and undermines breastfeeding… The evidence is strong. Formula milk marketing, not the product itself, disrupts informed decision-making and undermines breastfeeding and child health.”


(1) The 1987 Follow Up Formula Standard legitimised these problematic products, that were deliberately invented to get round the marketing recommendations of the World Health Assembly in 1981. The standard’s poor composition requirements and total lack of marketing safeguards (based on the claim that follow-up formulas are not breastmilk substitutes) boosted the growth of a $ multi-billion market for these unnecessary products. Its existence undermined laws to protect breastfeeding, fuelled the obesity epidemic and added to the environmental burden.  One third of the world’s countries breastfeeding is a lifeline and the majority of children are breastfed in the 2nd year of life.  When this new work was started in 2012/13,  IBFAN proposed that the standard should be ‘sunsetted’ rather than updated.

(2) Reservations came from: Argentina Cuba, Vietnam, Panama, Guatemala, USA, Colombia, Costa Rica and Morocco. The Name of the Standard will be: Codex Standard for Follow-Up Formula for Older Infants and Product for Young Children**Other equivalent names for this product are drink for young children with added nutrients or product for young children with added nutrients or drink for young children.  

(3) While the standard has improved its requirements for ingredients (the 1987 standard set no upper limits for sugar!) banned health and nutrition claims and included many other labelling restrictions,  there are still unresolved problems including:  the sodium levels; the sweetness; that the drinks can contain flavourings; the inadequate safeguards to stop misleading Cross Promotion; the nutrient claim in one of the proposed names ‘drink/product with added nutrients’ and the lack of reference to the fact that the products are not necessary.

(4)  Risks of Ultra-Processed Foods (UPFs): UPFs form 50% of Britons’ calorie intake; Nelson et al Premature Deaths Attributable to the Consumption of Ultraprocessed Foods in Brazil  American Journal of Preventive Medicine  10.1016/j.amepre.2022.08.013 2022) article; Angel et al.  Ultraprocessed Foods and Public Health: A Need for Education. Mayo Clinic Proceedings, Volume 94, Issue 11, November 2019, Pages 2156-2157; Wang et al. Trends in Consumption of Ultraprocessed Foods Among US Youths Aged 2-19 Years, 1999-2018.JAMA. 2021;326(6):519-530. doi:10.1001/jama.2021.10238; Neri et al. Ultraprocessed food consumption and dietary nutrient profiles associated with obesity: A multicountry study of children and adolescents. Obes Rev 2022 Jan;23 Suppl 1:e13387.do10.1111/obr.13387. Epub 2021 Dec 9; Nelson et al. Premature Deaths Attributable to the Consumption of Ultraprocessed Foods in Brazil Ultra-processed foods, diet quality, and health using the NOVA classification system Monteiro et al.

(5)  Weak Codex standards have regularly been used in  attempts to stop governments bringing in strong marketing controls. The wrong assumption is made that  Codex standards are a ‘regulatory ceiling’ for trade purposes. These threats have been highlighted in the 2023 Lancet Series on Breastfeeding.

(6) In the 2019 CCFSNDU meeting the critically important sentence: ‘Cross promotion between product categories is not permitted on the [label/labelling] of the product’, that was supported by many developing countries, was replaced by much weaker text that was falsely presented as having the same ‘intent’.  Cross Promotion’ or ‘brand stretching’ is a deceptive marketing technique used to expand the sale of tobacco and other products with public health concerns. Cross Promotion of milks is especially harmful and increases the risk of infants not being breastfed or being fed with entirely inappropriate products.

(7) Text of new Preamble proposed by New Zealand and agreed: “This Standard is divided into two sections. Section A refers to Follow-up Formula for Older Infants, and Section B deals with Drink for Young Children with Added Nutrients, or Product for Young Children with Added, or Drink for Young Children, or Product for Young Children. The application of this Standard should be consistent with national/regional 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, as per the national context. Relevant World Health Organization (WHO) guidelines and policies and World Health Assembly (WHA) resolutions were considered in the development of this Standard and may provide further guidance to countries.”


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. 

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Nutrition International Launches the “Cost of Not Breastfeeding” Tool

The Cost of Not Breastfeeding Tool aims to provide policymakers and advocates with a user-friendly tool to generate estimates of the potential health, human capital and economic benefits of scaling up breastfeeding promotion and support strategies. Evidence generated from the tool will be integral to raising awareness with government, industry and donors for scaling breastfeeding in accordance with the Global Breastfeeding Collective’s seven recommended policy actions.

The Cost of Not Breastfeeding Tool was first developed between 2017 and 2019 by Dr. Dylan Walters and Alive & Thrive, with funding from the Bill & Melinda Gates Foundation. This tool was instrumental in advocacy at the global level, being used for the Global Breastfeeding Collective’s Investment Case, and at the country level directly supporting efforts to advocate for policy changes and increase investments in maternal and child nutrition in numerous countries. In 2022, Nutrition International updated and developed the second version of the tool in partnership with Alive & Thrive and Limestone Analytics, with funding from the Government of Canada. This new version of the tool contains updated datasets, new indicators, a new function to calculate results for different breastfeeding rate scenarios or targets, and online access to the results for more than 100 countries.

You may access the new tool here: