Breast-milk substitute questions and answers

The Ministry reviewed the New Zealand interpretation of the International Code because there was concern that it might not be meeting its intended objectives.

There had also been a series of World Health Assembly resolutions urging member states to strengthen national mechanisms to give effect to the International Code, along with changes in the marketing and distribution of foods for infants and young children.

The review was published in 2004. Consumer groups, maternity service providers, public health providers, industry and international bodies were consulted.

The Ministry met with stakeholders, Māori health practitioners, Pacific health practitioners and breastfeeding consumer and support groups.

The review document provided 11 actions as the basis for refining and strengthening the New Zealand interpretation of the International Code.

Action one is that the Ministry of Health prepare a single, standard reference document to be used by all parties.

The new publication is known as the Code in New Zealand.

It includes the revised Code of Practice for Health Workers (Health Workers' Code) the Infant Nutrition Council Code of Practice for the Marketing of Infant Formula (INC Code of Practice) and makes reference to, and is closely linked with the Code for Advertising of Food and the Food Standards Code.

The Code in New Zealand supersedes the 1997 Ministry publication Infant Feeding Guidelines for New Zealand Health Workers, and the 1997 version of the INC Code of Practice.

The Code in New Zealand aims to be clearer, simpler and more accessible.

The Health Workers’ Code, included in the publication, aims to ensure that health workers protect, promote and support breastfeeding, giving clear, consistent and accurate information about the importance of breastfeeding and the health consequence of not breastfeeding.

The Health Workers’ Code also requires health workers to meet their obligation to give detailed information and advice to parents, caregivers and families of breastfed and formula-fed infants on infant feeding.

It also means that health workers have guidance on how to create a breastfeeding friendly environment in their organisation.

The Code in New Zealand means that mothers and families should be given information to make an informed choice about feeding their infant, with appropriate advice and support.

It also means that infant formula should not be marketed in New Zealand, and follow on formula should not be marketed in a way that undermines breastfeeding.

Thus mothers are enabled to make the best possible feeding choice, based on impartial information and free of commercial influences, and to be fully supported in doing so.

The Code in New Zealand is an important part of creating an overall environment that protects, promotes and supports breastfeeding.

Improper marketing and promotion of food products that compete with breastfeeding are important factors that often negatively affect the choice and ability of a mother to breastfeed her infant optimally.

Given the special vulnerability of infants and the risks involved in inappropriate feeding practices, usual marketing practices are therefore unsuitable for these products.

The Ministry monitors compliance with the Health Workers’ Code and the INC Code of Practice.

The Ministry does this by receiving complaints about potential breaches of either Code of Practice.

If an issue is not resolved to the complainant’s satisfaction through a natural justice process, it will be submitted to a Compliance Panel for a decision.

There is an appeal process, and an adjudicator, for complaints unresolved by the Compliance Panel.

The Advertising Standards Complaints Board is responsible for monitoring compliance with the Code for Advertising of Food.

The Ministry for Primary Industries is responsible for administering and monitoring compliance with the Food Standards Code.

Anyone who has concerns about the practices of a health worker or an organisation, INC companies’ marketing, advertising of follow-on formula or food for infants over six months of age; or the labelling, composition or quality of formula or other food products can make a complaint.

See the Code in New Zealand document or the complaints procedure for guidance on how to make a complaint.

New Zealand adopted the International Code in 1983. A voluntary, self-regulatory implementation and monitoring process was set up in 1997.

New Zealand's breastfeeding rates for 2012/13 are as follows:

• At six weeks, the rate of full breastfeeding (includes exclusive and full) was 70% of European/Other babies, 58% of Māori babies, 57% of Pacific babies and 60% of Asian babies
• At three months, the rate of full breastfeeding (includes exclusive and full) was 59% of European/Other babies, 43% of Māori babies, 46% of Pacific babies and 58% of Asian babies
• At six months, the rate of full breastfeeding (includes exclusive and full) was 28% of European/Other babies, 15% of Māori babies, 18% of Pacific babies and 29% of Asian babies.

Although New Zealand has breastfeeding rates at birth that are consistent with other OECD countries, rates are low at six weeks, especially among Māori and Pacific women.

Exclusive breastfeeding prevalence drops sharply in the first six weeks after birth and then continues to decline as partial and artificial feeding becomes more common.

There are a number of barriers to continued breastfeeding. These include:

• a lack of breastfeeding education and support
• returning to paid work and the cost of equipment for expressing breast milk
• breastfeeding must be learned and initial problems are almost universal
• awareness of common problems and solutions is low
• many women do not have access to appropriate help for overcoming breastfeeding problems when they need it
• pain and exhaustion are common reasons for introducing formula
• supplementation of breastfeeding with formula is common at all stages and partly accounts for ethnic disparities in exclusive breastfeeding rates
• early introduction of solids (from around three months) seems to be common, particularly in Māori and Pacific communities.

There are a number of strategies, initiatives, and programmes that protect, promote and support breastfeeding.

The relevant strategies are the New Zealand Health Strategy, the New Zealand Disability Strategy, He Korowai Oranga: Māori Health Strategy, Ala Mo‘ui: Pathways to Pacific Health and Wellbeing 2010–2014, the Primary Health Care Strategy, Reducing Inequalities – intervention framework and the Health Equity Assessment Tool.

Also, in 2009, the National Strategic Plan of Action for Breastfeeding 2008–2012 was published.

Key policy documents include Food and Nutrition Guidelines for Healthy Pregnant and Breastfeeding Women: A background paper, and Food and Nutrition Guidelines for Healthy Infants and Toddlers (Aged 0–2): A background paper, and the Code in New Zealand.

Initiatives, providers and programmes include the Baby Friendly Hospital Initiative, maternity service providers, Well Child providers, breastfeeding advocacy and support programmes, regional pregnancy and parenting programmes.

Breastfeeding is the normal, natural way to feed infants, and is part of laying the foundations for a healthy life from infancy and childhood.

A substantial body of evidence shows that breastfeeding contributes positively to nutrition, health and wider well-being for babies, mothers and whānau/families.

For instance, breastfed infants have increased resistance to illnesses, better cognitive development, and reduced risk of a range of conditions including diabetes and obesity.

Benefits for mothers include protection against postpartum haemorrhaging, and breast and ovarian cancer.

The World Health Organization (WHO) recommends that infants be fed exclusively on breast milk from birth to six months of age.

After that time, appropriate complementary foods should be introduced and breastfeeding continued up until two years of age or beyond (WHO 2003).

Breastfeeding is very important in the first six months of life, and its importance continues into toddlerhood.

Breastfeeding meets the full nutritional requirements for healthy full-term infants for the first six months and, in conjunction with complementary foods, provides an essential part of child nutrition into the second year and beyond (WHO 2003).

The aim of the Code in New Zealand is to contribute to safe and adequate nutrition for infants.

Health workers should give accurate, objective and consistent information and educational material on breastfeeding and formula feeding, and should discuss the benefits and problems associated with the different methods of feeding so parents can make an informed decision.

Health workers must ensure appropriate use of formula when necessary.

You can download and order copies of the Code in New Zealand from the Publications section of this website – Implementing and Monitoring the International Code of Marketing of Breast-milk Substitutes in New Zealand: The Code in New Zealand.