As a 501(c)3 organization, NABA REAL functions to educate the public, state and federal legislators, policymakers, government agencies, and the health care system about breastfeeding and the hazards of not breastfeeding. It does this through numerous activities, including: 

Code Monitoring

The International Code of Marketing of Breast Milk Substitutes is a set of recommendations from the collective membership of the highest international body in the field of health – the World Health Assembly, regarding the marketing practices of companies producing breast milk substitutes. It is a recognition that the use of breast milk substitutes and the marketing of such products lie outside the channels of regular commercial operations. The Code functions as a tool to curb the unethical marketing practices, false and misleading advertising, and complicity by health care professionals, the health care system, and governments that combine to influence a mother to replace her breast milk with a commercial substitute, either completely or partially. The Code does not ban the sale or use of infant formula. The Code also forms the foundation of other breastfeeding advocacy tools, such as the Baby Friendly Hospital Initiative. Without support of the Code, these breastfeeding initiatives are diluted and weakened.

The United States entered into a consensus agreement in 1994 endorsing the Code and other WHA resolutions up to that date. The US also joined all other nations in consensus agreement in 1996 and 2001 on support for the Code and the resolutions being considered at each time. The Code is a voluntary agreement that has no legislation or mandates for companies to adhere to and no sanctions for violating. Therefore Code violations are intense in the US, with all formula makers and much of the infant feeding industry in violation of one or more of the articles or resolutions.

NABA REAL monitors the Code in the US. We have conducted two monitoring projects with their respective reports available, Selling Out Mothers and Babies and Still Selling Out Mothers and Babies. Violations of the Code are spotted and reported by NABA’s Code monitors. This is a volunteer group of breastfeeding advocates who have attended NABA’s Code training workshop and report periodically on violations in their area of the country. Everyone is encouraged to report Code violations to NABA for inclusion in the country report.  


Code HelpCenter

Since the Code is a compromise between breastfeeding advocates and the infant feeding industry, there are a number of gray areas and levels of uncertainty regarding situations and materials that crop up in various settings. While the WHA resolutions are targeted towards closing loopholes in the Code, there still remain ever-changing marketing practices and products that require consultation. You can obtain help with questions regarding the Code by contacting NABA REAL through e-mail at:

Code Resources

Allain A, Kean YJ. Breaking the rules: stretching the rules 2007. Penang, Malaysia, International Code Documentation Center, 2007

Armstrong H, Sokol E. The International Code of Marketing of Breast-Milk Substitutes: What it means for mothers and babies world-wide. (revised) Raleigh, NC: International Lactation Consultant Association, 2001

Chetley A, Allain A. Protecting infant health: a health worker’s guide to the International Code of Marketing of Breast Milk Substitutes. Penang, Malaysia: IBFAN, 1998

Interagency Group on Breastfeeding Monitoring (IGBM). Cracking the code. London, IGBM, 1997

International Baby Food Action Network (IBFAN). Breaking the rules, stretching the rules 1998. Penang, IBFAN/ICDC, 1998

International Code Documentation Center (ICDC). State of the Code by Country 1998, State of the Code by Company 1998, Penang, IBFAN, 1998

International Code Documentation Center (ICDC). Breaking the rules, stretching the rules 2001. Penang, IBFAN S/B, 2001

Mehdi T, Wagner-Rizvi T. Feeding fiasco: pushing commercial infant foods in Pakistan. Islamabad, Pakistan: TheNetwork, 1998

Radford A, Meiklejohn D, Dickson D. Breaking the rules 1994. Cambridge, UK: Baby Milk Action, 1994

Radford A, Arts M. Breaking the rules 1991. Penang: IBFAN/IOCU, 1991

The Code handbook: a guide to implementing the International Code of Marketing of Breastmilk Substitutes. Penang, Malaysia: International Code Documentation Center, 2nd ed

Sokol E, Allain A. Complying with the Code? A manufacturers’ and distributors’ guide to the Code. Penang, IBFAN, 1998

TheNetwork—Association for Rational Use of Medication in Pakistan. Milking profits: how Nestle puts sales ahead of infant health. Islamabad, Pakistan: TheNetwork, 1999

Walker M. Selling out mothers and babies: marketing breast milk substitutes in the USA. Weston, MA: NABA REAL, 2001

Walker M. Still selling out mothers and babies: marketing of breastmilk substitutes in the USA. Weston, MA: NABA REAL 2007

Wemos. Breaking the rules Europe: a European report on violations of the WHO/UNICEF International Code of Marketing of Breastmilk Substitutes. Amsterdam: Wemos, 1998