ATNI’s work on Breast-milk Substitute (BMS) Marketing

27 August 2020

Nutrition within the first 1,000 days of a child’s life, from conception to two years old, is critically important to their development and their health.

Breastfeeding is a crucial element of infant and young child nutrition. It is the best start in life a child can be given. Scaling up exclusive breastfeeding in the first six months of age to near universal levels could prevent the deaths of over 820,000 children under five each year. This is why the World Health Organisation (WHO) recommends that babies everywhere are breastfed exclusively for the first six months, at which point safe, appropriate complementary foods should be introduced to meet the children’s evolving nutritional requirements. WHO also advises that complementary foods should not be used as breast-milk substitutes, and that infants and young children should continue to be breastfed until they are two or older.

How ATNI provides information on BMS marketing to stakeholders

Inappropriate marketing of breast-milk substitutes and complementary foods can undermine optimal infant and young child nutrition. Many organisations, including Save The Children, Helen Keller International, the International Baby Food Action Network (IBFAN) and others have documented widespread examples of inappropriate marketing of these products in markets around the world for many years. ATNI strongly supports the view of the WHO and others that all nations should adopt laws and regulations that fully implement The International Code of Marketing of Breast-milk Substitutes and all19 subsequent relevant World Health Assembly (WHA) resolutions. However, the most recent assessment by WHO found that, as of April 2020, the number of its 194 members states to have measures substantially aligned with the Code was only 25. A further 42 had moderately aligned measures and 69 had only included some the provisions; 58 had no legal measures at all.

In the absence of comprehensive Code-aligned regulation in all markets, ATNI believes that baby food companies should unilaterally adopt policies to responsibly market all of their products in all markets – as the Code calls on them to do, i.e. to implement its recommendations in full. ATNI’s goal is to provide stakeholders with objective, comprehensive, regular, systematic assessments of the extent to which the world’s largest baby food companies’ marketing have done so. ATNI is well-positioned to conduct this work having many years of experience in designing and publishing private sector accountability tools on all dimensions of the global nutrition challenge.


ATNI is fully independent of the food and beverage industry. Our funding comes exclusively from governments agencies like the UK Department for International Development (DFID), the Dutch Ministry of Foreign Affairs (DGIS) and Irish Aid, or philanthropic foundations such as the Bill & Melinda Gates Foundation and the Robert Woods Johnson Foundation. ATNI is overseen by an independent Board and adheres to a range of publicly available governance policies, including one on that ensures we have no Conflict of Interest.

While ATNI consults a wide range of stakeholders in developing the methodologies for our Indexes and other private sector accountability tools, the final decisions on the content, scope, scoring and presentation of the results is taken by ATNI, with advice from academic experts or leading organisations in the nutrition field. Following the publication of each Index, we discuss our findings with the companies we assess and provide them with recommendations on how they can improve. Moreover, the institutional investors that support our work use our analysis in their research and engagement with the rated companies. FTSE Russell is increasingly drawing on our research in this area to inform its decisions about which companies are included within its FTSE4Good Indexes. Our recently released Investor Expectations on Nutrition, Diets and Health, which can be used by all institutional investors in their research and engagement with companies, include the expectation that any companies that make or market formulas or complementary foods comply with the Code.

ATNI’s assessments of baby food companies’ marketing policies, practices and disclosure

Each of our Global Access to Nutrition Indexes includes a sub-ranking that assesses the world’s largest baby food manufacturers’ marketing of breast-milk substitutes and complementary foods, the results of which feed into the scores of those baby food companies’ included in our Global Indexes. Over time, the number of companies assessed has increased; the forthcoming 2021 Global Index will evaluate the ten largest baby food companies in the world, which in 2018 accounted for more than 63% of global market share.

ATNI’s approach to assessing companies comprises two elements:

  1. Each company’s policies, practices and disclosure relating to the marketing of these products are assessed using ATNI’s methodology to determine the extent to which they are marketed in line with the recommendations of the International Code of Marketing of Breast-milk Substitutes and all subsequent relevant World Health Assembly (WHA) resolutions, including WHA 69.9 adopted in May 2016.
  2. For each Global Index, ATNI selects two countries where extensive independent studies are conducted of companies’ marketing practices using the NetCode Protocol, developed by the WHO with UNICEF, WHO Collaborting Centers, NGOs, academic institutions and selected Members States. ATNI contracts the employee-owned international health research company Westat to conduct these studies.


Companies’ scores on each element are combined to generate their overall score on the marketing of BMS and CF. The scoring system is set out in our methodology, noted above.

The results from the 2018 Index showed that none of the six major companies assessed is yet close to marketing all of their products fully in line with the Code – which would be indicated by a score of 100% in our assessment. However, there is a wide variation in the scores: the highest score of only 46% was achieved by Danone, followed by Nestlé with a score of 45%. Abbott ranked third with an overall BMS Marketing score of 34%; Friesland Campina scored 25% and RB (which now owns Mead Johnson’s formula brands) scored only 10%. Kraft Heinz scored zero and ranked last. These scores illustrate why many organisations like Save The Children, UNICEF, IBFAN and others advocate so strongly for much greater action from this sector to bring their marketing in line with the Code.

Global Index 2018 | BMS Chapter

What progress does ATNI hope to see over the next decade?

Optimal infant and young child nutrition is critical to achieving global nutrition goals, such as those set by the World Health Organization (WHO) for 2025 on improving maternal and infant nutrition and those related to combating growing levels of overweight and obesity, and reducing deaths and illness related to diet-related chronic diseases. It is also key to delivering SDG 2 – Zero Hunger and SDG 3 – Good Health and Wellbeing, which in turn underpin the achievement of many other SDGs. Huge additional efforts therefore need to be made by all stakeholders to improve on the current situation where only two in every five infants under six months are exclusively breastfed around the world, to boost continued breastfeeding from six months of age onwards and ensure that all young children have adequate, healthy, balanced diets.


One new initiative designed to invigorate corporate action related to this agenda – which ATNI strongly welcomes – is the Breastmilk Substitutes Call To Action – the Road to Code Compliance. It was issued to the whole baby food industry on June 25th 2020. This unique and important step is supported by WHO, UNICEF, 1000 Days, BRAC, FHI360, FHIsolutions, Helen Keller International and Save the Children. Essentially, the Call to Action asks each and every baby food company to commit to full compliance with the International Code of Marketing of Breast-milk Substitutes and subsequent resolutions (the Code) globally (including coverage of breastmilk substitutes up to 36 months of age), and by the end of 2020 disclose a concrete plan for achieving this goal by 2030 at the latest, with delineation of clear incremental steps. ATNI has been asked by the signatories to evaluate the companies’ responses and to monitor implementation of their commitments over the next decade – a role we are honoured to play.

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