Islamabad: Pakistan is still struggling to fully curb aggressive formula milk marketing and remains among countries only “moderately aligned” with the International Code of Marketing of Breast-milk Substitutes, with significant gaps persisting in monitoring, enforcement and safeguards against commercial influence of formula milk companies, says a new joint report by the World Health Organization (WHO) and UNICEF.
The report, titled “Marketing of Breast-milk Substitutes: National Implementation of the International Code, Status Report 2026”, assessed laws and regulations in 194 WHO member states to evaluate how effectively countries are restricting the marketing of infant formula and related products.
Pakistan was classified by WHO and UNICEF as “moderately aligned with the Code” based on its 2018 legal measures regulating the marketing of breast milk substitutes.
According to the report, only 37 countries worldwide are substantially aligned with the International Code of Marketing of Breast-milk Substitutes, while 39 countries, including Pakistan, fall in the moderately aligned category. Another 72 countries have only partial legal provisions and 46 countries still have no legal measures at all.
WHO and UNICEF warned that despite gradual progress in legislation, major loopholes continue to allow aggressive promotion of formula milk products globally through advertisements, sponsorships, digital marketing and indirect influence over healthcare systems.
The report noted that countries with stronger legal protections report significantly better breastfeeding rates. Exclusive breastfeeding rates were recorded at 54 percent in countries substantially aligned with the Code compared to only 24 percent in countries with no legal measures. Continued breastfeeding at one year reached 81 percent in countries with stronger protections compared to 44 percent in countries without legislation.
The report repeatedly referred to Pakistan while detailing national legal protections and gaps in implementation.
According to the report, Pakistan’s legal measures cover breast milk substitutes up to 12 months of age and also include complementary foods, feeding bottles and teats within the scope of regulation. However, Pakistan does not require monitoring and enforcement systems to be independent, transparent and free from commercial influence, which WHO and UNICEF identified as an important component of effective implementation.
The report further showed that Pakistan defines sanctions for violations of the Code but does not clearly identify authorities responsible for monitoring compliance.
Pakistan was also listed among countries that prohibit advertising of breast milk substitutes, ban promotional devices at points of sale, prohibit gifts to pregnant women and mothers and restrict direct contact with mothers for promotional purposes.
However, several important protections were found to be missing or only partially covered.
The report stated that Pakistan prohibits the use of healthcare facilities for promotion of formula milk products and bans displays of covered products and promotional placards within healthcare facilities. However, it does not prohibit distribution of materials provided by manufacturers inside health facilities, use of health facilities for promotional events or use of personnel paid by manufacturers and distributors.
Similarly, Pakistan has provisions restricting certain forms of engagement between formula milk manufacturers and healthcare workers, including restrictions on financial inducements, free or low cost supplies and product samples. However, the report indicated that some other forms of industry engagement and sponsorship remain insufficiently regulated.
WHO and UNICEF warned that globally only 35 countries prohibit gifts to health workers from formula milk companies, only 24 ban sponsorship of professional meetings and scientific conferences and only 56 prohibit free or low cost supplies of formula milk within healthcare systems.
The agencies also highlighted the growing threat posed by digital marketing of breast milk substitutes.
According to the report, the World Health Assembly in 2025 called on countries to strengthen regulation of online and social media marketing of breast milk substitutes and infant feeding products. WHO noted that companies are increasingly using social media platforms, digital advertisements, influencers and artificial intelligence driven targeting tools to market infant formula products to parents.
The report further stated that only 34 countries globally define the full scope of the Code by covering products marketed for children up to three years of age, complementary foods improperly marketed to infants and feeding bottles and teats.
Similarly, although 91 countries prohibit formula milk advertisements and 119 ban promotional devices at points of sale, only 77 prohibit nutrition and health claims on labels while only 32 prohibit informational and educational materials produced by the industry itself.
WHO and UNICEF concluded that stronger legal protections against unethical marketing practices are directly associated with improved breastfeeding rates and stressed that implementation of the International Code should be treated as a major public health and human rights obligation worldwide.
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