The SUN Civil Society Cambodia developed pagers on BMS code (Sub Decree 133) for Policy Makers, Health Workers and Media that jointly developed by HKI, MOH, UNICEF, WHO and A&T. It summarizes key messages on the code that these stakeholders need to know in simple form. More info: Hou Kroeun (HKroeun@hki.org )

1. Kampong Thom Hospital, 2013, UNICEF Cambodia
Breastfeeding: The evidence is clear
Breastfeeding gives children the best start in life. Initiating
breastfeeding within one hour of birth can prevent about 20 percent
of newborn deaths.1
Infants exclusively breastfed for six months are
11 times less likely to die from diarrhea and 15 times less likely to
die from pneumonia.1,2
Longer duration of breastfeeding is also
linked with higher intelligence, school achievement, and earning
ability.3
Despite this, Cambodian mothers are not receiving the breastfeeding
support they need:
•• The consumption of breastmilk substitutes among children
under 2 years nearly doubled between 2000 and 2010
(from 4.8 percent to 9.3 percent).4
•• Only 36 percent of Cambodian mothers reported receiving
breastfeeding counseling and support from health providers.5
•• Thirty-three percent of children between 6 and 24 months
from the urban quintile were fed with breastmilk substitutes.4
•• Twenty-five percent of women delivering in private clinics
used infant formula, which is three times more than women
delivering in the public sector.4
PROMOTING AND PROTECTING BREASTFEEDING IN CAMBODIA:
THE ROLE OF HEALTH FACILITIES AND WORKERS IN SUPPORTING SUB-DECREE NO
133 AND JOINT PRAKAS NO
­061
• Initiation of breastfeeding within
1 hour of birth
• Exclusive breastfeeding for the
first 6 months of life
• Continued breastfeeding for 2
years and beyond along with
nutritionally adequate, safe,
age appropriate, responsive
complementary feeding starting
after six months8
Optimal breastfeeding
practices include:
Footnote
1. Begum, K., Dewey, K., Alive Thrive Insight, “Impact of early initiation of
exclusive breastfeeding on newborn deaths,” 2010.
2. Barros, A., et al., The Lancet, Vol. 379, “Countdown to 2015: a retrospective
review of survey data from 54 countries: equity in maternal, newborn, and child
health interventions,” 2012.
3. Victora, C., et al., The Lancet Global Health, 3 (4): e199, “Association between
breastfeeding and intelligence, educational attainment, and income at 30 years of
age: a prospective birth cohort study from Brazil,” 2015.
4. Prak, S., et al., Nutrients 2014, 6, 2920-2930, “Breastfeeding Trends in
Cambodia, and the Increased Use of Breast-Milk Substitute—Why Is It a Danger?.”
5. Assessment of Promotion of Foods Consumed by Infants and Young Children in
Phnom Penh: Assessment and Research on Child Feeding (ARCH) – Cambodia
Country Report, Helen Keller International, 2015.
6. World Health Organization, “International Code of Marketing of Breast-milk
Substitutes,” 1981.
7. Royal Government of Cambodia, “Sub-Decree 133 on Marketing of Products for
Infant and Young Child Feeding” and “Joint Prakas 061 on Implementation of
Sub-Decree on Marketing of Products for Infant and Young Child Feeding,” 2005
and 2007.
8. Holla, R., et al., BPNI and IBFAN, “The Need to Invest in Babies report,” 2013.
9. Save the Children, Helen Keller International, UNICEF, World Health Organization,
World Vision, “Joint Statement on breast milk substitutes in Cambodia,” May
2014.
10. Bearup, S., Justice and International Mission Unit, “Unethical Marketing of Infant
Formula and Breastmilk Substitutes in Cambodia 2009,” 2009.
11. IBFAN, “Report on the Situation of Infant and Young Child Feeding in
Cambodia,” 2011.
12. World Health Organization, UNICEF, “Acceptable medical reasons for use of
breast-milk substitutes,” 2009.

2. International Policy for Breastfeeding Promotion6
Because marketing of breast milk substitutes can interfere with a mother’s decision to breastfeed, the World Health
Assembly adopted The International Code of Marketing of Breastmilk Substitutes (BMS Code) in 1981. The Code and
subsequent World Health Assembly resolutions promote and protect breastfeeding by prohibiting the promotion of any
breastmilk substitute as a partial or total replacement of breastmilk.
Cambodia’s Sub-Decree No
133 and Joint Prakas No
0617
Adopted in 2005, the Sub-Decree regulates the marketing of breastmilk substitute products by limiting how and where
companies can advertise and market products to parents of young children. The Joint Prakas No
061, signed in 2007,
instructed the MOH, the Ministry of Commerce, the Ministry of Industry, Mines and Energy, and the Ministry of Information
to jointly implement, monitor, and enforce the Sub-Decree No
133. Restrictions include:
•• Advertising of infant and young child feeding products
•• Prohibiting of the marketing of infant and young child feeding products
•• Labeling of feeding products for children under 2 years, including complementary foods
•• Advertising and marketing of feeding bottles and rubber and plastic teats
Violations of the Sub-Decree are Common in Cambodia9,10,11
•• One in three mothers reported seeing breastmilk
substitute branding on health facility equipment or
materials after delivering their child.5
•• One in five mothers of children under age 2 reported
observing branding/logos of breastmilk substitutes on
materials or equipment within a health facility. They
also reported that a health professional recommended
they feed their youngest child a breastmilk substitute.
•• Approximately one in 10 mothers reported receiving a
free breastmilk substitute from a health professional.5
WHERE TO REPORT VIOLATIONS
Attn: Secretariat of the Executive Working Group, AING Hoksrun, Pharm, Msc., Chief of Food Safety Bureau,
Department of Drugs and Food, Ministry of Health, No. 80 Samdech Pen Nuth Blvd, Toulkok, Phnom Penh, Cambodia,
Tel: +855 85 538 066 l Fax/Phone: + 855 23 880 248 l E-mail: hoksrunaing@gmail.com
The Health System is Essential to Promoting and Protecting Optimal
Breastfeeding.
Health providers play an important role in ensuring BMS manufacturers and distributors do not violate Sub-Decree No
133 in health facilities. In addition, by promoting and protecting breastfeeding, providers can help ensure all mothers
and families receive unbiased information to choose the safest, healthiest, and most nourishing methods of feeding
their children.
What should Health Facilities and Workers do to Support Sub-Decree 133?
Public and Private medical establishments and workers must:
•• Support mothers to start breastfeeding within the first hour after birth4
•• Promote regular communications between health providers and mothers encouraging exclusive breastfeeding
•• Provide skilled support and counseling to help mothers sustain breastfeeding
•• Only in unique cases, provide proper guidance on how to use breastmilk substitutes only on the basis of the
World Health Organization’s “Acceptable medical reasons for use of breastmilk substitutes” (Note: Although
Article 15b of Sub-Decree 133 allows health workers to provide advice on use of BMS to caretakers/relatives of
children in very special case, this does not allow them to provide the BMS directly to patients)10
•• Report any violation to the Executive Working Group/Oversight Board
Medical establishments and health workers must not:
•• Promote breastmilk substitutes
•• Sell or allow the sale of food for children under 2 years of age
•• Allow companies selling/producing food products for children under 2 years to display products
•• Accept money, gifts from manufacturers or distributors, or products featuring the names or logos of products for
children under 2 years
•• Accept or offer product samples or supplies to any person
•• Demonstrate how to use formula for children under 2 years, except to mothers or family members in a special
case, and in such a case, shall clearly explain about the hazards of using infant formula
•• Provide formula company representatives with the list of recent births and contact information of families
•• Allow company-sponsored events on child nutrition, health, and development in association with health facilities
and hospitals
•• Conduct professional evaluation, research, or other activities related to such products in a hospital or health center