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 POLICYMAKERS AND GOVERNMENT LEADERS IN SUPPORTING SUB-DECREE 133
• 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.

2. Policymakers and Government Leaders are Essential to Protecting Optimal
Breastfeeding Practices in Cambodia
All government officials, including parliamentarians, Council of Ministers, Ministers, ministerial and inter-ministerial staff,
and local authorities are responsible for ensuring breastmilk substitute companies adhere to laws and regulations set forth
in Sub-Decree 133 and Joint Prakas No 061. By promoting and protecting breastfeeding, we can ensure that all mothers
and families receive the very best, unbiased information to help them choose the safest, healthiest, and most nourishing
method of feeding their children.
What can Policymakers and Government Leaders do to Support Sub-Decree
133 and Joint Prakas No 061?
•• Assign relevant ministries and departments, and identify and hold accountable individual officials for the
implementation, monitoring and enforcement of Sub-Decree No 133 and Joint Prakas No 061.
•• Help build awareness among planners, decision makers and government officials on importance of breastfeeding
protection through enforcement of Sub-Decree No 133 and Joint Prakas No 061.
•• Never accept an invitation from breastmilk substitute companies or sellers to attend any event for the promotion of
a breastmilk substitute.
•• Do not allow breastmilk substitute companies or sellers to use any government compound or building to advertise
promotion of a breastmilk substitutes
•• Monitor the advertising, marketing and labeling of infant and young child feeding products
•• Report/file all violations with the Secretariat of the Executive Working Group. Violation reports should provide the
following information and materials:
• Date, Name of Place where the violation was found/seen/heard.
• Name of the specific place (e.g. name of supermarket, hospital, health center, store, community, etc.).
• Sample/picture of the violation (material, event programme).
• For TV/radio: the name of the program/show and the name of the TV channel/radio frequency and the time
when it was seen/heard.
• For Facebook/web-sites/other social media: the name of the web-link, the account name, other relevant
information.
•• Be a strong and vocal advocate for budgetary allocations for nutrition in Cambodia.
•• Support the sub-national level to effectively enforce Sub-Decree No 133 and Joint Prakas No 061.
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 and 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
Though the Royal Government of Cambodia has taken strong
steps to safeguard infant and young child health and nutrition
through the national Sub-Decree 133 and Joint Prakas No 061,
breastmilk substitute companies continue to violate its marketing
and advertising provisions and adopt marketing practices that
are explicitly banned in the country.
•• Although illegal without government permission,
point-of-sale promotion-displays, price discounts, gifts/
samples, information materials-of infant and young
child feeding products is widespread: 41 percent of
stores that sold these products had promotions for
breast-milk substitutes and 38 percent had promotions
for complementary foods.5
•• In Phnom Penh, 86 percent of mothers with a child
under 2 years of age reported having seen, heard,
or read a commercial promotion of infant and young
child feeding products. In addition, more than three in
four mothers reported seeing one on television and one
in four mothers observed the promotion in a store/shop. 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