The Global Strategy on Infant and Young Child Feeding

On 18 May 2002, the 55th World Health Assembly (WHA) adopted the Global Strategy on Infant and Young Child Feeding (GS). The full text of the GS is included in another WHA document, and is available online at http://www.who.int/gb/EB_WHA/PDF/WHA55/ea5515.pdf. The GS is a guide for country-specific approaches to improving feeding practices. It is not an innovative document, but strongly reaffirms commitments to implementation of the Innocenti Declaration, including the International Code of Marketing of Breastmilk Substitutes and the Baby Friendly Hospital Initiative. And it clearly defines optimal feeding, as in WHA Resolution 54.2 of 2001, as exclusive breastfeeding for the first six months of life; continued breastfeeding for up to two years of age or beyond; and timely, adequate, safe and properly fed complementary feeding. The GS considers good nutrition an essential component of the health and human rights of women and children, and a key contribution to poverty reduction.

There is, however, new emphasis on women and children living in special circumstances: malnourished infants and young children who need immediate access to more and better food; low birth weight infants, for whom breastfeeding is particularly crucial; infants and children who are victims of natural or man-made emergencies; HIV-infected women, who need adequate counselling for an informed decision about infant feeding that suits their situation and subsequent practical support; disadvantaged groups, such as orphans and children in foster care, adolescent mothers, women with disabilities or dependence, mothers who are imprisoned or belong to otherwise disadvantaged groups.

The GS, unanimously endorsed by all Member States of WHO, states that Governments carry the primary obligation to formulate, implement, monitor and evaluate national policies and plans, with adequate resources. In this sense, the GS represents a powerful instrument for advocacy and action to be used by all concerned parties. But the GS recognizes as well that success in the implementation of effective interventions will be achieved only if all these parties fully contribute. Among them, international organizations, health professional bodies, employers, educational authorities, the mass media, and NGOs, including community-based support groups.

A special paragraph, one that raised the hottest discussion during this session of the WHA, is devoted to manufacturers and distributors of industrially processed foods. Recognizing that "low-cost complementary foods, prepared with locally available ingredients using suitable small-scale production technologies in community settings can help to meet the nutritional needs of older infants and young children" (para 16), the GS invites commercial enterprises to ensure "that processed foods … meet applicable Codex Alimentarius standards" and "that their conduct at every level conforms to the International Code, subsequent relevant WHA resolutions, and national measures that have been adopted to give effect to both" (para 44). The GS states as well that international organizations should facilitate the work of Governments to ensure "that the International Code and subsequent WHA resolutions are respected in trade policies and negotiations" (para 48), a clear warning to the possibility that WTO agreements could prevail over WHO recommendations.

Transformed into action by Governments and other concerned parties, the GS will probably achieve its aims in the medium-to long-term. The participation of a wide political and geographical spread of actors in its development should ensure a sense of ownership and a high level of commitment. But putting into practice all its recommendations is not an easy task, and many political and technical obstacles will have to be overcome. Governments, international agencies and NGOs will also need additional financial resources, and great care is needed to ensure that business involvement is confined to the two areas expressed above. The role and duties of different actors should always be clearly spelled out. IBFAN groups, that were successful in achieving this during the development of the GS, must continue to protect the interests of infants and young children from the vested interests of industrial and trade corporations.