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Health experts met in
Geneva from 28th to 30th March to review research on infant feeding
for the World Health Organisation in order to settle a heated
debate about the optimal duration of exclusive breastfeeding.
The Expert Consultation
recommends exclusive breastfeeding for six months, with the
introduction of complementary foods and continued breastfeeding
thereafter, as most beneficial for public health.
It recognizes the
reduction of infectious disease morbidity and reduction in mortality
as the most important potential advantage of exclusive breastfeeding
for six months, especially the reduction of gastrointestinal
infections.
The experts add
a caution that individual infants may need feeding interventions
that differ from the recommendations when poor iron status or
growth faltering is observed.
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The
Expert Consultation recommends
(full
text)
The Expert Consultation recommends exclusive breastfeeding
for 6 months, with introduction of complementary foods and
continued breastfeeding thereafter. This recommendation
applies to populations. The Expert Consultation recognizes
that some mothers will be unable to, or choose not to, follow
this recommendation. These mothers should also be supported
to optimize their infants' nutrition.
The Expert Consultation also recognizes the need for complementary
feeding at 6 months of age and recommends the introduction
of nutritionally adequate, safe and appropriate complementary
foods, in conjunction with continued breastfeeding.
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Ending seven years
of controversy
In 1994 the World
Health Assembly, the policy-setting body of WHO, adopted a Resolution
(WHA 47.5) calling
for complementary feeding to be fostered from 创about 6 months创
- i.e. for exclusive breastfeeding to be promoted to about 6
months. However, many manufacturers of complementary foods continue
today to label products for use before 6 months of age, putting
infants at increased risk of diarrhoeal disease and death.
While the health
community has been pointing to research demonstrating the hazards
of early complementary feeding, the baby food industry has lobbied
member states of the World Health Organization and other international
bodies, such as the Codex Alimentarius Commission, to support
the introduction of complementary foods at the age of "4 to
6 months" (see British
Medical Journal 9 September 2000).
The issue was debated
again at the WHO Executive Board Meeting in Geneva in January
2001 (see IBFAN daily updates from
the EB). A proposed draft Resolution was accepted by the
Executive Board in which the options of "about 6 months" or
"4 to 6 months" were left to be determined by the Fifty-fourth
World Health Assembly in May 2001, giving the Expert Consultation
time to make its recommendations, which are now ready. Over
3000 scientific references were identified, reviewed and evaluated.
The outcome of this review was subject to a global peer review
and finally the scrutiny of the Expert Consultation.
Betty Sterken of
IBFAN磗 Codex Working Group said: 创This rigorous process
leaves no doubt that exclusive breastfeeding for the first 6
months of life will optimize the health of infants and their
mothers and reduce both illness and death due to infectious
diseases.创
WHO's Member States
are expected to adopt the recommendations of the Expert Consultation
at the Fifty-fourth World Health Assembly in May 2001, ending
seven years of controversy over the appropriate age to foster
complementary feeding.
The Fifty-fourth
World Health Assembly also marks the 20th anniversary of the
adoption of the International
Code of Marketing of Breastmilk Substitutes.
Possible impact
on trade
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The
health vs profit dilemma
For optimal nutrition, for immunisation and for bonding,
infants need to be breastfed. Yet for every child that
is exclusively breastfed for six months, an average of
US$450 worth of infant food will not be bought
and on a global scale that means billions of dollars in
profit will not be made.
It has been calculated that the annual value of commercial
infant foods currently promoted for use by infants between
the ages of four to six months is at least one billion
US dollars.
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The adoption of
a World Health Assembly Resolution incorporating the recommendations
of the Expert Consultation will send a strong message to the
November meeting of the UN Codex Alimentarius Commission. The
proposed Resolution calls on Member States: ``to encourage
the Codex Alimentarius Commission to take the International
Code and relevant subsequent Health Assembly resolutions into
consideration in developing its standards and guidelines.``
The UN Codex Alimentarius
Commission sets food standards and is due to discuss whether
complementary foods should be labelled for use from 创4 months创
or 创6 months创 at its November meeting.
The industry has
been pressing WHO Member States and Codex for a standard allowing
labelling of complementary foods from 创4 months创 despite the
scientific evidence of the risks associated with early complementary
feeding. If the industry succeeds, it could attempt to argue
that the Codex standard should prevail to protect existing sales,
estimated to be worth US$1 billion. The industry might also
attempt to use World Trade Organisation rules (which look to
Codex standards) to challenge the policies of the 61 countries
which already promote exclusive breastfeeding until 6 months
of age, to enable further expansion of sales.
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