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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
200. 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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