16 January 2001: WHO Executive Board Meeting - Statement by Consumers International/IBFAN

Agenda Item, 3.1 Global Strategy on Infant and Young Child Feeding

Statement by Consumers International/IBFAN
15 January 2001

Mr Chairman, Director General, honourable Members of the Board, friends, good afternoon. I welcome the opportunity to speak on behalf of Consumers International. On the issue of infant feeding, Consumers International is a partner with the International Baby Food Action - IBFAN - a coalition of over 150 citizens groups who have been working to protect infant health in more than 90 countries for the last two decades.

Consumers International and IBFAN in this, the twentieth anniversary of the landmark adoption of the International Code, wish to continue working with WHO in our efforts to ensure that all the Resolutions of the World Health assembly are upheld. We welcome the report of the Secretariat. To quote from it: "the aim of the of the strategy should be to help fulfil the right of every child to the highest attainable standard of health by protecting, promoting and supporting optimal feeding practices"

It is undeniable that the highest attainable standard of health for the majority of the worlds infants is
attained through breastfeeding. There are a number of issues related to the report which fail to reflect this which we would like to mention. Firstly , the issue of period of exclusive breastfeeding - about 6 months,
versus 4 to 6 months . We already have a World Health Assembly Resolution (WHA 47.5) which addresses
and resolves this problem and urges members states to foster complementary feeding from about 6 months.

Although research continues to support the appropriateness of this policy; and although the policy is, as of today, in place in 61 countries, the status of this Resolution is continually ignored and undermined.

We hear Dr Brundtlands call for science-based evidence. On this question we understand that WHO already carried out a review of studies in developing countries in 1998 which clearly recommended about 6 months.
On the other hand, there seems to be no scientific basis for a policy of 4-6 months. In this current review,
given that few, perhaps only 25 of the 2,900 references being examined, meet the required criteria, we
have to question the delay.

The economic interests are evident. A conservative estimate of the value of sales of infant foods in those two short months is at least one billion dollars. But should financial gain influence health policy?

If, as the report states, the review will be ready in March, we assume it will available to assist in the
adoption of a Resolution settling the marketing question in May 2001 and that matters will not be
delayed till 2002. Such a Resolution in 2001 would greatly facilitate the adoption of a strong Codex
standard on complementary foods which would benefit the majority of the worlds infants. If decisions are delayed again who will take responsibility for the infant lives that might be lost as a result?

As you know, IBFAN has been monitoring the International Code and Resolutions for 20 years. We are now confronted with two new problems, namely health claims and internet advertising.

Our second concern is Health Claims. Increasingly companies are bringing out new versions of products, medicalising normal infant feeding behaviour, and making claims which are in direct contravention of the
spirit of the Code and which can be very confusing for mothers. To give just two quick examples. This
company claims that its product significantly improves symptoms in 94% of babies This one claims to
stop diet related colic in 48 hours. - with only a passing reference to breastfeeding.

Thirdly, Internet advertising. This is becoming increasingly prevalent and respects no national boundaries or national laws. If you are in any doubt about the blatant nature of such advertising can I urge you to see for yourself on your own computers. A resolution clearly showing that such promotion is contrary to WHO Policy and the provisions of the International Code would be invaluable and would underscore that the Code and the Resolutions are universal.

This leads us to our 4th concern, the important question of the Independence of monitoring.

WHO, as the highest health policy setting body in the world, should be crystal clear in its guidelines and recommendations. Yet in the Resolution currently under discussion, there is an important contradiction in Operative Paragraph 2.5.. How can a monitoring body be both transparent, independent and free from commercial influence, while at the same asked to work especially with the private sector?

Would we expect the public to be confident about research into the safety of, for example beef, or
tobacco, if all the research was done in conjunction with or funded by the meat or tobacco industry?

This question of independent research leads to our fifth concern, the controversial issue of vertical
transmission of HIV. This issue was brought into sharp focus when the US and Swiss media made an attack
on UNICEF, simply for refusing to accept corporate donations of formula for their pilot projects on HIV. This shows how industry involvement can distort health policies and public perceptions of them. In this case donated formula was presented as the simple solution to the problem. The British Medical Journal and other media, have now thankfully highlighted the falsity of this simplistic view, which ignored the risks of artificial feeding. We appreciate Dr Nabarros comments on this.

Its important to keep such things in perspective: while 1.7 million babies might have contracted HIV through breastmilk in the last 20 years, almost certainly, over 15 million babies will have died from lack of
breastfeeding in only 10 years.

We still do not have the answer to this terrible dilemma. Only research will help. We feel that in addition to
any research done by and with commercial enterprises - research that it is completely independent from any wealth generating objectives must be done. Only then will the important questions be properly addressed.
For example primary prevention of HIV infection of the mother and the impact of patterns of breastfeeding, in particular exclusive breastfeeding, which seems to confer a much reduced risk of HIV transmission than mixed feeding. This would be much more feasible and culturally appropriate for the disadvantaged, those most
at risk.

Thank you, Mr Chairman, for giving us the opportunity to speak today. We would be happy to share our other concerns about the draft Resolution and other parts of the report with members of the Board.

Statement presented by Madame Blanche Bationo, IBFAN Afrique, on behalf of Consumers International and IBFAN