2 April 2001 - WHO expert consultation on the optimal duration of exclusive
breastfeeding recommends 6 months

WHO Expert Consultation on the Optimal Duration of Exclusive Breastfeeding Recommends 6 months

IBFAN press release - 2 April 2001

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.

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.

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 "about 6 months" - 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´s Codex Working Group said: ´´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.´´

WHOs 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

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.

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 ´´4 months´´ or ´´6 months´´ at its November
meeting.

The industry has been pressing WHO Member States and Codex for a standard allowing labelling of complementary foods from ´´4 months´´ 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.