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Geneva, Switzerland, WHO, 2012. 8 p. (FWC/MCA/12.1)The purpose of this Framework is to provide guidance to governments on key priority actions, related to infant and young child feeding, that cover the special circumstances associated with human immunodeficiency virus (HIV). The aim of this guidance is to create and sustain an environment that encourages appropriate feeding practices for all infants and young children, while scalingup interventions to reduce HIV transmission. This Framework aims to build on the links and synergies between maternal and child health and investments, economic and human, in HIV prevention and control. This will bring additional benefits for all children, The Framework’s purpose and target audience not just for those who are HIV-exposed. The audience for this Framework includes national policy-makers, programme managers, regional advisory bodies, public health authorities, Country Coordinating Mechanisms, United Nations staff, professional bodies, nongovernmental organizations and other interested stakeholders, including the community. The current document is an update of the previous Framework, published in 2003, and has been developed in response to both evolving knowledge and requests for clarification from these key sectors. It is based on the latest HIV and infant feeding recommendations; the previous Framework no longer applies.
Implications of the new WHO guidelines on HIV and infant feeding for child survival in South Africa.
Bulletin of the World Health Organization. 2011 Jan 1; 89(1):62-7.The World Health Organization released revised principles and recommendations for HIV and infant feeding in November 2009. The recommendations are based on programmatic evidence and research studies that have accumulated over the past few years within African countries. This document urges national or subnational health authorities to decide whether health services should mainly counsel and support HIV-infected mothers to breastfeed and receive antiretroviral interventions, or to avoid all breastfeeding, based on estimations of which strategy is likely to give infants in those communities the greatest chance of HIV-free survival. South Africa has recently revised its clinical guidelines for prevention of mother-to-child HIV transmission, adopting many of the recommendations in the November 2009 World Health Organization's rapid advice on use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants. However, one aspect of the new South African guidelines gives cause for concern: the continued provision of free formula milk to HIV-infected women through public health facilities. This paper presents the latest evidence regarding mortality and morbidity associated with feeding practices in the context of HIV and suggests a modification of current policy to prioritize child survival for all South African children.
HIV, infant feeding and more perils for poor people: New WHO guidelines encourage review of formula milk policies.
Bulletin of the World Health Organization. 2008 Mar; 86(3):210-214.The release of the new WHO guidelines on HIV and infant feeding, in a global context of widespread impoverishment, requires countries to re-examine their infant-feeding policies in relation to broader socioeconomic issues. This widening scope is necessitated by compelling new reports on the scale of global underdevelopment in developing countries. This paper explores these issues by addressing feeding choices made by HIV-infected mothers and programmes supplying free formula milks within a global environment of persistent poverty. Accumulating evidence on the increase in malnutrition, morbidity and mortality associated with the avoidance or early cessation of breastfeeding by HIV-infected mothers, and the unanticipated hazards of formula feeding, demand a deeper assessment of the measures necessary for optimum policies on infant and child nutrition and for the amelioration of poverty. Piecemeal interventions that increase resources directed at only a fraction of a family's impoverishment, such as basic materials for preparation of hygienic formula feeds and making flawed decisions on choice of infant feeding, are bound to fail. These are not alternatives to taking fundamental steps to alleviate poverty. The economic opportunity costs of such programmes, the equity costs of providing resources to some and not others, and the leakages due to temptation to sell capital goods require careful evaluation. Providing formula to poor populations with high HIV prevalence cannot be justified by the evidence, by humanitarian considerations, by respect for local traditions or by economic outcomes. Exclusive breastfeeding, which is threatened by the HIV epidemic, remains an unfailing anchor of child survival (author's)
Indicators for assessing breast-feeding practices. Report of an informal meeting, 11-12 June 1991, Geneva, Switzerland.
Geneva, Switzerland, WHO, Division of Diarrhoeal and Acute Respiratory Disease Control, 1991. 14 p. (WHO/CDD/SER/91.14)An informal meeting convened by the WHO Division of Diarrhoeal and Acute Respiratory Disease Control on behalf of the Organization's Working Group on Infant Feeding was held on 11-12 June 1991, at WHO headquarters in Geneva. The purpose of the meeting was to reach a consensus on the definitions of key breast-feeding indicators and specific methodologies for their measurement. In addition to the WHO participants, the meeting was attended by representatives of UNICEF, the United States Agency for International Development (USAID) and the Demographic Health Surveys (DHS) Program of the Institute for Resource Development/Macro International Inc., who had played an important role in developing the proposed indicators. The Swedish International Development Agency (SIDA) was also invited but was unable to send a participant. The participants are listed in Annex 1. This report summarizes the discussion and consensus reached on breast-feeding indicators derived from household survey data. No consensus was reached on proposed breast-feeding indicators to be measured through enquiries at health facilities. It was agreed that this topic required further discussion, bearing in mind, for example, the monitoring of the "Ten steps to successful breast-feeding". (excerpt)
Lancet. 2003 Aug 16; 362(9383):542.An increasing number of mothers with HIV in Uganda are breastfeeding their babies after UNICEF stopped donating free infant formula. Doctors implementing the prevention of mother-to-child HIV transmission (PMTCT) project said on Aug 7 that most of the women could not afford infant formula. “They have a choice of whether to breastfeed or buy infant formula”, said Saul Onyango, national PMTCT coordinator. (excerpt)
Review and evaluation of national action taken to give effect to the International Code of Marketing of Breast-Milk Substitutes: report of a technical meeting, The Hague, 30 September - 3 October 1991.
[Unpublished] 1991. 24 p. (WHO/MCH/NUT/91.2)The report of the national actions in marketing breast-milk substitutes includes a review and evaluation summarized in the accompanying annex and the results of a meeting. Participants found the evaluation helpful, that progress had been made, and that the International Code of Marketing of Breast-milk Substitutes must be viewed in a broad context. Lessons learned and recommendations are given for the development and implementation of national measures, as well as the training and education in the health sector, the information to the general public and mothers, monitoring and enforcement, and manufacturers and distributors of products within the scope of the Code. Successful implementation depends on a clear international perspective, on all concerned parties' involvement in development and monitoring, and a continuing commitment to a complex process. Difficulties encountered were lack of 1) political commitment, 2) integration of sectors, and 3) recognition that the Code applied to all counties; there were also questions about the scope of products included in the Code. There is no limit to age group. Partial adoption is not sufficient and has a negative impact. The Code was being ignored in countries moving toward a market economy. Health professionals were unaware of new developments in infant feeding practices. The Code assumes a compatible relationship between manufacturers and health personnel, which is not the case. Manufacturers used mass media and formal and informal educational sectors to disseminate information about their products with the approval of authorities who considered the use consistent with the Code. The expanding international telecommunications systems have proved to be a crippling challenge to some countries without the tools to know how to regulate programming. The feeding bottle is an inappropriate child care symbol for breast feeding, which is frequently found in public places. Monitoring has been uneven. Enforcement is hampered by an absence of, inadequacy in, and inability to apply sanctions. Joint health and industry provisions are weaker than the Code, and marketing strategies do not conform to the Code. Manufacturers apply the Code differently in developed and developing countries. Not enough attention has been paid to feeding or pacifier products. Retail stores sell infant formula next to other infant food products which is misleading.
The role of the health sector in the development of national and international food and nutrition policies and plans, with special reference to combating malnutrition, 13th Plenary Meeting, 24 May 1978.
Geneva, WHA, 1978 May 24. 10 p. (WHA31.47/WHA34.22)The 31st World Health Assembly (WHA) has considered the Director General's report on the role of the health sector in the development of national and international food and nutrition policies and plans and endorses the functions of the health sector in this field. The WHA is convinced that malnutrition is 1 of the major impediments to realizing the goal of health for all by the year 2000, and that new approaches based on clearly defined priorities and maximum utilization of local resources are needed for a more effective action to combat malnutrition. The WHA recommends that Member States give the highest priority to stimulating permanent multisector coordination of nutrition policies and programs and to preventing malnutrition in pregnant women, lactating women, infants, and children by doing the following: 1) supporting and promoting breast feeding with educational activities to the general public, 2) legislative and social actions to facilitate breastfeeding by working mothers, 3) implementing the necessary promotional and facilitating measures in the health services and regulating inappropriate sales promotion of infant foods that can be used to replace breast milk, 5) ensuring timely supplementation and appropriate weaning practices and the feeding of young children with the maximum utilization of locally available and acceptable foods, and 6) conducting, if necessary, action oriented research to support this approach and the training of personnel for its promotion. Governments and multilateral and bilateral organizations and agencies are urged to support the proposed programs of research and development in nutrition through their technical and scientific institutions and workers and by financial contributions. A copy of the international code of marketing of breastmilk substitutes is included. The 11 articles of the code cover the following: aim and scope of the code, definitions, information and education, the general public and mothers, health care systems, health workers, persons employed by manufacturers and distributors, labelling, quality, and implementation and monitoring.
AFRICA HEALTH. 2001 Mar; 23(3):39.The UN Children's Funds (UNICEF) has been criticized for not approving offers by baby food manufacturers to donate supplies of formula-feed milk to HIV-infected women in Africa. The Wall Street Journal, and other US newspapers have portrayed companies like Nestle and Wyeth-Ayerst as heroes in the fight against HIV/AIDS, and UNICEF as a villain. UNICEF holds to its position, backed up by research, that formula-fed infants are four to six times more likely to die of disease than those who are breastfed. A UNICEF spokesman said the Wall Street Journal had failed to mention that "...only 5% or less of women in Africa have access to their HIV status, and therefore the idea of distributing formula to prevent mother-to-child transmission is moot, unless you send it to every woman in Africa, which would be a major public health disaster." The debate in the US media has highlighted divisions within the UN system on how to advise mothers in countries where HIV prevalence is high about feeding their babies. Some feel UNICEF is adopting an inflexible position in its desire to promote the benefits of breastfeeding. Dr. Peter Piot, head of Joint UN Programme on HIV/AIDS said, "There is a divide across organizations about what is right and wrong, and there are strong feelings". Infant feeding has become a complex issue with no single remedy that can be applied across the board. (full text)
The milk of human kindness. How to make a simple morality tale out of a complex public health issue.
BMJ. British Medical Journal. 2001 Jan 6; 322(7277):57-8.On December 5, 2000, the Wall Street Journal ran a lead news story and an accompanying editorial claiming that donations from baby food manufacturers would stop the mother-to-child transmission of HIV. The article contended that the UN Children's Fund's (UNICEF) feud against the formula industry was to be blamed for allowing AIDS to spread, especially in sub-Saharan Africa, and for killing millions of children. In 6 days, the American dailies had taken a highly contentious health issue and turned it into a battle between the corporations and the international health agency. Despite assaults from the media, as well as from several UN officials, UNICEF remains firm in its stance against accepting donations. Carole Bellamy, executive director of UNICEF, explained that a rush to promote formula feeding could lead to the spread of other infectious diseases. Bellamy notes that if formula is to be used, it needs to be done in a targeted manner. Moreover, Bellamy argued that the paper failed to acknowledge that UNICEF is leading the way in addressing mother-to-child transmission. WHO officials also expressed frustration at the paper for implying that formula donations were the easy answer to the difficult HIV/AIDS crisis. However, the Wall Street Journal rejected the powerful criticisms it has received from the international community and has made no apologies for the story and the hard-hitting editorial.
UNICEF and baby food manufacturers. UNICEF continues to base its actions and programmes on the best interests of the child [letter]
BMJ. British Medical Journal. 2000 Oct 14; 321(7266):960.This article presents the response of Carol Bellamy, executive director of the UN International Children's Emergency Fund (UNICEF), to the article by Yamey about the alliances UNICEF is seeking to form with manufacturers of infant formula that do not comply with the international code of marketing of breast milk substitutes. Bellamy confirms that UNICEF will continue to refuse donations from manufacturers of infant formula whose marketing practices violate this code and subsequent World Health Assembly resolutions. It is noted that there has been considerable discussion within the organization regarding this issue. This emerged when UNICEF participated in discussions with five large pharmaceutical companies on the possibility of obtaining various drugs to fight HIV/AIDS at discounted prices on behalf of developing countries. One of these companies is widely viewed as violating the code. This has been misinterpreted as a sign that UNICEF is weakening its support for breast-feeding and the code. However, Bellamy indicates that UNICEF believes that in the face of AIDS, their support for breast-feeding must be strengthened, not diminished. At the same time, UNICEF will uphold its support of the code and will continue to call violators of the code to account publicly.
BMJ. British Medical Journal. 2000 May 20; 320(7246):1362.International specialists in infant feeding expressed concern that the policy of WHO of establishing partnerships with private industry has gone too far, with the result that debate about the infant food industry's role in marketing breast milk substitutes is being stifled. Specialists, who want the WHO to recommend exclusive breast-feeding to babies up to 6 months, claim that at a recent joint meeting on infant feeding they were prevented from discussing the issue. In addition, some papers intended for the meeting were edited so that they were less critical to the infant food industry. Although 20 of the 28 consultants signed a statement saying that scientific evidence was now sufficient to warrant changing of the current WHO recommendation on the introduction of complementary feeding from age 4-6 months to about 6 months, no discussion was allowed. In response, a spokesman for the WHO stated that the current recommendation of WHO on the duration of exclusive breast-feeding was excluded in the discussion because of the WHO’s research that is under way in this connection. As far as the alleged censorship of the background papers is concerned, he explained that WHO documents have to conform to a high standard of scientific objectivity and balance. Lastly, WHO cited that the food industry continues to play an important and constructive role in relation to infant feeding.
Infant feeding in Bolivia: a critique of the World Health Organization indicators applied to Demographic and Health Survey data.
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY. 1994 Feb; 23(1):129-37.1989 Demographic and Health Survey data for Bolivia is used to examine trends in World Health Organization (WHO) designated breast feeding measures. WHO measures are evaluated. WHO measures are the exclusive breast feeding rate (under 4 months), predominant breast feeding with supplementation of nonmilk liquids (under 4 months), timely complementary feeding rate, continuous breast feeding rate for children aged 12-15 months, bottle feeding rate, ever breast fed rate, and median duration of breast feeding. The timely complementary feeding rate or those 6-9 months receiving solid or semisolid foods is 55%. The continuous feeding rate is 66% for the 12-15 month old infants, and just under 50% for infants aged 20-23 months. Almost 50% of breast feeding infants also receive bottle feeding. 97% are ever breast fed. The median duration of breast feeding is 17 months. At under 4 months 57.6% receive both breast milk and other milk and not solids, and 8% are not breast fed. At 6-9 months 54.7% are receiving breast milk and solids, and almost 33% receive breast milk and other milk. About 15% are not being breast fed. At 10-11 months about 15% are still being exclusively breast fed, and almost 25% are not being breast fed at all. At 12 months about 4% receive breast milk and no solids. Exclusive breast feeding occurs among just under 50% of mothers who have always lived in the city and among those who migrated to the city. The highest rates are among women who lived in the country. The greatest differences in breast feeding are among mothers who always either lived in a city or the country. The lowest complementary feeding rate occurs in the city-always group (39.3%). The highest complementary feeding rate occurs among the town group (73.1%). Continued breast feeding is lowest in the city-always group. The highest proportion of infants receiving bottles is among infants with mothers who migrated to the city (72.0%) followed by city-always mothers (60.1%). The WHO indicators are found to be useful standards for guiding research and developing policy and practice norms.
MOTHERS AND CHILDREN. 1994; 13(1):5.As part of an ongoing effort to halt the decline of breast feeding rates in Africa, 35 representatives of 12 different African countries met in Mangochi, Malawi, in February 1994. The Code of Marketing of Breastmilk Substitutes was scrutinized. National codes were drafted based on the "Model Law" of the IBFAN Code Documentation Centre (ICDC), Penang. Mechanisms of implementation, specific to each country, were developed. Strategies for the promotion, protection, and support of breast feeding, which is very important to child survival in Africa, were discussed. The training course was organized by ICDC, in conjunction with IBFAN Africa, and with the support of the United Nations Children's Fund (UNICEF) and the World Health Organization (WHO). Countries in eastern, central, and southern Africa were invited to send participants, who included professors, pediatricians, nutritionists, MCH personnel, nurses, and lawyers. IBFAN Africa has also been conducting lactation management workshops for a number of years in African countries. 26 health personnel (pediatricians, nutritionists, senior nursing personnel, and MCH workers), representing 7 countries in the southern African region, attended a training of trainers lactation management workshop in Swaziland in August, 1993 with the support of their UNICEF country offices. The workshop included lectures, working sessions, discussions, and slide and video presentations. Topics covered included national nutrition statuses, the importance of breast feeding, the anatomy and physiology of breast feeding, breast feeding problems, the International Code of Marketing, counseling skills, and training methods. The field trip to a training course covering primary health care that was run by the Traditional Healers Organization (THO) in Swaziland was of particular interest because of the strong traditional medicine sector in many African countries. IBFAN Africa encourages use of community workers (traditional healers, Rural Health Motivators, Village Health Workers, Mother Support Groups) to promote breast feeding.
[Breast feeding and the infant food industry: mutual respect as a form of collaboration (letter)] Lactancia materna e industria dietetica infantil: el respeto mutuo como forma de colaboracion.
ANALES ESPANOLES DE PEDIATRIA. 1993 Jun; 38(6):560-1.A letter from a pediatrician responding to comments on an earlier publication about breast feeding and the infant formula industry acknowledges the importance of having adequate preparations available for infants who for any reason cannot be breast fed. But some continuing advertising and marketing practices of the infant formula industry, along with inappropriate maternity ward routines and sociocultural changes, are jeopardizing the practice of breast feeding in rich and poor countries alike. The World Health Organization and UNICEF estimate that nutritional, infectious, and diarrheal diseases are more prevalent today than 20 years ago, and that abandonment of breast feeding is a factor in at least 1 million infant deaths each year. The nutritional problems caused by abandonment of breast feeding are not as drastic in developed countries, but some protections against allergies and infections are lost, as are the emotional bonding between the mother and infant. Furthermore, in developed countries the least advantaged groups are the least likely to breast feed. The World Health Organization General Assembly in 1974 called attention to the decline of breast feeding and requested member nations to promulgate laws regulating advertising and marketing of infant formula. A global campaign by health organizations and citizens' groups led to adoption by the World Health Organization in 1981 of an international code for marketing of milk substitutes. Various countries have subsequently adopted its measures, at least in part. Despite the code, bottle feeding continues to become more prevalent. A Spanish decree of 1992 established regulations for the wording and illustrations on infant formula containers and in advertising. A statement indicating the relative superiority of mothers' milk is required, and advertising of infant formulas is restricted to scientific publications. The wording may not imply that bottle feeding is equivalent to breast feeding. Advertising at points of sale, distribution of samples, and similar activities directed toward the consumer are prohibited. Health administrators are given responsibility for assuring that information on infant feeding provided to pregnant women and families is objective and coherent, and for limiting use of artificial preparations to infants requiring them. The World Health Organization/UNICEF August 1990 meeting established as goals for 1995 the establishment of multisectorial national committees on breast feeding, the guarantee that all maternity wards would establish routines support of breast feeding, the promulgation of measures to put into practice all articles of the international code for marketing of milk substitutes, and the approval of laws to protect the practice of breast feeding by working women. Although Spain's new legislation is an important step, much remains to be done.
CENTRAL AFRICAN JOURNAL OF MEDICINE. 1992 Jul; 38(7):314-5.Participants at a 1992 WHO/UNICEF consultation meeting on HIV transmission and breast feeding weigh the risk of death from AIDS with the risk of death from other causes. Breast feeding reduces the risk of death from diarrhea, pneumonia, and other infections. Artificial or inappropriate feeding contributes the most to the more than 3 million annual childhood deaths from diarrhea. The rising prevalence of HIV infection among women worldwide results in more and more cases of HIV-infected newborns. About 33% of infants born to HIV-infected. Some HIV transmission occurs through breast feeding, but breast feeding does not transmit HIV to most infants HIV-infected mothers. Participants recommend that, in areas where infectious diseases and malnutrition are the leading causes of death and infant mortality is high, health workers should advise all pregnant women, regardless of their HIV status, to breast feed. The infant's risk of HIV infection via breast milk tends to be lower than its risk of death from other causes and from not being breast fed. HIV-infected women who do have access to alternative feeding should talk to their health care providers to learn how to feed their infants safely. In areas where the leading cause of death is not infectious disease and infant mortality is low, participants recommend that health workers advise HIV-infected pregnant women to use a safe feeding alternative, e.g., bottle feeding. Yet, the women and their providers should not be influenced by commercial pressures to choose an alternative feeding method. Health care services in these areas should provide voluntary and confidential HIV testing and counseling. Participants stress the need to prevent women from becoming HIV-infected by providing them information about AIDS and how to protect themselves, increasing their participation in decision-making in sexual relationships, and improving their status in society.
[India: breast feeding is obsolete, the bottle is modern] India: amming er gammeldags, flaske er moderne.
JOURNALEN SYKEPLEIEN. 1992 Sep 7; 80(14):21.In July, 1992 Indian health groups met in New Delhi to demand that the government promote a child nutrition code based on the 1981 code of the WHO which stated that mother's milk is quite sufficient and is the best nourishment for infants. Every day approximately 40,000 children are born in India, but thousands of them die in infancy because of infection caused by the unsanitary mixing of milk powder in unsterile bottles. Indian health activists want the government to regulate the production, access, and distribution of mother's milk substitutes, bottles, and child nutriments. A new law based on internationally recognized codes for marketing mother's milk substitutes could put an end to the present irresponsible marketing. Activists are not opposed to the production of milk powder, but they think it should only be used when the mother has no milk. The turnover of India's child nutrition industry is about $280 million per year with an annual increase of 5%. The use of bottle feeding has infiltrated the whole urban scene, and it is spreading in rural areas. Women consider bottle feeding a modern way of child feeding. 60 million kg of milk powder is produced yearly and sold under 25 different product names. Amul and Nestle command 85% of the growing market. Experts have calculated that 1 billion liters of mother's milk is wasted and replaced by substitute milk every year. Many Indian children get their first substitute milk at health posts where free or subsidized milk is distributed despite notices calling on mothers to breast-feed. According to a national survey sponsored by UNICEF, almost 1/2 of India's mothers give their children milk substitutes at the instigation of doctors or health personnel. 63% of children in the state of West Bengal were undernourished because families did not buy enough milk powder. The activists want the government to launch an offensive against the advertisement of breast milk substitutes in state-owned TV and radio and to promote proper nutrition in magazines read by millions of the Indian middle class who use these products most.
Lancet. 1993 Feb 13; 341(8842):430.Between 1980 and 1989, the percentage of mothers breast feeding for 6 to 11 months in Bolivia fell from 91% to 82%. Urbanization and the rising attraction of western culture have contributed to this decline. In the early 1990s, 122 developing countries have instituted efforts to eliminate a dangerous western practice (free or low-cost infant formula distribution by manufacturers to maternity units). The International Association of Food Manufacturers claimed its members would stop distributing infant formula to maternity wards in those countries where such distribution is against the law. Thus many health proponents have appealed to heads of state to make free or low-cost infant formula distribution to hospitals illegal. In late 1991, UNICEF/WHO established the baby-friendly hospital initiative to further promote non-distribution of infant formula to maternity wards. As of February 1993, 90 developing and 14 developed countries have signed on to the initiative. Guatemala and the Philippines have selected 26 and 22 hospitals, respectively, to become baby-friendly. Worldwide, 767 hospitals are either working towards baby-friendly status or have already met conditions to be baby-friendly. Governments must monitor compliance with bans on infant formula distribution. UNICEF and WHO believe that such monitoring and cooperation from industry should facilitate total cooperation with order by developing country governments by June 1993.
DIALOGUE ON DIARRHOEA. 1991 Sep; (46):4.Artificial feeds constituted with contaminated water and unclean bottles are the leading cause of diarrhea in infants. Companies market artificial feeds globally as infant formula (a substitute for breast milk) and follow-up formula (a complement to breast milk). Breast milk is best for all 0-12 month old infants. Breast-fed infants do not need any formula even follow-up formula. Indeed >6-month old infants require solid healthful foods and breast milk. Like infant formulas, follow-up formula made with contaminated water or bottles can cause the infant to become ill with an infection, and offering follow-up formulas to infants impedes weaning and is costly. Follow-up formulas do not complement breast milk, but instead tend to replace it. The 1986 WHO World Health Assembly has even declared that, in some countries, provision of follow-up formula is not necessary. WHO fears mothers could use follow-up formula instead of infant formula because it has a higher protein and mineral content thus increasing the risk of dehydration during diarrhea. Follow-up formula can result in an unbalanced diet. Since the International Code of Marketing of Breastmilk Substitutes does not address formulas marketed as a complement to breast milk, formula companies market follow-up formulas in both developed and developing countries. Most mothers do not know the risks of using follow-up formulas, however. Governments have several alternatives to stop the marketing of these formulas. They can design and implement a code that defines breast-milk substitutes as any formula perceived and used as a breast milk option even if promoted as a breast-milk complement. They can also amend an existing code. WHO offers technical assistance to any member government who wishes to design, implement, and monitor such a code.
HYGIE. 1992; 11(2 Suppl):8-14.In 1991, the Executive Director of UNICEF addressed the World Conference on Health Education in Helsinki, Finland which centered on international cooperation in improving health. Health educators should convince world leaders to apply the money available after reductions in military spending due to the end of the Cold War toward revitalizing health and education systems and alleviating poverty. Another opportunity that they should not let slip away is that more countries are choosing democracy. The international consensus is now leaning toward human centered development. At least 71 national leaders and representatives from 88 other countries have supported the World Summit Plan of Action which emphasizes health education efforts leading toward child survival. This global, political endorsement also presents a plan for social mobilization. Health educators have already contributed greatly to the success of achieving universal child immunization (>80%) by the end of 1990. They communicated health education messages via the mass media and traditional channels to motivate individuals and society to immunize their children. UNICEF has 27 goals for the 1990s such as eradication of polio and guinea worm disease. In 1989, UNICEF, WHO, UNESCO, and about 100 other agencies began the Facts for Life initiative by 1st publishing a book. Lay and professional health educators have incorporated its messages into various media: street theater, radio, comics, soap operas, billboards, T-shirts, and bumper stickers. Medical research has shown that individual responsibility for one's own health adds years to life expectancy, e.g., individuals should not smoke. Health educators face the challenge of reaching adolescents, especially since most behavior patterns are established during adolescence. Other challenges include developing effective messages to curb the AIDS pandemic, to motivate hospitals to promote breast feeding, and to encourage world leaders to place children's needs at the top of society's priorities.
HYGIE. 1992; 11(2):5.WHO and UNICEF have joined to work toward reversing the trend toward infant formula use and strengthen all infants' chances of receiving the benefits of breast feeding. The WHO/UNICEF Baby-Friendly Hospital Initiative encourages health workers and facilities to promote, protect, and support breast feeding instead of hampering it. This initiative followed a decision by major manufacturers and distributors of infant formulas to comply with Article 6 of the International code of Marketing of Breast-Milk Substitutes by December 1992. This action, if carried out, would stop the distribution of free and low cost supplies to maternity facilities in developing countries. Indeed WHO and UNICEF plan to persuade all such facilities worldwide to promote and protect breast feeding within their facilities as well as in the community. They have prepared guidelines to successful breast feeding for health facilities. Entire communities need to recognize the benefits of breast feeding and not expect mothers to breast feed only in the home. In 1991, 12 developing countries tested the initiative. The goals included a stop in the distribution of free and low cost supplies of infant formulas in hospitals and maternity centers and to initiate transformation of hospitals into baby-friendly hospitals by February 1992. Each of the countries had witnessed an end to free and low cost supplies of infant formula to health facilities. The governments, nongovernmental organizations, and even the infant formula industry are monitoring the situation to assure compliance. The IFM has targeted 42 other developing countries where infant formula is still distributed to enforce the Code. The infant formula industry has not yet decided to do the same in developed countries, however. Yet 2 leading manufacturers said they would not do anything to compromise the goals of the initiative.
HYGIE. 1991; 10(3):16-22.The Executive Director of UNICEF stresses at the 14th World Conference on Health Education held in Helsinki, Finland the importance of grabbing new opportunities in our changing world. An important boost to health educators is the World Summit for Children which witnessed for the 1st time world leaders committed to comprehensive and specific resolutions to improve the quality of life for children--a true opportunity to solve a global problem. Health educators can play a key role in solving global problems by showing leaders how health education can help solve these problems. Indeed political will as demonstrated at the World Summit for Children provides the needed impetus to launch a revolution of improved health for all. Now they can help convert the growing international consensus for human centered development into reality. He also points out that the success of the campaigns for universal child immunization and for oral rehydration therapy are due to health educators. Health educators should apply these successful techniques that simplifies modern medical knowledge into basic health messages which in turn empowers families and communities to save and improve lives to further improve the health of the world. A challenge that remains is promoting healthy life styles, especially among adolescents whose health problems include pregnancy, sexually transmitted diseases, and alcohol abuse. AIDS presents another challenge. Health educators need to encourage hospitals to promote breast feeding and to provide maternity services centered around the infant. Improvement in child and adult health cannot occur, however, if the people do not demand changes in society. Health educators can lead this movement by communicating and advocating healthful changes.
DEVELOPMENT DIALOGUE. 1989; (2):5-38.The story of IBFAN, the International Baby Food Action Network, from its beginning with 6 members in 1979, to its status of 140 groups worldwide in 1989 is told by its founder, Annelies Allain. IBFAN celebrated its 10th anniversary in October 1989 with a week-long Forum of 350 organizers from 67 countries. IBFAN is a single-tissue grass-roots organization, almost entirely women: the issue is that bottle-feeding kills babies. It has mounted a successful campaign ending in passage of the WHO/UNICEF International Code of Marketing of Breast-milk Substitutes in 1981. With this success, the political power of the "third system," of people, as opposed to government and transnational corporations, was recognized. The most important fundamental activity of IBFAN is to amass information to make its point that million of babies, primarily in developing countries, have died from consuming powdered formula instead of breast milk. IBFAN also set out to show that milk companies have influenced medical school training, health care providers, UN and WHO policies, and governments of developing countries through advertising and tax income. IBFAN's methods are boycott, corporate marketing analysis, shareholder, resolutions, and numerous strategies invented by local activists. The baby food industry responded by forming the International Council of Infant Food Industries, headed by a former WHO Assistant Director General, and applied for registration as an official NGO with the WHO. Again in 1987 they formed the Infant Food Manufacturers Associations, headed by a former WHO staff member, and gained WHO NGO status, claiming to advance infant nutrition and adhere to the WHO Code. Ibfan's current emphasis is on combatting free infant formula given out at maternity hospitals, the most effective way to block successful lactation, is developed as well as developing countries. An effort to monitor this activity will mark the 10th anniversary of the Code in 1991.
MIDWIFERY. 1990 Sep; 6(3):115-6.The author of this editorial expresses her concern for the violation of the WHO International Code of Marketing of Breastmilk Substitutes (1981). The impetus for this article was a television program which showed bottle feeding among the poor with inadequate supplies of clean water, without sanitation, with expensive fuel used to boil water and sterilize bottles, and expensive formula. Posters advertising artificial milk were prominently displayed on hospital walls; local women were representing milk companies and doctors were supporting milk substitutes. Also, concern was expressed for the TV presentation about drugs being used to treat diarrhea for those under 4 years. Pediatricians had actively sought to change distribution practices of this drug in drop form, reached an agreement, and discovered the distribution pattern unchanged. The condition of the disadvantaged who are affected by marketing forces is in constant need of action.
Washington, D.C., World Bank, 1989. 55 p. (World Bank Technical Paper No. 102)After a brief explanation of the impact of breastfeeding on fertility worldwide, inaccurate assumptions about the decline of breastfeeding are explored to point out the need for renewed promotion of breastfeeding by World Bank projects. Breastfeeding, by inhibiting fertility through lactational anovulation, is one of the most important determinants of fertility, especially for 83% of couples in developing countries who do not use modern contraception. Many believe that breastfeeding does not need promoting in areas where it is the norm, yet this belief does not take into account the need for supporting breastfeeding women, teaching them to breastfeed exclusively and frequently for the 1st 4 months. The belief that declines in breastfeeding are inevitable is belied by recent evidence in developed countries. The reliability of breastfeeding as a contraceptive for individual women varies: poor, undernourished women who breastfeed extensively may be protected up to 21.7 months (Bangladesh). Advantages of breastfeeding include significant savings of money, foreign exchange, scarce contraceptive supplies, medical treatment of diarrhea and malnutrition in infants, and possibly mothers' time. In contrast, other caregivers can prepare milk substitutes, but breastfeeding can be encouraged in the work setting, or milk expressed for later use. A review of 68 World Bank Projects revealed that 37% of all Population, Health and Nutrition projects, enumerated in an appendix, contained explicit actions to promote breastfeeding. 10 recommendations for promoting breastfeeding end the report.
In: Programmes to promote breastfeeding, edited by Derrick B. Jelliffe and E. F. Patrice Jelliffe. Oxford, England, Oxford University Press, 1988. 227-34.The involvement of UNICEF in promotion of breastfeeding as opposed to bottle feeding of formula in third world counties is described: 1st a tour of selected national and regional programs; 2nd a historical brief; 3rd a rationale for the program. UNICEF has supported educational programs and all types of media campaigns, training of health professionals, seminars for government officials, and publication of guidelines for obstetric clinics and hospitals. UNICEF has the task of compiling legislative texts on the WHO Code on breastfeeding substitutes. By 1985, 6 countries had passed the Code, and legislation was in progress in 40 others. 13 other nations have advertising of milk substitutes under government control. UNICEF has close ties with numerous non-governmental organizations to promote breastfeeding. UNICEF's action on breastfeeding officially began in 1970, with the Pan American Health Organization meeting in Bogota, in attempts to modify commercial marketing of formula mixes. in 1981, WHO adopted the International Code governing marketing of milk substitutes. In 1982, UNICEF adopted a policy placing promotion and protection of breastfeeding at the highest priority. They recommend that a minimum of 3 months paid maternal leave, and facilities at work for nursing and day care. The scientific evidence of the nutritional, immunological, anti-infective, contraceptive and maternal benefits of breastfeeding are well established. Nations and families can avoid heavy cash losses by using breast milk instead of expensive, imported substitutes and bottles.