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Maternal and Child Nutrition. 2017 Aug 10; 1-3.Written by the WHO/UNICEF NetCode author group, the comment focuses on the need to protect families from promotion of breast-milk substitutes and highlights new WHO Guidance on Ending Inappropriate Promotion of Foods for Infants and Young Children. The World Health Assembly welcomed this Guidance in 2016 and has called on all countries to adopt and implement the Guidance recommendations. NetCode, the Network for Global Monitoring and Support for Implementation of the International Code of Marketing of Breast-milk Substitutes and Subsequent Relevant World Health Assembly Resolutions, is led by the World Health Organization and the United Nations Children's Fund. NetCode members include the International Baby Food Action Network, World Alliance for Breastfeeding Action, Helen Keller International, Save the Children, and the WHO Collaborating Center at Metropol University. The comment frames the issue as a human rights issue for women and children, as articulated by a statement from the United Nations Office of the High Commissioner for Human Rights.
[Geneva, Switzerland], World Health Organization [WHO], 2006. 9 p.The purpose of this paper is to examine the nutritional aspects of feeding home-modified milk. This paper focuses only on non-breastfed children aged 0 to 6 months with no access to infant formula. Feeding older non-breastfed infants is described in another WHO document. Other problems, including the risk of dilution error when modifying the milk, the risk of bacterial contamination, and the risk that it will cause occult bleeding in the gut if not adequately boiled are acknowledged, but will not be discussed here. (excerpt)
Geneva, Switzerland, WHO, 2006. 11 p.The Code is a set of recommendations to regulate the marketing of breast-milk substitutes, feeding bottles and teats. The Code was formulated in response to the realization that poor infant feeding practices were negatively affecting the growth, health and development of children, and were a major cause of mortality in infants and young children. Poor infant feeding practices therefore were a serious obstacle to social and economic development. The 34th session of the World Health Assembly (WHA) adopted the International Code of Marketing of Breast-milk Substitutes in 1981 as a minimum requirement to protect and promote appropriate infant and young child feeding. The Code aims to contribute "to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of breast-milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution". The Code advocates that babies be breastfed. If babies are not breastfed, for whatever reason, the Code also advocates that they be fed safely on the best available nutritional alternative. Breast-milk substitutes should be available when needed, but not be promoted. The Code was adopted through a WHA resolution and represents an expression of the collective will of governments to ensure the protection and promotion of optimal feeding for infants and young children. (excerpt)
BMJ. British Medical Journal. 2007 Mar 10; 334(7592):487-488.Recently, the World Health Organization updated its recommendations of 2000 on infant feeding in the context of HIV. At that time, data had just been published quantifying the risk of infection through breast feeding so avoiding breast feeding was acknowledged as the only effective way of avoiding transmission. WHO had also just published a meta-analysis of the mortality risks of not breast feeding, but in non-HIV infected populations. Considerations of these data resulted in the statement that, "When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is recommended." Since the 2000 recommendations, the main emphasis of most national programmes aimed at preventing mother to child transmission of HIV has been to avert transmission of HIV in young infants. The most difficult challenge has been how to make breast feeding safer in communities with a high prevalence of HIV where breast feeding is the traditional mode of feeding. Remarkably, the dilemma of infant feeding and HIV has split scientific communities and programme managers into opposing camps. Even with the risk of HIV transmission, some maintain that breast feeding may still be the best option for many mothers infected with HIV because of its anti-infective and nutritional advantages. Others promote commercial infant formula, arguing that the risks of diarrhoea and malnutrition associated with formula feeding are lower in most urban communities, or that the risks of not breast feeding may not be as great for infants born to mothers infected with HIV who, to prevent transmission, choose to give formula milk from birth; it has been suggested that this active decision making and motivation may result in safer preparation and use of formula milk. (excerpt)
Are WHO/UNAIDS/UNICEF-recommended replacement milks for infants of HIV-infected mothers appropriate in the South African context?
Bulletin of the World Health Organization. 2004 Mar; 82(3):164-171.Little is known about the nutritional adequacy and feasibility of breastmilk replacement options recommended by WHO/ UNAIDS/UNICEF. The study aim was to explore suitability of the 2001 feeding recommendations for infants of HIV-infected mothers for a rural region in KwaZulu Natal, South Africa specifically with respect to adequacy of micronutrients and essential fatty acids, cost, and preparation times of replacement milks. Nutritional adequacy, cost, and preparation time of home-prepared replacement milks containing powdered full cream milk (PM) and fresh full cream milk (FM) and different micronutrient supplements (2 g UNICEF micronutrient sachet, government supplement routinely available in district public health clinics, and best available liquid paediatric supplement found in local pharmacies) were compared. Costs of locally available ingredients for replacement milk were used to calculate monthly costs for infants aged one, three, and six months. Total monthly costs of ingredients of commercial and home-prepared replacement milks were compared with each other and the average monthly income of domestic or shop workers. Time needed to prepare one feed of replacement milk was simulated. When mixed with water, sugar, and each micronutrient supplement, PM and FM provided <50% of estimated required amounts for vitamins E and C, folic acid, iodine, and selenium and <75% for zinc and pantothenic acid. PM and FM made with UNICEF micronutrient sachets provided 30% adequate intake for niacin. FM prepared with any micronutrient supplement provided no more than 32% vitamin D. All PMs provided more than adequate amounts of vitamin D. Compared with the commercial formula, PM and FM provided 8–60% of vitamins A, E, and C, folic acid, manganese, zinc, and iodine. Preparations of PM and FM provided 11% minimum recommended linoleic acid and 67% minimum recommended a-linolenic acid per 450 ml mixture. It took 21–25 minutes to optimally prepare 120 ml of replacement feed from PM or commercial infant formula and 30–35 minutes for the fresh milk preparation. PM or FM cost approximately 20% of monthly income averaged over the first six months of life; commercial formula cost approximately 32%. No home-prepared replacement milks in South Africa meet all estimated micronutrient and essential fatty acid requirements of infants aged <6 months. Commercial infant formula is the only replacement milk that meets all nutritional needs. Revisions of WHO/UNAIDS/UNICEF HIV and infant feeding course replacement milk options are needed. If replacement milks are to provide total nutrition, preparations should include vegetable oils, such as soybean oil, as a source of linoleic and a-linolenic acids, and additional vitamins and minerals. (author's)
Comparison of the efficacy of a solid ready-to-use food and a liquid, milk-based diet for the rehabilitation of severely malnourished children: a randomized trial. [Comparaison de l'efficacité d'une nourriture solide prête à l'emploi et d'un régime liquide à base de lait, en vue du rétablissement d'enfants souffrant de malnutrition grave : un essai randomisé]
American Journal of Clinical Nutrition. 2003 Aug; 78(2):302-307.Background: The World Health Organization recommends a liquid, milk-based diet (F100) during the rehabilitation phase of the treatment of severe malnutrition. A dry, solid, ready-to-use food (RTUF) that can be eaten without adding water has been proposed to eliminate the risk of bacterial contamination from added water. The efficacies of RTUF and F100 have not been compared. Objective: The objective was to compare the efficacy of RTUF and F100 in promoting weight gain in malnourished children. Design: In an open-labeled, randomized trial, 70 severely malnourished Senegalese children aged 6–36 mo were randomly allocated to receive 3 meals containing either F100 (n = 35) or RTUF (n = 35) in addition to the local diet. The data from 30 children in each group were analyzed. Results: The mean (± SD) daily energy intake in the RTUF group was 808 ± 280 (95% CI: 703.8, 912.9) kJ·kg body wt-1·d-1, and that in the F100 group was 573 ± 201 (95% CI: 497.9, 648.7) kJ·kg body wt-1·d-1 (P < 0.001). The average weight gains in the RTUF and F100 groups were 15.6 (95% CI: 13.4, 17.8) and 10.1 (95% CI: 8.7, 11.4) g·kg body wt-1·d-1, respectively (P < 0.001). The difference in weight gain was greater in the most wasted children (P < 0.05). The average duration of rehabilitation was 17.3 (95% CI: 15.6, 19.0) d in the F100 group and was 13.4 (95% CI: 12.1, 14.7) d in the RTUF group (P < 0.001). Conclusions: This study indicated that RTUF can be used efficiently for the rehabilitation of severely malnourished children. (author's)
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.
MOTHERS AND CHILDREN. 1992; 11(3):6-7.The International Baby Food Action Network (IBFAN) is a coalition of over 40 citizen groups in 70 countries. IBFAN monitors the progress worldwide of the implementation of the International Code of Marketing of Breastmilk Substitutes. The Code is intended to regulate the advertising and promotional techniques used to sell infant formula. The 1991 IBFAN report shows that 75 countries have taken some action to implement the International Code. During 1992, the IBFAN Code Documentation Center in Malaysia conducted 2 training courses to help countries draft legislation to implement and monitor compliance with the International Code. In April, government officials from 19 Asian and African countries attended the first course in Malaysia; the second course was conducted in Spanish in Guatemala and attended by officials from 15 Latin American and Caribbean countries. The resource people included representatives from NGOs in Africa, Asia, Latin America, Europe and North America with experience in Code implementation and monitoring at the national level. The main purpose of each course was to train government officials to use the International Code as a starting point for national legislation to protect breastfeeding. Participants reviewed recent information on lactation management, the advantages of breastfeeding, current trends in breastfeeding and the marketing practices of infant formula manufacturers. The participants studied the terminology contained in the International Code and terminology used by infant formula manufacturers to include breastmilk supplements such as follow-on formulas and cereal-based baby foods. Relevant World Health Assembly resolutions such as the one adopted in 1986 on the need to ban free and low-cost supplies to hospitals were examined. The legal aspects of the current Baby Friendly Hospital Initiative (BFHI) and the progress in the 12 BFHI test countries concerning the elimination of supplies were also examined. International Labor Organization conventions on maternity legislation also need to be implemented to support breastfeeding.