13.13 Infant and young child nutrition: implementation plan

Document A64/22 is a report from the Secretariat reporting on the implementation plan for action on maternal, infant and young child nutrition. 

See WHA63.23, the resolution from WHA May 2010 on maternal, infant and young child nutrition.

See Outline of Implementation Plan on Infant and Young Child Nutrition

See WHO Topic page on nutrition for health and development

Background papers at http://www.who.int/nutrition/EB128/en/index.html

See the PHM statement read at the 64^th WHA.

WHA Watch Comments in preparation for the 64th WHA

This is an important area and WHO Watch will be following the development of the implementation plan closely. Both undernutrition and obesity are linked to the increasing dependence of poor countries on the rich countries for their food security; a process that has been accelerated by trade agreements, climate change, and use of cereals for biofuels. It is imperative that nutrition strategies address not only the immediate nutritional needs of children (i.e. their right to nutrition), but also the complex socioeconomic and political determinants of malnutrition. If these root causes are not addressed, the global food crisis will continue to be a threat to the livelihoods of poor and marginalized groups across the developing world. At the same time, country governments and international bodies such as the WHO must actively advocate for policies and measures to enforce a regulation of trade and marketing of unhealthy foodstuffs in order to protect the health of populations, and of children in particular, from aggressive corporate influence.
There is a concern that the focus within WHO has shifted on nutrition in general, to the detriment of breastfeeding and complementary feeding. Breastfeeding is a major safeguard against early child malnutrition and needs to be protected, promoted and supported within the broad social, economic and environmental context and as part of comprehensive primary health care. Support has to be at all levels. Making it easy for mothers to breastfeed also requires provisions such as laws governing workplace practice, statutory paid time off work and a general acceptance of breastfeeding including in public places. IBFAN's reports on the ongoing violations of the International Code of Marketing of Breast-milk Substitutes are strong indicators that the battle for breastfeeding still needs to be fought.
In order to prevent the later consequences of inadequate nutrition in early childhood, the control of marketing practices should be strongly enforced, especially in schools and other areas where children and adolescents gather. Binding regulations in the public interest are necessary and crucial, as voluntary agreements by corporations are inadequate and often disregarded when manufacturers feel free, especially in the South. The envisaged industry participation in the development and implementation of the plan is therefore of concern. The WHO report suggests their involvement in regional and national consultations from the very outset, without any mention of guidance on the management of conflicts of interest. Any consultation process should be made transparent through publication on the website of all submissions, including those coming from the private sector. All actors involved should be clearly identified and all conflict of interest, including institutional ones, should be disclosed. WHO topic and program websites should disclose donors.
The implementation plan must be aligned with the wider health systems, that should be based on primary health care with strong community participation. This is crucial to make nutritional interventions sustainable in local contexts. The use of ready-to-use therapeutic foods (RUTF) should be restricted to the treatment of severe acute malnutrition and should not be employed for use in chronic undernutrition or prevention. Local production of RUTF should be accelerated, together with a focus on sustainability of such interventions by promoting awareness of the basic ingredients of such packaged products, in order that users may cultivate or purchase such constituent foods in the future. In addition, technical interventions to fight malnutrition have to be balanced with decentralised social interventions that allow for community control and address the underlying determinants of nutritional problems. These strategies need to be comprehensive and in line with broader socioeconomic objectives, and not be based on centralised, top-down solutions.
The long-term and definitive elimination of malnutrition rests on consistent action to tackle its structural determinants. Any short-term strategy must, at the minimum, ensure that it does not postpone acting on the long-term goals of peace, right to nutrition, social justice and disparity reduction. The WHO must insist that food security and sovereignty are essential for good nutrition, and that measures to promote such food sovereignty are supported also by other sectors and institutions.
 

Watching Report of  this agenda point in the 64th WHA (May 20, 2011)

The item was discussed in Committee B in the end of the morning. Statements were made by Sri Lanka, India, Bahrein, Bangladesh, Thailand, USA, Turkey, China, Nigeria, Jamaica, Canada, Iraq, Malaysia, Bolivia, Tanzania, Australia, Paraguay, Kuwait, Democratic Republic of Congo, Morocco, Chinese Taipei, Burundi and Indonesia.
Countries from southeast Asia were aligned with the following points:
- WHO needs to reinforce the focus on breastfeeding (exclusive breastfeeding until 6 months and overall breastfeeding until at least 2 years of age), like the baby friendly hospital initiative and mother friendly environments;
- management of severe malnutrition should be done with culturally acceptable food instead of Ready to Use Food (RUTF) when possible, or locally produced RUTF;
- regulation of the market of baby food and respect to the International Code of Marketing of Breast Milk Substitutes are needed.
Many other countries also shared the importance to invest in breastfeeding promotion and support. Many countries brought their experiences in implementing the plan, reporting on implementation strategies and progress made. The need to have adapted implementation strategies according to each country's context as well as adequate monitoring systems was stressed by many.
African countries reported on the high prevalence of micronutrients deficiencies.
Paraguay called on the need to involve civil society in order to have a real intersectoral approach and acknowledged that the challenge is to see nutrition as a human right, which is not only food supplementation, but also allowing conditions for safe nutrition and life.
Followed the statements by civil society:
International Lactation Consultant Association (ILCA) urged the WHO not to shift attention to general nutritional interventions in detriment of breastfeeding promotion and support. Focus on breastfeeding cannot be lost.
Consumers International warned of the numerous code violations reported by IBFAN and stated that industry participation in the implementation of the plan is of great concern, since there is no mention of conflicts of interest. In this WHA, Dr. Chan said that we should pick the good industries and run with them but the report shows that there are no good ones. So if the role of industry expands to the policy setting, the effects of recommendations will be compromised at all levels.
Then came the PHM statement (read by Camila Giugliani), which was very much aligned with the preceding two civil society organizations. The statement recalled also upon the need to intervene in the wider socioeconomic and political determinants of malnutrition, and that nutrition strategies must be part of a wider strong health system based on primary health care.
The PHM statement was followed by International Association of Infant Food Manufacturers, and so the interventions ended with the industry's perception, stating that WHO needs to promote the involvement of the private sector, and that locally available foods do not meet the needs of children, so mothers need counseling and education which they can provide!
Finally, the secretariat (by means of Dr. Alwan, assistant Director-General) addressed some of the interventions. He said that he had taken note of  the comments made by the delegate form Thailand regarding the need to accord greater priority to strengthening the implementation of the International Code of Marketing of Breast-milk Substitutes. To civil society, he assured that WHO will continue to apply the guidelines for interaction with the private sector during the consultations on the implementation plan and that the biannual reporting on the global strategy for infant and young child feeding and the Code will continue. He also said that a draft of the comprehensive implementation plan would be prepared by August 2011, circulated to members for comments in September 2011, and submitted to the EB in January 2012. Besides that, he mentioned that consultations would be held in Burkina Faso and Sri Lanka (and maybe  in the Americas) before the EB. The Watchers need to keep on watching this issue!