6.3 Nutrition: Infant and young child nutrition

Secretariat Note

In 2010 the Health Assembly requested the Director-General to develop a comprehensive implementation plan on infant and young child nutrition. The Board at its 128th session amended the scope of the plan to include maternal nutrition. An outline plan was discussed by the Sixty-fourth World Health Assembly, and in a series of consultations with Member States. The expanded draft of the plan, amended to reflect this input, is presented to the Board for its review. In addition, the Secretariat has prepared the biannual report to the Board on the implementation of the International Code of Marketing of Breast-milk Substitutes, including the results of surveys undertaken in 2010–2011, illustrating the bottlenecks of implementation, and proposing solutions.

• Document EB130/10:  Maternal, infant and young child nutrition: draft comprehensive implementation plan
• See also Draft Review of Nutrition Policies (2010)
• See WHO's website for Draft Comprehensive Implementation Plan (includes background papers and reports of regional consultations)

Watchers' notes of EB discussion

The opening statement was by the Papua New Guinea delegate who praised the draft resolution and stated the progress made by his country in this regard. He however deplored the use of private public partnerships to push interventions saying that market based goods tend to have higher concentration of unhealthy substances. Most Member States commented the draft and noted its prime importance in improving general health status of populations.

Estonia, on behalf EU, highlighted the need to include private sector effort, and stressed that the WHO needs to highlight breastfeeding, by raising concerns that only 30% of children are breastfed in the first 6 month.

Brunei noted the significance of having universal health care as it has components of maternal and child provisions and linked malnutrition in early life to obesityand other NCDs. It supported the International Code on Baby Foods and stated that by increasing maternal job leaves and promoting exclusive breastfeeding they have achieved progresses.

The AFRO region was represented by Cameroon which detailed the successes of the continent in nutrition mentioning vitamin A supplementation, promotion of exclusive breastfeeding and the enactment of baby friendly legislation in fifteen countries. AFRO suggested that governments should be stimulated to properly fund initiatives, emphasis should be given to promoting transformation of local foods and keeping actions focused at the community level.

Many countries called for intersectoral efforts with India adding that there is a need for intersectoral and institutional convergence. Similarly, the benefits of exclusive breastfeeding and the alarming increase in obesity were noted.

Norway wants a stronger emphasis on baby friendly hospital initiatives in the draft.

The EMRO, represented by Qatar, noted the need for supplements in some cases and highlighted that the political situation in the region was adversely affecting nutrition. Canada stated that targets must be measurable and adaptable to country situations and requested a background paper from the Secretariat on how it was developed.

Canada also noted that the plan should be viewed as a menu of choices for Member States while the US pointed out that marketing of food and non-alcoholic beverages to children was missing and urged standardized guidance of labelling necessary to assist legislative processes at country level.

Syria noted the important role of maternal knowledge in nutrition and Mexico asked for more dialogue between governments and health professionals especially on favorable labour issues for women.

Iran saw the need to understand links between non-dietary issues and malnutrition by using blood disorders as an example.

NGOs were heard next with “International Association of breastfeeding consultants”, “Save the Children” and “Consumers international” making submissions. “Save the Children” suggested that interventions should target the poor and should be aimed at reducing inequity within country and closing health worker gap.

“Consumer international” stressed potential areas of conflict of interest in the Scaling Up Nutrition (SUN) private public partnership and the omission of inappropriate promotion of baby foods. In conclusion, good quality presentations were made on the draft; however, the major concerns remain on the role of the private sector and the need to keep such actions at a community level  

PHM Comment

The covering notes (EB130/10) includes the biennial report on the implementation of the International Code of Marketing of Breast Milk Substitutes.  Some states have taken some actions to implement the code.  See report.  Generally disappointing. 

The Annex to EB 130/10 is an important report. It has been subject to extensive consultation and incorporates insights from a range of other strategies.  

It commences with a broad overview of the global nutrition situation. This is a very useful resource.  The paper then proceeds to review the implementation of effective nutrition plans at the country level. There are some big shortfalls. The paper then sets out five draft targest for a comprehensive implementation plan to guide on-going monitoring and evaluation.  

The paper suggests five actions towards the achievement of these targets. These have clearly been carefully thought about and together they provide a useful framework for addressing the global nutrition crisis.

From a PHM perspective the main weakness of this report lies in the careful and general language used to refer to some of the more contentious issues.  Clearly this has been judged necessary by the Secretariat as part of negotiating the politics of this field. While the report covers the key issues, in some cases it does so at such a level of generality as to be almost invisible.  Given the ongoing challenges of implementing the International Code on Breast Milk Substitutes it is likely that a more robust and more explicit approach to food trade, retail, marketing etc will be necessary.

Food security and healthy nutrition reflect the outcomes of a complex mix of: 

• productive and distributive arrangements in agriculture, trade, retail and marketing which are themselves shaped by: 
• local specificities regarding land, climate (including climate change), demography (eg urbanisation) and economic development; all of which take place in the context of; 
• political and commercial relations of power and interests (including the role of transnational food corporations and big power manoevering over trade relations; which are conducted within
• global institutions including the WTO, WEF, G20, OECD, UNCTAD, FAO, WHO, etc. 

From a PHM perspective it is self-evident that the interests of transnational food companies are not closely aligned with the objectives of this policy. Likewise it is self-evident that the 'national interests' of the big powers which dominate trade negotiations do not align closely with the objectives of this policy.  However, there is a great deal of work to be done in terms of building a clear platform regarding the regulation of TFCs and trade reform and building a broader constituency around that platform.  

Part of the problem is that while unregulated TFCs and unfair trade agreements frame nutrition outcomes for all countries, the circumstances in each country are often quite specific to that country (differences in climate, land, crops, industries, imports and exports, etc). For this reason, consideration of the intersectoral dimensions of food security and healthy nutrition need to be considered at the national and regional level as well as at the global level. Global strategies for the regulation of TFCs and for trade reform need to be cast in terms which encompass the development and nutrition needs of people in all countries.     

PHM Comment at EB 130th

 From a PHM perspective the main weakness of this report lies in the careful and general language used to refer to some of the more contentious issues. Given the ongoing challenges of implementing the International Code on Breast Milk Substitutes it is likely that a more robust and more explicit approach to food trade, retail, marketing etc will be necessary.

In our view, the document is silent about the inappropriate promotion of baby foods (paragraph 37). A specific reference to paragraph 4 of WHA Resolution 63.23 on Infant and Young Child Nutrition should be added: “to end inappropriate promotion of food for infants and young children”.

While we view the enhancement of maternal education as important (paragraph 42), a warning should be included about food and beverage industry involvement. Corporate-sponsored nutrition education materials present an even more complex problem than straightforward advertising because they blur the boundaries between marketing and education. The Plan should refer to the WHO Recommendations on the Marketing of foods and Non-alcoholic Beverages to Children that restrict marketing, including in ‘settings where children gather’ (e.g. schools) and to ‘avoid conflicts of interest.’