Goal 3 of the United Nations Sustainable Development Goals (SDGs) is to “ensure healthy lives and promote well-being for all at all ages.” Around the world, there are still children that experience malnutrition leading to stunting, low birth weight, overweight and wasting. Also, there are children who are less breastfed and mothers with anaemia. But countries at the annual World Health Assembly (WHA) last week agreed to continue work towards improving maternal, infant and young child nutrition as well as put an end to all forms of malnutrition by 2030.

At the concluding session of the 71^st World Health Assembly (WHA) which took place from 21-26 May, countries agreed to the draft resolution [pdf] on improving infant and young child feeding. The resolution was proposed by 18 countries and took into account two reports on Comprehensive implementation plan on maternal, infant and young child nutrition, Document A71/22 [pdf] and Safeguarding against possible conflicts of interest in nutrition programmes, Document A71/23 [pdf] which were noted by the WHA committee.

The resolution urges member states “to increase investment in development, implementation and monitoring and evaluation of laws, policies and programmes aimed at protection, promotion, including education and support of breastfeeding, including through multisectoral approaches and awareness raising.”

It also urges member states to “to implement and/or strengthen national mechanisms for effective implementation of measures aimed at giving effect to the International Code of Marketing of Breast-milk Substitutes as well as other WHO evidence based recommendations.” And it further urges them “to celebrate World Breastfeeding Week as a valuable means to promote breastfeeding.”

In addition, the resolution requests that WHO, upon request, provide technical support to member states in order to support infants and young child feeding and to continue to develop tools for training, monitoring and advocacy to support member states with implementation regarding the revised Ten steps to successful breastfeeding and a Baby-Friendly Hospital Initiative (BFHI).

China emphasised that food supply by the private sector is important and hence, the secretariat should not exclude the private sector while implementing these initiatives.

Vietnam pointed out the importance of considering the specific context of countries in policy development and implementation of nutrition at country level. The context should benefit the country as well as government regulations, and implementation should ensure harmonisation of interest between parties, government and people, it said.

France underscored the need for coordination of work with the works of other bodies on the subject of nutrition.

Essentiality of Breastfeeding

Ecuador took the lead, along with other countries, to highlight the significance of breast milk and breastfeeding for infants and young children. According to Ecuador, protecting maternal nutrition and breastfeeding is not an attack on the milk industry in Ecuador, the maternal milk is a human right and every child only needs his or her mother’s milk and love to develop socially.

Kenya also emphasised that “breastfeeding is critical for child survival, nutrition and development.”

For Brazil, “protecting and promoting healthy infant nutrition and breast milk for infants is essential.” Brazil also said it is already stimulating the use of the Ten steps to successful breastfeeding as part of the implementation of the Baby-friendly Hospital Initiative (BFHI). However, it expressed its dissatisfaction with the current step 9 of the Ten steps to successful breastfeeding “on the use and risks of feeding bottles, teats and pacifiers.”

Non-state actors like the FDI World Dental Federation, and the International Baby Food Action Network (IBFAN) also expressed their concerns regarding breastfeeding.

FDI World Dental Federation urged member states to strengthen legislation on the International Code of Marketing of Breast-milk Substitutes and emphasised that breast milk substitutes that contain sugars increase the risk of developing early childhood caries.

IBFAN highlights that the “industry and the produce that works to further their interest undermine and obstruct countries’ attempts to curb inappropriate marketing practices,” and reminded member states “of their moral and political obligation to strengthen code implementation, monitoring and enforcement, ensuring that they are free from commercial influence.”

Targeted Support for Overweight and Low Breastfeeding

South Africa lauded the progress made so far on global targets on stunting and anaemia but highlighted that prevalence of overweight is increasing and that rate of exclusive breastfeeding remains lower than 50 percent, especially in countries in Africa and Asia. South Africa, therefore, requested that the secretariat provide targeted support regarding these concerns.

Kenya, on behalf of the African region, also highlighted the increasing prevalence of obesity and overweight adults and children in the African region and requested that WHO support member states in curbing and reversing this trend.

Conflicts of Interest in Nutrition Programmes

Many countries expressed their views on the report [pdf] on safeguarding against possible conflicts of interest in nutrition programmes regarding maternal, infant and young child nutrition. While some fully supported the idea of safeguarding, others had reservations regarding certain aspects of the report.

Kenya, on behalf of the African region, said African countries “cannot remain silent on the unacceptable issue of inappropriate forms of promotion of foods for infants and young children and calls on member states to continue taking all necessary measures in the interest of public health to end the inappropriate promotion of foods for infants and young children.” The region said it “welcomes the piloting of conflicts of interest tools at the country level, the six WHO regions, to test the applicability and practical value.”

The Dominican Republic said it hopes to see an increase in the rate of maternal breastfeeding and an end to advertising of secondary foods for infants.

Pakistan requested WHO’s support in “monitoring and implementation of the International Code of Marketing Breast-milk Substitutes and the net code protocol which will enable establishment of effective monitoring systems to eliminate inappropriate marketing of foods to infants and young children.”

However, the United States said it shares a “common objective in promoting breastfeeding as well as adequate and timely complementary feeding and also by ensuring breast milk substitutes are properly used when necessary on the basis of adequate information under appropriate marketing even distribution,” but that it also remains committed to achieving nutrition with all stakeholders even the private sector through cost-effective and evidence-based measures that are tailored to the actual context.

The US added that it is concerned with the report on conflicts of interest which it said discourages collaboration rather than encouraging it, and highlighted that every organisation has conflicts of interest, not only private companies.

Similarly, Vietnam contested WHO’s approach to conflicts of interest and mentioned that the country will continue to engage with the private sector.

The UK also said it believes there is a significant need for guidance on dealing with conflicts of interest in member states’ engagement with non-state actors and pointed out that the report on conflicts of interest should be improved for acceptability and usefulness for all relevant stakeholders.

The UK, therefore, requested a “consultation process with a range of expert stakeholders who can take a responsive view on this with good representation across business, government, civil society and the UN.” It said that “if possible [it] should take place prior to the proposed pilot testing that commences at country level or at least in parallel to it,” and asked that a “revised guidance document should also be tabled at a future EB [Executive Board] for discussion and endorsement.”

IBFAN argued that WHO’s conflicts of interest guidance is fundamentally flawed because of its definition. According to IBFAN, defining conflicts of interest as conflicts between diverging interests instead of conflicts of a person or an institution could make areas of conflicts become common ground if left uncorrected, and thereby would lead to harmful redefinition at national level which would increase the risks of conflicts of interest and undue influences.

Secretariat Response

WHO Assistant Director-General for Non-Communicable Diseases and Mental Health Svetlana Akselrod responded on behalf of the secretariat. She mentioned the newly approved WHO 13^th General Programme of Work (GPW 13), which already “highlighted the objective to reduce stunting, wasting and overweight,” but also said that “the improvement of maternal infant and young children feeding is required for all of them, as well as for other … achievements of the ambitious goal to improve the lives of billions of people.”

On anaemia, she said, “WHO is working with the partners to look at the new interventions,” for instance, folic acid supplementation.

On overweight, she said “WHO is working on the revision of the dietary counselling for children receiving complementary feeding as part of the integrative management of childhood illness as well as the implementation of the commission [on] ending child obesity.”

On the issue of conflicts of interest, she said that “WHO will convene a consultation on the 23^rd of October to review countries’ experience and further discussion, the implementation of the approach illustrated by secretariat.”

In the end, countries unanimously agreed to improve infant and young child feeding and the committee approved the resolution.

Image Credits: WHO SEARO.