World Health Assembly: what’s on the agenda?

    Important progress was made in the protection, promotion and support of breastfeeding at the January 2005 World Health Organization (WHO) Executive Board meeting. The Executive Board sets the agenda for the upcoming World Health Assembly (WHA) meeting in May and prepares and adopts resolutions for discussion by the full Assembly of Member States. For those working on infant and young child nutrition, this year’s outcome promises to be an important step forward in a number of key areas, especially after last year’s disappointing results of seeing the proposed infant and young child nutrition resolution¹ deferred for more discussions.

    But this year’s improved  proposed resolution did not take place without overcoming some serious obstacles. Instead of basing the revisions on the 2004 draft resolution, the WHO Secretariat had gutted and redrafted the document to remove important critical provisions needed for the protection of infant health.

    They deleted:

    The Secretariat’s new resolution did not sit well with its original sponsors. Tonga, one of the original sponsors, noted that the Secretariat had deleted 31 of the 41 lines and that the resolution tabled by the Secretariat did not represent the one forwarded to the Executive Board during the Assembly of 2004. The Tonga delegate presented the views of the .ve sponsoring countries, namely, that the original draft be returned for discussion as required by the rules of the Assembly. "If we do not discuss the original draft, we may set a dangerous precedent," he said. The member from Nepal, who had cosponsored the resolution, supported his comments. And after some further discussion a drafting group was struck. Important provisions were then reinserted into the resolution.

Infant deaths  add urgency

    Two recent infant deaths in France related to the pathogenic Enterobacter sakazakii bacteria contaminating powdered formula² added urgency for the WHO Board to act quickly to address this global risk.  These serious formula risks also added impetus for continued support to improve breastfeeding practices. Duration and exclusivity of breastfeeding remains far from optimal. Estimates of children’s deaths before the age of five are still at an alarming 10.8 million annually. Low cost interventions, of which exclusive breastfeeding is the most effective, can prevent an estimated two out of three deaths.³ Support systems to enable exclusive and continued breastfeeding are needed and needed now.

Marketing persists

    Despite overwhelming efforts by many health care workers and governments to protect breastfeeding, the marketing behaviours of the infant foods industries persist, adding additional work and costs to overburdened health care systems in addition to compromised health.

    Eliminating nutrition and health claims on these products remains a critical priority. Deceptive promises of higher  IQs and better brain and eye development with no scientific backing for fortified formulas have led parents to mistakenly believe that formula feeding can be as good as breastfeeding. And in addition, the compromising of health professionals through sponsorships or other financial support from the infant foods industries remains a global phenomenon.

    Here in Canada formula manufacturers, Nestlé and Mead Johnson were linked to a Pediatric Nutrition Day for dietitians at the Children’s Hospital of Eastern Ontario. Because of public protest this event was cancelled (see p. 8). All these company behaviours are intended to retain market share for their harmful products and to minimize and sabotage the full support needed for breastfeeding.

The deaths of babies and the recall of Pregestimil did not affect Mead Johnson’s advertising of the product. This promotion remained on the Mead Johnson Website while no information could be found to warn parents about the contaminated formula.

Key items adopted by the Executive Board to go before the full assembly in May are:

WHO Executive Board 115R12⁴ urges Member States:

1) to continue to protect, promote and support exclusive breastfeeding for six months as a global priority…and for continued breastfeeding up to two years and beyond, by implementing fully the WHO global strategy on infant and young child feeding, encouraging the formation of a comprehensive national policy, …and allocation of adequate resources for this process;

2) to ensure that nutrition and health claims are  not permitted for foods for infants and young children except where speci.cally provided for in relevant Codex Alimentarius standards or national legislation;

3) to ensure, in situations where infants are not breastfed, that  clinicians and other health care providers, community workers and families, parents and other caregivers, are … informed that powdered infant formula may contain pathogenic microorganisms …and that this information be conveyed through explicit warnings on packaging;

4) to ensure that .nancial support for professionals working in infant and young child health does not create con.icts of interest.

References

1. INFACT Canada. Babies will have to wait…INFACT Canada Newsletter Spring page 1-2, 2004 [Return]

2. Institut de Veille Sanitaire. Ministère des Solidarités, de la santé et de la famille. Retrait de lots de Pregestimil. Communiqué de presse, 10 décembre, 2004  [Return]

3. Jones G. et al. How many child deaths can we prevent this year? Lancet 362: 65-71, 2003  [Return]

4. WHO Infant and  Young Child Nutrition EB115. R12, January, 2005  [Return]