WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTE
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMt'\1lTTEE Fifty-f'rrst session Manila 18-22 September 2000
WPRlRC511INF .DOC.l 10 August 2000 ORIGINAL: ENGLISH
Provisional agenda item 15
FIFTY-THIRD WORLD HEALTH ASSEMBLY, AGENDA ITEM 12.4 INFANT AND YOUNG CHILD NUTRITION: FOLLOW-UP
This document contains a briefing note on a new global strategy for infant and young child feeding. The background to the new global strategy is described and a
proposed timetable for development of the strategy is provided. The document follows a discussion on infant and young child nutrition at the Fifty-Third World Health Assembly. It should therefore be read in conjunction with
document WPRlRC5119 and is scheduled for discussion under agenda item 15, Coordination of the work of the World Health Assembly, the Executive Board and the Regional Committee. The Regional Committee is asked to comment on the briefing note and its views will be forwarded to WHO Headquarters. Infant and young child nutrition is on the agenda for the 107th session of the Executive Board in January 2001. The main issues related to nutrition in the Western Pacific Region and an analysis of the WHO's response are provided in The Work of WHO in the Western Pacific Region: 1 July 1999-30 June 2000, pp.75-80.
-~ WORLD HEALTH ORGANIZATION ~ ,?,
REGIONAL COMMITTEES Sessions 2000
RC/20001NUT 20 July 2000
Fifty-third World Health Assembly, agenda item 12.4 Infant and young child nutrition: follow-up
-
Briefing note submitted to the regional committees on a new global strategy for infant and young child feeding
INTRODUCTION 1. The Fifty-third World Health Assembly, in reaffirming the importance attributed by Member States to WHO activities related to infant and young child nutrition and to further discussion of the new global strategy, requested the Director-General to place on the agenda for the 107th session (January 2001) of the Executive Board an item on infant and young child nutrition. l The Health Assembly also encouraged discussions on this issue at regional level. The present document outlines the work on drawing up a new global strategy for infant and young child feeding as a basis for discussion.
FORGING A NEW VISION 2. Improved infant and young child nutrition is central to human well-being, and as such contributes in turn to both economic development and poverty reduction. Globally, malnutrition whether intrauterine growth retardation, deficiency of iodine, vitamin A or iron, and protein-energy malnutrition - is a significant cause of reductions in disability-adjusted life expectancy (DALE); and the young are almost always the frrst to suffer and the worst affected. 2 Inappropriate feeding accounts for at least one-third of the malnutrition and contributes considerably to morbidity and mortality in under-five children. WHO has long supported Member States in their efforts to improve the feeding of infants and young children to ensure their survival, health and growth. 3. Much has been accomplished since the frrst international meeting on infant and young child nutrition in 1979.3 The combined scientific and epidemiological evidence, and the accumulated programmatic experience provide a solid technical basis for continuing concerted national and international action. 4. Over the past two decades WHO and its partners have promoted several major approaches. First, the Baby-friendly Hospital Initiative and the International Code of Marketing of Breast-milk 1
Decision WHA53(1O). See document A5317. See document WHA33/19801RECIl, Annex 6.
2 3
RC12000INUT
Substitutes are frameworks for ensuring that both health services and marketing practices contribute to good nutrition. Their universal implementation has effectively raised awareness of the specific nutritional needs of the very young and the ways in which these needs should be met. Second, the success of approaches to integrated management of childhood i1lness is due, in part, to the explicit inclusion of appropriate feeding as a key intervention. Third, the WHO multicentre growth reference study, which is under way in six countries, will establish the optimal growth ofbreastfed infants as the normative model. This international reference will provide a strong advocacy tool for promoting the right of all children to achieve their full genetic growth potential. 5. Nevertheless, much more needs to be done, nationally and internationally, to encourage appropriate feeding practices for infants and young children. WHO gives priority to the following: • promoting exclusive breastfeeding (only an estimated 35% of infants are exclusively breastfed between 0 and 4 months of age); • ensuring timely, appropriate and safe complementary feeding while breastfeeding continues (frequently, other foods are introduced too early, infants are weaned too early, or other foods are introduced later than desirable); • reinforcing policies that support breastfeeding by women at work (such as increasing the proportion of women covered by nD standards and other measures); • preventing premature interruption of exclusive breastfeeding and avoiding artificial feeding from becoming the norm by reversing the decline in prevalence and duration of breastfeeding, and improving public education and training of health workers; • meeting the nutritional needs of children at high risk of HN infection and in difficult circumstances during complex emergencies.
LAYING THE FOUNDATION 6. A technical consultation on infant and young child feeding (Geneva, 13 to 17 March 2000) was undertaken by WHO in conjunction with UNICEF. It was attended by experts in strategy and programme development, staff of the two organizations, and representatives of n.o, UNHCR, UNAIDS and the ACC Subcommittee on Nutrition. Participants assessed the strengths and weaknesses of current feeding policies and practices, identified barriers to implementation of policies, reviewed crucial interventions in order to identify feasible and effective advances, and contributed to a comprehensive draft strategy that (if adopted) would guide Member States and the international community. 7. Participants concluded that a comprehensive global strategy for infant and young child feeding should include elements of the following nine programmatic activities: • measuring trends and progress in infant-feeding practices; • increasing rates of exclusive breastfeeding; • improving complementary feeding;
2
RC12000lNUT
• strengthening and expanding the Baby-friendly Hospital Initiative; • integrating support throughout the health care system for appropriate feeding practices; • identifying effective models for community support ofbreastfeeding women; • promoting policies and practices to support breastfeeding in the workplace; • strengthening implementation of the International Code of Marketing of Breast-milk Substitutes; • understanding the impact of globalization on infant feeding. 8. Several significant issues were examined, including human rights, I the nutritional status of women, protein-energy and micronutrient malnutrition, growth and development, maternal and child morbidity and mortality, HN and infant feeding, and feeding during emergencies.
A NEW GLOBAL STRATEGY
9.
The strategy currently has three main objectives: • to improve the survival, health, nutritional status, and growth and development of infants and young children through optimal feeding. Ensuring the survival, health and nutrition of women, in their own right and in the context of their role as mothers, is fundamental to attaining this objective; • to guide government policy and action - and related support provided by the international community - for protecting, promoting and supporting optimal feeding practices for infants and young children; • to enable mothers, families and caregivers in all circumstances to make - and implement informed choices about optimal feeding practices for infants and young children.
10. Building on past achievements, the strategy will reaffirm commitment to existing goals, including attainment of the operational targets of the Innocenti Declaration,2 continued implementation of the Baby-friendly Hospital Initiative, and wide observance of the International Code of Marketing of Breast-milk Substitutes. It will also emphasize the three high-priority areas set out below.
1 Especially as defined in the Convention on the Rights ofthe Child (the child's right to nutritious food and adequate feeding) and in the Convention on the Elimination of All Forms of Discrimination against Women (on the social significance of maternity). 2 The Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding (1990) has four operational targets for all countries: appointment of an authoritative national breastfeeding coordinator and multisectoral committee; ensuring all maternity facilities are "baby-fiiendly"; action is taken to give effect to the principles and aim of the International Code of Marketing ofBreast-rnilk Substitutes; and legislation is enacted to protect breastfeeding rights of working women.
3
RCI2000INUT
(a) Exclusive breastfeeding. Existing initiatives need to be strengthened, and new approaches developed, in order to protect, promote and support exclusive breastfeeding. 1 The dual challenge for governments is to advocate strongly breastfeeding and to enact policies and develop programmes that reinforce family and community support for breastfeeding mothers, including that provided by mother-to-mother support groups the world over. This support includes: ensuring that "baby-friendly" principles are applied wherever mothers give birth and that the high standards of the Baby-friendly Hospital Initiative are maintained through careful monitoring; promoting adoption of effective measures - including legislation - to give effect to the International Code of Marketing of Breast-milk Substitutes; and protecting the maternity rights - including breastfeeding - for women at work.
Complementary feeding. Timely, safe and adequate complementary feeding, with continued breastfeeding, needs to be made a high priority of global nutrition. Indeed, the continued faltering growth of many children suggests that complementary feeding practices remain inadequate. More needs to be done to improve feeding practices through use of locally available and affordable foods, to determine guidelines and indicators of appropriate nutritional outcomes, and to expand the content and availability of objective and consistent information and educational materials for health workers, mothers and families. Action-oriented research is also needed to identify causes of and remedies for growth faltering. (b)
(c) Feeding in special circumstances. The best hope for averting the disability and death that are so common among infants and young children during emergencies is to ensure that they are adequately cared for and fed. However, meeting their nutritional needs during natural disasters, famine and civil unrest, in refugee settings, in the presence of HNIAlDS, or when they are already severely malnourished is complex and demanding. New approaches are required both to meet the needs of this especially vulnerable population group and to cope with the growing scale, variety and frequency of new emergencies that threaten its nutritional status. 11. It is crucial to define operational responsibilities for improving infant and young child feeding practices, and to determine ways in which to mobilize the necessary resources. For governments, for example, these responsibilities cover areas such as public information and education, preservice and inservice education and training for health workers, programme monitoring and evaluation, and action-oriented research. For international organizations, they include establishing standards and guidelines, strengthening national capabilities through technical support, and monitoring progress using global data banks and appropriate indicators.
THE WAY FORWARD 12. Successful international strategies all have common features: careful preparation, clear scientific basis, widespread ownership, and acceptance by governments as much as by their citizenbeneficiaries. Successful formulation and implementation of a new strategy for infant and young child feeding will thus depend on:
1 The WHO multicentre growth reference study (see document A5317, Annex) aims to improve understanding of the age range during which breast milk alone is sufficient to meet the healthy infant's nutritional requirements for growth and development. In addition, in developing the new strategy, WHO is systematically reviewing the relevant scientific literature published since the report in [995 ofthe WHO Expert Committee on Physical Status (WHO Technical Report Series, No. 854).
4
RC/ZOOOINUT
• a country-based approach; the people are involved, from the outset, in tailoring the strategy to their specific needs; • participation of all the main actors - governments and civil society together - in development of, support for, and implementation of, the strategy, including framing of intersectoral policy to give effect to it in ways that are consistent with their specific circumstances; • endorsement of WHO's governing bodies, and powerful consensus within the international community; • international advocacy and support, grounded on the best available scientific and epidemiological evidence. 13. On the basis of these principles and the inputs provided during the technical consultation, WHO is drafting a global strategy for infant and young child feeding (see timetable in Annex). It will be conSidered at regional consultations during the last quarter of 2000 and the first quarter of 2001. In addition, Member States will assess the suitability and expected effectiveness of the draft strategy, and identify priorities, action areas and operational targets for governments, international organizations and civil society. The draft will be revised in the light of comments and circulated for information and feedback to Member States and other interested parties. Lastly, the Director-General will submit the final revised text to the Executive Board at its 109th session (January 2002) and to the Fifty-fifth World Health Assembly (May 2002) for endorsement.
CONCLUSION 14. The technical consultation by WHO and UNICEF focused on fundamental issues relating to the feeding of infants and young children and critical examination of ways of addressing them. The process represents a significant step towards formulation of a new consensus-based global strategy. WHO and its international partners are working out an approach that is technically sound. It will be designed to produce a lasting reduction in malnutrition, poverty and deprivation. Although WHO can recommend the strategy, it is for governments and civil society everywhere to decide whether it is accepted, adapted, then applied.
5
RCI2000INUT
ANNEX
PROPOSED TIMET ABLE FOR DEVELOPMENT OF A GLOBAL STRATEGY ON INFANT AND YOUNG CIDLD FEEDING June-August 2000 l. (a) Continue preparation of draft strategy and plan of action.
(b) Develop guidelines for Member States: • • • • • to review elements to assess their applicability in specific environments to assess their comprehensiveness to evaluate their usefulness and potential effectiveness to describe how the strategy complements/embodies/includes national policy. I
(c) Prepare a comprehensive report on infant and young child feeding for the regional committees in 2000; brief regional offices. (d) IdentifY funds needed for next steps in the process. June-August 2000 2. (a) Field test elements and compoonents of the strategy in two countries.
(b) Together with regional offices, identify: • 2 countries/region September 2000
= 12 countries
(IdentifY appropriate national focal points for reviewing, assessing and evaluating the draft strategy)
(c) Dispatch draft strategy and guidelines to these countries Allow 2 months for assessment Provide technical support or visits from regional advisers/short-term consultants Consolidate feedback and incorporate into draft strategy. 3. (a) Prepare progress report for 107th session of the Executive Board (January 2001) and .Fifty-fourth World Health Assembly (May 2001) (submit in October 2000). (b) Edit, finalize and issue background papers of March 2000 technical consultation.
October 2000
January 2001June 2001
(c) Joint WHOIUNICEF regional meetings: three to four regional/biregional meetings The Americas AfricaiEastern Mediterranean Europe South-East Asia/Western Pacific (d) Consolidate comments and produce next draft.
Purpose of regional meetings: - to review country analyses in detail - to develop further the draft strategy
June-September 2001
4. (a) Circulate revised drafts to Member States and interested parties for information and feedback. (b) Consolidate final draft strategy and plan of action.
October 200 I
5. Prepare for 109th session of the Executive Board (January 2002) (submit in October 2001): • draft strategy and plan of action • comprehensive report on infant and young child nutrition • draft resolution for the Executive Board.
January 2002 May 2002
6. Consideration of draft strategy and plan of action by the Executive Board. 7. Submission of strategy and plan of action for consideration by the Fifty-fifth World Health Assembly.
6