WORLD tiEALTH ORGAMIZA· T ION
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU RiGIONAL DU PACIFIQUE OCCIDENTAL
•
ORGANISATION MONDIALE DE LA SANTi
REGIONAL COMMITTEE Thirty -third session Manila 20-24 September 1982 Provisional agenda item 16
WPR/RC33f14 Rev.l 18 August 1982 ORIGINAL: ENGLISH
INFANT AND YOUNG CHILD FEEDING AND INTERNATIONAL CODE OF MARKETING OF .BREAST -MILK SUBSTITUTES
The Regional Committee is expected to follow up and review the implementation of the operative paragraphs of resolutions WHA33.32, WHA34.22 and WPR/RC32.Rll. This report sets out the information available concerning activities in the field of infant and young child feeding, as part of the regular programme in this area, and as a follow-up to the World Health Assembly and Regional Committee resolutions. An integral part of the information provided on infant and young child feeding is the status of implementation of the International Code of Marketing of Breast-milk Substitutes. A summary of the regional status is included; attention is drawn to the revised Guiding Principles for facilitating reporting by Member States on action taken in the field of infant and young child feeding (Annex 2); and an explanation is given of the sequence of reporting as provided for in the resolutions (Annex 3 consists ·of a timetable for reporting). A proposal with regard to the type of reporting to be undertaken in the future is included in paragraph 10 for the Regional Committee's consideration.
WPR/RC33/14 Rev.l page 2 1. INTRODUCTION Resolutions of the ·World Health Assembly and the · Regional Committee for the Western Pacific 1. At its thirty-second session, in September 1981, the Regional Committee for the Western Pacific adopted resolution WPR/RC32.Rll on infant and young child feeding, relating to World Health Assembly resolution WHA33.32 on the same subject, and resolution WHA34.22 on the International Code of Marketing of Breast-milk Substitutes, referred to hereafter as the International Code. The resolution urged Member States to support the implementation of the Health Assembly resolutions and to make appropriate use of Guiding Principles prepared by the WHO Secretariat for facilitating reporting by Member States on action taken in the field of infant and young child feeding. In the same resolution, the Regional Committee decided to follow-up and review at future sessions the status of implementation of the two Health Assembly resolutions. 2. In May 1982, the Thirty-fifth World Health Assembly adopted resolution WHA35.26, a copy of which is attached as Annex 1, which urged Member States to give renewed attention to the need to adopt national legislation, regulations or other suitable measures to give effect to the International Code. The present report sets out information available concerning action taken in the 3. field of infant and young child feeding, as part of the regular programme of activities in this area, and as a follow-up of the World Health Assembly and Regional Committee resolutions. The information is based on the five-theme discussion framework used during the Joint WHO/UNICEF Meeting on Infant and Young Child Feeding held in October 1979, namely; the encouragement and support of breastfeeding; the promotion and support of appropriate and timely complementary feeding (weaning) practices with the use of local food resources; the strengthening of education, training and information on infant and young child feeding; the development of support for the improved health and social status of women in relation to infant and young child feeding; the appropriate marketing and distribution of breast-milk substitutes. An integral part of the information provided is the status of implementation of the International Code of Marketing of Breast-milk Substitutes.
WPRfRC33fl4 Rev.l page 3 4. It is important to recall that the majority of the activities are not carried out in isolation, but form part . of more comprehensive programmes on maternal and child health and nutrition, which are essential elements of the strategy for health for all by the year 2000. Guiding principles for facilitating reporting by Member States on action taken in the field of infant and young child feeding
5. In the Philippines, a national consultation on infant and young child feeding, held prior to the thirty-second session of the Regional Committee in September 1981, reviewed the Guiding Principles. The discussions led to the preparation of a long-term plan of action on infant and young child feeding, which will include the development of measures to give effect to the International Code. 6. Taking into account the comments of Member States made during the regional committee sessions and the national consultations held in 1981,1 revised Guiding Principles, attached as Annex 2, were prepared for distribution to Member States. It is hoped that they will facilitate the preparation of national reports on action taken and permit their consolidation and presentation to the Regional Committee and subsequently to the World Health Assembly. on infant and youn lementation of the
7. The two World Health Assembly resolutions and the Regional Committee resolution established dates by which the Director-General and the Regional Director should report in relation to infant and young child feeding and the International Code. Annex 3 consists of a timetable for the submission of reports by Member States and the WHO Regional Office for the Western Pacific. The provisions of the various resolutions and of the International Code itself, which form the basis of the timetable, are described below: Resolution WHA33.32- Infant and Young Child Feeding (1 980):2 Operative paragraph 6(7): the Director-General to submit a report to the Thirty-fourth World Health Assembly on the action of WHO and Member States regarding the promotion of breastfeeding and infant and young child feeding (1981: completed); and thereafter in even-numbered years, i.e. the Thirty-fifth World Health Assembly (1982: completed); the Thirty-seventh World Health Assembly (1984); and so on. This report will be made up of information provided by Member States through the regional committees in 1983. (1)
1National consultations to review the Guiding Principles were held in India and Zaire, in addition to the Philippines. 2Handbook of Resolutions and Decisions of the World Health Assembly and the Executive Board, Vol. II, 4th ed., 1981, page 21.
WPR/RC33fl4 Rev.l page 4 Resolution · WHA34.22 .;. · International Code of Marketing of Breast-milk Substitutes 0981):1 (2) Operative paragraph 5(3): the Director-General to submit a report to the Thirty-sixth World Health Assembly (1983) on the status of compliance with and implementation and monitoring of the International Code at country, regional and global levels. (3) Article 11.6 of the International Code stipulates that, in accordance with Article 62 of the Constitution of WHO, Member States shall communicate annually to the Director-General information on action taken to give effect to the principles and aim of the Code.2 (4) Article 11.7 of the International Code requests the Director-General to submit a report in even.;..numbered years on the status of implementation of the International Code: i.e. to the Thirty-fifth World Health Assembly (J 982: completed); the Thirty-seventh World Health Assembly (1984); and so on.2 This report will be made up of information provided by Member States through the regional committees in 1983. Operative paragraph 3: the regional committees to follow-up and (5) review implementation of this resolution in the spirit of resolution WHA33.17 on WHO's structures in the light of its functions. Resolution WPR/RC32~Rll.;.. Infant and Young Child Feeding (1981):3 (6} Operative paragraph 2(2): urges Member States of the Western Pacific Region to use the Guiding Principles for facilitating reporting by Member States on action taken in the field of infant and young child feeding. The Guiding Principles include a section on the International Code, as "Theme five". (See Annex 2, page 21 of the present document). (7) Operative paragraph 3: the Regional Committee to follow-up and review at future sessions implementation of its present resolution which gives full and unanimous support to resolutions WHA33.32 and WHA34.22. In view of operative paragraph 3 of resolution WHA34.22 (see(5) above), it was decided that a report should be submitted to the present, thirty-third, session of the Regional Committee. Routine biennial reporting to the Regional Committee will commence in 1983 (see (1) and (4) above}.
loocument WHA34fl981/REC/l, page 21. 2oocument WHA34/1981/REC/l, Annex 3, page 71. 3Handbook of Resolutions and Decisions of the WHO Committee for the Western Pacific, Vol. II, 3rd ed., 1982, page 49. Regional
WPR{RC33/14 Rev.! page 5 In even-numbered years, the Director-General is to report to the World Health 8. Assembly on both infant and young child feeding (see (1) above) and the status of implementation of the International Code (see (4) above), through the regional committees (see (5) above); therefore reports are required from Member States for consideration by the regional committees in odd-numbered years ( 1983 and odd-numbered years thereafter). However, Member States are to report annually on action taken to give effect to the International Code (see (3) above), though it is not expected that these reports will be presented to the regional committees in ·even-numbered years or to the World Health Assembly in odd-numbered years. 9. Requirements from Member States to the WHO Regional Office for the Western Pacific from 1983 onwards are therefore: (a) In odd-numbered years: reports on infant and young child feeding and implementation of the International Code using the Guiding Principles. These reports will be presented to the Regional Committee in September of odd-numbered years and sent to the Director-General for incorporation in his report to the World Health Assembly in even-numbered years. (b) In even-numbered years: reports on implementation of the International Code in order .to fulfil the requirements of Article 62 of the Constitution of WHO. Since "Theme five" of the Guiding Principles refers to the International Code, that section may be used in preparing the reports. Unless the World Health Assembly decides in the future that a special report is required, as it did by resolution WHA34.22 {see (2) above), or alters the sequence of reporting, these reports will not be presented to either the Regional Committee or the World Health Assembly. 10. It is felt that this reporting sequence is somewhat complicated and might lead to confusion in the future. The Regional Committee is therefore requested to consider whether it would like to recommend a routine annual reporting by Member States on both infant and young child feeding and implementation of the International Code, using the ~uiding Principles, leaving it to the Secretariat to use the material submitted as required by resolutions of the World Health Assembly and the Regional Committee. · 2. SUMMARIES China 11. In China, the efforts of the health services have focused on publicity and education, especially of pregnant and lactating women, with the aid of posters and other publications and the mass media. Women are entitled to a maternity leave of from 56 days to 70 days in the case of those practising family planning and even up to six months on request. Breast-feeding facilities and breast-feeding breaks during working hours are available to working women. · 12. The Ministry of Light Industry has studied such aspects as the production of appropriate breast-milk substitutes and weaning foods and the standardization of products. In kindergartens and nurseries in major cities, such as Beijing and Shanghai, planned diets are being tested and promoted on the basis of recommended dietary aUQwances. With a view to promoting family planning, special consideration is given to the children of one-child families.
OF ACTIVITIES
WPR/RC33/14 Rev.l page 6 13. At the Shanghai Children's Hospital, a study is under way on the extent to which breast-feeding is practised, its duration and associated factors, other infant feeding practices, and the volume and composition of breast-milk produced by mothers from different oc_cupational backgrounds. Th~se stud~es will ~rovi?e data comparable with those resultmg from the WHO collaborative studies on the subJect. 14. Plans are being made to organize a national seminar on breast-feeding in Shanghai towards the end of 1982. Cook Islands
15. The main emphasis in Cook Islands has been on health education for the promotion of breast-feeding and good weaning practices through the public health system; in particular through ante-natal care and post-natal home visits. Since May 1981, maternity leave for working mothers has been six weeks. Breast-feeding campaigns have been conducted since July 1981, through radio stations and other channels. Public health nurses are required to include in their monthly job reports information on efforts to encourage and support breast-feeding. 16. The Government reports that there is no advertising or .other form of promotion of infant formulae or weaning foods anywhere on Cook Islands.
17. In Fiji, a national food and nutrition plan, which demonstrates an increased awareness of the importance of infant and young child feeding, is being developed with the support of F AO; UNDP and WHO. In the context of the development of national nutrition policies, a national workshop was organized with WHO support in July 1981, which undertook a detailed review of infant and young child feeding. 18. An infant feeding survey was conducted in Suva to determine reasons for the decline in breast-feeding over the years, especially among the Indian population group. Efforts in the area of promotion and educ~tion are continuing. Guam 19. The Government of Guam strongly supports breast-feeding and is considering measures to encourage it, thus turning the trend away from bottle feeding, alleviating many nutritional problems, and reducing morbidity and mortality among young children. 20. The measures envisaged for promotion include: extension of maternity leave for Government employees from two weeks to six weeks, so that an adequate breast-milk supply can be established before the mother resumes employment; provision of flexible work scheduling for employees who are breast-feeding; financial incentives to encourage the establishment of child care facilities at or near work sites; recruitment of experienced nurses to provide education on breast-feeding to the public and to mothers who have just delivered at Guam Memorial Hospital; and making it possible to rent breast pumps through government health agencies. 21. The Government is now in the process of determining the cost of these measures.
WPR/RC33/14 Rev.J page 7 Hong Kong
22. The Department of Health provides education and information through various publicity channels to pregnant women and mothers of infants and young children. 23. Emphasis is placed on the training of health workers and health educators. A nutritional subcommittee recently concluded studies in relation to an appropriate education programme for breast-feeding. The studies were also inten9ed to ascertain the reasons for the decline in breast-feeding among mothers attending maternal and child health centres. 24. The distribution of samples of infant formulae and the promotion of breast-milk substitutes are not permitted in maternal and child health centres; advertising of infant formulae by the private sector through the mass media ceased in 1978. 25. The Urban Services Department has been requested to study, in relation to Article 9 of the Code, the question of labelling requirements for infant formulae. Lao People's Democratic Republic 26. Breast-feeding for approximately 12 months appears to be the normal pattern in rural areas. In the urban areas, however, where women work outside the home, it has been observed that they are forced to resort to breast-milk substitutes; however, health education activities continue to promote breast-feeding. 27. The Government is considering the formulation of policies in this area following the reorganization of the maternal and child health and nutrition services. 28. A UNICEF-supported complementary food production project is expected to be operational soon. Though imported ingredients will be used initially, it is hoped that local food resources will meet requirements in the future. Malaysia 29. In Malaysia, breast-feeding is encouraged and supported mainly by personnel involved In the delivery of the maternal and child health services through advice to mothers attending ante-natal clinics and child health sessions. Advice on the introduction of supplementary feeding (weaning) practices is also provided to mothers at ante-natal clinics and during child health sessions. Cooking demonstrations are given on the preparation of various types of weaning food using local ingredients.
30. Community education and information on infant and young child feeding are provided through the mass media, and the distribution of literature and pamphlets. Training of all categories of nursing personnel has been revised and updated in order to strengthen the community health component; it includes the topic of infant and young child feeding. This is also being emphasized in the undergraduate curricula of medical schools. Efforts are being made to get the personnel of the milk industry more actively involved in education and training.
WPR/RC33/14 Rev.l page 8 31. The appropriate marketing and distribution of infant formulae and weaning foods are being actively pursued through the Code of Ethics governing the infant formula industry, which was implemented in June 1980. Activities of the milk industry in relation to marketing and distribution of infant formulae are monitored through the Government Liaison Committee. A vetting committee meets monthly to vet all printed material and literature on infant formulae prepared by the milk industry. All forms of advertising in the mass media in relation to infant formulae have been banned. New Zealand 32. Representatives of local manufacturers of milk substitutes have agreed to cooperate in producing a document setting out the steps they will take to ensure that the International Code is observed as far as is practicable. 33. A meeting to discuss implementation of the International Code was also held between the Departments of Health, Agriculture and Fisheries, and Trade and Industry, and the New Zealand Dairy Board. 34. Hospital boards and district health offices have been informed about the 1979 WHO/UNICEF Meeting on Infant and Young Child Feeding and the International Code. 35. Promotion of breast-milk substitl.ltes in New Zealand is not considered to be a problem, as breast-feeding is reported to have increased in the past decade and to be practised by 82 per cent. of mothers during their children's early infancy.
Papua New Guinea 36. The Government introduced a national nutrition policy approved by the Nat ional Executive Council in 1978 and created a Baby Feed Supplies Control Act in 1977. Any form of advertising that encourages bottle-feeding is prohibited. It is considered that there is a need for follow-up action in the field of nutrition, including infant and young child feeding. A national workshop on nutrition, supported by WHO, was held in Port Moresby in January 1982, which recommended follow-up studies to the Government as well as efforts to ensure strict enforcement of Government policies. The workshop was intersectoral in nature and all the government departments and agencies concerned, as well as nongovernmental organizations, participated. 37. A national nutrition survey wHl review the effectiveness of national policies on infant and young child feeding and the control of breast-milk substitutes. 38. A WHO-supported study on maternal attitudes towards breast-feeding and weaning was started in 1981 and is expected to provide much useful information on infant and young child feeding. Philippines 39. A comprehensive long-term infant and young child feeding plan has been developed, including an educational programme for key Ministry of Health officials, health workers, and personnel of nongovernmental organizations. The programme includes surveys on knowledge with regard to, and attitudes towards, breast-feeding (lmong health workers, as well as a series of seminars and training sessions for all health personnel cadres.
WPR/RC33fl4 Rev.l page 9 40. The Government has initiated steps to facilitate rooming-in practices, health education for mothers, and supportive measures for the strengthening of education, training and information. There is already an active consumer group which is encouraging the Government to take more action in this field. 41. Phase II of the WHO collaborative study on breast-milk volume and composition has been completed. 42. WHO also collaborated, in conjunction with UNICEF, in a national consultation in December 1981 on the development of a national code of marketing of breast-milk substitutes. The draft code is being reviewed by the Ministry of Health before being submitted to the authorities for adoption as national legislation. Republic of Korea 43. In the area of breast-feeding, the Government, through the Korea Hospital Association and the Society of Paediatrics, is encouraging all clinics and hospitals to improve the operation of rooms for the newborn. Activities in relation to the young-child feeding programme will be implemented through the newly constructed maternal and child health centres. Fourteen of these centres were constructed in 1981 and a total of 91 will have been constructed by 1984. 44. Appropriate and timely complementary feeding practices, using local food resources, are being promoted and supported. In particular, the development of suitable native food for infants is being encouraged by the Society of Paediatrics as well as through public health educational activities. 45. Seminars and workshops are being planned to identify problems and work out solutions in relation to the strengthening of education, training and information on infant and young child feeding. The National Institute of Health now incorporates the subject of infant and young child feeding in all training courses for health workers. Health education on breast-feeding has been strengthened through the mass media and through the distribution of publications and leaflets.
46. A workshop on breast-feeding is to be organized in October 1982 by the Society of Paediatrics and the Fourth Asian Congress of Paediatrics. Samoa 47. The Agriculture Department in Samoa has recently developed an infant formula with a high local food content. While some inappropriate marketing techniques have been used in the past, more recently, collaboration between infant food manufacturers and the Government has been reported to be adequate. The Health Department favours the preparation of national legislation to give effect to the principles and aims of the International Code. Singapore 4$. The Code of Ethics on the Sale of Infant Formula Products was adopted in Singapore in November 1979.
WPR/RC33/14. Rev.l page 10 4.9. A subcommittee of the Sale of Infant Formula Ethics Committee, consisting of representatives of the Ministries of Health and Environment and the Singapore Breast-feeding Mothers' Group, monitors the activiti~s of commercial firms in this respect. So.lomon Islands 50. The Government of Solomon Islands is establishing a national nutrition committee to define goals and identify target groups and the main Jines of action, in particular the promotion of nutritional health in both the adult and chiJd populations. 51. Primary health care workers are being trained to promote breast-feeding and to provide advice on proper weaning practices using local foods. Maternal and child health and rural health clinics are used for promotional purposes. Public information is being upgraded. The Government is now considering introducing legislation to limit the promotion and sale of infant formulae and weaning foods.
Tokelau 52.
Tokelau has unreservedly expressed its support of the WHO resolutions.
53. Health facilities provide information and education on breast-feeding at ante-natal and post-natal clinics. Working mothers are given breaks for breast-feeding. 54. Despite access to milk substitutes and other imported food items, traditional local foods remain the staple food items for weaning. Imported weaning foods are not sold, or distributed through the health care system.
55. Special postgraduate training programmes are planned for nursing staff who will in turn disseminate information and knowledge to maternal and child health aides in support ofbreast~feeding. Women are also being trained in home economics. 56. There is no societal or community support to women to facilitate breast-feeding. Sharing of child care responsibilities among the extended family members is common practice. There are regulations on maternity leave and job security during maternal leave.
57. Women's clubs and the Women's Committees are very active in promoting primary health care, including family health care.
Tonga 58. In Tonga, approximately 80 per cent. of mothers practise breast-feeding; bottle feeding is resorted to mainly by working mothers.
59. Regular breast-feeding promotional Government health facilities and the radio.
activities
are
conducted
through
60. There are no local commercially produced weaning foods; mothers receive instruction in clinics about appropriate weaning practices. 61. Infant and young child feeding is emphasized in all training programmes for health and agriculture extension workers.
WPR/RC33f14 Rev.l page 11 62. In the absence of breaks, working mothers tend to resort to bottle feeding as a supplement to breast;..feeding. 63. No legislation exists on the marketing of milk products since they are imported. The Ministry of Health assists mothers who cannot breast-feed by ordering supplies of breast-milk . substitutes and giving appropriate instruction. There are no sales promotion efforts and the Ministry of Health feels that the continued monitoring of market products .is adequate at this stage. Vanuatu 64. Breast-feeding is promoted within the health care system through posters in all units of the health services network; newspapers, radio and other mass media are also being used. Advice on correct weaning practices is provided by nurses during pre- and post-natal consultations. 65. Studies are planned on the extent of artificial feeding and of malnutrition among infants. The health authorities report that almost all children are breast-fed, at least half of them until they are 12 or 18 months old. There is no advertising of breast-milk substitutes, which are available only in the two main towns where 18 per cent. of the population lives. The remaining 82 per cent. of the population does not have accessto breast-milk substitutes. The Ministry of Health therefore considers that breast-milk substitutes do not as yet present a major problem.
VietNam 66. Breast-feeding is widely practised in Viet Nam and there are no problems in relation to this or breast-milk substitutes. 67. Emphasis has been placed on the education of mothers regarding continuation of breast-feeding and the provision of appropriate supplementation. 68. Staff of the kindergarten system, which covers nearly 25 per cent. of the total number of children in the country, are trained in appropriate child feeding. 69. Women are protected by legislation from heavy work during pregnancy and are .entitled to an allowance of one hour during working time for breast-feeding until the child reaches the age of 12 months. 70• Plans are being made to produce supplementary food with the assistance of UNICEF and the World Food Programme. 3. SUMMARY OF REGIONAL STATUS 71. All countries or areas recognize the need to address themselves to the problems of infant and young child nutrition although, as their reports indicate, the status of compliance with . and implementation of the International Code of Marketing of Breast-milk Substitutes is not uniform throughout the Region. Various activities are either being implemented or are planned. They are aimed at encouraging and prolonging. breast-feeding and introducing a well balanced diet for infants and young children, including improved weaning foods.
· WPR/RC33/14 Rev. I page 12 The enactment of legislation to enforce compliance takes time and the process up to it tends to lag behind other national efforts. Three countries in the Region had promulgated legislation prior to the introduction of the International Code, namely: l~ading
72.
Papua New Guinea - Baby Feed Supplies Control Act, adopted by Parliament in July 1977; Singapore - Code of Ethics on the Sale of Infant Formula Products, adopted in November 1979; Malaysia - Code of Ethics for Infant Formula Industry, implemented in June 1980. In the Philippines a draft national code based on the International Code is being deliberated at ministerial level. 74. Infant and child nutrition has always enjoyed high priority with Member States. Governments are requesting technical cooperation in conducting national workshops and in research activities directly related to specific areas of infant and young child feeding. Such cooperation will be provided in the context of WHO and WHO/UNICEF nutrition programmes. · 7 5. 7 3.
WHO and UNICEF are cooperating closely in relation to infant and young child feeding, which is considered by both agencies to be an important component of the nutrition programme in the context of primary health care.
WPR/RC33/l4 Rev.l page 13/14 ANNEX l RESOLUTION OF THE WORLD HEALTH ASSEMBLY
THIRTY-FIFTH WORLD HEALTH ASSEMBLY
WHA35 .26
14 May 1982
INTERNATIONAL CODE OF MARKETING OF BREAST-MILK SUBSTITUTES The Thirty-fifth World Health Assembly, Recalling resolution WHA33.32 on Infant and Young Child Feeding and resolution WHA34.22 adopting the International Code of Marketing of Breast-Milk Substitutes; Conscious that breast-feeding is the ideal method of infant feeding and should be promoted and protected in all countries; Concerned that inappropriate feeding practices of infants result in greater incidence of infant mortality, malnutrition and disease, especially in conditions of poverty and lack of hygiene; Recognizing that commercial marketing of breast-milk substitutes for infants has contributed to an increase in artificial feeding; Recalling that the Thirty-fourth World Health Assembly adopted an International Code intended to, inter alia,deal with these marketing practices; Noting that while many Member States have taken some measures related to improving infant and young child feeding, few Member States have adopted and adhered to the International Code as a "minimum requirement" and implemented it "in its entirety", as called for in resolution WHA34.22; URGES Member States to give renewed attention to the need to adopt national legislation, regulations or other suitable measures to give effect to the International Code; REQUESTS the Director-General (a) to design and coordinate a comprehensive programme of action to support Member States, in their efforts to implement and monitor the Code and its effectiveness; (b) to provide support and guidance to Member States as and when requested to ensure that the measures they adopt are consistent with the letter and spirit of the International Code; (c) to undertake, in collaboration with Member States, prospective surveys, including statistical data of infant and young child feeding practices in the various countries, particularly with regard to the incidence and duration of breast-feeding.
Thirteenth plenary meeting, 14 May 1982 A3S/VR/13
WPR/RC33/14 Rev.l page 15 ANNEX 2
WHO/GP/81/Rev.l
GUIDING PRINCIPLES FOR FACILITATING REPORTING BY MEMBER STATES ON ACTION TAKEN IN THE FIELD OF INFANT AND YOUNG CHILD FEEDING (Follow-up to Assembly resolutions WHA33.32 and WHA34.22)
World Health Organization Geneva, Switzerland June 1982
WPR/RC33/14 Rev.l Annex 2 page 16
Guidin? principles for facilitating reporting by Member States on act1on taken in the field of infant and young child feeding (Follow-up to Assembly resolutions WHA33.32 and WHA34.22)
I.
INTRODUCTION
1. The Thirty-third World Health Assembly, in resolution WHA33.32 on infant and young child feeding, 1 requested the Director-General to submit to the Thirty-fourth World Health Assembly, in 1981, and tpereafter in even years, a report 2 on the steps taken by WHO to promote breast-feeding and to improve infant and young child feeding. 2. The Thirty-fourth World Health Assembly adopted the International Code of Marketing of Breast-milk Substitutes in May 1981.3 Article 11, paragraph 6, of the Code provides that "in accordance with Article 62 of the Constitution ••• Member States shall communicate annually to the Director-General information on action taken to give effect" to its principles and aim. Article 11, paragraph 7, states that the Director-General "shall report in even zears to the World Health Assembly on the status" of its implementation. 3. During the discussions on the International Code at the Health Assembly and the Executive Board in May 1981 the Director-General was asked to prepare guidelines which would facilitate Member States' monitoring of and reporting on action taken at the country level to give effect to the principles and aim of the Code. Bearing in mind the Assembly's emphasis that the Code be viewed within the overall framework of infant and young child feeding, a set of guiding principles was prepared to cover a broad range of related issues, as in the discussions which took place during the WHO/UNICEF Meeting on Infant and Young Child Feeding held in October 1979. This meeting's five main discussion themes were retained for this purpose.
l Document WHA33/1980/REC/l, pp. 32-34. 2 The first two progress reports were presented to the Thirty-fourth and Thirty-fifth World Health Assemblies as documents A34/7 and A35/8 respectively. 3 Document WHA34/1981/REC/l, resolution WHA34.22 and Annex 3; International Code of Marketing of Breast-milk Substitutes, Geneva World Health Organization, 1981. 4 The Health Assembly, in resolution WHA34.22, also requested the Director-General to report on a one-time basis to the World Health Assembly, in May 1983, "on the status of compliance with and implementation of the Code at country, regional and global levels"; and, "based on the conclusions of the status report, to make proposals, if necessary, for revision of the text of the Code and for measures needed for its effective application". The Director-General requested comments from Member States for the purposes of this report in a circular letter dated 7 June 1982 (reference C.L.8.1982).
WPR/RC33/14 Rev.l Annex 2
page
17
4. The guiding principles were first distributed to Member States as part of the documentation prepared for the 1981 regional committee meetings. The consensus emerging from the discussions at these meetings was that the guiding principles constituted a useful basis for national action and reporting; that they focused on the types of national action most likely to improve infant and young child feeding practices~ and that they correctly emphasized the need for increased coordination and cooperation between different sectors in this regard. · 5. In the light of the comments made during the discussions at the regional committee meetings, and at the national consultations held in India, the Philippines and Zaire, the Director-General has revised the guiding principles as a preliminary step in the first full reporting cycle on infant and young child feeding to be based essentially on country-supplied information. That is, in the spirit of resolution WHA33.17, 1 and using the guiding principles as a common reporting framework, Member States are asked to communicate, through the regional committee meetings in 1983, information on action taken by them in the field of infant and young child feeding in general, and as a follow-up to relevant Assembly resolutions in particular. 6. The regional reports prepared on the basis of the information provided by Member States will be forwarded to the Director-General for use in preparing the next progress report on infant and young child feeding which is to be presented to the Thirty-seventh World Health Assembly in May 1984. This process will be repeated in future years as .part of the regular biennial reporting procedure on this subject.
1 On the study of the Organization's structures in the light of its functions by which the Health Assembly urged the regional comittees, inter alia, "to increase their monitoring, control and evaluation functions so as to ensure the proper reflection of national, regional and global health policies in regional programmes and the proper implementation of these progratiiDes, and to include in their programmes of work the review of WHO's action in individual Member States within the regions".
WPR/RC33/14 Rev.l Annex 2 page 18
II.
MAIN SUBJECT AREAS FOR MONITORING AND REPORTING
7. The elements listed below form an outline of the core content! of information desirable within each of five main themes. They form a basis on which appropriate measures to improve infant and young child health and nutrition may be developed within national primary health care plans and strategies for health for all. Theme one: Encouragement and support of breast-feeding
8. Interest in breast-feeding, and knowledge about its benefits and the factors influencing it, will determine in large measure the nature and ext<mt of national action to improve infant and young child feeding practices. The availability of information to all sectors of society, public and private, on the importance of breast-feeding is critical in this respect; so too is the development of appropriate formal and non-formal social support systems to protect, facilitate and encourage successful breast-feeding. 9. For monitoring and reporting in this area, it would be important to have information on: (a) current patterns of breast-feeding; (b) information on breast-feeding being provided to parents, the general public, policy makers, health workers, students, and others concerned with infant and young child nutrition and health; (c) education for future parents on appropriate infant and young child feeding practices; pre-natal care and counselling concerning preparation for, and maintenance of, breast-feeding; (d) health care practices which influence breast-feeding including those connected with home-delivery care, and maternity practices in hospitals and other facilities of health care systems, for example routine procedures regarding feeding and rooming-in of neonates; (e) national measures designed to protect and promote breast-feeding, including legislation concerning maternity leave, family allowances, security of employment durirtg maternity leave, and creches and other facilities at or near the work place to enable working mothers to continue breast-feeding;
1 Although the guiding principles are intended as a common reporting framework for use by all WHO Member States, it is recognized that they will necessarily be adapted according to national needs and circumstances. Thus, while the elements grouped under the five main themes form the core content for reporting, the type and amount of information actually available concerning each will depend on national health priorities and information collection capacities. Further, the elements call for information on action in the field of infant and young child feeding which is often qualitiative in nature or expressed for the most part in estimates based both on the enlightened opinion and experience of national health officials and on statistical and other informa tion that may be readily available in countries.
WPR/RC33/14 Rev.l .Annex
2
page 19
(f) formal and non-formal community support measures for mothers and families which facilitate appropriate infant and young child feeding practices, for example, nursing mothers' groups and other women's organizations, creches and other child-care arrangements; (g) steps being taken in this area to improve inadequate situations and practices, including programmes and plans within the framework of primary health care. Theme two: Promotion and support of appropriate and timely complementary feeding (weaning) practices with the use of local food resources
10. The promotion and support of appropriate and timely complementary feeding practices with the use of local food resources is a vital part of any programme to improve the health and nutrition of infants and young children. The extent of the general public's knowledge in this regard, particularly of those persons directly responsible for child care, and of policy makers, health workers and others, has a direct impact on the health and nutritional status of infants and young children, as does the extent of action to promote sound weaning practices. 11. For monitoring and reporting in this area, it would be important to have information on: (a) national weaning norms, and recommendations such as those issued by government departments or those emanating from professional bodies including paediatric and other associations; (b) educational activities for the general public or specific audiences, for example in health care and related services, dealing with appropriate weaning practices; (c) types of foods used for feeding infants during the weaning period, including those which are home-prepared or industrially-manufactured; (d) any health or nutrition problems of significant prevalence and/or severity associated with the weaning period; (e) steps being taken in this area to improve inadequate situations and practices, including programmes and plans within the framework of primary health care. Theme three: Strengthening of education, training and information on infant and young child feeding
12. It is generally recognized that health and health-related personnel play a key role in guiding infant and young child feeding practices. The extent to which such personnl are trained in infant and young child feeding needs and the encouragement of appropriate feeding practices, and the concern they show for this issue by providing mothers and families with timely, objective and consistent information, are all important factors ih promoting the overall healthy growth and development of infants and young children.
WPR/RC33/14 Rev.l Annex 2 page 20
13. For monitoring and reporting in this area, it would be important to have information on: (a) the infant and young child nutrition and feeding component within basic training and continuing education programmes for personnel in health and health-related fields; (b) the information on infant and young child feeding that is included in the training curricula of community workers from other sectors who normally come into contact with mothers and families, for example agricultural extension worke.rs and school teachers; (c) the information on infant and young child nutrition and feeding in primary and secondary school programmes; (d) steps being taken in this area to improve inadequate situations and practices, including programmes and plans within the framework of primary health care. Theme four: Development of support for improved health and social status of women in relation to infant and young child feeding
14. The health, social and economic status of women directly affects their opportunities for mother-child contact as well as their options for infant and young child feeding, and child care generally. Women are more capable of providing for the nutritional needs of their children when their own socioeconomic, health and nutritional status is secure; where adequate social support measures exist; and to the extent that objective information concerning infant and young child feeding is readily available to them. 15. For monitoring and reporting in this area, it would be important to have information on: (a) the general health/nutritional status and reproductive patterns of women in the country; (b) national female employment patterns, including women in wage-earning and non-wage-earning occupations; (c) legislative support measures (as in 9(e) above); (d) formal and non-formal community support measures for mothers and families (as in 9(f) above); (e) the participation of women's organizations in the promotion of appropriate infant and young child feeding and rearing practices~ (f) steps being taken in this area to improve inadequate situations and practices, including programmes and plans within the framework of primary health care.
wPR/RC33/14 Rev.l Annex 2 page 21/22
Theme five:
Appropriate marketing and distribution of breast-milk substitutes
16. The aim of the International Code of Marketing of Breast-milk Substitutes is to contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion of breast-feeding, and by ensuring the proper use of breast-milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution. The Code applies to the marketing and related practices of breast-milk substitutes, including infant formula. !t also applies to other products when they are marketed or otherwise represented to be suitable, with or without modification, for use as a partial or total replacement of breast milk; and to feeding bottles and teats. 17. . For monitoring and reporting in this area, it would be important to have information on~
(a) national legislation, regulations or other measures, for example decrees, directives, and voluntary agreements, concerning the marketing and distribution of products within the scope of the Code (Article 2); (b) steps that have been taken to bring the Code, and national measures developed to give effect to it, to the attention of health workers including those responsible for organizing health services; those responsible for providing health services; and those responsible for the training of health workers at all levels; (c) how the Code is being implemented and monitored through existing national health, regulatory, commercial and other administrative structures; and whether these structures may have been modified to accommodate Code implementation and monitoring; (d) whether there are any provisions bf the Code that are specifically not being applied or whether additional measures have been taken that are not provided by the Code; (e) quality control of products within the scope of the Code, including applicable standards and testing requirements; existence of relevant national standards; application of recognized international · standards·, (f) a description of efforts made to involve interested parties - namely professional associations, the infant-food industry, and nongovernmental, particularly women's, organizations - in implementing the Code and in monitoring marketing and distribution practices in accordance with it; (g) steps being taken in this area to improve inadequate situations and practices, including programmes and plans within the framework of primary health care.
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WPR/RC33{14 Rev.! page 23 ANNEX 3 TIMETABLE FOR REPORTING Action by Member States and the WHO Region·a l Office for the Western Pacific 1982 Member States 1983 End-March - Submit report on infant and young child feeding and on implementation of the International Code. to the Regional Office, using the revised Guiding Principles (see paragraph 7(1), (4) and (5) of present report) 1984 End-March- Submit report on action taken to I'(!Ve effect to the principles and aims of the International Code to the Regional Office (see paragr;tph 7(3) of present report) If the Regional Committee decides to institute regular annual reporting on both implementation of the International Code and infant and young child feedingTsee paragraph 10) the material to be submitted in 1984 will be the same as in 1983
End-April - Report on status of infant and young child feeding and implementation of the International Code, using the Guiding Principles, submitted to the Regional Office (see paragraph 7(7) of present report) End-August (to arrive in Geneva no later than 15 September)- Submit to Director-General information on status of implementation of the International Code for the special report to be presented to the seventy-first session of the Executive Board and the Thirty-sixth World Health Assembly (see paragraph 7(2) of present report); The Director-General's circular letter dated 7 June 1982 refers. A subsequent letter from the Regional Director wiJI ask that this information should be copied to the Regional Director for the Western Pacific WHO Regional Office for the Western Pacific January- Request the WHO Programme Coordinators to remind Member States to use the revised Guiding Principles in reporting on infant and young child feeding and implementation of the International Code to the Regional Office by end of Marc h ~-
Request the WHO Programme C ators to remind Member States to report on action taken to give effect to the principles and aims of the International Code to the Regional Office by end of March
If the Regional Committee decides to institute regular annual reporting on both implementation of the International Code and infant and young child feeding ""(See paragraph 10) the material to be submitted In 1984 will be the same as in 1983
April - Consolidate reports received from Member States for submission as document for the thirty-fourth session of the Regional Committe!! May/June .- Reports received from Member States consolidated for submission as present document for the thirty-third session of the Regional Committee - Revised Guiding Principles to sent to Member States, together with a request that the Information on status of implementation of the International Code, asked for by the Director-General in his circular letter dated 7 June 1982, should be copied to the Regional Director for the Western Pacific End September - After discussion at the Regional Committee, send material t() WHO, Geneva for the seventy-third session of the Executive Board and the Thirty-seventh World Health Assembly October /November - Resolution of t he thirty-third session of the Regional Committee (if any) to be disseminated to Member States October-November - l?.esolution of the thirty-fourth session of the Regional Committee (if any) to be disseminated to Member States ~
Atrll - In fulfilment of Article 62 of t e Constitution of WHO, reports on t he action taken to give effect to the the principles and aims of the International Code to be sent to the Director-General