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SCN Working Group on Breastfeeding and Complementary Feedingheld during the ACC/SCN's 28th Session in Nairobi, Kenya, on Thursday 5 April 2001 Chair: Miriam Labbok, USAID
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The Working Group paid tribute to the outstanding work of colleague Nancy-Jo Peck, who is sadly missed by all |
UPDATE ON ISSUES DISCUSSED BY THE WG LAST YEAR
The agenda was designed to include reporting on agency and other activities in follow-up of last year's issues, exchange of information on latest scientific, program and policy advances related to breastfeeding, complementary feeding, related HIV/AIDS issues, and others of interest to WG participants, provision of advice to SCN on these matters, and identification of critical issues for further discussion as part of a 1-2 year workplan. To this end, the time allotted was divided into four sections with discussion initiated by pre-selected participants:
WHO was asked to report on progress on the Infant and Young Child Feeding Strategy, UNICEF provided an update on the Code, on the Baby Friendly Hospital Initiative (BFHI) and on the implications of the Convention of the Rights of the Child (CRC), including discussion of issues in HIV vulnerable populations. FAO commented on actions on community and complementary feeding in household food security, Netherlands, Norway, and Sweden presented bilateral reports and Benin, Gambia, Kenya, South Africa, USA, Zimbabwe, and a representative of the Asian region provided brief country reports. The World Alliance of Breastfeeding Action (WABA) presented their materials and plans for future action. In addition, a report on actions taken in support of the new ILO Maternity Protection Convention was presented.
A highlight of the session was the presentation of the results of the WHO systematic review of published literature related to the optimal duration of exclusive breastfeeding. This expert consultation concluded that there is a scientific rationale for policy recommending exclusive breastfeeding "for six months." WHO further defined this as 180 days of exclusive breastfeeding. The presentation included mention of the need for additional attention to micronutrients and maternal nutrition, and the need for much additional research to fully address all the issues involved. Further, an USAID/Linkages/Wellstart-funded report on "Readiness for Supplementation" underlined that infants may not be physically or physiologically ready for consumption of other foods prior to 6-7 months (the report can be requested by email info@wellstart.org, and eventually it will be on www.wellstart.org), and women experience increased fertility with less than 6 months exclusive breastfeeding. The session was rounded out with a report on breastfeeding trends, and the role of maternal micronutrient status and supplementation in support of breastfeeding.
Recent research findings were presented demonstrating that there is no statistically significant difference in HIV passage when infants exclusively breastfed for at least three months are compared with artificially fed infants. This similarity continues through 15 months of age. The research also illustrated the protective effect of exclusive breastfeeding when compared to mixed feeding in this regard. In addition, preliminary modeling was presented that suggests that breastfeeding, even mixed feeding, would result in lower overall mortality in most endemic areas. It also suggests that there is little likelihood that there is any advantage to rapid weaning following exclusive breastfeeding. The implementation issues of MTCT programs and the need for evaluation were presented and discussed. A four-country study on breastfeeding in selected African countries was presented. This study concludes that there has been a reduction in support for breastfeeding as a result of fears and misinterpretation of the UNAIDS/WHO/UNICEF guidance related to HIV and breastfeeding.
The WG participants voted by hand tally on three issues:
Since the third issue had not been part of the presentations, only participants who felt they had adequate previous knowledge upon which to base a decision were invited to vote. All votes were unanimous among those who chose to register a vote, and are reflected in the recommendations below. The following ten issues were presented in summary during the final session and are reflective of the discussion.
Last Year's Issues may be Summarized as Six Issues for which Updates were Requested
Recommendation: That WHO continues this process and reports again next year, highlighting changes created through the planned open process and including input from bilaterals and interested UN and other agencies. Rationale: This Strategy will be an important contribution to international feeding policies and its guidance may impact on breastfeeding and complementary feeding worldwide.
Recommendation: That progress, implementation and efforts in support of 1) the Code, including new efforts in training and capacity building in Code implementation and awareness, 2) Breastfeeding Friendly Hospital Initiative, 3) ILO Maternity Protection Convention, and 4) other aspects of the Innocenti Declaration continue to be a focus of the reporting in the WG. In addition, the WG wishes to stay informed concerning the use of the CRC reporting process in ensuring the protection, support and promotion of breastfeeding. Rationale: These documents and policies serve as the basis for international support for breastfeeding and complementary feeding, and progress on their implementation remains fundamental to infant and young child health and nutrition.
Recommendation: That the SCN Chair write to Dr. Brundtland to congratulate her on the process that has led to improved recommendations on the duration of exclusive breastfeeding that is allowing the field to go forward. Other content of the letter could include: q support for the Infant and Young Child Feeding Strategy, q a call for increased research, q a call for increased attention to healthcare professional training in exclusive breastfeeding, q increased investment in programmatic support for optimal breastfeeding, q change in monitoring and reporting indicator to "percent exclusive breastfeeding 0-6 months," and q consensus of the WG that the Innocenti wording on the duration of breastfeeding "for at least 2 years " be maintained, including during the forthcoming discussions on the rights of the child. Rationale: The process pursued since the last SCN meeting has resulted in unambiguous guidance to be presented to the World Health Assembly for approval. Since the Assembly has approved documentation in the past that has called for support for introduction of complementary food at about six months, the new recommendation should not be controversial. The letter would indicate that SCN support for the revised guidance is in direct follow up to last year's meeting, and reconfirms additional actions deemed necessary to support the revision.
Recommendation: That the SCN call upon all UN agencies 1) to actively promote exclusive breastfeeding in all populations, and 2) to report on the balance of attention given to this as compared to attention given to prevention of HIV transmission through breastfeeding. Also, there is a need for mutually understood terminology in data exchange on breastfeeding and on breastfeeding and related HIV research and issues. Rationale: These issues were highlighted as critical in virtually all the presentations and discussions in the WG in 2000 and 2001. It was evident from the presentations this year that, while there have been a few projects designed to address this, little change has occurred in the global understanding (or misunderstanding) of this guidance which clearly states that exclusive breastfeeding must be protected and supported in all populations.
Recommendation: Preliminary data on morbidity and mortality outcomes among exclusively breastfed, mixed fed and artificially fed infants and their mothers in the ongoing UN-sponsored pilot projects that provide infant formula should be analyzed and presented as soon as possible. If outcomes among artificially fed infants are not better than among breastfed infants, this information should be disseminated and the feeding intervention should not be continued as part of the projects. Rationale: There is much research showing that the use of artificial feeding in disease endemic areas is associated with significant increases in morbidity and mortality. In order to avoid doing harm to participants, pilot interventions must include the collection of impact data and the assessment of risks and benefits in a timely manner. There is concern that current pilot interventions may not be in compliance with international standards for activities with human subjects unless there is collection, analysis and reporting on the safety and outcomes, including subsequent health and mortality.
Recommendation: Early in the planning process for the SCN's 29th Session in 2002, the SCN Secretariat will remind all WG chairs to interact with each other to ensure that issues of mutual concern are considered in all relevant WG meetings. Rationale: WG participants noted that the emergency WG has fully considered breastfeeding in its deliberations; other working groups did not fully consider their the contribution and issues surrounding breastfeeding and complementary feeding in relation to their mandate. Friendly reminders and interaction will help avoid gaps.
Four Additional Issues are Presented for Futher Discussion and to be Addressed in the Next Year's Workplan
Recommendation: Breastfeeding/breastmilk should be taken into account in all work on household food security and in assessing women's economic contribution. Rationale: Breastfeeding is the staple source of food for about 5% of the population of Africa and yet is ignored in current food balance sheets and in economic assessments of food availability and use.
Recommendation: Presentations must be included in next year's WG meeting addressing this issue and related indicators, training, growth, with a focus on both appropriate and adequate food and feeding behaviors. Rationale: Due to the dramatic circumstances and issues raised this year, this important subject was barely addressed.
Recommendation: That the SCN Secretariat serve as a communication expediter when meetings or strategy development on issues that might impact on breastfeeding, nutrition and food come to their attention. We also recommend if SCN participants become aware of such events/discussions, that they forward this information to the Secretariat to communicate to the WG for action. Rationale: Multiple sectors impact on breastfeeding, complementary feeding, and food and nutrition, including those that address women's lives, fertility, and food production.
Recommendation: That the SCN request all UN agencies to report on support for and progress in community activities, programs and advocacy for these optimal breastfeeding behaviors. Rationale: Given the recognition by WG participants that optimal breastfeeding includes the definition above, given that few agencies or individuals are aware of this, given that breastfeeding provides the staple food for a percentage of the world's population, given that the nutritional status of reproductive age women may impact on breastfeeding, and given that these populations are considered the most vulnerable, all agencies and organizations involved in health or nutrition should support optimal breastfeeding behaviors.
United Nations System