United Nations System
Standing Committee on Nutrition

Working Group on Breastfeeding and Complementary Feeding

held during the ACC/SCN's 29th Session in Berlin, Germany, March 2002

Chair: M Labbok, UNICEF, Co-Chair: R Saadeh, WHO
Rapporteurs: Jay Ross, AED/LINKAGES, Reina Buijs, Netherlands

Synthesis of Working Group Purpose and Approach:

Purpose:

1. Update and further the existing 10 Issues of the WG
2. Reach consensus on the next steps, and
3. Develop task force goals, leadership and tentative members to address aspects of the next steps.
   

Approach: The Breastfeeding and Complementary Feeding Working Group (BCFWG) has been very active for several years, and by 2001, the group had developed 10 issues/themes that needed attention. The group used an approach that included brief presentations, prepared handouts distributed in advance of the session, discussion, and brainstorming. The result was lively discussion and, for efficiency, this year, the 10 issues were integrated as five issues.

Issue, Discussion, Recommendations and Next Steps

Issues 1 and 2: Update on strategies, policies and activities related to breastfeeding and to complementary feeding

Discussion: The discussion emphasized a real need to continue communication and sharing of timely information covering workplans in this area. Since all present are generally supportive of all presented approaches to breastfeeding and complementary feeding, the decision is to spend less time presenting and more time on discussion in the future. In order to inform renewed emphasis on initiatives in this area, there was a call for improved databases on current BF/CF approaches

Recommendations:

The WG should continue to strive for brevity during the meetings, increase and improve communication.

Recommendations for future WG activities:

• Stress continued BF in all CF activities.
• Expand all BF/CF initiatives into maternal nutrition
• Evaluate the role and impact of Code, Maternity Protection, and BFHI to inform decision-makers (UNICEF will take a lead role)
• Coordinate on terminology, definitions, indicators and messages
• Expand and improve guidance and databases on CF (WHO will take a lead role)
• Support family/small producer/manufacture of CF

Issue 3: BF and MTCT

Discussion: This area could be summarized in four points:

1) Spillover, i.e., increase use of formula by those not diagnosed as positive, is a reality due to media, misunderstanding, and other pressures, even where HIV is not endemic.

2) Rapid cessation seen as problematic,

3) Free and subsidized formula supply is virtually always associated with communication/ counseling/logistical and/or health problems

4) BF/MTCT has led to neglect of BF support, protection and promotion

Recommendations:

Recognizing the need to increase balance between EBF support and PMTCT support, in both counseling and resources, the working group reaffirmed the current WHO/UNICEF advice to support EBF for all and to continue to assess ways to achieve it. In addition, the WG called for increased inter- and intra-agency collaboration on this issue, increased efforts to translate the science to others, and to increase attention to the issues involved in appropriate counseling.

The development of ongoing task force on these issues was recommended.

Issue 4: Exploration of cross-sectoral efforts in support of BF/CF

Discussion: Several countries and organizations have implemented or are considering cross-sectoral or integrated/convergent approaches that reach outside of the nutrition community for catalysis and synergy. Given current emphasis on integrated approaches, these experiences may be helpful in future program planning.

Recommendations:

The WG should support:

• Increasing inter- and intra-agency collaboration
• “Harmonizing” programs and messages
• Developing a child–oriented (sometimes the term “pediatric” was used) health benefit point of view in other sectors

Issue 5: Increasing advocacy for BF/CF for the mother-child dyad in the life cycle context

Discussion: This should be a theme throughout all work of the WG. Suggested related areas of concern for possible task force attention listed during a brainstorm included:

• CF: (home based vs. commercially prepared; data needed on infant feeding practices)
• Nutritional support needed for breastfeeding mothers, especially in context of HIV and BFHI
• Vertical interventions vs. integrated, cross-sectoral or holistic interventions
• EBF support and promotion beyond step 10
• Harmonization of terminology
• Evaluation of the impact of the Code
• Communication: accurate HIV information for public; how to improve poor counseling skills; BF needs more support than promotion
• Monitoring, indicators and data bases need clarity
• Advocacy
• Coordination with the HIV working group
• Interagency and intersectoral collaboration, especially on HIV and infant feeding
• Indicators

Volunteers for specific subject areas will be considered for possible task force formation. Of these the four were developed and listed below.

Recommendations:

• Develop the selected task forces
• Continue discussion at WG meetings with reports from task forces as the presentations
• Need to revitalise WG issues areas, especially BF and CF
• Expansion of breastfeeding programming to related nutrition for mother and CF is needed
• Many aspects of the issues of interest to the WG need additional funding support
• Ask the SCN to present the message that these issues must be included in the advocacy of the leadership of WHO and UNICEF

Working Group Next Steps:

• Next meeting of working group will continue brevity of presentation, and emphasize Task Forces and a united presentation by WHO and UNICEF
• WHO and UNICEF will assess which ongoing programs relate to expressed WG interests
• WHO and UNICEF will consider re-establishment of an interagency action panel to explore future approaches
• Interested participants/volunteers will be asked to lead or participate in the formation of these task forces
  • i. MTCT and BF TF: Truth in Advertising and Counseling – volunteers: hgoldman@usaid.gov
  • ii. Exclusive Breastfeeding: how do we achieve it? – volunteers: michael.krawinkel@ernaehrung.uni.giessen.de
  • iii. TF on Code and Maternity Protection – tentative convener: David Clark, volunteers: narada@eureka.lk.com,(n.warnasuriya), elburgl@hotmail.com
  • iv. Advocacy Task Force – JROSS@aed.org