United Nations System
Standing Committee on Nutrition

Working Group on Breastfeeding and Complementary Feeding

held during the SCN's 33rd Session, Sunday 12 March all day, and Tuesday 14 March 1400-1600 hours, Geneva

Chair: David Clark (UNICEF)
Co-Chairs: Isatou Jallow (The Gambia) and Kay Dewey (UC Davis)

• Agenda
• Presentations and other documentation:
  • Presentation by Ellen Piwoz, Academy for Educational Development on “The very important contribution of breastmilk to energy and other nutrient requirements beyond 6 months of exclusive breastfeeding"
  • Presentation by Kathryn Dewey, Programme in International and Community Nutrition, University of California, Davis on “Breastfeeding and Risk of Child Obesity"
  • The 33rd Session agreed to support the Innocenti 2005 Declaration on Infant and Young Child Feeding which reaffirms the original Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding and reiterates that these actions are urgent and necessary to ensure the best start in life for our children, for the achievement of the Millennium Development Goals by 2015, and for the realization of the human rights of present and future generations. The Declaration can be found at: http://innocenti15.net/declaration.pdf.pdf 

Sunday, 12 March 2006

Morning Session - Joint session with Working Group on Nutrition in Emergencies

Given the overlapping sessions of the Working Groups on Breastfeeding and Complementary Feeding and Nutrition in Emergencies at this year’s SCN, and the overlap of the work of the two groups, it was decided to hold a joint session from 10.00 am to 12.00 am. The topics discussed during the joint session were:

• Statement on use of preventing and controlling micronutrient deficiencies in populations affected by an emergency
• Infant Feeding in Emergencies (including HIV/AIDS)
• Report on Innocenti + 15 meeting, Declaration and publication

Tina VanDenBriel of WFP made a presentation on the use of multiple micronutrient supplements in emergencies, focusing on the Joint Statement of UNICEF/WHO/WPF (2006). The work was triggered by the Tsunami, and the presentation looked at the evidence of effectiveness of multiple micronutrient supplementation and its relationship to morbidity and mortality. In a literature review of 14 studies among young children almost all studies showed an increase in Hb and iron status, and it appears that multi- micronutrient supplements lead to greater reduction in anemia than Fe alone. The results for zinc status are mixed (impact on morbidity not always measured). So far it has been seen that distribution can take place through existing channels/programmes with minimal increase in workplace health staff, advocacy and education is essential to success, and careful M&E is required. Delivery of the supplements will continue until the emergency phase is over.

Adrian Diaz of Accion Contra el Hambre (Argentina) made a presentation on Nutrition and child development, examining the multi-systemic effect of poverty, malnutrition and infectious disease on early child development. It was noted that there are technical limitations in the assessment of the relationship between nutrition and child development. The need for evaluating the child with an integrated approach, and the development of integrated programmes were emphasized.

David Clark, UNICEF, spoke about the 15th Anniversary of the Innocenti Declaration, which took place in Florence, Italy on 21 and 22 November 2005. The event took stock of progress made in the protection, promotion and support of breastfeeding since the “Innocenti Declaration” of 1990, including the adoption of the Global Strategy for Infant and Young Child Feeding in 2002. The 2005 Innocenti Decclaration adopted at the Anniversary builds on the 1990 Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding, covering infant and young child feeding practices as a whole. It also seeks to identify roles and responsibilities of key players and emphasizes that these responsibilities need to be met in order to achieve a vision of an environment that enables mothers, families and other caregivers to make informed decisions about optimal infant feeding. The question was raised as to whether it would be possible to have the declaration endorsed by the World Health Assembly, and it was explained that this would be difficult in 2006 since it had not been submitted to the Executive Board in January. A campaign for endorsement of the Declaration by organizations such as midwives and other medical associations was proposed.

Afternoon Session – Working Group on Breastfeeding and Complementary Feeding

The session began with a review of implementation of the 2005 workplan. It was noted that implementation had been disappointing, but this was due to the non-specific nature of the recommendations of last year’s Working Group, which was in turn a result of the lack of time available to the Group (only 2 hours). It was noted that in the future, recommendations and action plan should be clear, doable, with the identification of a person or institution responsible for implementation of each task.

One of the recommendations that had been fulfilled was the creation of a task force on human rights and IYCF. David Clark of UNICEF presented the workplan of the task force as follows:

• Work with relevant HR bodies to ensure IYCF is adequately considered and reflected in Human Rights processes such as the reporting processes and the drafting of guidelines and other instruments.
• Articulate and disseminate details of the roles and responsibilities of all relevant actors, including the international community, in the context of IYCF, using the 2005 Innocenti Declaration as a starting point.
• Assist in the implementation of the concluding observations of the CRC through, e.g. UNICEF programming, WHO tools on implementation, NGO community/coalitions at country level.

2006 will be the 25th Anniversary of the International Code of Marketing of Breast milk Substitutes. WHO described plans to celebrate the event at the World Health Assembly in May. A questionnaire on Code implementation is being sent out to all Member States and the results will be displayed at the Assembly. A Q&A on the Code will also be published and made available. UNICEF described plans to build Code capacity at the regional and country levels during 2006.

Kay Dewey of the University of California, Davis, made a presentation on the case for the link between breastfeeding and child obesity. More than 20 studies on this issue have been published within the past 7 years, and the evidence is now strong that the risk of child obesity is lower among children who were breastfed, particularly for breastfeeding durations of at least 6 months. There are several potential biological explanations for this association, including impaired self-regulation of energy intake in bottle-fed infants and/or metabolic programming of body composition later in life due to certain constituents in breast milk. Residual confounding is another possible explanation, i.e., that there are differences in characteristics of breastfeeding parents, such as child feeding or physical activity patterns, that explain the lower levels of fatness in their children, rather than breastfeeding itself. However, most studies that have adequately controlled for such variables have still found a relationship between breastfeeding and lower risk of child obesity.

Tuesday, 14 March 2006

The Working Group continued its deliberations on Tuesday 14 March. Ellen Piwoz of the Academy for Educational Development made a presentation on “The very important contribution of breastmilk to energy and other nutrient requirements beyond 6 months of exclusive breastfeeding”. While a great deal of attention has been given to the need for appropriate and adequate complementary feeding after 6 months, it was noted that sometimes this has caused us to lose sight of the very important contribution of breast milk to child health and survival after 6 months. Breast milk is a major source of energy and other nutrients in the diets of infants after 6 months, particularly in developing country settings. The dilemma of HIV transmission during breastfeeding has refocused attention on the importance of breast milk after 6 months as programs struggle to come up with “Acceptable, Feasible, Affordable, Sustainable and Safe” feeding alternatives for HIV-exposed infants. Mozambique targeted evaluation of early breastfeeding cessation and replacement feeding options in three Provinces. The studies have concluded that:

• Meeting the nutritional needs of infants > 6 months is challenging taking into account local food availability, variety, and price – even when breastfed
• Removing BM from the diets of infants > 6 months creates several challenges, including the need to increase food expenditure 2-3 fold/day “just to keep even” – other costs too
• Nutrient dense, fortified spreads hold promise for improving the diets & nutritional status of infants > 6 months – price still an issue
• Need to test alternative diets – there is a strong desire to use local foods

The remaining time of the Working Group was devoted to the identification of priorities and agreement of the action plan for 2006/2007, which was agreed as follows:

1. Improve communication among members of the Working Group through:

1. Creation of a list of members of the Working Group
2. Establishment of a list serve for the Working Group
3. Utilization of space on the SCN website

2. Celebrate the 25th Anniversary of the International Code of Marketing of Breastmilk Substitutes through:

1. Promotion of World Breastfeeding Week, which is focused this year on the Code (Working Group Secretariat will ensure members have access to the relevant materials)
2. Encourage members of the WG to monitor Code implementation and report violations to the International Code Documentation Center, Penang. (Secretariat will provide links to monitoring guidance).
3. Members and their organizations will follow-up on WHO questionnaire to Member States on state of Code implementation.

3. Seek SCN endorsement of the 2005 Innocenti Declaration on Infant and Young Child Feeding.
The WG Secretariat will explore the possibility of the SCN endorsing the Declaration.

4. Support rolling-out of the new WHO Growth Standards.
WG Secretariat will share all WHO communication materials with Members of the WG, and Members will report back to the WG on how these materials have been used to support the roll out.

5. Encourage the revitalization of BFHI and extension into the community.
WG will encourage WHO and UNICEF to increase efforts to revitalize the BFHI as they disseminate the new Assessment and Training Materials. This includes the encouragement of reassessment. WG Secretariat will provide information on these materials to WG members. WG will request WHO and UNICEF to report to SCN next year on actions taken to revitalize BFHI, and will ask UNICEF specifically to compile a global database on BFHI assessment and training, including information on countries that have successfully taken the baby-friendly model to the community level. WG Secretariat will also approach UNAIDS regarding the incorporation of BFHI into PMTCT programmes.

6. Establish a taskforce on HIV and Infant Feeding.
A taskforce on HIV and Infant Feeding has been established, chaired by Ted Greiner. A workplan will be submitted to the Working Group and shared with members by 30 June 2006.

7. Establish a taskforce on complementary feeding.
A taskforce on Complementary Feeding has been established, chaired by Kay Dewey. A workplan will be submitted to the Working Group and shared with members by 30 June 2006.