WHO Guidance on Ending the Inappropriate Promotion of Foods for Infants and Young Children Dept. of Nutrition for Health and Development, WHO World Breastfeeding Conference Johannesburg, South Africa December 13, 2016

Development of Guidance 2010: WHA called on Member States to “end inappropriate promotion of food for infants and young children” 2012: WHA requested clarification and guidance on how to end inappropriate promotion 2013-15: Scientific and Technical Advisory Group (STAG) convened July 2015: Recommendations released for public comment and hearings with civil society, private sector, and Member States April 2016: Final version disseminated May 2016: Adopted by WHA

STAG Background Documents Review of global and national recommendations for complementary feeding Current marketing practices and global market analysis for baby food products Report on existing global and national regulatory environment In-depth marketing studies in Brazil, Cambodia, Nepal, Norway, Senegal, and Tanzania Review of health effects of commercially available complementary foods Review of effects of marketing commercially available complementary foods on attitudes and behaviours

Key concerns identified—Interference with Breastfeeding Follow-on formula, growing-up milk BMS market is large and growing fast: $44.8B  $70.6B Toddler milks is fastest growing category Promotion of growing up milks is common Milk consumption inversely associated with breastfeeding intensity Covered by International Code? Codex Alimentarius? Cross-promotion through other complementary food products “Stages” Similar colours, designs, slogans, mascots or symbols as infant formula

Key concerns identified—Obesity & NCDs Some complementary foods high in sugars, trans fat, saturated fat, salt Consumption of unhealthy snack foods (marketed for older children) is common among young children Promotion of unhealthy snack foods is very common

Key concerns identified—Conflicts of Interest Using health care to market products Public-private partnerships Special concerns for formula industry Responsibility on both sides

Key concerns identified—Benefits of Commercial Products May provide nutrients otherwise not easily accessible in children’s diet (esp. micronutrients) Can be inexpensive alternative to improve nutritional status Convenient and time-saving for families Complementary foods do not seem to displace breast milk after 6 months of age (although quality of evidence is poor) Commercially-available vs. home-prepared complementary foods: No evidence of reduction in stunting, anaemia, or micronutrient deficiencies Heterogeneous results on nutritional composition

Recommendations Purpose: Age range: 6-36 months protect breastfeeding prevent obesity and noncommunicable diseases promote a healthy diet clear and accurate information on feeding. Age range: 6-36 months Foods and beverages targeted to age range (leaves out general family foods) Excludes supplements and home fortificants Includes government and non-profit programmes

Recommendations Promotion should be based on the Guiding Principles with emphasis on “suitable, nutrient-rich, home- prepared, and locally available foods”. Products that function as breast-milk substitutes (including follow-up formula and growing-up milks) are breast-milk substitutes and should not be promoted Only promote foods meeting all the relevant national, regional and global standards for composition, safety, quality and nutrient levels and are in line with national dietary guidelines. Strengthen Codex standards.

Recommendations Messages should: Messages should not: Include statement on need for breastfeeding through 2 years and no complementary foods before 6 months State recommended age of introduction Be easily understood Messages should not: Suggest use before 6 months Discourage breastfeeding or imply equivalence to breast milk Promote bottle feeding Convey endorsements

Recommendations No cross promotion of BMS using other products Differentiate designs, labels, slogans, logos No direct contact for BMS marketers Avoid conflicts of interest (health care vs. industry) No free, reduced-price products No donations of equipment, supplies or services No gifts or incentives to health care staff No gifts or coupons to parents, caregivers and families No education to parents in health facilities No sponsorship of meetings of health professionals and scientific meetings

Recommendations Apply WHO set of recommendations on the marketing of foods and nonalcoholic beverages to children. A range of strategies should be implemented to limit the consumption of unhealthy foods.

WHA Resolution 69.9 “Welcomes with appreciation” the guidance Urges Member States to: take all necessary measures… to end the inappropriate promotion of foods for infants and young children, including in particular implementation of the guidance …while taking into account international obligations establish a system for monitoring and evaluation of the implementation of the guidance recommendations to continue to implement the International Code of Marketing of Breast-milk Substitutes

WHA Resolution 69.9 Calls for implementation by: Manufacturers and distributors of foods for IYC Health care professionals Media and creative industry Calls for support from civil society for advocacy and monitoring Requests WHO to: Provide technical support to Member States Review implementation experience and consider revision Report on implementation in 2018 & 2020 Recognizes Codex

Thank you