GLOBAL STRATEGY FOR INFANT AND YOUNG CHILD FEEDING A comprehensive guide for action Presented by James Akré Department of Nutrition for Health and Development World Health Organization Geneva, Switzerland

Why, when and how? In 1998, the governing bodies of WHO called for revitalization of the global commitment to appropriate infant and young child nutrition, in particular: breastfeeding complementary feeding Work on a new global strategy began in late 1999 and continued until May 2002.

Core principles (1) A new global strategy should build on past achievements, particularly: the International Code of Marketing of Breast-milk Substitutes (1981) the Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding (1990) the Baby-friendly Hospital Initiative (1991)

Core principles (2) A new global strategy should go further and emphasize: Comprehensive national policies, including: Feeding in exceptionally difficult circumstances, e.g. low birth weight, natural disasters and other complex emergencies, refugee settings, internally displaced persons, HIV/AIDS Health services that protect, promote and support appropriate feeding practices

Core principles (3) A new global strategy should be grounded on the best available scientific and epidemiological evidence, for example regarding: the optimal duration of exclusive breastfeeding prevention of mother-to-child transmission of HIV

Core principles (4) A new global strategy should be as participatory as possible, thus: Consultations in Brazil, China, Philippines, Scotland, Sri Lanka, Thailand, Zimbabwe 6 regional consultations with more than 100 countries, and ILCA, LLLI, IBFAN, WABA Inputs from all 192 WHO Member States Comments solicited from the food industry

Defining the challenge (1) Malnutrition is responsible, directly or indirectly, for 54% of the 10.8 million deaths annually among children under five in developing countries. Well over two-thirds of these deaths, which are often associated with inappropriate feeding practices, occur during the first year of life.

Distribution of 10.8 million deaths per year among children under five years of age in developing countries, 2001 Deaths associated with malnutrition 54% Sources: For cause-specific mortality: EIP/WHO For malnutrition: Pelletier DL, et al.. AMJ Public Health 1993; 83:1130-3.

Defining the challenge (2) No more than 34% (2000) of infants worldwide are exclusively breastfed during the first 4 months of life (38% in 2004). Complementary feeding frequently begins too early or too late. Foods are nutritionally inadequate/unsafe. Malnourished children are more often sick. Rising incidences of overweight and obesity in children are a matter of serious concern.

Aim of the Global Strategy The aim of the Global Strategy is to improve —through optimal feeding — the nutritional status growth and development health, and thus the survival of infants and young children.

Objectives of the Global Strategy to raise awareness of the main problems affecting feeding, identify approaches to their solution, and provide a framework of essential interventions; to increase commitment of all concerned parties for optimal feeding practices; to create an environment enabling informed choices about optimal feeding.

Breastfeeding As a global public health recommendation, infants should be exclusively breastfed for the first 6 months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to 2 years of age or beyond.

Complementary feeding (1) Infants are particularly vulnerable during the transition period when complementary feeding begins. Thus, foods should be: timely - introduced when the need for energy and nutrients exceeds what can be provided through exclusive breastfeeding; adequate - provide sufficient energy, protein and micronutrients to meet growing child’s nutritional needs;

Complementary feeding (2) Foods should also be: safe - hygienically stored and prepared, and fed with clean hands using clean utensils and not bottles and teats; properly fed - given consistent with a child’s signals of appetite and satiety, and meal frequency, and feeding method should be suitable for age.

Other feeding options For those few health situations where infants cannot or should not, be breastfed, the best alternative: expressed breast milk from infant’s mother breast milk from a wet-nurse or milk bank a breast-milk substitute fed with a cup depends on individual circumstances. Infants who are not breastfed need special attention since they constitute a risk group!

Improving feeding practices (1) Caregivers need access to objective, consistent and complete information, free from commercial influence, about: recommended period of exclusive breastfeeding timing of introduction of complementary foods types of food to give, how much and how often how to feed foods safely

Improving feeding practices (2) Mothers should have access to skilled support — e.g. trained health workers, lay and peer counsellors, certified lactation consultations — to help them initiate and sustain appropriate feeding practices, and to prevent difficulties and overcome them when they occur. Community-based networks offering mother-to-mother support, and trained breastfeeding counsellors working within/closely with the health care system, have an important role.

Achieving the objectives (1) All governments should reaffirm the relevance of the Innocenti Declaration targets: national BF coordinator and committee maternity services practising the Ten Steps applying the International Code, and subsequent relevant resolutions of the World Health Assembly enacting legislation protecting the breastfeeding rights of working women

Achieving the objectives (2) It should be a priority for all governments to meet the following additional targets: develop a comprehensive feeding policy ensure that health and other sectors protect, promote and support appropriate feeding promote appropriate complementary feeding and continued breastfeeding consider new measures for giving effect to the International Code and subsequent resolutions

Obligations & responsibilities Governments, international organizations and other concerned parties share responsibility for ensuring fulfilment of: the right of children to the highest attainable standard of health care and nutrition, the right of women to full/unbiased information, and adequate health care and nutrition. Each partner should acknowledge its responsibilities. All partners should work together to achieve the Strategy’s aim and objectives.

Governments The primary responsibility of governments is to: formulate implement monitor evaluate a comprehensive national policy on infant and young child feeding.

Other concerned parties Health professional bodies NGOs including community support groups Commercial enterprises Employers & trade unions Education authorities, mass media, child-care facilities International organizations, e.g. WHO, UNICEF, FAO, global lending institutions

Conclusion The Global Strategy provides governments and other concerned parties with both: a valuable opportunity, and a a practical instrument for rededicating themselves to: protecting promoting supporting safe and adequate feeding for infants and young children everywhere. Now the Strategy needs to be translated into action!

When shall we start? Many of the things we need can wait. The children cannot. To them we cannot answer tomorrow. Their name is today. Gabriela Mistral, Chile Nobel Prize for Literature, 1945

Two questions for ILCA and its members How can ILCA and its members —acting internationally, regionally and locally —help to ensure full implementation of the Global Strategy? How will implementation of the Global Strategy promote the professional development, advancement and recognition of lactation consultants worldwide for the benefit of breastfeeding women, infants and children?

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