The International Baby Food Action Network Newsletter


Complementary feeding: the debate


"WHO has always been a trusted leader in providing scientifically sound technical guidance on matters related to improving global health. Restriction of debate seriously weakens this trust."
--Audrey J Naylor, Wellstart International. Letter to the editor, BMJ 391:956, 2000


  To the surprise of many working in infant feeding, the World Health Organization under the leadership of Dr. Gro Harlem Bruntlandt is backsliding in its obligation to mothers and children around the world. Over the years we had come to expect WHO to champion breastfeeding protection through the International Code and the vital WHA resolutions on infant and young child nutrition. Previous years have seen the passage of some important resolutions strengthening and updating the Code. The slipping of breastfeeding support as a focus of WHO's efforts to improve infant health is evident in its position on age of introduction of complementary foods. In both 1992 and 1994 important resolutions were passed confirming the position of member states regarding the age of complementary feeding to be "at about 6 months". Notwithstanding these resolutions and despite the frustrations of the global community of health workers, researchers and advocates, WHO's secretariat has stubbornly embraced the position of introduction of complementary foods "from 4 to 6 months".

In March 2000 WHO-UNICEF convened a global technical consultation on infant and young child feeding. When the experts present began discussion on the age of exclusive breastfeeding, WHO staff insisted that the topic not be discussed. In response 20 of the 28 consultants who were not WHO/UNICEF staff read an independent statement into the record which supported "at about 6 months" as the appropriate age. To support their position of "at about six months" the experts cited evidence as reviewed by Brown, Dewey and Allen, in Complementary feeding of young children in developing countries: a review of the scientific knowledge. WHO/NUT/98.1: _ there is no growth advantage for most infants, _ less nutritious foods are replacing valuable nutrient-dense breastmilk, increased risk of morbidity especially from acute respiratory disease, the number 1 killer of infants between 4 to 6 months. Yet, even without WHO's support over 60 countries have now adopted as policy, "at about 6 months".

In response to its critics, WHO has again proposed to carry out a review of the literature on complementary feeding and results will be released sometime in 2001.

In the meantime, the infant foods industry has been lobbying to stall WHO's reconsideration of its position. The current "4 to 6 months" is a position they are actively pursuing at the Codex Alimentarius. If successful, this will become the marketing standard by which all national food laws and regulations will be judged in any trade dispute at the WTO. Lower Codex standards could threaten high national marketing laws based on the International Code. Clearly WHO is putting itself in an isolated position and the global expectations of WHO as the champion of health for all, no less the most vulnerable, appears to be seriously compromised.

*Fostering appropriate complementary feeding practices from the age of about 6 months WHA 47.5 *to ensure that complementary foods are not marketed or used in ways that undermine exclusive and sustained breastfeeding WHA 49.15 *Naylor A. 2000. Statement circulated at Technical Consultation on Infant Feeding, March 2000, and at the ACC/SCN working group on breastfeeding and complementary feeding, Washington *WHO/UNICEF Technical Consultation on Infant Feeding, March 13-17, 2000.

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