Scrutinising the 2018 WHA Resolution on IYCF: How to Salvage?

The 71th World Health Assembly (21-26 May, 2018) has generated much controversy, especially around the latest infant and young child feeding resolution. Prior to the WHA, representatives from IBFAN (Baby Milk Action, INFACT Canada, and GIFA) participated in the 142nd WHO Executive Board meeting in January, and along the way provided technical support to Member States on drafting a resolution that aimed to protect optimal infant and young child feeding. Initially led by Ecuador, Member States had four meetings and eventually established a draft consensus text before the WHA that aimed to safeguard 5 critical areas – the Baby-friendly Hospital Initiative (BFHI), implementation and monitoring of Code and relevant WHA resolutions, WHO Guidance on ending inappropriate promotion of foods for infants and Young children (the 2016 WHO Guidance), appropriate infant and young child feeding in emergencies, and conflicts of interest in nutrition programmes.

On the first day of the Assembly, sponsored by the Russian Federation and co-sponsored by Botswana, Canada, Gambia, Georgia, Ghana, Mozambique, Nepal, Pakistan, Panama, Russia, Senegal, Sierra Leone, Thailand and Zambia, the draft resolution text was tabled for adoption. The next day, USA proposed a draft Decision (Agenda item 12.6 A71/A/CONF./5) that omitted a number of safeguards that were put in place to protect infant and young child feeding from commercial influence, such as implementation and monitoring of the Code and relevant WHA resolutions, implementation of the WHO Guidance, and conflicts of interest.

Even though the proposed Decision did not gain official support from other Member States, Italy proposed to open the tabled resolution for re-drafting on the 3rd day, and there was no objection from other Member States. What ensued was a drafting committee chaired by Thailand, and a whirlwind of long gruesome drafting hours, with a large US delegation that outnumbered other countries. In the meantime, IBFANers who attended the WHA lobbied to retain as much as possible the aforementioned 5 critical areas, in an attempt to avoid a “watered-down” resolution that hardly serves to protect infant and young child health. On the 5th day of the Assembly, consensus was reached in the drafting room on a revised draft resolution.

The re-drafted resolution that was eventually adopted (A71/A/CONF./4 REV. 1) has raised several points of concern in the context of safeguarding infant and young child nutrition from commercial influence. Some of the key points are highlighted below:

  • OP1.1 mentions “multisectoral approaches” in regards to development, implementation and monitoring and evaluation of laws, policies and programmes aimed at protection, promotion, including education and support of breastfeeding. Industry may attempt to use this as an entry point for their involvement in initiatives such as breastfeeding education and promotion. It is important to recall previous resolutions that address conflicts of interest and commercial influence in nutrition. Such “multisectoral approaches” should not include companies that manufacture or market products covered in the scope of the International Code, or parties that work for their interest.

 

  • In the original draft, OP1.3 called for Member States to implement and strengthen national monitoring and enforcement mechanisms for the International Code and subsequent relevant World Health Assembly resolutions. The adopted resolution omitted references to “subsequent relevant World Health Assembly resolutions” and mechanisms for “monitoring and enforcement”. What was added was “WHO evidence-based recommendations” which usually would take years to develop and would hinder Member States from taking preventive actions to safeguard infant and young child health when a harmful practice is identified or a health risk arises. Although evidence-based recommendations may be used to strengthen Code implementation rather than to undermine it, countries and public health advocates have relied on subsequent resolutions, not evidence-based recommendations, to prevent many inappropriate marketing practices. It is important to insist that the International Code be read together with subsequent relevant WHA resolutions, and that monitoring has to be free from commercial influence.

 

  • Even though the original draft urged Member States to implement the 2016 WHO Guidance on inappropriate promotion of foods for infants and young children, it was omitted in the adopted resolution despite the fact that it is an evidence-based recommendation. Instead, the adopted resolution carries a general text (OP1.5) that does not specify which recommendations Member States are urged to implement. This makes the resolution vulnerable to recommendations that may undermine the Guidance and the protection of optimal infant and young child feeding. The 2016 WHO Guidance provides clear recommendations to restrict promotion of commercially produced food or beverage products that are marketed as suitable for feeding infants and children from 6 months up to 36 months – a barrier to many forms of promotion that have been rampantly employed by industry. To avoid the WHO Guidance being undermined, it is important to reinforce governments’ obligations to implement the WHO Guidance and industry’s obligations to adhere to it, as set forth in WHA resolution 69.9 [2016].

 

  • The original draft requests WHO to provide technical support to Member States, specifically in implementation and monitoring of the International Code and subsequent relevant WHA resolutions, the 2016 WHO Guidance, and BFHI. The revised provision omitted the three important components, and was replaced with a generalised text (OP2.1). There are a number of initiatives led by WHO in recent years to support countries in scaling up protection, promotion, and support of breastfeeding and optimal infant and young child feeding. Some examples are Code monitoring support through NetCode, implementation guidance on BFHI through Ten Steps to Successful Breastfeeding, and the Implementation Manual on the WHO Guidance – all of which work to curb aggressive marketing practices in different ways. Weakening of WHO’s support will hinder the progress on these initiatives, likely resulting in countries facing industry wielding its influence to obstruct or undermine attempts to curtail inappropriate marketing practices. It is necessary to recall the numerous previous resolutions that reinforced WHO’s obligation to provide support on implementing and strengthening these components.

As always, IBFAN “shows up” to protect infant and young child nutrition – representatives from IBFAN-GIFA, Baby Milk Action, INFACT Canada, IBFAN Asia, IBFAN Luxembourg, and IBFAN-ICDC.

ICDC sees this year’s resolution as an overt and gradual attempt by industry-friendly countries to water-down a whole body of work that UN agencies, international NGOs and Member States have built up around the Code over the years. However, not all will be lost if Member States and national groups remain vigilant. While it is important to acknowledge the danger spots, ICDC maintains the position that past recommendations can be relied upon to interpret the latest resolution to ensure protection of infant and young child feeding, especially from conflicts of interest and commercial influence.

Constance Ching from IBFAN-ICDC lobbying with delegates from different countries

Update

On 8 July, the New York Times published an article “U.S. Opposition to Breast-Feeding Resolution Stuns World Health Officials“, which exposes the political inner-workings of the IYCF resolution at the 2018 World Health Assembly. Representatives from Baby Milk Action and INFACT Canada (our sister organisations and members of IBFAN) were interviewed and quoted in the article.

Other articles on the same topic:

U.S. threatened Ecuador over support for resolution encouraging breastfeeding, report says (CBS News)

Trump administration’s opposition to breastfeeding resolution sparks outrage (The Guardian)

U.S. threatens nation over world breastfeeding resolution, shocking health officials (USA Today)

Why Breast-Feeding Scares Donald Trump (New York Times Editorial Board)

Trump denies US opposition to WHO breastfeeding resolution (BBC News)

The WHO breastfeeding resolution behind the debate (CNN)

There may be politics but there is no debate: Breastfeeding is the best health option (CNBC)

Trump Stance on Breast-Feeding and Formula Criticized by Medical Experts (New York Times)

U.S. effort to weaken an international breast-feeding resolution has a long history (The Washington Post)

Trump Admin Favored Corporations In Opposing Breastfeeding Resolution: Report (Huffington Post)

US ‘threatened Ecuador with trade sanctions’ if it introduced UN breastfeeding resolution (The Independent)

US has long protected commercial interests over breastfeeding (Aljazeera news)

US stuns world health community by opposing breastfeeding (The Sydney Morning Herald)

‘It was blackmail’: US ‘bullied other countries to stop WHO promoting breastfeeding’ (South China Morning Post)

Trumps weighs in on breastfeeding debate, defends formula (The Jakarta Post)

Milk and money (The Indian Express)