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Baby food industry lobbies WHO on breast feeding advice

Gavin Yamey, BMJ

Manufacturers of infant food are lobbying the World Health Organization (WHO) to delay any change to its recommendations on the optimal length of exclusive breast feeding.

The current WHO guidelines advocate complementary feeding at "4-6 months." But many nutrition specialists believe that these guidelines lead to complementary foods being offered from the age of 3 months, or even earlier, and that the WHO should change its recommendations to "about 6 months" (20 May, p 1362). Some member states of the WHO, together with advocacy groups on breast feeding, hope that a resolution will be made to adopt this change at the World Health Assembly in May 2001.

A document passed to the BMJ shows that the International Association of Infant Food Manufacturers is lobbying the WHO at its six regional committee meetings this year, at the WHO's executive board meeting in January 2001, and at the World Health Assembly in May 2001.

The lobby message states: "Any action dealing with Infant and Young Child Nutrition should be delayed until the World Health Assembly 2002."

The document contains "supporting facts" to justify the message, discussing the importance of an international study on infant growth being carried out by the WHO, which should be finished by 2002. The document says: "The current pressure to push through a Resolution on Infant and Young Child Nutrition at the 2001 World Health Assembly does not allow sufficient time to conduct the kind of reasoned, science-based study that WHO had planned."

But many nutrition specialists believe that the scientific evidence already exists to support a change in the WHO's policy, and that the growth study was not set up to determine the optimal length of exclusive breast feeding.

Nancy-Jo Peck, scientific adviser to the Geneva Infant Feeding Association, the European coordinating centre of the International Baby Food Action Network, said: "The growth study is not designed to answer the question about the appropriate age for exclusive breast feeding or the age to introduce complementary foods."

James Akré, technical officer in nutrition at the WHO, agreed that the primary aim of the study was not to answer this question, but he said that passing a resolution on breast feeding in 2001 would be "a distraction" from the "cyclical mandate to go to the [World Health Assembly] every two years, on even years, to report on infant and young child nutrition."

In addition to the growth study that would, he said, "contribute to an improved understanding of the optimal duration of exclusive breast feeding," the WHO is conducting a systematic review of the scientific literature on this optimal duration, which it will submit to the Cochrane Library in 2001.

Dr David Nabarro, executive director at the WHO, said in a letter to the BMJ: "WHO seeks to facilitate informed debate [about the optimal duration] in ways that best respond to the interests of its member states and their citizens. This may not always reflect the interests of individuals and organisations who are keen for WHO to be associated with a specific public health policy recommendation and are impatient with the structured process of scientific analysis that WHO is expected to pursue."

The secretary general of the International Association of Infant Food Manufacturers, Dr Andrée Bronner, said: "Our position is to say `wait until the international [WHO] recommendations are made.' Member states belong to the WHO because they believe in its authority."