Rachel, thanks for your quick and considered
response, defending the Global Strategy as a good
resource for breastfeeding advocates. I always
see WHO documents through the prism of
breastfeeding in the context of HIV, and lately
to defend breastfeeding against the provision and
distribution of huge quantities of ready to use
(?therapeutic?) foods in resource-poor
areas. RUTFs are being used to treat and lately
to prevent severe acute malnutrition, including
that caused by recommendations for premature
weaning by HIV+ mothers (see
<http://www.unicef.org/nutrition/index_51688.html>http://www.unicef.org/nutrition/index_51688.html
or
<http://www.unicef.org/media/media_46991.html>http://www.unicef.org/media/media_46991.html
or
<http://www.unicef.org.uk/store/group_display.aspx?grp=42BF34CE-45C8-4AAB-A2EC-B5F5EC418F20>http://www.unicef.org.uk/store/group_display.aspx?grp=42BF34CE-45C8-4AAB-A2EC-B5F5EC418F20
Rates of exclusive breastfeeding were reported to
be 2% in Niger while containers of packaged
peanut paste foods were distributed to thousands
of children to first treat and then prevent
malnutrition. See
http://www.un.org/apps/news/story.asp?NewsID=22155&Cr=Niger&Cr1.
In Malawi HIV+ mothers are advised to stop
breastfeeding at 6 months to reduce the length of
time that their infants are exposed to the virus,
and then RUTFs are used prophylactically to head
off the malnutrition known to result from
premature weaning. See
http://www.projectpeanutbutter.org/PPB/Project_Peanut_Butter.html
and
<http://www.med.unc.edu/infdis/news/unc-receives-nearly-2-2-million-to-study-nutritional-supplements-to-protect-hiv-positive-mothers-and-their-infants-in-africa>http://www.med.unc.edu/infdis/news/unc-receives-nearly-2-2-million-to-study-nutritional-supplements-to-protect-hiv-positive-mothers-and-their-infants-in-africa
While the targets you quote from the Global
Strategy are indeed reassuring, I find the
following basis of the strategy, promoting
maternal decision-making, but being less than
clear about breastfeeding, as well as its aims
and objectives, to be much more ambigious, and thus less helpful:
"The global strategy for infant and young child feeding is based on
respect, protection, facilitation and fulfilment of accepted human
rights principles. Nutrition is a crucial, universally recognized component
of the childs right to the enjoyment of the highest attainable
standard of health as stated in the Convention on the Rights of
the Child. Children have the right to adequate nutrition and access
to safe and nutritious food, and both are essential for fulfilling their
right to the highest attainable standard of health. Women, in turn,
have the right to proper nutrition, to decide how to feed their children,
and to full information and appropriate conditions that will
enable them to carry out their decisions. These rights are not yet
realized in many environments
Determining the aim and objectives
6. The aim of this strategy is to improve through optimal feeding
the nutritional status, growth and development, health, and thus
the survival of infants and young children.
7. The strategys specific objectives are:
to raise awareness of the main problems affecting infant and young
child feeding, identify approaches to their solution, and provide
a framework of essential interventions;
to increase the commitment of governments, international
organizations and other concerned parties1 for optimal feeding
practices for infants and young children;
to create an environment that will enable mothers, families and
other caregivers in all circumstances to make and implement
informed choices about optimal feeding practices for infants and
young children.
Pamela Morrison IBCLC
Rustington, England
-----------------------------
Date: Mon, 28 Dec 2009 08:42:41 -0500
From: Rachel Myr <[log in to unmask]>
Subject: WHO 2003 Global Strategy for Infant and Young Child Feeding
Pam Morrison writes, about the WHO 2003 Global
Strategy for Infant and Young Child Feeding and
other recent WHO documents: "Whatever the
reason, when we look to more recent WHO documents to provide back-up
for our current breastfeeding advocacy, we find
that clear endorsement of _breastfeeding_ is
actually pretty sketchy, and in some cases non-existent.
Has anyone else noticed this too? - I'd be interested in others' impressions."
Here are my impressions, which differ from Pam's in this case.
This post sent me straight to the .pdf in
question at
http://whqlibdoc.who.int/publications/2003/9241562218.pdf
which I did not recall as being equivocal in its
support of breastfeeding. Breastfeeding is
repeatedly mentioned throughout the document, as
in this example, from the section on 'Achieving
the strategy's objectives': A first step to
achieving the objectives of this strategy is to
reaffirm the relevance indeed the urgency of
the four operational targets of the Innocenti
Declaration on tthe Protection, Promotion and
Support of Breastfeeding.' Those four targets
involve establishing a national BF coordinator in
each country, assuring that all maternity
services practice the Ten Steps to Successful
Breastfeeding, and "giving effect to the
principles and aim of the International Code of
Marketing of Breast-milk Substitutes and
subsequent relevant Health Assembly resolutions
in their entirety" and "enacting imaginative
legislation protecting the breastfeeding rights
of working women and establishing means for its enforcement."
The importance of exclusive breastfeeding for the
first six months and of continuing to breastfeed
throughout at least the first two years of life
while safe complementary foods are introduced are
emphasized many times, starting in the
introduction and going right through the document.
If this is a 'sketchy' endorsement of
breastfeeding, I would like to see the document
that would qualify as 'clearly' endorsing
it. I've found the informational materials for
health professionals at this part of the WHO
website to be generally good, unfortunately far
better than the advice I hear dispensed by
pediatricians, other physicians, midwives and
child health nurses on a daily basis in this country.
Rachel Myr
Kristiansand, Norway
--------------------------------------------
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