Working together to support optimum nutrition and informed infant feeding choices

In light of the upcoming Global Congress on Implementation of the International Code of Marketing of Breastmilk Substitutes (BMS Congress), the Asia Pacific Infant and Young Child Nutrition Association (APIYCNA) reiterates its desire to contribute to a balanced, evidence-based dialogue about access to optimum nutrition. Ways to do so include the protection and support of breastfeeding, the responsible marketing of formula and the provision of adequate information about infant formula when necessary. To examine the effectiveness of the implementation of the WHO Code, a holistic, multi-stakeholder approach is required to create in all-inclusive, supportive ecosystem to encourage breastfeeding and to improve nutritional outcomes for mothers, infants and young children.

Every infant has the right to high quality nutrition. Breastfeeding is the best start in life for a baby. When mothers are unable to breastfeed or choose not to, a safe and nutritious alternative is required. In this context, scientifically developed and clinically-proven infant formula is the only recognised sole-source nutrition alternative to breastfeeding for infants.

However, too many infants around the world, whether they are breastfed, mixed-fed, formula-fed or given alternatives, are afflicted by malnutrition and its consequences – principally stunting, wasting and being overweight. The infant and young child nutrition industry remains committed to contributing to addressing health challenges, providing high quality, safe and age-appropriate nutrition for infants and young children, and to supporting education on healthy nutrition.

A multifaceted approach is required with stakeholders

In order to adequately support optimum infant nutrition, a holistic approach involving multiple stakeholders is required to effectively address this important issue, including strengthening maternity leave and social protections, workplace policies, public support, readily available lactation facilities, conducive culture, counselling and funding. APIYCNA and its members support all of these elements, while at the same time seeking to help parents and caregivers who are unable or choose not to breastfeed. Indeed, the WHO Code itself makes provisions for the involvement of industry and other stakeholders “to cooperate in activities aimed at the improvement of maternal, infant and young child health and nutrition”^[1]

APIYCNA hopes that the current debate can be moved beyond what has unfortunately become a polarised breastfeeding vs. Breast-milk Substitute discussion towards an inclusive approach that recognises the multifaceted nature of the topic, in which there is a need for all stakeholders, including industry, to help deliver optimum nutrition in line with the principles of the WHO Code.

The BMS Congress is a missed opportunity to rally all stakeholders, including the private sector, and acknowledge the role it can play in supporting access to optimum nutrition and information in a responsible way.

Access to Nutrition

“Scientists and health experts worldwide agree that children who are wellnourished are much more easily able to develop the cognitive and behavioural skills they need to reach their full learning potential.”
– Multi-sectoral Approaches to Nutrition: The Case for Investment by Education Programmes, UNICEF

APIYCNA members are cognisant of their responsibility to further the health of infants and young children who are not – or cannot be – breastfed. Infant formula is formulated to strict regulatory standards and is the only food recognised by the WHO as a suitable and safe alternative to breastmilk. In these situations, infant formula is life-saving and life-sustaining.

Formula feeding is a necessity for some families, and it is important that these families have adequate information including information about infant formula products, their availability, and about any changes and updates.

Since the WHO Code was introduced, continuing changes to family structures mean that some family types and parents approach feeding choices differently. It is important that the situations in which infants are raised and the needs of these groups, including non-nuclear and rainbow families, are considered by the Congress.

It is essential to unite all efforts towards improving access to a diverse range of highquality nutritional options as children grow, as well as providing healthcare professionals, parents and caregivers with up-to-date information that caters to the evolving and individual needs and preferences of the children in their care. This will ultimately lead to improved nutrition and health outcomes for infants and young children.

Access to information: the question is not “if” but “how” such access should take place

APIYCNA members comply with all laws and regulations in the countries in which they operate and have extensive internal approval and audit processes in place to ensure their online and offline content meets all legal, regulatory and nutritional science requirements. In addition, manufacturers of infant and young child nutrition have their own internal and external mechanisms for policy compliance. Our members support efforts by national governments to ensure compliance with all national laws and regulations, including digital, are met.

APIYCNA and its members support the right of parents and caregivers to make the appropriate choices for the infants in their care based on transparent and factual information. A recent study showed that parents and caregivers want access to information in order to make informed nutrition choices^[2]. The same study also underscored that in a post-pandemic virtual world, ensuring access to information for parents, as well as online availability of suitable options that are well-tolerated by healthy infants, is essential.

Parents should be supported when choosing how to feed their baby, and should have their choices respected, whatever their feeding journey. We support parents with factual, scientifically-validated nutrition information, including on packaging and on digital channels, so that they can make informed decisions for their particular circumstances. It is a responsibility we take seriously.

Interactions with healthcare professionals

Over the years, improvements in maternal, infant and young-child nutritional health have been achieved through effective collaboration between healthcare professionals (HCPs), scientists and industry. In this context, engagement between manufacturers and paediatricians is very important.

APIYCNA shares the joint position of seven European Paediatric Associations which support fully transparent interaction with providers of nutritional products, based on current scientific, societal, and ethical standards^[3] to facilitate providing paediatricians with the information needed to “fulfil their essential role in providing parents and other caregivers with information and support on optimal infant and young child feeding practices”^[4]. This interaction is both useful and legitimate provided that it is carried out in compliance with professional and ethical standards. HCPs are experienced and well-informed individuals, with the ability to make professional decisions in the best interests of their patients. Furthermore, in the recent paper ‘Promoting breastfeeding and interaction of paediatric associations with commercial providers of nutritional products – are they compatible?’^[5], these European Paediatric Associations stated that “…the assumption of the WHO that interaction of paediatricians and their organisations with companies providing BMS [breastmilk substitutes] would undermine support for breastfeeding and ‘compromise patient care’ is not supported by accountable evidence.” In conclusion, our industry welcomes all opportunities to work constructively with all relevant stakeholders, including policymakers and healthcare professionals, to promote evidence-based policies, ethical frameworks and parent and caregiver support to improve infant and young-child health and nutrition outcomes.

[1] WHO Code – Preamble (see p 12 of the WHO Code available on https://www.who.int/publications/i/item/9241541601: (retrieved: 12 June 2023)

[2] See for example INC, Parents have their say about feeding infants and toddlers. Latest results of a comprehensive research study of parents from Australia and New Zealand, 2023,
https://www.infantnutritioncouncil.com/wp-content/uploads/2022/06/Parents-have-their-say.pdf (retrieved
12 June 2023)

[3] Bognar Z, De Luca D, Domellof M, Hadjipanayis A, Haffner D, Johnson M, et al. Promoting breastfeeding and interaction of pediatric associations with providers of nutritional products. Front Pediatr. 2020;8: 562870.

[4] World-Health-Assembly. WHA Resolution 69.9. Ending inappropriate promotion of foods or infants and young children. Geneva: World Health Organisation; 2016.

[5] https://www.karger.com/Article/Pdf/529217