So what is the messaging really saying about the use fortifiers?
“The Trustees also recognize that, in the case of preterm and newborn babies it is not always possible to follow this best practice and help is required in the form of expressed breast milk from the mother or from a donor, the use of fortifiers or the use of specially formulated preterm infant formula which needs to be research save and of high-quality. ….It is research proven that for very small preterm babies; the milk of their mothers needs fortifiers to ensure a healthy brain development of the baby. Consequently, even existing breast milk from mothers of very preterm babies needs to be supplemented with, what we feel is very important, a research and high-quality proven fortifier.”
WHO recommendations say: “LBW infants who are able to breastfeed should be put to the breast as soon as possible after birth when they are clinically stable, and should be exclusively breastfed until six months of age. This recommendation does not address sick LBW infants or infants with birth weight less than 1.0 kg.”
Statement_Human_Milk_Based_Fortifiers by First Steps Nutrition.
Over emphasis on the need for fortifiers: This issue came up when we were working on the revised EU Directives. During the Parliament’s First reading in June 2012 a last minute proposal put forward by UK MEP Julie Girling was adopted. This distorted WHO’s position on LBW formulas and said (our emphasis): “Nonetheless, low birth-‐weight infants and pre-‐term infants often have special nutritional requirements which cannot be met by mother’s own milk or standard infant formula”. We alerted WHO and UK pediatricians and thankfully, the general approach agreed by the Permanent Representatives and the Council was slightly better: (16a) “The nutritional requirements of low birth weight and/or preterm infants depend on the medical condition of the infant, in particular on his weight in comparison with that of an infant in good health, and on the number of weeks the infant is premature. It is to be decided on a case by case basis whether the infant’s condition requires the consumption under medical supervision of a formula adapted for the dietary management of his specific condition.”
One of the groups supporting it is in the Czech Republic Nedoklubko see this link: http://spokojeni.org/2019/11/neonatologicke-dny-2019/
IBFAN is often asked whether NGOs have links to baby food companies – and its getting increasingly tricky when there are so many new groups being created – some are kick started by large grants from the private sector. We have called these BINGOs (Business Interest NGOs) to distinguish them from genuine PINGOs (Public Interest NGOs). BINGOs often start campaigns that look good superficially but they need to be scrutinised carefully. Sadly many organisations fail to take such responsibilities seriously and get drawn in.
From the archives
Feeding babies in neonatal units – how an important campaign nearly got derailed.
This may remind readers of another campaign for special care babies launched in 2017 – whose linked with industry were not immediately obvious.
Letter from Professor Mary Renfrew of Dundee University that explains what happened when an appeal got thrown open to all and sundry.
Dear colleagues
You may remember the correspondence a few weeks ago about this Open Letter on feeding for babies in neonatal units and their mothers – co-signatories included companies that profit from the sale of breastmilk substitutes. As one of the co-authors of the Open Letter – and having been unaware that co-signatories would include these companies – I have now followed up on the matter. I asked Leith Greenslade either to remove the company logos from the list, or to remove my university logo. The decision she made was to remove my university logo.
I have today posted the statement below on the Linked In site where she published the original letter. Please feel free to circulate this statement as you wish. I am keen that we do not lose the intent of the original letter. I am therefore including here links to two of our publications that informed much of the content of the letter, hoping that this work can perhaps be used to strengthen people’s understanding of the problem and the potential solutions.
http://www.journalslibrary.nihr.ac.uk/__data/assets/pdf_file/0008/64718/FullReport-hta13400.pdf – see the chapter at the end on the research agenda.
Statement published today (15/2/2017) on Leith Greenslade’s Linked In site-
As one of the co-authors of this letter, I am in full support of its content and I hope that it has an impact and promotes new research directions for babies in neonatal units and their mothers. After the letter was agreed by the co-authors, however, a wider group was asked to co-sign. I was unaware that those asked would include companies that profit from the sale of breastmilk substitutes until the final version of the letter was published and I saw the full list. Having been a researcher in the field of breastfeeding for several decades, I believe that presenting the logos together without everyone involved first being aware and in agreement is inappropriate. There are serious conflict of interest issues, and appearing as co-signatories suggests a formal collaboration that does not in fact exist. I have therefore asked to have my university affiliation removed from the list of signatories. Other co-signatories may similarly be unaware.
Click here for a You Tube interview with Leith Greenslade
Here are the logos on the appeal. We understand that Save the Children has also asked that the Danone logo is removed, or failing that that their logo to be removed.
EFCNI Policy regarding cooperation, funding and donations of specific industries
Baby milk industry
“The Trustees strongly support that breastfeeding is necessary for the healthy development of babies, that it is crucial for saving preterm and newborn babies lives and influences a child’s development far into the future. Every baby should have access to breast milk. It should be the first choice and should be regarded as best practice.
The Trustees also recognize that, in the case of preterm and newborn babies it is not always possible to follow this best practice and help is required in the form of expressed breast milk from the mother or from a donor, the use of fortifiers or the use of specially formulated preterm infant formula which needs to be research save and of high-quality.
It is research proven that for very small preterm babies; the milk of their mothers needs fortifiers to ensure a healthy brain development of the baby. Consequently, even existing breast milk from mothers of very preterm babies needs to be supplemented with, what we feel is very important, a research and high-quality proven fortifier.
EFCNI is aware of the WHO’s code in relation to marketing of infant formulas and will not enter into initiatives which contravene these. EFCNI accepts financial donations from milk manufacturers. EFCNI will not provide direct endorsement of infant milk products e.g. logo on packaging or promotions which promote infant formula instead of breastfeeding.
No infant feeding products or product information will be passed onto any beneficiary of our training grants nor will personal data be passed onto a milk manufacturer. In this matter, we agree with the International Code of Marketing of Breast-milk Substitutes.
The Trustees do not believe this industry contravenes with the cause, vision and mission of EFCNI as stated in the statutes.”