Will the baby food industry get their way at Codex or will Member Sates protect breastfeeding and child health?
IBFAN, ENCA, ILCA, HKI and partner NGOs have been attending many Codex Alimentarius meetings this Autumn. The Codex Committe on Food Labelling (CCFL) in September (finalised new Guidelines on Front of Pack Nutrition Labelling FOPNL) and the Codex Commission (CAC44) adopted the FOPNL Guidelines. The Codex Nutrition meeting (CCNFSDU) has almost finished discussing the Proposed Draft revised standard for Follow-up Formula and the Guidelines on Ready to Use Therapeutic Foods (RUTF).
What next? There will be one more day to discuss the Report on 1st December. The next CCNFSDU meeting (where the Preamble and structure of the follow-up formula standard where the marketing of these products will be decided ) will not be until early 2023 – not June 2022 as originally planned. IBFAN advocates one standard for infant formula, Formulas for Special Medical Purposes (FSMPs), Follow-up Formula and Drinks for Young Children – so that all the products are properly safeguarded under the International Code and Resolutions and not promoted. This should have been the very first thing Codex discussed.
What has happened so far?
Thursday 25th November, key issues: Conflicts of Interest, credibility of Codex science…
This final day focused on General Principles for the Establishment of Nutrition Reference values for babies 6-36 months, with Ireland taking the lead. We repeated our many concerns about the credibility and independence of the science used by Codex, stating that for Codex to be effective it needs to be trustworthy. We mentioned our worry about multi-stakeholderism and gave the example of the recent partnership between FAO and a baby food company [Danone]. Perhaps in response (?) FAO gave a statement about its procedure for providing scientific advice.
Although this was not strictly part of the discussion, we asked how existing standards could be cleaned up – highlighting the fact that the infant formula and follow-up formulas standards have three references to the meaningless term ‘history of safe use’ – a term that industry has used for decades to establish trust in their products and new ingredients.
We pushed for Conflict of Interest safeguards and the WHO wording, “Relevant convincing / generally accepted scientific evidence or the comparable level of evidence under the GRADE classification.” The EU once again was very helpful and expressed many concerns about the need for caution and proposed good wording calling for independent reviews of science.
Wednesday 24th November, key issues: how sweet are products? how should they be described and labelled?
Carbohydrates (sweeteners) The meeting discussed the opinion of the Codex Committee of Methods of Analysis (CCMAS)that there are currently no validated methods to measure the sweetness of carbohydrate sources. This gave some of the countries and companies pushing the products, New Zealand, Australia, the US, the baby food industry (ISDI) and others an opportunity to call for the deletion of a key sentence saying it would be difficult to regulate: “for products based on non milk protein, carbohydrate sources that have no contribution to sweet taste should be preferred and in no case sweeter than lactose. A number of countries and observers – Norway, Uruguay, Mexico, Brazil, EU, Chile, Switzerland, WHO, NHF, IBFAN and ENCA were very keen to limit of the level of sweetness in these products and supported the retention of the sentence.
We highlighted the obligation of all governments to reduce the 30% contribution of the food system to global Greenhouse Gas emissions and the inevitable growing public demand for plant-based products. If it is not possible to determine the sweetness of these highly processed, unnecessary products, surely they should not be promoted. We also raised the fact that many countries have a serious conflict of interest and should be placing child and planetary health above trade concerns.
Definition and Name of the Product: “Drink/product for young children with added nutrients or Drink for young children means a product manufactured for use as a liquid part of the diversified diet of young children
[which may contribute to the nutritional needs of young children]“ 1 In some countries these products are regulated as breast-milk substitute
Following a clear majority for the removal of the promotional text at the end of the definition the Chair agreed to its removal, stating that there was no logic or meaning in nutrition terms. However, the Chair refused to allow further discussion on the problematic aspects of labelling: cross promotion and the text “with added nutrients.” We asked why she had not used the same logic to guide the Committee on this critically important matter – advocated by the exporting countries who stood to gain. The nutrients referred to are all industrially produced, not food-based so their efficacy will be very low. The addition of the words is deceptive and deliberately promotional to hide the risks of these ultra-processed products.
We reminded the Chair that the debate on labelling had been curtailed in November 2019 and that there had been no proper consensus on the key issues of cross-promotion. The Chair had promised that the Baby Drinks (Section B) would remain open until the structure and preamble is finalised and the promotion of these products is settled.
Four names for the Product: The confusion and lack of consensus on these issues has led to the product having four different names: Product for young children; Drink for young children; Product for young children with added nutrients; Drink for young children with added nutrients.
Tuesday 23rd November, Key issues: Flavourings will be forbidden for follow-up formulas 6-12months but permitted for drinks 12-36 months – although National or regional authorities may restrict or prohibit the use of the listed flavourings.
Debate focused on the essential ingredients for Follow-up formulas from 6 months and Drinks for Young Children 12-36 months. The most controversial issue was flavourings. Following almost unanimous opposition from Member States a sentence was added stating that no flavorings will be permitted for follow-up formulas for older infants. However, despite strong opposition from many countries, WHO, UNICEF and public interest NGOs, fruit extracts and vanilla flavourings will be permitted for the baby drinks. Many developing countries already regulate these products as breastmilk substitutes so opposed any flavourings. The EU (representing 27 countries) also questioned the safety of fruit extracts as flavouring agents in that many contain additional compounds and also saw no technological need for them since children don’t seek flavoured products. With no consensus reached, a compromise sentence was added: National or regional authorities may restrict or prohibit the use of the listed flavourings. The main countries pushing the flavourings were the US, Canada, Australia and New Zealand along with industry front groups and the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) who argued that a prohibition of flavours would put the baby drinks at a disadvantage to ‘less good’ products that don’t meet Codex standards. It is of huge concern that ESPGHAN continues to support so many industry positions at Codex, as the have done for so many years.
We argued that flavourings promote products and mislead parents and carers – especially if packages are idealised with images of fresh fruits – that act as a health claim. In reality these products pose many risks for young children in that they are highly processed, sweetened and displace breastfeeding, other fresh milks or other healthier family foods. Our call for no GM ingredients – supported by Ecuador – was not taken up.
Monday 22nd November, Key issues: The Guidelines on Ready to Use Therapeutic Foods will forbid health and nutrition claims and general sale. It also calls for use in an “appropriately designed programme that promotes continuation of breastfeeding, appropriate transition to nutritious family food and psycho-social support for recovery.“
The discussed spanned two days and the draft document will go to the next Codex Commission Meeting (CAC) for adoption. Together with UNICEF we succeeded in getting some important recommendations through: RUTF should only be used in an appropriately designed programme; they should not be on general retail sale nor should they carry nutrition and health claims (IBFAN RUTF ). We failed to get a mention of re-lactation (supported by the USA, Colombia and Brazil) and a reference to the International Code and Resolutions (supported by India and other countries). This would have addressed problematic issues such as donations, cross branding with infant formula and other promotional tactics.
The Preamble will recommend that: RUTF should be used with an “appropriately designed programme that promotes continuation of breastfeeding, appropriate transition to nutritious family food and psycho-social support for recovery” that RUTF is a WHO recommended option; its use does not preclude other dietary options including the use of locally based foods; RUTF is not for general retail sale.
The labelling section specifies that RUTF shall be used in conjunction with breastfeeding, that exclusive breastfeeding is recommended for the first six months of life and continued breastfeeding is recommended for up to two years and beyond, that RUTF should not be used under 6 months and should not carry nutrition or health claims.
Unhealthy Food and Agriculture Organisation partnerships: In 2021 FAO adopted a new private Sector engagement strategy that is already shifting FAO’s focus from protecting its integrity, impartiality and mandate, towards working with the private sector, attracting funding for FAO and facilitating business operations. FAO’s partnership with the baby food company Danone is especially worrying for the ongoing Codex discussions on baby feeding products. FAO and WHO are the parent bodies of Codex. FAO’s partnership with Croplife a trade association that promotes agricultural technologies such as pesticides and plant biotechnology) was evident at the Codex Commission (CAC) and we believe it resulted in the critical comments being overlooked and excluded from the CAC Report.
Aside from the risks to child health, the global trade of these products will add an unnecessary burden to the environment. “The most alarming finding in our research is a very large proportion of greenhouse gas emission impact is associated with the so-called growing up milks or toddler formula … In China, nearly half of the sales of milk formula is toddler formula. For the UK alone, carbon emission savings gained by supporting mothers to breastfeed would equate to taking between 50,000 and 77,500 cars off the road each year”.
For more: The manufacture of breastmilk substitute products is pumping tons of CO2 into the atmosphere. Dr. Julie Smith, Hon Ass Prof, Australian Centre for Economic Research on Health.
IBFAN COMMENT ON REVISION OF FOLLOW FORMULA STANDARD IBFAN FUF scope etc
IBFAN considers that the text is NOT ready for adoption for the following reasons:
- The lack of adequate safeguards to prevent inappropriate marketing of these products will lead to an increase of their needless use around the world as projected in business forecasts. WHO and other health authorities declare follow-on milks and toddler milks for young children “not necessary”. Continued breastfeeding is recommended for up to two years and beyond for optimal young child health, hence the use of these products, which function as breastmilk substitutes pose a risk to the health of young children during critical stages of growth and development. The current text will lead to children being fed inappropriate, expensive, highly processed products that pose health risks and do not meet their nutritional needs.
- The current text fails to forbid the deceptive marketing strategy of cross promotion between product categories for drinks for young children, other formula and follow-up milks and products. The text in Section 9.6.5 forbids only references TO infant formula. Current marketing practices demonstrate that this is an insufficient safeguard. The text should clearly state that marketing of Drinks for Young Children should not ‘resemble’ share branding or cross promote infant formula, FSMPs and other drinks and foods marketed for infants and young children. Since the debate on this issue in the 41st CCNFSDU in November 2019 was brought to an early close through lack of time and since numerous Member States have stated that they would have preferred stronger language, the issue of cross promotion should be reopened at CCFSND42.
- 9.6.5 The labelling of the product as defined in Section 2.1 shall not refer to, RESEMBLE or Cross Promote infant formula, follow-up formula for older infants, or formula for special medical purposes intended for infants, including numbers, text, statements, or images of these products.
- On the issue of product definition, the overwhelming majority of countries and observers (28 plus 27 EU members (and more in CRDs)were in favour of the deletion of text that implies that these products may have added value for child nutrition. The EU cited the European Food Safety Authority (EFSA) scientific advice on young child formulae in 2013, that these products have “no unique role” and “cannot be considered as a necessity to satisfy the nutritional requirements of young children” when compared to other foods that may be included in their normal diet. Only 14 countries proposed retaining the promotional text.
- Drinks for young children are not necessary therefore it is critical that the ban on health and nutrition claims be mandatory. Claims will be deceptive and mislead parents and care givers into believing that the use of these products provide benefits that cannot be derived from breastmilk, animal milks, other drinks or complementary family foods.
- Follow-on milks and drinks for young children must carry the warnings regarding intrinsic contamination for products in powdered form.
- IBFAN maintains its original position that all four categories of products that FUNCTION as breastmilk substitutes – infant formulas, formulas for special medical purposes, follow-up formulas and drinks for young children – should be brought under one Codex standard that is divided into 4 parts with one overarching preamble. It would then be clear that all products are covered by the marketing restrictions outlined in the International Code and subsequent relevant WHA Resolutions, ie – they should not be promoted in any way.
IBFAN COMMENT ON PROPOSED DRAFT GUIDELINES FOR READY TO USE THERAPEUTIC FOODS (RUTF) IBFAN RUTF
Summary: Children affected by severe acute malnutrition (SAM) need efficacious and timely treatment and RUTF is ONE of the options for the dietary treatment of children with uncomplicated SAM. However, it is critical that it’s use is appropriate and does not undermine support for continued breastfeeding or re-lactation, since this is the most important requirement for the rehabilitation of children suffering from malnutrition.
It is also critically important to protect against commercial exploitation. The claim that they are helping feeding malnourished children is the perfect cover for the baby industry’s predatory marketing tactics, and Codex Guidelines or Standards are used to fuel the opening up of global markets.
The current draft guidelines contain some good provisions, but on the question of promotion they rely on the weak safeguards contained in the Standard for Foods for Special Medical Purposes (FSMPs) – products that are on general sale. The FSMP standard does contain a ban on ‘advertising’ – but this far from adequate. Above-the-line ‘advertising’ is the crudest form of commercial promotion and the Guidelines should clearly recommend prohibition of all commercial promotion, including claims, (health, nutrition, convenience, etc) cross-promotion with infant formula, sponsorship and the myriad other forms of marketing currently used to maintain and expand the FSMP market. Also the Guidelines fail to specifically ban promotional claims. Claims are MARKETING TOOLS that are not appropriate for therapeutic foods and are forbidden for foods for infants and young children by WHA Resolution 63.23.
Codex is proposing a very short Preamble to the Guidelines. IBFAN disagrees and believes that a well-defined preamble is essential. It must highlight the appropriate use of RUTFs and the safeguards and recommendations of WHO, UNICEF and WFP in order to stop the use of RUTF undermining breastfeeding and sustainable, culturally appropriate family-food based feeding of young children and local economies. It is essential that the Preamble highlights the importance of breastfeeding and re-lactation support as the first option to promote optimal rehabilitation of children with uncomplicated SAM.
All these safeguards should be stated in the preamble, along with a clear prohibition for general sale, to alert all involved in the production, distribution, and implementation of care programs.
While accepting the caution regarding long lists of documents, it is surely most important to include the reference to the International Code of Marketing of Breastmilk Substitutes and subsequent relevant WHA Resolutions, especially as this is specifically mentioned in Article 4.4 of the Codex Code of Ethics for International Trade in Food, that states: “National authorities should be aware of their obligations under the International Health Regulations (2005) with regard to food safety events, including notification, reporting or verification of events to the World Health Organisation (WHO). They should also make sure that the international code of marketing of breast milk substitutes and relevant resolutions of the World Health Assembly (WHA) setting forth principles for the protection and promotion of breastfeeding be observed”
The FSMP safeguards are not a sufficient safeguard. The Guidelines should contain a full Preamble, forbidding general sale and all forms of marketing.
The labelling of RUTF for children from 6 to 59 months with SAM must be in accordance – NOT ONLY with the Standard for the Labelling of and Claims for Foods for Special Medical Purposes (CXS 180-1991), the General Standard for the Labelling of and Claims for Pre-packaged Foods for Special Dietary Uses (CXS 146-1985), and Guidelines on Nutrition Labelling (CXG 2-1985) BUT ALSO the Guidelines for Use of Nutrition and Health Claims (CXG 23-1997) that include a prohibition on the use of nutrition and health claims for foods for infants and young children.
In addition to the proposed safeguards, the labelling of RUTF should include the following prominent additional safeguards and WARNINGS:
There should be no promotional claims
The products should not be flavoured
The product must only be used for the therapeutic treatment of Severe Acute Malnutrition, strictly under medical supervision
Potable drinking water must be available for children receiving RUTF treatment.
The labelling of the product shall not refer to, resemble or cross-promote infant formula, follow-up formula for older infants, or formula for special medical purposes intended for infants, including numbers, text, statements, or images of these products.
These products must only be used for the treatment of SAM and strictly under medical supervision.
Potable drinking water must be available for children receiving RUTF treatment
Products are not to be sold on the open market
FUF: IBFAN FUF comment
Front of Pack Labelling: IBFAN COMMENT FOPN
WHO/UNICEF INFORMATION NOTE – Cross–promotion of infant formula and toddler milks, WHO, 2018).
Worldwide Baby Food Drink Market In-depth Research Report 2021, Forecast to 2026, expects 7.7% growth from $68bn in 2020 to 91bn by 2026 – more than 30% in 5 years!
Codex Paper What You Don’t Know About the Codex Can Hurt You: How Trade Policy Trumps Global Health Governance in Infant and Young Child Nutrition.http://ijhpm.com. Int J Health Policy Manag 2021, x(x), 1–15. Katheryn Russ1*ID, Phillip Baker2ID, Michaela Byrd3, Manho Kang3ID, Rizki Nauli Siregar3ID, Hammad Zahid3, David McCoy4ID
Towards Building Comprehensive Legal Frameworks for Corporate
Accountability in Food Governance Daniel Dorado1 · Sofía Monsalve2 · Ashka Naik1,3 · Ana María Suárez4
New Codex promotional materials:
New publications from FAO and WHO:
- Review of derivation methods for dietary intake reference values for older infants and young children which was developed by FAO in response to the request for scientific advice to develop general principles for the establishment of Codex nutrient reference values for older infants and young children.
- Protein Quality Assessment in Follow-up Formula for Young Children.
- WHO summary report on the available evidence for essential fatty acid profiles in ready-to-use therapeutic foods for treating children with severe wasting
- WHO summary on the available evidence for the content of iron in ready-to-use therapeutic foods for treating children with severe wasting
Spanish Translation of RUTF update:
Lo logrado en Codex recientemente
Ya terminó la discusión sobre las Directrices para los “alimentos terapéuticos listos para usar” y el documento se enviará al CAC para su adopción.
Logramos éxito en que se aceptaran algunas de nuestras recomendaciones -pero no todas, (IBFAN RUTF: http://www.babymilkaction.org/wp-content/uploads/2021/11/IBFAN-comment-RUTF-Nov-2021-final.pdf), en particular, no logramos incluir la relactación (con el apoyo de EE. UU., Colombia y Brasil), mayor énfasis en los alimentos locales y el Código Internacional y las Resoluciones como lo han pedido muchas veces la India y otros países.
No lo logramos porque toca asuntos como las donaciones, marca cruzada con fórmula infantil y otras tácticas promocionales.
Sin embargo, es un triunfo y un gran alivio que las pautas recomienden ahora que los “alimentos terapéuticos listos para usar” solo se utilicen en un programa diseñado apropiadamente y que no deben estar a la venta minorista general ni incluir declaraciones de propiedades nutricionales y saludables:
El Preámbulo recomendará que: Los “alimentos terapéuticos listos para usar” deben usarse en un “programa diseñado apropiadamente que promueva la continuación de la lactancia materna, la transición apropiada a alimentos familiares nutritivos y el apoyo psicosocial para la recuperación”. Así mismo, dice que los “alimentos terapéuticos listos para usar” son una opción recomendada por la OMS; que su uso no excluye otras opciones dietéticas, incluido el uso de alimentos de origen local; también los “alimentos terapéuticos listos para usar” no están destinados a la venta minorista general.
La sección de etiquetado especifica que los “alimentos terapéuticos listos para usar” se deben usar junto con la lactancia materna, que se recomienda la lactancia materna exclusiva durante los primeros seis meses de vida y que se recomienda continuar la lactancia materna hasta por dos años y más, y que los “alimentos terapéuticos listos para usar” no deben usarse antes de los 6 meses y deben no llevan declaraciones de propiedades nutricionales o saludables.