Global trading standards must follow WHO in

restricting harmful marketing

75^th World Health Assembly, Geneva, 22-28^th May, 2022

 

IBFAN, the global network that has helped governments stop harmful marketing of baby feeding products for the last 40 years, attended the 75^th World Health Assembly (WHA) in May. With so many difficult political issues on the Assembly agenda  –  emergencies,  military conflicts, decisions on pandemics, the climate crisis, the need for sustainable WHO financing to name just a few – infant health and the global trade of baby feeding products seemed to some a small topic that had to take its turn.

Most governments know that the unethical marketing of baby feeding products contributes to the annual toll of 800,000 baby deaths from unsafe feeding and that many more do not reach their full potential because they are not breastfed. However, with the pressure to join multi-stakeholder initiatives,  health-harming corporations are being accepted as legitimate ‘partners’ and funders in health and are gaining increased access to policy-making processes at all levels, including at WHO.  Risky technologies and products claiming to protect and solve all manner of problems are being promoted,  obscuring the fact that for infants and young children, breastfeeding is a resilient practice that provides food, care, immune support and protection, even from the worst of emergency conditions. It also protects against malnutrition in all its forms.  However, breastfeeding needs strong legal protection from predatory marketing.(1)

In 1981 the World Health Assembly – the world’s highest health policy setting body – passed the first consumer protection tool of its kind –  the International Code of Marketing of Breastmilk Substitutes followed by 20 subsequent Resolutions  This ‘code’ is a minimum obligation for all governments and the global baby-feeding products industry (whose US $55 billion turnover is led by the corporate giants Nestlé, Danone, Abbott and Mead Johnson/Reckitt) must also comply with it. 144 countries have adopted laws based on the Code since 1981, however, because of undue commercial influence, too many have legal loopholes that allow harmful marketing to flourish. The corporations are never held financially responsible for the harm they cause and all the ‘costs’ are externalized to governments, families and babies. Indeed the financial cost of sub-optimal feeding is especially important at this time of global inflation following the pandemic.

Four WHO reports published this year look at the global nature of the corporate strategies, with the report on digital marketing explaining how companies target new mothers with algorithms and celebrity influencers that reach millions with single postings.(2)

Over 45 countries spoke on the Maternal, Infant and Young Child Nutrition Agenda Item when it came up, many stressing the importance of protection against deceptive tactics that idealise and mislead all parents about the safety and nutritional value of baby feeding products.(8)

Ensuring that global trade rules do not harm infant and young child health:

High on IBFAN’s list of concerns (3) was the need for policy coherence between global trading standards and WHO decisions – a critically important matter that some exporting countries would prefer not be raised at the WHA. WHO and the Food and Agriculture Organisation (FAO) are the funders and ‘parents’ of the Codex Alimentarius Commission, the food standard setting body with the dual mandate of protecting health and ensuring fair practices in trade. All Codex work is subject to approval FAO and WHO and the Codex Code of Ethics for International Trade requires observance of the Code and Resolutions. (4) Clearly Codex should follow WHA decisions, not the other way around as suggested by the USA in its intervention:

“It is also critical that the [digital] guidance does not infringe upon the work and mandate of other international bodies, especially Codex Alimentarius given its leading role in developing science-based safety standards for food products.”

Since 1995 IBFAN has advocated the incorporation of WHA resolutions into baby food standards and guidelines and has witnessed how often decisions are not based on credible scientific evidence but on politically influenced consensus that favours the interests of agri-food industry and exporting countries. In March 2023, Codex will make an important decision on the revision of the Codex Follow-up Formula standard: should companies be allowed to freely promote the unnecessary, sweetened, flavoured, ultra-processed milk drinks for young children 12-36 months that fuel the obesity epidemic and add to the environmental burden? Or should the standard follow WHO guidance that clearly states that these products – confusingly cross-promoted with infant formulas for newborn babies ­– function as breastmilk substitutes and should not be promoted anywhere, but especially where breastfeeding into the second year is a lifeline for babies.(5,6)

‘Cross Promotion’ or ‘brand stretching’ is a well-known, deceptive marketing technique used to expand the sale of products such as alcohol, tobacco, soft drinks and baby formulas. In June 2022 the Brazilian Institute for Consumer Protection (Idec) filed a Public Civil Action (ACP) against Nestlé Brasil, Mead Johnson Brasil and Danone, claiming that the Cross Promotion strategy causes confusion, deception and harm, especially for fathers, mothers, caregivers and young children.

 

 

 

 

 

 

 

 

 

 

While all governments have a sovereign right and duty to adopt health-protective laws to protect citizens, a weak industry-friendly Codex standard could dissuade some. Aware of these risks, several countries called on WHO for help with trade and marketing matters, to ensure that health takes priority over trade concerns.

Bangladesh delivered a strong statement on behalf of eleven Member States of South East Asia, reminding the meeting that breastfeeding is a “socio-cultural component of human heritage binding the newborn with the mother after their birth through skin-to-skin contact” and calling for stronger implementation and monitoring of the Code.  As Bangladesh,  the delegate also asked WHO to:

“mobilize global support … to  address trading and export standards, guidelines and regulations in compliance with the International Code of Marketing of Breastmilk Substitutes and subsequent WHA Resolutions and … to promote gradual phasing out of the cross-branded products that function as breastmilk substitutes within the Codex Alimentarius revision of the draft standard for Follow-up Formula.”

Thailand supported Bangladesh’s call for curbs on digital marketing and cross-promotion and asked WHO to:

“collaborate with the World Trade Organisation (WTO) or other relevant trade agreement bodies to ensure our global efforts to catch up with this modern marketing into this guidance. Otherwise, this will be another piece of paper without implementation … impossible for us to follow.”

Mexico regretted the marketing that is leading to a reduction in breastfeeding across the world and picking up on the WHO EU policy brief, called on the WHO Secretariat:

“to strengthen the document, EB 150.7 to provide assistance to Member State so that guides, regulations and standards on marketing correctly implement the International Code of marketing of breastmilk substitutes  …  the adoption of legal frameworks that cover all children, children’s food and related products, as well as covering all foods that are taken by pregnant women.   We see that there is a conflict of interest, so we need to ensure that we have proper policies for children, following the 10 steps for the  promotion of breastfeedi

 

Photo above: Maternal milk promoted in Timor-Leste Danoné Lactamil, misleadingly and confusingly cross-promoted with infant formula for newborn babies. Is this for the mother or the baby? This ultra-processed product targets breastfeeding mothers, undermining confidence in breastfeeding and normal family foods.

Argentina regretted the high early suspension of breastfeeding, stressed that health teams should make  decisions and that Member States should base their sanitary or phyto-sanitary measures on standards, international guidelines or recommendations.

Dr Francesco Branca, WHO Director of Nutrition and Food Safety, speaking after the debate, appreciated the requests from Bangladesh and committed to identify actions to address those concerns, and help ensure the strongest possible safeguards for child health , including in the discussion of the forthcoming Codex standards

IBFAN highlighted the cruelty of expecting poorly-resourced countries to tackle cross-border marketing problems alone. Babies in these countries stand to suffer the most when breastfeeding is undermined. Exporting nations such as the USA, Canada, New Zealand, Australia, Europe, Japan and China all profit from formula sales, yet take no responsibility for their companies.

The European Union is often outspoken on food safety matters at Codex, including on baby feeding products and  growth hormones. But they are weak on the issue of promotion of  Follow-on formulas. In 1992, in an attempt to address problems with the EU’s enormous export of breastmilk substitutes to Africa and other developing countries, an EU  Council Resolution was passed, calling on EU-based companies to comply with the Code when marketing in importing countries. The Resolution also outlined monitoring, reporting and accountability proposals.[7]  It’s high time this idea was revisited, strengthened and converted into binding EU Regulation.

Although the USA expressed support for breastfeeding as a priority programme area, it made no reference to the contamination in the Abbott factory apart from mentioning the critical importance of safe breast milk substitutes. No mention was made of the lack of US Code legislation and mandatory paid maternity leave that has underscored and exacerbated the current long-running infant formula shortage.

The draft Decision approved by the January Executive Board meeting (EB150/7) was adopted without amendment.  It calls on the WHO Director General to “develop guidance for Member States on regulatory measures aimed at restricting the digital marketing of breastmilk substitutes, so as to ensure that existing and new regulations designed to implement the International Code of Marketing Breastmilk Substitutes and relevant Health Assembly resolutions subsequent to its adoption adequately address digital marketing practices..” and to report back in 2024.

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For more: Elisabeth Sterken (elisabethsterken@gmail.com), Dr Magdalena Whoolery (missmagda@hotmail.com), Ellie MacGregor (ellie@alpp.org), Alison Linnecar (alinnecar@gmail.com), Maryse Arendt (maryse.arendt@pt.lu ) Patti Rundall (prundall@babymilkaction.org)

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www.babymilkaction.org  www.ibfan.org

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(1) Advancing children's right to healthy food environments Webinar 1: Advancing industry interferences in policy making” on #Vimeo https://vimeo.com/700464678?ref=tw-v-share

Interference in public health policy : Baby food and Tobacco tactics.World Nutrition Issue.  Vol 8 No 2 (2017)

When the Sun casts a Shadow Multi-stakeholder Partnerships: What are the risks?  The case of Scaling Up Nutrition (SUN)

[2] How the marketing of formula milk influences our decisions on infant feeding. WHO UNICEF 2022

Marketing of breast-milk substitutes: national implementation of the international code, status report 2022.  WHO UNICEF IBFAN

Scope and impact of digital marketing strategies for promoting breastmilk substitutes.  WHO 2022

Policy Brief: Effective regulatory frameworks for ending inappropriate marketing of breast-milk substitutes and foods for infants and young children in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2022.

Australia’s Role in Global Infant Food Security: Implications of the US Milk Formula Shortage

[3] IBFAN also made interventions on Non-Communicable Diseases,  the need to correct and strengthen WHO’s Conflicts of Interest policy to exclude all health harming industries (rather than just arms and tobacco) and called for safeguards in emergencies to protect and support for breastfeeding, skin-to-skin contact and re-lactation and to ensure that micronutrient interventions are not commercially promoted and do not undermine sustainable food production, food security and biodiversity. The multi-agency Ukraine statement and  Operational Guidance on Infant Feeding in Emergencies V3 warn of the risks of baby feeding products during emergencies.

[4] The programme of work of the Codex Commission is funded through the regular budgets of WHO and Food and Agriculture Organisation (FAO). CODE OF ETHICS FOR INTERNATIONAL TRADE IN FOOD requires Member States to “…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 World Trade Organisation (WTO) was set up to ensure that trade between nations flows as freely as possible and is outside the UN system.  However,  the Agreement on the Application of Sanitary and Phytosanitary Measures  allows WTO members to set their own standards on food safety and animal and plant health, as long as they are based on science, applied only to the extent necessary to protect human, animal or plant life or health, and not arbitrarily or unjustifiably discriminate between countries where identical or similar conditions prevail. Members are encouraged to use international standards, guidelines and recommendations but may adopt higher levels of protection if there is scientific justification for it, or if they are based on appropriate assessment of risks.

[5] Dr. Julie Smith, Honorary Associate Professor,  Australian Centre for Economic Research on Health:  “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.”

[6] IBFAN Press Release 2019:  Exporting countries put trade before the health of the planet and children. “Cross Promotion’ or ‘brand stretching’ is a well-known, deceptive marketing technique used to expand the sale of products such as alcohol, tobacco, soft drinks and baby formulas, whose marketing is restricted because of public health concerns. Cross Promotion where products copy the branding and appearance of infant formulas is especially harmful because it increases the risk of young infants being fed with entirely inappropriate products”

www.babymilkaction.org/archives/23295

[7] “In 2017, the EU is the biggest supplier of infant formula with one third of global volumes, with China and
South-East Asia in second and third place respectively.” Global infant formula products market: estimations and forecasts for production and consumption China Dairy July 2018

EU Council Resolution on marketing of breast-milk substitutes in third countries by Community-based manufacturers. (Official Journal C 172 , 08/07/1992):  “Whereas the application of the International Code provides without doubt an excellent way to achieve this in these countries … 1. The Community will contribute to the application of appropriate marketing practices for breast-milk substitutes in third countries.2……the Commission will instruct its delegations in third countries to serve as contact points for the competent authorities. Any complaints or criticisms with respect to the marketing practices of a manufacturer based in the Community could be notified to them.3. The Commission will be ready to examine such cases and to assist in the search for a satisfactory solution for all parties concerned.”  EU Export Directive (required labels in the appropriate language)

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(8) Excerpts from some of the 45 interventions made by Member States’ on Agenda item 18 (not accurate)

Angola-18.1: …In the absence of legislation on the marketing of breast milk substitutes, which is awaiting validation and publication, we are faced with  companies that commercialize these substitutes and that are increasingly gaining adherence, including influencing health professionals to prescribe them. Angola is working hard to maintain adherence to breastfeeding during the 1st hour after childbirth, to promote exclusive breastfeeding during the first six months of life and continued up to two years, ensuring that during the 1,000 days of life, from the intrauterine period, the child benefits from the components of breast milk which will protect against infectious diseases and allergies. However, We recognize that the country still needs technical assistance from the WHO to finalize the Code of Breastmilk Substitutes and food fortification policy as an action aimed at reducing chronic malnutrition in the country

Argentina Argentina-18.1 .. Despite having regulatory frameworks and appropriate health actions, Argentina still shows a high early suspension of breastfeeding for non-medical reasons, therefore and in relation to the use of breast milk substitutes, we understand that it should be the health team who must define the circumstances for its use and that any form of direct promotion to the people, could undermine good health practices. However, Argentina considers that the regulatory guidelines to restrict the digital marketing of substitutes must be carried out in a balanced framework guided by the principle of reasonableness, so as not to hinder access to these products in cases where breastfeeding is not can be carried out and when they are essential for the nutrition and feeding of the infant. Regarding the Global Strategy for Food Safety, Argentina would like to highlight the inclusion of the reference to the agreement on Sanitary and Phytosanitary Measures of the WTO in objective 5.4, which stipulates that Member States must base their sanitary or phyto-sanitary measures on standards, international guidelines or recommendations

Brazil Brazil-18.1 : ….Brazil appreciates the DG report on maternal, infant and young child nutrition. The benefits breastfeeding brings to the child, mother, family and society as a whole are countless. Our country is moving towards achieving one of the Global Nutrition Goals: to reach 50% of infants under six months exclusively breastfed by 2025. Brazil created a programme for the promotion, protection and support of breastfeeding, aiming to ensure the right of women and children to breastfeeding.

Bangladesh: Bangladesh speaks on behalf of eleven Member States of South East Asia. At the outset, we thank the Secretariat for preparing the technical brief and a comprehensive report on “MIYCN”.
2. Breastfeeding is a socio-cultural component of human heritage binding the new-born with the mother after their birth through skin-to-skin contact. Breastfeeding is a proven passage to supply nourishment to our children, both in the present and past, and will remain so in the future as well.
3.  No more scientific research is needed to justify the usefulness of breastfeeding for the health of the newborn in terms of its adequacy as a food for new born. Rather the alternatives to breastfeeding can have negative and long-term impacts on the human health. South East Asia believes in continuing breastfeeding through promotion, protection and support which includes better enforcement of BMS Code legislation.
4. We appreciate WHO’s support for the market research on the impact of formula milk marketing practices, industry’s tactics, and experiences from a consumer perspective. WHO ‘s Strategic Action Plan to address the double burden of malnutrition  for the SEAR countries  has been vital for our region.
5. SEAR Member States have started focusing on policy measures and implementing population-based measures including regulatory actions to promote healthy diets and reduce obesity and dietary risk of NCDs. But we are suffering from setbacks owing to capacity gaps and commercial determinants.
6. Several countries in the SEA Region have the potential to contribute to Universal Salt Iodization. But there are challenges in ensuring proper implementation of Universal Salt Iodization (USI) remain obvious.
7. In view of the foregoing, South East Asia proposes following five recommendations to the Director General:
a. To encourage the Member States to enforce BMS legislation.
b. To support the Member States to be resilient in addressing  the marketing campaigns for BMS products including digital marketing strategies;
c. To undertake advocacy efforts and external assessment of USI programmes at regional level to support the countries with a view to achieving optimum iodine status;
d. To strengthen monitoring and surveillance system for salt iodization through integrating them in the national M&E system for ensuring sustainable USI activities;
e. To provide sustainable funding to scale up implementation of the Comprehensive Implementation Plan on MIYCN and USI.
8. The SEAR countries support the recommendations and report.
Chair,With your permission, I would like to deliver few sentences on behalf of my country Bangladesh.  Bangladesh would urge upon the Director General to put in place the following:  First, to mobilize global support using its existing resources to  address trading and export standards, guidelines and regulations in compliance with the International Code of Marketing of Breast-milk Substitutes and subsequent WHA Resolutions;  Second, to promote gradual phasing out of the cross branded products that function as breastmilk substitutes within the Codex Alimentarius revision of the draft standard for Follow-up Formula;  And finally, encourage the Member States in ensuring compliance with the WHO UNICEF Ten Steps to Successful Breastfeeding.

China: In this area, China has continuously strengthened its knowledge related to maternal and newborn health care, so as to provide an enabling environment for improving maternal and infant nutrition. China is willing to make the following suggestions: First: WHO to provide guidance to member states in data assessment related to NGOs, achievements and established a platform for Member States to share successful experience and lessons;  Second:WHO to collaborate with Member States on further concrete measures for multi-sectoral cooperation on digital marketing of breastmilk substitutes and strengthened exchanges and communication with Member States so they increase the applicability and operability.Third: focus on the positive role of improving public health literacy facing the digital marketing of breast milk substitutes and provide more technical support to members states. Fourth: to support the WHO to play a greater role in promoting global improvement on maternal nutrition, especially in developing countries. We  welcome the updated who global food safety strategy. China will refer to the updated strategy further strengthened China’s food safety system taken into account China’s national conditions and actively engage with the global food safety community to provide information and assistance to strengthen the safety system to promote realization of health related SDGs Thank you.

Canada: asked for amendment to Food Safety Decision 18.2 – 150.8.  Is a Co-sponsor with UAE on plans for well-being; Wellcomes the report o Behavioural Science.

Columbia:In favor of WHO report; supports International Code on Marketing of BMS. Has been working on different actions on marketing of BMS. Wants to present a draft resolution in 2023 on the prevention of spinabidifa. We need to strengthen systems for controlling and monitoring food safety.

Ecuador: talks about reproductive health; mental health; iodine deficiency; wants to carry on with epidemiological surveillance

Finland:  Finland aligns herself with the  statement of the European Union and thanks the Secretariat for the report on behavioural sciences for better health. Health Related behaviours at individual community and national levels are essential to achieving desired health outcomes. We need to encourage people to make healthy and sustainable choices and to promote health-enhancing behaviour and increasingly take into account the role of Misinformation and Disinformation on health. Finland wishes to emphasise two matters. First, health is produced and it can be endangered everywhere in our societies. Therefore, monitoring and addressing continuous risk factors and health determinants is essential. Many of the determinants of health are beyond the direct influence of individuals. Policies and environments have a major impact on health. Second, healthy choices and healthy options are only possible when they are available. Many of the determinants of health are beyond direct influence on individuals. The prevention of obesity is an example. Reducing energy intake and being physically active is simple in theory, but difficult to implement due to reduced access to the price of healthy food, advertising of unhealthy products and lack of safe environments for physical activity. Commercial advertising can rapidly change behavioural patterns. This will be a major challenge for health promotion. [without] being informed by behavioural sciences and measures used by media and businesses, our actions won’t be successful. Understanding behaviour helps to promote the use of reliable research based data in decision making and implementation of health promotion. Finland has recently established the Centre for cultural behavioural and Media Insights centre which is ….. record in advance for when you report a problem to European office on behavioural and cultural insights. We were promoting health and developing our environments to help grow and receive actions across sectors of society. Finland is happy to support the adoption of resolution .. well being and health promotion. We also support the adoption of a traditional Maternal Infant ….

France EU-18.2: speaking for the 27 EU MSs and Turkey, North Macedonia, Albania, Bosnia, Montinegro, Iceland (EFTA and EEA), Ukraine and Rep of Moldova.  The EU wish to recall statement at EB 150. We support Food Safety a  One Health Approach is vital if we are to have sustainable systems for the long -term and is important when it comes countering the risk of future pandemics.   We must ensure that gradually we do not include  Growth Hormones in our food because this is a key component in our strategy.  Wealso  recognise the risks of  live animals being sold in markets to prevent instances of propagation. And we think this is very important. We also welcome the fact that FAO and WHO are working together and that the environmental dimension is are being taken on board by the WHO to a greater extent. We believe that it’s important to work together in order to create a global One Health plan. We wish to support the action plan that we have before us in this area. And we must be very careful in the way that we work in future that we do not overlap with others who are doing the same kind of thing. We need to have clear definition of everyone’s responsibilities within the system. Thank you.

Ghana:In agreement with Zambia’s statement. Start right, feed right initiatives.  Covid caused food insecurity in 2021, Ghana made commitments to improve affordability and availability of food. Overweight walking wellness systems. Urges all MSs to improve MIYCN and  food safety systems.

India – Improving exclusive BF in country and started anemia-free program. Eat Right India campaign to create awareness of healthy, safe, and sustainable foods. Counseling is provided to pregnant and

Japan Refers to the N4G and wants to promote collaboration and the One Health Approach.

Malaysia Malaysia-18.1-2

Mexico: Exclusive breastmilk in the first six months of the life in the life of an infant up until two years of age, protects our children and also protects against different infectious and non communicable diseases such as diabetes. Nonetheless, we see that the protection of breastfeeding is at risk. And this is because there is a lot of marketing that is carried out by companies for breastmilk substitutes and this is leading to a reduction in breastfeeding across the world. We at the WHO must ensure that we have actions that are implemented that have an impact on breastfeeding so that we can support our infants. We would like the Secretariat of the organization to strengthen the document, EB 150.7 so that we know that we need to provide assistance to member state so that there are guides, regulations and standards on marketing so that there is a correct implementation of the International Code of marketing of breast milk substitutes. The adoption of legal frameworks that cover all children’s food and related products, as well as covering all foods that are taken by pregnant women. We see that there is a conflict of interest, so we need to ensure that we have proper policies for food for children. We  also need to ensure that we are following the 10 steps for the WHO and UNICEF to promote breastfeeding. We need to be investing in our future and in our children. Thank you

Namibia: wants zinc and iodine assistance. Has a draft food safety bill that will be enacted soon through Namibia’s  food quality institute.

New Zealand: As a Pacific nation – so refers to climate  change, including for SIDS (Small Island Development States) –

Niger: supports Zambia statement made on behalf of 47 MSs.  Countries are facing problems with implementing policies to restrict marketing of BMS that undermine BF;  Niger has drafted a  national policy on food security 2017-2027 on nutritional food provision that includes strategy on feeding IYC  exclusive BF and infant foods and consumption of salt.  Strategy on women, expectant mothers and their nutrition.  We are going to improve the serious problems  facing

Nigeria:   We support the statement by Zambia.  Nigeria commends WHO for its work on limiting marketing of BMS. Nigeria has made progress toward institutionalisation of the  implementation of a  national policy and code for BMS that has been developed and approved   The BMS  Code clearly discourages formula feeding and advertisements of formula.  Only breastmilk for the first 6 months of life.. Refers to the national Committee on BMS advertising.   Goes on to talk about Iodine and micronutrients. Nigeria has a national programme of fortification matters.

Norway:  1.45 Welcomes Guidance on Digital marketing. Supports regulating the marketing of BMS and other infant foods, refers to access to qualified  health workers and the impact of food production on climate, (63.14?)  loss of bio-diversity, .

Paraguay: Marketing of highly processed foods needs to be restricted. Labeling needs to be on BMS to be controlling NCDs that may be associated with BMS. Digital marketing of BMS and young child foods needs regulation.

Peru: 1.56 Welcomes the   report. BF is the healthiest and safest way of child feeding with many benefits on health and development and benefits for mothers. Supports draft decision of WHO that restricts marking of BMS substitutes.

Philippines: Mentions Cross promotion

RUSSIA: thanks the Director General for his report reflecting progress on maternal Infant and Young Child Nutrition. We also note that it includes information on the implementation of national measures to give effect to the International Code of Marketing for Breastmilk Substitutes. The Russian Federation is undertaking comprehensive and consistent work in this area. A number of problems are described in the report. For instance, the fact that breastfeeding is not as widespread as it could be, there is only partial implementation of the International Code. We also see that there is a high level of marketing of the substitutes and formula. These are problems we also encountered in the Russian Federation. We believe that the work done by the WHO experts particularly in terms of the implementation of their plan on Maternal Infant and Young Child Health will indeed be a good step forward. We would like to note that at present within the Russian Federation, we are actively discussing amendments to legislation on advertising. This should establish a full ban on advertising of breast milk substitutes for children during the first year of life. With reference to maternal nutrition here we would note that within the Russian Federation, virtually all regions are to a greater or lesser extent iodine deficient. Bearing in mind the fact that transient hypothyroidism in newborns can lead to irreparable consequences for a child’s health, we have a number of clinical recommendations for pregnant women that prescribe Iodine supplements to be taken throughout pregnancy. Therapeutic diets also provide for the use of iodized salt. Thank you

Senegal:Access to nutritious foods for vulnerable groups. When it comes to the promotion of BMS we do have problems that need to be overcome This has allowed us to move forward..

Slovakia. Slovakia-18.1 …  Slovakia welcomes six commitments of the WHO Global Tokio Nutrition summit to accelerate progress on the 2025 nutrition targets, in particular speaking about scaling up quality breastfeeding promotion and support. Unfortunately, slow progress has been made in increasing the breastfeeding. Globally, 44% of infants under six months of age were breastfed in 2020. One of the priorities of the Slovak National Action Plan for Obesity Prevention is to promote a healthy start in life, at as earliest stage as possible. Breastfeeding is considered the best choice for mothers, newborns and infants, providing nutritional and health benefits such as increased resistance to infections. The r esearch has also demonstrated that breastfed children are less exposed to the risk of NCDs at later age. At national level, Slovakia has developed a preventive guideline on the implementation of Baby friendly hospitals guided by BFHI initiative in cooperation with WHO. For the past year, exclusive breastfeeding has increased from 62% of exclusively breastfed newborns to 67%. The rooming-in system increased from 65.5% to 68%. Slovakia would like to express its continued support and engagement when working on improving the maternal, infant and young children nutrition. …

Sri Lanka Sri-Lanka-18.2:….Sri lanka notes the reports by Director General on these two agenda items While implementing all relevant evidence based interventions as an integrate MCH package island wide, Multi-sector Action Plan for Nutrition 2018 – 2025 has been developed to support inter sector collaboration in providing services to improve nutrition in the population. The National Nutrition Policy was recently revised emphasising on mothers, infants and young children nutrition highlighting the need for strong legislation to control unethical marketing of food and beverages The government of Sri Lanka welcomes the decision on developing guidance on regulatory measures aimed at restricting digital marketing of breast milk substitutes and to gazette the Sri Lanka Code for Promotion, Protection and Support of Breastfeeding and Marketing of Designated Products as an Act of Parliament after being revised to incorporate relevant WHA resolutions…..

Thailand: Thailand aligns itself with Southeast Asia regional statement made by Bangladesh. We are looking forward to a practical and comprehensive guidance on regulatory measures aimed at restricting the digital marketing of breast milk substitutes. It is obvious that the guidance includes suggested solution for cross and surrogate promotion, marketing through package and public information by the industry. WHO, furthermore, should also collaborate with WTO or other relevant trade agreement bodies to ensure our global efforts to catch up with this modern marketing into this guidance. Otherwise, this will be another piece of paper without implementation, and it is impossible for us to follow. Health promotion is the most neglected and underfunded component in public health. We are delighted to welcome this first well being and Health Promotion resolution of the who and we need regular reports on the outcome. We need to secure the funding and body to endorse health promotion. In every country to diminish health, social and economic costs from non communicable diseases and create better wellbeing for all. Finally, Thailand support decision on who global strategy for food safety, the strong political commitment is crucial to achieve food safety implementation along the food supply chain, including multi sectoral collaboration. Furthermore, the effective monitoring and evaluation system needed to generate reliable evidence for food safety matter Management. Thank you.

UK: Support restricting the digital marketing of BMS and looks forward to reports of implementation in 2024.Lack of progress ..high number of

USA: The global strategy for food safety. We support Canada’s amendment to the draft decision EB 158 And we signal our support for these edits. I’ll move to my intervention on item 18.1. ensuring the survival and well being of newborns children and women remain an urgent global challenge that good nutrition and effective coverage of nutrition specific interventions can help address the United States is pleased to be working on our commitments made during the UN Food Systems Summit, and the 2021 Nutrition For Growth Summit. These investments and commitments made by other Member States are crucial to prevent more children from falling into malnutrition and will also help build resilient health and sustainable food systems to overcome setbacks caused by the COVID 19 pandemic global climate crisis and recurring conflict, like Russia’s war in Ukraine. The secondary effects of Russia’s war in Ukraine have the potential for devastating malnutrition outcomes. The United States is focused on ensuring the continuity and the delivery of nutrition services and health systems, particularly for women, infants and young children and the first 1000 days and beyond to mitigate the potential declines in breastfeeding and increased rates of micro-nutrient deficiencies disease and wasting. The United States strongly supports breastfeeding, a priority programme area in the US Global nutrition coordination plan, and recognises the critical importance of ensuring sufficient access to safe breast milk substitutes in countries including the United States, when breastmilk is not available. Regarding the draft decision, the United States calls on WHO to conduct its work in a consultative and transparent manner and to ensure that it addresses gaps in existing guidance while considering the range of approaches Member States use to protect and support breastfeeding. It is also critical that the guidance does not infringe upon the work and mandate of other international bodies, especially Codex Alimentarius given its leading role in developing science based safety standards for food products. Thank you.

International Atomic Energy Agency IAEA-18.1. Good nutrition is fundamental to human health at all ages. Nearly every country in the world is affected by malnutrition and many experience multiple burdens of malnutrition. The IAEA is supporting its Member States in combatting malnutrition in all its forms. Nuclear and stable isotope techniques generate accurate data that provide evidence for improving nutrition interventions and programmes. Through these techniques, many Member States have the capacity to assess body composition, breastfeeding practices, micronutrient absorption from foods, the link between acute malnutrition early in life and later diseases, and to understand the evolution of childhood obesity. One of the priorities of the IAEA is early life nutrition. The IAEA is collaborating with the WHO on a research project to provide knowledge on the link between early life nutrition and later childhood health, the effectiveness of early life interventions to reduce later childhood obesity and the impact of different nutrition interventions on lean tissue accretion in moderately malnourished children. In cognizance the central role diet quality plays in ensuring good nutrition, the IAEA has continued to support national programmes in Botswana, Malawi, Benin, Central African Republic and Ivory Coast to understand how specific interventions contribute to the reduction of iron deficiency – anemia – as it is associated with poor cognitive and motor development in children. For example, the IAEA supports. Malawi to assess the impact of a multiple micronutrient supplementation on anaemia, markers of iron status, anthropometry and body composition amongst children aged 6–23 months. Results showed that supplementing children with a mix of micronutrients resulted in increased haemoglobin concentration in blood, and that the children had greater muscle tissue (fat–free mass) compared to those not receiving supplementation. Protein quality, defined as the quantity and balance of essential amino acids, is a major determinant of nutrition status especially in the early years of life. Measuring protein quality is not easy. Through an IAEA–supported research project, a new isotopic technique to measure protein digestion from foods was
developed and can be used for example to evaluate the protein quality of complementary foods. We look forward to continuing and further expanding our collaboration with the WHO and other partners in combating malnutrition in early life.