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close this bookSCN News, Number 16 - Nutrition of the School-aged Child (ACC/SCN, 1998, 80 p.)
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News and Views

Urban Malnutrition: a Rising Policy Problem

Over the period 2000-2025, the rural population of the developing world is projected to increase from 2.95 billion to 3.03 billion. Over the same period, the urban population of the developing world is projected to double - from 2.02 billion to 4.03 billion (United Nations Centre for Human Settlements, UNHCS, 1996).

While we can be sure that the number of people living in urban areas in the developing world will increase rapidly in the next 25 years, we do not know how many of them will be poor and undernourished. Furthermore, we do not know whether the absolute number of urban poor and undernourished will increase more quickly than the rural number. In other words,

· will there be a shift of poverty and undemutrition from rural to urban areas?

· are the opportunities for (and constraints to) income generation, food security and improved nutrition different for those living in urban areas compared with those living in rural areas?

· what do the answers to these questions imply for policy research and for policymaking in urban areas?

Research at the Food Consumption and Nutrition Division of the International Food Policy Research Institute (IFPRI) has begun to provide some answers to these questions. Newly assembled data suggest that the absolute number of poor and undernourished in urban areas is increasing and is accounting for a growing share of overall poverty and malnutrition.

Data to analyse trends in rural/urban comparisons of poverty and child malnutrition, are extremely scarce. IFPRI sought assistance from colleagues at the World Bank and WHO and gained access to poverty and malnutrition data, disaggregated into rural and urban areas, for a number of countries over at least two points in time. The data show that for 9 out of 14 countries, the absolute number of underweight¹ children in urban areas is increasing. These 9 countries constitute a large percentage of the developing world given that they include China, Nigeria, Egypt, and the Philippines.

¹Underweight is defined as weight-for-age <-2SD below the NCHS reference median value

For the majority of the countries studied:

· the number of urban poor is increasing;
· the share of the urban poor in overall poverty is increasing;
· the share of urban preschoolers in overall numbers of underweight preschoolers is increasing; and
· the number of underweight preschoolers in urban areas is increasing (see graph below).

The locus of poverty and undernutrition appears to be changing from rural to urban areas

Why is more research needed on urban poverty and under-nutrition?

Despite this upward trend in the numbers, there is surprisingly little research on urban poverty, food insecurity and malnutrition. The available research is often fragmented by issue or by discipline. Moreover, while many of the studies within cities utilise and generate rich case-study data, these studies are frequently limited in terms of the general conclusions that they can draw about other areas of the city or the city as a whole. The dynamics of urban poverty and the links to rural poverty also have been under-researched. Finally, community, NGO, and municipal and national government responses to urban poverty and malnutrition have not been systematically documented and evaluated with a resulting set of best practices.


Percent of all Underweight Children that Reside in Urban Areas

The authors argue that this closing of the rural-urban gap is a sufficient basis to call for more research on urban poverty, food and nutrition issues. The demand for urban food and nutrition policy research is rapidly outstripping the existing stock. Further research in this area is likely to have large payoffs in terms of assessment, analysis and action.

Based on a forthcoming IFPRI Discussion Paper (1998), 'Growing Urban Poverty and Undenutrition and the Urban Facts of Life: Implications for Research and Policy' by Lawrence Haddad, Marie Ruel and James Garrett. Copies of discussion papers can be obtained from FCND, IFPRI, 2033 K Street, NX, Washington, D.C. 20006, USA, Tel: 1 202 862 5600 Fax: 1 202 467 4439 Email: ifpri@cgnet.com This note was prepared by Bonnie McClafferty at the FCND, IFPRI. See also page 54 for further details about IFPRI's recent activities in nutrition.

Data Sources: WHO Global Database on Child Growth and Malnutrition, (WHO 1997, see page 68); UN Population Divisions Urban and Rural Areas by sex and age: The 1992 Revision, UN 1993, and World Urbanization Prospects: The 1994 Revision (1995).

Genetically-Modified Crops'. the Social and Ethical Issues

The Nuffield Council on Bioethics (UK) - an independent body established to consider major ethical issues arising from developments in medicine and biology - has recently started an inquiry into the ethical issues raised by genetically modified crops. A Working Party has been established to discuss this issue and a report will be published early in 1999.

What are genetically modified crops?

In contrast to traditionally bred varieties, genetically-modified plants have foreign or synthetic DNA inserted directly into their cells to confer desirable characteristics such as disease resistance or improvement of storage or processing characteristics. This method of genetic improvement has obvious benefits for agriculture. The private sector has invested heavily in this technology, and most scientists, who have spent years developing and perfecting the techniques involved, believe that such crops are safe to grow and eat.

Genetically modified soya, maize and cotton are increasingly grown in the United States, and genetically modified crops are already entering the human food supply in parts of Europe. In some areas of the world, however, these crops are being grown in the absence of a free press and with little public awareness of science.

In 1997 approximately 30 million acres worldwide, were planted, with genetically modified crops

Environmental and safety concerns

There are major concerns about the environmental impact and safety of genetically modified crops. One of the main environmental concerns is the effect that the introduced genes will have once they are released into the environment. No one knows the long-term consequences of interbreeding between genetically modified crops and wild species.

Nutritionally, there are questions as to whether the introduction of a new gene could disturb metabolic pathways within the plant such that the proportions of fats, carbohydrates and other constituents are altered. Specifically, there is concern that the introduction of a new gene may increase the production of toxins in the plant, or indeed, be itself toxic.

There is also debate over the possible transfer of antibiotic-resistance genes to the gut of livestock fed with genetically modified maize, and the possibility of eventual transfer to humans.

Finally, there is the issue of consumer choice. Consumers have a right to know what they are eating and drinking. As US growers do not segregate genetically modified soya from traditionally-bred soya, countries importing US soya are unable to track which products are derived from genetically modified crops. Within the UK, a general aim of regulations has been that people should have a choice about whether to consume genetically modified foods. Given the difficulties of separating genetically modified foods, however, labelling has become a major issue in Europe.

Implications for developing countries

Genetically modified crops may potentially offer substantial benefits to developing countries, such as increasing yields and improving food consumption. However, it is likely that technology will continue to be directed towards the needs of rich countries, and it is unclear whether developing countries will have access to these new technologies. There is also the danger that new genetically modified products will undermine the market for commodities from developing countries. The United Nations Environmental Protection agency (UNEP) has adopted non-binding guidelines for the management of the release of genetically modified organisms¹. However, many developing countries cannot afford to implement what some see as essential safeguards when genetically modified crops enter the environment or food chain. Some have argued that lower safety standards are justified.

¹ Tzotzos, G.T. Genetically Modified Organisms. A Guide to Biosafety. Wallingford, UNIDO, UNEP, CAB International, 1995. Copies will soon be available to order from the UNEP website at http://www.unep.org

As part of the inquiry, the Nuffield Council on Bioethics is inviting comments on the development of genetically modified crops and the implications for consumers, the environment and the current regulatory framework. The Council would also like to hear views on the way in which ethical issues are being approached, now and in the future.

Please send your comments to: Dr Sandy Thomas, Secretary to the Working Party on the Genetic Modification of Crops, Nuffield Council on Bioethics, 28 Bedford Square, London WC1B 3EG, UK. Tel: 44 171 631 0566 Fax: 44 171 323 4877 Email: ncob@cableinet.co.uk by August 31st 1998. As the Council may publish some of the views expressed, please make it clear if you wish your response to be treated in confidence. Further information can be found in the consultation document 'Genetically Modified Crops: the Social and Ethical Issues', available on the web at http://www.shef.ac.uk/~doe/or from the Nuffield Council on Bioethics.

Source: The Nuffield Council on Bioethics consultation document 'Geneticatly Modified Crops: the Social and Ethical Issues', April 1998.

Human Rights and Nutrition in the SCN

The 25th Session of the ACC-SCN saw a breakthrough in the recognition of linkages between nutrition as a development goal and nutrition as a human right. Over the last two SCN sessions -Ghana (1996) and Kathmandu (1997) - there has been increasing recognition of the international human rights system as a hitherto unexplored opportunity for strengthening nutrition analysis and advocacy, and for strengthening action towards sustain-able access for all to adequate food and nutritional well-being.

A human rights approach can embrace broad nutrition policy issues and give added support to ongoing and future nutrition-relevant programmes. The advantages of using the human rights system of internationally agreed legally-based norms, institutions and procedures to strengthen the cause of ending hunger and malnutrition, is becoming better understood by the nutrition community.

There is also a growing recognition that the nutrition community itself can, through the SCN mechanism, play an important role in strengthening the work of the United Nations in promoting economic, social and cultural rights and in particular, the right to food and nutrition. The contributions by SCN participants include the provision of data, the documentation of experiences from efforts that do or do not work, and the dissemination of a comprehensive understanding of the linkages between nutrition goals and other development goals. This would improve the content of the obligatory periodic reports by member states (that have ratified the human rights conventions relevant to food and nutrition), and enhance the analysis by expert treaty bodies, notably the Committee on Economic, Social and Cultural Rights (CESCR) which has a Secretariat at the UNHCHR office in Geneva.

The momentum for a new global drive for nutrition has perhaps never been greater, underpinned as it is by the message from the UN Secretary-General Mr. Kofi Annan in his proposal for UN reform launched in 1997, that human rights shall resume a central place throughout the work of all United Nations agencies, programmes and funds. Also, the celebration of the 50th anniversary of the Universal Declaration on Human Rights this year has put into focus the human rights movement and its linkages to peace and economic and social development as the two other fundamentals of the UN Charter.

Specifically, the offer by the UN High Commissioner for Human Rights to host the 261" ACC-SCN Session in Geneva on April 12-151999, is a sign that nutrition may in the future figure much more centrally on the UN agenda at large. It is now up to the SCN and its participants to become better informed about the human rights system and the challenges it offers to the UN, to member countries, and to civil society in partnership for a move that may make a difference. The 26"' SCN Session in 1999 will provide an opportunity for advancing understanding through its symposium "The substance and politics of a human rights approach to food and nutrition policies and programming", which will take place on April 12,1999.

By Wenche Barth Eide (Institute for Nutrition Research/School of Nutrition, University of Oslo, P.O. Box 1046 Blindern, 0316 Oslo, Norway. Tel: 47 22 85 1375 Fax: 47 22 85 1376 Email: w.b.eide@basalmed.uio.no) and Uwe Kracht (World Alliance for Nutrition and Human Rights (WANAHR), Viale delle Medaglie d'Oro 415, 00136, Rome, Italy. Tel/Fax: 39 06 35 40 9595 Email: kracht@flashnet.it), rapporteurs for the SCN Working Group on Nutrition, Ethics and Human Rights. See also page 24. The background document provided by this Working Group "The Promotion and Protection of the Human Right to Food and Nutrition by ACC-SCN Member Agencies: Obligations and Opportunities', is available by email from Wenche Barth Eide (address above).

A Multinutrient Package for Tea Plantation Workers for Better Health, Productivity and Profitability

Results from a study to evaluate the effects of micronutrient supplementation on tea plantation workers and their families in India have demonstrated a significant, positive impact on the workers' health and productivity. Initiated in 1996, the study was conducted in the plantation district of Chikmagalur, Kar-nataka State, South India - a district with endemic iodine deficiency disorders (IDD), and high prevalences of iron deficiency anaemia and vitamin A deficiency (VAD). The overall objective of the project was to intervene for nine months with a multinutrient package of supplemental iron (240mg ferrous sulphate twice a week), vitamin A (1600 IU once a week) and iodised salt (30ppm for daily cooking in the household), and to evaluate the effects of this intervention on the health, productivity and profitability of the workforce and their families.


A tea plantation, India. (T. Gopaldas)

The workers were responsible for dosing themselves and their family members. A simple IEC (information - education -communication) sheet on the dosing regimen and benefits was developed in the local Kannada language and was distributed to the workforce at frequent intervals throughout the intervention period.

Significant improvements in the health of the workforce and their dependents were observed: haemoglobin levels increased (from 108g/l to 121g/l in females and from 116g/l to 140g/l in males); clinical signs of iron deficiency, VAD and IDD were significantly reduced (49%®11%, 19% ® 14% and 17% ® 7%, respectively); and common health problems and hospital referrals decreased, Above all, the intervention created a feeling of being cared for, and the majority of the workforce reported that they 'felt better', 'ate more' and 'felt less tired'. Marked improvements in worker productivity were also observed with an increase in the average amount of tea plucked (and hence increased income) over the intervention period. The total number of pluckers employed decreased over the intervention period. The analysis of profitability showed that the total cost of the micronutrient package (Rs 43,050, or Rs 61.5 (about US$1.5) per worker + family per annum) was recovered in the cost of labour saved (Rs 111,800),

India is the largest producer of tea in the world, accounting for nearly 30% of the global production of tea. The tea industry in India is unique in that it employs 40-50% women workers. The workforce live on the plantations and their health and welfare are the general responsibility of the estate's management. This project, funded by OMNI-ILSI, was jointly planned and implemented by Tara Consultancy Services and the management of the tea estate, and used the plantation's own infrastructure and on-going management information systems. This approach, together with a simple intervention and the empowerment of the workers to take care of themselves and their families, has ensured the continuation (and funding) of the intervention by the management after the project ended in early 1998.

Based on the report 'A Multinutrient Package for Tea Plantation Workers for Better Health, Productivity and Profitability, by Tara Gopaldas and Sunder Gujral. Tara Consultancy Services, Bangalore, India, 1998. For further information and a copy of the report, please contact Professor Tara Gopaldas, Director, Tara Consultancy Services, "Saraswati", 124/B, Varthur road, Nagavarapalya, Bangalore - 560 093, India, Tel: 91 80 5242999 Fax:91 80 5288098.

Breastfeeding Promotion: A Cost Effective Intervention

Investing in breastfeeding promotion is among the most cost-effective interventions for child survival, equal to conventional practices such as immunisations and vitamin A supplementation, and surpassing oral rehydration therapy. This is the main conclusion from the Breastfeeding Cost-Effectiveness Study, conducted in Brazil, Honduras, and Mexico, initiated in 1992.

The aim of the study was to provide comparative data on the cost-effectiveness of breastfeeding promotion. To determine the impact of the breastfeeding promotion programmes, prevalences and rates of exclusive breastfeeding were compared for two groups of women:

1. those who delivered at a hospital with a breastfeeding promotion programme;
2. those who delivered at a nearby hospital without such a programme.

The programme involved 17 specific breastfeeding promotion activities during hospitalisation for childbirth. Results showed a significant impact on breastfeeding (see graph below and references 1 and 2).


Breasfeeding status in programme and control hospitals

To determine costs, each hospital programme was described in terms of activities undertaken for breastfeeding promotion. The nature and level of resources (personnel, facilities and materials) associated with each activity were then determined and the direct institutional costs and savings of breastfeeding promotion for one year were determined. Programme maintenance costs of recurrent activities were itemised. All resources were identified and valued in terms of their economic or opportunity costs. A discount rate of 3% was used to calculate the annual value for capital goods. From the profile of costs developed, the difference in incremental costs between breastfeeding promotion at the programme and control hospitals, incremental savings per birth, and net incremental costs per birth was obtained.

Cost-effectiveness was calculated by determining the reduction in risk of diarrhoea and acute respiratory infection (ARI) from hospital differences in the prevalence of exclusive and partial breastfeeding. Mortality effects of differences in these breast- feeding practices were derived by using relative risks for mortality for diarrhoea and ARI previously reported (3). Demographic and Health Survey data were used to make assumptions about baseline prevalences of diarrhoea and ARI in infants less than six months of age, and hence the number of diarrhoeal and ARI deaths averted.


Comparative Cost-effectiveness of Health Interventions

Although the Mexico programme appears to be the most cost-effective (graph above), its cost-effectiveness stems largely from capitalising on the savings from less use of infant formula, which was not the case in Brazil and Honduras. Given the low rate of coverage and the extremely short duration of exclusive breastfeeding, Mexico is an example of a programme in which objectives of coverage and effects are not being met and for which additional investments are needed.

The range of cost-effectiveness estimates obtained in this analysis provides an indication of expected values in different programme and policy contexts (graph above). When compared to the interventions to control diarrhoea, breastfeeding promotion in all three countries compared favorably with ro-tavirus and measles immunisation. When breastfeeding promotion includes a shift from formula to almost no formula feeding, as in the case of Mexico, its cost-effectiveness is comparable to other health interventions, including iodisation of salt ($5 per DALY gained), vitamin A supplementation ($9), or short course chemotherapy for tuberculosis ($3). However, even after savings that result from the elimination of formula have been fully exploited and no longer can be used to offset other costs, as in the case of Brazil and Honduras, breastfeeding promotion still remains a highly attractive intervention, similar to the Expanded Programme on Immunisation Plus and vitamin A supplementation.

Eliminating formula feeding and instituting 'rooming-in' have been appealing options for policy makers eager to realise their savings potential. However, limiting breastfeeding promotion activities to these changes without the next step of establishing comprehensive support and educational activities for mothers is to miss out on an extremely cost-effective health investment. As the results from this study show, hospital-based breastfeeding promotion results in dramatic improvements in the duration of exclusive breastfeeding and is also one of the most cost-effective interventions available to improve infant and child health.

References:

1. Perez-Escamilla R, Lutter CK, Segall, AM, Rivera A, Trevino-Siller S, Sanghvi T. (1995) Exclusive breastfeeding duration is associated with attitudinal, socioeconomic and biocultural determinants in three Latin American countries. J Nutr, 125 2972-2984.

2. Lutter CK, Perez-Escamilla R, Segall A, Sanghvi T, Teruya K, Wickham C. (1997) The effectiveness of a hospital-based breastfeeding promotion programme to promote exclusive breastfeeding among low-income women in Brazil. Am J Public Health, 87(4) 659-663,

3. Victora CG, Vaughan JP, Lombardi C, Fuchs SMC, Gigante LP, Smith PG, Nobre LC, Teixeira AMB, Moreira LB, Barros FC. (1987) Evidence for protection by breast-feeding against infant deaths from infectious diseases in Brazil. The Lancet ii 319-321.

4. Horton S, Sanghvi T, Phillips M, Fiedler J, Perez-Escamilla R, Lutter C, Rivera A and Segall-Correa A. (1996) Breastfeeding and priority setting in health. Health Policy and Planning 11(2) 156-168.

By Chessa Lutter, Regional Advisor, Food and Nutrition Program, Pan American Health Organization, 525 Twenty-third Street, N.W., Washington, D.C. 20037-2895, USA, Tel: 1 202 974 3871 Fax: 1 202 974 3682 Email: lutterch@paho.org This study was supported by the US Agency for International Development under the Latin American and Caribbean/Health and Nutrition Sustainability Project contract to University Research Corporation (LAC-0657-C-00-0051) and subcontract to International Science and Technology Institute (90/01/3700). The study director was Dr. Tina Sanghvi.

Breastfeeding Promotion: The Haitian Experience

As the 1991-94 political crisis wore on in Haiti, women were forced to spend more time away from home in an effort to provide for their family's survival. As a result, exclusive breast-feeding for three months plummeted from 13% in 1987 to 3% in 1995(1,2).

In response, the breastfeeding promotion programme started in 1994 with the introduction of the Baby Friendly Hospital Initiative. This was followed by a one-year national breastfeeding promotion campaign, launched in 1995 by the Minister of Health. A coordination committee oversaw the activities which included:

· wide partnership with churches, NGOs, the Haitian Medical Association, local cooperatives, and youth organisations;

· promotion by traditional birth attendants, priests, voodoo priests, youth, community workers, and health workers;

· testimonies on the values of breastfeeding by mothers who had successfully breastfed exclusively for six months;

· mass media support in the form of promotional materials, radio broadcasting, audiotapes with the programme jingle and breastfeeding messages played in local taxis, and promotional activities in local markets.

The campaign became a national event that drew the attention of the press and national authorities. Momentum peaked in 1996 when both the President and the Prime Minister participated in several events to celebrate the World Breastfeeding Week.

The breastfeeding promotion programme was one of the most successful and visible social development programmes implemented in Haiti during these difficult times. Key messages on breastfeeding had reached nearly every village. Moreover, various intervention areas throughout the country reported dramatic increases in the rate of exclusive breastfeeding for six months from 0% to more than 50%, while cases of severe diarrhoea and malnutrition declined. Factors responsible for the success of the programme are summarised in Box 1 below. There were problems however, and a number of lessons were learned (Box 2, above right).

Box 1: Success factors

· Adoption of a community-based strategy which fostered wide mobilisation and participation.

· Testimonies of healthy babies as a result of exclusive breastfeeding.

· Ease with which breastfeeding promotion integrates into cultural ceremonies because of its association with new life, health, happiness and love.

· Economic hardships, which facilitated the communication of messages on the economic value of breast-feeding.

The programme was engineered by a small number of highly motivated organisers (despite efforts to engage as many people in the process as possible), and most key players have now moved on. It has now lost momentum, although behavioural changes have been sustainable. In addition, many institutions and NGOs have integrated breastfeeding promotion into their regular activities. However, the goodwill among policy-makers and decision-makers is fading in the absence of a constant reminder. This is of particular concern because legislation on the marketing of breastmilk substitutes has not been adopted in Haiti, and the protection of breastfeeding in the work place (including markets) needs to be emphasised and promoted.

The biggest weakness in the programme is that it has not secured national support for promotion, protection and support of breastfeeding. Unfortunately, this is not unique to the breastfeeding programme as virtually all sectors in the country suffer from lack of national interest.

Box 2: Lessons learned

· Breastfeeding promotion can play an important role in crisis management. The political crisis in Haiti provoked large-scale migration within the country, disruption of many social mechanisms, breakdown of public health services, and a sharp deterioration of the health situation. Promotion of and support for exclusive breastfeeding for six months provided parents with better skills to avert the threat of disease and ensure survival of their young infants.

· The importance of community empowerment ensured that communication efforts led to sustainable behaviour change, which goes beyond the life of the programme.

· A chain reaction can be generated by mobilising successful mothers to share their experiences with others.

· Involving fathers and male leaders in the process of building a breastfeeding movement is important. Their proven enthusiasm and involvement in providing support for breastfeeding gave the impression that their indifference to child care is as much born out of ignorance and lack of capacity as it is a 'macho' behaviour.

References

1. Cayemittes M, Chahnazarian A. Survie et sante l'enfant en Ha (EMMUS-I). Port-au-Prince, Institut Haen de l'Enfance, 1989.

2. Cayemittes M, Rival A, Barr B, Lerebours G, Ame Gon M. Enqu mortalitmorbiditt utilisation des services (EMMUS-II) Ha 1994/95. Port-au-Prince, Institut Haen de l'Enfance; Calverton, Macro International, Inc., 1995.

By Menno Mulder-Sibanda and Flora S. Sibanda-Mulder, c/o UNICEF/WCARO, B.P. 443, Abidjan 04, Cote d'lvoire. Tel: 225 42 32 27 Fax: 225 21 05 79 Email: mmsfssm@globeaccess.net


Figure

The national breastfeeding promotion campaign year ended with a mural painting competition in the Port-au-Prince metropolitan area. The winning murals were compiled in a 1997 calendar that was developed to sensitise and inform the public on the Code on the Marketing of Breast Milk Substitutes. This picture shows one of the winning murals.

News from the World Alliance for Breastfeeding Action

The World Alliance for Breastfeeding Action (WABA) arose out of the 1990 Innocenti Declaration. It is a conglomerate network, consisting of large and small networks, interested individual organizations and interested individuals. WABA has a very flat structure, but as a democratic entity, still has to organise responsibilities. WABA therefore has a Steering Committee; a small, hard-working Secretariat in Penang led by its most able Director; an International Advisory Council; Regional Focal Points; and eight Task Forces.

The Alliance makes maximum use of electronic media. Much of WABA's global interaction goes via cyberspace, although being electronically literate is no prerequisite for joining the Alliance. True to its grassroots responsibilities, WABA will always find a way of getting messages across, be it by hand or foot, mouth, pigeon or snail mail!

Breastfeeding: the best investment

This year, WABA has chosen 'Breastfeeding: the Best Investment as the theme for the World Breastfeeding Week (August 1-7,1998). A number of economic studies reviewed in WABA's action folder for the 1998 World Breastfeeding Week, provide powerful arguments for advocacy efforts with governments, health care institutions, employers, funding agencies and others. For example, in Iran an increase in exclusive breastfeeding from 10% in 1991 to 53% in 1996, saved US$50 million on the cost of importing of breastmilk substitutes.

This year's World Breastfeeding Week materials from WABA provide all the information needed to calculate some of the economic losses that artificial feeding implies. The information also emphasises that breastfeeding is worth more than its cost savings. Advocacy should begin on the basis that breastfeeding is a woman's right; advocacy messages can then go on to show that efforts to protect, support and promote breastfeeding will yield significantly reduced costs for health care and for infant foods. These savings may help to reduce foreign exchange spending.

Breastfeeding, women and work: from human rights to creative solutions

WABA has just concluded its annual Steering Committee (SC) meeting, which was held in Quezon City, the Philippines. Prior to the meeting, a workshop entitled 'Breastfeeding, women and work: from human rights to creative solutions' was held (sponsored by SIDA). Numerous ideas were presented and discussed for creative solutions to the difficult situation breast-feeding mothers find themselves in when they have to combine 'mother work and other work'.

ILO is updating its Conventions concerning maternity protection provisions - a subject that will be on their annual meeting agenda in June, 1999. There is a looming threat that the WTO's rules will override national legislation on worker's rights issues. This might be counteracted if maternity protection at work is recognised as 'core labour standards' of special importance, and which will continue to be under the protection and jurisdiction of ILO in the future.


World Breastfeeding Week, 1-7 August 1998, will have the theme 'Breastfeeding: the Best Investment'.

The workshop finally adopted a "Quezon City Declaration" which summarises the concerns of the WABA partners and asks for continued vigilance as well as sharing of positive experience.

HIV and breastfeeding

At the June meeting in the Philippines, the WABA Steering Committee issued a position statement on HIV and breastfeeding. In brief, the WABA SC is concerned that the full economic and health consequences of the recent WHO/UNAIDS/UNICEF policy on HIV and infant feeding have not been adequately analysed (see page 63). Alternatives to infant formula such as expressed and heat-treated human milk are listed in the policy guides, but their use has not been adequately studied and is not explained in the same detail as is infant formula use.

WABA emphasises that the single most important condition that must apply if infant formula is used systematically in high HIV-prevalence areas is that only generic labelling of tins of formulae be permitted. Finally, WABA recommends that the health workers who live with the counselling problems on a day-to-day basis be heard and that they be given resources to study their own situation and propose appropriate remedies.

By Elisabet Helsing, co-chair, Steering Committee, WABA. The World Breastfeeding Week action folder, and other WABA information is available from the WABA Secretariat, P.O. Box 1200,10850 Penang, Malaysia. Fax: 60 4 657 26 55 Email: secr@waba.po.my Further information about the 1998 World Breastfeeding Week, other WABA activities and more action ideas are available on the WABA website at http://www.elogica.com.br/waba/The coordinator of the World Breast-feeding Week, Denise Arcoverde from Brazil, is also responsible for bringing the Alliance into the electronic age, and can answer questions on this (origem@elogica.com.br).

In Praise of Nevin
A message from Richard Jolly, on behalf of the SCN

A symposium, followed by a gala banquet, was held on June 26th 1998 at MIT Laboratory of Human Nutrition, in honour of the enduring and broad ranging contributions made by Nevin Scrimshaw during his distinguished career. The event was held during Nevin's 80th year. Richard Jolly, Chairman of the SCN, relayed the following message to Nevin during this important event.

We thank you Nevin, for your leadership and inspiration from the very beginnings of the ACC/SCN, throughout its life and to the SCN's latest meeting a few months ago in Oslo. Way back in 1955 you helped bring to birth the Protein Advisory Group, to provide the advice UNICEF needed for its child-focused programmes. Seven or eight years before that you had inspired Hans Singer to write the first UN publication on economic development and children, drawing on your early research on nutrition and cognitive development in infants and young children.

All this stretches to 50 years - yet you remain ever young in your vitality, enthusiasm and freshness of mind. So many of the good things of the SCN have grown from your own leadership and commitment: you organised in the UNU the first SCN meeting on nutrition and economic adjustment policy, you have been the force behind the working group on iron deficiency, endlessly pressing for practical actions to tackle the most widespread of all micronutrient deficiencies. You have been by far the most dedicated supporter of all the SCN's work and activities - at once forthright and practical, upright and professional and always wonderfully generous and creative. You have made these contributions both in your own name but always carrying with you the strong support of the UNU.

"Human progress is neither automatic nor inevitable. Even a superficial look at history reveals that no social advance rolls on the wheels of inevitability. Every step towards the goals of justice requires sacrifice, suffering and the tireless exertions and passionate concern of dedicated individuals." So said Martin Luther King, of the giants who give leadership and of the ordinary citizens who together become the force of social movements and human progress.

We thank you, Nevin, for being one of these individuals - one of the giants of nutrition as well as a committed citizen of humanity - who has helped and succeeded to bring real and widespread advance in nutrition in so many countries over the last half century. We thank you for your wisdom and vision - and for your boundless energy and impact in carrying vision into practical action. We look forward to many further occasions of working with you and being inspired by your words, research, writings and ideas.