|4th Report on the World Nutrition Situation - Nutrition throughout the Life Cycle (ACC/SCN, 2000, 138 p.)|
|CHAPTER 3: BREASTFEEDING AND COMPLEMENTARY FEEDING|
Improvements in breastfeeding behaviours have occurred at the same time as demographic changes, such as increased urbanization and increases in hospitalization for childbirth, female education and employment, and use of modern contraceptives, which traditionally have been negatively associated with breastfeeding.40 The role of national and international initiatives in support of breastfeeding and complementary feeding in light of these positive changes is noteworthy.
In response to concerns about changing breast-feeding behaviours with negative consequences for infant health, a number of national and international initiatives have been implemented to promote breast-feeding. Three have been particularly important:
1. The International Code of Marketing of Breast-milk Substitutes adopted by the World Health Assembly in 198141 and subsequent relevant World Health Assembly resolutions, collectively known as The Code, provide guidelines for the marketing of breastmilk substitutes, bottles, and teats. To ensure infant feeding decisions free from the influence of marketing pressures, the Code aims to restrict such practices, including direct promotion to the public. Furthermore, World Health Assembly resolutionsb urge that there be no donations of free or subsidized supplies of breastmilk substitutes and other products covered by the Code in any part of the health care system. The Code has been adopted by many governments, either as a norm or through legislation. Despite a mixed record of compliance by infant formula manufacturers,42 it has had a major impact on the way formula is advertised and marketed. The Code has been particularly effective in the virtual elimination of the direct marketing to women who receive services through the public sector and in the restriction of marketing to health providers. The legal status of the Code, by country, is presented in Appendix 10.
b Resolution 39.28 passed in 1986 deals with specially formulated milks (so-called follow-up milks). Resolution 47.5 passed in 1994 deals with removing obstacles and preventing interference that mothers may face.
2. The Innocenti Declaration, which focuses on the need to protect, promote, and support breastfeeding, was signed by more than 30 countries in 1989. One operational target of this declaration is the universal implementation of the Ten Steps to Successful Breastfeeding, which forms the basis for the third major initiative: the WHO/UNICEF Baby Friendly Hospital Initiative.
3. The WHO/UNICEF Baby Friendly Hospital Initiative was endorsed by the Forty-Fifth World Health Assembly in 1992.43 This initiative has influenced the routines and norms of hospitals throughout the world through the Baby Friendly certification process. A hospital is designated as Baby Friendly when it has agreed not to accept free or low-cost breastmilk substitutes, feeding bottles, and teats and to implement the Ten Steps. To date, more than 14,500 hospitals in 142 countries have been certified, and many others are attempting to become certified.44