Nutrition Policy and Practice
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Nutrition Policy and Practice
In spite of the abundant benefits associated with continued breastfeeding for babies, women and the society at large, very few babies are breastfed as required. Internationally, 3 out of 5 babies under the age of 6 months are not properly breastfed and just 45% of babies continue breastfeeding for a period of 2 years (Chaudhary, Shah, & Raja, 2011). The primary factor dispiriting determinations to enhance rates of breastfeeding is the promotion of feeding teats and bottles as well as belligerent and unceasing marketing of close breastmilk substitutes. Worldwide sales of breast-milk substitutes in 2014 amounted to approximately US$ 44.8 billion, and this amount is predicted to increase to over US$ 70.6 billion by the end of 2019 (World Health Organization, & UNICEF, 2018). Unsuitable marketing of food products which tend to compete with breastfeeding normally impact the mother’s decision to breastfeed her baby negatively. Considering the risks associated with unsuitable feeding practices and the infants’ special susceptibility, normal marketing practices are inappropriate for these particular foods. However, the pervasiveness of unsuitable marketing practices is very common in many nations, and these practices are progressively targeting novel and non-customary settings, such as internet sites and social media platforms.
Various relevant bodies have come on board to lessen and eradicate unsuitable marketing practices, and ascertain the efficacy of fortification and promotion of breastfeeding. Some of these bodies include the World Health Assembly (WHA) resolutions (“the Code”) and The International Code of Marketing of Breast-milk Substitutes. In 2010, retorting to these mounting issues World Health Assembly encouraged all Member States to cease from practicing unsuitable promotion of food for young children and babies. Later in 2012, the World Health Assembly asked the World Health Organization (WHO) to develop guidance and clarifications on the unsuitable promotion of foods for young children and babies. In 2016 (7), the WHA approved and welcomed the Guidance on ending inappropriate promotion of foods for infants and young children (“the Guidance”) (World Health Organization, 2016). The Guidance applies to drinks and foods primarily marketed for infants and young children at the age of 6–36 months. It comprises of seven recommendations. The Guidance further elucidates the latitude of the Code and encompasses some requirements for the marketing of complementary foodstuffs. Besides, the Guidance asserts that no complementary foodstuffs are supposed to be endorsed for usage before the age of 6 months. The act of promoting complementary foodstuffs for babies at the age of less than 6 months is as well outlawed under resolution World Health Assembly (WHA39.28) that asserts that “any food or drink given before complementary feeding is nutritionally required may interfere with the initiation or maintenance of breastfeeding and therefore should neither be promoted nor encouraged for use by infants during this period (Rayner, Jewell, Al Jawaldeh, & World Health Organization, 2017). United Nations Children’s Fund (UNICEF) and WHO have also emphasized the significance of upholding the breastfeeding practice and of enlivening the practice where it seems to be declining. This is in the determination of the two bodies to enhance the nutrition and health of young children and infants. Determinations to encourage breastfeeding and to deal with challenges that may dishearten it are a part of the general nutrition and child health initiatives of these bodies (Addison, Hill, Bode, Robertson, Choudhury, Young, & Tappin, 2019).
In May 1980, the Thirty-third World Health Assembly, in their totality sanctioned the recommendations and statement and approved by unanimity at this joint UNICEF/WHO conference and passed certain mention of the recommendation that “there should be an international code of marketing of infant formula and other products used as breast-milk substitutes” (Kristine, Phan, Nguyen, Henjum, Ribe, & Mathisen, 2017), asking the Director-General to prepare such a code in close consultation with the Member States and with every other party involved. This code for marketing infant formula and breastmilk substitutes seeks to ensure that health claims on these food products do not mislead the public. The primary purpose of this Code is contributing to the provision of adequate and safe nutrition for babies, by protecting and promoting breastfeeding, and by ascertaining the appropriate usage of breastmilk substitutes based on sufficient information and through suitable marketing and distribution. This Code takes effect on the marketing, and the concomitant practices, of various products such as breast-milk substitutes, milk products, beverages, foodstuffs, and bottle-fed complementary foods. It also takes effect on their availability and quality, and information regarding their usage (Grummer-Strawn, 2018). This Code requires governments of the member states to take responsibility and make sure that impartial and unswerving information is offered on infants and young children feeding for usage by mothers and other parties involved in the field of infants and young children’s nutrition. This particular obligation ought to cover the design, provision, planning, and distribution of information, or their control. Educational and informational materials whether visual, audio, or written, dealing with the feeding of babies and meant to reach expectant mothers and mothers of newborns and young children, ought to include clear information on various points enlisted under Article 4 of the Code (Hidayana, Februhartanty, & Parady, 2017).
The WHO Code further asserts that there ought to be no publicity or any form of promotions to the ordinary people of foods that fall within the scope of the WHO Code. Distributors, as well as manufacturers, are not supposed to offer either directly or indirectly, expectant mothers, or their family members, product samples within the latitude of the WHO Code. In compliance with the Code, there should be no promotion schemes to persuade sales directly to the consumers at the retail level, like tie-in sales, discount coupons, premiums, loss-leaders, special displays, and special sales for products within the scope of the Code (Vinje, Phan, Nguyen, Henjum, Ribe, & Mathisen, 2017). This provision is supposed to put restrictions on the instituting of pricing practices and policies meant to offer food products at subsidized prices on a long-term basis. In other words, there should be no point-of-sale, provision of samples, advertising, or any other promotion device at the retail level. It also requires that producers and distributors should not provide expecting mothers or their young children with any kind of gifts of utensils or articles that might encourage the usage of bottle-feeding or breast-milk substitutes (World Health Organization, & UNICEF, 2018). What is more, the Code endeavors to ensure that health claims on these food products do not mislead the public by lobbying with healthcare systems and workers of WHO Member States. For example encourages the healthcare systems to take suitable actions to hearten and safeguard breastfeeding and indorse the doctrines of the Code, and also provide proper information and guidance to healthcare specialists concerning their responsibilities (Hou, Green, Chum, Kim, Stormer, & Mundy, 2019). Healthcare facilities are not supposed to be used for displaying products, posters or placards about products within the scope of this Code, or for distributing material given out by manufacturers or distributors. The information offered by the manufacturer and distributor to healthcare specialists about products within the scope of the Code ought to be constrained to systematic and accurate matters, and such information is supposed not to propose or create a belief that bottle-feeding is equal or superior to breastfeeding (Morgan, Waterston, & Kerac, 2018).
According to Article 9 of the WHO Code, proper labels need to be designed to offer essential information regarding the suitable usage of products, and so as not to undermine breast-feeding. The Manufacturer and distributor of infant formula must ensure that all containers are conspicuous, clear, and easily understandable and readable. They should have messages printed on them in an appropriate language, or on labels that cannot be separated from them. These labels should include the words “Important Notice” or their equivalents, statements of the advantage of breastfeeding, statements that the product(s) ought to be consumed only on the prescription of a healthcare worker, and instructions for suitable preparations, and a caution against the health risks of improper preparations. The containers and labels should not have photos of babies. They should also not have other texts or pictures that can romanticize the usage of infant formula (Barennes, Slesak, Goyet, Aaron, & Srour, 2016). However, they can have graphics to enable easy identification of the products as breastmilk substitutes and for demonstrating preparation methods. Foodstuff products that fall within the latitude of the Code, promoted for the purpose of infant feeding, and fail to meet all the infant formula requirements, but can be modified to do so, ought to have a warning label that the unmodified products should not be the only source of nutrition of a baby. The Code further necessitates that labels of foods within its scope should state all the following points (1) ingredients used to manufacture them; (2) analysis/composition of the products; (3) storage conditions need, and (4) batch number and the expiration dates, considering the storage and climatic situations of the concerned country (Galateau-Salle, Churg, Roggli, Travis, & for Tumors, W. H. O. 2016).
Front of Pack (FOP) nutrition labeling is an auspicious means to influence parent’s packaged food choices towards healthier selections, substitutes, and enhance the diets of an increasing global infant population who are obese or overweight. Nevertheless, there exist numerous labeling designs presently in usage that may lead to misunderstanding, particularly as some of the methods are exceedingly complicated. Front of Pack nutrition labeling methods which have been confirmed efficient in enhancing consumers’ choices are the consistent, simple, and colored ones that also do not need intense mathematical knowledge. The labeling systems should also be easily interpretable. The current warning labels that have been employed my manufactures in most infant food products include numerous efficient features and present a chance for additional investigation to assess their efficiency.
According to the World Health Organization Code, ‘marketing’ of breast‐milk substitutes comprises of product advertising, promotion, public relations, selling, information services, and distribution. Some of the commonest mediums of marketing include free supplies, online promotion, information support lines, print, and point-of-sale promotion. In the past few years, new communication technologies have availed more sophisticated avenues for marketing and promotion (Grummer‐Strawn, Zehner, Stahlhofer, Lutter,Clark, Sterken, & WHO/UNICEF NetCode, 2017). Banned marketing practices might amenably state or simply indicate the ‘naturalness’ of the food products, ease‐of‐usage, and superiority or equivalence to breast milk. For quite a long time, it has been known that some marketing practices might slightly prejudice parents’ selections by generating a misleading understanding of what is optimal or the most ‘scientific’ food for babies and shaping perceived communal norms regarding substitutes to breastfeeding. Recent studies in neuroeconomics have highlighted the way marketing practices may prey on standard neurological procedures to upsurge the possibility of consumers’ mistakes, influencing choice perspectives to upturn time stress or pressures, and manipulating how copious importance is placed on different products qualities in consumers’ decision‐making processes.
Systematically, the effects of commercial marketing practices on breastfeeding are difficult to segregate. Numerous researches, together with randomized trials, indicate adversative effects of marketing practices on breastfeeding duration and exclusivity (Bai, Fong, & Tarrant, 2015). Marketing to healthcare specialists, who are the main influence on parents’ baby feeding decisions, is said to be promoting the use of breast‐milk substitutes. High brand recognition rates have as well been revealed to be connected to decreased breastfeeding (Piwoz, & Huffman, 2015). The promotion of infant formulas and solid foods directly decreases rates of breastfeeding by cross‐marketing infant formula and by encouraging pre-mature weaning from exclusive breastfeeding. In their research, Pomeranz, Palafox, & Harris, (2018) found out that the increasing in advertisement of infant food products, including toddler food and baby food and formula, within the scope of the WHO Code but away from the scope of the Manufacturers and Importers Agreement of 1992 (MAIF), might weaken efforts to increase the breastfeeding duration and contribute to premature weaning as well as decreased exclusivity of breastfeeding (Atchan, Davis, & Foureur, 2017). Modern marketing practices such as Internet advertising and social media are also not addressed by present policies. In order to fully put the WHO Code into practice, effective legislations are likely needed.
The Innocenti Declaration, sanctioned by 139 governments at the 1990 World Summit for Children, states that “Every government ought to come up with national breastfeeding policies” (Carrington-Windo, 2018). On the other hand, the Global Strategy on Infant and Young Child Feeding that was established by The United Nations Children’s Fund (UNICEF) in partnership with World Health Organization (WHO) was solidly recommended by the 55th WHA in the year 2002, and again by the Executive Board of UNICEF in the year 2002 (Grummer‐Strawn, Zehner, Stahlhofer, Lutter, Clark, Sterken, & WHO/UNICEF NetCode. (2017). This Global Strategy stipulates crucial topics that ought to be covered by national policies. Furthermore, national specialists are advised to assimilate their infant feeding policies into other pertinent policies, when suitable. The WHO Global Strategy for Infant and Young Child Feeding (WHO-IYCF) outlines the responsibilities of both educators and services in Early Childhood Education and Care to offer suitable infant and young children support, information, and feeding programs (Pries, Huffman, Mengkheang, Kroeun, Champeny, Roberts, & Zehner, 2016). Nonetheless, intercontinental studies have revealed that nutrition practices and policies have been insufficient in ECEC services, predominantly in the infant feeding area. Moreover, there is evidence that ECEC educators require supplementary assistance and support to work properly with babies and young children in order to enhance their understanding, and develop positive attitudes to generate a supportive environment. It is now clear that babies and young children are at present imperceptible in both service and predominant policies notwithstanding their special wants and needs. Recognizing the roles played by policies in ensuring quality practices, proof for babies’ development and safety calls for a transformation in Early Childhood Education and Care (ECEC) practices and legislations. On a national echelon, integrating ideas of baby agency and what they mean in practice ought to be incorporated in the National Quality Framework (Habtewold, Islam, Sharew, Mohammed, Birhanu, & Tegegne, 2017). That could include integrating more baby feeding practice instances, for example, receptive educator modeling for sustaining infant appetite self-sufficiency including food refusal; reverence for babies’ cues instead of commanding feeding times to aid in the development of baby agency and nutrition consumption. Eminence practices necessitate an all-inclusive progressive methodology with areas pertinent to baby feeding (Hockenberry, & Wilson, 2018).
The Australian National Quality Framework (NQF) is the primary public policy controlling Early Childhood Education and Care practices. It delineates quality anticipations and configurations for home- and center-based ECEC services and offers assistance on service practices, procedures, and policies within contexts of incessant quality improvements (Farrell, 2018). The cornerstone of the Australian National Quality Framework is the National Quality Standard (NQS) which is strengthened by regulation and legislation. NQS pushes for quality and understanding of nutrition by assessing seven incorporated quality standards: governance and leadership, staffing arrangements, infant’s health and safety, collaborative partnerships with parents and communities, collaborative partnerships, educational program and practices linking to the national Early Years Learning Framework (EYLF), and relationships with children (Hunkin, 2018). Current studies have delineated the inconspicuousness of toddlers and infants in the Early Years Learning Framework and the ensuing difficulties with understanding the EYLF in practice, particularly as babies have specific needs and wants compared to older children. Examples of such needs and wants are their physical activity, healthy eating, and developing agency in feeding. In the Australian Early Years Learning Framework, educator practices in these aspects are as well directed by the National Healthy Eating and Physical Activity Guidelines (HEPA) (Peden, 2018). These HEPA guidelines or strategies are an Early Childhood Education and Care (ECEC)-special resource and are referenced in the National Quality Standard (NQS) as a public standard. The HEPA is reinforced by the Australian Physical Activity Guidelines for Children, the Australian Infant Feeding Guidelines (AIF), and Australian Dietary Guidelines for Children. The Australian Infant Feeding Guidelines offers referenced methodological strategies for all health specialists operating from Australia working with babies that are in general lined up with the World Health Organization commendations for Infants and Young Children Feeding (WHO-IYCF). The WHO provides worldwide recommendations for broader audiences including families and ECEC educationalists. Some diminutive methodical disparities exist between the AIF and WHO-IYCF, for instance, infant feeding sterilization/storage/ handling and breastfeeding duration.
The nature and level of breastmilk substitutes advertising to parents
and health specialists have in transformed owing to the expression of public
concerns of unsafe and unethical marketing of baby food products in the late 70s (Brady, 2012). These public concerns ended in the WHO Code in the 80s. The
two trends emaciated and started to weaken before the institution of the WHO
Code. Earlier, there was a peak in the Medical Journal of Australia, and very diminutive
publicity in the Medical Journal of Australia post‐Code. That designates that as anticipated,
companies’ marketing reacted to public or health professionals’ condemnation, and
possibly in expectation of, and to ward off, public regulations. Nevertheless, conformity
to voluntary regulations is not yet complete. Over 20 companies have robust premeditated
product incentives to mess up with agreements so as to penetrate into new
markets, launch fresh foods, or abuse newfangled opportunities for advertising
and selling. It might as well be anticipated that the corporations will assume policies
to minimalize the effects of the WHO Code on profit and sales, and this is
supported by Australian Women’s Weekly data. Infant food products promotion,
although covered by the WHO Code, continues to exist in the Australian Women’s
Weekly.
References
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