IPNAP Position Paper Updated 01 Mar 2011

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<p>POSITION PAPER OF THE INFANT AND PEDIATRIC NUTRITION ASSOCIATION OF THE PHILIPPINES (IPNAP) IPNAP strives to be a key contributor in promoting the health and well-being of infants and young children, thereby helping to eradicate malnutrition and to reduce infant mortality in the Philippines. - The IPNAP Vision</p> <p>Malnutrition is a serious problem, globally and locally. The World Health Organization (WHO) estimates that malnutrition is directly or indirectly responsible for at least 35% of deaths of children less than five years of age. In the Philippines, over 30% of children in the country are malnourished. The WHO reports that inappropriate infant and young child feeding practices are associated with malnutrition, and the infant and child nutrition industry has come together to be part of the solution. In the Philippines, the industry is represented by the Infant and Pediatric Nutrition Association of the Philippines (IPNAP) whose members include Abbott, Fonterra, Mead Johnson, Nestle and Wyeth. These five companies from New Zealand, Switzerland, and the United States formed IPNAP in 2008 to promote responsible business practices and ethics among its members, coordinate the industrys approach to combating the myriad issues surrounding inadequate infant nutrition and to underline these companies commitment to the Philippines. IPNAP helps to promote and improve the nutrition and well-being of Filipinos by providing nutritious and safe food products that meet the highest standards of food safety and quality. IPNAP also supports multi-sectoral efforts to improve infant nutrition, in line with the Philippine Government and its agencies, the medical profession, international and local non-governmental organizations and the general public.</p> <p>December 2010 Manila, Philippines</p> <p>1</p> <p>INFANT AND CHILD NUTRITION PROGRAMS AND POLICIES IN THE PHILIPPINES Key messages: 1. IPNAP and its members are committed to solving the problem of malnutrition through improved infant and young child feeding practices. All IPNAP members believe that breastmilk is best for infants.</p> <p>IPNAP supports the international policies of the WHO and global UNICEF that promotes exclusive breastfeeding for the first 6 months and appropriate complementary feeding from 6 months onward up to 2 years. In support of breastfeeding and in adherence with international standards and locals regulations, IPNAP members have not advertised infant formula 0-6 months since 1986 and 6-12 months since 2007.</p> <p>2. IPNAP supports public-private partnerships for the development of programs and dissemination of information on infant and young child nutrition.</p> <p>IPNAP members participate in government-approved feeding programs to assist lower income families with malnourishment issues.</p> <p>IPNAP members are prepared to increase their donations of young child nutritional food products for feeding purposes in cooperation with the Philippine government, including during emergencies.</p> <p>IPNAP believes that the industry, the government and NGOs should work together to educate and through improved policy provide help to mothers so that they can continue the breastfeeding initiated at the birth of the infant.</p> <p>IPNAP believes parents and caregivers should be properly informed with evidence-based advice on optimal feeding practices.</p> <p>3. IPNAP members products are developed through the most rigorous scientific</p> <p>2</p> <p>method. All nutritional claims are scientifically substantiated.</p> <p>IPNAP member companies employ nutrition experts and food technologists, and are advised by external nutritionists, pediatricians and scientists.</p> <p>Maintaining the very highest standards of food quality and safety is a core value of every IPNAP member company. Specific and very strict hygiene and quality management procedures are implemented and continuously improved.</p> <p>Infant formulas a breastmilk substitute formulated for infants up to 6 months of age are developed according to national legislation and standards set by international bodies such as the FAO/WHO Codex Alimentarius Commission. No other breast-milk substitute is as nutritious as infant formula.</p> <p>Follow-on milk and growing-up milk which is different from infant formula and developed for infant 6 months onwards and 1 year onwards respectively provide nutrition for the healthy development of infants and young children.</p> <p>4. The two primary reasons mothers stop breastfeeding are inadequate milk flow (34.5%) and working outside the home (25.5%). Contrary to speculation, advertising does not factor in to their decision to stop breastfeeding.</p> <p>This is supported by the 2008 National Nutrition Survey conducted by the Food and Nutrition Research Institute of the Department of Science and Technology. The survey also showed that advertising influence had a negligible effect (1.3%) on the mothers decision on the kind of milk to give her child. The single biggest factor was affordability (40.3%). IPNAP believes that industry, the government and NGOs should work together to develop and implement policies and programs that would address these issues, and IPNAP expresses its full support for the Rooming-in and Breastfeeding Act.</p> <p>5. Excessive legislation that goes beyond international standards may be harmful to the more important interest of the welfare of children and achievement of the UN MDGs.</p> <p>3</p> <p>Based on the erroneous premise that aggressive industry promotion of infant formula is directly responsible for low breastfeeding rates in the Philippines and, by association, malnutrition, these policies proceed to over-regulate the industry beyond international standards.</p> <p>6. IPNAP members significantly contribute to the Philippine economy, operating several manufacturing plants and also exporting, employing more than 5,000 Filipinos directly, paying more than PhP 17 billion in taxes, procuring over PhP 30 billion in local goods and services, and investing nearly PhP 100 million a year in corporate social responsibility programs aligned with the Millenium Development Goals. In recent years, several IPNAP members have shifted global call center and other business process operations to the Philippines, resulting in more new jobs.</p> <p>I. BACKGROUND Childhood malnutrition is a serious problem in the Philippines, where over 30% of children nationwide are malnourished. A National Nutrition Survey conducted by the Food and Nutrition Research Institute (FNRI) of the Department of Science and Technology (DOST) showed there was a significant increase in the proportion of children aged 0-5 years who were underweight and under height when comparing data from 2005 to 2008. In a recent workshop conducted by the World Bank in Indonesia, it was reported that the Philippines faces serious under-nutrition in children under five, with alarmingly high prevalence rates well above 20% - and many babies begin life already malnourished, weighing in at less than 2,500 grams at time of birth. The Philippines is likewise behind in accomplishing the United Nations Millenium Development Goals (MDG) with respect to eradicating extreme poverty and hunger (Goal #1), reducing child mortality (Goal #4) and improving maternal health (Goal #5). The Department of Health (DOH) reported that the infant mortality rate is at 25 per 1,000 live births more than twice the MDG goal of 11 per 1,000 live births with 54,058 infant deaths per year. The outlook is far from encouraging, and these studies suggest the situation may be getting worse. Together with other contributing factors such as lack of education, poverty, and social injustice, the World Health Organization (WHO) estimates that: Malnutrition in children is related to inappropriate infant and young child feeding practices. Only 35% of infants less than 6 months of age are exclusively breastfed and complementary feeding practices are far from optimal. Improvement of breastfeeding practices could save annually the lives of about one million children. Complementary feeding along with continual breastfeeding for up to two years or beyond could save the lives of another half a million children.</p> <p>4</p> <p>- WHO website report on the World Health Assembly (WHA), May 2010 These strategies have been echoed for the past 30 years, with WHO and global UNICEF recommendations calling for a comprehensive, multi-sectoral, evidence-based approach to improving infant and young child nutrition, a strategy that is widely accepted by the international community of developed and developing nations. International guidelines and regulations to address malnutrition and improve infant and young child feeding have also been in place since the 1980s. Globally, the promotion of infant nutrition and corresponding regulation of the infant and child nutrition industry is guided by the International Code of Marketing of Breast-milk Substitutes (ICMBS) and applicable provisions of the Codex Alimentarius, together with the aforementioned international policies of the WHO and UNICEF. These policies are further explained in Annex I. The member states of the WHO, in drafting the ICMBS, recognized that breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants, and that breastfeeding is an important aspect of primary health care. 1 At the same time, they acknowledged that:</p> <p>1. There is a legitimate market for infant formula; 2. It is important for infants to receive appropriate complementary foods at 6 months of age; and 3. Inappropriate feeding practices lead to infant malnutrition, morbidity and mortality in all countries.2 This calls for a responsible dissemination of information through health workers and other appropriate means, and requires that health workers have access to evidence-based, factual information, and must be made fully aware that infant formula produced according to national standards and international guidelines is the only safe and fully-nutritious alternative to breastfeeding. It is their responsibility to assess the individual circumstances of mother and child, and in cases where first age formula should be fed, they must be prepared to instruct users in proper preparation, handling and storage. It is within this framework that IPNAP and its members operate. In addressing the issue of infant and childhood malnutrition, IPNAP and its members believe that breastmilk is best for infants, and supports exclusive breastfeeding up to 6 months. Additionally, in a country like the Philippines where over 30% of the children are still malnourished, IPNAP believes it has a responsibility to promote and encourage appropriate complementary feeding, and the consumption of products with higher nutritional benefits, versus less nutritious alternatives.</p> <p>II. CHALLENGES IN IMPROVING INFANT AND CHILD NUTRITION1 2</p> <p>ICMBS ICMBS</p> <p>5</p> <p>IPNAP and its member companies work within the parameters of Philippine laws and regulations in the industrys approach to improving infant and child nutrition. Currently, the primary law regulating the industry is Executive Order No. 51 3, more commonly known as the Milk Code. Signed into law in 1986 by then President Corazon Aquino, the Milk Code substantially reproduces the provisions of the ICMBS, requires that products be developed in accordance with the Codex Alimentarius, and adopts the same international policy of promoting breast-feeding while recognizing the need to inform the public about proper use of breast-milk substitutes and related products. The Milk Code and other relevant laws and regulations are further explained in Annex II. The Philippines was one of the first countries to substantially adopt the International Code of Marketing of Breastmilk Substitutes (ICMBS) more than twenty years ago and continues to have one of the strictest regulatory environments for the industry in Asia. While several Asian countries have adopted the ICMBS by law in similar manner as the Philippines, most have not. According to International Baby Food Action Network (IBFAN), countries in Asia that have adopted all or most of the provisions are India, Maldives, Nepal, the Philippines and Sri Lanka. Countries which have many of the provisions are Bangladesh, Cambodia, Indonesia, Kyrgyzstan, Mongolia, Pakistan, Tajikistan, and Vietnam. Countries which have only a few provisions are China, Israel and Laos. Those countries which have adopted a voluntary code are Bhutan and Malaysia. Finally, countries that have adopted only some provisions voluntarily include Afghanistan, Brunei, Japan, South Korea, Singapore, Taiwan and Thailand.</p> <p>IPNAP members adhere to the Milk Code and other stringent national, regional and global standards and laws to ensure the highest levels of quality and safety demanded of one of the most strictly regulated industries in the world. On Safety With the ultimate goal of protecting infants health, the member companies of IPNAP employ nutrition experts and food technologists, and are advised by external nutritionists, pediatricians and scientists. Today the industry is able to produce formulas and complementary food that incorporate and benefit from scientific advances. Infant formulas will never be equivalent to breast milk, but they are an important complement that families use and can if consumed appropriately and correctly contribute to important nutrition and health outcomes for the child, particularly when breast milk is not available. When prepared according to manufacturers instructions, no other breast-milk substitute is as safe and nutritious as commercial infant formula.3</p> <p>National Code of Marketing of Breastmilk Substitutes, Breastmilk Supplement and Other Related Products.</p> <p>6</p> <p>Quality and safety criteria are communicated by labeling products with culturally appropriate instructions in the local language on proper preparation and handling of infant formulas. To ensure that illiterate mothers are clearly informed about how to correctly prepare infant formula, all labels carry simple descriptive pictures. Because no other breast-milk substitute is as safe, infant formula plays a crucial public health role in fulfilling the nutritional needs of babies whose mothers cannot or choose not to breastfeed. In times of calamity, UN agencies engaged in emergency relief operations provide affected families with generic infant formula manufactured and packaged in accordance with Codex Alimentarius standards as well as ready to use infant formula (RUIF).</p> <p>On Responsible Advertising The Milk Code and its Revised Implementing Rules and Regulations (RIRR) require approval of an Inter-Agency Committee (IAC) for advertising, promotion or marketing activities for infant formula (0-6 months), breast-milk substitutes, and bottle-fed complementary food. IPNAP member companies comply with this and submit to the IAC all advertising, promotions, marketing materials and activities for approval, including sponsorships and support for medical and scientific...</p>