The World Health Assembly (WHA) Resolution 54.2*, adopted in May 2001, followed the conclusions and recommendations of the Expert Consultation on the Optimal Duration of Exclusive Breastfeeding, mandated by the World Health Organization (WHO) to provide relevant scientific expertise. In summary, the Expert Consultation concluded that exclusive breastfeeding for six months confers several benefits on the infant and the mother and recommended: "Exclusive breastfeeding for six months, with the introduction of complementary foods and continued breastfeeding thereafter."

Expert Consultation on exclusive breastfeeding

The Expert Consultation stated: "In developing-country settings, the most important potential advantage of exclusive breastfeeding for six months over exclusive breastfeeding for four months followed by partial breastfeeding for six months relates to infectious disease morbidity and mortality, especially those due to gastrointestinal infection (diarrhoeal disease)."

However, the Expert Consultation also stated: "Exclusive breastfeeding to six months can lead to iron deficiency in susceptible infants. In addition, the available data are insufficient to exclude several other potential risks associated with exclusive breastfeeding for six months, including growth faltering and other micronutrient deficiencies, in some infants. In all circumstances, these risks must be weighed against the benefits provided by exclusive breastfeeding, especially the potential reduction in morbidity and mortality." Accordingly, the Expert Consultation highlighted the need for more research to be done, as: "There are several unanswered questions that are important for policy-making with regard to defining the optimal duration of exclusive breastfeeding and maximising its benefits."

The Expert Consultation recognised that: "Some mothers will be unable to, or choose not to, follow this recommendation; they should be supported to optimise their infants' nutrition."

Expert Consultation on complementary foods

Thus WHA recommends, as a global public health recommendation following the Expert Consultation, that after an initial six months of exclusive breastfeeding, infants should start receiving nutritionally adequate, safe and appropriate complementary foods, and at the same time continue to be breast-fed to up to two years of age or even beyond. The introduction of complementary foods signifies the beginning of a transition period when the baby's need for energy and nutrients exceeds what can be provided solely through exclusive and frequent breastfeeding or breast-milk substitutes. The first step in this process is the introduction of infant cereals.

Global strategy on infant and young child feeding

One year following the adoption of WHA Resolution 54.2 the WHA adopted a "Global strategy for infant and young child feeding" (Resolution 55.25), which reiterates the importance of ensuring exclusive breastfeeding for six months and promoting the timely, adequate, safe and appropriate complementary feeding together with continued breastfeeding.

The global strategy was developed over a two-year participatory process in which fundamental factors affecting the protection, promotion and support of optimal feeding practices for infants and young children were examined. The aim was to formulate a sound strategy that will contribute to a lasting reduction in malnutrition, poverty and deprivation.

Resolution 55.25*, among other things, urges Member States to implement the global strategy, taking into account national circumstances, in order to ensure optimal feeding for all infants and young children and to strengthen structures for the implementation process including monitoring and evaluating its effectiveness.

The resolution also requests the Codex Alimentarius Commission to continue to improve the quality standards of processed foods for infants and young children and to promote their safe and proper use at an appropriate age within the framework of its operational mandate. This includes adequate labelling consistent with the policy of WHO, in particular the International Code of Marketing of Breast-milk Substitutes, WHA Resolution 54.2 and other relevant resolutions of the Health Assembly.

The WHO Director General was requested also to promote the continued cooperation with, and among, all parties concerned with implementing the global strategy.

Codex Alimentarius processCodex Alimentarius process

At a meeting in Berlin in November 2002, the Codex Alimentarius Committee on Nutrition and Foods for Special Dietary Uses (CCNFDSU)** discussed how to translate WHA Resolution 54.2, and the latest information and research on infant nutrition, into their revision of the Standard for Processed Cereal-Based Foods for Infants and Young Children.

The Committee has discussed the revision of the Standard for more than seven years, and has held two meetings since the adoption of Resolution 54.2. To date, no final consensus on the overall Standard, including labelling, has been reached. However, the Committee agreed to define the scope of the Standard as covering: "Cereal-based foods intended for feeding infants as a complementary food generally from the age of six months onwards, taking into account infants' individual nutritional requirements, and for feeding young children as part of a progressively diversified diet, in accordance with World Health Assembly Resolution WHA 54.2 (2001)."

What is the Codex Alimentarius?

The Codex Alimentarius is a combined initiative of the Food and Agriculture Organization (FAO) and WHO. It has become a global reference point for consumers, food producers and processors, national food control agencies and the international food trade. This "food code" has had an important impact on food producers and processors as well as on consumers.

The significance of the Codex Alimentarius for consumer health protection was underscored in 1985 by United Nations Resolution 39/248, whereby guidelines were adopted for use in the elaboration and reinforcement of consumer protection policies. The guidelines advise that: "Governments should take into account the need of all consumers for food security and should support and, as far as possible, adopt standards from the Codex Alimentarius" of FAO and the World Health Organization. In all, 166 countries are members of the Codex Alimentarius.

Nestlé's action

Nestlé's decision taken almost two years ago to support WHA Resolution 54.2 stays firm, and we have changed our infant formula labels accordingly as well as infant cereal labels in developing countries where we implement the WHO Code as a minimum standard. Introducing infant cereals from six months represents the first step on several stages, which aims to inform that suitable complementary foods are used consistent with the age and nutritional needs of infants and young children. The new WHA recommendation is also reflected in all our other communication materials relating to infant nutrition.