REPOST: Baby Milk Action Policy Blog – P.Rundall
7th March, 2023, Dusseldorf
IBFAN, WHO, UNICEF and partners breathed a sigh of relief today at the Codex Nutrition Committee in Dusseldorf. After 10 years of tortured discussions in a Committee dominated by food corporations and powerful exporting countries, the main text of the revision of the 1987 Codex Standard for Follow-Up Formula was finalised with the addition of some important safeguards at the last minute. (1) The fact that the meeting was webcast for the first time (private recording was banned previously) might have contributed to the good outcome.
Despite 8 countries saying that a preamble was not necessary and reservations from the USA about trade, the new standard (2) will be sent to the Codex Alimentarius Commission for adoption in July and WILL refer to the International Code of Marketing of Breastmilk Substitutes and subsequent WHA Resolutions (the International Code).
While the standard has also improved its requirements for ingredients (the 1987 standard set no upper limits for sugar!), banned health and nutrition claims and included many other labelling restrictions, there are still unresolved problems. (3)
IBFAN urges governments to waste no time before bringing in strong marketing controls for all products up to 36 months in line with the International Code and Resolutions. If not, the ‘improved’ new Standard will lead to renewed commercial promotion and a slew of new ultra-processed products for young children with all their attendant risks.(4) IBFAN, WHO and UNICEF are ready to help governments achieve this, ideally before these products are allowed on markets.
Governments have the sovereign right to adopt any legislation they consider necessary to protect child health as long as it does not violate international trade principles. The newly added references to the International Code and Resolutions in the Preamble will make it less likely that Code-aligned laws trigger costly, time-consuming WTO discussions or other challenges that have a chilling effect on policy-making. (5)
What happened this week
In a skilfully managed debate, the Chair, Dr Anja Brönstrup, allowed plenty of time – two days – for debate on the final crucial aspects that had been left to the very end of the revision. In the 2019 meeting, the debate was curtailed, resulting in a bad decision on whether Cross Promotion should be forbidden.(6)
The industry notion that there should be two separate standards was quickly rejected, as many countries called for ONE standard with two parts. Many also called for a Preamble that would protect breastfeeding and help governments position the products correctly in their regulatory frameworks. With such strong arguments and a clear majority, Canada, Switzerland, Australia and the EU changed their positions and indicated that they could support or at least ‘live with’ the compromise Preamble proposed by the New Zealand. (7). The 9 reservations will be specified in the report but will not stop the Standard going forward for adoption by the Commission in July.
Some of the statements and written comments from country delegates:
John Oppong-Ottoo, for the African Union:
Gry Hay, for Norway: “Norway appreciates the proposed preamble text provided by the New Zealand chairs. Although we would have preferred a more comprehensive wording [its] referral to key WHO and WHA documents, as well as a reference to subsequent WHA resolutions concerning infant and young child feeding ….provides context for understanding and implementing the standard. This will be of great importance for many countries in order to facilitate coherence with global policies to protect breastfeeding … WHO and UNICEF have documented how parents and pregnant women globally are exposed to aggressive marketing for baby formula milk and how marketing of formula milk influences decisions on infant feeding and undermines breastfeeding… The evidence is strong. Formula milk marketing, not the product itself, disrupts informed decision-making and undermines breastfeeding and child health.”
(1) The 1987 Follow Up Formula Standard legitimised these problematic products, that were deliberately invented to get round the marketing recommendations of the World Health Assembly in 1981. The standard’s poor composition requirements and total lack of marketing safeguards (based on the claim that follow-up formulas are not breastmilk substitutes) boosted the growth of a $ multi-billion market for these unnecessary products. Its existence undermined laws to protect breastfeeding, fuelled the obesity epidemic and added to the environmental burden. One third of the world’s countries breastfeeding is a lifeline and the majority of children are breastfed in the 2nd year of life. When this new work was started in 2012/13, IBFAN proposed that the standard should be ‘sunsetted’ rather than updated.
(2) Reservations came from: Argentina Cuba, Vietnam, Panama, Guatemala, USA, Colombia, Costa Rica and Morocco. The Name of the Standard will be: Codex Standard for Follow-Up Formula for Older Infants and Product for Young Children*. *Other equivalent names for this product are drink for young children with added nutrients or product for young children with added nutrients or drink for young children.
(3) While the standard has improved its requirements for ingredients (the 1987 standard set no upper limits for sugar!) banned health and nutrition claims and included many other labelling restrictions, there are still unresolved problems including: the sodium levels; the sweetness; that the drinks can contain flavourings; the inadequate safeguards to stop misleading Cross Promotion; the nutrient claim in one of the proposed names ‘drink/product with added nutrients’ and the lack of reference to the fact that the products are not necessary.
(4) Risks of Ultra-Processed Foods (UPFs): UPFs form 50% of Britons’ calorie intake; Nelson et al Premature Deaths Attributable to the Consumption of Ultraprocessed Foods in Brazil American Journal of Preventive Medicine 10.1016/j.amepre.2022.08.013 2022) https://www.eurekalert.org/news-releases/970082. Review article; Angel et al. Ultraprocessed Foods and Public Health: A Need for Education. Mayo Clinic Proceedings, Volume 94, Issue 11, November 2019, Pages 2156-2157; Wang et al. Trends in Consumption of Ultraprocessed Foods Among US Youths Aged 2-19 Years, 1999-2018.JAMA. 2021;326(6):519-530. doi:10.1001/jama.2021.10238; Neri et al. Ultraprocessed food consumption and dietary nutrient profiles associated with obesity: A multicountry study of children and adolescents. Obes Rev 2022 Jan;23 Suppl 1:e13387.do10.1111/obr.13387. Epub 2021 Dec 9; Nelson et al. Premature Deaths Attributable to the Consumption of Ultraprocessed Foods in Brazil. https://doi.org/10.1016/j.amepre.2022.08.013; FAO. Ultra-processed foods, diet quality, and health using the NOVA classification system Monteiro et al.
(5) Weak Codex standards have regularly been used in attempts to stop governments bringing in strong marketing controls. The wrong assumption is made that Codex standards are a ‘regulatory ceiling’ for trade purposes. These threats have been highlighted in the 2023 Lancet Series on Breastfeeding.
(6) In the 2019 CCFSNDU meeting the critically important sentence: ‘Cross promotion between product categories is not permitted on the [label/labelling] of the product’, that was supported by many developing countries, was replaced by much weaker text that was falsely presented as having the same ‘intent’. Cross Promotion’ or ‘brand stretching’ is a deceptive marketing technique used to expand the sale of tobacco and other products with public health concerns. Cross Promotion of milks is especially harmful and increases the risk of infants not being breastfed or being fed with entirely inappropriate products.
(7) Text of new Preamble proposed by New Zealand and agreed: “This Standard is divided into two sections. Section A refers to Follow-up Formula for Older Infants, and Section B deals with Drink for Young Children with Added Nutrients, or Product for Young Children with Added, or Drink for Young Children, or Product for Young Children. The application of this Standard should be consistent with national/regional health and nutrition policies and relevant national/regional legislation and take into account the recommendations made in the International Code of Marketing of Breast-milk Substitutes, as per the national context. Relevant World Health Organization (WHO) guidelines and policies and World Health Assembly (WHA) resolutions were considered in the development of this Standard and may provide further guidance to countries.”