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What do the draft regulations propose?
Recent draft regulations on foodstuffs for infants and young children aim to further encourage exclusive and prolonged breastfeeding among South African mothers. However, if promulgated in their current form, the draft regulations would not only limit the amount of information mothers will be able to access about infant nutrition and complementary foods – due to a proposed restriction on communication between infant food manufacturers and healthcare professionals (HCPs) regarding the various products and ingredient benefits – but could have the unintended consequence of increasing levels of malnutrition and potentially child morbidity and mortality, says the Infant Feeding Association (IFA).
The IFA supports exclusive breastfeeding
“The IFA fully supports initiatives that actively promote, increase and protect exclusive breastfeeding for at least the first 6 months of a baby’s life, followed by a diet of breastmilk and appropriate complementary foods for as long as possible thereafter. Numerous studies irrevocably prove that breastfeeding is the single most effective nutrition intervention for saving lives. In fact, developing countries such as Malawi and Madagascar have significantly reduced their under-five child mortality rates by increasing breastfeeding amongst mothers,” says Lisa Walker, IFA spokesperson.
From a local perspective, South Africa’s under-five child mortality rate has shown little improvement since 1990. Similarly, the country’s breastfeeding rates have remained stagnant since 2000, clearly highlighting the need for initiatives that promote, protect and support exclusive and prolonged breastfeeding with the intention of reducing child mortality.
Some SA women can't breastfeed exclusively for 6 months
At present, approximately 8% of South African babies are exclusively breastfed for the first six months of life with 31% fed a diet of both breastmilk and solid foods thereafter.
However, says Walker, there are a number of reasons why it can be difficult for South African women to breastfeed exclusively and for a prolonged period of time as implied by the draft regulations.
“Many mums have to return to work after just four months of maternity leave while others have health complications and are unable to breastfeed. Migrating mums often have to leave their babies in the care of a relative or caregiver far away from their primary residence due to few alternative options.
"These barriers clearly indicate the need for public-private partnerships that aim to further support breastfeeding mothers. On a governmental level, a change in policy could be explored that grant mothers extended maternity leave. Corporate SA could place a stronger focus on creating child-friendly working environments that support mothers by allowing regular breastfeeding breaks and offering suitable places for mums to breastfeed their babies while working,” says Walker.
The implications on baby's diet after 6 months
The draft regulations' proposed restriction on communication between infant food manufacturers and healthcare professionals (HCPs) regarding the various products and ingredient benefits, may severely limit the healthcare professionals' ability to provide mums with the best and most adequate nutritional advice for their babies.
“The majority of mothers who are unable or choose not to breastfeed rely on their HCP to provide sound, scientific information on breastmilk substitutes as well as guidance on selecting the most adequate nutritional solution for their babies. The restrictions suggested by the draft regulations may also apply to complementary foods, typically introduced to a baby’s diet after six months when breastmilk alone no longer provides adequate nutrition,” says Walker.
Without access to information, says Walker, mothers may inadvertently include nutritionally inadequate products in their babies’ diets such as tea, rice milk, soya milk or whole milk, potentially exacerbating the problem of malnutrition in South Africa. “International case studies suggest that regulations must strike a balance between promoting exclusive and prolonged breastfeeding while allowing mums full access to scientific information on breastmilk substitutes via their HCPs if it is to achieve a reduction in malnutrition.”
An example: Malawi
Walker points to Malawi as example. In terms of regulations, the country adopted the World Health Organisation’s (WHO) International Code of Marketing of Breast Milk Substitutes. It also dedicated a significant amount of energy and resources to 10,000 frontline health workers to educate mothers on hygiene, nutrition and breastfeeding. The results were phenomenal and Malawi has the highest breastfeeding rate in the world, combined with a 59% reduction in its under-five child mortality rate since 1990.
However, despite a significant increase in its breastfeeding rates, Malawi has one of the highest percentages of stunted children – an indicator of malnutrition – at 48% due to a lack of education about the transition from breastmilk to complementary foods. The same trend is witnessed in other developing countries such as Madagascar and Peru.
“The high rate of stunted children in these countries indicates that stringent regulation is not in itself the solution; any regulation needs to provide support and education to mothers to prevent malnutrition,” says Walker. “While appropriate regulation is key to increasing the breastfeeding rate in SA, its effectiveness would be enhanced if coupled with active awareness and education programmes on a national basis.
“The IFA supports the ‘breast is best’ philosophy and encourages mothers to breastfeed exclusively for as long as possible,” says Walker. "However, in cases where this isn’t possible, mothers should be able to make an informed decision about providing alternative sources of nutrition to their babies and children via their HCPs, and to ensure the appropriate use of such substitutes.”
She adds that the IFA is hopeful that it will be afforded the opportunity for further engagement with the Department of Health once the department has reviewed the IFA submission on the draft regulations.
About the Infant Feeding Association (IFA):
The Infant Feeding Association (IFA) was formed to facilitate industry dialogue with all key stakeholders and role-players to encourage responsible marketing standards for the infant food industry.
The IFA has publicly stated its support for the World Health Organisation’s (WHO) International Code of Marketing of Breast Milk Substitutes and subsequent relevant World Health Assembly (WHA) resolutions, which aim to:
- Protect and promote breastfeeding; and
- Ensure the proper use of breastmilk substitutes when these are needed. The WHO Code recognises the importance of breastfeeding while acknowledging that there is a legitimate market for breastmilk substitutes when breastfeeding is not possible.
The IFA members seek to promote safe and adequate nutrition for infants by encouraging and supporting breastfeeding as the best start in life and by manufacturing high-quality breastmilk substitutes for use when a safe alternative to breastmilk is needed.
