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what informs the OG-IFE stipulation that BMS should not be donated?

This question was posted the Infant and young child feeding interventions forum area and has 5 replies.

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Vicky Sibson

First Steps Nutrition Trust

Normal user

9 Jun 2022, 15:12

hello

I had a question on section 6 of the OG-IFE that states (rightly, of course) that BMS should not be donated in an emergency, and necessary products shoudl be procured. This does not come from the 1981 Code, so I assume it comes from one of the WHA resolutions. Does anyone know which one, off the top of their head? 

Alessandro Iellamo

FHI360

Normal user

9 Jun 2022, 18:53

Hi Vicky

how are you? Great question. The only thing I can say is that the OG-IFE is consensus-driven guidance  and it's not always based on other references and guidance, in fact, it is a set of standards on it own that evolved since the late 1990s.....that endorsed by the World Health Assembly in 2010 

on the other end, there is  nice work done by IBFAN on explaining the Code vs Infant Feeding in Emergencies

http://worldbreastfeedingweek.net/wbw2009/images/icdc_%20focus_english.pdf

Thanks again..

Michelle Pensa Branco

SafelyFed Canada, Co-Founder/Clinical Lead

Normal user

9 Jun 2022, 20:35

Hi Vicky,

I think Alessandro's comment is the most useful - the OG-IFE draws from multiple resources and statements, but is an expert consensus standard in its own right and stands on its own authority. 

If you are looking at the evolution of how donations are treated within the Code, there are three resolutions that pop to mind that clarify/tighten requirements around donations - WHA 39.28 (1984), WHA 47.50 (1994) and WHA 63.23 (2010). 

Hope that's helpful!

Michelle 

Isabelle Modigell

IYCF-E Consultant

Frequent user

10 Jun 2022, 17:53

Hi Vicky,

To add to what colleagues have already shared, The Code itself does not mention emergency situations, but subsequent WHA resolutions 47.5 in 1994 have dealt with its application in this context. Donations of BMS continued to occur after 1994, which led to the development of the OG-IFE and WHA Resolution 63.23 in 2010 (supersedes WHA 47.5). This resolution endorses the OG-IFE and makes it clear that there should be no donations of BMS. Resolution 63.23 urges Member States “to ensure that national and international preparedness plans and emergency responses follow the evidence-based Operational Guidance for Emergency Relief Staff and Programme Managers on IFEs, which includes… the need to minimize the risks of artificial feeding by ensuring that any required breastmilk substitutes are purchased, distributed and used according to strict criteria. (Source: UNICEF BMS SOP)

The OG-IFE indeed  offers stand-alone, consensus-driven, normative guidance – endorsed by the WHA. I would say that the recommendations around donations were informed by IFE CG members’ collective experiences with BMS Donations during past emergencies e.g. Armenia 1988 (13 years to return to pre-disaster breastfeeding rates following inappropriate BMS distributions); Tsunami 2004 in India (Adhisivam et al. 2006 – occurrence of diarrhoea 3 x higher among children fed with free BMS), Botswana floods 2005/6 - free formula through the health system for BMS-exposed infants (Creek et al, 2010) and the Central Java earthquake in 2006 (Hipgrave et al. 2011) to name a few.

Hope that helps!

Isabelle

Jodine Chase

IFE Core Group Facilitator

Normal user

13 Jun 2022, 18:33

To further add to this discussion, this issue of donations is the only one where interpretation says a subsequent WHA resolution has superceded the original text of the Code.

There is a two-page summary of the Code and all subsequent relevant resolutions with UNICEF and WHO logos on it, in IBFAN's  "Breaking the Rules, Stretching the Rules" reports in 2014 and 2017. Those reports were behind a paywall and subsequently are unavailable so I can't share it here. 

The language in this summary is as follows, emphasis is mine.

"Note: Articles 6.6 and 6.7 of the Code have been superseded by WHA 39.28 [1986], WHA 45.34 [1992] & WHA 47.5 [1994]"

IBFAN's Code Essentials series also references this, but again, they are not publicly available: 

And as Sarah points out WHA 47.5 is now superseded by 63.23. There is a document in the Save the Children IYCF-E Toolkit from 2017 that summarizes the portions of the Code and the subsequent WHA resolutions relevant to emergencies: https://unicefeapronietoolkit.files.wordpress.com/2017/08/1-summary-code-sections-and-emergencies.pdf

It's a good document, I think, although it could do with an update, since it doesn't include anything on WHA 69.9 (relevant to commercial complementary foods).

I also note it's common for people to refer to the Code or to WHA 47.5 where it says, in reference to BMS donations, that "the supply is continued for as long as the infants concerned need it." (replacing Article 6.7 which says "institution or organization should take steps to ensure that supplies can be continued as long as the infants concerned need them.")

WHA 63.23 does not repeat that language, so if it completely supersedes WHA 47.5, which supersedes Article 6.7, we have lost that language.

Vicky Sibson

First Steps Nutrition Trust

Normal user

14 Jun 2022, 06:32

Thank you so much to everyone who has taken the time to answer my quesstion so comprehensively, Vicky

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