Revised standard for follow-up formula should protect optimal infant and young child feeding

At a Codex meeting in Hamburg, Germany this week, many countries called for changes to an international standard on follow-up formula, a product marketed for children over six months of age that often displaces breastfeeding. Updating the standard to define follow-up formula as a breastmilk substitute will help protect optimal breastfeeding and complementary feeding practices.

Codex Alimentarius (referred to as “Codex”) is a joint body of the Food and Agriculture Organization (FAO) and the World Health Organization (WHO) that develops harmonized international food standards, guidelines and codes of practice in order to protect the health of consumers and ensure fair practices in food trade. Helen Keller International is an official observer at Codex.

Since Codex standards often serve as the basis for legislation in individual countries, they can have a profound impact on the health and nutrition of infants and young children. A Codex committee is currently undertaking a full review of the Codex Standard for Follow-up Formula.

Changes to the standard are needed now because:
• There is growing evidence that companies are promoting follow-up formula in a way that also promotes infant formula, a product targeted for infants under six months of age who should be exclusively breastfed. Products share similar color schemes, designs and brand names and have similar slogans, mascots and symbols. This practice undermines breastfeeding and may also confuse consumers into buying the wrong product.
• The current standard is misleading, stating, “The products covered by this standard are not breastmilk substitutes and shall not be presented as such.” In fact, these products are used by families as breastmilk substitutes.
• In 2016, the World Health Assembly passed a resolution (WHA 69.9) to provide “Guidance on Ending the Inappropriate Promotion of Foods for Infants and Young Children.” This guidance clearly states that the International Code of Marketing of Breast-milk Substitutes applies to follow-up formula/growing-up milks that are marketed as “suitable” for older infants and young children from the age of 6 months to 36 months, as well as to infant formula. Thus the Codex standard needs to be revised to align with this.

At the 38th Session of the Codex Committee on Nutrition and Foods for Special Dietary Uses, in Hamburg, Germany this week (December 5-9th), many countries joined the call for clarifying language on this issue. They called for these milk products marketed for children, who should instead be receiving the far more nourishing and protective breastmilk, to be defined as breastmilk substitutes which fall under the International Code of Marketing of Breast-milk Substitutes. While the process of revising the Codex standard is still ongoing, countries agreed that there should be policy coherence with WHA resolutions and WHO guidelines. Including a specific reference to the Code and WHA Resolution 69.9 in the standard would be a significant step toward protecting optimal infant feeding and the health of infants and young children around the world.

In summary, many country delegations at Codex are making it clear— follow-up formula is a breastmilk substitute and should not be promoted.