Promotion and consumption of breastmilk substitutes and infant foods in Cambodia, Nepal, Senegal and Tanzania

The World Health Organization (WHO) and UNICEF define optimal infant and young child feeding as practising exclusive breastfeeding from birth through the first 6 months of life and feeding with safe and appropriate complementary foods starting from 6months of age together with continued breastfeeding for up to 2 years and beyond (WHO & UNICEF 2003). Meeting the nutritional requirements of children from the age of 6months is challenging when foods fed to children are low in essential micronutrients, low in high quality fats, high in factors that inhibit absorption of nutrients and not adequately dense in calories. To meet the specific nutrient requirements of this vulnerable group, WHO guidelines (Pan American Health Organization & WHO 2003) recommend the use of low-cost fortified products as needed, along with continued breastfeeding; however, these products need to be promoted in a way that protects both breastfeeding and the consumption of high-quality local foods. The International Code of Marketing of Breast-milk Substitutes (WHO 1981) was adopted by the World Health Assembly (WHA) in 1981 to stop the promotion of breastmilk substitutes, which has been shown to be detrimental to breastfeeding practices. In May 2010, the 63rd World Health Assembly recognized that the promotion of some commercial foods for infants and young children also undermines progress in optimal infant and young child feeding (WHA 2010), and in May 2012, the Assembly requested the director general to provide clarification and guidance on the issue of inappropriate promotion of foods for infants and young children (WHA 2012). Information on promotion and consumption of foods for infants and young children in countries around the world is limited. Policy makers at both the global and national levels seeking to improve infant feeding practices and specifically those tasked with providing guidance on promotion of commercially produced complementary foods could benefit from more detailed information on the rates of consumption of foods by infants and young children as well as the prevalence and nature of the promotion of these foods. In response to the call in 2012 by global policymakers for guidance, Helen Keller International, through the Assessment and Research on Child Feeding (ARCH) Project, has conducted research on the promotion of commercially produced foods and their consumption by infants and young children in the largest urban areas of four countries: Cambodia, Nepal, Senegal and Tanzania. TheARCHProject also gathered data on the labelling of commercially produced foods consumed by infants and young children in these four sites. This supplement describes the results from this research. The four study sites are not only geographically diverse but also vary in legislation governing the promotion of infant foods. Strong laws governing the promotion of breastmilk substitutes and commercially produced complementary foods exist in Nepal and Tanzania, covering products for children up to 12months and 5years of age, respectively. Promotion is less strictly regulated inCambodia (where promotions are permitted with government approval) and in Senegal (where promotion is only prohibited within health facilities). The first six articles in this supplement describe information collected from mothers of children under the age of 2 years on exposure to promotional practices