The World Health Organisation's approach to labelling infant formula is misguided and could put lives at risk, writes Dr Constantin Gurdgiev.
This week the world Health Organisation (WHO) - a UN agency created in 1948 with an aim of attaining "by all peoples of the highest possible level of health", including complete physical, mental and social wellbeing - is involved in a row with medical, human rights and aid organisations over a recommended resolution restricting the use of baby formula.
The WHO is by no means a stranger to controversies. In the late 1990s, it was widely acknowledged that its mishandling of the anti-malaria drug treatment programmes and a ban on the use of proven insecticides resulted in the disease becoming more treatment-resistant. The agency achieved equally dreadful results in a fight against cholera, diarrhoea and tuberculosis - all targets for elimination by the WHO. In the case of its Aids programmes, they were so flawed that the UN removed the project from WHO hands.
As announced last Friday, the 58th World Health Assembly in Geneva will tomorrow adopt a new version of the International Health Regulations. Along with a host of much needed measures aimed at increasing global efforts in fighting major diseases and health risks, the assembly has indicated that the new regulations will include adoption of the January 2005 recommendations by the WHO that all infant formula sold worldwide should bear warning labels similar to those placed on tobacco and alcohol products.
According to the Independent Women's Forum, such an action will force women back into the dark ages of having no options but to abandon their active careers outside the home. Aside from the women's rights considerations, the action may endanger a large number of people in the developing world.
Two dimensions of the advantages of replacement formula over breast-feeding are completely ignored by the WHO's new proposals: the issues of HIV infections and nutritional health of mothers and children.
According to researchers from the Johns Hopkins University School of Medicine in Baltimore, US, "breast-feeding is responsible for an increasingly large proportion of worldwide paediatric HIV infection".
Studies show that worldwide HIV infection via breast-feeding is on the rise - a trend that is expected to worsen in the future as more women infected with the virus enter childbearing age. In South Africa, between 1991 and 2001, the rate of HIV infections amongst women increased from approximately 1 to 25 per cent.
Over one third of all children of HIV positive mothers are currently carrying the virus, with over 30 per cent of these children dying within the first year after birth. In Malawi, Tanzania and Zimbabwe urban antenatal HIV infection affects between 17 and 32 per cent of mothers. Yet, the WHO would rather ban life-saving formulas than abandon its political objective of vilifying the international producers of replacement food.
Studies also show that supplementation of breast milk with nutritional additives was not a statistically equivalent source of reducing micronutrient deficiencies in developing countries.
In India, Indonesia and Sub-Saharan African countries, there is strong evidence that the HIV epidemic is associated with low nutritional ability of women to breast-feed. According to a January 2005 report published by the American Society for Nutritional Sciences (ASNS), "nutrition is an important component of comprehensive care for the HIV-infected woman". This makes it imperative that the HIV-positive mothers be spared the added stress of breast-feeding.
In addition, medical studies show that vitamin and mineral deficiencies are associated with both the HIV infections of mothers and their breast-fed infants. The WHO recognised this problem in the past - its own 2001 recommendations on infant feeding state that "when replacement feeding is feasible, avoidance of all breastfeeding by HIV-infected mothers is recommended".
The wholesale approach to regulation advocated by the WHO ignores widely varying local realities of nutritional health of mothers, availability of safe formula supplies and other regional specifics.
Instead the WHO prefers a one-size-fits-all approach - a wholesale vilification of formula.
This policy goes against the objectives of the UN HIV/Aids programmes, nutritional health agenda and the need for increasing women's choices and rights in society. It potentially puts under risk millions of lives in the regions where the precipitous decline in life expectancy already acts as a major factor retarding future socioeconomic development.
Dr. Constantin Gurdgiev is a Lecturer in Economics (TCD) and a Director of the Open Republic Institute (www.openrepublic.org)