Born into this World: Breastfeeding and the Politics of Infant and Young Child Feeding

By Marie McGrath, ENN Co-Director on 9 July 2018

Marie has worked on infant and young child feeding in emergencies since 2001. She coordinates the IFE Core Group, an international interagency collaboration on infant and young child feeding in emergencies.

In the Irish language, there’s a phrase “rírá agus ruaille buaille” (trans: uproar, hubbub, tumult, commotion, ruction, rough & tumble)” which captures the essence of the escapades of the recent World Health Assembly (WHA) around the Infant and Young Child Feeding (IYCF) Resolution in which ENN has been closely involved. Here’s our version of events.

ENN and the IFE Core Group met last December to set our priorities as a collective – securing an IYCF Resolution with specific reference to the recently revamped Operational Guidance on IFE, a key policy guidance produced by the group, was deemed top of the list and ENN ran with it. Many months followed of collegiate collaboration between a hearty global mix of non-governmental organisation (NGOs), civil societies, United Nations (UN) agencies, and countries – Member States who are at the heart of the WHO constitution – to develop a rich, tight and action-oriented resolution. The WHA theme of ‘Universal Health Coverage for all’ gave us a key ‘in’ to connect IYCF with health. With Ministries of Health as the key target audience, we saw a wonderful opportunity to emphasise emergency preparedness around policy (such as the International Code of Marketing of Breastmilk Substitutes) and capacity development, and to link humanitarian and development programming. Ecuador stepped up to sponsor this Resolution and brokered endless discussions between countries to enrich the content and winning further buy-in and ownership.

In tandem, we secured (against stiff competition) an official side event at the WHA, led by Bangladesh, Ireland and Madagascar, and co-sponsored by Burkina Faso, Canada, Chad, Ecuador, France, Nigeria, The Philippines and Thailand. We aimed to help make the case for the IYCF Resolution and to brief Member States on key guidance and resources, to help them deliver on commitments. We also collaborated with the Scaling Up Nutrition (SUN) Civil Society Network with a screening of the MILK film, an award-winning documentary that, in the Director Noemi Weis’s words, “brings a universal perspective on the politics, commercialization and controversies surrounding birth and infant feeding”. Little did we know the level of political wrangling that was to unfold – in fact, we seemed to move into Spielberg movie territory...

We entered WHA week with the news of a counter IYCF Resolution from the United States. What transpired is detailed in a New York Times article shared in the UK’s The Guardian newspaper today (9th July 2018). Our WHA week was dominated with trying to protect and secure a tight IYCF Resolution that would not only have value, but which also wouldn’t introduce risk; a weak Resolution, many said, would be worse than no Resolution at all. Rooms, corridors and corners became the site of frantic discussions. WhatsApp groups went crazy with lobbying. Social media was ablaze as supporters were galvanised to stand strong. All countries (Member States) have an equal vote and say at the World Health Assembly; but what transpired undermined this important principle. Some questioned whether true “consensus” was really achieved; a tricky place to get to when negotiating parties have very different undeclared agendas and are flexing muscles behind the scenes. “What a missed chance”, I heard many say – instead of constructively galvanising countries around a positive Resolution, we were engaged in a dispiriting battle of words and reformulation of text, to the bitter end.

So where did we get to? We secured an IYCF Resolution – definitely not perfect but one heaps better than that first offered by the US; and critically, one that does more good than harm. ENNs original objective for engagement - to bring attention to the protection of infants and children and their mothers in emergencies and to prepare for this - was successful.  The wording agreed in the Ecuadorian-led Resolution was included in the final agreed Resolution. I witnessed, first hand, the role of civil society in advocacy and support to government, and the power of collaboration, networking and connections.  A resilient global community stood firm and on balance, I feel won.

From here, the only way is up. This debacle is fuelling an uprising of support to protect, promote and support safe and appropriate infant and young feeding worldwide, including in the most fragile and crisis affected contexts where mothers and children need the greatest protection. Without it, breastfeeding would never have made the pages of the New York Times and Guardian.  Every cloud...