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The Hon. George Miller                                                  The Hon. John Kline

Chairman                                                                      Ranking Member

Education and Labor Committee                                     Education and Labor Committee

U.S. House of Representatives                                         U.S. House of Representatives

Washington, DC  20515                                                  Washington, DC  20515

Dear Chairman Miller and Ranking Member Kline:

Child Nutrition Reauthorization (CNR) Bill

Dear Chairman Miller

As Policy Director of Baby Milk Action, a member of the International Baby Food Action Network, and the Secretariat of the Baby Feeding Law Group,  a coalition of 24 health professional and lay organisations in the UK, including the Royal Colleges of Paediatrics, Nursing and Midwifery, I am writing to express concern about  the potential ramifications for the health of infants and young children,  and in particular the children of low-income women, of the Child Nutrition Reauthorization Bill.  

I urge you to support including language that  directs the Agriculture Department (USDA)  to get expert advice from an independent scientific body (such as the Institute of Medicine) to develop a rigorous independent science-based decision-making process which could  determine the safety and efficacy of ingredients used in breastmilk substitutes and baby foods.   

Such a move would be in line with the recent position taken by the US at the World Health Assembly where there was an extensive discussion about the use of nutrition and health claims on baby milks and foods during the debate on Infant and Young Child Nutrition.   I am pleased to say that the US delegation, including I believe the Surgeon General Benjamin,  played a key role in supporting  the adoption of a strong Resolution (WHA Resolution 63.23 ) (1) which among other things, called for an end to all such claims. 

The final text recognised:  "that the promotion of breast-milk substitutes and some commercial foods for infants and young children undermines progress in optimal infant and young child feeding;”   that " inappropriate feeding practices and their consequences are major obstacles to attaining sustainable socioeconomic development and poverty reduction"   and called upon Member States to  "end inappropriate promotion of food for infants and young children and to ensure that nutrition and health claims shall not be permitted for foods for infants and young children, except where specifically provided for, in relevant Codex Alimentarius standards or national legislation"

Since the use of breastmilk substitutes presents many risks to infant health,  and certainly has no equivalence or health advantage over breastfeeding,  nutrition and health claims on such products can never be justified, and there are,  in any case, very few claims that are  'specifically provided for.'    However,  claims - most  based on small industry funded studies -  are widely used in the US and all over the world,  misleading  and distorting parents' and health workers' perceptions about the nutritional value and safety of baby foods, undermining breastfeeding and placing children health and lives at risk. This is why we hope that the Resolution will prompt policy makers in the US and elsewhere  to take  tough action to end the use of all such claims.  

This does not mean that the quality of breastmilk substitutes should be poorer.  Manufacturers have a responsibility to ensure that all their products are as safe and nutritious as possible.   Indeed,  the  opinion  of the UK Baby Feeding Law Group  is that if any ingredient is unequivocally demonstrated to be essential, beneficial and SAFE for all those babies who are not breastfed - it should be a mandatory ingredient, pre-authorised and listed in the regulations governing the product. However it is crucial that  the safety and efficacy of the ingredients  is  demonstrated by an independent review of all data which must include a substantial proportion of independently-funded research. 

The UK Government's Scientific Advisory Committee on Nutrition (SACN)  also supports this principle : “We find the case for labelling infant formula or follow on formula with health or nutrition claims entirely unsupportable. If an ingredient is unequivocally beneficial as demonstrated by independent review of scientific data it would be unethical to withhold it for commercial reasons. Rather it should be made a required ingredient of infant formula in order to reduce existing risks associated with artificial feeding. To do otherwise is not in the best interests of children, and fails to recognise the crucial distinction between these products and other foods.”

We have been in correspondence with Ricardo Uauy, chair of the WHO/FAO expert committee on fats, who  is also concerned about the use of claims and gave us permission to quote him on the evidence surrounding the efficacy of synthetic DHA:

“The evidence for effectiveness of DHA addition to formula for term babies in terms of improved long term mental development is weak at best. Data from a population based very large study (n=800) per group recently completed in Mexico does not support a benefit from DHA supplementation on measures of mental development at 18 to 24 months. The studies that demonstrate effects are smaller in numbers and few if any show effects beyond 4 yrs of age. This issue remains open from a research point of view, but until stronger data are available I would opt for a view that the effects of DHA on mental development are not sufficiently documented to establish public health policy. Whether it should be available and used subject to physician and parental choice it is a different story, I would make it available without claims in this regards. Whether a claim that “DHA containing formula is closer to human milk composition”, although factually true it is misleading in terms suggesting it parallels the benefits of human milk feeding.” (2)

The systematic Review by the Cochrane Library on Long Chain Polyunsaturated Fatty Acids in 2007 concluded that there were no proven benefits of LCPUFAs.   We also understand that there are concerns about the safety of these ingredients and that 98 reports have been made to the Food and Drug Administration of adverse reactions to synthetic DHA enriched formulas.  

We hope that you agree that there is an urgent need for the Child Nutrition Reauthorization to base its decisions on sound, objective independent information, and that steps are taken  to ensure that there is no undue commercial influence in this process. In addition we strongly urge that if whatever  ingredients are permitted, that tough action is taken to ensure that they are NOT accompanied by nutrition and health claims.   If the US Government were to take such action, it would have an important and profound impact on infant health, not only in the US but also globally. 

With very best wishes  and thanks for your consideration of these points.

yours sincerely 

Patti Rundall, OBE

Policy Director 

1 WHA Resolution 63.23 on Infant and Young Child Feeding:  http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_R23-en.pdf   

2  Longchain polyunsaturated fatty acid supplementation in infants born at term Simmer K, Patole S, Rao SC  www2.cochrane.org/reviews/en/ab000376.html

Baby Feeding Law Group (BFLG) 

Strengthening UK Baby Food Laws

Patti Rundall,  OBE,  Policy Director, Baby Milk Action

Secretariat of  the Baby Feeding Law Group

C/o Baby Milk Action, 34 Trumpington St,   Cambridge   CB2 1QY    

Work Tel: 01223 464420, Mobile: 07786 523493, Fax: 01223 464417

prundall@babymilkaction.org  www.babymilkaction.org

www.babyfeedinglawgroup.org.uk

The Baby Feeding law Group is a coalition of 24 leading health professional and lay organisations working to bring UK and EU legislation into line with International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly Resolutions. 

BFLG Member organisations: Association of Breastfeeding Mothers - Association for Improvements in the Maternity Services - Association of Radical Midwives - Baby Milk Action - Best Beginnings – Breastfeeding Community - Breastfeeding Network - Caroline Walker Trust - Community Practitioners and Health Visitors’ Association - Food Commission - Heart of Mersey - Lactation Consultants of Great Britain - La Leche League (GB) - Little Angels - Midwives Information and Resource Service - National Childbirth Trust - Royal College of Midwives - Royal College of Nursing   - Royal College of Paediatrics and Child Health - The Baby Café - UK Association for Milk Banking - Unicef UK Baby Friendly Initiative - UNISON - Women’s Environmental Network.

The Baby Feeding Law Group is also a member of the Breastfeeding Manifesto Coalition which is calling for action in 7 areas to protect, promote and support breastfeeding.  Baby Milk Action takes the lead on Objective 7. 

http://www.breastfeedingmanifesto.org.uk