Objective: The marketing of infant/child milk-based formulas (MF) contributes to suboptimal breast-feeding and adversely affects child and maternal health outcomes globally. However, little is known about recent changes in MF markets. The present study describes contemporary trends and patterns of MF sales at the global, regional and country levels. Design: Descriptive statistics of trends and patterns in MF sales volume per infant/ child for the years 2008-2013 and projections to 2018, using industry-sourced data. Setting: Eighty countries categorized by country income bracket, for developing countries by region, and in countries with the largest infant/child populations. Subjects: MF categories included total (for ages 0-36 months), infant (0-6 months), follow-up (7-12 months), toddler (13-36 months) and special (0-6 months). Results: In 2008-2013 world total MF sales grew by 40·8 % from 5·5 to 7·8 kg per infant/child/year, a figure predicted to increase to 10·8 kg by 2018. Growth was most rapid in East Asia particularly in China, Indonesia, Thailand and Vietnam and was led by the infant and follow-up formula categories. Sales volume per infant/ child was positively associated with country income level although with wide variability between countries. Conclusions: A global infant and young child feeding (IYCF) transition towards diets higher in MF is underway and is expected to continue apace. The observed increase in MF sales raises serious concern for global child and maternal health, particularly in East Asia, and calls into question the efficacy of current regulatory regimes designed to protect and promote optimal IYCF. The observed changes have not been captured by existing IYCF monitoring systems. Keywords Infant and young child feedingNutrition transition Formula Breast-milk substitutes Breast-feeding is important for infant and young child health and development, and for maternal health, in both developed-and developing-country settings (1)(2)(3) . It is ranked as the single most effective intervention for the prevention of deaths in children under 5 years of age (4) . To achieve optimal growth, development and health the WHO recommends that infants should be exclusively breast-fed for the first 6 months of life and thereafter receive nutritionally adequate and safe complementary foods while continuing breast-feeding for up to 2 years of age or beyond (5,6) . Although significant progress has been made in some countries, the global exclusive breast-feeding rate improved only marginally from 33 % in 1995 to 37 % in 2014 (7) . Every year an estimated 823 000 deaths, or 13·8 % of total deaths, in children under 2 years of age would be prevented if breast-feeding were scaled up to a near-universal level in high-mortality low-and middleincome countries. For mothers, a universal level of breastfeeding in all countries would prevent an estimated 20 000 deaths from breast cancer annually (8) . Suboptimal infant and young child feeding (IYCF) also incurs higher health system expenditures through increas...

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BackgroundDespite scientific evidence substantiating the importance of breastfeeding in child survival and development and its economic benefits, assessments show gaps in many countries’ implementation of the 2003 WHO and UNICEF Global Strategy for Infant and Young Child Feeding (Global Strategy). Optimal breastfeeding is a particular example: initiation of breastfeeding within the first hour of birth, exclusive breastfeeding for the first six months; and continued breastfeeding for two years or more, together with safe, adequate, appropriate, responsive complementary feeding starting in the sixth month. While the understanding of “optimal” may vary among countries, there is a need for governments to facilitate an enabling environment for women to achieve optimal breastfeeding. Lack of financial resources for key programs is a major impediment, making economic perspectives important for implementation. Globally, while achieving optimal breastfeeding could prevent more than 800,000 under five deaths annually, in 2013, US$58 billion was spent on commercial baby food including milk formula. Support for improved breastfeeding is inadequately prioritized by policy and practice internationally.MethodsThe World Breastfeeding Costing Initiative (WBCi) launched in 2013, attempts to determine the financial investment that is necessary to implement the Global Strategy, and to introduce a tool to estimate the costs for individual countries. The article presents detailed cost estimates for implementing the Global Strategy, and outlines the WBCi Financial Planning Tool. Estimates use demographic data from UNICEF’s State of the World’s Children 2013.ResultsThe WBCi takes a programmatic approach to scaling up interventions, including policy and planning, health and nutrition care systems, community services and mother support, media promotion, maternity protection, WHO International Code of Marketing of Breastmilk Substitutes implementation, monitoring and research, for optimal breastfeeding practices. The financial cost of a program to implement the Global Strategy in 214 countries is estimated at US $17.5 billion ($130 per live birth). The major recurring cost is maternity entitlements.ConclusionsWBCi is a policy advocacy initiative to encourage integrated actions that enable breastfeeding. WBCi will help countries plan and prioritize actions and budget them accurately. International agencies and donors can also use the tool to calculate or track investments in breastfeeding.

This case control study evaluates the association between hospitalization due to infection and feeding practices among infants aged >or= 3 days to < 6 months. Mothers of 191 cases hospitalized for infections and 208 healthy controls were interviewed using a standardized questionnaire documenting infant-feeding history. Results given in odds ratio and 95% confidence intervals (OR, 95% CI) were adjusted for age, education, and place of delivery. Exclusively formula-fed infants were more likely to be hospitalized for any infection (3.7, 1.8-7.5), pneumonia (3.0, 1.2-7.4), and diarrhea (10.5, 2.5-41.9) compared to exclusively breastfed infants. Infants who did not receive any breast milk were more likely to be hospitalized for any infection (3.5, 2.1-5.9), neonatal sepsis (4.9, 1.3-18.3), pneumonia (2.8, 1.5-5.4), and diarrhea (19.6, 6.5-58.6) than infants who received any breast milk. This study showed a strong positive association between the intake of formula and/or nonbreast milk supplements and the risk of hospitalization for infectious causes.

Background There is growing recognition that current food systems and policies are environmentally unsustainable. There is an identified need to integrate sustainability objectives into national food policy and dietary recommendations. Research Aims To (1) describe exploratory estimates of greenhouse gas emission factors for all infant and young child milk formula products and (2) estimate national greenhouse gas emission association with commercial milk formulas sold in selected countries in the Asia Pacific region. Method We used a secondary data analysis descriptive design incorporating a Life Cycle Assessment (LCA) concepts and methodology to estimate kg CO2 eq. emissions per kg of milk formula, using greenhouse gas emission factors for milk powder, vegetable oils, and sugars identified from a literature review. Proportions of ingredients were calculated using FAO Codex Alimentarius guidance on milk formula products. Estimates were calculated for production and processing of individual ingredients from cradle to factory gate. Annual retail sales data for 2012–2017 was sourced from Euromonitor International for six purposively selected countries; Australia, South Korea, China, Malaysia, India, Philippines. Results Annual emissions for milk formula products ranged from 3.95–4.04 kg CO2 eq. Milk formula sold in the six countries in 2012 contributed 2,893,030 tons CO2 eq. to global greenhouse gas emissions. Aggregate emissions were highest for products (e.g., toddler formula), which dominated sales growth. Projected 2017 emissions for milk formula retailed in China alone were 4,219,052 tons CO2 eq. Conclusions Policies, programs and investments to shift infant and young child diets towards less manufactured milk formula and more breastfeeding are “Triple Duty Actions” that help improve dietary quality and population health and improve the sustainability of the global food system.