• Assess the strengths and weaknesses of feeding policies and practices
• Review barriers to the implementation of current policies
• Review key interventions to identify the best ways forward, and
• Review a draft strategy that, when finalized, will guide us in the years to come.

This consultation will be followed by regional and national meetings, with governments and other interested parties.

As experts in your respective fields, you will be identifying the way forward:

Each of the major forms of malnutrition easily dwarfs most other diseases globally, and the young are among the first—and the worst—affected.

• Some 30 million low-birth-weight babies—about 24% of the total—are born every year, reflecting intrauterine growth retardation.
• And almost 49% of the 10 million deaths among under-five children each year in developing countries are associated with malnutrition.

As we start our deliberations, we need to keep in mind just how complex effective strategy development really is!

WHO, UNICEF and their partners, particularly in the UN system, have considerable experience in developing sound, sustainable global approaches to concrete problems that result in tangible improvements in human health and nutrition. There are numerous, and often very different, international strategic instruments, which involve widely differing political and socioeconomic forces. But the successful ones all have this in common:

• They have been carefully prepared

• They benefit from indispensable coalition and consensus building, and

• They enjoy a sense of ownership—among governments as much as among their citizen-beneficiaries.

The tangible results are here with us today—for all to see and profit from.

It is important that we proceed as part of a careful step-by-step process leading to the development of a systematic, consensus-driven global strategy for infant and young child feeding.

• As the next step, I will inform the forthcoming World Health Assembly of the outcome of this consultation.

• I will then provide WHO’s Executive Board and the Health Assembly next year with feedback from our Member States and other interested parties on a draft global strategy for infant and young child feeding.

• In 2002, I will submit the revised draft global strategy, after consultation, to the Executive Board and the Health Assembly for discussion, endorsement and decision.

Let us go back two decades, to 1979. I wonder if you remember that 1979 was the International Year of the Child, during which WHO and UNICEF organized a major international meeting on the very topic of today’s consultation.

The preparation of an effective global strategy is a process that is dependent as much on public awareness as on political will. Today, we are being given a unique opportunity to contribute to the flow of human history in an effort to improve child nutrition and health, helping to make a purposeful and lasting difference for tomorrow’s babies and mothers.

But this will be possible only if the international community recognizes what it takes to formulate a successful global strategy—just like its successful implementation, they both depend on:

• A bottom-up approach, where countries and their citizens "own" a strategy because it is right for them—because they have been involved, from the outset, in developing and adapting it according to their specific needs. Visibility is everything; thus, we need to see coherent national policies that deal specifically with infant and young child feeding across sectors.

• All the main actors—governments and civil society combined—need to be squarely behind this process and participating positively from their unique perspective.

• An international consensus needs to be reached in the governing bodies of UNICEF and WHO, and

• International advocacy and support, which are solidly grounded in the best available scientific and epidemiological evidence, need to be provided, consistent with our two organizations’ complementary mandates.

You have been asked to participate in this consultation to help us identify the way forward. It is of course essential to build on experience, both successes and failures; but I invite you also to give free rein to your imagination and to suggest new initiatives that go beyond traditional approaches to improving infant and young child feeding.

How can we communicate better, and to the widest possible number, the importance of something that until only recently, in evolutionary terms, has been a major survival strategy for our species? How can we raise awareness worldwide? How can we make sure that people everywhere understand that breastfeeding represents nothing less than a pledge of allegiance to ourselves?

In just eight short years, the Baby-friendly Hospital Initiative has enabled more than 16 000 institutions in 171 countries to be designated "baby-friendly" according to the recognized international criteria. But there are obvious imbalances, with some countries only half-heartedly taking up the challenge—or not at all. How can we make change? And what can we do about quality assurance where the Initiative is already being applied?

During my travels in Africa and Asia, I have witnessed the extraordinary challenge that mothers everywhere in resource-poor settings face in attempting to meet their children’s feeding needs. There is no more fitting tribute to these mothers—and possibly no more suitable approach—than learning from what they do, and supporting them to do it better, in a cost-effective way with particular emphasis on timely, adequate and safe feeding.

Let us continue our focus on marketing and the forces that try to compete with Mother Nature’s market share as a source of food for our babies. But let us also find new ways to ensure that all concerned parties—including governments, nongovernmental organizations, professional groups, and food manufacturers and distributors—fulfil their agreed responsibilities. Let us also begin to pay more attention to what is going on further upstream—the larger forces in society, both traditional and modern, that sometimes lead to:

premature interruption of exclusive breastfeeding, or

permit artificial feeding, which should be the exception, to become the rule.

Then there is the painful double threat that HIV/AIDS holds for appropriate infant-feeding practices in areas of high prevalence—the threat of transmission through breastfeeding and the threat of death if a child is not breastfed. We simply must refine our collective knowledge in this vital area.

I would like to close on a brief personal reflection. During the last session of WHO’s Executive Board, I listened with a mixture of pride and admiration to a summary of the latest breastfeeding prevalence figures from Norway:

92% of mothers are breastfeeding their child at 3 months of age

80% are breastfeeding at 6 months and, long after complementary feeding has begun,

40% are still breastfeeding at 12 months!

These figures are of course due, in part, to the excellent conditions offered to working mothers. But as a Norwegian mother and grandmother, I know that there’s more to the story than this.

How is it that mothers throughout Scandinavia regularly breastfeed their babies for long periods, while in so many other industrialized countries—even where women’s participation in the labour force is modest—rates are often dismally low?

Is it only, or even mainly, because of the generous conditions offered mothers in paid employment?

Or is it as much due to the high value that society places on children getting a good start in life that these conditions are so generous?

My question, then, is this:

Before we finally decide how to make things better, are we satisfied that we really know enough about what motivates mothers’ infant-feeding choices—and the factors that sustain or undermine positive choices?

A generation ago WHO published the results of a major collaborative study on breastfeeding that began in 1975 in 7 developing and 2 industrialized countries. Perhaps the time is right for a new collaborative study that will help us build a solid evidence-based foundation for a new strategy for improving feeding practices for infants and children the world over.

I wish you every success in your deliberations. UNICEF and WHO are counting on your contribution. More to the point, so are the 130 million babies born in this world every year!