Multi-country study to map national legal measures related to complementary feeding and assess their alignment to global guidance and explore the nutritional suitability and appropriateness of labelling among common commercially produced complementary foods (CPCF) in selected countries in Latin America and the Caribbean.
BACKGROUND AND CONTEXT
Early childhood, especially between conception and the first three years of life, is a critical period where 80 percent of brain development occurs, paving the way for adequate development, growth, and well-being. Adequate nutrition during this period is essential: while breastfeeding supports healthy growth and brain development, protects against infections, and promotes bonding and cognitive stimulation, adequate complementary feeding is a unique nurturing opportunity to provide infants and young children with foods, in addition to breastmilk, that are frequent and diverse, which contain the micronutrients they need for the rapid growth of their body and brain, and offer them in a loving and patient way while responding to their hunger and satiety cues. Adequate nutrition in early childhood contributes to progress towards Sustainable Development Goal 2, especially target 2.1 (ending hunger and ensuring access to safe, nutritious, and sufficient food all year round in particular the poor and people in vulnerable situations, including infants under 1 year of age) but also contributes to SDG target 3.4 (reduce premature mortality from NCDs) given that the first years are crucial to establish dietary habits.
UNICEF and WHO recommend that children under the age of 5 (6-59 months of age) consume foods from at least five of the eight food groups, which is known as the minimum dietary diversity
. Children live in child food poverty when they do not meet this minimum, and this is particularly damaging as insufficient dietary intake of essential nutrients can cause the greatest harm to child survival, physical growth, and cognitive development. In the Latin America and the Caribbean (LAC) region, 38 percent of children under 5 live in child food poverty, and 21 percent do not consume fruits and vegetables. As such, only 62 percent consume foods from at least five of eight food groups: Costa Rica, Peru and Bolivia are at the top of the list of countries with the highest percentages (76 percent, 74 percent, and 71 percent, respectively), while Guyana, Suriname and Haiti are at the bottom of the list (40 percent, 28 percent, and 19 percent, respectively).
The inappropriate feeding of infants and children in early childhood is one of the main causes of malnutrition in all its forms. Stunting, wasting, and micronutrient deficiencies appear when foods are not provided at the adequate frequency, quantity, and with the adequate diversity and interaction. At the same time, overweight rises when children in early childhood consume foods with high sugar, salt, or fat content, which predispose them to prefer less healthy foods later on. The consumption of ultra processed foods is one of the main causes of micronutrient deficiencies this age group. In LAC, stunting, wasting and overweight reach 11.5 percent, 1.4 percent and 8.6 percent respectively.
In LAC, rapid urbanization has changed food availability and food practices leading to many families changing traditional diets for processed and ultra processed foods. Obesogenic food environments, that favor the availability and consumption of ultra processed foods high in sugar, saturated, trans fats and salt, and are low in essential nutrients and fiber, are prevalent in urban areas, especially the most vulnerable and socially and economically disadvantaged. At the same time, the availability of commercially produced complementary foods (CPCF) has increased in the last few years globally and while some types of these products -specifically appropriately formulated, fortified cereals/porridges - can be an important source of micronutrients for infants and young children in some contexts, there is also great concern about the damage that CPCF may cause during the first years of life: they can contribute to all forms of malnutrition displacing other nutrient dense foods, may shape their preferences and eating habits throughout their lives, and predispose children to suffer from diet-related non-communicable diseases.
Packaging, labelling, and promotion/advertising of these products can contribute to families’ dependence on these products to the detriment of homemade foods. Changing food environments and other factors, including parental labor situations, prompt caregivers worldwide to buy CPCF – such as infant cereals, purées, pouches, snacks, and ready-to-eat meals.
Globally, CPCF nutrient composition and promotion and labelling requirements are provided by Codex Alimentarius and the World Health Organization (WHO), including the World Health Assembly Resolution 69.9. However, in LAC, the suitability of CPCF in terms of promotion (nutritional profile and labeling) against recommended standards and the existence and content of national policies, standards and legislation for CPCF in the region are largely unknown.
Building on the COMMIT study conducted in East Asia and The Pacific, the UNICEF Regional Office for Latin America and the Caribbean (UNICEF LACRO) aims to address these knowledge gaps.
OBJECTIVES & SCOPE OF WORK
Objectives
Under the overall guidance of the Regional Nutrition Specialists of UNICEF Regional Office of Latin America and the Caribbean, the institution will:
• Determine alignment of available national legal measures relevant to CPCF in LAC against international standards and guidelines on CPCF nutrient composition and labelling requirements.
• Determine if CPCF in LAC currently on the market in selected countries are in line with international standards for promotion based on their nutrient composition and labelling practices.
Scope of work
The institution will work closely with the Regional Nutrition Specialist and in collaboration with relevant LACRO and HQ team members, and relevant UNICEF Country Office colleagues, to conduct the following tasks:
1. Develop a research/study protocol and workplan: This study has two research components:
a. Component 1) regional mapping of national legal measures for CPCF (mandatory and voluntary) and assessment of their alignment against international standards and guidelines on CPCF nutrient composition and labelling requirements. The research/study protocol should include a) legal and policy desk review, b) identification and/or adaptation of existing regional and global standards to LAC as needed to establish which exact standards alignment will be assessed against (e.g. adaptation of the WHO Europe NPPM to LAC). Also refer to section 3; and c) methodology for identification of the legal measures, data extraction and analysis in coordination with UNICEF Country Offices, including suggestions for involvement of national stakeholders.
b. Component 2) benchmark CPCF currently on the market in two selected LAC countries against international standards and guidelines on CPCF nutrient composition and labelling requirements to determine their suitability for promotion. The research/study protocol should include a) desk review, b) identification and adaptation of existing regional and global standards to LAC, as needed (i.e. adaptation of the WHO Europe NPPM to LAC). Also refer to section 3; and c) field research in at least 2 countries (to be identified with UNICEF LACRO), including methodology for store sampling, CPCF sampling strategy (identification and selection/purchasing) and data management and analysis in coordination with UNICEF Country Offices, including suggestions for involvement of national stakeholders.
The study protocol (approximately 15 pages) should include title, introduction, research objectives, ethical considerations, data collection, management and analysis methodology, data collection tools (including local/cultural adaptation), references, workplan, timeline, etc. This should include the review of existing assessment tools. The study protocol will be reviewed by UNICEF LACRO and Headquarters and the research team must make changes accordingly.
2. Ethical approval: The research team must prepare the documentation for UNICEF to submit the research/study protocol for ethics committee(s) review and approval.
3. Adaptation of available global standards and recommendations to LAC. Conduct an inventory of global and regional standards relevant to nutrient composition and labeling of CPCF from WHO and the Codex Alimentarius and propose an adaptation for the LAC region of the Nutrient and Promotion Profile Model (similar to the one developed for the WHO European Region17), i.e. an adapted nutrient and promotion profiling model for LAC. The national legal measures, and the nutrient composition and labelling of CPCF will be evaluated against relevant requirements by comparing/benchmarking them against this adapted version. Adaptations should include comprehensive definitions of claims made in front-of-pack labeling (e.g. octagons) in LAC.
4. Regional Desk Review and policy mapping:
Component 1: Regional legal and policy desk review consisting of legal measures including national policies, standards and legislation regulating the nutrient composition and/or labelling requirements specific to CPCF or applicable to all foods, including CPCF, in all LAC countries. This includes national and regional nutrient profile models, standards, and recommendations of nutrient composition and labeling.
Component 2: Regional review of existing documentation, reports, national surveys, scientific articles, and other publications, focusing on the LAC region as much as possible, regarding:
a. Commonly used CPCF promoted as suitable for infants and young children aged below 36 months in LAC;
b. CPCF nutrient content and their nutritional suitability;
c. Labeling of CPCF and appropriateness of labeling and claims;
d. Marketing practices and how this influence parents/caregiver’s consumer behavior, including packaging, promotion/advertising;
e. Data on consumption of CPCF by children aged below 36 months and analysis in relation to diet and nutrition indicators to strengthen evidence related to drivers and on why it is important to take action in improving quality of CPCF;
f. Consumer perceptions and choice of CPCF.
The analysis of the regional desk review and policy mapping should include alignment of available national legal measures relevant to CPCF in LAC against standards and guidance on CPCF nutrient composition and labelling requirements, i.e. Nutrient and Promotion profile model adapted to the LAC region (activity 7 component 1). Key recommendations should be proposed based on initial findings.
5. Field Research and data collection in 2 countries in LAC selected in collaboration with UNICEF LACRO (for Component 2); please consider for your proposal, as a reference of the 2 potential countries, Mexico and Argentina (the final choice of countries will be done at the beginning of the contract).
This includes travel and accommodation costs to 2 LAC countries (to be decided), purchasing CPCF and data capturing (photography and scanning etc.)
a. Identify large and small retail outlets and select main stores based on the story sampling strategy.
b. Conduct an inventory of CPCF available for sale in physical stores.
c. Capture nutrient content and labeling practices of the CPCF identified.
Given the time limit to conduct the study it must end by December 2025, activities 3, 4 and 5 should be started simultaneously, while completing component 3 first. The three activities will be needed to conduct components 6 and 7.
6. Data management: Use relevant data management techniques and tools (e.g. using the ONA Data app (https://ona.io/home/products/ona-data/features/) to facilitate data entry (categorization, double data verification etc.). All databases/datasets accompanying each deliverable should be shared with UNICEF.
7. Analyse the data collected using adequate tools for analysis to allow the comparison of the nutrient content and labeling with the adapted standards to LAC to assess the suitability of CPCF for promotion of infants and young children aged 6 to 36 months (see point 3). As part of the analysis, include:
Component 1:
a. Assessment of alignment of legal measures in LAC against guidance on CPCF nutrient composition and labelling requirements against the Nutrient and Promotion profile model adapted to the LAC region;
b. determining the proportion of legal measures meeting standards and guidelines on nutrient composition and labelling.
Component 2:
a. Assessment of alignment of CPCF in two LAC countries against standards and guidance on CPCF nutrient composition and labelling requirements (i.e. against the Nutrient and Promotion profile model adapted to the LAC region);
b. determining the proportion of CPCF meeting standards and guidelines on nutrient composition and labelling;
c. identifying the proportion of CPCF that would require a warning labels (e.g. high in sugar).
8. Draft report with key findings and recommendations and finalize it after receiving inputs from UNICEF.
9. Final report of the project (approximately 45 pages) including executive summary, keywords, introduction, methodology, ethical considerations, results, conclusions, discussion, recommendations at regional and country levels, acknowledgements, author’s contribution, declaration of conflict of interest, references (following UNICEF’S guidelines for publications). In addition, include recommendations based on the study results. It also includes support and follow up during translation and publication of the report.
10. Policy briefs: Develop two regional policy briefs with a summary of the findings and recommendations, one per research component (approximately 8 pages each). The research team will provide support and follow-up during the translation and publication process.
11. PowerPoint Presentation: Develop a PowerPoint presentation with a summary of the findings and recommendations. The research team will provide support and follow-up during the translation and finalization process.
12. Dissemination activities: Support the dissemination and presentation of the findings in relevant fora and events at regional and country levels.
13. Follow up and reporting: The research team will engage in regular meetings with the UNICEF LACRO team, in collaboration with HQ colleagues, to provide updates on the study's progress and to collaboratively assess and refine the research approach as needed.
14. Manuscript submission for publication in scientific journal, scientific publications in English. Follow-up to comments and recommendations during publication process.
