1 National Policy, Programme and Coordination
In 1990 one of the Innocenti Declaration targets was for countries to appoint a national breastfeeding coordinator.
Countries which did this made much faster progress with the BFHI. The Global Strategy
requires all countries to have a comprehensive policy on IYCF. Countries without a policy find it difficult to make consistent progress. Having a policy and a coordinator to ensure implementation helps a country move ahead much more effectively.
(See http://www.who.int/nutrition/topics/global_strategy/en/ )
2 Baby Friendly Initiative (BFHI)
A Baby Friendly hospital implements all the ‘Ten Steps to Successful Breastfeeding’ (see http://www.unicef.org/newsline/tenstps.htm
), the second Innocenti Declaration target, and follows The Code by not accepting free or subsidized supplies of infant formula, or any promotional items. All staff have breastfeeding training, and the hospital is assessed regularly to ensure the standards are followed. All mothers and babies in a Baby-Friendly hospital are holistically cared for in a way which supports breastfeeding. This gives the best chance of successful breastfeeding. The Baby Friendly Initiative also includes establishment and fostering of community outreach support for breastfeeding mothers. Breastfeeding rates have been shown to be higher among babies born in Baby-Friendly hospitals than among babies born in other hospitals. More than 20,000 hospitals world-wide have achieved Baby Friendly status.
3 The International Code
The devastating effects of bottlefeeding, aggressive marketing of breastmilk substitutes by manufacturers, and general decline in breastfeeding caused great concern and motivated a movement to raise the alarm.In 1981 it led to the World Health Assembly’s adoption of the International Code of Marketing of Breastmilk Substitutes
(also known as the Code). The aim of the Code is to protect and promote breastfeeding, and help provide for safe adequate nutrition for infants by regulating all marketing of breastmilk substitutes. Subsequent World Health Assembly Resolutions
have clarified and strengthened the Code. The resolutions have the same status and are included within it. A notable problem continues to be the lack of motivation and skill to support mothers to breastfeed, in light of competition from well funded, often aggressive, marketing of breastmilk substitutes and other products. Clever slogans, striking images, giving free samples or supplies, and many attractive gifts have been used to persuade mothers, health professionals and health workers that bottle feeding is as good as breastfeeding. Both the Innocenti Declaration
and the Global Strategy
stress the need for countries to restrain infant formula manufacturers from aggressively marketing and promoting their products by adopting and implementing the Code. To be really effective, the provisions of the Code need to be fully enforced by being enacted in national legislation.
4 Maternity Protection in the Workplace
One of the most common reasons mothers give for stopping breastfeeding is their return to paid employment. Many countries are working towards laws to enable mothers to have paid maternity leave for exclusively breastfeeding for 6 months.Support to continue exclusive breastfeeding, for example, by provision of a workplace crèche, a room for private expression, and paid breaks during working hours would help.
5 Health and Nutrition Care System
This covers all health workers, clinics, doctors, hospital inpatient / outpatient services and nutrition services for mothers and babies on discharge from the maternity hospital. Babies born in Baby Friendly hospitals are more likely to start breastfeeding. Mothers need ongoing skilled breastfeeding support from midwives, lactation consultants, community health workers, or appropriately trained peer counsellors to enable exclusive breastfeeding for 6months. Where all mothers receive at least 7 skilled support/counselling contacts exclusive breastfeeding rates are higher. (1)
Support is necessary for all mothersto ensure breastfeeding is going well.
(1). Britton et al, Cochrane Review 2009. ‘Support for Breastfeeding Mothers (Review)’.See http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001141.pub3/pdf/standard (Accessed on 15 June 2012).
6 Mother Support and Community Outreach
The first mother-to-mother support groups were started more than 50 years ago, by a small group of American women who felt that support from doctors and health workers was insufficient. Mothers found that they could help each other more effectively. Mother support groups have now spread worldwide working in different ways in different places. Mothers share experiences andfind solutions for their difficulties.
7 Infant Feeding and HIV
In the early 1990’s, doctors discovered that HIV was transmitted from mothers to their babies during both pregnancy and breastfeeding. For 20 years, health services and families struggled with the dilemma of how to feed the baby born to an HIV infected mother. Research has shown that if a baby is exclusively breastfed, transmission is less likely than if the baby is mixed fed (partly breastmilk and other milks). The choice was between exclusive formula feeding or exclusive breastfeeding.It has been shown that antiretroviral (ARV) drugs given to the mother and the baby can reduce transmission to a very low rate even if the baby is breastfed. In many countries,where formula feeding is difficult or dangerous, mothers can be treated with ARV drugs, and encouraged to breastfeed exclusively to six months, and to continue breastfeeding with complementary feeding for 12months, or until they are able to provide a nutritionally adequate and safe diet.(2)
(2). WHO Guidelines on HIV and infant feeding 2010. See WHO Website:http://www.who.int/maternal_child_adolescent/documents/9789241599535/en/ (Accessed on 15 June 2012).
8 Infant Feeding During Emergencies
The number of people and babies affected by emergencies today has more than tripled since the 1990s. Often the first help offered by the outside world is formula and feeding bottles.It is difficult to use these safely in emergencies. It is preferable to support mothers to breastfeed. Humanitarian aid workers need training in basic support and relactation skills for breastfeeding mothers and foster mothers. Countries are encouraged to establish emergency preparedness arrangements, including listing lactation counsellors available to respond to emergency situations to support aid workers caring for babies. Disasters and emergency situations can happen in any country; the best preparation is good breastfeeding practices!
9 Information Support
In order to make informed choices about breastfeeding, it is vital that mothers have accurate, appropriate and sufficient information. Groups advocating promotion, protection and support of breastfeeding need to provide accurate information, to educate and communicate on breastfeeding issues.This needs development of strategies at national and government level for Information, Education and Communication (IEC). These IEC strategies are essential to change attitudes influenced by the formula industry, or cultural and traditional practises, that affect decisions at the community and household levels. Comprehensive IEC strategies use a wide variety of media to convey concise, consistent, appropriate, action oriented messages to targeted audiences at all levels.
10 Monitoring and Evaluation
All health programmes should be monitored and evaluated, so that they can be assessed and improved. If you are a health professional, you could assess if activities related to the above areas are being recorded as part of your monitoring and evaluation e.g. if mothers receive breastfeeding counselling, is it recorded and reported anywhere in the patient records?
The UK WBTi Working Group would like to thank WABA and IBFAN Asia for permission to use material from the World Breastfeeding Week 2012 Action Folder and Insert and from the World Breastfeeding Trends Initiative website.