Putting the Global Strategy for Infant and Young Child Feeding

into Practice for IBCLCs: Think Globally – Act Locally

Prepared byMiriam Labbok, MD, MPH, FACPM, FABM

UNICEF NYHQ

Primary References

The Global Strategy on Infant and Young Child Feeding (http://www.who.int/gb/EB_WHA/PDF/WHA55/ea5515.pdf ) pp. 4-18, 20-22.

ICDC/IBFAN. Health Workers Guide to the Code. 2003.

Contents

What is optimal infant and young child feeding? Scientific rationale and rationale for action

Programme approaches that work Basics of the Global Strategy, Guidelines

for Action: Guidelines: Nine Operational Targets Guidelines: UNICEF’s model for action

Lactation Consultants – IBCLCs: What is our role?

Optimal Infant and Young Child Feeding

Six months exclusive breastfeeding Continued breastfeeding with appropriate

complementary foods and feeding for 2 years and beyond

Related maternal nutrition and care (Birth Interval of 3 years or more)

According to the evidence, and the newly endorsed 2002 WHO/UNICEF Global Infant and Young Child Feeding Strategy

Extensive study in the last decade

SURVIVAL 1993 Ford et al. New Zealand N=485 w/cont.

EBF at discharge or in last 2 days: about 1/2 the SIDS 2001 Arifeen et al Bangladesh N=1677 prospective obs.

Compared to EBF, other patterns had 2.23-fold risk of death, 2.4 fold from ARI and 3.94 from diarrhoea

2001 Bertran et al 15 national surveys 55% of diarrhea and ARI deaths could be prevented by EBF for

at least 3 months with continued BF 2002 Coutsoudis et al South Africa

Reduces HIV transmission via breastfeeding by half

2004 Chen and Rogan USA 20% reduction in postneonatal mortality with BF

Contents

What is optimal infant and young child feeding? Scientific rationale and rationale for action

Programme approaches that work Basics of the Global Strategy, Guidelines

for Action: Guidelines: Nine Operational Targets Guidelines: UNICEF’s model for action

Lactation Consultants – IBCLCs: What is our role?

Impact of Baby-friendly in Belarus Operations Research: 16 BFH, 15 Control hospitals 17,046 mother-child pairs Findings: BFH children were

more likely to be breastfed, more likely to be exclusively breastfed at 3 months and 6 months Significantly less likely to experience GI tract infections Significantly less likely to experience eczema

Longer term impact: 2862 infants exclusively breastfed for 3 mo (with continued mixed

breastfeeding);621 infants exclusively breastfed for ≥ 6 mo. From 3 to 6 mo, weight and length gain was slightly greater in the

3-mo group but the 6-mo group had a faster length gain from 9 to 12 mo and a larger head circumference at 12 mo.

A significant reduction in gastrointestinal infection was observed during the period from 3 to 6 mo in the 6-mo group.

Kramer et al, JAMA 2001 and Am J Clin Nut 2003

Interventions that work:Progress on the Code by Year and

Number of Countries

1120 25

36

4653

0

10

20

30

40

50

60

70

80

90

1995 1998 2004

Some provisions

Law - based on Codeas minimum standard

In addition, 16 countries have drafts waiting to be adopted and 27 are working on Code implementation.

Progress on Exclusive Breastfeeding Percent Exclusive Breastfeeding and Percent Increase by Region, 1990 and 2000

We have come a long way, and We have a long way to go to achieve 60% by 2015!!

0

10

20

30

40

50

60

70

Global

EAPRO

ROSA

MEN

A

WCA/ ESA

Dev. Countries

1990

2000

+40%+48%+5%+8%+8% +17%Note: On average, TACRO, and CEE/CIS countries also experienced significant increases, however, the region’s population was covered adequately represented to estimate regional trends.

30

46

42

48

20

30

40

50

60

Urban 1990 Rural 1990 Urban 2000 Rural 2000

Pe

rce

nta

ge

Much greater increase in urban exclusive BF; higher rates in rural areas

MICS and DHS data from 29 developing countries

Exclusive Breastfeeding (< 4 mos.) By Urban/Rural, 1990-2000

How much does Breastfeeding Contribute to the Epidemic?

5000

1000

250

40

14

0 1000 2000 3000 4000 5000

Population

WRA

H+ Women

Births to HIV+

HIV+infants

HIV via BF

HIV via EBF 3

5

T0 T1 T2 T3 T4 T5

Rel

ativ

e Im

port

ance

of

Influ

ence

Pre-&Pregnancy Wks 1-2 Wks 6-8 Mo. 4-6 Mo. 7-12 >1yr

Family, Workplace and Societal pressures

Maternal ConcernsAbout Breastfeeding

Overcoming Potential Obstacles and Providing Support for Breastfeeding by Time Period

Obstetric staffPediatric Staff

Maternity Staff

Schematic of approximate number of feeding episodes needed per day, by age and by food type

0

2

4

6

8

10

Birth6m 12m

18m24m

30m36m

48m60 m

Family Food(FF)

CF:modif iedFF

BF

Young children need nearly as much protein and calcium as adults, but their stomachs are small, so they must be fed many times per day

When growth problems occur

CommonFeeding

Frequency Shortfalls

Contents

What is optimal infant and young child feeding? Scientific rationale and rationale for action

Programme approaches that work Basics of the Global Strategy,

Guidelines for Action: Guidelines: Nine Operational Targets Guidelines: UNICEF’s model for action

Lactation Consultants – IBCLCs: What is our role?

Implementing the “Global Strategy for Infant and Young Child Feeding”

(GSIYCF)

Nine Operational Targets: Four Action areas The Roles for “Concerned Parties”

What are the Nine “Operational Targets” of the Global Strategy?

Of the nine specific operational targets in the Global Strategy, the first four targets are the Innocenti Declaration reaffirmed with urgency. In brief, the operational targets call on governments for measures to establish:

1. Coordinator/Committee – Support the development of a national breastfeeding coordinator of appropriate authority and a multisectoral national breastfeeding committee.

2. BFHI – All maternity services should be enabled to fully practise the Ten Steps to Successful Breastfeeding [the Baby-friendly Hospital Initiative].

3. International Code - Support implementation of the International Code of Marketing of Breastmilk Substitutes and subsequent relevant WHA Resolutions ("the Code").

4. Maternity Protection - Be creative in supporting legislation to protect the breastfeeding rights of working women (ratification and/or implementation of the ILO Maternity Protection Convention 2000 No. 183 and Maternity Protection Recommendation 2000 No. 191).

What are the Nine “Operational Targets” of the Global Strategy?

5. Develop Policy and Programmes - Support develop, implement, monitor and evaluate a comprehensive policy on infant and young child feeding

6. Ensure multisectoral, and multiple level support for optimal breastfeeding –Build on development and other multisectoral strategies to provide consistent/complementary messages from all sectors

7. Support proper complementary foods and feeding –The preparation and content of age-appropriate complementary foods, as well as the active, frequent and responsive feeding needs should both be included in programming, while active support for breastfeeding is continued;

8. Address exceptionally difficult circumstances – 1. include infant and young child feeding in emergencies in national policies2. include special policies, guidance and support for infant feeding in areas

with HIV/AIDS

9. Enhance legislation to support the previous eight operational targets

PreviousInitiativeAreas:

InnocentiGoals

AddedInitiative

Areas:Global IYCF

Strategy

1. LEGAL(Protection)

2. HEALTH SYSTEM(Support)

3. FAMILY/COMMUNITY/

SOCIETY(Protection, Support and Promotion of Normative Behaviours -- Optimal

Breastfeeding, Complementary Feeding, micronutrients, especially iron, related maternal

nutrition, and birth delay and spacing)

1. MultisectoralNational

Committee

OngoingThreat to

Sustainability

CommercialSector

Marketing

4. CROSS-CUTTING:

HIV/IFEMERGENCIES

M&E

Given these targets, what actions should be taken?First: Advocacy and SensitisationThen: Checklists, Action Steps and Reference Materials to support countries to carry out the four key action areas to implement the Global Strategy: 1. Build Multisectoral National Policy and

Commitment

2. Create Mother and Baby-friendly Care through Health Services and Training Reform

3. Support Community/ Communications/ Social Advocacy

4. Ensure Crosscutting Programming Issues and Needs are considered in all IYCFC activities (e.g., HIV/Infant Feeding and Emergencies.)

Contents

What is optimal infant and young child feeding? Scientific rationale and rationale for action

Programme approaches that work: Basics of the Global Strategy, Guidelines for Action: Introductory Considerations Guidelines: Nine Operational Targets Guidelines: UNICEF’s model for action

Lactation Consultants – IBCLCs: What is our role?

The Global Strategy Outlines the Role for “Concerned Parties”

“Concerned Parties” (CPs) are groups that have an important role in: advocating the rights of women and children and creating a supportive environment on their behalf

CPs can help to remove both cultural and practical barriers to appropriate infant and young child feeding practices.

These include Health Professional Bodies and NGOs

Main Responsibilities of Health Professional Bodies

1. Ensuring that basic education and training for all health workers cover: 1. lactation physiology, 2. exclusive and continued breastfeeding, 3. complementary feeding, 4. feeding in difficult circumstances, 5. meeting the nutritional needs of infants who have to be fed

on breastmilk substitutes, and 6. the International Code of Marketing of Breast-milk

Substitutes and the legislation and other measures adopted to give effect to it and to subsequent relevant Health Assembly resolutions;

Main Responsibilities of Health Professional Bodies

2. Training in how to provide skilled support for exclusive and continued breastfeeding, and appropriate complementary feeding;

3. Promoting achievement and maintenance of “baby-friendly” status;

4. Observing, in their entirety, their responsibilities under the International Code of Marketing of Breast-milk Substitutes ;

5. Encouraging the establishment and recognition of community support groups and referring mothers to them.

Main Responsibilities of Nongovernmental Organizations

1. providing their members accurate, up-to-date information about infant and young child feeding;

2. integrating skilled support for infant and young child feeding in community-based interventions and ensuring effective linkages with the health care system;

3. contributing to the creation of mother- and child-friendly communities and workplaces that routinely support appropriate infant and young child feeding;

4. working for full implementation of the principles and aim of the International Code of Marketing of Breast-milk Substitutes and subsequent relevant Health Assembly resolutions.

Main Responsibilities of Parents, Caregivers, and the Community

Most directly responsible for feeding children; Ensure that they have accurate information to make

appropriate feeding choices; Additional sources of information and support are

found in a variety of formal and informal groups, including breastfeeding-support and child-care networks, clubs and religious associations.

Community- based support, including that provided by other mothers, lay and peer breastfeeding counsellors and certified lactation consultants, can effectively enable women to feed their children appropriately.

Most communities have self-help traditions that could readily serve as a base for building or expanding suitable support systems to help families in this regard.

What is the Role of the Lactation Consultant?

Counsellor and Support Interpretation of Status Remediation Follow-up Risk reduction/Primary and

Secondary Prevention Policy-maker Bio-Ethicist Influential for Social Change International Advocate “Above all else, do no harm”

What is the Role of the Lactation Consultant concerning the GSIYCF?

Ensure that the latest understanding of the evidence is considered

Be an Evidence-based Advocate Apply the Principles in your work Encourage Policy Change in every

setting Be Influential for Social Change You are a Local, National and

International Advocate Do your Job! “Above all else, do no harm”

Thank you!!!

Muchas Gracias!!!

Merci!!!

Cпасибо!!!

Danke!!!

Salamat po!!!

Arigato!!!

Shokhrun!!! Parakalofi!!!

Scheh-scheh!!!