Status of formula feeding, commercial foods, trends, possible

GHG emissions

Name of the Speaker: Dr. S. K. Roy

Chairperson

Bangladesh Breastfeeding Foundation (BBF)

Name of the Country: Bangladesh

Bangladesh

Infant and Young Child Feeding (IYCF) trends in Bangladesh 1993-2007

9

46

29

86

13

45

28

90

17

4659

87

24

42

62

90

4858

71

97

363752

89

4343

7491

0

25

50

75

100P

erc

en

t

BDHS93-94

BDHS96-97

BDHS99-00

BDHS2004

CMNS2005

MICS2006

BDHS2007

Breastfeeding initiation within 1 hour of birthExclusive Breastfeeding Rate <6 monthsComplementary feeding at 6-9 monthsContinued breastfeeding at 20-23 months

IYCF Practices Indicator Status in 2005

(BDHS)Status in 2007

(BDHS)Initiation of breastfeeding within 1 hour

24% 37%

Exclusive Breastfeeding for first 6 months

42% 43%

Median Duration of Breastfeeding

32 Months 32.8 months

Bottle Feeding (< 6 mo.) 22% - <6m

27% - 6-9 m

40.4 of <2 yrs

Complementary Feeding (6 - 9 mo.)

62% 74 %

Exclusive breastfeeding rates remain stagnant in Bangladesh for last 15 years

46

45

46

42

43

40

41

42

43

44

45

46

47

1993-1994 1996-1997 1999-2000 2004 2007

EBF

Trend of nutritional status of <5 children 1996 to 2007

55

45 43

36

18

1013

16

56

48 48 46

0

10

20

30

40

50

60

BDHS 1996-97 BDHS 1999-2000 BDHS 2004 BDHS 2007

Stunting (height for age) Wasting (wt for ht) Underweight (wt for age)

BDHS 2007

BF practices in South Asia

Afghanistan

Afghanista

n

Afghanista

n

Afghanista

n

Afghanistan

Baby Friendly Hospital Initiative

• BFHI launched in 1992 in Bangladesh• Hospital policy developed by BBF and endorsed by

the Govt. in 1992• At present 499 maternity service facilities out of

650 are Baby friendly • 20,000 health care providers have been trained

on BFHI.

Implementation of the International Code

• 1984: BMS (Regulation of Marketing) Ordinance • 1990: BMS (Regulation of Marketing) Amendment

at the national assembly .• 1992: BMS importers signed MOU with MOHFW to

stop free milk supply • 1993: Director, IPHN was appointed as authorized

officer by the MOHFW for the implementation of BMS ordinance.

• 1993: An advisory committee formed for monitoring & implementation of the code.

• 1993: Directive banning BMS advertising in the media issued by the government in December

Implementation of the International Code

• 1993: MOHFW submitted a written request to M/O Commerce to include BMS in list of restricted imports SO What/// delete!

• 1997: Three milk companies sued and were fined by the court. Two companies withdrew product from market..

• 2003: External monitoring is done in 105 hospitals SO What///

• Violation of the code by the milk company still continues unfortunately in collusion with health professionals

Issues hindering optimal infant feeding in Bangladesh

Traditional beliefs /practices:

• 1. Use of prelacteal (honey, mustard oil, sugar water,

plain water)

• 2. Mixed feeding before first 6 months of age (Breast

milk with rice powder??, suzi, cows milk etc.)

• 3. beliefs that milk comes in after 3 days

Our Lacking:• Lack of support to the mother in the community• Lack of skill BF counselor

• Lack of knowledge on BF in the community

• Lack of confidence of the mother

• Lack of family support

• Lack of skilled health service provider in the hospitals

• Lack of program activities

• Lack of proper monitoring system

• Lack of fund

Out Our enemies:

• Aggressive marketing of BMS

• Tricky promotion of BMS

• Unholy allaince with policy makers

Research Findings

References Intervention Breastfeeding status at last assessment,

<6 mo

Haider et al 2000 Peer counselors, home visits up to 15 occasions including 2 in last trimester of pregnancy, 4 in month and every two weeks thereafter up to month 5.

Visit duration 20-40 minutes

Exclusive breastfeeding

Intervention-56%

Control-5%

Examples of Law violation by commercial babyfood companies

including nestle

Questions

How to break the unholy alliance between Companies and policy makers?

Nestle Organized workshop for doctors on the occasion of WBW 09

How to stop the tricky promotion of commercial baby foods?

• Distributing leaflet of Chu. Chu

Silicone Nipple ad inside the

Chu. Chu baby diaper packet

and also using a picture of a

baby with feeding bottle. Using

the slogan ‘Best choice for

your baby’ and has three

different size for the infant (for

1-3 month, 3-6 month and <6

month)

• Advertisement through TV

channels.

How to stop uncontrolled & aggressive marketing of commercial baby

foods?

• Nestle importing

and selling products

having no

registration in

Bangladesh and

does not have any

information in local

Bangla language

GHG in Bangladesh

• 40 Tons Infant formula are imported which will have to emit 612.3 tons of Carbondioxide annually.

Kind of support breastfeeding women need :

Kind of support breastfeeding women need :

1. Support with care, nutrition and information during pregnancy

2. Support at delivery to establish breastfeeding within 1 hr.

3. Follow up support/ visit for exclusive breastfeeding.

4. Crèches and nursing breaks at the work place

5. Protection & restricting Unethical Marketing and Advertising of BMS

1. Support with care, nutrition and information during pregnancy

2. Support at delivery to establish breastfeeding within 1 hr.

3. Follow up support/ visit for exclusive breastfeeding.

4. Crèches and nursing breaks at the work place

5. Protection & restricting Unethical Marketing and Advertising of BMS

Programme Challenges

• Integrating of IYCF activities in different programmes

• Skilled health services provider

• Effective communication materials

• Strategy to protect aggressive marketing of BMS

Some Examples of Poster BBF using on BMS

Powder Milk

Don’t buy illness with your hard

earned money

Powder Milk

Warning

This Product is not sterile (WHO)

Diarrhoea

Pneumonia

Dysentery, Malnutrition

Meningitis

Ear infection, Allergy

Early death

If Survive:

Diabetes & hart diseases

5 prime messages on BF

Give 3 meals and additional 2 meals everyday to the PW & LW

Give colostrum within one hour after birth

EBF from birth to 6 months (180 days) is enough for a child even

no need a drop of water

Give family food after 6 months with BF and continue BF upto 2 yrs

Continue BF & other family foods frequently when baby is sick

Thank you