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Protecting, promoting and
supporting breastfeeding By France Bégin, Ph.D.
UNICEF Nutrition NYHQ
Breastfeeding Seminar The TOPS Program
9-11 May 2017
The Science Prevalence of breastfeeding practices Enabling environment Community support Improving breastfeeding counselling Examples from selected countries Challenges Breastfeeding Advocacy Initiative Conclusions
OUTLINE
Prevent 800,000 child deaths annually
Significantly reduce neonatal mortality
Protect infants against deadly infectious diseases
Support brain development and increase IQ
Help prevent childhood overweight and obesity
Protect women against breast and ovarian cancers
Be environment-friendly
Reduce health care costs
What would you do if something could…?
Improving breastfeeding would…
87% of them among infants less than 6 months of age
Reduce infection-related mortality (<3mo) by 88%
More than 54% of all diarrhea episodes And 32% of all respiratory infections prevented (in LMICs)
annually save lives of about 820,000 children U5
have a profound effect on common illnesses
Breastfeeding protects health and contributes to development
Breastfeeding also protects against: • Childhood obesity and type 2 diabetes Reduces risks of breast and ovarian cancers
Longer breastfeeding associated with higher performance on intelligence tests • Average of 3 IQ points, controlling for maternal IQ • Improved academic performance (some studies) • Increased adult earnings
Globally, less than half of all newborns are put to the breast within one hour of birth
Source: UNICEF global databases, 2016
Globally, just over two out of five infants are exclusively breastfed
Source: UNICEF global databases, 2016
Source: UNICEF global databases, 2016
The rate of exclusive breastfeeding declines steadily throughout the 0-5 month period in all regions
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Per cent of infants aged 0-5 months receiving breastmilk only, breastmilk and plain water, breastmilk and non-milk liquids, breastmilk and other milk/formula, breastmilk and complementary foods and no breastmilk, by region, 2016*
No breastmilk
Breastmilk and complementary foods
Breastmilk and other milk/formula
Breastmilk and non-milk liquids
Breastmilk and plain water
Breastmilk only
Source: UNICEF global databases, 2016
Globally, less than half of children are still breastfed at 2 years
Per cent of children 12-15 months of age who are breastfed, 2015t
Per cent of children 20-23 months of age who are breastfed, 2015t
Rapid progress is possible
Increase in percentage of exclusively breastfed infants <6m
0
20
40
60
80
Niger (4) SierreLeone (5)
Kazakhstan(4)
BurkinaFaso (3)
State ofPalestine
(4)
Sudan (4) Kenya (5)
Baseline2005-09
Most recent2010-14
What can be done to have a world where all women are empowered and supported to breastfeed???
UNICEF for every child
Enabling environment – adequate national laws and policies
International Code of Marketing of Breastmilk Substitutes (BMS)
• Protects women from misinformation by prohibiting all advertising an promotion of BMS
• Prohibits the use of the health care system to promote BMS
National quality standards reflect baby-friendly standards
Maternity protection
UNICEF for every child
DRAFT Overview of monitoring and enforcement actions in UNICEF programme countries
NutriDash findings confirm that monitoring and enforcement of the Code are very weak
Enabling environment – Baby-friendly health facilities
• 10 Steps to Successful Breastfeeding • Recent systematic review (58 studies from 19
countries) shows positive impact of the 10 Steps on BF rates*
• Need to integrate into national policies and quality standards
• BFHI Guidance currently under revision
* Pérez-Escamilla, R., Martinez, J. L., and Segura-Pérez, S. (2016) Impact of the Baby-friendly Hospital Initiative on breastfeeding and child health outcomes: a systematic review. Maternal & Child Nutrition, 12: 402–417.
UNICEF for every child
Source: UNICEF global databases, 2016
Skilled birth attendants can provide vital support for early initiation – we need to seize this opportunity
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* Per cent of newborns put to the breast within one hour of birth by birth delivery attendant, by region, 2015
Skilled birth attendant (e.g., doctor, nurse, midwife)
Untraditional birth attendant (e.g. traditional) or others (e.g., relatives) t
Marginally higher rates with skilled attendants
Marginally higher rates with unskilled/other
Rates about the same/no comparison available
Community support
Peer-to-peer support group
Mothers’ support group
Community mobilization
Use of mobile technology
UNICEF for every child
Improving Breastfeeding counselling
• Greatest improvements in breastfeeding rates seen when counselling or education delivered in a combination of settings by involving health systems, home and family and the community environment concurrently.*
• Several issues related to breastfeeding counselling and support not addressed as specific recommendations in guidelines
• Guideline development on counselling and support for breastfeeding (WHO-UNICEF consultation, May 2017)
• Use of innovative technologies/videos
* Sinha B. Interventions to Improve Breastfeeding Outcomes: Systematic Review and Meta Analysis. Acta Paediatrica. 2015
GETTING THE WORD OUT IN THE MEDIA
“UN supports "brelfies" to encourage breastfeeding”
“New Mothers, Get Babies to the Breast Faster, UNICEF Says”
“More than half of newborns not breastfed in first hour raising health risks – UNICEF”
“77 million newborns globally not breastfed within first hour of life: UNICEF”
“Uno de cada dos bebés no toman leche materna al nacer”
“Lagging Worldwide Breastfeeding Rates Keep Newborn Lives At Risk”
“Delaying Breastfeeding At Birth Increases Risk Of Newborn Death By 80%: UN” (highly cited article)
“Les selfies d’allaitement maternel plébiscités par les Nations unies”
“Le lait maternel, « premier vaccin des nouveau-nés », selon l’Unicef”
“UNICEF Promosikan 'Brelfie', Dukung Menyusui di Ruang Publik”
“How Important Is Breastfeeding An Hour After Birth? 6 Facts Revealed In New UNICEF Study”
“Babies breastfed within an hour of birth are less likely to die. Yet only 50% are”
Communication for behavior and social change Example from Alive & Thrive projects
Interpersonal communication and mass communication had a combined and mutually
reinforcing impact
Investments in effective legislation, community-based promotion and communication strategies, and the provision of skilled counselling and support at scale led to: Significant increase in national EBF rates in Burkina
Faso, Guinea Bissau, Kenya, Timor Leste and Zambia Increased Early Initiation rates in Cambodia, India,
Rwanda, Serbia, etc. Ongoing efforts Nigeria c-IYCF counseling package (GoN, USAID- SPRING,
UNICEF)
UNICEF for every child
Examples from selected countries
Lack of political commitment and investment Lack of unified voice Fragmented programs Alignment of BF data with standard global
indicators; frequency of surveys Pressure from infant formula companies Emergency situations
Challenges
Our vision: a world where all women & families are empowered & supported to breastfeed
BREASTFEEDING ADVOCACY INITIATIVE
• Foster leadership and alliances and effectively integrate and communicate BF messages
• Mobilize resources and promote accountability
• Build knowledge and evidence
Breastfeeding Advocacy Initiative Strategic Goals
BREASTFEEDING ADVOCACY INITIATIVE
Call to Action - 7 Policy Asks 1/2
BREASTFEEDING ADVOCACY INITIATIVE
1. Increase funding to reach the 2025 WHA global target: raise the rate of exclusive breastfeeding in the first six months to at least 50 per cent.
2. Fully implement the International Code of Marketing of Breastmilk Substitutes and relevant World Health Assembly resolutions, through strong legal measures that are monitored, free from commercial influence, and enforced.
3. Enact family leave and workplace breastfeeding policies building on the International Labour Organization’s maternity protection guidelines, including provisions for the informal sector.
Call to Action – 7 Policy Asks 2/2
BREASTFEEDING ADVOCACY INITIATIVE
4. Implement the Ten Steps to Successful Breastfeeding in maternity facilities, including providing breastmilk for sick and vulnerable newborns.
5. Improve access to skilled lactation counselling as part of comprehensive breastfeeding policies and programmes in health facilities.
6. Strengthen links between health facilities and communities, and encourage community networks that protect, promote, and support breastfeeding.
7. Create monitoring systems that track the progress of policies, programmes, and funding towards achieving both national and global breastfeeding targets.
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Breastfeeding provides substantial benefits for women and children in high- and low-income countries alike
Breastfeeding is a fundamental driver in achieving the SDGs and one of the smartest investments a country can make
Success is possible but it requires government leadership to make BF a policy priority, increase investment and work with communities and families.
Promoting and supporting breastfeeding is a collective societal responsibility: BAI has put forth a collective call to action with 7 policy asks to governments, donors and policy makers… Join us!
Conclusions