Breastfeeding: Global and National Commitment

1. Breastfeeding: Global and National Commitment Dr. Abhishek Ingole P.G. Community Medicine

2. Nutrition interventions around the life course Death Early initiation of breastfeeding Exclusive breastfeeding for 6 months Pregnancy Ageing Birth 7days Diet and micronutrients during pregnancy GLOBAL STRATEGIES IYCF 28 days Adequate complementary feeding 6-24 months Continued breastfeeding 1 year Adulthood 19 years 5 years Pre-pregnancy dietary advise for adolescent girls and women Adolescent dietary advise 10 years Micronutrient supplementation as necessary Energy & nutrient adequate diet School meals

3. Global and National Commitment: Key Initiatives • The Innocenti Declaration on Protection, Promotion and Support of Breastfeeding ;1990 and the Innocenti Declaration on Infant and Young Child Feeding; 2005. • Global Strategy for Infant and Young Child Feeding; 2004. • World Breastfeeding Week campaign since1992. • The Infant Milk Substitutes Act 1992 and The IMS Amendment Act; 2003 • National Guidelines for Infant And Young Child Nutrition; 2004 • The Joint Statement on Infant and Young Child Feeding; 2006

4. The Innocenti Declaration In 1990, 30 countries together with their partner organizations decided to create a global action plan to reverse the declining breastfeeding rates. A collaboration of technical staff, known as Integracy Group for Action on Breastfeeding (IGAB) with WHO, UNICEF, USAID and SIDA at the Florence meeting on 30 July- 1 Aug 1990 adopted the Innocenti Declaration on Protection, Promotion and Support of Breastfeeding.

5. Operational targets of the Innocenti Declaration • To appoint a national coordinator and a breastfeeding committee composed of representatives from relevant government departments, NGOs and associations of health professionals; • Ensure that every facility providing maternity services fully practices all the “Ten steps to successful breastfeeding” • Give effect to the principles and aim of the International Code of Marketing of Breast-milk substitutes • Enact legislation protecting breastfeeding rights of working women and establish means for its enforcement.

6. The Innocenti Declaration: Achievements • The Declaration inspired the establishment of the Baby-Friendly Hospital Initiative (BFHI) • It called on all countries to follow the Ten Steps of successful Breast-feeding to improve maternity practices • It ensured full support for mothers intending to breastfeed.

7. The Innocenti Declaration On 22nd November 2005, at the 15th anniversary of Innocenti declaration, another declaration was passed on Infant and Young Child Feeding.

8. Operational targets of the Innocenti Declaration • Develop a comprehensive policy on IYCF, in context of national policies and programmes for nutrition, RCH and poverty reduction. • Protect, promote and support exclusive breastfeeding for six months and continued breastfeeding up to two years of age or beyond. • Provide guidance on feeding infants and young children in exceptionally difficult circumstances, and on support required by mothers, families and other caregivers.

9. Global Strategy for Infant and Young Child Feeding • Jointly Developed by WHO and UNICEF in 2004 • Aims to improve - through optimal feeding - the nutritional status, growth and development, health, and thus the very survival of infants and young children. Objectives - • Improve the feeding of infants and young children • Increase the commitment of governments, civil society and international organizations.

10. Comprehensive action Steps for implementing the Strategy for IYCF in countries • Identify and orient key stakeholders and prepare for developing a comprehensive strategy • Assess and analyse local situation • Define preliminary national objectives • Identify and prioritize actions 5. Develop a national strategy and plan of action 6. Implement and monitor To develop, implement, monitor and evaluate a policy on infant and young child feeding in the context of national policies and programmes for nutrition, child and reproductive health, and poverty reduction.

11. World Breastfeeding Week • World Alliance for Breastfeeding Action (WABA) organized the WBW campaign in 1992 as their first social mobilization effort to raise awareness and stimulate action globally in support of breastfeeding. • WBW is celebrated in more than 100 countries every year from 1–7 August to mark the Innocenti’ anniversary on 1 August. • WBW has mobilized governments, ministries, civil society organizations to conduct activities in support of breastfeeding.

12. The Infant Milk Substitutes Act 1992 An Act to amend the Infant Milk Substitutes, Feeding Bottles and Infants Foods • It provides for the regulation of production, supply and distribution of infant milk substitutes, feeding bottles and infant foods • To protect and promote breastfeeding and ensure the proper use of infant foods. ‘The IMS Amendment Act 2003’ was enacted on 2nd June 2003 • It prohibits promotion of breast-milk substitute products on the pretext of distribution of educational or informational material.

13. The IMS Amendment Act 2003 • No person shall donate or distribute infant milk substitutes or feeding bottles or infant foods to anyone except to an orphanage. • All products should mention in a clean, conspicuous and easily understandable manner, the words “IMPORTANT NOTICE ” and - a) A statement - “MOTHER’s MILK IS BEST FOR YOUNG BABY ”. b) A statement that “ The product should be used only on the advice of health worker or medical personnel.” c) A warning – “ Infant milk substitutes are not the sole source of nourishment of an infant.”

14. National Guidelines for Infant And Young Child Nutrition; 2004 • Objective to achieve the nutritional goals set by planning commission of the Tenth Five Year Plan - • Initiation of Breastfeeding 15.8 % to 50% • Exclusive breastfeeding 55.2% to 80% • Complementary feeding 33.5% to 75% • To intensify nutrition and health education. • To bring down the prevalence of underweight children and malnutrition.

15. December 20, 2006 It appealed the chairperson of the planning Commission to recognize ‘Breastfeeding’ as food security for infants and include it in National Food Security Plans and make it a part of annual reporting of Government of India.

16. Breastfeeding Promotion Network of India (BPNI) • National network of organizations and individuals dedicated to protection, promotion and support of breastfeeding and optimal infant and young child feeding practices. • It was founded on 3rd Dec., 1991 at MGIMS, and is working under the National coordination of Dr. Arun Gupta, 3500 members allover India and multiple partner organizations.

17. MDG: A Commitment Breastfeeding improves short and long term maternal and child health; and thus contribute to the attainment of the Millennium Development Goals (MDGs) 4 and 5 REDUCE CHILD MORTALITY and IMPROVE MATERNAL HEALTH to achieve by 2015.

18. Prevalence of exclusive breastfeeding among children<6 months of age

19. Glaring gaps in policy and programmes of IYCF • That’s the reasons why NFHS 3 did not show very encouraging results. • India’s 6th position in South Asia puts us to shame. • Three areas of action need to be acted upon.

20. Essential Actions to promote, protect and support appropriate IYCF practices Legislation and policy Implementation Improving Health system and health worker skills Improving family and community practices

21. What works? Breastfeeding education • Good Information and skilful counselling (pregnancy, birth and later) • Assistance at birth and later • ‘Counsel’ and help to prevent sore nipples, engorgement, and solve these if they arise • ‘Counselling’ on complementary feeding • Counselling on feeding options for emergencies and special situations. Breastfeeding [IYCF] Support Centres at cluster and block level in NRHM

22. Newborn deserves the best Nutrition, Improved survival, Optimum development and a Healthy Life Breast-feeding can do this miracle!!!... Thank You!