Dr.S.Preethi (MD) Community medicineYenepoya medical College

Celebrated 1 to 7 August , > 170 countries

2015 marks the 25th Anniversary of Innocenti Declaration

WHO & UNICEF August 1990 protect, promote & support

Galvanize Promote Inform

Strengthen Engage

Every fifth young child in world lives in India

Every second child in India is malnourished

Three out of four young children in India is anemic

Every second newborn in India is at risk of reduced learning capacity

due to iodine deficiency

Exclusive breastfeeding -nursing -baby indicates desire- 6 months

Continued breastfeeding - nursing beyond six months- 2yrs 

Mixed breastfeeding -breast milk & supplements before 6 months

Formula feeding - fed with a bottle and receives only formula, cow’s milk

to specialty formulas

1981 - The Int Code of Marketing Breast-milk Substitutes

1990 - Innocenti Declaration on the Protection, Promotion and

Support of Breastfeeding

1991 - Baby-friendly Hospital Initiative

1992 - Infant Milk Substitutes Feeding Bottles, and Infant Foods

(Regulation of Production, Supply and Distribution) Act (IMS Act)

which was further amended in 2003

National Guidelines on Infant and Young Child Feeding in 2006

However , India has failed to implement both of these effectively

Health benefits of Breast milk on Infants

Lowers rate of type-2 diabetes.

Intelligence level high

Benefits for mothers

reduces risks of breast and ovarian cancer

return to their pre-pregnancy weight faster

lowers rates of obesity.

Infant formula does not contain the antibodies -linked water-borne

diseases that arise from mixing powdered formula with unsafe water

Malnutrition can result from over-diluting formula to "stretch" supplies.

'The Earth - Our Mother - is in crisis!' and 'Over 20 years of evidence has shown how infant formula production, packaging and use are adding to this crisis!'

Colostrums feeding

Exclusive breast feeding

Complementary feeding

16% to 50% 55% to 80%

34% to 75%

In India, the NFHS-3 (2005-2006 )

Only 24 % children under three years are breastfed within 1hr of birth

Only 46 percent children in the age group 0-6 months are exclusively breastfed

DLHS - 3 (District level household and facility survey) Fact Sheets 2007-

2008

Initiation of breastfeeding within one hour of birth – 40.2%

Complementary feeding along with continued breastfeeding

in 6-9 months- 23.9%.

MDG-4 (Under 5 mortality target RATE- 55/1000 LB)

Reduce by 2/3rd between 1990 and 2015

12th Five year plan IMR 40 – 25 by 2017

Assam – 83 per 1,000 live births highest under-five mortality rate

Kerala recorded lowest under-five mortality rate of – 15/1000 LB

Tamil Nadu – 27/1000 LB

Ghutti (a mixture of herbs, extracts and flavorings) Pakistan 2- 3 days

In Ethiopia, infants -boiled water and butter-protect against infection

Chinese babies are given herbal tea for the first 2-3 days.

In Mysore, India, babies are bottle-fed sugar water

In peninsular Malaysia a paste of corn flour and water is given

Certain facts Powdered milk not completely sterile, and to be mixed with hot water

Modified animal milk no longer considered adequate for milk feeds for

a baby less than 6 months old

Exclusive breastfeeding stands out as a single most effective

intervention for child survival

Ref: Arun Gupta et al (Breastfeeding and Complementary Feeding as a Public Health Intervention for Child Survival in India) Indian journal of paediatrics

Exclusive breastfeeding can cut down HIV transmission rates from

HIV positive women to their offspring by half in comparison with

those who practice mixed feeding.

Evidence-based ways to universalize optimal infant and young

child feeding (IYCF) practices

Ref: Arun Gupta et al (Breastfeeding and Complementary Feeding as a Public Health Intervention for Child Survival in India) Indian

journal of paediatrics

WHO AND UNICEF Recommends Initiation of breastfeeding within the first hour of life

Exclusive breastfeeding for the first six months of life

Breastfeeding on demand

No use of bottles, teats or pacifiers

At six months, other foods should complement breastfeeding for up

to two years or more.

Timely -need for energy and nutrients exceeds

Adequate –provide sufficient energy growing child

Safe –hygienically stored and prepared

Implemented in about 16.000 hospitals in 171 countries 

1. Written breast feeding policy

2. Train all health care staff

3. Inform all pregnant women about the benefits and management

4. Help mothers initiate breast feeding within half-an-hour of birth.

5. Show mothers how to breast feed and maintain lactation – separation

6. Give newborn infants no food or drink other than breast milk

7. Practice rooming in - 24 hours a day.

8. Encourage breast feeding on demand.

9. Give no artificial teats or dummies to breast feeding infants.

10. Foster the establishment of breast feeding support groups

The signs of poor attachment are:

More of the areola is visible below the

baby’s bottom lip than above the top lip –

or the amounts above and below are equal;

the baby’s mouth is not wide open;

the baby’s lower lip points forward or is

turned inwards;

the baby’s chin is away from the breast.

The signs of good attachment are:

more of the areola is visible above the

baby’s top lip than below the lower lip;

the baby’s mouth is wide open;

the baby’s lower lip is curled outwards;

the baby’s chin is touching or almost

touching the breast.

Cradle-hold Cross-cradle hold

Lying on your side

Football hold Laid back

150 ml per kg body weight per day, divided into 8 feeds in 24 hours

Each 100 ml of mature breast milk

• 70 calories

• 89.97 g water

• 7.4 g carbohydrates (primarily lactose)

• 4.2 g fat

• 1.3 g protein

Ref :ttp://www.parentingscience.com/calories-in-breast-milk.html#sthash.QPdQMVB6.dpuf

• Breast changes: The breasts feel fuller or firmer, or milk leaks or can be expressed

•Less supplement consumed

•Stool changes: The infant’s stools become softer, more like those of a breastfed infant

Lactogogues

Drugs used are metoclopramide (given 10 mg 3 times a day for 7–14 days) or

domperidone (given 20–40 mg 3 times a day for 7–10 days).

However, drugs help only if the woman also receives adequate help and her breasts are

fully stimulated by the infant suckling.

International code regulate marketing of breast-milk substitutes -1981

All formula labels must state benefits & breastfeeding risk substitutes

No promotion of breast-milk substitutes

No free samples of substitutes given to pregnant women

No distribution of free or subsidized substitutes to health workers

Infant conditions

Galactosemia Maple syrup urine disease Phenylketonuria <1.5 kg <32 week

Maternal conditions

HIV (AAFSS) HSV-1 Anti-epileptic drugs Topical iodine Cytotoxic drugs

Possible reasons for suboptimal breastfeeding

1.Lack of proper information to mothers

2. Lack of by the commercial industries

3. Inadequate health care support

4. Inability of the health care providers to help mothers experiencing

breastfeeding difficulty

5. No mention of BFHI in NRHM document

6. Inadequate mechanism to enforce “The Infant Milk Substitutes,

Feeding Bottles and Infant Foods (Regulation of Production,

Supply and Distribution) Act, 1992”, as amended in 2003(IMS

Act)

7. Inadequate counseling to HIV positive women regarding infant

feeding options

WHO recommends at least 16 wks of absence from work after delivery

Mothers abandon EBF before six months – no sufficient time, place to

breastfeed or express and store their milk at work.

Mothers need access to a safe, clean and private place in or near their

workplaces to continue the practice.

Express your breast milk before you go to work, and leave it for the carer to give to your baby:

Express in a relaxed way and express as much breast milk as you can

Cover the cups of expressed breast milk with a clean cloth or plate

Leave the milk in the coolest place refrigerator or freezer

You do not need to boil or reheat your breast milk

Germs do not start growing in EBM for at least 6-8 hours, even in a hot

climate, and outside the refrigerator

14 weeks of maternity leave

Paid leave (at least 2/3 of salary) and medical benefits

both paid by social security or social/health insurance

One or more breastfeeding breaks as part of working time

Health protection for pregnant and breastfeeding workers

Job protection against dismissal if pregnant or breastfeeding

Non-discrimination against hiring women of childbearing age

Inclusion of working women from the non-formal sector

Breaks can be combined at beginning or end of the working day

Where practicable, establishment of facilities for nursing under

adequate hygienic conditions at or near the workplace

Maternal absentee rates due to infant illness in two US companies

- 25% if breastfed

- 75% if artificially fed

Reduced absenteeism leads to cost savings

Providing breastfeeding support to employees results in cost

benefit

Less turnover of employees and training of new ones

Goal: To reduce IMR 44 – 25 (2017)

Objective: To Increase the EBF rate by educating and enabling lactating

mothers to breast feed at their workplace

Strategies:

1. Paid maternity and breast feeding breaks

2. Shorter working days and flexible working hours

3. Crèches at workplace

4. Home caregivers brings baby to work for feeds

5. In all these cases, regular communication between mother,

employer and trade union

Pilot study: FGD among working women to get inputs on how to

make the working place atmosphere friendly to breast feed their

babies.

1. Neonatal Integrated comprehensive approach ( Neonatal care

and breast feeding education)

2. Intersectorial Co-ordination of existing infrastructures

3. Political commitment

4. Implementation of 2003 IMS Act strictly by making the

existing laws more stringent

5. Baby Friendly Hospital Initiative

6. Operational research for evidence based interventions

7. Infant during emergencies

8. Health and nutrition care

9. Develop a network of support at work

10. A realistic timeline for their achievement,

and measurable process and output indicators that will permit an

accurate monitoring and evaluation

Accessibility Indicators:

No: of crèches in different Govt and private sectors in the city

No: of breastfeeding supporting groups in the city

Percentage of breast feeding clinics in the city

Quality Indicators:

Rate of EBF under 6-months

Rate of complementary feeding at one yr of age

Rate of early initiation of breastfeeding in the last 24 months

Rate of lactating women getting absent at workplace

Impact indicators:

Prevalence of IMR, Under-5 MR

Breastfeed exclusively and frequently for the whole maternity leave

Learn to express your breast milk soon after your baby is born

Avoid starting other ways of feeding before you really need to

Continue to breastfeed at night, in the early morning, and at any

other time that you are at home.

Breastfeed your baby after you have expressed

use the formula within 2 hours, and then throw away any left

over or feed it to an older child.

Teach the carer properly and carefully

While you are at work express your breast milk 2-3 times each

workday (about 3 hourly)

8-hour work period

8:00 a.m. Begin work

9:45-10:00 Use break to express milk

12:00 noon Take allowed lunch period to express milk

2:30-2:45 Use break to express milk

5:00 p.m. Leave work

Bhalwar R. Text Book of Public Health and Community Medicine. 1st ed. Pune: Dept of Community Medicine, AFMC. 2009. Pp 750-60.

Park.K. Text Book of Preventive and Social Medicine.22nd ed. Jabalpur: M/S. Banarasidas Bhonot Publishers;2013.Pp 480-523.

Women and work manual. Availabe from: http://uhs.berkeley.edu/Facstaff/pdf/healthmatters/Breastfeeding%20and%20Working%20from%20WomensHealth.pdf. Last retrieved on 22nd July 2015.