Post on 30-Dec-2015
How IMS Act implementation can bring down IMR in Karnataka
State?
Dr Arun Gupta MD
Member, PM’s Council on India Nutrition ChallengesCo-Chair Global Council International Baby Food Action
Network(IBFAN) and Regional Coordinator Asia
........“Inappropriate feeding practices lead to infant malnutrition, morbidity and mortality in our children. Promotion of infant milk substitutes and related products like feeding bottles and teats do constitute a health hazard. Promotion of infant milk substitutes and related products has been more pervasive and extensive than the dissemination of information concerning the advantages of mother’s milk and breastfeeding and contributes to decline in breastfeeding. In the absence of strong interventions designed to protect, promote and support breastfeeding, this decline can assume dangerous proportions subjecting millions of infants to greater risks of infections, malnutrition and death………”
Sh. Arjun SinghSh. Arjun SinghMinister of Human Resource Development while introducing Minister of Human Resource Development while introducing the Bill read out the Statement of objecives in the the Bill read out the Statement of objecives in the ParliamentParliament
The criticality of feeding practices is not just children are vulnerable , this time their brain develops very fast.
Years of life
Brain development
Underweight (-2sd) NFHS-3
Over 60 million
1.35 million die
by 5 years,
1. million
during first year
First Year is Critical!
India enacted a Law in 1992India enacted a Law in 1992
1992:Bill 41 of 1992 was enacted
“Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992’(IMS Act)
It was strengthened by an Amendment in 2003 Cable TV networks Act in 2000 banned all TV ads All Parties supported it. ACASH and BPNI gazetted as NGOs
Guidelines on Infant & Young Child FeedingGuidelines on Infant & Young Child Feeding
Breastfeeding Saves LivesBreastfeeding Saves Lives!!Risk
of
Mor
tality
National Norms of infant and young child feeding
• Initiation of breastfeeding within one hour of birth
• Exclusive breastfeeding for the first six months
• Timely and appropriate complementary feeding after six months along with continued breastfeeding till 2 years or beyond
Lancet Child Survival Series,2003, Jones G et al. Indian J Pediatr 2006
U-5 Child deaths (%) saved by universalising key interventions in
India
Impact of NOT Following Recommended Norms
Deaths attributed to sub-optimal breastfeeding Public Health Nutr. 2006 Sep; 9(6): 673-85
10
Impact of Following Recommended Norms
Protective effect on non-communicable diseases ◦Obesity◦Diabetes ◦high systolic blood
pressureIncreased performance
in intelligence tests 11
Child Feeding Practices-KarnatakaChild Feeding Practices-Karnataka
Routine maternity practices in Routine maternity practices in medical college hospitals medical college hospitals
Facilitating factors
Evidence based advocacyPolitical willLegislations to protect from commercial sector, Legislation for Maternity protectionWorkforce training Implementation at facility and community levelCommunication campaignsResearchMonitoring and evaluationCoordination and multi-sector engagement (Advances in Nutrition 3, 790-800, 2012)
Need For the Act
Parliament noted that promotion of baby
foods was pervasive that led to decline of
breastfeeding, which is responsible for disease
and death among children as well as
malnutrition.
Objectives of IMS Act
1. Prohibit any kind of promotion.
2. Educate pregnant women & lactating mothers.
3. Restrict & Control use of Infant Milk
Substitutes & Infant Foods.
4. Define roles & responsibilities of health care
institutions & health workers.
What Needs to be done? What Needs to be done?
ProtectionPromotionSupport
Program Coordinationand Advisory Committee
IHACIHACCode + Code +
Maternal Maternal BenefitisBenefitis
Brazilian Breastfeeding PolicyBreastfeeding and
Complimentary Brazil Network
Legal Protection
Brazilian Human Milk Bank Network
Innovating Component
Kangaroo Method
Monitoring and Evaluation
Education
Broadcasting, Social Mobilization
and AwardsWBW
Baby and Mother Friendly Hospital
Initiative
The breastfeeding gear model for scaling up and sustainability of breastfeeding programs.
The breastfeeding gear model for scaling up and sustainability of breastfeeding programs.
Exclusive Breastfeeding 0-6 months and BF trends comparing Brazil and Mexico
Perez-Escamilla et al.Adv. Nutr. 3: 2012.
19
1867: Nestle started the commercialisation of formula and has been the subject of a global boycott since 1977 Nestle advert from 1936.
Baby food market was built on‘Trust’
“In less developed countries, the best form of promoting baby food formulas may well be the clinics which the company sponsors”
Nestlé in Developing countries 1970
and dependency
Nestle AD 1915
Offering Free Sample
Nestle Advertisement 1920Nestle Advertisement 1920
A Mother’s Treasure!
What is so critical?
For milk ejection3/4
Enhancing factors Hindering factors
Emptying of breast
Frequent Suckling
Expression of milk
Night feeds
Bottle feeding,Incorrect positioning,
Painful breast
Sensory impulse from nipple
Prolactin in blood
Prolactin “milk secretion” reflexProlactin “milk secretion” reflex
Action ONE on Promotion Gear
IYCF Counsellors in Health facilitiesFor good skilled counselling, accurate information,
unbiased , free from commercial pressuresBaby Friendly Hospitals …Both in public and private sectorPrivate sector can make it an income generating
activity.This action is part of this guidelineFacility Based Newborn care could form the Vehicle for human resource, funding etc. Its time for action
Action TWO on Protection Gear
Implement the IMS Act effectivelyDistrict level seminars for health care workers Inform people about itMonitor regularly and reportAppoint a State/Distt. nodal persons
Ban sponsorship of conferences completely Its time for action to protect women and children
Action THREE on Support Gear
WABA World Breastfeeding Week 1-7 August WABA World Breastfeeding Week 1-7 August 2015 2015
Need to support women
Six months maternity leave for all women Informal sector needs the most
NFSA: IGMSY……….. universalize it.Breastfeeding breaks, Flexi hours: Private sector should come forward and create
breastfeeding space for working women at work and allow six month leave.
Its time for action to support women and children
Have a PLAN..2-3 year with a budget
Appoint a Coordinator State Committee on IYCF/BF
LeadershipHigh priority
Action FOUR on Master Gear
World Breastfeeding Costing Initiative (WBCWorld Breastfeeding Costing Initiative (WBCii))
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Thanks for your
attention !!