Overcoming Barriers in Breastfeeding.pptx

What are the difficulties in practice of intiation and continuation of breastfeeding ...

1. Overcoming Barriers in Breastfeeding Dr.D.Gunasingh MD DCH Dean and Principal, Professor of Pediatrics Arunai Medical College & Hospital, Tiruvannamalai

2. Barriers… Save the Children UK and the World Health Organization: "The active and aggressive promotion of breast milk substitutes by their manufacturers and distributors continues to be a substantial global barrier to breastfeeding. "Promotion and marketing have turned infant formula, which should be seen as a specialised food that is vitally important for those babies who cannot be breastfed, into a normal food for any infant."  .” The mother knows that there is an alternative to breastfeeding”… Barrier

3. Sarah Redshaw , from the BabyCentre website, said: "It is crucial to bear in mind the various barriers and challenges faced by mothers when it comes to breastfeeding.  "Generally mothers are aware that breastfeeding is best for their baby but often don't get the right support if they encounter problems in the early weeks - which many, many do.  "As a result, significant numbers give up on breastfeeding

4. 5,416 different species of mammals .

5. Solution to Insufficient milk syndrome . Formula is widely viewed by mothers and doctors alike as the solution to breastfeeding problems rather than a cause or contributor to breastfeeding problems .

6. Launched in 2004, the World Breastfeeding Trends Initiative ( WBT i ) assists countries to assess the status of and benchmark the progress in implementation of the  Global Strategy for Infant and Young Child Feeding  in a standard way. The WBT i  assists countries to measure strengths and weaknesses on the ten parameters of policy and programmes and 5 practices that protect, promote and support optimal infant and young child feeding (IYCF) practices. 

7. The prevalence of initiation of breastfeeding in the Vellore Medical College Hospital Place: Government Vellore Medical College Hospital Post Natal Ward. Primarily caters to rural population of Vellore and Thiruvannamalai districts Design: Population survey / cross-sectional survey Study population: Women who delivered live baby within last 24 hours and willing to participate in the study. Both mother and baby have no complication

8. Sample Size Total Number of Mothers Interviewed: 150 Year: 2006 Total Number of Deliveries: 5710 Total Number of Normal Deliveries: 2227 Total Number of LSCS: 2207 Others: 1276 Maternal Death: 17

9. Results Only 1 mother in 150 initiated breastfeeding within one hour of childbirth > 99% of the mothers initiated breastfeeding after one hour Only 1 mother was given the baby inside the labour room No mother was told by healthcare professionals (HCP) to breast-feed immediately 20% of the neonates received pre- lactile feeds 95% of the infants had received breastfeeds. 5% of the infants did not receive breastfeeds at the time of interview.

10. 20% of the mothers had problems in initiation of breastfeeding. But, nobody received any help from the HCPs. Only 5% of the mothers were aware that they have to initiate breast-feeding within 1 hour of delivery. No mother had ante-natal counselling. 90% of the mothers knew that colostrum is good for the baby Only 5% of the mothers knew that exclusive breastfeeding duration is six months 99% of the mothers were aware that bottle-feeds are dangerous for the health of the infant Only 10% of the mothers, in caesarian section, had initiated breast-feeding within 4 hours.

11. Barriers Lack of Quality research to identify the gaps recommended standard breastfeeding practices Caesarian section, interfere with early initiation because of pain and exhaustion Working mothers T he perception of breasts as sexual objects may lead women to feel uncomfortable about breastfeeding in public. Nuturing function is downplayed Male health providers are often faced with challenges. Formula used in first few days without any valid reasons…Fear of hypoglycemia.. Preterm may not suck effectively Probable solut ion Need more research Appropriate pain management and ? Reducing LSCS Adequate support ??? Use formula as medicine … use rationally Oropharyngeal colostrum…MOM…Donors milk

12. Barriers Probable solution Lack of training & knowledge among health care provider to give practical help in the delivery room Frequent hands on training sessions by a knowledgeable person Lack of scientific approach to insufficient milk Proper training Violation of “The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992 as Amended in 2003 (IMS Act) “ Need to create more awareness A structured lactation management course by medical university is not available TNMGRU may start a course IBCLC qualified experienced Medical Lactation consultant not available We need to have more medical lactation consultant

13. Decline of Breastfeeding In the 19th century breastfeeding was almost universal; Borden developed condensedmilk in 1856 Nestlé produced ‘ Farine Lactée’in 1867, substitute feeding became feasible. Overthe next 100 years, breastfeeding rates declined as women entered the workforce and formula companies began widespread advertising campaigns. Mortality in very young infants from malnutrition,diarrhoea and pneumonia—virtually unknown previously—increased dramatically

14. Decline of Breastfeeding In 1944, 88% of Swedish mothers were breastfeeding their infants at 2 months of age; by 1970 the rate had declined to 30%.

15. Milk and Murder In 1939, Cicely Williams a pediatrician working in Singapore found the link between promotion of breast milk substitutes and increased malnutrition and spoke at the Rotatory club titled . “Milk and Murder”

16. Milk and Murder She Stated “Misguided propaganda on infant feeding should be punished as the most criminal form of sedition and these deaths should be regarded as murder. She continued to highlight the plight of innocent infants who were being deprived of their mother’s milk only because of the gross over promotion of Breast milk substitutes by companies like Nestle .

17. Fight against Nestle 1972- International organization of consumer unions(IOCU) suggested a code of practice for Advertising of Infant foods” February 1974: War on Want publishes The Baby Killer, a report on infant malnutrition and the promotion of artificial feeding in the Third World. This article was translated into German with a more appropriate title “ Nestle KILLS Babies In 1973- A British magazine published a cover story titled “ The Baby food Tragedy” which highlighted the link between promotion of infant food resulting in decline of Breast feeding and increased infant malnutrition.

18. Nestle Boycott 1974- WHA (World Health Assembly) noted general decline is Breast feeding and urged member states (Including India) to “Review sales promotion activities on Baby foods and introduce remedial measures. In 1977 Frustrated by Nestle’s continued unethical marketing practices, the “Nestle Boycott ” was launched by a group in USA

19. In 1978, Edward M Kennedy, chairman of the USA Senate Subcommittee on Health and Scientific Research “Can a product which requires clean water, good sanitation, adequate family income and a literate parent to follow printed instructions be properly and safely used in areas where water is contaminated, sewage runs in the streets, poverty is severe and illiteracy high?” May 21, 1981: The World Health Assembly overwhelmingly adopts the International Code. Only the US votes against the Code.

20. The Innocenti Declaration In August 1990, government policymakers, WHO, UNICEF and other organisations got together and signed, which aimed to protect, promote and support breastfeeding * Breastfeeding provides ideal nutrition for infants and contributes to their healthy growth. * Reduces incidence and severity of infectious diseases, lowering infant morbidity and mortality * Reduces the risk of breast and ovarian cancer among women

21. The Innocenti Declaration Exclusive breastfeeding is  “as a global goal for optimal maternal and child health and nutrition”. Obstacles to breastfeeding within the health system, the workplace and the community must be eliminated. A ll governments to develop national breastfeeding policies and set appropriate national targets.

22. The World Alliance for Breastfeeding Action (WABA) 1991 The idea of WBW was conceived by WABA. The short history follows … The birth of WABA The idea of the World Alliance for Breastfeeding Action (WABA) was born on the evening of 14 February 1991 in a little restaurant in downtown New York, following an NGO planning meeting organised by UNICEF to follow up on the Innocenti Declaration and strategize for a coordinated global effort to protect, promote and support breastfeeding. Baby do the WABA Crawl You can feel so big and tall Throw the bottle to the wall All the others, they feel small

23. World Breastfeeding week Commemorates the Innocenti Declaration, ever since, the World Breastfeeding Week has been celebrated every year from August 1 to 7 from 1992. The initiative encourages breastfeeding and spreads awareness on how mother’s milk helps improve the health of newborns around the world and make their immunity system stronger.

24. 1983- India adopted the”Indian National code for Marketing of breast Milk Substitute” This is only a code not a law. In 1984,1986,1988,1990 and 1992 WHA urged the member states to implement the international code. 1992- Indian parliament finally enacted the IMS Act 2002- Amendment of IMS Act is introduced in the Parliament 2003- Amendment act is passed The Infant Milk Substitutes, Feeding Bottles and Infant Foods Act 1992 and its 2003 amendment

25. Source: Euromonitor International India Passport report of Baby Foods 2016 Effectiveness of the IMS Act Restricting baby milk sales