IYCF activities: perspective in Bangladesh Dr. S.K.ROYSenior Scientist, ICDDR,B & Secretary, BBF Dhaka, Bangladesh
Welcome to the World of Breastfeeding
IYCF in Bangladesh • survival • nutritional status • growth • development of infants and young children.
Successful development in Bangladesh • 1980’s -BF promotion • Ratified global commitments to IYCF • 1981- WHA passed the resolution on the International Code of Marketing of BMS • 1984- passed • 1989- CPPBF • 1991- A national conference on breastfeeding in led to the Dhaka Declaration- & • A pledge for the protection, promotion and support of BF signed by the President and PM
Cont… • 1991- BFHI • 1992 WBW observed • 1993- Amendments of BMS • 1995 -MOHFW introduced BINP • 2001-Maternity leave law • 2003-Recommended EBF was extended from 5 months to 6 months • BBF –central office headed by CEO, 7 PM and other support staff. • A 15 member BOT govern the foundation and 7 SC provide technical support.
Formulation of strategy • The MOHFW need for improving BF and CF practices • Initiated the development of the National strategy for IYCF • The process began in 2004 convened by IPHN with collaboration WHO and UNICEF.
Goal & objectives To improve - the nutritional status -growth and development -health, and survival of infants and young children.
Cont… Specific objectives achieved by 2010, are: • Early initiation of BF -from 24% to 50% • Increased EBF rate 42% to 60% • Continued BF-90% of children aged 20-23 months • 50%(CF) of children aged 6-9months receive appropriate CF
Strategies • The priority strategies for IYCF in Bangladesh fall into 4 categories: • Legislation, Policy and standards • health system support • Community –based support • IYCF in exceptionally difficult circumstances
Legislation ,policy & standards • Strategy 1:Code of marketing of breast-milk substitutes • Strategy 2:Maternity protection in the workplace • Strategy 3:Codex standards • Strategy 4:National policies and plans
Health system supports • Strategy 5: BFHI • Strategy 6:Mainstreaming and prioritization on IYCF activities • Strategy 7: Knowledge and skills of health service providers
Community based support • Strategy 8: Community based support for IYCF • Strategy 9:IYCF in exceptionally difficult circumstances
World situation at a glance Source: www.childinfo.org/eddb/brfeed/index.htm
GLOBAL bar indicate year 1990 and bar indicate year 2000 Source: www.childinfo.org/eddb/brfeed/index.htm
Breastfeeding status in 2006 Exclusive Breastfeeding Rates Non NNP areas 60% NNP areas 86% Colostrum Feeding 90% Baby Friendly Hospitals 498 (out of 550) Maternity leave 4 months Code for the marketing of breast milk substitutes Violation in place
Infant Feeding Situation • Exclusive Breastfeeding Rate: Under 6 months 56% • Initiation with in one hour after birth: 51.8% • Complementary feeding at 4 to 5 months: 23% • Continuing breastfeeding upto 1 year: 90.5% • Continuing breastfeeding upto 2 year: 75% Source:Surveillance study by BBF:2005
Goal- lower morbidity Mortality of children Improve the nutritional status of women Objective- To ensure Exclusive Breastfeeding upto 6 months To improve (CF) practice after 6 months and continue breastfeeding upto 2 years To improve nutrition of pregnant and lactating mothers BBF goal & objective
Activities of BBF • Awareness building and social mobilization • Training • Community Development through MSG • BCC and Advocacy • Curriculum development • Hospital development through BFHI • Empowerment of women through gender sensitization • Counseling of antenatal and postnatal mother
Action/Achievements • THE BREAST-MILK SUBSTITUTES (REGULATION OF MARKETING) ORDINANCE No. XXXIII of 1984 has been enforced. • Dhaka Declaration, signed in 1991, on protection, promotion and support of breastfeeding- by Honorable President Abdur Rahman Biswas and Honorable Prime Minister • Extension of paid maternity leave for working women from 3 months (6 weeks before & 3 weeks after delivery) to 4 months (after delivery) on 9 July, 2001
Legal Action on BMS Code • Three milk companies were sued and fined by the court • Two companies withdrew their products after sending legal notice • Five companies changed their products label after sending letter from BBF
BBF observed 2nd National Conference on BF & CF (IYCF) 2006 Theme Breastfeeding and complementary feeding: Cornerstone for National Development and the way to achieving MDGs
Summary • Inaugural Total Participants 700 • Total Registration 511 • Total Organizations 44 • Professional Categories 35 • Total Plenary Session 10 (Speaker) 20 • Symposium 4 (Speaker) 14 • Scientific Session 7 • Participants : Professionals Group
Topics of Plenary session • Breastfeeding Movement – global – History-Now –National • IYCF – global Strategies Regional Situation • BMS – Code Status – global –Regional • BF – SNL • Complementary feeding • New WHO Child Growth Chart - BF • Maternal Institution optimizing • Mother Support activity – global/National • Revitalization and Sustainability of BFHI • 2nd Child Survival Revolution
Topics of Symposium session • Breastfeeding Challenges/Opportunities IYCF – in NNP • IYCF – Policy/Legislation IMCI – IYCFFood Safety – Food Hygiene • IYCF Breaking Double Burden of Malnutrition Early Childhood Development • Childhood Obesity Food Base Dieting guidelines IYCF : Way forward of Bangladesh
Scientific session Excellence of Breastfeeding Exclusive Breastfeeding Complementary feeding Program issues on IYCF Staff Development Session (IYCF, Code MSG).Breastfeeding and Infection/code Maternal Nutrition and BreastfeedinInfant and Child Nutrition
Outcomes To review where we are on global perspective • Make awareness on BF, CF, MN • New prescriptive WHO Growth Standards • HIV & infant feeding guidelines. • Exchange ideas with International Experts • Endorsement of Policy Makers, DP’s,UNICEF, WHO, Stakeholders, Scientists, Health Service providers and NGO’S
Action: Awareness building • Mass awareness increased by commitment of GO, NGOs, donor agencies and in the electronic and print media • Observed World Breastfeeding Week (WBW) in collaboration with GO and NGOs over the last 13 years • National conference on review of BFHI involving the policy makers and program managers of PHC as well as the renowned peditricians and Gynnaechologists • BCC materials on child nutrition, BF promotion and MN have been distributed to stakeholders, 498 BFHI and 52 NNP UZs
Action: Training • Transformation of 30 hospitals (out of 550) into Baby Friendly (88 %) • Trained more than 600 health care providers on the management of BF • In addition trained 1000 internee doctors on BF and 500 intern nurse on same issue • Provided refresher training to 200 doctors and nurses of different BFH in Bangladesh • Journalists have been trained up and their actively engaged in monitoring and follow-up of BFHI
Trained 26 core trainers of MSG formation in 13 NNP UZ Provided refresher training for 46 core trainers in 23 UZ Provided training for 2265 CNO/CNPs on MSG Oriented 27465 MSG members by forming 1831 MSG groups Developed resource book and training booklet for MSG formation Action MSG
Nutrition Triangle Food Security Caring practices Disease control
Task ahead on IYCF • More 152 Maternity Health facilities have to be converted into Baby Friendly • Establish BFMCs in more BFHs • Implement Mother Support Group (MSG) activities in 105 NNP upazilas. • The programme on HIV and breastfeeding will be updated. • Develop module of crèche establishment • Strict monitoring, reporting and urgent legal action for violations. • Develop course curriculum on CF on the basis of IYCF and Maternal Nutrition .
Cont.. • There will be a 4 in 1 training programme by inclusion of BF,CF, MN and HIV & breastfeeding • Develop and revise policy and legislation on IYCF and MN. • Continuous advocacy activities at all level on the values of IYCF • Translate Infant and Young Child Feeding strategy into action. • Adapting HIV and (IYCF) practices on the basis of WHO/UNICEF guidelines and “National Strategy on IYCF in Bangladesh”.
Challenges of IYCF and MN nutrition programme • The sustainability of BFH at all levels • To monitor and revitalize BFHI hospitals • Monitoring and implementation of the code for marketing of BMS. • To improve EBF to over 95%. • To improve maternal nutrition status to an acceptable level • Meeting the targets of second child survival. • To develop an effective Programme to improve maternal malnutrition
Opportunities • BBF is a nodal agency for BF activities having a secretariat • Countrywide general awareness on the importance of BF • BBF maintains a strong national & international network • GoB commitments through Dhaka Declaration, direct support through NNP and MOHFW • Legislation on BMS Code • Legislation on four months maternity leave • Government endorsement on EBF for 6 months (180 days)
Global Opportunities • Breastfeeding identified as a key intervention to meet the MDG (UN) • EBF can reduce 13% and proper CF can reduce 6% of child mortalitySource: LANCET 2000 • Global IYCF policy (WHO/UNICEF)