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Breastfeeding Module1: Session 1
1.
2.
3.
4. Learn about
breastfeeding
Complete 20 hours of
breastfeeding
education
But most importantly…
Have fun
Then
HAVE FUN
Then
HAVE MORE FUN
Then
GO Breastfeed the
world - LOL
5. 1. The Baby Friendly Hospital
Initiative: A part of the global
strategy
2. Communication skills
3. Promoting breastfeeding during
pregnancy
7. 1. State the aim of the WHO/UNICEF Global Strategy
for Infant and Young Child Feeding.
2. Outline the aims of the Baby-friendly Hospital
Initiative (BFHI).
3. Describe why BFHI is important in areas of high
HIV prevalence.
4. Explain how this course can assist this facility at
this time.
5. Review how this course fits with other activities
8. During the last half of the twentieth century,
appreciation of the uniqueness of human
milk and the value of breastfeeding as a
natural resource has inspired government
and private sector public health initiatives to
promote, protect and support breastfeeding.
9. Breastfeeding promotion:
Efforts focus on the advantages of
breastfeeding to the individual baby and
mother.
Includes dissemination of advantages in
regard to the global ecology:
decreased waste from bottles and manufacturing
diminished environmental costs of care and
feeding of dairy cattle.
10. Breastfeeding protection:
Involves legislated rights of women and children
that enable breastfeeding.
Included are adequate maternity leaves and
appropriate child care facilities.
Also involves prohibiting certain marketing
practices of companies manufacturing breast
milk substitutes.
11. Breastfeeding support:
Accomplished through evidence based
hospital policies, health worker practices and
community programs designed to increase
initiation and duration
12. Produced and adopted in 1990 in Spedale degli
Innocenti, Florence, Italy.
The meeting, "Breastfeeding in the 1990s: a
Global Initiative" was co-sponsored by the
United States Agency for International
Development (USAID) and the Swedish
International Development Authority (SIDA).
The Declaration, adopted by participants at the
WHO/UNICEF policy makers’ meeting included
four operational targets for the year 1995.
13. The tenets of the Innocenti Declaration
state that all governments, by the year
1995, should have:
Appointed a national breastfeeding
coordinator and establish a
multisectoral breastfeeding
committee;
Ensured that every facility providing
maternity services fully practices all
of the UNICEF/WHO Ten Steps to
Successful Breastfeeding;
14. By 1995, all governments should have:
Taken action to give effect to the
principles and aim of all Articles of the
International Code of Marketing of
Breast-milk Substitutes and subsequent
WHA resolutions; and
Enacted imaginative legislation
protecting the breastfeeding rights of
working women and established means
for its enforcement.
15.
Recognizing the need to help
motivate birth facilities to
implement Innocenti target #2, the
United Nations Children's Fund
(UNICEF) and the World Health
Organization initiated the Baby-
Friendly Hospital Initiative (BFHI).
Receipt of the Baby-Friendly
designation indicates that a birth
facility has created an environment
that is supportive of optimal infant
16. Aims to improve – through optimal feeding –
the nutritional status, growth and development,
health, and thus the survival of infants and
young children.
Supports exclusive breastfeeding for 6 months,
with timely, adequate, safe and appropriate
complementary feeding, while continuing to
breastfeed for two years and beyond.
Also supports maternal nutrition, social and
community support.
17. The Global Strategy urges that hospital routines
and procedures remain fully supportive of the
successful initiation and establishment of
breastfeeding through the:
implementation of the Baby-friendly Hospital
Initiative
monitoring and reassessing already
designated facilities; and
expanding the Initiative to include clinics,
health center, and paediatric hospitals
18. All governments should develop and implement a comprehensive
policy on infant and young child feeding, in the context of national
policies for nutrition, child and reproductive health, and poverty
reduction.
All mothers should have access to skilled support to initiate and
sustain exclusive breastfeeding for 6 months and ensure the timely
introduction of adequate and safe complementary foods with
continued breastfeeding up to two years or beyond.
Health workers should be empowered to provide effective feeding
counseling, and their services should be extended in the
community by trained lay or peer counselors.
Governments should review progress in national implementation of
the International Code of Marketing of Breast milk Substitutes, and
consider new legislation or additional measures as needed to
protect families from adverse commercial influences.
Governments should enact imaginative legislation protecting the
breastfeeding rights of working women and establishing means for
its enforcement in accordance with international labor standards.
19. The strategy specifies responsibilities of:
governments
international organizations
non-governmental organizations
and other concerned parties
Engages all relevant stakeholders
Provides framework for accelerated
action
20. Currently, the US has scored 7 out of a
possible 50 points on the US National
Report Card, which is produced by the
Healthy Children Faculty and is based on
progress toward the Innocenti targets.
21. Baby-Friendly USA was founded in 1997
as the responsible agency for the
UNICEF Baby-Friendly Hospital Initiative
in the United States.
22. The program is built around a list of 10
research-supported practices, the Ten
Steps to Successful Breastfeeding, which
were developed for maternity facilities.
“Baby-Friendly” and “Baby-Friendly
Hospital Initiative” are certification marks
of the US Fund for UNICEF.
23. Following a United States feasibility study
completed in 1994, an objective on-site
evaluation tool was developed by Wellstart
International to investigate hospital policies and
procedures and implementation of the Ten
Steps to Successful Breastfeeding.
The first U.S. assessment of the implementation
of the Ten Steps to Successful Breastfeeding
was conducted in 1996.
24. Baby-Friendly USA Inc. was incorporated by Dr.
Karin Cadwell in 1997, at the direction of the US
Committee for UNICEF, to implement the
initiative in the United States. Every year more
and more hospitals and birth centers in the
United States have earned the designation
"Baby-Friendly®
Hospital.”
25. Adopted by the World Health Assembly (WHA) in 1981.
Calls for all governments to regulate marketing
practices that promote artificial feeding (formula and
other breastmilk substitutes) as well as feeding devices
such as bottles and nipples.
To date, no substantive legal action has been taken to
implement this Code in the US.
However, the Baby-Friendly Hospital Initiative standards
include Code compliance in Baby-Friendly designated
facilities.
26. In the U.S. national objectives for
breastfeeding initiation and duration have
been published for each decade since
1990.
The initial 1990 goals were 75% initiation
and 35% continuation to six months.
Those goals were not met.
The U.S. met the goal of 75% initiation for
the first time in 2007.
27. The Healthy People 2020 (HP2020)
objectives, established by the U.S. Dept.
of Health and Human Services:
track national breastfeeding rates
also address some of the most challenging
barriers to breastfeeding success faced by
U.S. mothers.
28. One goal focuses on worksite lactation support
programs.
Two new objectives focus on maternity care
practices.
One includes a target to reduce formula
supplementation within the first two days of life.
Current CDC data show that over 25% of breastfed
infants receive formula before two days of age.
Known to decrease milk production
Can lead to negative infant health outcomes
Another goal addresses providing recommended
maternity care for lactating mothers and their
babies.
29. Healthy People 2020 objectives propose
increasing the proportion of infants who
are breastfed:
Ever: 81.9%
At 6 months: 60.5%
At 1 year: 34.1%
Exclusively for 3 months: 44.3%
Exclusively for 6 months: 23.7%
30. The United States Breastfeeding Committee
(USBC ) published “Breastfeeding in the
United States: A National Agenda” in
2001, establishing strategic goals for
breastfeeding activities in the U.S., which
were reconfirmed by the USBC in 2009.
31. Goal 1: Assure access to comprehensive,
current and culturally appropriate
lactation care and services for all
women, children and families.
Goal 2: Ensure that breastfeeding is
recognized as the normal and preferred
method of feeding infants and young
children.
32. Goal 3: Ensure that all federal, state and
local laws relating to child welfare and
family law recognize and support the
importance and practice of breastfeeding.
Goal 4: Increase protection, promotion and
support for breastfeeding mothers in the
work force.
33. An action plan for breastfeeding is based on
education, training, awareness, support and
research.
“Together we can shape a future in which
mothers can feel free to breastfeed their
children without societal hindrances.”
34. The Blueprint was replaced in 2011 by
The Surgeon General’s Call to Action to
Support Breastfeeding, a document that
identifies many methods for creating an
optimal environment for breastfeeding
success in public and private sectors.
35. Many professional organizations such as
the American Academy of Pediatrics, the
American Dietetic Association, the
Association of Women’s Health, Obstetric
and Neonatal Nurses, among others, have
published policy statements in support of
breastfeeding as a public health priority.
36. Breastfeeding rates used to develop the Healthy
People 1990 and 2000 goals were collected
retrospectively by a formula manufacturer, Abbott
(Ross) Labs.
In 2001, the Centers for Disease Control
and Prevention (CDC) began to collect
breastfeeding initiation and duration rates
through the National Immunization Survey.
The CDC now publishes an annual report of
breastfeeding progress for U.S. targets.
37. US has made progress on achieving
the Healthy People goals, but this
improvement has not been
dramatic.
38.
39. There is a wide variation in
breastfeeding initiation, duration and
exclusivity from state to state.
40. Percent of Children Ever Breastfed among Children Born in 2007 (provisional)
Source: CDC
41. Percent of Children Born in 2007 who Were Breastfed at 6 Months of Age
(provisional) Source: CDC
42. Percent of Children Born in 2007 still Breastfeeding at 12 Months:
(provisional) Source: CDC
43. Percent of Children Born in 2007 Exclusively Breastfed Through 3 Months
(provisional) Source: CDC
45. Percent of Children Born in 2007 Exclusively Breastfed Through 6 Months of Age
(provisional) Source: CDC
46. The mPINC Survey (Maternity Practices for
Infant Nutrition and Care) was first
conducted in 2007 by the Centers for
Disease Control and Prevention (CDC).
47. The survey consisted of 34 questions related
to maternity and infant feeding practices,
and was sent to all hospitals and birth
centers providing maternity care in the
United States.
The response rate was more than 80% .
48. Scores were categorized into one of seven
maternity care practice domains:
labor and delivery;
postpartum breastfeeding assistance;
postpartum contact between mother and infant;
postpartum feeding of breastfed infants;
breastfeeding support upon discharge;
staff breastfeeding training and education;
and structural and organizational factors related to
breastfeeding.
50. State and local initiatives might include:
State public health and perinatal regulations
State laws protecting breastfeeding mothers in the
workplace, a mother’s right to breastfeed in public,
exclusion from jury duty while breastfeeding
State and local breastfeeding coalitions
State and local World Breastfeeding Week activities
Local Baby-FriendlyHospital Initiative workgroups
State and local participation in national initiatives
51. A joint project of the United Nations Children’s
Fund (UNICEF) and the World Health
Organization, initiated in 1991.
Designed to recognize hospitals and birth
centers that have taken steps to provide an
optimal environment for breastfeeding through
full implementation of the Ten Steps to
Successful Breastfeeding.
52. Is administered in the US by Baby-Friendly USA,
Inc. a not-for-profit organization.
Is linked to the “International Code of Marketing
of Breast-Milk Substitutes” in its goal to end free
distribution of infant formulas to mothers,
families, health care workers, maternity facilities
and hospitals.
Is based on the Innocenti Declaration (WHO,
1990) and encompasses the Ten Steps to
Successful Breastfeeding.
53. 1. Have a written breastfeeding policy
that is routinely communicated to
all health care staff.
2. Train all health care staff in skills
necessary to implement this policy.
3. Inform all pregnant women about
the benefits and management of
breastfeeding.
54. 4. Help mothers initiate breastfeeding
within one hour of birth
5. Show mothers how to breastfeed
and how to maintain lactation even
if they are separated from their
infants.
6. Give newborn infants no food or
drink other than breast milk, unless
medically indicated.
55. 7. Practice rooming-in, allowing
mothers and infants to remain
together 24 hours a day.
8. Encourage breastfeeding on
demand.
9. Give no pacifiers or artificial nipples
to breastfeeding infants.
10. Foster the establishment of
breastfeeding support groups and
refer mothers to them on discharge
from the hospital.
56.
Each of the Ten Steps has several sub-steps.
A review of the materials available from
Baby-Friendly USA including the Hospital
Self-Appraisal Tool will orient the Baby-
Friendly Task Force/ Committee members to
what each step entails and its basic criteria
and give the health care provider an idea of
the scope of policies that need changes in
order to optimally promote, protect, and
support breastfeeding
57. WHO/UNICEF reaffirmed the BFHI in 2006,
keeping the same Ten Steps. However, Step 4 is
now interpreted as: Place the baby skin to skin
with its mother immediately after birth. Skin to
skin should be continuous an uninterrupted
until the completion of the first breastfeeding.
This step applies to all births, regardless of
feeding intention. (Mothers who choose not to
breastfeed should stop skin to skin before the
baby latches on to the breast.)
58. The WHO/UNICEF (2009) identifies
“acceptable medical reasons” for
supplementation:
Infants who should not receive breast milk or any milk
except specialized formula
Infants for whom breast milk remains the best feeding
option but who may need other food in addition to breast
milk for a limited period
Maternal conditions that may affect breastfeeding
recommendations, e.g. physical incapacity, some
medications, some infectious illnesses, some cases
where there is addiction.
59.
In most cases the need for formula
supplementation does not preclude
breastfeeding or the use of human milk (if
available), either the mother’s own milk or
banked donor human milk.
Banked donor milk may also be used as a
supplement instead of formula.
60. Breastfeeding should be supported and
improved (unless there is a rare
contraindication to breastfeeding) and
supplements discontinued as soon as
possible without harming the health of the
baby.
61. DiGirolamo et al.(2001) looked at
mothers’ experience of Baby-Friendly
practices:
Those who experienced none of the Ten Steps were
eight times more likely to stop breastfeeding before
6 weeks.
Experiencing additional practices in line with the Ten
Steps decreased the likelihood of early weaning.
62. Only 7% of the nationally surveyed mothers
experienced 5 Baby-Friendly practices.
Compared to these mothers, mothers who
experienced 0 practices were 8 times more
likely to stop breastfeeding early.
Additional practices decreased the risk for early
termination (DiGiorlamo et al., 2001).
63. The special needs of HIV-positive women can be
fully accommodated without compromising baby-
friendly hospital status
WHO/UNICEF/UNAIDS policy statement on HIV and
infant feeding states that mothers have right to
information and support that will enable them to
make fully informed decisions
It is important to continue to support breastfeeding
for women who are HIV-negative or of unknown HIV
status
64. The process of implementing
the Baby-Friendly Hospital
Initiative in the US as of April
2010 is called the “4 D
Process”.
66. Process of implementing the Ten Steps works best
when the task force:
Seeks high level medical or administrative support.
Builds a multi-disciplinary implementation team.
Establishes the team as credible change agents with help of
administrative representatives.
Undertakes facility assessment using the “Hospital Self-
Appraisal Tool.
Highlights successful areas and celebrates achievements.
Identifies areas of challenge.
Prioritizes plan of action; begin with the easiest steps.
Continues to address challenges, celebrating and prioritizing
as barriers are successfully surmounted.
67. Improved Care and Service to
Breastfeeding Families
Improved Utilization of
Resources
Positive Public Image
68. Increased Breastfeeding Rates
From 1995-1999, the time of implementing
the 10 Steps, breastfeeding initiation rates
increased from 58% to 87%.
Exclusive breastfeeding rates increased also
during this time period.
69. No advertising of breast milk substitutes to families.
No free samples or supplies in the health care system.
No promotion of products through health care facilities, including no
free or low-cost formula.
No contact between marketing personnel and mothers.
No gifts or personal samples to health workers.
No words or pictures idealizing artificial feeding, including pictures of
infants, on the labels or the product.
Information to health workers should be scientific and factual only.
All information on artificial feeding, including labels, should explain the
benefits of breastfeeding and the costs and hazards associated with
artificial feeding.
Unsuitable products should not be promoted for babies.
All products should be of high quality and take account of the climate
and storage conditions of the country where they are used.
70. Among the new targets for breastfeeding are the following new goals in the
Maternal, Infant, and Child Health category:
MICH-22: Increase the proportion of employers that have worksite lactation
support programs from 25% baseline to 38%.
MICH-23: Reduce the proportion of breastfed newborns who receive formula
supplementation within the first 2 days of life from 15.6% baseline to 10%.
MICH-24: Increase the proportion of live births that occur in facilities that
provide recommended care for lactating mothers and their babies from 2.9%
baseline to 8.1%.
In addition to these breastfeeding support goals, Healthy People 2020 raised
the targets for breastfeeding initiation, duration, and exclusivity, establishing
goals to increase the proportion of infants who are breastfed:
MICH-21.1: Ever from 73.9% baseline to 81.9% .
MICH-21.2: At 6 months from 43.4% baseline to 60.5%.
MICH 21.3: At 1 year from 22.7% baseline to 34.1%.
MICH 21.4: Exclusively through 3 months from 33.1% baseline to 44.3%.
MICH 21.5: Exclusively through 6 months from 13.6% baseline to 23.7%.
71. Actions for Mothers
and Their Families:
1. Give mothers the
support they need to
breastfeed their babies.
2. Develop programs to
educate fathers and
grandmothers about
breastfeeding.
Actions for Communities:
3. Strengthen programs that
provide mother-to-mother
support and peer counseling.
4. Use community-based
organizations to promote and
support breastfeeding.
5. Create a national campaign
to promote breastfeeding.
6. Ensure that the marketing
of infant formula is conducted
in a way that minimizes its
negative impacts on exclusive
breastfeeding.
72. Actions for Health Care:
7. Ensure that maternity care
practices around the United
States are fully supportive of
breastfeeding.
8. Develop systems to guarantee
continuity of skilled support for
lactation between hospitals and
health care settings in the
community.
9. Provide education and training
in breastfeeding for all health
professionals who care for women
and children.
10. Include basic support for
breastfeeding as a standard of
care for midwives, obstetricians,
family physicians, nurse
practitioners, and pediatricians.
11. Ensure access to services
provided by International Board
Certified Lactation Consultants.
12. Identify and address
obstacles to greater availability
of safe banked donor milk for
fragile infants.
73. Actions for Employment:
13. Work toward establishing paid
maternity leave for all employed
mothers.
14. Ensure that employers establish
and maintain comprehensive, high-
quality lactation support programs
for their employees.
15. Expand the use of programs in
the workplace that allow lactating
mothers to have direct access to
their babies.
16. Ensure that all child care
providers accommodate the needs
of breastfeeding mothers and
infants.
Actions for Research and
Surveillance:
17. Increase funding of high-
quality research on
breastfeeding.
18. Strengthen existing capacity
and develop future capacity for
conducting research on
breastfeeding.
19. Develop a national
monitoring system to improve
the tracking of breastfeeding
rates as well as the policies and
environmental factors that
74. Action for Public Health
Infrastructure:
20. Improve national leadership
on the promotion and support of
breastfeeding.
75. The Ten Steps To Successful Breastfeeding
The BFHI promotes, protects, and supports breastfeeding through The Ten
Steps to Successful Breastfeeding for Hospitals, as outlined by UNICEF/WHO.
The steps for the United States are:
1 - Have a written breastfeeding policy that is routinely communicated to all
health care staff. 2 - Train all health care staff in skills necessary to implement
this policy. 3 - Inform all pregnant women about the benefits and management
of breastfeeding. 4 - Help mothers initiate breastfeeding within one hour of
birth. 5 - Show mothers how to breastfeed and how to maintain lactation, even
if they are separated from their infants. 6 - Give newborn infants no food or
drink other than breastmilk, unless medically indicated. 7 - Practice “rooming
in”-- allow mothers and infants to remain together 24 hours a day. 8 -
Encourage breastfeeding on demand. 9 - Give no pacifiers or artificial nipples to
breastfeeding infants. 10 - Foster the establishment of breastfeeding support
groups and refer mothers to them on discharge from the hospital or clinic
