This document discusses breastfeeding and related policies and practices. It notes that breastfeeding rates in India are low, with only 24% of children breastfed within 1 hour of birth and 46% exclusively breastfed for the first 6 months. Several national and international policies aim to promote and protect breastfeeding, including the International Code of Marketing of Breastmilk Substitutes (1981) and the Innocenti Declaration (1990). The document outlines best practices for breastfeeding, challenges to optimal rates, and strategies to support working mothers in continuing breastfeeding, such as paid maternity leave, breastfeeding breaks, and workplace facilities. Overall it emphasizes the critical importance of exclusive breastfeeding for child health, development, and survival.

1. Dr.S.Preethi (MD) Community medicine
Yenepoya medical College

3.  Celebrated 1 to 7 August , > 170 countries
 2015 marks the 25th Anniversary of Innocenti Declaration
 WHO & UNICEF August 1990 protect, promote & support

4. Galvanize Promote Inform
Strengthen Engage

5.  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

6.  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

7.  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

8.  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

9. Health benefits of Breast milk on Infants
Lowers rate of
type-2 diabetes.
Intelligence level
high

10. Benefits for mothers
reduces risks of
breast and ovarian
cancer
return to their pre-
pregnancy weight
faster
lowers rates of
obesity.

11.  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!'

13.  Colostrums feeding
 Exclusive breast feeding
 Complementary feeding
 16% to 50%
 55% to 80%
 34% to 75%

14.  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

15. 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%.

16.  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

18.  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

19. Certain facts
 Powdered milk not completely sterile, and to be mixed with hot water
 Modified animal milk no longer considered adequate for milk feeds fo
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 paediatr

20.  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

21. 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.

22.  Timely -need for energy and nutrients exceeds
 Adequate –provide sufficient energy growing child
 Safe –hygienically stored and prepared

23. 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

24. 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

25. 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.

26. Cradle-hold Cross-cradle hold
Lying on your side
Football hold Laid back

28.  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

29. • 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.

31.  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

32. 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

33. 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

34. 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

35.  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.

36.  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

38.  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

39.  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

40.  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

41.  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

42. 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.

43. 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

44. 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

45. 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

46.  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

47.  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.

48.  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)

49.  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

51.  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/Breastfeedi
ng%20and%20Working%20from%20WomensHealth.pdf.
Last retrieved on 22nd
July 2015.