The document discusses barriers to breastfeeding, highlighting the influence of aggressive marketing of breast milk substitutes and insufficient support for mothers during early breastfeeding challenges. A study at Vellore Medical College revealed that a very low percentage of mothers initiated breastfeeding within one hour postpartum, with many lacking proper guidance and awareness about breastfeeding practices. It emphasizes the need for improved training for healthcare providers and more robust breastfeeding policies to promote optimal infant feeding practices.

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

9. 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

10. 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

11. 5,416 different species of mammals.

12. 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.

13. • Launched in 2004, the World Breastfeeding Trends Initiative
(WBTi) 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 WBTi 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.

21. 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

22. • 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

23. 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.

24. • 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.

25. 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
• The 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 solution
• Need more research
• Appropriate pain management and ?
Reducing LSCS
• Adequate support
• ???
• Use formula as medicine … use rationally
• Oropharyngeal colostrum…MOM…Donors
milk

26. 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

29. 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

30. 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%.

31. 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”

32. 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.

33. 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.

34. 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

35. 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.

36. 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

37. 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.
• All governments to develop national breastfeeding policies
and set appropriate national targets.

38. 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

39. 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.

40. 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

41. Source: Euromonitor International India Passport report of Baby Foods 2016
Effectiveness of the IMS Act
Restricting baby milk sales
2011 2012 2013 2014 2015 2016
0
100
200
300
400
500
600
700
800
469.6
541.5
625.9
704.5
734.6
760.9
23.2 24 24.7 25.4 26.1 26.9
China India
Year
'000
Tonnes