BREASTFEEDING TRENDS INICTIATIVE IN ECUADOR Rocío Caicedo B. Md MSc. Doctor and Nutrition Coordinator in Calderon Hospital. IBFAN Group Ecuador Coordinator. rocio.caicedo@hgdc.gob.ec Maria Elisa Herrera F, MSc. Teacher and Researcher, Public Health School, San Francisco University - IBFAN Group mherrera@usfq.edu.ec

Background The latest National Health and Nutrition Survey (ENSANUT-ECU) in Ecuador, was conducted in 2012. When evaluating the indicators of malnutrition in children under 5 years of age in the last quarter of a century (1986-2012), it shows as chronic malnutrition has decreased, the weight-to-height remains similar. A consequence of this trend is an increase in overweight and obesity over time in the Ecuadorian Child (4.2% in 1986 to 8.6% in 2012), revealing the coexistence of poor nutrition due to deficit and an excess in the population (Freire et al., 2014).

Breastfeeding Trends In Ecuador This research evaluates the progress made in implementing the Global Strategy for Infant and Young Child Feeding (ALNP being its Spanish acronym), hosted by Ecuador in 2008. The tool applied was that established by the Asia Group of IBFAN, which was called the World Breastfeeding Trends Initiative (WBTi). WBTi establishes a framework for assessing the progress that a country has made in implementing the ALNP Global Strategy, helps the key authors plan and make decisions at various levels of action, and identifies the strengths and weaknesses of their policies and programs.

Breastfeeding Trends In Ecuador We evaluate the country's situation and the progress made in implementing the Global Strategy for Infant and Young Child Feeding. With the participation of key actors at local, provincial and national levels, this report shows the strengths and weaknesses that prevail in the implementation of Child Feeding Practices, Policies and Programs. The report also establishes strategies that seek to protect, promote, and support the ALNP in Ecuador.

Breastfeeding Trends In Ecuador 15 Indicators were investigate, compile and analyze information on its policies, programs, government practices, and the degree of implementation Part I refers to ALNP policies and programs (indicators 1 to 10) Part II refers to ALNP practices (indicators 11-15) National policies, programs and coordination The Child’s Friend Hospital Project (Ten Steps to Successful Breastfeeding) Implementation of the International of Marketing Code of Breastmilk Substitutes Maternity protection Health and nutrition care systems (to support breastfeeding and ALNP) Support for mothers and social assistance within the community Information support Child feeding and HIV Child feeding during emergencies Monitoring mechanisms and evaluation system Early initiation of breastfeeding Exclusive breastfeeding Average duration of breastfeeding Bottle Feeding Complementary feeding  

Results Policies and Programs Practices Compliance 47/100 Policies and Programs 27/50 Practices 74/150 Policies, Programs, Governmental Practices Both scores rank the country at a low level of compliance, that corresponds to the yellow color according to WBTi.

Indicators with a critical compliance Policies and Programs Monitoring and evaluation system Emergency infant feeding Policies, Programs and National Coordination Practices Bottle Feeding Median duration of breastfeeding Score Score 3 3 2 3 3 Indicators with a critical compliance

Policies, Programs and National Coordination This is a central indicator of the country's implementation, because it outlines the guidelines and strategies to achieve the objectives set. Ecuador has a national development plan 2013-2017 (Republic of Ecuador - National Planning Council, 2013) which includes goals and indicators for food and nutrition for children. Weakness Points

Policies, Programs and National Coordination The discontinuity of the strategies and their managers is a limitation for us. The primary health and nutrition sectors are poorly linked. They are prone to politicization and refer little attention to the measurement of their results (Banco Mundial, 2007). Operationally, infant feeding programs encounter difficulties in collecting and analyzing the information generated, showing long response times, and making it difficult to obtain timely and adequate monitoring and to follow up policies and interventions. Weakness Points

Recommendations to Fill de Gaps Policies, Programs and National Coordination To follow the recommendations published by UNICEF and IBFAN in their report (UNICEF/IBFAN, 2016) states that the National Policies must be accompanied by a detailed action plan that precisely defines the objectives, schedule, plan to action, monitoring and evaluation. Distribute the responsibilities, and implement a systematic monitoring and evaluation to measure the progress made

Emergency Infant Feeding The Ministry of Public Health of Ecuador enacted legislation on infant feeding in emergencies with the purpose of establishing the guidelines for the food and nutrition of families who have been victims of emergencies and disasters. This legislation lacks strategies for its application in order to support, protect, and promote adequate nutrition for the infant and young children during emergencies and disasters. Weakness Points

Recommendations to Fill de Gaps Emergency Infant Feeding To develop an intersectoral policy to care for nurses, infants and young children during emergencies and disasters, and also to coordinate these actions through the National Secretariat for Risk Management

Monitoring and Evaluation System Although nutritional data from pregnant women and children under 5 years old are collected in Ecuador, these data are not processed in the short term, limiting results-based decision making. As a result, consolidation of data from the first level to the national scale is slow, inefficient, and unusable. Weakness Points

Recommendations to Fill de Gaps Monitoring and Evaluation System It is recommended to decentralize the analysis process of the data generated. Make at the region level, periodic reports are to allow timely decision making Implement a strategy for the periodic evaluation of maternal and child feeding programs and implement supervision and monitoring systems

Median duration of breastfeeding In Ecuador, the average duration of breastfeeding is 15.3 months, being lower in the urban area (14.5 months) than in the rural area (17.1 months) (Freire, et al., 2014). In Ecuador, poor support from health services, poor community care in breastfeeding and complementary feeding, and the rapid integration of women into work, limit and reduce breastfeeding during the first year of the child's life. Weakness Points

Recommendations to Fill de Gaps Median duration of breastfeeding We recommend working on breastfeeding promotion strategies, as part of a national program that revalues the culture of breastfeeding, and implementing lactation support rooms in workplaces where there are more than 20 women of childbearing age (Ministerio de Salud Pública, 2011).

Bottle feeding Weakness Points The use of the bottle has great promotion, which weakens the practice of breastfeeding in the country. 30% of the of children (0-5 months) of the poorest quintile are feeding through a bottle. Furthermore, as the age advances, the percentage increases. This causes discontinuation of breastfeeding and inappropriate complementary feeding from the baby’s, since very early ages. (Freire, et al., 2014). Weakness Points

Conclusion Several gaps hinder the compliance with the strategy. However, the failure of National Policies, Programs and Coordination shows a significant impact on their overall compliance. This, along with a short duration of breastfeeding and the extensive use of bottle feeding, significantly affect the infant's ALNP in Ecuador. It is recommended to create a responsible body to periodically monitor and evaluate this strategy.

THANK YOU VERY MUCH María Elisa Herrera F, MSc Teacher and Researcher, Public Health School of San Francisco University FUNBBASIC/IBFAN Ecuadorian group mherrera@usfq.edu.ec Rocio Caicedo Borrás, MD. Technical Coordinator of Nutrition and Human Milk Bank of the Educational Hospital of Calderón. Coordinator of FUNBASIC/IBFAN Ecuadorian Group. rocio.caicedo@hgdc.gob.ec THANK YOU VERY MUCH