Dr Vandana Prasad National Convenor PHRN World Breastfeeding Trends Initiative (WBTi) Perspectives in Challenges and Future Actions INDIA Dr Vandana Prasad National Convenor PHRN

What Has Changed Since 2005 Assessment While initiation of breastfeeding within one hour of birth and initiation of complementary feeding between 6-9 months seem to have improved from NFHS2 (1998-99), Exclusive breastfeeding for the first 6 months has fallen from 46.9% to 46.3% Median duration of breastfeeding from 25.4 months to 24.4 months Bottle feeding has increased from 13.7% to 16.4%.

Contd. Opportunities lost on policy, programmes, BFHI, implementation IMS Act, HIV and BF (minus points given) Definite gains in Maternity Protection Score increased by 1 point….(68 to 69)

List Of Partners For The Assessment Process NATIONAL CORE GROUP: JP Dadhich, Radha Holla, Arun Gupta (BPNI), Vandana Prasad, Priya Soibam (PHRN), Ajay Gaur (Medical College, Gwalior), Anurag Singh (Medical College, Jodhpur) NATIONAL PARTNERS IBFAN BPNI PHRN IAP NNF FOGSI Medical Colleges Mobile Crèches National Health Systems Resource Centre

Positive Experiences During The Process Another tactic to reinforce long standing campaign issues; a new peg Growth in understanding and analysis Satisfaction of having all information pertaining to BF in one place and updated for easy reference and advocacy New partnerships explored through working together for a specific output Greater outreach achieved Offered a new potential space for intervention and advocacy (Ministry of Panchayati Raj)

Challenges Faced During The Process Lack of priority from participating agencies and institutions Lack of data on issues specific to breastfeeding and support services Lack of specificity in the tool; subjective, descriptive and yet quantitative! Inflexibility of tool, specially for follow up; indicators are static and not able to show progress or lack of it compared to its own previous (like ‘new action’ for Code) Some issues poorly covered (creches have only 1 point!)

Challenges Faced During The Process lack of clarity on the indicators themselves – some points too general – support to mothers and community outreach net scores may be the same even though major fluctuations may have occurred in individual indicators Different participants had different perceptions on each indicator If action is not visible it is a challenge to retain interest in the process of studying, so it was a challenge to demonstrate some movement since 2005. Could not capitalise on the potential for intervening through Panchayati Raj Min because of bureaucratic indolence

Methods Used To Tackle The Challenges Regularity of contact with partners; more effective coordination First time that the coordination was shared with another interested agency (PHRN) Sub groups formed on each indicator though some did not come through Larger meeting of partners and policy makers to create consensus on scoring and recommendations through a process of negotiation Creative use of the tool - deduction of points, explanatory notes and presentations Constant reference to action, past present and potential

Suggestions For Improving The Process Need to link more with action Need to modify the tool to accommodate issues like creches Need to modify the tool to allow for qualitative assessments and descriptive detail in some manner Perhaps need a different follow up tool that can look at greater details in each subsequent round Process indicators (for WBTi process) can also be built in for each country

Thank You