7/2/2015WBW World Breastfeeding Week (WBW) 2007 Breastfeeding 1 st Hour save ONE Million Babies SCN WG :BREASTFEEDING and COMPLEMENTARY FEEDING Arun Gupta on behalf of WABA

7/2/2015WBW Beginning Breastfeeding within ONE hour :Beginning life with “life”

7/2/2015WBW Objective To draw the world’s attention to save ONE million babies with just ONE action, just ONE hour support and just ONE message…. To encourage establishing breastfeeding within ONE hour as key indicator of health progress by all communities locally and globally.

7/2/2015WBW BFHI 1992 Step 4 was, “Help mothers initiate breastfeeding within a half-hour of birth”

7/2/2015WBW World Summit for Children Commitments Millennium Development Goals (MDG) 4 to reduce U-5 child mortality 40% of all child deaths are neonates Need to scale action to reduce neonatal deaths as progress is reported to be slow Almost all deaths in developing countries

7/2/2015WBW Risk of neonatal mortality according to time of initiation of breastfeeding within ONE hour Pediatrics 2006;117:

7/2/2015WBW Potential Mechanisms Suckling shortly after birth have a greater chance of successfully establishing and sustaining breastfeeding throughout infancy. However, the effect of early initiation persisted after controlling for established neonatal breastfeeding patterns. Early feeding with non human milk proteins may severely disrupt normal gut function Rich immune and non-immune components that are important for early gut growth and resistance to infection. Promotion of warmth and protection may reduce the risk of death from hypothermia.

7/2/2015WBW Key findings of the study 30% of the study population initiated breastfeeding after day 1 (late initiation) 30% were not exclusively breastfed in the neonatal period Exclusive breastfeeding was associated with a 4 fold reduction in risk of death when compared to infants who were fed solids or other milk. This confirms previous findings.

7/2/2015WBW Key findings Translating these benefits to the whole population of neonates (breastfed and not breastfed) means that 16% of neonatal lives can be saved if all babies were breastfed from day 1, and 22% if breastfeeding were started within the first hour. Neonatal mortality was also shown to increase markedly as delay in initiation increased.

7/2/2015WBW Global impact of increases in coverage and promotion of early initiation of breastfeeding in less developed settings. Projected absolute numbers of lives saved and the proportion of neonatal deaths avoided if 99% of infants initiated breastfeeding during the first hour or during the first day of life. [1][1] Only 38 of the 60 countries had data available on initiation of breastfeeding within 1 hour and 1 day of birth. The neonatal mortality rate for these 38 countries ranged from 15-70/1,000 live births. [1][1] Karen M Edmond, Ellie C Bard, Betty R Kirkwood, Meeting the millennium development goals for child survival: global impact of early initiation of breastfeeding on neonatal mortality. (Un published)

7/2/2015WBW Contd An additional 2.5 fold reduction in risk of death was demonstrated in babies who survived to day 2 who initiated breastfeeding on the first day of life (early initiation) compared to infants who initiated after the first day of life (late initiation). This type of effect of early initiation has never been reported.

7/2/2015WBW Contd… Neonatal mortality could be reduced by 24% if 99% of infants initiated breastfeeding on day 1 of life and by 31% if 99% of initiation was within the first hour. Numbers of lives saved were estimated to be 867,000 and 1,117,000 in these two cases."

7/2/2015WBW st ONE hour initiation cuts 22% of all neonatal deaths( 0-28 days) Pediatrics 2006;117: % 15.8%(IN DIA) India: 1.1 M World : 4 M 1 million If ALL Women start BF within ONE hour 250,000 babies can be saved in India and ONE MILLION in the world INITIATION OF BREASTFEEDING within ONE hour NEONATAL DEATHS SAVED

7/2/2015WBW Other benefits of ONE hour !!! Skin to skin Warmth Development Less bleeding postpartum

7/2/2015WBW Oxytocin factor Role of oxytocin which is best during first 45 minutes Suckling is at it best and babies are active during first hour

7/2/2015WBW Where we stand ? Initiation of breastfeeding within ONE hour In 38 countries : 26-52( 36 median) South Asia worst hit, but needed most

7/2/2015WBW Why World Breastfeeding Week(WBW):2007 for ONE hour support Should not allow to get it old Too important to ignore Currently this is not a key indicator in reports like UNICEF SOWC.

7/2/2015WBW What next Advocacy for support to mothers during 4 th stage of labour Policy : Coverage, promotion and reporting should improve along with exclusive breastfeeding