GETTING THE POLITICS RIGHT TO SUPPORT BREASTFEEDING AND ARVs YOGAN PILLAY DEPARTMENT OF HEALTH, SOUTH AFRICA 19 TH IAS CONFERENCE, DC, 25 JULY 2012

What were the Issues? Concern about low breastfeeding rates in SA – 8% (DHS, 2003) – infants 0 to 6 months, 25,7% were reported to be exclusively breastfed whilst 51,3% were mixed fed, with solids and formula being introduced far too early in life (HSRC). Concern about high mortality rates in SA – IMR 40/1000 and under 5 mortality 56/1000 HIV prevalence in pregnant women – 30% So...how can we implement an exclusive breastfeeding policy in a country with high HIV prevalence? 2

Actions by the Minister Requested the Department to convene a national stakeholder meeting with representatives from academia, civil society, professional bodies and labour unions, and traditional leaders and healers Ensure that experts, including WHO and UNICEF attend Experts requested to present the evidence followed by discussion in small groups 3

Quote from the Minister’s speech (Aug 2011) “I asked the Department to invite academics and researchers as well as a wide range of stakeholders and partners to both present the evidence on breastfeeding so that we can generate consensus on policy and practice on breastfeeding, especially in the context of HIV. Without pre-empting the outcomes of this consultative meeting my view is that we need to reposition, promote, protect and support breastfeeding as a key child survival strategy in South Africa”. 4

Tshwane Declaration of Support for Breastfeeding in South Africa 5

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What political support have we seen in the provinces? Media Statement: KZN Health encourages mothers to exclusively breastfeed for the first six months to save lives of babies – Announcing the Breast Feeding Week Campaigns which commence on the 1st to the 7th August 2011, the MEC for Health Dr Sibongiseni Dhlomo says; “We want partners and families to support women when they are breastfeeding.” 9

Limpopo Encourages Exclusive Breastfeeding "Breastfeeding is fundamental to the survival of all children as it, amongst others, provides all the nutrients the baby needs to grow and develop, while at the same time builds a strong bond between mother and child. We would really like to encourage mothers to breastfeed their babies as breast milk contains antibodies that helps in the strengthening of the babies' immune system, thus preventing common illnesses such as diarrhoea and pneumonia," said MEC Magadzi. 10

Speech by the Honourable MEC for Health, Mr Mxolisi Sokatsha, on the occasion of the commemoration of World Sight Day and Eye Care Awareness Month “Breastfeeding is in the process of repositioning and promoted as a key child survival strategy in South Africa. The benefits of breastfeeding are well recognised for both infant and mother. Breastfeeding has profound impact on child’s survival, health, nutrition and development - and we have known this for decades. These benefits will obviously be lost when formula feeding is given. We must all partner to scale up promotion, support and protection of breastfeeding to improve child survival. Encouraging breastfeeding, providing accurate information about the benefits of breastfeeding and support will increase awareness, acceptance, and will encourage more women to do what is best for their babies - and that is to breastfeed”. 11

Conclusions Leadership by the Minister, followed by the MECs Getting the experts to present the case Engaging with stakeholders Implementation!!!! 12

WC MEC at the opening of the Oudtshoorn Clinic (MBFI) “Breastfeeding is acknowledged to be the best way of feeding and caring for infants and is important for infant development, while also providing benefits to the mother. Research findings on the introduction of MBFI in health facilities have been associated with a reduction in infant mortality, particularly as a result of diarrhoea and respiratory infection”. 13