How IMS Act implementation can bring down IMR in Karnataka State? Dr Arun Gupta MD Member, PM’s Council on India Nutrition Challenges Co-Chair Global Council International Baby Food Action Network(IBFAN) and Regional Coordinator Asia

“Inappropriate feeding practices lead to infant malnutrition, morbidity and mortality in our children. Promotion of infant milk substitutes and related products like feeding bottles and teats do constitute a health hazard. Promotion of infant milk substitutes and related products has been more pervasive and extensive than the dissemination of information concerning the advantages of mother’s milk and breastfeeding and contributes to decline in breastfeeding. In the absence of strong interventions designed to protect, promote and support breastfeeding, this decline can assume dangerous proportions subjecting millions of infants to greater risks of infections, malnutrition and death………” Sh. Arjun Singh Minister of Human Resource Development while introducing the Bill read out the Statement of objecives in the Parliament

The criticality of feeding practices is not just children are vulnerable, this time their brain develops very fast. Years of life Brain development Underweight (-2sd) NFHS-3 Over 60 million 1.35 million die by 5 years, 1. million during first year First Year is Critical!

India enacted a Law in :Bill 41 of 1992 was enacted “Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992’(IMS Act) It was strengthened by an Amendment in 2003 Cable TV networks Act in 2000 banned all TV ads All Parties supported it. ACASH and BPNI gazetted as NGOs

Guidelines on Infant & Young Child Feeding

Breastfeeding Saves Lives! Risk of Mortality

National Norms of infant and young child feeding Initiation of breastfeeding within one hour of birth Exclusive breastfeeding for the first six months Timely and appropriate complementary feeding after six months along with continued breastfeeding till 2 years or beyond

Lancet Child Survival Series,2003, Jones G et al. Indian J Pediatr 2006 U-5 Child deaths (%) saved by universalising key interventions in India

Impact of NOT Following Recommended Norms Deaths attributed to sub-optimal breastfeeding Public Health Nutr Sep; 9(6):

Impact of Following Recommended Norms Protective effect on non-communicable diseases ◦ Obesity ◦ Diabetes ◦ high systolic blood pressure Increased performance in intelligence tests 11

Child Feeding Practices-Karnataka

Routine maternity practices in medical college hospitals

Facilitating factors Evidence based advocacy Political will Legislations to protect from commercial sector, Legislation for Maternity protection Workforce training Implementation at facility and community level Communication campaigns Research Monitoring and evaluation Coordination and multi-sector engagement (Advances in Nutrition 3, , 2012)

Need For the Act  Parliament noted that promotion of baby foods was pervasive that led to decline of breastfeeding, which is responsible for disease and death among children as well as malnutrition.

Objectives of IMS Act 1. Prohibit any kind of promotion. 2. Educate pregnant women & lactating mothers. 3. Restrict & Control use of Infant Milk Substitutes & Infant Foods. 4. Define roles & responsibilities of health care institutions & health workers.

What Needs to be done? Policy, Plan and Coordination Communication and Information Health, Nutrition care System Mother support, community outreach BFHI IYCF in difficult circumstances Maternity Protection International Code, WHA Protectio n Promotio n Support

Program Coordination and Advisory Committee IHAC Code + Maternal Benefitis Brazilian Breastfeeding Policy Breastfeeding and Complimentary Brazil Network Legal Protection Brazilian Human Milk Bank Network Innovating Component Kangaroo Method Monitoring and Evaluation Education Broadcasting, Social Mobilization and Awards WBW Baby and Mother Friendly Hospital Initiative The breastfeeding gear model for scaling up and sustainability of breastfeeding programs.

Exclusive Breastfeeding 0-6 months and BF trends comparing Brazil and Mexico Perez- Escamilla et al. Adv. Nutr. 3:

1867: Nestle started the commercialisation of formula and has been the subject of a global boycott since 1977 Nestle advert from Baby food market was built on‘Trust’

“In less developed countries, the best form of promoting baby food formulas may well be the clinics which the company sponsors” Nestlé in Developing countries 1970 and dependency

Nestle AD 1915 Offering Free Sample

Nestle Advertisement 1920 A Mother’s Treasure!

What is so critical? For milk ejection 3/4

Enhancing factors Hindering factors Emptying of breast Frequent Suckling Expression of milk Night feeds Bottle feeding, Incorrect positioning, Painful breast Sensory impulse from nipple Prolactin in blood Prolactin “milk secretion” reflex

Action ONE on Promotion Gear

IYCF Counsellors in Health facilities For good skilled counselling, accurate information, unbiased, free from commercial pressures Baby Friendly Hospitals … Both in public and private sector Private sector can make it an income generating activity. This action is part of this guideline Facility Based Newborn care could form the Vehicle for human resource, funding etc. Its time for action

Action TWO on Protection Gear

Implement the IMS Act effectively District level seminars for health care workers Inform people about it Monitor regularly and report Appoint a State/Distt. nodal persons Ban sponsorship of conferences completely Its time for action to protect women and children

Action THREE on Support Gear

WABA World Breastfeeding Week 1-7 August 2015

Need to support women Six months maternity leave for all women Informal sector needs the most NFSA: IGMSY……….. universalize it. Breastfeeding breaks, Flexi hours: Private sector should come forward and create breastfeeding space for working women at work and allow six month leave. Its time for action to support women and children

Have a PLAN..2-3 year with a budget Appoint a Coordinator State Committee on IYCF/BF Leadership High priority Action FOUR on Master Gear

World Breastfeeding Costing Initiative (WBCi) Supported by:

Thanks for your attention !!