South Asia Brestfeeding Promotion Forum – 3 Meeting at Kabul 20 – 22 November 2006 Prof. Dr. Prakash S. Shrestha IBFAN, Focal Person Nepal

Infant and young child feeding and care in Nepal

IMR64 per 1,000 U5MR91 per 1,000 75,000 children below 5 die annually –135 children per day –every 10 minutes a child dies Child Death

Child Malnutrition Source: DHS 2001

Ever Breastfed Breastfeeding in Nepal is universal

Breastfeeding Duration

Throwing away colostrum

Breastfeeding with complements No breastfeeding Exclusive breastfeeding Source: NMIS4 Discarding colostrum (36 %) Too early and too late complementary feeding Too early introduction of water and other drinks Health workers knowledge often inadequate Issues Breastfeeding Status

Baby Friendly Hospital Initiative Districts with Baby Friendly hospitals, hospitals baby friendly

National Code on Promotion & Protection was developed in 1994 SAARC Code was developed in 1996 But the implementation of code is not satisfactory.

Maternity Protection Leave is Variable. In Government Office 45 days for the mother  But in private institute it is variable in some it is only 30 days.  But in some organization paternal leave is also given for 1 week But we are requesting for 6 month maternal leave & 2 week for paternal leave

Economics of Breastfeeding It seems not much important has been given to it. Control on Import of BMS control is not that effective.

Health Care System During 1994 – 1998 Capacity Building initiative was Good But since then the effort in the capacity building initiative is not sufficient Recently passed the National Strategy in Infant and Young Child Feeding

Gaps:- 1.National Committee on Protection & Promotion of Breastfeeding not effective. 2.Need of Formation of National Committee on Infant and Young Child Feeding 3.Lack of proper monitoring of BMS 4.Code of BMS voilation is very common 5.Reassessment of BFHI Hospital not done regularly 6.Due importance is not given to Infant and Young Child Feeding in pre-service training

National Priorities/Challenges National Advocacy and community promotion Capacity building of Health Workers Baby Friendly Hospital Initiative (BFHI) “Breastmilk Substitutes (Marketing Control) Act,” Scaling up of community based programmes that are aimed at improving child feeding and care Scaling up of community based programmes Integration of IYCF component in neonatal & safe motherhood

Suggested – Recommendation for IYCF in Nepal 1.Expansion of National BF Committee to National IYCF Committee 2.Formation of IYCF working group 3.Appointment of National Coordinator for IYCF 4.Training and Orientation in IYCF 5.Develop National strategy for IYCF based upon global strategy for IYCF 6.Strengthening BFHI and other related activities 7.Initiate action to strengthen pre-service curricula of health personals on IYCF

Suggested – Recommendation for IYCF in Nepal Contd ……. 8. Revise existing curricula of non-medical institution to give emphasis on IYCF 9. Strengthen breast feeding & complementary feeding promotion activities 10. Enforce and monitor the Act/Regulation/Code of marketing of breast milk substitutes 11. Advocate for optional maternity protection legislation 12. Design comprehensive IEC strategy on IYCF 13. Empower/enable/develop community counselor and support group to promote & support IYCF 14. Conduct operational research to improve IYCF

Suggested – Recommendation for IYCF in Nepal Contd ……. 15. Obtain support for IYCF from all concerned parties 16. Facilitate linkages between community groups and health system for referral follow-up

Thank you