1. Breastfeeding : Challenges and Opportunities
Arun Gupta MD FIAP
2nd National Conference on Breastfeeding and Complementary Feeding (Infant and young Child feeding)
DHAKA BANGLADESH
19 August 2006

2. Introduction List some challenges and opportunities
Explain how do we convert challenges to opportunities,
Growing HIV and prevention of infant HIV as a case for scaling exclusive breastfeeding

3. List MDG 4 achievement HIV
High level attention for declaring “breastfeeding education” a public health priority
Scaling to 90% early and exclusive breastfeeding
Scaling up ORT and Newborn care to 100%

4. MDG 4
The targets of the 1990 Innocenti Declaration and the 2002 Global Strategy for Infant and Young Child Feeding remain the foundation for action. While remarkable progress has been made, much more needs to be done.

5. Challenges Remain !
Shift emphasis from Curative to preventive services
Support women employed outside the home, including in the non-formal sector.

6. Prevent infant HIV
Look at your PMTCT programmes see how this is addressed: Informed choice on infant feeding
How many women get a test and how many who are positive choose Replacement feeding?
Are they supported to avoid mixed feeding, challenge is to achieve exclusivity of both either breastfeeding or artificial feeding
Aim at HIV free child survival
Build populations and communities with high rates of exclusive breastfeeding

7. Exclusive breastfeeding Prevents HIV in infants
Most mothers are either negative or not tested, better prevent transmission as well as ensure HIV free child survival
Early Exclusive Breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. AIDS :

8. High level attention for declaring “breastfeeding education” a CORE public health priority
Lack of adequate understanding with policy makers and programme managers, economists
Need serious dialogue and education using breastfeeding education as a prevention ORT as treatment intervention for diarrhea, still the major cause of infant mortality
Need to accelerate infant mortality reduction for reaching goals of U-5 child mortality
Discuss to dissect 0-12 month period and month period of under five mortality and wise allocation of resources. Are we truly using 75% of child health and nutrition resources during first year, analyse and present.

9. Contd: Continuum of care : 4th stage of labour
Acceleration of reduction of infant and neonatal mortality

10. Growing numbers of underweight children and obesity
If we reduce infant mortality rate(IMR) by other means and don’t prevent child malnutrition , we will end up having more underdeveloped children and later adults, thus the society as whole

11. Childhood Obesity
Global epidemic, alarming increase of prevalence & severity
Severe psychosocial & health burdens, huge costs, difficult to treat
Primary prevention greatly needed, breastfeeding is the answer other than changing children's’ life style
Koletzko B, Chen W, Dietz W, et al. Obesity in children and adolescents world-wide: current views and future directions. JPGN 2002 (August)

12. U-5 child deaths (%) saved with preventive and treatment interventions
UNIVERSAL COVERAGE IS THE ANSWER

13. Breastfeeding reduces later risk for overweight and obesity by ≈20-50 %

14. Scaling to 90% early and exclusive breastfeeding
Serious Action is needed at ALL levels
Call upon your governments to commit financial resources for implementing the Call for Action
One to one counselling

15. Scaling up ORT and Newborn care to 100%
Link breastfeeding education to these two interventions effectively
Given the current trend we ignore breastfeeding the most since it is not delivered like vaccines.
Both have a good potential but we end up treating diarrhea that too does not have a wide reach
Newborn care like warmth and exclusive breastfeeding need more emphasis.

16. Otherwise ? What’s that …….exclusive breastfeeding ?
What’s that….. ORS?
Will remain as questions only !

17. Thanks !