1. 20 years of breastfeeding advocacy from research to reaching hearts & minds
Chantell Witten, RD(SA)
North West University, Nutrition Department
PhD candidate at the North West University, Center of Excellence for Nutrition
Member of the South African Civil Society for Women, Adolescents’ & Children’s Health
Member of the National Department of Health Breastfeeding Technical Working Group
I would like to thank the organizers for the invitation to make this presentation and take this opportunity to present in my capacity as an affiliate to the organizations listed on my title slide. My presentation is heavily influenced by the EVIDENT thinking which focuses on EVIDENCE-informed policy decision-making and making science useful. The 20 years of breastfeeding is set in the context of South Africa, looking back from the early 2000s to date

2. Outline of my presentation
The breastfeeding context in South Africa
Multi-sectoral perspective to breastfeeding advocacy
What is the evidence
Have we reached hearts & minds
In the next 8 slides I would like to address the following:
Briefly set the breastfeeding landscape of SA
Give a perspective on the multisectoral nature for breastfeeding advocacy
Revisit the evidence for breastfeeding advocacy in South Africa
- And finally, a challenge to us in South Africa to reaching hearts and minds in South Africa?

3. The breastfeeding context in South Africa
RSA: EBF 7.4% (SANHANES, 2013)
WHA %
South Africa has a rich and progressive policy environment as shown the number of policy directives starting in The Integrated Mutrition Programme, launched in 1994 had a key focus area on breastfeeding and already in 1994, South Africa initiated the Baby-Friendly Hospital Initiative. And impressively, St Monica Maternity Hospital in Cape Town retains its MBFI accreditation. Since then, to date in SA at least 70% of public hospital facilities with maternity services are MBFI accredited.
Of course the South African landscape of breastfeeding was marred with the HIV epidemic and in 2001 South Africa launched the PMTCT programme which provided free infant formula until early the end of free infant formula was marked by the bold and very welcomed Tshwane Declaration in which our minister of Health declared South Africa as a breastfeeding country for all mothers, irrespective of their HIV status, given the move to life long ARV treatment for all HIV positive pregnant women. At the time of the first WBC in India, South Africa legistlated the International Code for the Marketing of Breastmilk Substitutes, as Regulations R991.
But despite all these positive policy changes, South Afica’s Breastfeeding rates did not change, remaining low at less than 10%

4. National Breastfeeding rates 1998 -2012
This slide illustrates the poor progress we have made over the past 14 years, the data shows that we are deteriorating in many aspects of the breastfeeding continuum low EBF rates, shortened BF duration and earlier introduction of other foods by more mothers with infants < 6months. How can we reverse this negative trend?

5. The Multi-sectoral lens on breastfeeding advocacy
Government Policy
Advocacy as a wide range of activities conducted to influence
decision makers at various levels.
Research
Programme
Implementation
Breastfeeding is a component of Nutrition and therefore also requires multi-sectoral action. While Breastfeeding research is well established in 2015 there were more than 100 systematic reviews on the function and outcomes of breastfeeding. In South Africa, our Government policies reflect this science and research but the real challenges is programme implementation and social behaviour change. Let me illustrate this,
Receptive audience

6. The policy-practice gap in breastfeeding advocacy: South Africa
In early 2016, we had the launch of the Breastfeeding Lancet Series re-emphasizing the evidence base for BF. Our Government IYCF related policies have been revised and updated in line with the UN guidelines. To reach the WHA target of 50% EBF for infants 0-6 months, we need more than research and policies, we need coverage and uptake of optimal breastfeeding practices. For this you need programme coverage at scale and at a heightened intensity with a receptive community/population. Which sadly is not the case. As shown by this headline coverage of a popular family restaurant anti- breastfeeding sentiment.

7. What is the advocacy-practice gap
In October this year, Menon et al shared the first ever at scale country evaluation of a multi-level multi-media breastfeeding intervention programme which showed significant positive change with increased breastfeeding rates and duration.

8. What does the evidence tell us
Given the evidence, South Africa needs to invest in:
Access to high-quality, accurate breastfeeding information on all platforms
Access to formal support (peer, family, and professional)
Given the evidence, it is clear that beyond the policy environment, South Africa needs to implement a programme that provides high-quality accurate BF information and institutionalize formal breastfeeding support beyond the clinic walls.

9. National Department of Health Breastfeeding campaign
What are the best practices from the successful Alive & Thrive IYCF programme

10. The evidence is not promising on the advocacy – practice gap
RSA: EBF 7.4% (SANHANES, 2013)
WHA %
The big question is given the evidence, can South Africa close the advocacy – practice gap beyond the policy environment. And will we continue to see this negative headlines andpoor BF rates in our next DHS.

11. South Africa still has a long way to go to win hearts and minds
Thank you!
So, in conclusion, yes South Africa has a long way to go to close the gap between research and community action and NO, we have not yet won hearts and minds. And in the words of Prof Linda Richter we still need Breastfeeding champions, more so in our communities.