1. SCALING UP BREASTFEEDING ACTIVITIES IN BRAZIL
Marina F. Rea
IBFAN
National Committee of Breastfeeding, MoH Brazil
WBC 2, December 2016

2. BREASTFEEDING OUTCOMES.
Trends in Exclusive Breastfeeding 0-6 months in Brazil

3. BREASTFEEDING OUTCOMES.
Trends in Median duration of breastfeeding in Brazil, in months

4. Exclusive Breastfeeding 0-6 months and BF trends comparing Brazil and Mexico, observing below the program coordination and gear model of execution in these countries
Perez-Escamilla et al.
Adv. Nutr. 3: 2012.
These two countries may provide us interesting considerations on how to carry out a BF Prog, observing the trends in EBF 0-6 months, and also BF median duration. For many years Bra has had a national BF coordinator, has settle goeals
The breastfeeding gear model for scaling up and sustainability of breastfeeding programs.

5. Minist.Health BF Coordination and assessors Committee
BRAZILIAN BREASTFEEDING INCENTIVE PROGRAMME
PRIMARY HEALTH CARE NETWORK
HUMAN MILK BANK
BFHI
CODE
Minist.Health BF Coordination and assessors Committee
KANGAROO CARE
WBW, CAMPAIGNS
WORKING WOMEN & BF
EDUCATION
/INF MATERIALS
MONITORING
Analogous to a well-oiled engine, our successful programme indicates the need for several key "gears" to be working in synchrony and coordination. 

6. In January 2016 Brazil was a special mention at Lancet on Breastfeeding:
“In Brazil, the length of breastfeeding increased dramatically from 2.5 months in to 14 months in due to a combination of policy, health service, civil society, and mass media initiatives.”
According to Lancet “an increase in 10 percentage points on EBF 0-6 months and continuation till 2 years or beyond could represent a saving in 6 million US dollars in treatments in Brazil.”
“A study in Brazil including 30 years of follow-up
suggested an effect of breastfeeding on intelligence,
attained schooling, and adult earnings, with 72% of the
effect of bf on income explained by the increase in IQ”.

7. PRIMARY HEALTH CARE BREASTFEEDING & COMPLEMENTARY FEEDING NETWORK
Recent years of improvement in this component:
3.992 tutours on BF & CF
210 workshops;
Skilled capacity of health workers at primary health care units;
local training at1.753 UBS;
53 UBS certified by MoH, and
more 108 UBAAM only in Rio de Janeiro.

8. PRIMARY HEALTH CARE BREASTFEEDING & COMPLEMENTARY FEEDING NETWORK
362 municipalities (6.5% ) with local trained health workers and health units.
…still a lot to be done!

9. WORKING WOMEN AND BREASTFEEDING
-Increase of maternity leave to 180 days to all working women
Creche at workplace
A room for express and storage breastmilk at workplace
Workshops to form Tutors in each state
Number of Tutors
Number of companies with
Room
Number of certified
Room for express & storage bm 29
671
231
175

10. WORKING WOMEN AND BREASTFEEDING
MATERNITY LEAVE INCREASES EXCLUSIVE BREASTFEEDING in BRAZIL - a study with mothers.
EBF: NO
YES
Do not work/ Work outside home/ work but in maternity leave

11. CHALLENGE: Different ways to work, different employers: how pregnant and lactating women can cope?

12. KANGAROO METHOD CARE
A method to incentive mother and father to increase bonding with premature and low birth weight babies
Brazil Maternities with KMC ,0% Profesionals skilled on the KMC: 25%

13. BABY-FRIENDLY HOSPITAL INITIATIVE
Launched in 1991 in Brazil.
In 1993 the first Hospital – IMIP, Recife, PE.
In 1994 the first private hospital – became BFH
Brazil BFHI criteria:
To implement the Ten Steps to Successful Breastfeeding
To implement the WHO Code of Marketing of Breast Milk Substitutes and national Code
To implement the mother-friendly care for labour and delivery
To allow parents to access the neonate at risk.

14. Training courses performed for the implementation of BFHI in Brazil , sponsored and carried out by MoH.
Courses
Number of trained health professionals 
Clinical management and Promotion of Breastfeeding
10.842
BFHI Training Course for Assessors
427
Breastfeeding Counseling Course
463
BFHI Short Course for Decision-makers
2.536
BFHI Updating Course for Assessors
234
Here is not included local training courses in municipalities and maternity hospitals, difficult to quantify.

15. BABY-FRIENDLY HOSPITAL INITIATIVE
Annual numbers of newly BFHI accredited hospitals in Brazil
382 hospitals were accredited for the BFHI, an average of 15 per year.

16. BRAZIL BABY-FRIENDLY HOSPITALS ACCORDING TO STATES AND TO THE PROPORTION OF NEONATES BORN IN BFHI01 01 08 26 11 19 29 15 13 01 11 07 02 03 01 08 02 11 20 23 02
BABIES BORN IN BFH IN BRAZIL 03 15 40
year
2013
2014
Total births
% births in BFH
23%
27% 21 17 16
Total 326 BFH
YEAR:2016
Number of maternity hospitals (2014) – 4705.

17. 220 Banks 171 Human milk collect units
HUMAN MILK BANK 9 13 10 57 14 18 7 5 3 1 4 6 15
Distribution of HMB according to states
220 Banks 171 Human milk collect units

18. SOCIAL MOBILIZATION AND CAMPAIGNS
WORLD BREASTFEEDING WEEK AND DAY OF MOTHER´S MILK DONATION

19. BRAZILIAN CODE
It is based in the International Code 1981 and subsequent relevant World Health Assembly Resolutions
Approved in1988 – as a sanitary resolution
Revised in1992 and in 2001.
Approved as Law by parliament and signed by presidt. in 2006.
Law regulated as a Decree 8552 in 2015.
STRENGTHS:
OBJECTIVE – includes protection of breastfeeding till 2 years and beyond
SCOPE – includes infant formula plus baby foods and milks for young children till 3 years, bottles, teats, pacifiers, HMF, formulas for dietetic use.
LABELS with WARNING – according to the type of product.
COMMERCIAL PROMOTION - with WARNING – according to the type of product
MONITORING – annually by strong IBFAN group present all over the country.

20. As a CONCLUSION, and according to The Lancet:
“Brazil exemplifies a country with strong civil society engagement and
participation, in which policies and programmes addressing all three levels of the conceptual framework (individual, settings, and structural)
have been implemented simultaneously.
The Code, enacted shortly after adoption by the World Health Assembly, has been updated three times and is rigorously monitored for compliance.
Paid leave is available to mothers (24 weeks) and fathers (3 days).
A systematic process for certification and recertification
of hospitals as “Baby Friendly” to maintain quality standards has
been instituted and health-worker training has been extensive.
An innovative network of human-milk banks in more than
200 hospitals has established the use of human milk and breastfeeding as a valued and normative practice.
Visible government leadership and investment and active civil society
participation underpin Brazil’s breastfeeding achievements.
(…)
Nonetheless, it is the tenth largest market for baby milk formula,
and is projected to reach $951 million by 2019.”
Therefore, Breastfeeding implementation activities should continue strongly and always be a priority !

21. Thank you! …to have more breastfed healthy and wonderful children!