1. Breastfeeding Week 1-7 August Public education presentation Presented by: add your name 1 Created by Inge Kleinhans, 2013 Public Relations Officer of JuPHASA.

2. What is exclusive breast feeding? With the exception of drops or syrups consisting of vitamins, mineral supplements or medicines, an infant receives only breast milk and no other liquids or solids, not even water. When expressed milk is given, the preferred term is breast milk feeding.

3. The World Health Organisation and breastfeeding Breastfeeding is the best way to provide infants with the nutrients they need. WHO recommends exclusive breastfeeding starting within one hour after birth until a baby is six months old. Nutritious complementary foods should then be added while continuing to breastfeed for up to two years or beyond.

4. The World Health Organisation and breastfeeding continued Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development. Virtually all mothers can breastfeed, provided they have accurate information, and the support of their family, the health care system and society at large. Colostrum, the yellowish, sticky breast milk produced at the end of pregnancy, is recommended by WHO as the perfect food for a new-born, and feeding should be initiated within the first hour after birth. Exclusive breastfeeding is recommended up to 6 months of age with continued breastfeeding along with appropriate complementary foods for up to two years of age or beyond.

5. Advantages of breast feeding 1. Provides all of the infants nutrient requirements. 2. Antibodies and macrophages protect against certain infections. 3. Breast milk is easily digested. 4. Breast milk is hygienic, convenient and readily available. 5. It strengthens the psychological bonding process.

6. Advantages of breastfeeding continued 6. Lower incidence of allergies. 7. Less expensive. 8. Breastfed babies are rarely overweight. 9. Lower incidence of sudden infant death syndrome. 10. Breast cancer is less frequently in women who have breastfed. 11. Can suppress ovulation but isn’t safe to rely on as only method of birth control.

7. 10 steps to successful breastfeeding Every facility providing services and care for new-born infants should: 1. Have a written breastfeeding policy. 2. Train all staff to implement the policy. 3. Inform all pregnant women on the benefits of breastfeeding. 4. Help mothers to initiate breastfeeding within half an hour after birth. 5. Show mothers how to breastfeed and to maintain lactation.

8. 10 Steps to successful breastfeeding continued 6. Give new-born infants no milk or feeds other than breast milk. 7. Allow mothers and infants to remain together 24 hours per day. 8. Encourage natural breastfeeding and on demand. 9. Do not give or encourage the use of artificial teats or dummies. 10. Promote the establishment of breastfeeding support groups. *Based on the UNICEF/WHO Joint statement 1989

9. HIV positive mothers and breastfeeding Exclusive Breastfeeding for 6/12, introduce complementary foods, continue Breast Feeding up to 12/12. Breast Feeding beyond 12/12 not recommended. Abrupt cessation not recommended, gradually stop over one month, continue Antiretroviral (ARV) for one week after breastfeeding is fully stopped.

10. Treatment regimen for HIV positive mothers Maternal regimens First antenatal visit All women (any gestational age) are immediately initiated on fixed dose combination (FDC) if HIV+. If currently on lifelong Antiretroviral Treatment (ART)- continue the ART regimen if compatible with pregnancy. * The South African Antiretroviral Treatment Guidelines 2013

11. Prevention of mother to infant transmission If the mother is on lifelong ART or antenatal prophylaxis then Nevirapine (NVP) is given at birth and then daily for 6 weeks. If the mother breastfeeds and isn’t virally suppressed, continue NVP for infant until one week post cessation of breastfeeding. Mothers who aren’t on ART before or during delivery and tests HIV+ post-delivery, NVP should be started for the neonate as soon as possible and daily for 6 weeks. Unknown maternal status (orphan)NVP immediately. If rapid HIV test +, infant must continue NVP for 6 weeks. Discontinue NVP if follow up at 6 weeks with HIV DNA polymerase chain reaction (PCR) is negative. If the mother is on Zidovudine (AZT) regime, infant must be given NVP at birth and then daily for 6 weeks with a HIV DNA PCR at 6 weeks. If negative and breastfeeding continue NVP till one week post cessation breastfeeding.

12. All images courtesy of the World Health Organisation http://www.who.int/mediacentre

13. All images courtesy of the World Health Organisation http://www.who.int/mediacentre

14. All images courtesy of the World Health Organisation http://www.who.int/mediacentre

15. All images courtesy of the World Health Organisation http://www.who.int/mediacentre

16. All images courtesy of the World Health Organisation http://www.who.int/mediacentre

17. All images courtesy of the World Health Organisation http://www.who.int/mediacentre

18. All images courtesy of the World Health Organisation http://www.who.int/mediacentre

19. Helpful links For more information and in depth videos on breast feeing please visit: www.youtube.com/user/who www.who.int

20. Thank you The end.