1. Regional Consultation Meet on Nutrition Bhubhneshwar
Importance of Breastfeeding for Child Survival , Development and Health
Regional Consultation Meet on Nutrition Bhubhneshwar
18-19 July 2005
Dr.Arun Gupta MD FIAP
National coordinator BPNI
BP-33, Pitampura, Delhi

2. Three Major Killers in India
Neonatal sepsis
Diarrhoea
Pneumonia
Source: Robert et al. LANCET 2003;361:

3. Neonatal sepsis
Breastfeeding is the No. 1 preventive intervention compared to any other intervention
Lancet Series on child survival, and now on newborn survival : 2003 and 2004
Definition of Breastfeeding : Exclusive breastfeeding for the first six months and continued breastfeeding for next six months

4. Diarrhea
Breastfeeding is the No. 1 preventive intervention compared to any other intervention
Lancet Series on child survival, and now on newborn survival : 2003 and 2004
Definition of Breastfeeding : Exclusive breastfeeding for the first six months and continued breastfeeding for next six months

5. Pneumonia
Breastfeeding is the No. 1 preventive intervention compared to any other intervention
Lancet Series on child survival, and now on newborn survival : 2003 and 2004
Definition of Breastfeeding : Exclusive breastfeeding for the first six months and continued breastfeeding for next six months

6. Look at other interventions
Under-5 deaths preventable through universal coverage with individual interventions
Look at other interventions
Source: Jones et al. LANCET 2003;362:65-71

7. 10th Five year Plan GOALS

8. Trends in Infant Feeding Practices 1992 1999 (NFHS-1) (NFHS-2)

9. Exclusive breastfeeding falls rapidly from first month onwards (NFHS-2-1999)
Target line
Achieved

10. The deficit to
Make up!

11. It enhances brain development
Brain develops in first two years the most
Breastfeeding contributes to IQ, visual acuity, mathematical abilities and analytical capacity. ( evidence available)
Prepares children for BETTER LEARNING at PSE/Schools
What ever level of survival we achieve, we will always achieve higher level of child development: sustainable human development

12. Exclusive breastfeeding Prevents HIV in infants
Early Exclusive Breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. AIDS :

13. It prevents Obesity
Sufficient evidence available that BREASTFEEDING/ExBF prevents childhood obesity
15% urban populations are projected to be obese
American Academy of Pediatrics guidelines: rate Breastfeeding as number one preventive intervention along with decreased TV viewing
Treatment costs are horrible and unaffordable even by USA

14. It has Huge economic value
Market Value of breastmilk : difficult to put a cost !
Artificial feeding you have to spend about RRs 450 per day to feed a 3 months old infant, perpetuates income poverty by additional spending on milk and sickness
In the Milk banks of Norway it is available at 50 $ per liter as compared to the cost of powder milk formula of about 2-3 $ per day.
At Current level of production of breastmilk in India : 4000 million liters
If we achieve national goals : 6500 million liters
Economic worth $ 326 billion

15. 10th Five Year Plan Goals Exclusive Breastfeeding 0-6 months
Note: NFHS 2 data for exclusive breastfeeding 0-3 months and 10th Plan Goals data is 0-6 months

16. Exclusive Breastfeeding 4 states (BPNI Data 2003)

17. When malnutrition strikes…Under three
First three years are for ever…..
NFHS-2,

18. (IMR and Underweight U-3)
IMR (MOHFW, 2001)
Under-weight children (NFHS-2)

19. Exclusive breastfeeding prevents child malnutrition
Strikes Where it begins in early
child hood
0-6 months is critical, 6-12 is next
We allow child undernutrition to set in
With poor feeding( BREASTFEEDING and COMPLEMENTARY FEEDING )
Neonatal infections, Diarrhea, pneumonia, 2/3 mortality is in 1st year
According to WHO, 2/3rd mortality is related to poor feeding practices

20. Can we save babies? YES Make IYCF widely available
Prevent malnutrition in children

21. What works ? Behavior change and timing is critical
Intervention must be as close to desired change
Requires Skillful acts not as we deliver a vaccine

22. Experience from Bihar villages
20-80% mothers in rural area start some supplements within first 2 months.
Most mothers do so because they feel “not enough milk”
None of the ANMs in PHC could provide correct answer to what should be done, neither an AWW ( one of whom was MSc Home Science)
HWs and RMPs provide “top milk feeds as advice”
Commercial promotion makes formula and bottle use as common
Open your presentation with an attention-getting incident. Choose an incident your audience relates to. The incidence is the evidence that supports the action and proves the benefit. Beginning with a motivational incident prepares your audience for the action step that follows.

23. Summary findings of a qualitative study from 49 districts(98 blocks) BPNI, India 2003
Inadequate knowledge in the community as well as in the healthcare system.
Lack of access to skilled counselling and practical support by health care workers
Traditional practices. Lead to pre-lacteal feeding
Separation of mother and baby immediately after delivery continues. (in private sector)
Families and mothers believe that mothers don’t have enough milk.
Long working hours in offices and in the field
Confusing/conflicting messages by health functionaries

24. What ICDS offers? Women workers : AWWs and helpers
Context is “food” for poor or malnourished,
SNP and PSE as core interventions
Food based interventions tackling “HUNGER”
And for the younger ones it is not an issue

25. What is left out ?
Lack of understanding what are determinants of child malnutrition
For the 0-6 months it is Exclusive breastfeeding and 7-24 months continued BREASTFEEDING with adequate complementary feeding
ICDS’s position as true child development programme
Nutrition and health education : weakest and IYCF is missing; skills on IYCF counseling for motivation of mothers are non existent .

26. REPOSITION ICDS Outcome should be “Smart kids” Healthy kids
Smiling kids
Smart ADULTS
Smart SOCIETY

27. What makes women successful in BF
Practical help and support from all quarters especially health care providers.
Good accurate information and timely counseling
Building confidence when they have a ‘feeling’ of not enough milk,
Assistance
To initiate breastfeeding within one hour,
Assistance in proper sucking position to allow effective and frequent sucking and thus optimal milk transfer;
Prevent breast problems like sore nipples and engorgement,
Solve problems if they do arise,
Answer any questions if mothers may have,
Counseling on adequate and appropriate complementary feeding,
Counseling on HIV and Breastfeeding for infant feeding options and support to their choice.

28. ACTION:Make breastfeeding support visible more widely available
Making breastmilk more widely available
Mother support networks
Breastfeeding support centers;(this is not another building)
Successful women offering help
Redefine the role of workers specifically holding AW responsible for under three nutrition and IYCF counseling as service in DWCD organogram

29. Integrate IYCF effectively In outreach programmes
What does that mean?
Strengthening of Pre-service
7 days training on Breastfeeding, complementary feeding, and HIV for ALL health professionals
3- days training for frontline workers
(We have done this for NACO recently) putting infant feeing in the counselors training, other departments also needed to do similar exercise)
In service : Additional skills training is necessary

30. Put effective monitoring in place
Exclusive breastfeeding 0-6 months as lead proxy indicator of progress
With its allocations
With a Context
With an accountability mechanism
REPORT it annually

31. What health systems offers?
So far relied on pieces of occasional information not on education which requires skills
Inadequately equipped with skills
Less supportive of breastfeeding
HWs and doctors believe they know enough
Encourage adoption of artificial feeding for no fault of women

32. What Health should do?
Implement the “Investing in Development” A Practical Plan to Achieve the MDGs: Report to the UN Secretary General Millennium Project NY 2005” and offer
“Neonatal Integrated Package” that includes, breastfeeding education including for HIV positive mothers.
Provide continuing education services to ICDS
Cant wait for IMNCI to be available universally
Newborn care and BREASTFEEDING must be universalized now

33. I& Y C F Counseling: A Training Course
Course- Structure (Algorithm)
I& Y C F Counseling: A Training Course
The 3 in 1 course
SKILLS
Director
Preparation of trainers (learning training skills 1wk)
Learning through conducting training using module 1wk
Trainer + Co-trainer
Training of trainers FLW 1wk
Training of FLW 3days

34. Can we do all this without costs?
This is what is we need to do differently
Reorganize resources for Care under one including maternal nutrition and care
10th Plan notes that improving infant feeding does not require additional spending. This thinking needs to change!
Ensuring this Free fluid costs!
Not delivered as vaccines but does much more than that
Requires as much spending

35. What other states are doing in collaboration with BPNI?
UP: training of ALL frontline workers in 8 districts ( Sitapur has begun)
Uttranchal : 13 district study on INFANT AND YOUNG CHILD FEEDING and FU with a state plan in one year.
Haryana : In its State allocation, budgeted on improving infant and young child feeding and got it
Training initiatives started in MP, Bihar, Rajasthan (Govt-BPNI-UNICEF)
Pondicherry, AP, Punjab: Initial enquiries with us

36. INVEST WISELY !
Put budget lines for IYCF action plans with annual monitoring in relation to development
At least match with vaccination programmes
11th plan is at arms length !

37. Reorganize resources, each step requires allocation
Prenatal- 0-6
months
6 m-3 yrs
3 -6 yrs.
CARE : Skills training
and
Counseling, care of women
HEALTH
Immunization etc
FOOD SUUPLY
for
Hunger/ PSE

38. National guidelines on IYCF launched 6 August, 2004

39. The law to protect, promote and support breastfeeding: 6 August,2004

40. Beginning of the rise of breastfeeding ! Be a part of history !!
Thanks !