1. World Breastfeeding Trends Initiative (WBTi) Assessment of the Status of Global Strategy for Infant and Young Child Feeding at National Level— achievements and Gaps SRI LANKA

2. Infant and Young Child Feeding Practices: Indicators 1 to 5 IndicatorExisting status Status in 2005 1.Percentage of babies breastfed with in one hour of birth 91.8%75% 2. Percentage of babies <6 months of age exclusively breastfed in the last 24 hours 75%58% 3. Babies are breastfed for a median duration of how many months? 6 months26 months 4. Percentage of breastfed babies less than 6 months old receiving other foods or drink from bottles in the last 24 hours 25%12% 5. Percentage of breastfed babies receiving complementary foods at 6-9 months of age 83%98%

3. Indicator 6 National Policy, Programme and Coordination Gaps Identified 1.Exclusive breastfeeding only up to 4 months in Sri Lanka 2.Develop National Plan to reach other stakeholders incl. Provincial, Local Govt. and other NGOs involved. 3.National breastfeeding committees should be from all related agencies & NGOs involved. 4.National BF Committees should be headed by a person with authority as a Minister.

4. Indicator 6 National Policy, Programme and Coordination RECOMMENDATIONS TO BRIDGE GAPS 1.Already changed to 6 months of Exclusive Breastfeeding since 2008. 2.Information should be disseminated for awareness creation especially to the grassroots level. 3.Priority should be given with participation of all stakeholders.

5. Indicator 7 Baby Friendly Hospital Initiative Gaps Identified 1.Number has not increased. 2.Focus is less after the initiation in 90s. 3.No proper monitoring system. 4.Current activities not expanded Recommendations to bridge the gaps 1.Funds should be provided to expand to other hospitals, especially to the regional hospitals. 2.More focused. 3.Monitoring system should be initiated. 4.Continuation of training advocacy, capacity building and support of baby friendly hospitals.

6. Indicator 8 Implementation of the International Code Gaps Identified 1.Is lacking. While the Dept. of Internal Trade has legal coverage to the Code, the support of other line agencies such as Health, Food & Marketing, Justice, Labour, etc. an NGOs need to be improved for proper implementation of the Code. 2.Lack of awareness of its significant impact on the health of mother and baby. 3.Lack of awareness of Code Policy. In spite of the Code, advertisements appear on electronic and print media. 4.Mothers are compelled to resort to formulae feeding.

7. Indicator 8 Implementation of the International Code RECOMMENDATIONS TO BRIDGE GAPS 1.Co-ordination to improve. 2.Media campaigns for sensitization and awareness creation. 3.Co-ordination with media and other agencies, and the NGOs for proper monitoring and legal action taken for violation of Code promptly. 4.Proper policy formulation for formulae feeding on exceptional cases.

8. Indicator 9 Maternity Protection Gaps Identified 1.Private sector employers do not give at least 14 weeks paid maternity leave, only 12 weeks are given. 2.No provision for women informal / unorganized agriculture sector 3.Paternity leave of 7 days (Government) insufficient. 4.Paternity leave not granted in the private sector.

9. Indicator 9 Maternity Protection RECOMMENDATIONS TO BRIDGE GAPS 1.The same provision as the Government Sector to be extended to the Private Sector or at least give 24 weeks Maternity Leave for the child to be exclusively breast-fed for 6 months. 2.Some protective measures in line with Government Sector and at least 24weeks Maternity Leave for Exclusive Breastfeeding. 3.Paternity leave of 7 days – insufficient. Increase it to 14 days. At least give the same Paternity Leave to the Private Sector as in the Government Sector.

10. Indicator 10 Health and Nutrition Care Systems Gaps Identified 1.Not included in school curricular. 2.Training programmes insufficient. 3.Health workers not adequately trained on implementation of the Code. 4.Inadequate infant feeding related to content skills especially on HIV AIDS. 5.In-service Training not provided throughout the Country regularly.

11. Indicator 10 Health and Nutrition Care Systems RECOMMENDATIONS TO BRIDGE GAPS 1.Should be included in Schools and other Education Programmes. 2.In-Service Training Programmes strengthened to provide knowledge & skills. 3.Provide systematic training on the Code. 4.Adopt Training and related Policy formulation. 5.Upgrade the Training especially in the regional areas.

12. Indicator 11 Mother Support and Community Outreach Gaps Identified 1.This community-based support for pregnant and breastfeeding mothers is an area where there is a big gap in Sri Lankan system. Although, the community support is given it is not done in a Systematic and planned way. 2.No information collection system by community-based support groups.

13. Indicator 11 Mother Support and Community Outreach RECOMMENDATION TO BRIDGE GAPS 1.A Strategy to strengthen the community-based support for the breastfeeding mothers. 2.Information gathering system to be established and direct information to and from the National to community and community to National level.

14. Indicator 12 Information Support Gaps Identified 1.Do not reach the local level 2.National IEC Campaign using electronic and print media to targeted audience – insufficient. Recommendations to bridge the gaps 1.Decentralization of IEC strategy especially to estate sector – most neglected. 2.Increase the media campaigns to reach all.

15. Indicator 13 Infant Feeding and HIV Gaps Identified1.Policy not in place Recommendations to bridge the gaps 1.Comprehensive Policy including all aspects to be prepared by Government.

16. Indicator 14 Infant Feeding During Emergencies Gaps Identified 1.Lack of Policy & Programmes. This came to light during Tsunami as a major draw-back with bottle feeding & formulae flooding the affected areas 2.National Co-ordinating Committee does not consist of all Stakeholders as UN, Donors, Military & NGOs, etc.

17. Indicator 14 Infant Feeding During Emergencies RECOMMENDATION TO BRIDGE GAPS 1.Proper Policy to be formulated. 2.National Co-ordinating Committee to be organized with all stakeholders as UN donors, Military and NGOs., etc.

18. Indicator 15 Mechanisms of Monitoring and Evaluation System Gaps Identified 1.Community-based support system and monitoring system – weak. Recommendations to bridge the gaps 1.A system should be built into the National System to collect information on community-based activities pertaining to Breastfeeding. The information system should be utilized especially at the grassroots level.

19. MILLENNIUM DEVELOPMENT GOALS (MDG) TARGETS MDG 1 (Nutritional Status of Children under 5) Percentage Low Birth Weight. 16% Percentage under Five - stunted: 18% Sri Lankan children are stunted with 4% being severely stunted. Stunting levels increase rapidly with age, peaking at 23% among children aged 18-23 months. Children of mothers with some secondary or higher education are much less likely to be stunted than children whose mothers have achieved only primary level or less education. Percentage under five - underweight. 22% : 4% classified as severely underweight. The percentage of children with underweight steadily increases with the age of the children underweight, which is higher for boys than girls and for estate children than for children in urban and rural areas. The proportion of children with underweight steadily decreases with increase of mother’s level of education.

20. Contd…. 2. MDG 4 (Child Survival) Under five mortality : 21 deaths per 1000 live births Infant Mortality Rate : 12 deaths per 1000 live births (Registrar General Department). Neonatal Mortality Rate : 10 per 1000 births.

21. Contd. 3. MDG 5 ( Improve Maternal Health) Maternal Mortality Ratio 14 per 100,000 live births Maternal Health Deliveries attended by trained health personnel : 99% of births in Sri Lanka are delivered by health professionals. Nearly 98% of deliveries take place in health facilities. Antenatal care coverage : Almost all the mothers (99%) have seen a health professional, a medical doctor, including specialist or midwife at least once with antenatal care. This fact is true in urban, rural and estate areas. This indicator is against slightly low for mothers with no education.

22. CHARTER ON THE RIGHTS OF CHILD Article 6 : Right of Live, Survival and Development The State shall recognize that every child has the inherent right to life and ensure to the maximum possible the survival and development of the child.

23. Article 25 : 1.The State shall recognize the Right of the Child to the enjoyment of the highest attainable standard of health and other facilities for the treatment of illness and ensure that no child is deprived of his right of access to such health-care services. 2.The State shall pursue the implementation of this right and, in particular, take appropriate measures:- a. To diminish infant and child mortality; b. to ensure provision of necessary medical assistance and health-care to all children with emphasis on the development of primary health-care.

24. Contd.. c. To combat disease and malnutrition through the application of readily available technology and through the provision of adequate nutrition food and clean drinking water, taking into consideration the dangers and risks of environmental pollution; d.To ensure appropriate pre-natal health-care for mothers; e.to ensure that all segments of society, in particular parents and children, are provided with the basic knowledge of child health and nutrition, the advantages of breast-feeding, hygiene and environmental sanitation and the prevention of accidents;

25. Contd…. f. To develop preventive health-care services, guidance for parents and family planning education and services. 3. The State shall recognize the right of a child who has been placed in any institution for the purpose of protection or treatment for his physical or mental health, to care, protection, and for a periodic review of the treatment provided to the child and all other amenities provided for such child. 4. The State shall promote and encourage international co-operation with a view to achieving progressively the full realization of the right recognized in this Article.