1. Ways and means to improve breastfeeding and Complementary feeding in India Dr Ranjana Zade Department Of Community Medicine

2. How have breastfeeding practices improved and what more needs to be done?

3. The Components Support Trained, kind and empowering health workers

4. The Components Promotion Use of face to face and mass media communication channels to change perceived norms Brazilian video

5. Initiation of breastfeeding When women deliver in hospitals, the Baby Friendly Hospital Initiative can have an impact

6. Promotion of increased duration Where the norm is to breastfeed exclusively for several weeks, extending this will be relatively simple but achieving 6 months for most mothers may not be

7. Why don’t mothers breastfeed exclusively?  Lack of knowledge  Lack of support for the working mother to be with her baby  Lack of lactation management/ breastfeeding counseling  Lack of confidence (confidence likely to increase as knowledge increases)

8. Time with the baby Europe got long family leaves (often about a year) because: Women voters made it a political issue Women were unwilling to have any or many babies unless they got it (low fertility rates) Pressure to require men to take as much as women

9. BF promotion methods of proven effectiveness Educating mothers during pregnancy; can be in small groups Evidence for impact: the most effective intervention for initiation and short-term duration Contents: Benefits to baby, mother, society Positioning and latching on Needs during the early days of BF Resources for assistance Address fears, problems, myths

10. Mass media and social marketing Comprehensive, multifaceted Variety of audiences (important to segment) Evidence of impact: improves attitudes Increases initiation rates and possibly duration

11. Professional education Basic and in-service education is required for any health professionals who deal with women pre or post- natally Perhaps health workers also need a change in job description that gives them an opportunity to put their new knowledge into action

12. Public acceptance Legislation ensuring the right to breastfeed Support to public breastfeeding Including breastfeeding in school curricula Too little research to know about effectiveness

13. Peer counseling Usually based on training volunteers who schedule 6-15 postnatal home visits during the early months Has been shown to lead to a dramatic increase in exclusivity, but not in the US or the UK Probably more effective if volunteers are organized in “Care Groups”

14. What Can Health Care Services Do? Change policies and procedures at health care facilities. - Inform women about breastfeeding during pregnancy, such as through antenatal visits and in childbirth education classes. - Establish rooming-in practices.

15. 10 Action ideas

16. 1.Policy-makers and managers to take just Ten Steps! 2. Take out public rally, issue a press release,hold a discussion forum in your area on where India stands and where can we go- calling for tensteps to move beyond. 3. People to to support women to breastfeed at the sign a petition http://www.onemillioncampaign.org/

17. 4. NRHM,State overnments to implement the BFHI and related actions in the health facilities and community settings, provide for home visits to counsel all women and families. 5. District Magistrate to include these actions while supervising the District plan of action. 6. Member of Parliament to write a letter to the government in support of this action. 7. Health workers, associations and individuals to desist from sponsorship by baby food companies

18. 8. Remain vigilant and report to the government if baby food manufacturers sponsor health meetings. 9. Each family member -support mother to give up the practice of giving prelacteal feeds and ensuring exclusive breastfeeding. 10. Organisers of the working places to support the development of creches at workplace and encourage others to do the same and government to provide maternity entitlements to all women

19. REMEMBER Not enacting a Code of Marketing is like fattening the chickens while leaving the door to their pen open to the fox

20. THANK YOU