Global Strategy

Global Strategy on Infant and Young Child Feeding Jean-Marc Olivé, MD, MPH WHO Representative of the Philippines

Office of the WHO Representative in the Philippines

Objective: To Promote Appropriate Infant

and Young Child Feeding Practices • Exclusive Breastfeeding 0-6 months east

• Continued Breastfeeding with safe and appropriate complementary – 6 months—2 years or beyond

• Breastfeeding in difficult circumstances: – – – –

Malnutrition HIV LBW Emergencies...

Office of the WHO Representative in the Philippines

What is the evidence for these recommendations?

Office of the WHO Representative in the Philippines

Major causes of death among children under five, world 2000 Pneumonia 20%

Other 29%

Deaths associated with undernutrition

Diarrhoea 12%

60%

Malaria 8% Perinatal 22%

Measles HIV/AIDS 5% 4%

Sources: For cause-specific mortality: For deaths associated with malnutrition: Caulfield LE, Black RE. Malnutrition and EIP/WHO the global burden of disease: underweight and cause-specific mortality. Paper in preparation.

Office of the WHO Representative in the Philippines

Effect of breastfeeding on mortality Relative reduction

• WHO pooled analysis, 2000 – Any vs. no BF • <2 mo • 6-8 mo • 12-15 mo

76% 41% 37%

• Arifeen et al., 2001 (<12 mo) – Exclusive vs. partial/no BF

75%

• Bahl, Kirkwood et al., unpublished (<6 mo) – Predominant vs. no BF – Predominant vs. partial BF

90% 65%

Office of the WHO Representative in the Philippines

Effect of breastfeeding on neurodevelopment • Meta-analysis of 28 studies (Anderson et al 1999): higher cognitive function in breastfed compared with formula fed infants – Normal birth weight: 2.66 points – Low birth weight: 5.18 points

Office of the WHO Representative in the Philippines

Possible long term effects of breastfeeding • Evidence that breastfeeding during infancy may be associated with lower: – Mean systolic blood pressure during childhood and adolescence – Mean total serum cholesterol in adult life – Risk of obesity during childhood and adolescence – Risk of diabetes/glucose intolerance

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Trends

• The past 20 years have seen limited improvements in feeding practices ❖ Breastfeeding rates improved in few countries ❖ stagnant or dropping in many ❖ Exclusive breastfeeding at 6 months of age low ❖ BFHI has slowed ❖Many gains lost ❖ International Code incompletely implemented ❖ Few countries with adequate maternity protection

Office of the WHO Representative in the Philippines

Exclusive breastfeeding at <6 months % exclusively breastfed (0-6 months)

60 50

42

40 30

46 34

33 23

25

23

20 10 0

AFR

AMR

EMR

EUR

SEAR

WPR

AFR N=65 AMR N=24 EMR N=17 EUR N=57 SEAR N=13 WPR N=19 Global N=195

GLOBAL

Office of the WHO Representative in the Philippines

Breastfeeding Rates at 0-1, 2-3 and 4-5 Months of Age from 1993, 1998 and 2003 NDHS

Percentage

100% 90% 80% 70% 60%

1993 1998 2003

50% 40% 30% 20% 10% 0% 0-1

2-3

4-5

Age (months)

Office of the WHO Representative in the Philippines

Continuing Breastfeeding Rate 12-15 months 100 88

87 79

80 67

67

AFR N=65 AMR N=24 EMR N=17 EUR N=57 SEAR N=13 WPR N=19 Global N=195

60 49

47

40

20

0 AFR

AMR

EMR

EUR

SEAR

WPR

GLOBAL

Office of the WHO Representative in the Philippines

Reasons for Sub-optimal Feeding Practices • Insufficient commitment and implementation of comprehensive IYCF policies • Misinformation, marketing and promotion of breast milk substitutes • Mistaken cultural, health and medical beliefs

Office of the WHO Representative in the Philippines

Reasons for Sub-optimal Feeding Practices • Inadequate training of health workers and lack of skilled support • Non-supportive environments at work, in public places and in the community • Insufficient links with community

Office of the WHO Representative in the Philippines

Global Strategy on Infant and Young Child Feeding

CAH

Office of the WHO Representative in the Philippines

NHD

Aim As inappropriate feeding is responsible for at least one-third of malnutrition: • To improve appropriate feeding of infants and young children • To increase the commitment of governments, society groups and international organizations to promote the health and nutrition of children

Office of the WHO Representative in the Philippines

About the Strategy • Integrated, comprehensive approach; built on previous achievements • Grounded in Science • Participatory, bringing together many stakeholders • Highlights the Urgency

Office of the WHO Representative in the Philippines

Operational Areas To Promote, Protect and Support Appropriate IYCF Practices Legi sla tion & Polic y

Improv in g famil y & com munit y pra cti ces

Improv in g Hea lth Sys tem s

Office of the WHO Representative in the Philippines

Guidelines and Tools Available for Local Adaptation Developing & strengthening policies • Global Strategy for IYCF • International Code • HIV/IF policy

Office of the WHO Representative in the Philippines

Guidelines and Tools Available for Local Adaptation Improving family & community practices – Food box- IMCI – C-IMCI planning guidelines – Lay/peer counselling guidelines – BFC course – CFC course – HIVC course

Office of the WHO Representative in the Philippines

Guidelines and Tools Available for Local Adaptation Improving Health Systems • BFHI monitoring and reassessment tool • Referral Care Manual • Indicators for assessing breastfeeding practices • Hospital Administrators Course • HIV/IF guidelines

Office of the WHO Representative in the Philippines

Guidelines and Tools Available for Local Adaptation Improving Health Systems – BFC course – HIVC course – CFC course – Training on management of severe malnutrition – Training on infant feeding in emergencies – Training in IMCI – Pre-service education material

Office of the WHO Representative in the Philippines

Examples of Elements within Operational Areas Developing & strengthening policies – Code – Codex – Maternity protection at work – HIV and infant feeding – other

Office of the WHO Representative in the Philippines

Examples of Elements within Operational Areas Improving family & community practices – Public awareness of the benefits of IYCF – Elimination of adverse commercial influences and misinformation – Lay and peer counselling – BF support groups – Community support to HIV + mothers – Improvement of workplace support

Office of the WHO Representative in the Philippines

Achieving the Objectives of IYCF strategy: Operational Targets • Appoint a national coordinator, establish a multisectoral national committee • Develop, implement, monitor and evaluate a comprehensive policy on infant and young child feeding • Effect the principles of the International Code of Marketing of Breast milk Substitutes • Enact legislation to protect working women and enforce its implementation Office of the WHO Representative in the Philippines

Achieving the Objectives of IYCF strategy: Operational Targets • Ensure that the health and other sectors protect, promote and support – exclusive and continued breastfeeding – timely, adequate, safe and appropriate complementary feeding with continued breastfeeding

• .. and, provide guidance on feeding in exceptionally difficult circumstances • Ensure that every facility providing maternity services fully practices the Ten Steps Office of the WHO Representative in the Philippines

Achieving Involvement and Co-ordination of many sectors/stakeholders National authorities BF/CF counsellorsPaediatricians

International agencies Obstetricians Nutritionists Midwives BFHI advocates IMCI implementation team

Achieving a common goal

Lactation consultants

Pre-service educators HIV-prevention & care advocates Code advocates In-service trainers Research groups Community-based Organizations Office of the WHO Representative in the Philippines