Health Systems Supportfor Breastfeeding:Successes, challenges andopportunities
Lesley Bamford
Child and Youth Health Directorate
National Department of Health
August 2011
WHO Recommendation
“As a global public healthrecommendation, infants shouldbe exclusively breastfed for thefirst six months of life to achieveoptimal growth, development andhealth. Thereafter, to meet theirevolving nutritional requirements,infants should receive nutritionallyadequate and safe complementaryfoods while breastfeedingcontinues for up to two years ofage or beyond.”
SA Infant and Young Child Feeding Policy
•Exclusive breastfeeding should bepractised during the first sixmonths of life, and breastfeedingshould continue up to two years ofage or beyond.
•Calls for comprehensive supportfor breastfeeding
•Individual rather than a publichealth approach to feedingchoices for HIV positive mothers(includes provision of replacementfeeds)
Key Actions
•Clear national commitment to protecting andpromoting breastfeeding
•Social mobilization to support breastfeeding asa social norm
•Create an enabling environment
–Ensure maternity protection for all mothers
–Regulate marketing of breastmilk substitutes
•Practical, sustained support for mothers toinitiate and sustaining breastfeeding
•Develop systems to better understand and tomonitor and evaluate breastfeeding practices
Package of breastfeeding support
•During pregnancy: good nutrition (includingmicronutrient supplementation), counsellingon exclusive breastfeeding
•During labour: physical, emotional,informational support reduce medicalinterventions that make the baby drowsy andless likely to initiate breastfeeding
The right breastfeeding support
at the right time to
the right group
Immediately after birth:
•Early breastfeeding - one hour, colostrum,constant skin-to-skin contact
•Assistance with good attachment and positioning
•Prompt treatment of breast conditions
•Continuation of breastfeeding when mother orinfant is ill
•Extra support for feeding vulnerable newborns(HIV exposed, LBW infants, teenage mothers)
The right breastfeeding support
at the right time to
the right group
Postnatal period
•Counselling on frequent and exclusivebreastfeeding
•Observation for correct positioning andattachment
•Resolving breastfeeding problems
•Support for the mother’s health and nutrition
•PMTCT follow-up where needed
Early childhood
•Ongoing support to exclusively breastfeed for sixmonths
•Introduction of complementary feeds from sixmonths with ongoing breastfeeding
•PMTCT follow-up where required
Ten steps for Successful Breastfeeding
1.Have a written breastfeeding policy that is routinely communicated to allhealth care staff.
2.Train all health care staff in skills necessary to implement this policy.
3.Inform all pregnant women about the benefits and management ofbreastfeeding.
4.Help mothers initiate breastfeeding within one half-hour of birth.
5.Show mothers how to breastfeed and maintain lactation, even if theyshould be separated from their infants.
6.Give newborn infants no food or drink other than breastmilk, unlessmedically indicated.
7.Practice rooming in - that is, allow mothers and infants to remaintogether 24 hours a day.
8.Encourage breastfeeding on demand.
9.Give no artificial teats or pacifiers (also called dummies or soothers) tobreastfeeding infants.
10.Foster the establishment of breastfeeding support groups and refermothers to them on discharge from the hospital or clinic.
Review of BFHI implementation
•41% of facilities were accreditedas being Baby-friendly
•73% of mothers initiatedbreastfeeding early
•90% of mothers who receivedcounselling initiated BF early
•Half were not breastfeeding at 10weeks
–Not having enough milk
–Baby didn’t want to BF
–Advice from family member orhealth worker
Ten steps for Successful Breastfeeding
Have a written breastfeeding policy that is routinely communicated to allhealth care staff.
Train all health care staff in skills necessary to implement this policy.
Inform all pregnant women about the benefits and management ofbreastfeeding.
Help mothers initiate breastfeeding within one half-hour of birth.
Show mothers how to breastfeed and maintain lactation, even if theyshould be separated from their infants.
Give newborn infants no food or drink other than breastmilk, unlessmedically indicated.
Practice rooming in - that is, allow mothers and infants to remaintogether 24 hours a day.
Encourage breastfeeding on demand.
Give no artificial teats or pacifiers (also called dummies or soothers) tobreastfeeding infants.
Foster the establishment of breastfeeding support groups and refermothers to them on discharge from the hospital or clinic.
X
x
x
x
BFHI: Strength and weaknesses
Strengths
•Health care workers valuedrecognition of their effortsto promote breastfeedingand child survival
Weaknesses
•Poor integration with othernewborn programmes(KMC, PMTCT) – resulted inmixed message
•Internal monitoring systemswere weak
•Lack of support afterdischarge
Critical success factors
•Functional BFHI committees
•Good management support
•No rotation of staff
Recommended Actions
•Strengthen implementation
•Integrate BFHI into a package of newborn care
•Ensure that hospitals support continuedbreastfeeding – mothers to stay with illchildren
•Strengthen breastfeeding support at PHCfacility and community levels
Kangaroo Mother Care
•Complications of preterm birthaccount for 45% of newborn deaths
•KMC facilitates skin to skin contact,promotes warmth, breastfeeding andgrowth and prevents infection
•Infants can be discharged fromnurseries and hospitals much earlier
•30% reduction in deaths for infantsbetween 1 and 2 kg
•BUT many hospitals still do notprovide KMC
Elize van Rooyen, 2006
Limpopo Initiative for Newborn Care (LINC)
•Integrated approach tonewborn care inhospitals
•Integrates programmes:
BFHI, PMTCT, KMC,Newborn resuscitation,care of ill newborns
•Practical guidelines andapproaches that localteams can use to improvenewborn outcomes
Where are the gaps?
Successful community strategies forpromoting breastfeeding
•Existing community groups
•Community mobilisationevents
•Mass media
•Home visits by peercounsellors and CHWs
PHC Re-engineering and PHCOutreach teams
•Establishment of PHC outreach teams includingCHWS
•Key roles will be to provide a comprehensivepackage of MNCH services
•Key roles of PHC outreach teams – supportingbreastfeeding
•Supported by PHC facility services
•Ensure that CHWs have skills and tools requiredto do this – and not too many other tasks
Conclusion
•The BFHI provides an excellent basis for supportingbreastfeeding as part of comprehensive newborncare.
•The PHC re-engineering process provides theopportunity to ensure that all mothers are supportedto breastfeed their infants as a key component of apackage of MNCH health and nutrition services.
•The basic interventions, programmes and tools areavailable.
•Action and commitment from many stake-holderswill be required
•Need to make breastfeeding promotion and supporteveryone’s business.
The right breastfeeding support
at the right time to
the right group
Thank you.