Global Strategy On Infant and Young Child Feeding

Global Strategy On Infant and Young Child Feeding State of Implementation in the context of MDG 4 Country: Bangladesh Presentation By. Ranjit Kumar Biswas Executive Director of National Nutrition Programme

Mortality Rates Indicator Status 1990 Target 2015 Status 2007 Under Five Population 17% (BBS 1991) Under Five Mortality 151 50 88 IMR 94 32 65 (BDHS 2004) NMR 52 18 million 11. 6 % (MICS 2006) 41

Child, Infant & Neonatal Mortality Reduction Trends (Source: Demographic and Health Surveys)

MDG 4 Tracking Indicator Coverage Level DPT immunization (DPT 3) 94% (CES 2006) Measles immunization 89% CES 2006) Use of improved drinking water facility 98% (MICS 2006) Use of improved sanitation facility 39% (MICS 2006) Skilled attendant at delivery 20% (MICS 2006) TT protection at birth 55% (MICS 2006) ORT for Diarrhea 70 % (MICS 2006)

IYCF Practices Indicator Status in 2005 Status in 2007 Initiation of breastfeeding 24% (BDHS 2004) within 1 hour 36% (MICS 2006) Exclusive Breastfeeding for first 6 months 42% (BDHS 2004) 58% (CMNS 2005) Median Duration of Breastfeeding 32 Months (BDHS 2004) Bottle Feeding (< 6 mo. ) 22% - <6 m 27% - 6 -9 m (BDHS 2004) Complementary Feeding (6 - 9 mo. ) 62% (BDHS 2004) 52 % (MICS 2006)

IYCF Policies and Programs Action taken during 2006 -2007 after the assessment in 2005 National Strategy for IYCF formulated and launched in 2007

Baby Friendly Hospital Initiative • BFHI launched in 1992 • Hospital policy developed by BBF and endorsed by the Govt. in 1992 • At present 498 maternity service facilities out of 650 are transformed into BFH. • 20, 000 health care providers have been trained on BFHI.

Revitalization of BFHI • A regular meeting of BFHI committee. • Regular training for the maternity staffs (Doctor & Nurse) on BF management • Training of the Aya and Ward boy of the hospitals • Regular antenatal counseling • Banning of artificial milk, bottle and tits in the hospital. • Hanging of 15 principle and regular discuss it with the hospital staff • Educate mother for EBF for 6 months and introduce CF after 6 months with continuation of BF upto 2 years.

Revitalization of BFHI • A system developed on Record keeping for the number of EBF babies and recorded within MIS. • Mother was taught on milk expression • LMC corner was established • During discharge from hospital mother was advised to exclusively breastfed their babies for 6 months and referred to LMC for followup.

Implementation of the International Code • 1984: BMS (Regulation of Marketing) Ordinance • 1990: BMS (Regulation of Marketing) Amendment at the national assembly. • 1992: BMS importers had MOU with MOHFW to stop free milk supply • 1993: An authorized officer was appointed by the MOHFW (Director, IPHN) for the purposes of BMS ordinance in July. • 1993: An advisory committee formed and gazetted for monitoring & implementation of the code. • 1993: Directive banning BMS advertising in the media issued by the government in December

Implementation of the International Code • 1993: MOHFW submitted a written request to M/O Commerce to include BMS in list of restricted imports • 1997: Three milk companies sued and were fined by the court. Two companies withdrew product from market. . • 2003: External monitoring is done in 105 hospitals • 2007: Review for amendment ongoing Violation of the code by the milk company still continues

Maternity Protection • Government order issued for extension of maternity leave from 3 months to 4 months • Limited Crèche established in the Govt and private sector. • Government approved exclusive breastfeeding (EBF) up to 6 months

Health and Nutrition Care • National Nutrition Program (NNP) under the Ministry of Health and Family Welfare has been implementing the nutrition activities in 105 sub districts of 34 districts of 6 divisions. . • Total Community Nutrition Centre 23246 • Total Community Nutrition Promotors 23246 • Total Community Nutrition Organizer 2243 • Total Field Supervisor 584 provide services at the field level under guidance of Upazila manager, concerned NGO officials and NNP officials.

NNP status • Colostrums feeding almost universal. • More than 97. 5 percent children started complementary feeding after 6 months of age

Supplementary feeding for Women and Children in 105 NNP Upazilas, January, 2007 Target Group Registered Received Food Supple. Pregnant Mother Lactating Mother 3, 148 2, 526 47, 686 3, 920 Under 2 Children Severe Malnutrition Growth Faltered Relapsed 11, 87, 654 84, 792 1, 03, 987 7, 039

Community Outreach • NNP covering 105 (out of 480) subdistrict 20 % • Another 63 by January 2008

Community Based Mother Support Group • Trained 105 core trainers of MSG formation in 53 NNP UZ • Provided refresher training for 63 core trainers in 31 UZ • Provided training for 3515 CNO/CNPs on MSG in 16 UZ • Oriented 3222 MSG in 15 upazilas • Developed resource book and training booklet for MSG formation

Information Support • Inter personal Counseling (NNP, MOHFW, NGOs) • Web site of BBF • IT centre services at BBF • BCC materials production , distribution and supply from BBF. • Billboards • Electronic medias • News & mass media

Infant Feeding During Emergencies • Joint Statement GOB-WHO-UNICEF (Aug 2007) • Joint statement BBF-WHO-UNICEF (Nov 2007) - Sidr

Infant Feeding During Emergencies • Preparing guideline for ensuring optimal feeding for IYCF during emergency • Awareness materials on IYCF was distributed for the health providers/workers to give support to the pregnant and lactating mother to the devastating area.

Infant Feeding and HIV • Prevalence of HIV infection is as low as 1%-2. 5% among the high risk groups • Prevalence of HIV raised to 4% among drug users (Dec 2003) • A total of 363 HIV cases has so far been detected in the country (Dec 2003) • In low income countries such as Bangladesh replacement feeding is very rarely “acceptable, feasible, affordable, sustainable and safe”(The joint United Nations Program on HIV/AIDS/WHO/UNICEF guidelines, 2001) • PTCT strategy under formulation

Monitoring and Evaluation • BDHS • MICS • CMNS • NNP MIS • BBF

• IYCF Activities of NNP (Nutrition Package 2006 -2010)

Protection, Promotion and support of IYCF • IYCF activities cut across both ABCN and national level nutrition services. • IPC and BCC within ABCN services • Initiation of BF within half an hour of delivery, promotion of optimum breast-feeding, EBF for first six months (180 days), followed by introduction of ACF on completion of six months. • Scaling up and sustaining BFHI.

Continue • Support activities for enforcement of the law on the marketing and distribution of breast milk substitutes • Promote and campaign for breast feeding intensively on a national scale • Awareness creation about disadvantages of formula / Bottle-feeding

Continue • Mother support activities up to the community level for ANC, PNC, EBF, ACF, MN. • Ensure the proper adaptation and dissemination of WHO/ UNICEF/ UNAIDS Guidelines on BF and other relevant issues. • Greater focus will be given to IYCF and to Baby Friendly Community Initiative.

Thank You