IYCF activities perspective in Bangladesh Dr S K

IYCF activities: perspective in Bangladesh Dr. S. K. ROY Senior Scientist, ICDDR, B & Secretary, BBF Dhaka, Bangladesh

Welcome to the World of Breastfeeding

IYCF in Bangladesh - survival - nutritional status - growth - development of infants and young children.

• • Successful development in Bangladesh 1980’s -BF promotion Ratified global commitments to IYCF 1981 - WHA passed the resolution on the International Code of Marketing of BMS 1984 - passed 1989 - CPPBF 1991 - A national conference on breastfeeding in led to the Dhaka Declaration- & A pledge for the protection, promotion and support of BF signed by the President and PM

• • • Cont… 1991 - BFHI 1992 WBW observed 1993 - Amendments of BMS 1995 -MOHFW introduced BINP 2001 -Maternity leave law 2003 -Recommended EBF was extended from 5 months to 6 months • BBF –central office headed by CEO, 7 PM and other support staff. • A 15 member BOT govern the foundation and 7 SC provide technical support.

Formulation of strategy • The MOHFW need for improving BF and CF practices • Initiated the development of the National strategy for IYCF • The process began in 2004 convened by IPHN with collaboration WHO and UNICEF.

Goal & objectives To improve - the nutritional status -growth and development -health, and survival of infants and young children.

Cont… Specific • • objectives achieved by 2010, are: Early initiation of BF -from 24% to 50% Increased EBF rate 42% to 60% Continued BF-90% of children aged 20 -23 months 50%(CF) of children aged 69 months receive appropriate CF

Strategies • The priority strategies for IYCF in Bangladesh fall into 4 categories: • Legislation, Policy and standards • health system support • Community –based support • IYCF in exceptionally difficult circumstances

Legislation , policy & standards • Strategy 1: Code of marketing of breastmilk substitutes • Strategy 2: Maternity protection in the workplace • Strategy 3: Codex standards • Strategy 4: National policies and plans

Health system supports • Strategy 5: BFHI • Strategy 6: Mainstreaming and prioritization on IYCF activities • Strategy 7: Knowledge and skills of health service providers

Community based support • Strategy 8: Community based support for IYCF • Strategy 9: IYCF in exceptionally difficult circumstances

World situation at a glance Source: www. childinfo. org/eddb/brfeed/index. htm

GLOBAL bar indicate year 1990 and bar indicate year 2000 Source: www. childinfo. org/eddb/brfeed/index. htm

Breastfeeding status in 2006 Exclusive Breastfeeding Rates Non NNP areas 60% NNP areas 86% Colostrum Feeding 90% Baby Friendly Hospitals 498 (out of 550) Maternity leave 4 months Code for the marketing of breast milk substitutes Violation in place

Infant Feeding Situation • Exclusive Breastfeeding Rate: Under 6 months 56% • Initiation with in one hour after birth: 51. 8% • Complementary feeding at 4 to 5 months: 23% • Continuing breastfeeding upto 1 year: 90. 5% • Continuing breastfeeding upto 2 year: 75% Source: Surveillance study by BBF: 2005

BBF goal & objective Goal • lower morbidity • Mortality of children • Improve the nutritional status of women Objective • To ensure Exclusive Breastfeeding upto 6 months • To improve (CF) practice after 6 months and continue breastfeeding upto 2 years • To improve nutrition of pregnant and lactating mothers

Activities of BBF • • Awareness building and social mobilization Training Community Development through MSG BCC and Advocacy Curriculum development Hospital development through BFHI Empowerment of women through gender sensitization • Counseling of antenatal and postnatal mother

Action/Achievements • THE BREAST-MILK SUBSTITUTES (REGULATION OF MARKETING) ORDINANCE No. XXXIII of 1984 has been enforced. • Dhaka Declaration, signed in 1991, on protection, promotion and support of breastfeeding - by Honorable President Abdur Rahman Biswas and Honorable Prime Minister • Extension of paid maternity leave for working women from 3 months (6 weeks before & 3 weeks after delivery) to 4 months (after delivery) on 9 July, 2001

Legal Action on BMS Code • Three milk companies were sued and fined by the court • Two companies withdrew their products after sending legal notice • Five companies changed their products label after sending letter from BBF

Action in last one year

BBF observed 2 nd National Conference on BF & CF (IYCF) 2006 Theme Breastfeeding and complementary feeding: Cornerstone for National Development and the way to achieving MDGs

Summary • • • Inaugural Total Participants Total Registration Total Organizations Professional Categories Total Plenary Session (Speaker) • Symposium (Speaker) • Scientific Session • Participants : Professionals Group 700 511 44 35 10 20 4 14 7

Topics of Plenary session • Breastfeeding Movement – global – History-Now – National • IYCF – global Strategies Regional Situation • BMS – Code Status – global –Regional • BF – SNL • Complementary feeding • New WHO Child Growth Chart - BF • Maternal Institution optimizing • Mother Support activity – global/National • Revitalization and Sustainability of BFHI • 2 nd Child Survival Revolution

Topics of Symposium session • Breastfeeding Challenges/Opportunities IYCF – in NNP • IYCF – Policy/Legislation IMCI – IYCF Food Safety – Food Hygiene • IYCF Breaking Double Burden of Malnutrition Early Childhood Development • Childhood Obesity Food Base Dieting guidelines IYCF : Way forward of Bangladesh

Scientific session Excellence of Breastfeeding Exclusive Breastfeeding Complementary feeding Program issues on IYCF Staff Development Session (IYCF, Code MSG). Breastfeeding and Infection/code Maternal Nutrition and Breastfeedin Infant and Child Nutrition

Outcomes To review where we are on global perspective • Make awareness on BF, CF, MN • New prescriptive WHO Growth Standards • HIV & infant feeding guidelines. • Exchange ideas with International Experts • Endorsement of Policy Makers, DP’s, UNICEF, WHO, Stakeholders, Scientists, Health Service providers and NGO’S

Action: Awareness building • Mass awareness increased by commitment of GO, NGOs, donor agencies and in the electronic and print media • Observed World Breastfeeding Week (WBW) in collaboration with GO and NGOs over the last 13 years • National conference on review of BFHI involving the policy makers and program managers of PHC as well as the renowned peditricians and Gynnaechologists • BCC materials on child nutrition, BF promotion and MN have been distributed to stakeholders, 498 BFHI and 52 NNP UZs

Action: Training • Transformation of 30 hospitals (out of 550) into Baby Friendly (88 %) • Trained more than 600 health care providers on the management of BF • In addition trained 1000 internee doctors on BF and 500 intern nurse on same issue • Provided refresher training to 200 doctors and nurses of different BFH in Bangladesh • Journalists have been trained up and their actively engaged in monitoring and follow-up of BFHI

Action MSG • Trained 26 core trainers of MSG formation in 13 NNP UZ • Provided refresher training for 46 core trainers in 23 UZ • Provided training for 2265 CNO/CNPs on MSG • Oriented 27465 MSG members by forming 1831 MSG groups • Developed resource book and training booklet for MSG formation

Four strategy for completion of IYCF activities

Nutrition throughout the cycle

Triple A process

Nutrition Triangle Food Security Caring practices Disease control

Task ahead on IYCF • More 152 Maternity Health facilities have to be converted into Baby Friendly • Establish BFMCs in more BFHs • Implement Mother Support Group (MSG) activities in 105 NNP upazilas. • The programme on HIV and breastfeeding will be updated. • Develop module of crèche establishment • Strict monitoring, reporting and urgent legal action for violations. • Develop course curriculum on CF on the basis of IYCF and Maternal Nutrition

Cont. . • There will be a 4 in 1 training programme by inclusion of BF, CF, MN and HIV & breastfeeding • Develop and revise policy and legislation on IYCF and MN. • Continuous advocacy activities at all level on the values of IYCF • Translate Infant and Young Child Feeding strategy into action. • Adapting HIV and (IYCF) practices on the basis of WHO/UNICEF guidelines and “National Strategy on IYCF in Bangladesh”.

Challenges of IYCF and MN nutrition programme • The sustainability of BFH at all levels • To monitor and revitalize BFHI hospitals • Monitoring and implementation of the code for marketing of BMS. • To improve EBF to over 95%. • To improve maternal nutrition status to an acceptable level • Meeting the targets of second child survival. • To develop an effective Programme to improve maternal malnutrition

Opportunities • BBF is a nodal agency for BF activities having a secretariat • Countrywide general awareness on the importance of BF • BBF maintains a strong national & international network • Go. B commitments through Dhaka Declaration, direct support through NNP and MOHFW • Legislation on BMS Code • Legislation on four months maternity leave • Government endorsement on EBF for 6 months (180 days)

Global Opportunities • Breastfeeding identified as a key intervention to meet the MDG (UN) • EBF can reduce 13% and proper CF can reduce 6% of child mortality Source: LANCET 2000 • Global IYCF policy (WHO/UNICEF)