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Status of formula feeding, commercial foods, trends, possible GHG emissions Name of the Country: Status of formula feeding, commercial foods, trends, possible GHG emissions Name of the Country: Bangladesh Name of the Speaker: Dr. S. K. Roy Chairperson Bangladesh Breastfeeding Foundation (BBF)

Bangladesh Bangladesh

Infant and Young Child Feeding (IYCF) trends in Bangladesh 1993 -2007 Infant and Young Child Feeding (IYCF) trends in Bangladesh 1993 -2007

IYCF Practices Indicator Status in 2005 (BDHS) Status in 2007 (BDHS) Initiation of breastfeeding IYCF Practices Indicator Status in 2005 (BDHS) Status in 2007 (BDHS) Initiation of breastfeeding 24% within 1 hour 37% Exclusive Breastfeeding for first 6 months 42% 43% Median Duration of Breastfeeding 32 Months 32. 8 months Bottle Feeding (< 6 mo. ) 22% - <6 m 27% - 6 -9 m 40. 4 of <2 yrs Complementary Feeding (6 - 9 mo. ) 62% 74 %

Exclusive breastfeeding rates remain stagnant in Bangladesh for last 15 years Exclusive breastfeeding rates remain stagnant in Bangladesh for last 15 years

Trend of nutritional status of <5 children 1996 to 2007 BDHS 2007 Trend of nutritional status of <5 children 1996 to 2007 BDHS 2007

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Baby Friendly Hospital Initiative • BFHI launched in 1992 in Bangladesh • Hospital policy Baby Friendly Hospital Initiative • BFHI launched in 1992 in Bangladesh • Hospital policy developed by BBF and endorsed by the Govt. in 1992 • At present 499 maternity service facilities out of 650 are Baby friendly • 20, 000 health care providers have been trained on BFHI.

Implementation of the International Code • 1984: BMS (Regulation of Marketing) Ordinance • 1990: Implementation of the International Code • 1984: BMS (Regulation of Marketing) Ordinance • 1990: BMS (Regulation of Marketing) Amendment at the national assembly. • 1992: BMS importers signed MOU with MOHFW to stop free milk supply • 1993: Director, IPHN was appointed as authorized officer by the MOHFW for the implementation of BMS ordinance. • 1993: An advisory committee formed 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 Implementation of the International Code • 1993: MOHFW submitted a written request to M/O Commerce to include BMS in list of restricted imports SO What/// delete! • 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 SO What///

 • Violation of the code by the milk company still continues unfortunately in • Violation of the code by the milk company still continues unfortunately in collusion with health professionals

Issues hindering optimal infant feeding in Bangladesh Traditional beliefs /practices: • 1. Use of Issues hindering optimal infant feeding in Bangladesh Traditional beliefs /practices: • 1. Use of prelacteal (honey, mustard oil, sugar water, plain water) • 2. Mixed feeding before first 6 months of age (Breast milk with rice powder? ? , suzi, cows milk etc. ) • 3. beliefs that milk comes in after 3 days

Our Lacking: • • Lack of support to the mother in the community Lack Our Lacking: • • Lack of support to the mother in the community Lack of skill BF counselor • Lack of knowledge on BF in the community • Lack of confidence of the mother • Lack of family support • Lack of skilled health service provider in the hospitals • Lack of program activities • Lack of proper monitoring system • Lack of fund Out Our enemies: • Aggressive marketing of BMS • Tricky promotion of BMS • Unholy allaince with policy makers

Research Findings References Intervention Haider et al 2000 Peer counselors, home visits up to Research Findings References Intervention Haider et al 2000 Peer counselors, home visits up to 15 occasions including 2 in last trimester of pregnancy, 4 in month and every two weeks thereafter up to month 5. Visit duration 20 -40 minutes Breastfeeding status at last assessment, <6 mo Exclusive breastfeeding Intervention-56% Control-5%

Examples of Law violation by commercial babyfood companies including nestle Examples of Law violation by commercial babyfood companies including nestle

Questions How to break the unholy alliance between Companies and policy makers? Questions How to break the unholy alliance between Companies and policy makers?

Nestle Organized workshop for doctors on the occasion of WBW 09 Nestle Organized workshop for doctors on the occasion of WBW 09

How to stop the tricky promotion of commercial baby foods? How to stop the tricky promotion of commercial baby foods?

 • Distributing leaflet of Chu Silicone Nipple ad inside the Chu baby diaper • Distributing leaflet of Chu Silicone Nipple ad inside the Chu baby diaper packet and also using a picture of a baby with feeding bottle. Using the slogan ‘Best choice for your baby’ and has three different size for the infant (for 1 -3 month, 3 -6 month and <6 month) • Advertisement through TV channels.

How to stop uncontrolled & aggressive marketing of commercial baby foods? How to stop uncontrolled & aggressive marketing of commercial baby foods?

 • Nestle importing and selling products having no registration in Bangladesh and does • Nestle importing and selling products having no registration in Bangladesh and does not have any information in local Bangla language

GHG in Bangladesh • 40 Tons Infant formula are imported which will have to GHG in Bangladesh • 40 Tons Infant formula are imported which will have to emit 612. 3 tons of Carbondioxide annually.

Kind of support breastfeeding women need : 1. Support with care, nutrition and information Kind of support breastfeeding women need : 1. Support with care, nutrition and information during pregnancy 2. Support at delivery to establish breastfeeding within 1 hr. 3. Follow up support/ visit for exclusive breastfeeding. 4. Crèches and nursing breaks at the work place 5. Protection & restricting Unethical Marketing and Advertising of BMS

Programme Challenges • Integrating of IYCF activities in different programmes • Skilled health services Programme Challenges • Integrating of IYCF activities in different programmes • Skilled health services provider • Effective communication materials • Strategy to protect aggressive marketing of BMS

Some Examples of Poster BBF using on BMS Some Examples of Poster BBF using on BMS

Powder Milk Don’t buy illness with your hard earned money Powder Milk Don’t buy illness with your hard earned money

Powder Milk Warning This Product is not sterile (WHO) Powder Milk Warning This Product is not sterile (WHO)

Diarrhoea Pneumonia Dysentery, Malnutrition Meningitis Ear infection, Allergy Early death If Survive: Diabetes & Diarrhoea Pneumonia Dysentery, Malnutrition Meningitis Ear infection, Allergy Early death If Survive: Diabetes & hart diseases

5 prime messages on BF Give 3 meals and additional 2 meals everyday to 5 prime messages on BF Give 3 meals and additional 2 meals everyday to the PW & LW Give colostrum within one hour after birth EBF from birth to 6 months (180 days) is enough for a child even no need a drop of water Give family food after 6 months with BF and continue BF upto 2 yrs Continue BF & other family foods frequently when baby is sick

Thank you Thank you