Breastfeeding Tsek Advocacy

7/25/2019 Breastfeeding Tsek Advocacy

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PROTECT INFANT HEALTH. SAVE LIVES.

BREASTFEEDING

TS

Tama Sapat Esklusibo


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Contents

1. Situation of Infants and Children

2. Current Evidence for Breastfeeding

3. National & Health Policies4. National Programs & Strategies

5. Breastfeeding TSEK:

Protecting Community Infants &

Young Children


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The Situation of Infants and Children

1


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4

The State shall protectand promote the right tohealth of the peopleandshall instill health

consciousness amongthem.

Philippine Constitution, Art 2, Section 15

The State protects a

Childs right to Lifeand Good Health


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5

Our National Commitment

The Philippines is committed to achieve

the Millennium Development Goals(MGD) by 2015.


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One of 4 children, under 5 years, is malnourished

NUTRITIONAL

STATUS

PREVALENCE ESTIMATED

NUMBER

(IN MILLION)*

Underweight 26.2% 3.35

Underheight 27.9% 3.57

Thinness 6.1% 0.78

Overweight 2.0% 0.26Source: 7thNational Nutrition Survey, 2008


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The continued high rates of moderate and

severe stunting (30%) and low birthweight

(20%) highlight the need for greater attention

to improving maternal nutrition andcomplementary feeding.

The State of the Worlds Children 2009

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Poor Nutritional Status

Predisposes to:

increased severity and duration of

diarrhea attacks Increased risk of dying from diarrhea

Ashworth and Feachem. Interventions for the control of diarrhoeal diseases among young children: weaning education.

Bulletin of the World Health Organization, 63 (6): 1115-1127 (1985)

9


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Mortality Impact of Underweight

5

reduction in low weight for age

by 2005

3

reduction in child mortality

10

Source: Pelletier and Frongillo. 2003. Pooled analysis of data from 59 countries from 1966 to 1996.


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Breastfeeding evens the playing field

Breastfeeding is a natural "safety net"

against the worst effects of poverty...it is

almost as if breastfeeding takes the infant

out of poverty for those first few months

in order to give the child a fairer start in

life and compensate for the injustice of

the world into which it was born.

James P. GrantFormer Executive Director UNICEF

3


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4Reduce by two

thirds the

under-five

mortality rate

between 1990

and 2015


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Key Facts 7.6 million children under the age of five die

every year (2010 figures).

More than half of these early child deaths are

due to conditions that could be prevented or

treated with access to simple, affordableinterventions.

Leading causes of death in under-five children

are pneumonia, preterm birth complications,diarrhoea, birth asphyxia and malaria. About

one third of all child deaths are linked to

malnutrition. 13Source: WHO. Global Health Observatory (http://www.who.int/gho/child_health/en/index.html)
http://www.who.int/gho/child_health/en/index.htmlhttp://www.who.int/gho/child_health/en/index.html


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CAUSES OF UNDER FIVE DEATHS, 2010

1 of 4 Philippine children under five years of ageare at risk of infection & death

Source: WHO. Global Health Observatory (http://www.who.int/gho/child_health/en/index.html)
http://www.who.int/gho/child_health/en/index.htmlhttp://www.who.int/gho/child_health/en/index.html


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Our newborns are at risk of dying

in the first 2 days of life


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Strategies

appropriate home care and timely

treatment of complications for newborns

integrated management of childhoodillness for all children under five years old

expanded program on immunization

infant and young child feeding

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Exclusive Breastfeeding Rates by Region


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Why breast milk?

Breast milk Artificial Milk

Protein Correct amount

Easy to digest

Partly corrected

Fat Enough essential fattyacids, lipase to digest

No lipase

Water Enough May need extra

Anti-Infective

PropertiesPresent

Immunizes & Protects

ABSENT

Adapted from: Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993

(WHO/CDR/93.6).


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If a new vaccine became available that could

prevent one million or more child deaths a

year, and that was moreover cheap, safe,administered orally, and required no cold

chain, it would become an immediate public

health imperative.Breastfeeding can do all this and more.

- 1994


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Evidence presented in the Series on Child

Survival 2003 , Series on Neonatal Survival

2005 , and the Series on Maternal and ChildUndernutrition 2008 , clearly pointed out

the importance of exclusive breastfeeding

for the first six months of life which couldsave more lives than any other intervention

studied while enhancing nutritional status

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The Clinical Evidence on ExclusiveBreastfeeding at Birth to 6 months

2


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Effect of Breastfeeding

22

For the vast majority of infants and youngchildren throughout the world, breastfeeding

saves lives

prevents morbiditypromotes optimal physical and cognitive

development

reduces the risk of some chronic diseases

Evidence of the benefits of breastfeeding for

mothers is growing as wellLeon-Cava et al. Quantifying the Benefits of Breastfeeding: A Summary of the Evidence. Washington, D.C.: PAHO 2002


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Infant Morbidity and Mortality

The greatest and most obvious

benefits of breastfeeding are forthe immediate health and survival

of the infant

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Infant Morbidity and Mortality

Rates of diarrhea, respiratory tract infections,

otitis media, and other infections, as well as

deaths due to these diseases, are all lowerin

breastfed than in non-breastfed infants

Exclusively breastfed infants have at least 2

times fewerillness episodes than infants fed

breast-milk substitutes.

24Source: Jones et al., 2003,; Chandra, 1979; Feachem, 1984; and Victora, 1987.


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Protection Against Infection

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INFECTIONS % REDUCTION

Acute otitis media

(exclusive BF 3-6 mos.)

50%

Recurrent otitis media

(exclusive BF >6 mos.)

77%

Upper respiratory tract infection(exclusive BF >6 mos.)

64%

Lower respiratory tract infection(exclusive BF >6 mos.)

77%

Gastroenteritis 64%

Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk,

originally published online February 27, 2012


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Neonatal Conditions

INFECTIONS % REDUCTION

Necrotizing enterocolitis 77%

RSV bronchiolitis(exclusive BF >4 mos.)

74%

Sudden Infant Death Syndrome (SIDS)(any > 1 month)

36%




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Percentage of infants 2-7 months of age reported as

experiencing ear infections, by feeding category in

the preceding month in the U.S.

Adapted from: Scariati PD, Grummer-Strawn LM, Fein SB. A longitudinal analysis of infant morbidity

and the extent of breastfeeding in the United States. Pediatrics, 1997, 99(6).


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Risk of diarrhea by feeding method

for infants aged 0-2 months, Philippines

Adapted from: Popkin BM, Adair L, Akin JS, Black R, et al. Breastfeeding and diarrheal morbidity.

Pediatrics, 1990, 86(6): 874-882.


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Type of Feeding

Hospitalized low birth weight infants who were

fed with formula milk had 4 times the

incidence of serious illnesscompared to those

infants who were breastfed.

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Randomized Controlled Trial of Low Birth Weight

Hospitalized Neonates comparing type of feeding

vs. percentage with serious illness


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There is a 2-4 fold increase in neonatal

mortality rate (NMR) in not receiving

colostrum. There is a 5-13% decrease in NMR

with exclusive breastfeeding

Babies who were not breastfed in the first 6

months of their lives are 25 times more likely

to die than those who experienced exclusive

breastfeeding from the time they were born.

Infant Mortality

Source: Jones et al., 2003,; Chandra, 1979; Feachem, 1984; and Victora, 1987.


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The timing of initiation of breastfeeding is

important as there is a higher risk of

deathamong infants with longer delayinthe initiation of breastfeeding.

Early Breastfeeding initiation

Mullany LC, et al. JNutr,2008; 138(3):599-603.


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Delaying Initiation of breastfeeding increases

risk of infection-related deathNepal 2008 N = 22,838 breastfed babies


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Relative risks of death from diarrhoeal disease

by age and breastfeeding category in Latin America

Adapted from: Betran AP, de Onis M, Lauer JA, Villar J. Ecological study of effect of breast feeding on infant

mortality in Latin America. BMJ, 2001, 323: 1-5.


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Relative risks of death from acute respiratory

infections by age and breastfeeding category

in Latin America

Adapted from: Betran AP, de Onis M, Lauer JA, Villar J. Ecological study of effect of breast feeding on infant

mortality in Latin America. BMJ, 2001, 323: 1-5.


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Protection Against Allergy

36

ILLNESS % REDUCTION

Atopic dermatitis (negative family history)

(exclusive BF > 3 mos.)

27%

Atopic dermatitis (positive family history)(exclusive BF > 3 mos.) 42%

Asthma (atopic family history)(exclusive BF > 3 mos.)

40%

Asthma (no atopic family history)


26%




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Protection Against Diseases

37

DISEASE % REDUCTION

Type I diabetes


30%

Type 2 diabetes

(any)

40%

Leukemia (ALL)


20%

Leukemia (AML)


15%

Obesity

(any)

24%




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Breastfeeding decreases the prevalence

of obesity in childhood at age five and six years, Germany

Adapted from: von Kries R, Koletzko B, Sauerwald T et al. Breast feeding and

obesity: cross sectional study. BMJ, 1999,319:147-150.


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Breastfeeding increases intelligence


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Child Development

Breastfeeding was associated with significantlyhigher scores for cognitive development than

was formula feeding

Premature infants derive more benefits frombreast milk than do full-term infants

The benefits of breastfeeding increased with

duration

Anderson et al. Breast-feeding and cognitive development: a meta-analysis.Am J Clin Nutr 1999;70:52535

40


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Child Development

Largest randomized trial ever conducted in the

area of human lactation (17,046 infants)

strongly suggest that with prolonged and

exclusive breastfeeding:

Improvement in cognitive development asmeasured by IQ (verbal IQ, performance IQ,

full-scale IQ)

Teachers academic ratings at age 6.5 yearswere significantly higher for both reading and

writingKramer et al. Breastfeeding and Child Cognitive Development :New Evidence From a Large Randomized Trial.

Arch Gen Psychiatry. 2008;65(5):578-58441


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Duration of breastfeeding associated with higher

IQ scores in young adults, Denmark

Adapted from: Mortensen EL, Michaelsen KF, Sanders SA, Reinisch JM. The association between duration of

breastfeeding and adult intelligence. JAMA, 2002, 287: 2365-2371.

Benefits of breastfeeding


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Benefits of breastfeeding

for the mother


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Short-term Benefits

Decreased post-partum blood loss

Rapid involution of the uterus

Decrease in post-partum depression Increased child spacing due to lactation

amenorrhea

44

Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk, originally published online

February 27, 2012


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Long-term Benefits

Reduced risk of chronic diseases:

Type 2 diabetes mellitus (no history of gestational

DM)

Rheumatoid arthritis

Cardiovascular disease (hypertension,hyperlipidemia)

Breast cancer (primarily premenopausal)

Ovarian cancer

Significantly decreased rate of child abuse/

neglect

45Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk, originally published onlineFebruary 27, 2012


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0 1 2 3 4 5 6

Adapted from: Beral V et al. (Collaborative group on hormonal factors in breast cancer).

Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47

epidemiological studies in 30 countriesLancet2002; 360: 187-95.

Breast cancer and breastfeeding:

Analysis of data from 47 epidemiological studies

in 30 countries

k f f l f d


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Risks of artificial feeding

Interferes with bonding

More diarrhea and

respiratory infections

Persistent diarrheaMalnutrition

Vitamin A deficiency

More likely to die

More allergy andmilk intolerance

Increased risk of some

chronic diseases

Overweight

Lower scores on

intelligence tests

May become pregnant

sooner

Increased risk of anemia,

ovarian and breast cancer

Mother

Adapted from: Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993 (WHO/CDR/93.6).

Baby


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Exclusive

BreastfeedingProtects Infant

Health & Saves

Newborn Lives


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Laws & Policies onExclusive Breastfeeding for 6 Months

3


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Key Health Policies Mandate Breastfeeding

for Infants & Young Children

Republic Act 7600Rooming-in and Breastfeeding Act and IRR

Republic Act 10028An Act Providing Incentives to All Government and PrivateHealth Institutions with Rooming-In and BreastfeedingPractices and For other Purposes

Executive Order 51, s. 1986National Code of Marketing of Breastmilk Substitutes andProducts (The Milk Code)


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DOH Administrative Orders

2005-0014National Policies on Infant and Young Child Feeding

2006-0012Implementing Rules and Regulation of E.O. 51, Otherwise known

as The Milk Code, Relevant International Agreements, Penalizing Violations

Thereof, and for Other Purposes

2007-0026Revitalization of the Mother-Baby Friendly Hospital Initiative

in Health Facilities with Maternity and Newborn Care Services

2008-0029 - Mother-Baby Friendly Hospitals

2009-0025 - Adopting Policies and Guidelines on Essential Newborn Care

2010-0010 - Revised Policy on Micronutrient Supplementation to Support

Achievement of 2015 MDG Targets to Reduce Under-five and Maternal Deaths

and Address Micronutrient Needs of Other Population Groups

Key Health Policies Mandate Breastfeeding

for Infants & Young Children

K H l h P li i


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Key Health Policies

Philhealth No. 12-2005Adoption of PhilHealth Benchbook on

Performance Improvement of Health Services

No. 26-2005Requirement for Accredited Hospitals to be

Mother-Baby Friendly Hospitals

No. 34-2006PhilHealth Newborn Care Package

DILG


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National Programs

Promoting Health & Lives ofInfants & Young Children

4

National Infant Young Child Feeding Strategy


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National Infant Young Child Feeding Strategy

20112016

Source: NCDPC, Department of Health


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Children have the right to adequatenutrition and access to safe and

nutritious food, and both are essential

for fulfilling their right to the highestattainable standard of health.

Infant Young Child Feeding Policy (IYCF), 2011-2015

Department of Health


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Infant Youth Child Feeding Strategy, 2011-2016

GOAL

Reduction ofchild mortality

and morbiditythrough optimalfeeding ofinfants andyoung children

OUTCOMES By 2016:

90 percent of newborns are initiated tobreastfeeding within one hour afterbirth;

70 percent of infants are exclusivelybreastfeed for the first 6 months of life;and

95 percent of infants are given timelyadequate and safe complementary foodstarting at 6 months of age.

Since 2008: Mother Newborn Child Health &


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Since 2008: Mother Newborn Child Health &Nutrition (MNCHN) Service Package

Financing

Health Facilities and Service PackagesHuman Resource

Health Products and Pharmaceuticals

Other Support Systems

Pre-Pregnancy

ServicesAntenatal care

Postpartum

and Postnatal

Care

Care during

Delivery

O M t l N b d Child


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Our Maternal, Newborn and Child

Protection StrategyPRENATAL AT BIRTH EXCLUSIVE FOR 6

MONTHSSUPPLEMENTARY

FOODS FOR 2YEARS

Health Plan Essential

Intrapartum and

Newborn Care

in Facilities

EINC Unang

Yakap

Exclusive

Breastfeeding

for 6 Months

in Communities

Breastfeeding

TSEK

Infant and Young

Child Feeding

(IYCF) Strategy


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Unang Yakap 4&5

Safer, evidence-based,better quality care

for mothers & newborns

in all health facilities


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Breastfeeding

is the nationalhealth strategy

to protect

infant health& save lives

(DOH, IYCF 2011-2016)

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Breastfeeding TSEK:

Exclusive Breastfeeding to 6

Months

5


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Tama- immediateand appropriate

breastfeeding within one

hour after birth

Sapat- mothers milkis sufficient ( in

nutrients and quantity)

for the baby up to 6

months

EKsklusibo- exclusivebreastfeeding for 6 months,

just pure mothers breastmilk only, not even water.

Helping mothers to initiate and to


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Helping mothers to initiate and to

exclusively breastfeed

needs an Inter-sectoral ResponseThe MDG-F Joint Program:

The Breastfeeding TSEK campaign is a componentof the Joint Program by the UN Country Team tohelp the Philippines achieve MDG # 1 and 4

Supported by the Spanish Government

It is called the MDG-F 2030: Ensuring Food Securityand Nutrition for Children 0-24 months in thePhilippines

Health Governance: Unang Yakap & Breastfeeding TSEK


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LGU Policies for

EINC Unang Yakap& Breastfeeding

TSEK

LGU Allocation of Resources for EINC

Unang Yakap & Breastfeeding TSEK

Mobilization & Advocacy

-Mothers

-Health Professionals

-Private SectorBuilding Competence &

Commitment of HealthProfessionals & Team TSEK

Health Governance: Unang Yakap & Breastfeeding TSEK

Peer Counselling Scaled Up forBreastfeeding Mother & Babies,

Pre, At-birth and 6 months

Plans & Policies: EINC in

Hospitals & TSEK Plan


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LGU Policies for

BreastfeedingTSEK

LGU Allocation of

Resources to sustain

LGU TSEK

Private Sector Mobilization

& Advocacy

Building Competence &

Commitment of the Team

TSEK Core Group

Breastfeeding TSEK in LGUs

Community Peer Counselling

Scaled Up for Breastfeeding

Mother & Babies

Health Staff develop TSEK

Plan for City Health

Investment Plan


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B tf di TSEK i LGU


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Breastfeeding TSEK in LGUs

Key Action Steps

1) Update LGU Ordinances & Health Policies

2) Train LGU Health Staff & TSEK Peer Counsellors

3) Develop the Breastfeeding TSEK Plan &

incorporate into LGU Health Plan

4) Mobilize TSEK Counsellors and build strong

community support

5) Mobilize private sector support: private health

sector, academe, business,

6) Monitor, Innovate & Sustain Breastfeeding TSEK


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Step 1: Formal LGU Support

LGU Ordinances & Guidelines Advocacy with LGU Stakeholders

Powerpoint presentations and handouts for LCEs

and TSEK Peer Counselors for use of CHDs Visual promotional materials to be used by

Mayors/ LGUs

Sample press stories, radio scripts for

Mayors/LGUs to promote local initiatives on

keeping mother and baby safe and healthy


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Step 2: Training of Peer Counselors

Training of Peer Counselors (PCs): A Training Institution , ARUGAAN, was hired to

conduct the Peer Counselors Training- training designis done and trainers reference manual being finalized

after the pilot run in 3 cities PC trainings conducted in Quezon City, Marikina,

Pasig, Taguig, Caloocan, Navotas, Paraaque, Pasay,Mandaluyong, Makati - a total of about 1,800 PCs

trained Mentoring done in Quezon City, Marikina, Pasig,

Taguig, Caloocan, Navotas, Paraaque,


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Training of Peer Counselors


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Step 3: Mentoring Done at the Barangay

House to House VisitsPracticum w/ Mentors

Regular monthly meetings w/ midwives

to process (share and learn) experiences

in actual counseling

Step 4: Monitoring with TSEKlist Card


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Step 4: Monitoring with TSEKlist Card


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Step 5: Mobilizing LGU Partnerships

Advocacy Kits & Materials

Joint issuance with DSWD,

Dep Ed, DILG, Civil Service

MOAs with NGOs, civic and

professional societies andgroups


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Step 6: Sustain Breastfeeding TSEK

Enact LGU policy allocating resources forBreastfeeding TSEK

Build breastfeeding facilities

Expand and motivate the TSEK PeerCounsellors

Strengthen mothers education

Build capacity of health facilities & LGUhealth professionals for safe & qualityEssential Intrapartum and Newborn Careor Unang Yakap


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Educate, Create, Support:Doctors, Nurses, Midwives

Mothers & Families

Erase Breastfeeding Myths


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Erase Breastfeeding MythsPractice Exclusive Breastfeeding for 6 Months


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Proteksyon ng Sanggol.

Pamana ng Buhay.

Alagang Tunay.


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TH NK YOU

Documents

Breastfeeding Tsek Advocacy