Text of 1 Revitalization of BFHI Randa Saadeh Scientist Nutrition for Health and Development SCN, Rome, 2007
Slide 1
1 Revitalization of BFHI Randa Saadeh Scientist Nutrition for
Health and Development SCN, Rome, 2007
Slide 2
Nutrition for Health and Development 2 In response to WHA
mandate 59 th WHA (WHA59.21) Infant and young child nutrition
(2006) 'revitalization of Baby-friendly Hospital Initiative to
protect, promote and support breastfeeding' Nutrition and HIV/AIDS
(WHA 59.11) urging Member States 'encouraging revitalization of the
Baby- Friendly Hospital Initiative in the light of HIV/AIDS'
Slide 3
Nutrition for Health and Development 3 And other global
strategies and joint initiatives Global strategy for infant and
young child feeding WHO/UNICEF (2002) Innocenti Declaration 2005
WHO/UNICEF on IYCF AEM, IBFAN, ILCA, LLLI, Wellstart, WABA Durban
statement on Nutrition and HIV WHO/UNICEF/WFP/UNAIDS/FAO/UNHCR
(2005)
Slide 4
Nutrition for Health and Development 4 Now where do we stand?
Have 20 000 BFHs However not accelerating at same pace and
reluctance to achieve baby-friendly status especially in private
hospitals Lack of support and recognition from governments some
slippage, i.e. falling back into old patterns rates of exclusive
breastfeeding for the first 6 months are still relatively low- 38%
counselling skills and coverage by health-care workers still need
to be enhanced poor supervision of trained staff and monitoring of
quality of services provided weakened commitment in the face of
HIV/AIDS pandemic and the number and gravity of other emergencies
influence of infant food industry
Slide 5
Nutrition for Health and Development 5 BFHI update and changes
Scientific-evidence Sections of new package Expansion and
integration options Technical updates on 'Ten Steps' and clinical
practice
Slide 6
6 Why now and what has been done?
Slide 7
Nutrition for Health and Development 7 Optimal Infant feeding
practice reduces Under-five mortality Source: Lancet Child Survival
Series 2003 expected % of reduction in U5M intervention
Slide 8
Nutrition for Health and Development 8 WHO Child Growth
Standards A growth chart for the 21 st century
Slide 9
Nutrition for Health and Development 9 Comparison of WHO with
NCHS length/height-for- age z-scores for boys Source: MGRS Group.
WHO Child Growth Standards: Length/height-for-age, weight-for-age,
weight-for-length, weight-for-height and BMI-for-age: Methods and
development. Geneva: World Health Organization, 2006
Slide 10
Nutrition for Health and Development 10 Policy Statements on
infant feeding "The breastfed infant is the normative model against
which all alternative feeding methods must be measured with regard
to growth, health, development, and all other short- and long-term
outcomes", American Academy of Pediatrics, 1997 "The promotion and
practice of breastfeeding is essential to the achievement of
optimal infant and child health, growth and development", American
Academy of Pediatrics, 2005 National infant feeding policies of
many countries recommend exclusive breastfeeding as the optimal
source of nutrition for the first six months of life.
Slide 11
Nutrition for Health and Development 11 Obesity Is the other
side of the spectrum of malnutrition Breastfed babies could have
30% reduced risk of becoming obese children compared with bottlefed
children Overweight children are at higher risk of becoming
overweight adolescent and adults. Other factors include exercise
and hereditary. Facts We know enough this still a challenge Picture
removed
Slide 12
Nutrition for Health and Development 12 BFHI update and changes
Scientific-evidence Sections of new package Expansion and
integration options Technical updates on 'Ten Steps? and clinical
practice
Slide 13
Nutrition for Health and Development 13 Baby-friendly Hospital
Initiative Revised, Updated and Expanded for Integrated Care
Section 1: Background and Implementation Section 2: Course for
Decision-makers Section 3: "20 hour" Course for Maternity Staff
Section 4: Hospital Self-appraisal & Monitoring Section 5:
External Assessment & Reassessment January 2006
Slide 14
Nutrition for Health and Development 14 New 20-hour Course
focuses on helping staff members support mothers to succeed with
early and exclusive breastfeeding and help implement the Ten Steps
content includes: HIV and infant feeding Mother-friendly birthing
practices and breastfeeding Support for women who are not
breastfeeding
Slide 15
Nutrition for Health and Development 15 The revised BFHI
assessment tools are: Still focused on what mothers and staff know
and can do, rather than self-reporting by management Revised to
reflect current evidence and added emphasis on the Code and support
for non-BF mothers Revised to include optional "modules" on: HIV
and infant feeding Mother-friendly care
Slide 16
Nutrition for Health and Development 16 Selected enhancements
to the Ten Steps Step 2: Addition of interviews of non-clinical
staff Step 4: Skin-to-skin and initiation of BF Change in
interpretation of step from: "Help mothers initiate breastfeeding
within a half-hour of birth" to "Place babies in skin-to-skin
contact with their mother immediately following birth for at least
an hour and encourage mothers to recognize when their babies are
ready to breastfeed, offering help if needed."
Slide 17
Nutrition for Health and Development 17 Step 6: Updates to the
acceptable medical reasons for supplementation Step 8: Feeding on
"demand" changed to "feeding on cue" Step 10: Post-discharge
support Addition of assessment of early post-discharge follow-up
and referral system
Slide 18
Nutrition for Health and Development 18 BFHI update and changes
Scientific-evidence Sections of new package Expansion and
integration options Technical updates on 'Ten Steps' and clinical
practice
Slide 19
Nutrition for Health and Development 19 Expansion options 1.5.1
Baby-friendly Communities 1.5.2 BFHI and PMTCT 1.5.3 Mother-baby
friendly care 1.5.4 Baby-friendly NICUs 1.5.5 Baby-friendly
Paediatric Care
Slide 20
Nutrition for Health and Development 20 Baby-friendly health
care everywhere! Integration into Child Survival strategies
Integration into IMCI Integration into Maternal Survival
Integration with EPI campaigns Integration into Emergency
preparedness and emergency response Others?
Slide 21
Nutrition for Health and Development 21 BFHI update and changes
Scientific-evidence Sections of new package Expansion and
integration options Technical updates on 'Ten Steps? and clinical
practice
Slide 22
Nutrition for Health and Development 22UnderwayUnderway
Revision of the 'Scientific basis for the Ten Steps' Physiological
basis Strengthening 'Step 10' and link to community
Slide 23
Nutrition for Health and Development 23 Finer points of skilled
practical management - infant not ready to feed immediately after
delivery Picture removed
Slide 24
Nutrition for Health and Development 24...the same baby showing
signs of readiness to feed 30-40 minutes after delivery Picture
removed
Slide 25
Nutrition for Health and Development 25 ..stretching and
twisting the nipple to help the baby to attach - but not effective
Picture removed
Slide 26
Nutrition for Health and Development 26 Babys real need - early
skin-to-skin contact on the delivery table Picture removed
Slide 27
Nutrition for Health and Development 27 Kangaroo Mother Care Dr
Nils Bergman, Cape Town, South Africa 12/2 Picture removed
Slide 28
Nutrition for Health and Development 28 Slide 4v Picture
removed
Slide 29
Nutrition for Health and Development 29 For revitalization of
BFHI In short keep alive sustain progress ensure quality and
adherence to global criteria use concept but stay focused show its
effectiveness and health impacts
Slide 30
Nutrition for Health and Development 30 Working together at
different levels and partners High quality of care for mothers and
children International Organizations Governments MOHs and others
Regional/ countries offices NGOs Professional/scientific groups
Civil society groups Industry Religious group
Slide 31
Nutrition for Health and Development 31 Working together with
critical partners all have a role with assigned responsibilities
and obligations expand and integrate within a defined framework but
follow agreed joint guidelines of working with private sectors and
avoid conflict of interest