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1 Revitalization of BFHI Randa Saadeh Scientist Nutrition for Health and Development SCN, Rome, 2007

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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'

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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)

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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

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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

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6 Why now and what has been done?

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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

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Nutrition for Health and Development 8 WHO Child Growth Standards A growth chart for the 21 st century

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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

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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.

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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

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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

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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

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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

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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

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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."

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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

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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

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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

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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?

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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

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Nutrition for Health and Development 22UnderwayUnderway Revision of the 'Scientific basis for the Ten Steps' Physiological basis Strengthening 'Step 10' and link to community

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Nutrition for Health and Development 23 Finer points of skilled practical management - infant not ready to feed immediately after delivery Picture removed

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Nutrition for Health and Development 24...the same baby showing signs of readiness to feed 30-40 minutes after delivery Picture removed

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Nutrition for Health and Development 25 ..stretching and twisting the nipple to help the baby to attach - but not effective Picture removed

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Nutrition for Health and Development 26 Babys real need - early skin-to-skin contact on the delivery table Picture removed

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Nutrition for Health and Development 27 Kangaroo Mother Care Dr Nils Bergman, Cape Town, South Africa 12/2 Picture removed

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Nutrition for Health and Development 28 Slide 4v Picture removed

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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

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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

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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

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32 Thank you!