Ensuring child survival and Development by Enhancing Optimal Infant and Young Child Feeding Practices

State Advocacy Workshop, Punjab, 29 July 2013

Dr Arun Gupta Regional coordinator, International Baby Food Action Network (IBFAN) Asia, and member Prime Ministers’ Council on India’s

Nutrition Challenges

OverviewContext : Enhancing! And Why !!How to do is the key questionSeven Strategies and facilitating

factors.BREASTFEEDING GEAR MODELActions for Punjab: Immediate,

medium and long term

The criticality of feeding practices is not just children are vulnerable , this time their brain develops very fast.

Years of life

Brain development

Underweight (-2sd) NFHS-3

Over 60 million

1.7 million die

by 5 years,

1.2 million

during first year

First Year is Critical!

National Norms of infant and young child feeding Initiation of breastfeeding within

one hour of birth Exclusive breastfeeding for the

first six monthsTimely and appropriate

complementary feeding after six months along with continued breastfeeding till 2 years or beyond

Punjab Indicators (NFHS Punjab Indicators (NFHS 3 -2005-06)3 -2005-06)

24.5

46.4

56.7

10.3

36

50

0

20

40

60

Initiation ofBreastfeeding within 1

hour of birth

Exclusive breastfeeding(0-6 months)

Complementary Feeding(6-9 months)

India Punjab

Punjab Indicators DLHS 3 Punjab Indicators DLHS 3 2007-082007-08

Children under 3 years breastfed within one hour of birth 44.6 Children age 0-5 months exclusively breastfed 32.4 Children age 6-9 months receiving solid/semi-solid food and breast milk

68.9

Deaths attributed to sub-optimal breastfeeding Public Health Nutr. 2006 Sep; 9(6): 673-85

53

18

55

20

0

10

20

30

40

50

60

Lower RespiratoryTrach (LRT)

Diarrhoeal Diseases(DD)

0-6 months

6-12 months

Impact of NOT Following Recommended Norms

7

Impact of Following Recommended Norms

Subjects who were breastfed experienced lower mean blood pressure and total cholesterol, as well as higher performance in intelligence tests. Prevalence of overweight/obesity and type-2 diabetes was lower among breastfed subjects

8

Facilitating factorsEvidence based advocacyPolitical willLegislations to protect from commercial sector, Legislation for Maternity protectionWorkforce training Implementation at facility and community levelCommunication campaignsResearchMonitoring and evaluationCoordination and multi-sector engagement (Advances in Nutrition 3, 790-800, 2012)

12th Five year Plan, NRHM/ICDS Mission Commitments A comprehensive National Policy backed by

resources Yearly Plan of Action National/State Breastfeeding and IYCF committees

with nodal officers at state/district levels Enforcement machinery for IMS Act and resources. An empathetic and skilled health worker must support

women at the time of birth , Skilled IYCF counselling centres in Health facilities in all district hospitals—and followed at CHC, PHC levels in a phased manner.

Well trained workforce having problem solving skills for AWW, ASHA and ANM

A network of Resource Centres on IYCF Strong Pre-service curriculum for doctors and nurses

Seven strategies

How to Enhance Optimal Infant and Young Child

Feeding Practices

PROTECTION

Protecting mothers from Baby food companies,

through existing IMS Act 1992/2003

Barrier: Violations of the Act continue

When Corporations Break the RULES at will !

Scientific Symposium on “Role of Nutrition during Pregnancy and Feeding of the LBW Infants , Organised by Nestle Nutrition Institute , 16th March , 2013 , Ludhiana

Posters in A pediatric Clininc in Varanasi Feb’2013

Key Actions for Protection

Appointing nodal officers at Distt and State through GO.

Control over medical and health conferences that attract IMS Act.

Awareness seminar for health workers and people

Promotion

Information, campaigns, advocacy, health workers training and skilled

counsellingBarriers: Perceived insufficient milk, misinformation, promotion of formula

milk

What is so critical?

For milk ejection3/4

What is promotion aboutMothers motivation, building her

confidence in her milk supplyPerceived insufficient milk is the

main reason to adopt artificial feeding

PersuasionSupport in first 72 hours is critical

in health system

Key Actions for PromotionCampaigns in PunjabiInfant and young child feeding

counselling centres in all health facilities

Workforce is trained in skills right up to community level

Building State’s capacity to deal with this load, resource centres in medical colleges

GO to institutionalize “breastfeeding counselling as a service”

Support

This means support at all levels of work

Barriers: In adequate maternity protection

Key Actions for SupportImplement the new National Food

Security ordinance in its letter and spirit.

“Promotion of exclusive breastfeeding for the first six months”

6000 Rs as cash incentive is linked to it.

Bring a law to provide six months leave to all employees.( Private, Unorganised)

Education, research, monitoring, coordination

Pre-service strengthening, Regular data review,

qualitative research, review of programmes

Barriers: Inadequate attention, lack of context,

goals etc

Key actionsImplement a strong pre-service

module in all under graduate courses of doctors and nurses

Set up a research committee and fund to carry out operational and other research

Coordination mechanisms

The breastfeeding gear model for scaling up and sustainability of breastfeeding programs.

Exclusive Breastfeeding 0-6 months and BF trends comparing Brazil and Mexico, observing below the program coordination and gear model of execution in these countries

Perez-Escamilla et al.Adv. Nutr. 3: 2012.

25

Master Gear !A State Committee with district

level representation Coordination mechanismsMaster gear fits well with each

gear and synchronized at right place

It sets the goalsMonitors progress of policy and

programmes every six months

Recommendations for PunjabSet up a state committee chaired by

principal secretary HFW, and having all “gears”

Assess policy and programmes ( all gears) to document baseline in 2013 and repeat 3-5 years to monitor trends.

Launch a Punjab Specific Scheme /Initiative like “Punjab Programme for Protection and Promotion of Breastfeeding ” and monitor it twice a year with clear goals and objectives.

Set up a machinery to implement IMS Act, like civil surgeon be nominated by GO.

Thank you !!