How IMS Act implementation can bring down IMR in Karnataka

State?

Dr Arun Gupta MD

Member, PM’s Council on India Nutrition ChallengesCo-Chair Global Council International Baby Food Action

Network(IBFAN) and Regional Coordinator Asia

........“Inappropriate feeding practices lead to infant malnutrition, morbidity and mortality in our children. Promotion of infant milk substitutes and related products like feeding bottles and teats do constitute a health hazard. Promotion of infant milk substitutes and related products has been more pervasive and extensive than the dissemination of information concerning the advantages of mother’s milk and breastfeeding and contributes to decline in breastfeeding. In the absence of strong interventions designed to protect, promote and support breastfeeding, this decline can assume dangerous proportions subjecting millions of infants to greater risks of infections, malnutrition and death………”

Sh. Arjun SinghSh. Arjun SinghMinister of Human Resource Development while introducing Minister of Human Resource Development while introducing the Bill read out the Statement of objecives in the the Bill read out the Statement of objecives in the ParliamentParliament

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

1.35 million die

by 5 years,

1. million

during first year

First Year is Critical!

India enacted a Law in 1992India enacted a Law in 1992

1992:Bill 41 of 1992 was enacted

“Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992’(IMS Act)

It was strengthened by an Amendment in 2003 Cable TV networks Act in 2000 banned all TV ads All Parties supported it. ACASH and BPNI gazetted as NGOs

Guidelines on Infant & Young Child FeedingGuidelines on Infant & Young Child Feeding

Breastfeeding Saves LivesBreastfeeding Saves Lives!!Risk

of

Mor

tality

National Norms of infant and young child feeding

• Initiation of breastfeeding within one hour of birth

• Exclusive breastfeeding for the first six months

• Timely and appropriate complementary feeding after six months along with continued breastfeeding till 2 years or beyond

Lancet Child Survival Series,2003, Jones G et al. Indian J Pediatr 2006

U-5 Child deaths (%) saved by universalising key interventions in

India

Impact of NOT Following Recommended Norms

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

10

Impact of Following Recommended Norms

Protective effect on non-communicable diseases ◦Obesity◦Diabetes ◦high systolic blood

pressureIncreased performance

in intelligence tests 11

Child Feeding Practices-KarnatakaChild Feeding Practices-Karnataka

Routine maternity practices in Routine maternity practices in medical college hospitals medical college hospitals

Facilitating factors

Evidence 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)

Need For the Act

Parliament noted that promotion of baby

foods was pervasive that led to decline of

breastfeeding, which is responsible for disease

and death among children as well as

malnutrition.

Objectives of IMS Act

1. Prohibit any kind of promotion.

2. Educate pregnant women & lactating mothers.

3. Restrict & Control use of Infant Milk

Substitutes & Infant Foods.

4. Define roles & responsibilities of health care

institutions & health workers.

What Needs to be done? What Needs to be done?

ProtectionPromotionSupport

Program Coordinationand Advisory Committee

IHACIHACCode + Code +

Maternal Maternal BenefitisBenefitis

Brazilian Breastfeeding PolicyBreastfeeding and

Complimentary Brazil Network

Legal Protection

Brazilian Human Milk Bank Network

Innovating Component

Kangaroo Method

Monitoring and Evaluation

Education

Broadcasting, Social Mobilization

and AwardsWBW

Baby and Mother Friendly Hospital

Initiative

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

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

Exclusive Breastfeeding 0-6 months and BF trends comparing Brazil and Mexico

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

19

1867: Nestle started the commercialisation of formula and has been the subject of a global boycott since 1977 Nestle advert from 1936.

Baby food market was built on‘Trust’

“In less developed countries, the best form of promoting baby food formulas may well be the clinics which the company sponsors”

Nestlé in Developing countries 1970

and dependency

Nestle AD 1915

Offering Free Sample

Nestle Advertisement 1920Nestle Advertisement 1920

A Mother’s Treasure!

What is so critical?

For milk ejection3/4

Enhancing factors Hindering factors

Emptying of breast

Frequent Suckling

Expression of milk

Night feeds

Bottle feeding,Incorrect positioning,

Painful breast

Sensory impulse from nipple

Prolactin in blood

Prolactin “milk secretion” reflexProlactin “milk secretion” reflex

Action ONE on Promotion Gear

IYCF Counsellors in Health facilitiesFor good skilled counselling, accurate information,

unbiased , free from commercial pressuresBaby Friendly Hospitals …Both in public and private sectorPrivate sector can make it an income generating

activity.This action is part of this guidelineFacility Based Newborn care could form the Vehicle for human resource, funding etc. Its time for action

Action TWO on Protection Gear

Implement the IMS Act effectivelyDistrict level seminars for health care workers Inform people about itMonitor regularly and reportAppoint a State/Distt. nodal persons

Ban sponsorship of conferences completely Its time for action to protect women and children

Action THREE on Support Gear

WABA World Breastfeeding Week 1-7 August WABA World Breastfeeding Week 1-7 August 2015 2015

Need to support women

Six months maternity leave for all women Informal sector needs the most

NFSA: IGMSY……….. universalize it.Breastfeeding breaks, Flexi hours: Private sector should come forward and create

breastfeeding space for working women at work and allow six month leave.

Its time for action to support women and children

Have a PLAN..2-3 year with a budget

Appoint a Coordinator State Committee on IYCF/BF

LeadershipHigh priority

Action FOUR on Master Gear

World Breastfeeding Costing Initiative (WBCWorld Breastfeeding Costing Initiative (WBCii))

Supported by:

Thanks for your

attention !!