Report : WHO/UNICEF Consultation on Breastfeeding Protection, Promotion and Support

8/8/2019 Report : WHO/UNICEF Consultation on Breastfeeding Protection, Promotion and Support

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DRAFT(wP)NUT/ICP,NT/2.2/00E

Repofiseries umber:RS/2007/GE/27(PHL)

Englishonly

R,EPORT

\YHO/UNICEFCONSULTATIONON BREASTFEEDING ROTECTION,PRO},IOTIONAND SUPPORT

Convenedy:WHO I]EALTH ORGANIZATIONREGIONALOFFICE ORTHE WESTERN ACIFIC

UN]TEDNATIONSCHILDREN'S UNDREGIONALOFFICE OREASTASIA AND PACIFIC

Manila,Philippines20 22 June 007

Not for salePrintedand distributedby:World Health OrganizattonRegional Office for the Westem PacificManila, Philippines

August2010


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NOTE

The views expressedn thisreporlare hoseof thc participantsn the WHO/UNICEFConsultation n Breastfeedingrotection, romotion ndSupporlanddo notnecessarilyeflect hepoliciesofthc Organization.

This report has beenpreparedby the World Health OrganizationRegional Officc {brtl.reWestem Pacific for govemmentsof Member Statesn theRegion and for thosewho parricipated n the WHO/LNICEF Consultationon BreastfeedingProtection,Promotion and Support.which was held in Manila, Philippines, i'om20 to 22 June2007.


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SUMMARYIn spite ofrvhat is knos'n about he greatbenefitsolbreastfeeding hat accrueto children, mothers, amilies and society-and the risks of disease nd morbidityassociatedwith bottle-feeding-the practiceofbreastfeedingcontinues o decline nmany partsof the Asia and Pacific region.Breastfeeding ompetes or mother's ime,especially ime sheneeds o eam ncome or the family, and breastmilk is beingmadeto competeagainstbreast-milk substitutes.The clear nferiority of the substitutessbeing maskedby very aggressivemarketingefforts of companies elling them. Thesecampaignsoftenprovide inaccurate nformation as well as ncentives o healthworkers and professionalsn clear violation ofthe national and ntemationalcodesand agreementsor marketingbreast-milk substifutes.These acticshaveundeminedthe efforts of govemments,nongovenmental organizations ]iGOs), individuals, andinternationalorganizationso provide mothersand families with accuratenformationto help them make he right choices or their children and hemselves.The aggressivemarketing of substitutes as also made t very difhcult for concemedhdividuals and

organizations o ffeate environments hatprotect,promote and supportbreastfeeding.To address heseand related ssues,a consultationon breastfeeding rotection,promotion and supportu'as organizedby theWHO RegionalOffice for theWestem Pacific and the Unitcd Nations Children's Fund GTNICEF)RegionalOfficefor EastAsia and Pacific. Parlicipants iom Australia, Cambodia,the Peopie'sRepublicof China,Fiji, Indonesia,apan,he LaoPeople'sDemocraticRepublic, Malaysia, {ongolia, New Zealand,PapuaNerv Guinea, he Philippines,Samoa,Singapore, olomon slands. hailand,Timor-Leste, anuatu, ndViet Nammet in Manila, Philippines. rorn 20 to 22 Jttne200l . The consultationwas designedto strengthen he regional netrl'ork n'ith new and bettertools andhuman and

knowledgeresources or expandingand sustaining he region's breastfeeding ulture.The consultationobjectiveswere to: sharesuccessfulexperiences nd essonsleamt, and to analyseconstraints o improving breastfeeding; iscuss he slatusof theBaby-Friendly Hospital lnitiative (BFHI) and future stepsneeded o strengthen ndsustain he initiative; review the statusof the adoption and mplementationoftheintemational and national codes or marketing breast-milk substitutes, nd dentifuactions hat will improve their effective mplementation;and dentifu innovative waysto promotea breastfeeding ulture and discouragea bottle-feedingculture.The three-dayu orkshop was divided into hvo main partsu'hich wereprefacedby presentations nd discussions n breastfeedingn the context of the Regional ChildSurvival Strategy, he economicso breastfeeding, nd country situationanalyses andavailabledata ools). The first part aimed at creating anenablingenvironment(personal,societaland political) for breastfeeding y sharingexperiences,ooking forways to strengthenBFHI, improving healthworker skills, andeffectively usingcommunication ools to transfom behaviour. The Cambodiacasestudy rvaspresented.The secondparl ofthe consultation ocusedon preventing a bottle-feedingculture from proliferating. The Philippine story was presented s an examplewhichled to extensivediscussions n how to bettermonitor and mplementcodesofmarketing of breast-milk substitutes. Technicalupdateson breastfeedingn


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emergencies, reastfeeding nd HIV, breastleedinghe orv-birth-rveight aby, helong-term effectsofbreastfeedingandbreastfeeding eyond six months concludedhepresentatlonsThrouglrouthecon:ul tat ion.mphasisasp)aced n theneedo denLi f lactions hatparticipantsv'ould commit to taking after he consultation. Therefore, o

conclude he workshop, ists of recommendations ndsuggested ctions vcrecompiled(basedon discussions ver the threedays) and organizedunder hefollowing areas:breastfeeding conomics; se of data,communicationand advocacy,strengtheninghe BFHI; creatingan enablingenvironment; ncreasinghealthworkerskills; and mplementationof the Code of Marketing of Breastmilk Substitutes.The participantsu'ere expected o retum to their respeclivecountriesand ouse hese ists-as well aspersonal ists that they rvereasked o prepare-to guidethem through a courseof action hat would strengthen nd expand he breastfeedingculture n their countries. With knowledgegained rom the consultationand heconlections made vith fellorvparlicipants, esource ersonsand representativesf

national and ntemational organizations, articipants vereexpected o becomeeffective drivers n their presentand future spheres finfluence.


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CONTENTS

1 .1 Backg round . . . . . . . . . . . . . . . . . . . . . . . . .1 .2 Ob jec t i ves . . . . . . . . I1 .3 Organ i za t i on . . . . . . . . . . . . . . . . . ' . . . . . . . .1.1 Participants,esource ersons, bsen'ers,lrepresentatie agenci s.andmembersf he ec re ta r i a t . . . . . . . . . . . . . . . . . . . . . . . . . 22 .PROCEEDTNGS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 .1 P rc l im ina r i es . . . . . . . . . . . . . . . . . . . . . . . . . .2.2 Part 1: Crcating n enabling nvironmentor breestfeeding.... . ... 52.3 Part2: Preventingbott le-feedingul turc .. . . . . . . . . .123 .CONCLUSIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 04 .ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . 2 2ANNEXES:

ANNEX 1 -ANNEX 2 -

ANNEX 3 -ANNEX .

PROGRAMME FACTIVITIESL]S]' OFTEN4POR-A.RYDVISERS, ESOURCEPERSONS, BSERVERS,GENCYREPRESENTATIVESAND SECRETARIATPROBLEM 4ATRIXRECON,IMENDATIONSND SUGGESTEDCTIONS

Key words

Child nutrition / Inlant nutrition / Asia / Pacific Islands Breastfecding


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1. INTRODUCTION

1.1 BacksroundIn the Westem Pacific Region, around2100 childrenunder age ive die every

day from cornmonpreventableand reatableconditions ncluding diarrhoea,pneumoniaandperinatalevents. \\{HO and LNICEF have developed he RegionalChild Survival Strategy,which was endorsed y theWHO RegionalCommittee n2005to placechild health higher on political, economicand healthagendasnMember States.The regional strategy ocuseson the implementationof anessentialpackage or child survival that ncludesbreastfeeding s he singlemost effectiven r a r . a n f i a r a ; - f - ^ , ^ - r ; ^ -

The ntemationalCodeof Marketingof BreasfMilk Substitutes,he nnoccntiDeclaration,and he BFHI are the most significantactionssupportcdby WHO andLINICEF to promoteandprotectbreastfeeding. n the 25 yearssince hebidh of theCode and 15years rom the aunchingof the BFHI, breastfeedingatesand durationstill need o improve. Breastfeedingateshave beenon the decline n nostdevelopingcountries n the region where or y aboutone third of infants ess hansix monthsold are exclusivelybreastfed. The aggressivemarketingand advertisingstrategies f the milk industryproducing nfant and fol ow-on formula have hwarledthe early andpromising gainsof the BFHI and made he nationally adoptedmeasuresfor regulatingbreast-milk substitutesnsufficient. Hospitals hat have beencertifiedas "baby-friendly" have often failed to strictly follorv the 10 steps equiredby t1.reBFHI over he ong erm, anda system or regularassessmcnteedso beincorporated nto quality assurance ystemsof routmc health service. At the sametime, it is increasingly ecognized hat rvomenneed support or breastfeedingwithintheir own communities.

WHO and LTIIICEFconveneda consultation o discusscommon ssuesandchallenges elated o BFHI and tire mplementationof the Intemational Code ofMarketing of BreasGMilk Substitutes, nd o identi|/ strategicactions hat willpromotea "breastfeeding ulture" and discouragea "bottle-feedingculfure" amongmothers and within the health community, with ful1 health systemsupport.1.2 Obiectives

The consultationobjectives vere o:(1)(2)(3)

share uccessfulxperiencesnd essonseamt,and o analyseconstraintso improvingbreastfeeding;discusshe status f theBFHI and uturesteps eededo strengthenandsustainhe nitiative;review he status f the adoption nd mplementationf theintemational ndnational odes f marketing f breastmilksubstitutes,nd dentifliactionshat will improveheir effectiveimolementation:nd


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identifu imovative ways to promotea breastfeeding ulture anddiscourage bottle-feedingculture.1.3 Organization

Vieu'ing breastleedingn the contextofthe RegionalChild Survival Strategy,looking at possibie vays o measrre he economicvalue of breastfeeding, ndanalysingavailablecountry data or settingcountry actionpriorities,primedthepafiicipants or the two main partsof the consultation.hr Part 1,group andplenarydiscussions n ways to createan enablingenvironment or breastfeeding yimproving BFHI and heaithq,orkerski11s ndperformance, nd changingbehavioursrvith effective communication ools" ollowed apresentation n the successful aby-lriendly community nitiative (BFCI) in Cambodia. In Parl 2, participantsu'ereurgedto think ofnew ways to preventa bottle-feedingculture rom proliferatrng. Thecurrentbattle n the Philippines' SupremeCourt (and n the media) over the expansionof the coverageof the Milk Code and he aunchof LNICEF's docurnenlary orntulafor Disaster: Violationsof the Philippine Milk Codeprovideda real-timeactionframervork or in-depth discussions n u'ays o monitor and enforcc he Code, heimportanceof "doing dre homervork"(including technicalupdates) or advocacy,andthe need o make clear commitments o achieve arsets. SeeAnnex I for the detailedprogrammeof activities)l . .1 Parlicipants. esource ersoofthe secretariat

Represerr lat i rs rom he o) lowingMemberStatesanicipatedn rheconsultation: ustralia 1) ,Cambodia 3) ,China 5) ,Fiji (2), ndonesia1) ,Japan 1) ,the Lao People'sDemocraticRepublic 2) ,Malaysia 1) ,N4ongolia3) ,NervZealand(2),PapuaNeu' Guinea 3) , he Philippines5) , Samoa1) , Singapore3) ,SolomonIslands 1) ,Thailand 3) ,Timor-Leste 2) ,Vanuatu 1) ,andViet Nam (4).The resourcepersonswere Ms Ali Maclaine of EmergencyNutrition Nehl'ork(United Kingdom), Dr Audrey Naylor of Wellstart ntematior.ralUnited StatesofAmerica),Dr Marina FerreiraRea of the Institute of Health of SdoPaulo (Brazil),Dr Julie Smith of the Australian ResearchCouncil (Australia),and Ms Ycong JooKean of the IntemationalBaby Food Action Network (IBFAN)/Intemational CodeDocumentation entre ICDC) PenangMalaysia).Obsen-ersncludedrepresentativesiom the DevelopmentAction for Wonen-TradeUnion Congress f the Philippines,Employers' Confederation f thePhilippines,Peopleof the Philippines or BreastleedingCoalition/ARUGAAN,Philippine Senate,United StatesAgency for InternationalDevelopmentPhilippines,lntemationalLabour Organization Philippines,and he United StatesCenters orDiseaseControl and Prevention.Other observersncluded representativesrom theTaichungVeteransGeneralHospital and he Bureau of HealthPromotion nTaichung.

(1)


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The secretariatwas composed frepresentatives f WHO Headquarters ndoffices of the Westem Pacific Region, Cambodia,China,Philippines andViet Nam,and UNICEF Headquarters nd offices of the EastAsia and PacrficRegion nCambodia,China, he Philippines,Thailand,Timor-Leste,and Viet Nam.SeeArmex 2 for the complete ist of participants.

2. PROCEEDINGSt . l Preliminaries2.1,.1 Opening

Dr ShigeruOmi, WHO RegionalDirector for the WestemPacific, opened heconsultationby outlining thebenefitsofbreastfeedingand hen askingwhy thesebenefits are not being taken advantage f-as shown n declining breastfeedingatesin the region and horv u'e might ensure hat the benefitsare not lost. He cited theWHO and -tNICEF's Global Stralegyon lnfant andYoung Child Feeding IYCF) asidentifoing responsiblegroupsand he roles they mustplay for promoting,protectingand supportingbreastfeeding.To reversenegative rends n breastfeedingates,Dr Orni called for "radical solutions" hat would in olve strengtheningBFHInonitoring, expandingsupporl or breastfeeding eyond hospitals,and using hemedia n a comprehensive ommunicationstratcgy o promotebreastfeeding.Scientific evidence ells us that breastfeedings the singlemost effective nterventionto preventchild deaths:and that all rvomen.with very ferv exceptions,are able obreastfeed-if enco and suDDorted. -Dr Shrseru mi

Dr StephenJ. At*'ood. Regional Advisor for Health and Nutrition LTNICEFEastAsia andPacificRegion, velcomedheparticipants n behalfof the RegionalDirector of the LTNICEFEastAsia and Pacific Regional Office. He asked vhybreastfeeding ontinues o be a subject so mpodant as o require continuous \{HOand LINICEF collaboration.a consultationof expertsacross he regionrvith resourcepersons iom around he world and media-grabbingattention. His ansrver: u'e rviilbe discussingnothing shortof life anddeath." He suggestedhat adequate oliticalcommitment,community educationand communication,counselling or u'omen andfamilies, and minimized or arrested nfluence of interestgroupswith agendasnconflict with breastfeeding upporl nay be parl of the "secret" to raising breastfeedingrates. Dr Atwood challenged he participants o act courageouslyand to hold each o"personalaction hat can be translated nto change in] institutions, communitiesandhouseholds."

Participants ntroduced hemselvesand electedoffice bearcrs or theConsultation: Ms Rokiah Don (Ministry of Health, Malaysia) as chairperson,Dr Yolanda Oliveros (Departmentof Health,Philippines) asVice-chair, andProfessorColin Binns (Curtin University of Technology,Australia); andDr Dai Yaohua (Capital Institute of Paediatrics,People'sRepublic of China) asraooorteurs.


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Dr TommasoCavalli-Sforza,RegionalAdviser in Nutr-itionand FoodSafety,WHO RegionalOffice for theWestem Pacific, reviewed he agenda nd ntroducedthe "Reporl Book." Eachparticipant eceiveda blankbooklet andwas urged,aftereachsession, o note on onepage he recomrnendationshat arose iom thediscussions.On the facingpage,parlicipantss'ere to list actions hey ntended o takebasedon these ecommendations.n the final session, afiicipantsu'ould thenidentifl' the most mpofiant actions o which they rvouldcomnit to doing in theirrespective ountriesand offices. Aly suggestionso modifu this tool wereq'elcomed.

2.1.2 Breastfeeding:ssentialor childsurvivalanddevelopmentDr Marianna Trias, RegionalAdviser:in Child andAdolescentHealth,WHORegional Office lor the WestemPacific, s'ith Dr Atu'ood, presentedssues elated obreastfeedingwithin the context of the WHOiUNICEF RegionalChild SurvivalStrategy.Basically, o improve child sun'iva1 n the region he\\TIO/LTNICEF

strategycalls for scalingup efTortshroughgreaterpolitical rvil1and he provision ofmore financial resources. Govemmentbudgct ailocation o child health n tl.re egionis the least amongall regionsof the uorld.) Dr Triaspointed out that breastfeedingspart ofthe essential ackage or child sun'ival and the recommendationsn thestrategy or protecting,promoting and supportingbreastfeeding anbe applied n allsettings hroughout he region. She nformed the participants hat WHO haspublisheda planning guide o help countries ranslate he globa1 ndregional strategyinto national strategies ndpolicy and actionplans.Dr Julie Smith,Australiur ResearchCouncil Fellow, shorvcd orv putting adollar value on breastmilk makes ,isible ts contribution o the economyasrvell as

the costofnot protecting. romotingar.id upporlingt. Shesuggcstedhateconomicanalyses ased n do1lar alues ndcosts anhelp motivate olicy-makerso protectbreastmilk andalsohelp bring aboutbetterunderstandingfthe economic ndfinancial ncentivesu'omen and fanilies flace.A clcarerunderstanding ftheseissues, heasserted,s neededo lormulateeffective tratesieso improrebreastfeeding ractices. Dr Smith concluded hat "Govcmrnentactioncan restoreandprotectbreastfeeding s he nonn (e.g.Nom'ay)" andpresented five-point actionplan:. have funding agreementsvith health system nstitutions o include BFHI;. provide incentir.es or healthprolessionals o improve outcomesonbreastfeeding;o raisemarketing and communitysupport o matchcommercialmarketingandpromotionbudgets;. implementpaid matemity leave and othcr breastfeeding-fiiendlyworkpiacepractices ndpolicies;. include mothers' milk production n food statisticsand GDP.

ln Nodhem Europe,supporlivenationalpolicies meannearly all mothersare stillbreastfeeding t six months comparedwith less hanhaif in this region. We could dothis here f the rvill is there and f we listen to producers women)aboutwhat gets nthe wav ofbreastfi


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Policy-makersmay respondmore to costsof illness,becauset imposesmore directandpolitically visible costson the health system hanbabiesdying.Emerging iteraturehighlights that feedinghuman nfantson bovinemilk is oneof thebiggestuncontrolled experimentsn humanhistory, and he results infant deaths,chronicdiseases, besity] are onlyjust now becomingevident n the data.-Dr Julie Smith.excerpts rom TJteEcononticsof BreastJbedittg..

Ms Karen Codling, RegionalNutrition Project Officer of the L'-I'IICEFEastAsia and Pacific Regional Ofhce, and Dr SN4MoazzemHossain,LINICEFProgrammeOfficer for Infant Feeding,guided heparticipants hrough he CountrySituation Analysis exercise.From the ProblemMatrix (Annex 3) producedby theparlicipants, t was evident hat complementaryeedingbelore six months,BFHIrgassessment,ndCode mplementationwere cross-country riority areasof concem:ald late complementary eedingand he absence fNGOs s'ere not consideredproblemsby most countries. In addition, he follorving gencralobsen'ationson usingdata or comparisons esulted lon-r he activity:. it is important to ensure hatyou are comparing ike with like;o it is imnonant to know the definitions and methodologies sed;. sometimes amplesizesare srnall andyou cannotcompare esultswith theresultsof previous (larger)sun'eys;. oompansons srosscountrymay not be meaningful (depends n dataused);o it is best o use onegoodsource or comparingacrosscountries;DHS andMICS are he most standardized ources.Dr Hossainpresenteda tutorial on lnterpret ingData from Area Grapl.rs f

Infant FeedingPattemsby Age. He shorved orv areagraphscouldbe used o quicklydisplayproblems ndchanges ndhou, hey couldalsobe used or designinginterventions. He usessoftware vrthg'hich areagraphscanbe produced n onehoura{ler data s provided.2.2 Part 1 creatins an enabling environment or breastfeeding2.2.1 Case tudy:Cambodia

Ms Svay Sary, YCF Coordinatorof the CambodianMinistry of Health,presented ambodia's chievementsrom 2000 o 2005: 490%ncreasen exclusivebreastfeeding, hreefold ncrease n breastfeedingnitiation rvithin one hour (87% ofnew-bom babies)and within one day (90% ofnerv-bom babies),and mprovement ncomplementary eedingpractices. The improvement n exclusivebreastfeedingpracticesu'asdue to a large decreasen the practice ofgiving water to infants.Govemment eadershipplayed a largepart in the success fbreastfeedingpromotionby supportingkey interventions-training, multimedia campaigns, ommunity-basedinterventions one fifth of villages are mplementing the Baby-FriendlyCommunitiesInitiative, or BFCI), and the BFHI. Ms Saryconcludedher presentationwith lessonsleamt (e.g.relevanceof community nitiatives), challenges aced(e.g.supporlofworking mothers),and further action o be taken:expandBFHI andBFCI, strengthen


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policy and egislation,and continue raining and comrnunication rogrammes.Discussions hat follou.ed revealed hat from 2004 to 2007, BFCI coverage rerv rom35 to 2000 villages. The Cambodianstrategyn thepast eu'years hasbeen o focuson promotingexclusivebreastfeeding, nd his year,emphasis througha televisioncampaignand roundtablediscussions,or example)wiil beplacedon early nitiation.The multimedia campaign 'as seen o havebeenhighly elfective andsamples f thetelevision advertisements 'ereshown o the oarticioants.2.2.2 Baby-Friendly ospital nitiative

Dr Marina FerreiraRea, SeniorResearcher f the Instifuteof Health ofSdoPaulo,defined he objectivesof BFHI as mplementing he Ten Steps oSuccessful reastfeedingnd ejecting onations ffiee and ow-cost upplies fbreast-milksubstitutesn the health acility. She cited studies iom around hervorldthat confirm: BFHI is important for starling(United Kingdom) and continuing(Srveden) reastfeeding,o achieveexclusivebreastfeedingBrazil, Bela:us,Switzerland)and o reducemorbiditl' (Belarus,an mportantstudy). Sheemphasizedthe imporlanceof training to standardizeBFHI in hospitals,of Step.{ wllch is norvinterpreted as placingbabies n skin-to-skincontactu,ith their mothers rnmediatelyfollowingbirth at east or onehour...." andofprovidingcommunity upporlorbreastfeeding others Step 0). Dr Reapointedout hemajor evisionso theBFHIglobal criteria and ools and nformed the pafiicipants hat updatedmaterials exceptSection5 for extemal assessors) re availableon the Intemetby searching nhttpllwrllw.u!&elqe .

In the discussionhat ol1ou'ed r Rea'spresentation.anicipants harcdexperiencesn their own and other countries. Issues anged iom coverage areChina's7000baby-friendly ospitals ignihcantn termsofpercontage fall Chinesehospitalsor percentage f all babiesdelivered n Chinesehospitals?) o the use ofWellstarl Intemational's raining and monitoring software it helps hosealreadywanting to becomebaby-friendly but horv do rve convincehospitals hat arenotinterestedn becorningbaby-fliendly to change'l) o the number ofsteps that shouldbe mplemented"a11 r nothing"or "some s better hannone"?).

Gencral ssues verealso raised egardrngmonitoring, coverageand he needto recertifl, backslidinghospitals. Suggestions n how to address hese ssuesincluded:r using extemalprofessionalassociationsor monitoring (successfully one nIndia);r involving communities n rronitoring hospitalsand having them certified;o using nerv echnology br monitoring (e g. using an SMS hotiine to reporlviolations and makequeries);o addressing nderlying reasonswhy hospitals esistbecomingbaby-friendly(e.g. he pressureo be profit-oriented,o kecppayingmoms estedn. ^ - - i . , ^ + ^ L ^ ^ - : . ^ l ^ \ ,Pr rv4 rs r rusp rLd rs r rr making BFHI accreditationa necessary ondition for hospital accreditationby govemment;


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providing policy-makerswith more evidenceof the benefitsof BFHI, suchas how it reducesmorbidity and mortality;having BFHI hospitalspost their annualcertificationstatuson a ueb site forfu1l disclosure;making ara ol lect ion oresystematic.

The efficacy ofBFHI is clearbut only a small number ofhospitals havebeenaccredited onsideringow long BFHI hasbeenaround:n 15years, 0 000hospitals.What a shame! \rhen arewe going to get he exponentialump? We can't usea linearapproach.What's u'rong?We have o grapplewith the ssue.-Dr Steohen . AhvoodDr Atu'ood asked or volunteers o form two groupsof five memberseach,one group to defendand the other to oppose he follorving statement:It's been 15years, nly 20 000hospitals.'m sorry.BFHI hashad ts chance.

It's t ime to stop his nitiative.The folJou ng arguments in summary)wereput forv'ard by the opposingpanels:

-\gree$ ith statement: topBFHI Disag. reel i lb s ta temetr t : roceed i lh BFI I IBFHI putsan extra burden on resources nd onhospitals; sustainability andstarting) s a problemand expensive-hosDitals can't afford d1is.BFHI is cost-saYing;he costofBFHI is paidoffeventuallv.

BFHI is a)ready n place,numbersale adequate,fbcus on otherprogrammes. Need to re\,italizebreastfeedingl societyor elseit rrill disappear rd be repiacedby bottlcfecdirg.BFHI has not made muchof a difference. Tbe problem s in implementation; et's hx BFHIbeforeendilg it.Better to put efforts n corunudty initiarives: ncouDLr ie .i le Cambodia Leremocr omene i rebirth at home, shouldscaleup BFCI instead.somecountries vith BFCI and no BFHI have reducedchild mofialitv .

It is impoftant filr mothers o havc skilledworkers(suchas l hospitals)presentduring deliveries -mothers' lives arc also mporlant; need o work to:trengthen osprrals'urk o comnounities.N4odelmothers and traditional birth attendants(TBAs) deliverhg door-to-doormessages remore effective thanBFHL

\4others$'ho want to breastfeed n hospitalswiilnot be suppodedwithout BFHI.Trainhg and educationcan be doneu,ithoutBFHI; TBAs and mid\r'ives can be fained. BFHI helps maintain raining; BFHI educates(peoplewili continue smoking if u'e don'tput upbarriers).Most BFHI hospitalshavenot been eassessed,how can we be sure t $'ill $'ork? Arguments orBFHI are subjective.

In New Zealand,20% ofbabies are exclusivelybrea'Lled iicr f i ie yearsof Bl HI. l\i. \\asach ieved i lh reassessmenlfho.p i ta ls :b is sevidence.BFHI hcludes the Code of Marketing and isaeainst ade in this globalizedworld. Breast-milk substituteswouid proliferate f BFHI

ended.It is difficult for hospitals o implement BFHIbecause f facilities eededor roomilg in.mothmnot wantins to breastfeed.\!fIO and UI.IICEF have developedgoodtools toimplemert BFHI; changesbehg askedofhospitalsarebasedon physiology.Using formula is a choice. The "choice" to use formula may not be aninfomed choice; here s no choiceaboutbreastfeeding,he choice s whether 1obecomeDregnaotor not.


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Dr Reaconcludedher presentation n BFHI with lessonseamt (e.g.manyBFHI hospitalshave reveded o pre-BFHI conditions)and suggestedhat more couldbe leamt by" for example, rnproving self-monitoring,avoiding"politics" incertification, eviewing the mechanicsof externalassessment,ndmaking BFHI partof the countryhealth systemstructure.To endthe session n BFHI, theplenarysuggestedurther actions hat couldbe taken:r move into the community where he problem s;. show an ncreasen BFHI co\,erage; et a target or the region u'e may befocusingon the wrong target;o focuson nationalgovemments get BFHI into national egislationand ntothe nationalhealth system-if a hospital s not BFHI-certif ied, t doesn'topen ts doors; ncorporate FHI aspartof a system, ot a progran.me;o fgotemments should] setstandards;his \\'ay, evenprivatchospitalscaneventuallybe madebaby-lriendly;o m a k e r h e < < r r n r r h l. . - - , - . l c ;o look furlher into rvhat canbe done rvilh BFHI and find more creative vaysto implementthe nitiativc: the u'ay BFHI is implemented s key and sdependent n us healthprof-essionals.

2.2.3 lncreasinghealth rvorker skills and mproving performance or breastfeedingDr RandaSaadeh,Scientist or Nutrition for Health andDevelopmentof theWorld Health Organization,explained he rationale or the currentemphasis ntraining as a way to address he many gapshighlighted n the Global Strategy or

IYCF, the InnocentiDeclaration2005, and heplanning guideon the mplcmentationof the Global Strategy. Key training courses n IYCF are isted and described n apamphlet, vhichDr Saadeh istributedalong *'ith a CD lor eachcountry. Dr Saadehcautroned articipants hat before ntroducing any courses,a comprehensiverainingplanmustbe prepared,vhich ncludes ctionsteps nd dentrfiesrainees.Shehighlighted he integratedcourse or fYCF Counseilingwhich u'asbasedon andbrought ogetherpreviouscounsellingcourses,and was updatedwith nerv evidenceand ints with the Global Strategy. The ntcgratedcourseaddresseshe urgent needto efficiently train large numbersofpeople.Dr Audrey Naylor, Presidentand Chief ExecutiveOfficer of Wellstar1

Intemational,presentedwaysto sfengthen preseruicecuricula by first identiffinghow the health professionactsas barriers o breastfeeding.Thesebarrier ncludehealthprofessionals-when they believe hat infant formula is "just asgood" or evenbetter han humanmilk as a result of the nfant formula industry's very aggressivemarketing effor1s and the ack ofknowledge ofhealth workers on the benefitsofbreastfeeding,he physiology oflactation, and the skills to help mothers,babies,andthcir flamilies.Dr Naylor proposed hat preserwice ducationcould be effective nhelping to overcome hesebarriers n ways that are sustainable,ar-reaching, ost-effective,and transformational, rom assessmento implementation o monitoring andevaluation. She dentified elements hat ncrease he success foreserwiceeduoation


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which include, ormal approvalby the nstitution, faculty involvement n planaing, amuitidisciplinary eadershipeam,and a coordinatorwho is given time for theresponsibility. Dr Naylor also ecommendedhe use of theLacrarionManagentetttCurriculwn; A Faculty Guide or Schoolsof Medicine,Nursing' and t'un'ition (1'" ed.-L999) a:nd actation Managernerzt elfstudy Modules,Level 1-The group assignment, resented y Dr Naylor, involved havingthreegroupsdevelop ecommendations n an ssueassignedo thcm. The ssueswere: for Group1, how to integrate n-service raining aspart of a country fYCF strategy; or Group2,horv to changepreservicecuriculum to includebasic actationmanagement; nd orGroup 3, innovative("out of the box") ways to train other han face-to-face.Thegroup repofiing sessionwas chairedby Dr Yoianda Oliveros.Group 1: Challenges acedby a country n implementinga trainngprogramme nclude he cost of the programme, he lack of trainers, he ength of thecourse five daysmay be too long). andhorv to train difierent groupsusing standards.To integrate he training programrne, he country 'ould have o increasets budget ortraining. It could then rain one ttainer for every nstitution, train one rainerat theregional evel, and .rold egularannual raining programmes.Therewould be onestandardcourse or training the trainers. Different tools (DVDs, CD-ROMs,paidonline courses) ould be used or differentparticipants e.g.doctors,peercounsellors).Training coursescan alsobe taught n phases although his couldincrease rzurspodation nd ogistical costs or participants).Group 2: For a country to changea presen'icecurriculum to includebasiclactation management,ts Ministry of Health *'ould have o rvork with the Ministry ofEducation.Medical schoolsu'ouid need o champion hese ssuesand chairsof

obstetricsandpaediatrics vould need o be involr'ed. Professional ocietieswouldalsoneed o be involved to pressure l.re chools o change heir curriculum. (InSolomon slands,hemessages taught n secondary chools.)In Malaysia, he NationalPlanof Action for Nutritionhas,since1992,included breastfeeding ducation. The plan is implementedby collaboratingagcnciesthrough a nationalcoordinatingcommittec underthe Nutrition and Food SafetyCouncil chairedby the Minister of Health. The Ministry of Women's Affairs (apowerful ministry) also supporlspresen'iceeducation.Dr Atu ood challenged !T{O and LINICEF to give all professional taff a

back-to-schools'eek. Al1 stalIwould go back to the institution where hey came romand rekindle o1d elationships vhlie championingbreastfeedingand other ssues.Filling holes n existing courses, appingprofessionalassociations, 1'nergisingmessagesrom WHO and LNICEF to training and educationalnstitutions,andtranslatingmessagesor community practitionerswere also suggested.Group 3: The constraintsof face-to-face raining identified by the groupwereexpense, ime away rom jobs, barriers rom environmental actorsbeing gnored,andthe uncertaintyof attainingdesired esults. A combinationof methodologies ndmodes of following up should be used or breastfeedingraining. Trainersshouldgo


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to the communitywhere experiences re ichest o reinforce he ink with thecommunity. A supportiveenvironmentandprogrammed ommunication singstandardizedmessages houldhelp give the communityconfidenceo shareexperiences.Trainersshouldprovidecontinuoussupportand ollow up. Trainerscouldpenetratehe communitywith messages singtechlology, e.g. elephonecounselling, -mail, adio,SMSmessages,istanceeaming, eleconferencing.CD-ROMs.

Other suggestions nd comments.. Mothersof low-birth-weight babies, vho spendmuch time in the hospitaland eam a lot, canpasson that eamingandbe asked o help othermothers.o Australia has a LactationResourceCentre tn by the AustralianBreastfeeding ssociationu'hich archivesscientificarticlesonbreastfeedingssues. This knou4cdge s combined vith knowledge rom thecommunity or training breastfeeding ounsellors.There s also a strongonline training component.o Norway has a breastfeeding ompetencyoentreu'ith advocacyandmediacomponents.o WHO hasdeveloped n Integrated4anagementfChildhood llness(IMCI) tool which canmodify IYCF training to becotnea computerizedcourseand a distance-leaming odule.o Needto increase ommunicationbetweenmothersand clinicians. A studyfound that mothers hink clinicians are mporlant n decisions egardingbreastfeeding ut clinicians don't think it is their role to influencesuci.idecisions;clinicianssaid hat they taiked aboutbreastfeedingvith nothersbut rnother said hat clinicians did not provideenough nformation.. Some laces annol e reachcd1 clectronic eans: sceleclroniccommunication or sorneareas o that you can useyour time and esourcesto reach essaccessiblereas.

2.2.1 ComrnunicationndsocialmobilizationMs SusanMackay, Regional ProgrammeCommunicationSpecialistof theLINICEF EastAsia and Pacific Regional Office, presented Only Mother's Milk!Hamessing he Pos,erof Communication or Change." Ms Mackayusedexamplesliom a remote village in the Lao People'sDemocraticRepublic and iom thePhilippines(an excerpt rom the LINICEF documentary Formula for Disaster") oshou'the effectsof infant-formula advertisingand emphasizedhe need o be able omatch ndustry marketing effor1su'ith advertising or mothcr's milk. Cambodia'stelevision spots, or example,u'ere fundedby the United Kingdom's Department orlntemational Developmentand developedby the BBC World Serv'iceTrust andthcMinistry of Health, and were basedon much research ndpretestingandproduceds'ith much talent. Other materials ncluded a television soapoperawith breastfeedingstoriesandradio phone-inprogrammes.Ms Mackay elaborated n the fo11os'ingsuggestlons:o developa framervork or monitoring andmeasuring mpact (need o use ascientf ic approacho communication):


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- 11 -. engagehepower of the community (usepadicipatorymethodologies);r get creatir.ebombard vith ail kinds of media; useCreate oolbox).h answer 0questions. s -Vackay ade he ol lorrngcommentsnd

e, '1, ' l i t inn al arr ooFeti ^r l e 'o Make arguments imple enough; creatives" will then ift the argumentso

another evel;r Be clever aboutwho we use as spokespersons;'ork on clanty-thsre's areal esistance f cleverpeople o soundsimplc;o The messages so compelling, e don't have o do n-rucho it;o Be strategic:use heright tool for the right market (e.g. hePhilippineSupreme oufl ( \ cnt") :o There s a lot of pro bono ir.rterest.We shouldget togetheras a region andprove to donors hatu'e canget resultsand hey can get a lot for the moneythey nvest.

2.2.5 Translatingessonsfrom previous essions)nto practiceParticipantswere askedby Dr Ats,ood to fonn three concentriccircles odiscuss hree eveis at u'hich a supportiveenvironment or breastfeeding anbecreated.The nnercircle(1 ) v.ascomposed fpersonswith dircctpersonalexperience vith breastfeedingvho discussedhe creationof tl.te nterior environtlentfor the breastfeedingmother. {embers of the rniddle circle (2) discussedhe creation

of the enviroru.nentn society or breastfeeding.The outercircle's (3) membersdiscussed he creationof the political environment or breastfeeding.Circle 1 (interior enr..ironnent): ducation,govemmentbenefits, ncomesupport ob, non-discriminationn law), rolemodel,doctor'ssupport, ption o useamidwife" hospitaland health rvorker support,husband'ssuppofi,mother's suppoft,smiling people,privacy, peaceand quiet, time, accesso baby,peersuppoft,place toexpressmr1k,accommodatingworkplaces,someone o explain thepain u'ith apersonal ouch, family supportand absence f temptation(no fonnula).Circle 2 (societalenvironment):spacewithin the work environment,altemativescheduleoptions,patemity eaves,community awarenesso value mothers,community andpeersupport,health u'orker suppod,u.orker federations uppoft,prenatalcounselling or fathersand grandfathers, on-traditionalpartnerssuppod,bab1, af6sand otherphysical "havens",visible supporl n commercialplaces e.g.decals n storessuppoftingbreastfeeding), nd awardsand ncentives.Circle 3 (political environment):matemity protection (guaranteedncome, sixmonths matemity leave, ob security,breastfeedingand child care acilities inworkplaces),protection rom thesocial concept hat formula feeding s the norm andmisinformation about formula, startbreastfeedingeducation n secondary chools and

legislate o requirebreastfeeding ducation, egulation and accreditationofhospitals,

We have o be asgoodas he new media.We have greatproductsandu'c can sellthem ust as u'e1lasothersdo. How canu'e get asgoodas hey finfant fbnnulamarketers] re? Ms SusanMacka


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patemity eaveand flexible schedules,ormula only by prescriptionand not availablein retail outletsand only throughpharmaciesor motherswho carurot reastfeed,axrebates or breastfeeding-friendly ,orkplaces ndbreastfeeding olicy.2.3 Pa:12: Preventinea bottle-feeding ulture2.3.1 Philippine toryhighlights

Dr YolandaOliveros,Director V of theNationalCenter or DiseasePreventionandControl (Deparlmentof Health,Philippines),prescnted Reversing heBottle-FeedingCulture n the Philippines." ln the Philippines,almost rvo hirds ofdeathsn children ess han age5 occur n thc first 6 monthsafterbirth. Ofthese,9 outof 10deaths ccur n infantsno texclusively reastled.Lr spiteofthese ealities,breastleedingnitiation and exclusivebreastfeedingatescontinue o decline, vhilethe economicburdenof using infant formula remainsheavy(5'165million, plusrelatedcosts or caring for sick and dying children). The Philippine response astaken he form ofan IYCF National Plan of Action andPolicy (N4ay2005) o ensurethat rvherevermothersare, hey receivebreastfeeding upporl. l-ocal andintemationalpartnershave been apped o help the govemment mplement he plan.u'hich receiveda boost from the AcceleratedHunger Mitigation Programof thegovemment June2007 to December2008). The latterprovides or IYCF training tocover75%o f all barangays villages). Tnpartnershipwith employerand etailergroups, he govemmenthas also setup somemothet-and-baby-fi:iendlyvorkplacesandmalls.

An attemptby the Departmentof Health to strengthenhe NationalCode ofMarketing by revising its implementingmles andregulationshas esulted n a battlewith the milk companies n the SupremeCourt andon the streetsof Manila.Milkcompanies pent early$100million n 2006 or marketing ndadverlisingbreast-milk substitutesn the Philippines(but only $.16million in the United States).The industryuseshealth facilities for promoting their productsand blatantlyviolatesthe Milk Code. Thebattle ragesalongmany fronts: for example, he AmericanChamberof Commerce,endorsed y the United Statesembassyn the Philippines,wrote to PresidentGloria Macapagal-Arroyoon behalfof the milk companies.Related o this issue s the effoft of the govemment o revive the Mother-Baby-Friendly Hospital nitiative (\{BFHI). \VtLile82% of govemmentandprivatehospitals reaccredited,ompliancevithSteps1 to 10 s uneven. To overcornehesebarriers, he govemmenthas revised he MBFHI policies (June2007) andu'ill holdnational and ocal seminarsand training. This year,MBFHI compliancehas alsobeenmade a requirement or a hospital o be accredited y the Philippine Health nsuranceprogramme.2.3 2 Codeof Marketingof Breast-MilkSubstitutes

Mr David Clark, Nutrition Specialist legal) for IINICEF, andMs Yeong Joo Kean, Legal Advisor for IBFAN/ICDC Penang, eportedon and raisedissues egarding he Intemational Code of Marketing of Breast-Mi1kSubstitutesn theAsia-Pacific region. They showed hat with 36.6%market share, he Asia-Pacificregion s a hugemarket for the baby-food ndustry and, as a result, marketing n the


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region s far s'orse han n any other region n the world. They presented ramplesofCodeviolations n all forms. They alsopresented he statusofCode in countriesofthe region-as a iaw, as voluntary codes,as a draft, amongothers-and the problemsof implementation n eachgroup. Growing concems egarding he Codeareinappropriate unding (suchas sponsorship y milk companies fhealthprofessionals'events)and the intrinsic contaminationof infant formula (public s notsufficiently informed and milk companies o not comply with the requirementoinform them ofrisks).Companies vill do rvhatever hey canget awalr with. The region's larvsarenotsufficiently trong. -Mr DavidClark

For the groupactivity, six groups vere otmed and tu'o groupseashwereassignedo oneof threescenarios.Scenario 1 entailedmilk companiesdefending hcir materials or health

workers to inform them about new infant formulas, and Food andDrugAdministration (FDA) representativeseviewing the materials o see f they cornplywith the Code. Group 2 representedhemilk companies,Group 1 represented DA.Group 2 pointedout that the materialssay that they are for medicalprolessionalsonly, use scier.rtific ata rvith recent eferences, nd nclude a statementthalbreaslmi lk is best or babies.Group 1pointed out s,ords, mages,data andclaims on the materials hat $'erenot factual.promotional,or not backedb1,evidence.They found referenceso be old,irelevant, or hardto read, and an attribution o be incorect. Fufther, he statement n

supporl ofbreastfeeding s smaller n tlpe than statements romoting theproduct (nota balancedpresentation).One of the materialshad no noticeon whom it u'as or.Mr Clark pointedout that this exerciseshows hat the Code s r.rot ompletelyclear. The Nan (Nestle)material s more compliant with the Codebut not all claimsare substantiated. he other piece vasmore clearly unscientif ic and not facfuai andclearlypromotional.Scenario2 had representativesGroup 3) ftom an infant food companyclaiming that the as, on the Code hampersprogrammes o prevent he transmissionofHIV to children, violatesa mother's right to information on infant feedlng,and s an

obstacle o providing free infant formula to HIV positive women who need t. Group4 representedhe Ministry of Health and defended he law against hesespecificaccusations.Infant Formula Companv (Group 3) Ministrv of Eealth (Group4)HfV virus can be tuaDsmitted lrough breastrnilk- mothersneed safealtematives.This lawprevents his.

The interestofindusty is to protect tsshareholders' rterests, not thoseof mothers.Article 5.1 bars advertising-this conflictsprhciple of fiee speech.This law (Code) is 26 yearsold. Massrvedevelopments ! terms oftechnoloey and The object ofthe Code remainsvalid: to

promote,supportard Drotectbreastfeediag. vidence


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Mr Clark reminded he participants hat theWHA is clear:donationsand orv-costproducts o healthworkers are not allo\\'ed. He pointed out that the Code s n-rorerelevant n the contextof HfV because t makessure hat infar.it ormula is preparedproperly and s givenon medical advice; t alsoprotects nfants of HIV positiveu,omen. With regard o ambiguities n the Code,N{r Clark recommendedhatgoven'mentsshouldadoptgood egislation o address hem.

Under Scenario 3, Group 6 represented formula companyoffering tosponsor paediatricsonference nddonate omeof it sprofits o the associationfi tendorseshe company's ormula. Group 5 represcntedhe exeoutile board oftheNational PaediatricAssociationu'hich must decide o accept he offer or not in lightof the lntemationalCode.Group6 citedseveral rticies e.g.7 5, 7 2, 7 3) o shorv 'hy sponsorshipf aconferencel,ouldno t violate he Code.They alsocitedArticles7.1,8.2 and.1.3osupport heir interpretationof the Code as allowing them to fund andbe aparlnerofthe breastfeeding ampaign. Finally, they cited Articles 9, 10 and 7.3, to ustifl' thecorrectnessf theassociation's ndorsementf theirproduct.Group 5 declined Group 6's offer on the basis hat acceptingsponsorshiproma milk companywould undemrine he association's esponsibility o adhere o theMilk Code andpromotebreastfeeding. n their vicw, rejecting he offer avoidsenteringapossibleconflict-of-interestsituation,asaccepting inancial supportandother ncentiveswould createconflicts of interest.Mr Clark agreed hat for a professionalhealth associationo endorseaproductis a violation of the Code andgovemmentsshouldbe on the ookout for conflicts ofinterest. The sponsorship f conferencess not clear n the Code andcountriesagainneed o clarifu these ssues n their laws. Dr Cavalli-Sforzasuggested nnotating he

scientificevidenceshowsour oew formulasare ascloseaspossible o breastmilk. Thereare not thesame isks any more from formula feedilg u,eneedclose co acl s'ith healt! professionals okeep hem up to date-ow productscomply withthc quality standards etbv Codex.

shows hat nfant formulamay not be safeandbreastmilk is still tbe best.World HealthAssemblyResolution59.21(2006)states he riskofinfant formula and condcmnspondered millt.

The arv . prelenring ( from proliding freesupplies o the hospirals,when tbe Codeallo$-s tunderarl icle6.6.\VIIA calls for informed decisionmaking by HIVpositivemothers.and he lar.prer.entsus from:hdring be ]ece5sarynforuratiotr.Anicle 24 2(c) ofCRC obligesgo\.emment ocombat disease nd malnutrition tbrough readilyavailable echnologyand lrrough he provisionofadeouate utdtious foods.

Govenunent s custodianofthe Codeand t is theresponsibilityof gol'ernment o give mothersil lorma on.\!-IlA Resolution59.21(2006)stateshe risk ofinfant lormula and condemns owderedmilk.

There s no need o repeal he law.

\\re have o beprcpared o defend he Codes'ith evidence, eferences, tc.We har-e oknorv more than e\,'ervone lse. \re have o know our sfulTcold. -Dr Atrvood


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Code o update t. Mr Clark also nfomed the participants hat IINICEF is organizinga regional Codeu'orkshop o startsettingup a regionalnetwork.

For an effectivemonitoring of the Code,Dr Smithpresentedhe followingproposed ivisionof responsibilities:IVIONITORINGFWHO ODE

Consumers/lVlothersroups/NGOsRo s: nformingonsumersCollecilngonrpLainisAdv0cacyStatistic;l gencyRoes :Recording/registrationfcomplaintsCollatingnd nalYseata

Healthuthorityiinistryf HeatthRoles:Acqulring/channeng esourcesoreducauonfpublicnd ealthrofessionalsnWHO odenvesiigationfcomplaintsnd nforcementfcomplianceReportingnd dviceogovefnment/internalionalgenciesInit t ion fdraftpdatednstrumentsoensurengoingffectivemplementaiion

LegisiatorsRoles:Rev w eportsEnactnd pdatepproprte nstrumentsoensureffectivemplementationfWH0CodeInternational'gencies/NGOsRoles:Revjewlobalnd egionalrendsnenforcementnd omplianceUpdate HO odeComrLl ateo esporsibe aJ!-ori ies

Selected omments rom the discussion:Dr Rea: The industry knows how to use he Codewell. The industrypeople arethe most preparedand have he best arguments.Dr Smith: Never underestimatehe power of public shaming.Ms Yeong: Govemmentsmust take responsibility.You cannotabdicate.Dr Rea: We have more allies than we think. They may ust not know about heCode.Dr Smith: Consumers eed o be mobilized.Mr iellamo: We need o engageothergroups,not necessarilyn health.Ms Codling: We should commit to training.

Cb allenges Suggested trategiesVery inle 1orno 1


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Dr Hossain: If 1'ouseesomething, ay something from the US DeparlmentofHomelandSecurity).

Shouldcodeviolationsbe postedon a United Nationsweb site?-\fter the Clark/Yeongpresentation, discussionensued egarding he postingof Codeviolations on the WHO u'eb site. This is horv, n summary, t unfolded:

Ms Don:Dr Cavalli-Sforza:

Dr Saadeh:Dr Atu'ood:Dr Smith:Ms Don:

Malal'sia nlorns WHO,TNICEF of violations hoping hey canhelp, but it hasn't happened et.WHO and LTNICEF houldconsider esponding o requestsreceived rom countries o publicize Codeviolations,by puttingthesecomplaints n thepublic domain, Ln'oughheir rvebsites.That is not the role of WHO but of govemments.Whv doesn'tLNICEF nublishviolations?From a community organizationstandpoint,q'e endorseherecommendationo put violations n a UnitedNations vebsite.\\rl{O and UI'ICEF shouldsettle he ssueof rvhat o do ivithrts of violations.2.3.3 Technicalupdates

Ms Ali Nlaclainesho.,r'edow breastfeedingn emergencies eeds o beprotected,promotedand supponed mandated y Arlicle 25 of'the Conventionof theRightsofthe Child ands'ithin the scope f the GlobalStrategy n IYCF) becauseinfants andyoung childrenaremost r,ulnerable n emergencies nd exposedo thehigli risks associated ith artificial feeding. Child morbidity andcrudemortality canincrease y 20% in as 1ittle as nl'o u'eeks n emergencies. n oneemergency,t wasfound tl.ratnlants rvho are not breastfedq'ere50 timesmorc likely to be admitted ohospital rvith dianhoeaand 8.5 times nore likely 1odie. Furlhennore, onnula,bottles and eatsareoften broughtrnto elrergencyareas. Often, this fonnula is in thewrong language, ear ts "useb1" date,or are specializedor medicalized omrulasthat are reely distributed o all mothers vith no guidance.A study ofbreastfeedingpracticesafteran earthquaken Indoncsia evealed hat onemonth after heeafihquakemany more infants (almost 15% n-rore), 'ho rverebeing breastfed eforethe earthquake,verebeing fcd formula by motherswho had receiveddonationsduring the emergency.Data also shorveda dramatic ncrease n the prevalence fdianhoea n infantsand childrenunderage2 after the earthquake-with the dianhoearatedouble or thosewho received ormula. than for thosewho did not.

Training and referencematerialson IYCF in emergenciesIFE) are availableonline (wv'w.emonline.net), l print, or on CD. The OperationalGuidancebooklethasalsous t beenupdated Version2.1,February 007). The booklet s anontechnicaldocumentwith a basic set of "dos" and "don'ts," zmdwould be usefulfor all levels of staffof nationalgovemments,United Nations agencies,NGOs anddonors. A regional FE meeting will be held in lndonesia,6 8 November2007, odeterminepracticalstepsand a strategy o support FE. Steps o take nclude:


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translateand distributekey IFE material-especially the OperationalGuidancebooklet;investigate our country'sIYCF policies,guidelinesandmaterials or IFE;i , lent i f i r l -ev nlerrerc 'providecountryand egional rientation nd raining:ensure ey players attend he regional IFE rneeting n lndonesia.

Donationsof breast-milk substitutes r bottles and eatsshouldnot be acceptednemergencies at all.Operational Guidanceon Infant and YoungChild Feedittg n Entergencies, 2.1(February007)Dr S\4 Moazzem Hossain, nfant FeedingAdvisor to LNICEF, presented nupdateon HIV and nfant feeding. TheUnited Nationsrecommendationsorbreastfeedingor HfV negative vomen or HIV statusunknown, s exclusivebreastfeedingor six nonths andcontinuedbreastfeeding or t$'o .vears r beyond.

The most appropriatenfant feeding option for HIV exposednfants(rvith IIIVpositivemothers)dependson individual circumstances,ncluding consideration fhealth ser-vices,ounsellingand support. United Nationsguidelinesstate hat "whenreplacement eeding s acceptable,easible,affordable,sustainable nd safe(AIASS)'avoidanceof all breastfeeding y HIV infectedmothers s recomluended.Otherwise,exclusivebreastleeding s recommended uring the first monthsoflife, andbreastfeeding houldbe discontinuedas soonas conditionsare n place, aking ntoaccount1ocalcircurnstances,he ndividual woman's situation,and isks ofreplacement eeding."To help HIV positivemothersmake hebestchoice, heyshould eceive

counselling hat ncludes nfonlation about he risks andbenefitsofvanous infantfeeding options,and guidance n selecting he most suitableoption for their situations.A study shou'ed hat early (0-3 nonths) mixed breastfeedings a risk factor forpostnatal ransmissionand that early breastfeeding essation ouldprevent a sizeableproporlion of postnatalHfV transmission 68% of all postnatalHIV infectionsoccuned after age6 months). Another study showed hat early mortality (throughage7 months) s higher n fbrmula-fed han breastfedHIV positive nf'antson AZT; thepredominantcauses finlant deathare diarrhoealdisease ndpneumonia.The samcstudy showed,ho*'ever, that HIV inlectron at 7 and 18 months s higher n breastfedthan formula-fed nfants, despite6 months of AZT, and at 18 months here s nodifference n mortality and HIV infection between onltula andbreastfed nfants.Govemmentsand other stakeholders hould revitalizebreastfeeding rotection,promotion and support n the generalpopulation. They shouldalso actively supportHIV infectedmotherswho choose o exclusivelybreastfeed, nd ake measuresomake replacementeeding safer or HIV infectedwomen who choose hat option.-United Nations recommendation 006

Dr RosaConstanzaVallenas,Medical Officer for Child andAdolescentHealth and Developmentof WHO, discussedhe long-termeffectsof breastfeeding.fugorous study hasshownthat breastfeeding s good for everyoneand givescredence


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to the earlyorigins hlpothesis that factorsaffecting he loetusand he 1'oung avelongJastingeffectsand are mportant causes fchronic diseases uch ashlpertension,diabetesand schemicheart disease.Having beenbreastfed,modestly educes loodpressure, omeu'hateduces otal serumcholesterol,and reduces y 22% the risk ofbeing overu'ei-eht r obese.Breastfeeding ignificantlyreduces by 37%) therisk ofdeveiopinglpe 2 diabetes,aising ognitive evelopmentcores y 4.9points,and spositively associated ith educational ttaimnent.

Dr Vallenasalso reportedon the feedingof lorv-birth-weight LBW) hfantsLBW being the direct causeof 27o/o f the million neonataldeaths hat occureachyear.LBW infants shouldbe breastfedor fed expressedmother'smi1k,donorhumanmilk, or pre-tern infant fomrula (not standard onnula). They shouldbe fed with a1 - l l n r c t h P r t l l a n q h ^ f r l , .

Resourceson these ssuescanbe found on http: ,'wr.q..rvho.inti1.ri1d-adolescent-health/ iications,/nu1.r i tron. i itmDr RandaSaadeh, cientistor Nutrition or HealtirandDevelopment fWHO, prcsentedBreastfeeding eyondSix Months." She eporled hat orcomplementary eeding, a revierv of cxistir.rgmaterialwas doneand a goodset ofindicators or complementary eeding s being developed now, only onegeneralindicator erists). Dr Saadchprescntcddataon the curent situation n the region (bycountry) n termsof the median duration of breastfeeding, ontinuedbreastfeeding t12-15monthsand20-23 months. omplernentaryeeding, nd imely nitiationofcomplementaryeeding.Shealso epodedon updates n recommendedractices:. exclusivebreastfeeding or 6 months,rvith ongoing breastfeeding p to 2yearsor beyond;. appropriate omplementary eeding of tl.re reastfedchild (guidingprinciples);. appropriate eedingof the non-breastfed hild age6-2,{ months.Dr Saadeh resenteddatasho*,ing hat afterexclusivebreastfeeding ndinsecticide-treated aterials,continuedbreastfeedingvith complernentaryeeding sthe most effectiveway of reducingunder-5mortality. CompLetrentaryeedingrcduceshe expected ercentagefunder-5morlality by 6%. Shealsoprovidedinformation on the energy equirements f children from all intake(includingbreastmilk) and iom complementary oods, he average ecommendedmeal flrcquency,he

feedingofchildren during and after lLness, nd otherguiding principles or feedingbreastfedand non-breastfed hildren.2.3.4 Generaldiscussionon technical ssues elated o breastfeeding

Dr Naylor moderated his discussionwhich includedquestionson:o positive effectsofbreastfeedingon rvomen n emergency ituations;r feasibility f implementing FASS for childrenof HIV positivemothers nthe Asia-Pacif ic region (it's different for eachmother);e definition of"exclusive breastfeeding" does t include "predominantbreastfeeding?);


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effectof anaesthesiarom caesareanectionon oxytocin or prolactin;frequencyof mixed feeding or this region;definition of timely complementary eeding;effect of continuous reastfeeding uringpregnancyon the amountofcolostrum or the newbom infant;reduction of the ncidenceofchild abusenvolving breastfedchildren a studyin Australia showed hat abuseby mothers s more ikely to be doneby thosewho are away &om their babies or 20 hours a day and did not breastfleed).

2.3.5 Recommendationsndsussested ctionsDr Atwood sumrlarized the recommendations nd suggested ctions hat arose{iom all the discussions ndpresented hese o theplenary or review and evision.The hnal version ofthis document, ncorporatingal1changes greedon by allparticipants f the consultation,s Annex 4 ofthis report seealsosection :Conclusions). The recomrnendations nd suggested ctions vcre organizedunder he

follorvingheadings:o Brea.teedngEconomics. Useof Data.Communication-ndAdrocacy. BFHI. Creatingan Enabling Environmento IncreasingHealth Worker Ski11so Code of Marketing2.3.6 Closingceremony

Dr Richard A. Nesbit, asActing RegionalDirector of the WHO RegionalOffice for the WestemPacific, re-emphasizedhe mportanceof this consultation,considering hat breastfeedings underthreat n the Asia Pacific regionwithbreastf'eedingatesdeclining and ndustry continuing o introducesubstitutes.Hepointed out that many partnersand stakeholders ave come ogether at thisconsultationand haveproduced angible outcomes n the fomr of recommendations.All participantsshould eel a part of the netrvorkofpeople and organizations orbreastfeedrngn the region and globally. Each s expected o implement the actionsand recommendations greedupon at this meeting n his or her country. Each s adriver of the effofts thattouch all parlsofsociety and everyoneneeds o u'orktogether. Dr Nesbit affirmed continuedsupporl rorn WHO and LTNICEFand hattheseorganizations .ill continue o collaborateon theseeffor1s.He thankedal1 hecontributors, esource ersonsand oticers ofthe consultation.

Ms Don thankeda1lparticipants or the very enriching consultationwhichgaveeveryone he opporfunity to shareexperiencesrom their countries.Sheurged allto bring the conclusionsandrecommendationso their countriesas a guideandexpressedhe wish to seesomeparticipants n Penang or the IBFAN meeting.


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3. CONCLUSIONSIn relation o breastfeeding conomics,t wasrecommendedhat pafticipantstake steps o increasehe visibility ofthe economicvalueofbreastfeedingand hehealth costsattributed o artificially fed infants. Theyu'ere alsourgcd to use availabledata o show u'omen's ime investment n breastfeeding ndhorv competition iom

bab.v-food roducersand employers educes he practiceof breastfeeding.Actions totake ncluded advocating he nclusionofbreast milk in nationalproductionstatistics;working rvith nutrition economistso developargumentsor emplol'mentequity rvithpaid matemity leave; and mplerientation of BFHI by shou'ingsavings o thehealthsystem iom breastfeeding. ntemationaland research rganizations re o gatherdatato link industry marketingwith decliningbreastfeedingates. PROFILES \'as citedas a useful ool for calculating he benefitsofbreastfeeding.In usingdata.communicationand advocacy, ecommendations ade"l'ereto:use WHO indicatorsand definitions vhenusing evidence o support YCF practices;locus on priorities (seeAnnex 3); promotebreastfeedingr.rpopular culture by citingbenefitsof breastfeeding, s u'el1as risks from not breastfeeding; sedata o establishnatior.ral oals;and o establisha stronger ink to the RcgionalChild Sun'ivalStrategy.Suggestedctionsnciuded:WHO/INICEF to help countries o IYCFsunreys;participants o commit to a timetable or addressing riority problems(Alnex 3); andLNICEFAITIO to help countries ind funding for breastfeedingcommunicationlans.To strengthenhe BFHI, recommendationsncluded: mproving monitoring ofhospitals;making BFHI part ofthe country hcalth-system tructure;and extendingBFHI to the community. Actions to take ncluded:WHOiLNICEF to disseminatehe

new BFHI package;LfNICEF Country Offices to map technological each braltematenonitoring tools;participants o advocatewith ministriesof health or BFHIcertification as standard or all hospita ls;participants o revicw the Cambodiaexperience nd visit Cambodia o understandBFCI; WHO/UNICEF and govenmcntsto commit o BFHI ccdification f ail hospitals y 2015;parlicipantso rvork vithNGOs andprofcssionalsocieties or BFHI extemal relieu's; andparticipants osupportgovemments o developa s'eb site to sho\\'statusof BFHI everyyear.For creatingan enablingenr,ironment, ecommendations 'ere:guarantee uietspaces or breastfeedingwomen; mprove access f working nothers to their babiesduring n.orking hours, ncreaseaccess fbreastfeedingmothers o supportivepcrsons

and groups;guarantee ccess o accurate nowledgeon breastfeeding: nsureadequatematemity andpatemity eave, a guaranteedncome, and ob securtty;makechangesn society and educational ystems o crcatea breastfeeding-posit iveulture;implementnational egulations o control marketing of breast-milksubstitutes; ndadvocate or breastfeeding rom a u'otnen's and child's rightspcrspective. Actions toachieve hese ecommendationsnclude: reviewing the statusofpresent legislation ormatemity protectionand meetingwith influential goverunent olficials about his (andalso or advocacy);exploringpossible inks with appropriatcworkers' andemployers'associationsor changesn the workplace or breastfeeding; dl ocatingwithministries ofeducation for inclusion ofbreastfeedingeducationn primary andsecondary ducation,basedon a draft curriculum outline; and nterviewing mothers of


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-21 -

LBW babieswhile they are n the hospitals o find out ifthey can becomebreastfeedingdvocates.To increase ealthworker skills, recommendationsncluded:strengtheninghecomplementarity fpreservice and n-servicc raining for various aspects ftheGlobal Strategy;adaptingpresen'ice raining to diflerent educational ultures;using a

combinationof online and face-to-face raining; linking rvithprofessional ocieties;andpromoting ntegated coursesendorsed y WHO'tNICEF. Participants 'ereasked o takeactions hat included:reporling he resultsof this meeting o seniorrepresentativesf govemment;and exploringknowledge ransfer o onlinecommunitiesby variousmedia. \\TIO and LTNICEFwere askedu'ith joining IMCIand IYCF training curriculum: finding rvays o more clearly int breastfeeding nd heRegionalChild Sunival Strategy hrough he Regional Comrnitteemceting; nvestingin the developmcntof interactiveCD trainingprogrammes;and n orking u ithgovemments o deveiopa clear and detailed rainingplan for all relevant .realthu'orkers,and o seekbudget or this.In relation o the Code ofN4arketing, he recomnendations vere: o buildcapacity n Code nplementation; improve monitoring of Code colrrpliance ndviolation; ncreasenderstandingy healthoi"licials ndu'orkers fconflictsofinterest, mproveknou'ledge ofrelevant groupson the Code;producean annotatedversion of the Code; ncrease rade and abour organizationnvolr,ement. To achievethese oals:organizationsre o suppoft anicipatior.rincludingof seniormanagement)n the -TNICEF-fundedlaining n NoYember t IBFAN-ICDC Penang,Malaysia, n the Code;WHO/TJNICEFo lacilitate egional ooperation ndr.retw'orking;BFAN-ICDC to draft an annotated nd updatedguidefor use of theCode; \TIO,UNICEF to strongl-v romote nstirution of fu1l arvs supportrng l.reCode

in selected ountries;UNICEF to shareorientationmoduleson the Code;parlicipantsto acceptpersonal esponsibilit-vor tl.iorough elf-kr.rouledge fthe Code and relatedissues;WHOTTNICEF o supporlsovemmentsn establishingodcsof conduct orhealthprofessionalsn issues elated o the Code;WHO/LINICEF/IBFAN o developa way to pubficize eponson the Code or publicuse;andall to rcvicw the status fnationalmonitoring l.stems f Codecompliance ndviolations.SeeAmer 4 lor the completeRecommendations nd Suggested ctionsdocument.

4. ACKNOWLEDGEMENTSThecontribution f the ollo$'ingagencieso funding his consultationsgratefuliyacknowledged:apanMinistryof Health,Programmeor TechnologyTransfer, ndAusAID.


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Thursday, l June200708:30 10:30 Increasing ealth 'orkerskrllsand mproi'ing erformanceorbreastfeeding10:30 11:00 Coffee reak11:00 12:00 Communicationnd ocialmobilization12:00 13:00 Lunchl3:00 1zt:30 Translatingessonsfromprer,iousessions)ntopracticePdrt 2: Preyenting a bottle feeding cLtlhtre14:30 15:00 Philippile toryhighlights15:00 15:30 Coffee reak15:30 17:00 Code frnarketingfbreastmilkubstitutes

Friday, 22 June 200708:00 10:00 Discussion f the Code mplen.rentationcenariosGroupu'ork)10:00 10:]5 CoffecBreak10:15 11:00 Report rom the six groupsandshortdiscussionsl1:00 12:00 Discussion f practical teps o improveCode mpler.nentationand enlorcement12:00 13:00 Lunch13:00 14:00 Techr-ricalpdates14:00 15:00 General iscussion n techdcal ssues elated o breastfeedingI 5:00 15:30 CoffeeBrcak15:30 16:15 Future lans16:15 17:00 General onclusions nd ecommendations17:00 17:30 Workshopevaluation17 :30 18 :00 Clos ine


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AN-I{EX 2LISTOFTEMPOR-ARYDVISERS, ESOURCEE.RSONS,OBSERVERS/REPRTSENTATIVEGENCIES,AND MEMBERSOF THE SECRETARLAT

1. TEMPORA,RY A.DVISERSDr ChanphengBanchithDeputy Chief, ObstetricDepartmentMahosotHospitalN4inistryof HealthBan Dong PalaneThongVientiane, Lao Peopie'sDemocraticRepublicTel.No.: +85620 560086Fax No.: +85621 21.2828Email: [email protected]

Dr Juanita Basilio\4edrcal Officer VII, Division ChieChild Health andDevelopmentDepartmentof Health (DOII)San .azaroCompound,Sta.Cruz,\{anila, PhilippinesTel . o. :Far No.: +63-2-7117t46Email: nitzbasilio,hotrlail.com;mchslgldoh.gov.ph

ProfessorColin BinnsProlessor, choolofPublic HealthCurt inL ni r ; rs i tyof Iec\nolog1'GPOBor U1987Penh,WA 6845AustraliaTel. No.: +61 8 92662952FaxNo.: +61 8 92662958Email: [email protected]

N{sVicenta BorjaSupen singHcal thProgram ff icerNational Center br DiseasePreventionand ControlDeparlment of Health (DOFI)San Lazaro Compound,Sta.Cruz,Manila, PhrlippinesTel.No.: +63 2- 7329956FaxNo.: +63-2-7116130Email: bessiebo{[email protected]


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Dr l lary CheaIYCF ProgramCoordinatorNational Matemal and C1lld Health CenterFrench Street,SrasChak.Daun PenhPhnomPenh,CambodiaTel.No-: (855)12 892-266FaxNo.: (E55) 3428-388Email: [email protected]

Dr Chua {ei ChienConsuitant,PaediatricianDepaftnlent of NeonatologyKK Women'sand Children'sHospital100 Bukit Timah RoadSingapqe-Zg!99Tel .No. : +65-639.11228Far No. : +65-62919079Email: [email protected]

f)r Dai YaohuaProfessor ndChaimanDepaftmentof Child HealthCapital nstitute of Paediatrics2 Ya Bao RoadBci ihg 100020,People's epublicol ChiraTel .No. : +E6-10-3563169Far No. : +86-10-E562025Enarl: th.dai@)263.net

Dr Elel'r'n del Castillo\{edical SpccialistVChief Trainirg Oiilcer for Medical andDrtrnredinel f reir i r o Prno-rrnrDr Jose abellaNlemorialHospitalSta.Cnrz, 4anilaPhilippinesTei. o.: +63-2-734556FaxNo.:Email:


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Dr Ding BingOperationDirector, Joy Media ProjectInformationOffice Deparlmentof GeneralAdministration\{inistry of HealthNo. I Xizhimenwai NanluXichengDistrict, 00044BeijinsPeople'sRepublicof ChinaTel .No. : 010-5 691957Far No.: 010-5 693237Email: [email protected]

lIs Rokiah Do nPrilcipal AssistantDrectorFarni )y eal rh erelopment i r s ionN4inistryof Health,62590,PutraravaMalaysiaTel.No.: +60-3 8888.1083Fax No.: +60-3-88 84647Email: [email protected]

Dr Tarua DaleFrankSpeca isL edicalOff icerPa;diatr ic ionGorokaGeneralHospitalP.O.Box 392GorokaEastern lighlands ProvinceGoroka,PapuaNcrv GuineaTel. No.: +615-1322117Far No. : +675-7321081Email:

Dr RegzmaaGongorFocalPoint and Researcheror BreastfeedmgPublic Health InstituleNutrition RescarchCenterPeaceStreet,17, Bayarzurkh DistrictUlaanbaatar4-04-6 , MongoliaTel-No.: +976-998-49'78Fax No.:Email: [email protected]


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Ms lfaria Imaculada GuterresNational Coordinator.NationalBreasdeedingAssociationAlola FoundationPO Box 3,!j]!, Timor-LesteTel. No.: +670

72 83591Far No.:Email [email protected]

Dr YupayongHangchaovanichDeputy ChairThai BreastfeedingCentreBangkok,ThailandTel .No. : =66-2-6595810FaxNo.: -66-2-8918-123Email: [email protected]

\{s Rosemarl' Kafa\ l a r v m a l n d h r l dH e a l r ' ru t r i t i o t : t r LMinistry of Healthand {edical SenicesP.O.Bo x 3.19Honiara,Solomon slandsTei .No. : +677-28169Fax No.: +677-2.1260Email:

lIs Azizan Nisha KhanChief Dietician and .'utritionistl{inistry of Health88 Amy Street, oorakBor 2223Govt BuildingSura.F i jTel. No.: +619-3346117Far No. : +679-3306163En.iaii: [email protected]

]Ir Pak KresnarvanHead,Sub-Directoratef FoodConsumptionDirectoratef Communt) Nutr i t ic ,nDirectorale Generalof Community Heafth\{inistry of I IealthJaka4q, ndonesiaTel .No. : +62-21-5277152FaxNo.: +62-21-5210176Email: [email protected]


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tr{s Lina LauruGeneralNurseShefaProvincialHealrh OfficePrivate Mail Bag 9009Port \rila, VanuatuTel -No. : +678-25356Far No.:Email:

NIs LuscyaneRai LigabalaruSenior egalOfhcerN4inistryof Health88 Amy Street,ToorakBo r 2223Gort BuildingSuva,FijiTel.No.: +6'79-3306177FaxNo.: +679-3306163Email: lligabalavu@gor,net.gov.l

lIr Rathanak LimDeputy DfuectorDepafimentof Drugs and Food,lzlBFStreet 21 ,Depo l I oulkokPhnom PenhCambodiaTe1. o. : (855)11463333Far No.:Email:

\Is Georgina {arauScientific Olfi cer Q.{utrition)Dir.ision of HealthP.O.Box 42Lorengau,ManusProvincePapuaNeu' GuineaTel. No.: +675-47091841709781Fax No.: +675-470903Email:


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IIr Sopon lekthonDeputy Director GeneralDepartmcntof HealthN{inistryof Public HealthTiwanont Road,MuangNontaburiDistrictBanekok, ThailandTel. No.: +66-2-590.1006Fa xNo.: +66-2-590.1005Emarl: [email protected]

Dr Darid N{okelaChief PaediatricianPort X{oresbyGeneralHospitalFree {ai1BagBoroko. NCDPapuaNew GuineaTe].No.: +675-3248200Far No.: +675-32503.12Iimail: [email protected]

Dr NguyenMai HuongTechnicalOfficerReproductiveHealth DepallmentMinistry of Healthl3 8A Giang Vo StreetIIa Noi, Viet \.-amTel. No.: -84-4-8233802Fax No.: + 84-,tr-8.16.1060fmai l : ma luongrh rahoo.con

\Is Ngul en Thi Hoa BinhDirector\Vomen. AIDS andReproductiveHealthCentreVietnam Women'sUniol39 HangChuoi streetHa Noi, Vict Na mTel. No.: +8.1-.1-972352Fax No_:+8,1-,1-972,1103Email: [email protected]

Dr NguyenThi LamDeputy DirectorNational Institute of Nutrition48-B Tang Bat Ho StreetHa Noi, Viet NamTel .No. : +84-4-9713086FaxNo.: +84-4-971785Email: [email protected]


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Dr Yolanda OliverosDirector fVNational Center or DiseasePreventionand ControlDepafimentof HealthSanLazaroCompound,Sta.Cruz,\'Ianila, PhilippinesTel .No. : -63-2-7438301oc.1700/1701Fax No.:Email:

l{s Cynthia PangErecutir,eCommittceMember (Education)Association or BreastfeedhgAdvocacy (ABAS-Singapore)SeniorLactation ConsultantKK \\''omen'sand Childr-en's ospital100Bukit Timah RoadS neapeIq.Z29E99Tel .No. : +65-96310687FaxNo.: +65-62937933Email: [email protected]

Dr KhamsengPhilavongFocalPo r t for Breast feedi rg. \c t i r i t ies- \ latemal rd Chi ldHeahl r i r ' ionMinistry of HeaithVientianeLao People's emocraticRepublicTel .No. :Far No. : -856-21-,152562Emai l :

\lr Pi XiaolinD ; . . ; ^ " 1 q r r f f \ , f F f r h c rCommodity and ServiceSupervisionDepartmentChina ConsumersAssociation11iF \'lachilery MansionNo. 248 Guanganmen$'aiStreet.Y , , o n u r r T l i c t r i n f R e i i i , r oPeople's epublicof Cl in aTel. No.:Far No.:Email: [email protected]


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trIr Niphon Popattanachain.,. ' ,r. ' q-^.-r"^, n--F'.1Food and Drug Administfation\{inistry olPublic HealthTirvanontRoad, {uang NontaburiDistrictBanekok, ThailandTel.No.: +66-2-5907009Far No. : +66-2-5907197Emaii: [email protected]

N[r JoshuaRamosDeputy DirectorR , , r e : , , o f F n n d , n r l D n , o cCivic Drive, Filin\,est ColporateCit.vtr{untinlupa,PhilippiriesTel.No.: +63-2-8.125606Far No. : -63-2-807E51Email:

\'Is SuafaiSalimaNutritionistn-^.-r- .--r ^ F Tf-" l rhPrivateMail Bag,{g!4, SamoaTel .No. : -685-21212Fax o.: +685-21,140E-mail:

Dr Gansukh SandagdorjHeadof HospitalAccreditation nitNational Center or Health DeYelopment,NIinistry ofllcalthEnkhtaivan treet-13Ulaanbaatar-2-06-,U,XlongoliaTel. o. : +9 16-11-329129FaxNo.: +976-1 -320633Emaii: gansukh nchd.nn or [email protected]


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N[s Svay SaryIYCF CoordinatorNational Nutrition ProgramNational Matemal and Cblld Health Center\4inistry of HealthFrenchStreet,SangkatSrahChakKhan Daun PePhnornPenh,CambodiaTel .No. : +855-12-778706FaxNo.: +E55-23'724267Emai l :nurr i r ion on ne.com.k l

f{s Christine StervafiSenior Advisor Q.trutntion)Non CommunicableDiseasesPolicYPublic HealthDrectorate\'finistry of HealthI 'O Box 5013Wellireton, Nerv ZealandTe1. o. : +6.1 4 8163939FaxNo.: +6.1 4 8162191Emaii: christhe stewart@moh. o\t nz

NIs Julie StufkensCoordinator\err Zea andBrea. t feedinguthor i tyPO Box 20-45,1Bisliopdale. hristchurch 5-1i,Nerv ZealandTel )io . +61 33 572072 ext 202FaxNo.: -6.133 5'/207Email : jul [email protected]

Dr llidemi TakimotoChief, Section of Matemal and Child HealthDeparlment of Health Promotionand ResearchNational Institute of Public Health2-3-6 Mrnami, Wako City,Saitama 510197, apan' l 'e l .No. : +81-48-458611FaxNo.: +81-48-4693517Email: [email protected]


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\Is Karin TanNutritionist, Nutrition DepartmentHealthPromotionBoard3 SecondHospitalAvenueSinsapore 68937Tel. No.: +65 64353827Far No.: +65 6,13 3609Email: [email protected]

Dr Tran QuangTrungDirector, Deparlmentof Inspection\linistry of Health1,18AGiangVo StreetHa Noi, Viet Na mTe1. o . : -84-4-8434816Far No.: -84-.1-273231Email: hangdk(@yahoo.comDr ShagdarUrantsetsegFoodHygiene nspectorThe StateSpecializednspectionAgcncyBarilgachdiir talbai-i 3Chingeltei du$'eg,Ulaanbaatar1- 2-38,MongoliaTe1. o. : +976-11-263766FaxNo.: +976-1 -263458Email: shinee [email protected]

Vs. llisliza VitalProject Officer IntegratedN{anagenentofChildhood llnesses\{imstry of Health Tinor-LesteRua Caicoli,PO Bor 374D!i, Timor-Leste'I'el.\o.: +670-733 628Far No. :+670-3325189Email:


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Dr Zhang DelingDeputy CounselDepartmentof Matemal and Child HealthCareand CommunityHealthMirristry of HealthNo. 1 Xizhimenwai NanluXicheng District,100044BeitinePeople'sRepublic of ChinaTel .No. : +86- 0-6E79-230,+Fax No.: -86-10-68192321Email: [email protected]

Dr Zhang RuijuanDeputy DkectorSchoolofPublic Health\{edical Coliege of Xi'an JiaotongUniversityNo. 76 YantaWest Road,Xi'an,People's epublic f ChinaTel .No. : +86-29-8265-5101Far No. : +86-29-8265-5032Email: [email protected]

2. RESOTB.CEPERSONS

Dr Audrey NaylorPresidentand Chief Executive OlficerWellstart lntemational85 Westview DriveSheibume, T 05482United Statesof AmericaTel .No. : 802)985-5160Fax No.Email: [email protected] [email protected]

Dr l{arina Ferreira ReaSenior lesearcherInstitueofHealth,SESSa uPauloRua JoaoMoura, 328 ap. 122,05,112-001lo PauloBraztlTel. No.:55-1 32932254Fax No. 55 11 38912329F - " i l - " - i & c c a t , , < h l ' r


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Ms llarvic Anne FelipeLegislative StaffOffice of SenatorPia CayetanoCommitteeon Health and DemographyPhilippine Senate5I, Rm. 505 GSISBldg.,Filancial Center,Roxas Blr.d.,PasayCrtyTel. o.: -63-2-5526683Far No.: +63-2-5526684Email:

USAID Philippines Ms Ma. Paz de SagunDeputy ChiefUSAID/PhilippinesP.O.Box EA.123. 000Emita,N4ani1a,hilippincsTel .No. : +63 2)552-9800Fax No.: +63 (2) 552-9399Emai l : pdesaern u'ard. :or

U.S.Centers or Disease Dr Ruox ei LiControlandPrevention MedicalEpidemiologistDivision of Nutrition and Physical ActivityNational Center or Chronic DiseasePreventionand Health PromotionCenters or DiseaseControl and Prer cntion4770 Bulord Highway, NE, MS;'K-2.1AtlantaGA 30341-3717United States f AmericaTel. No.: (770)488-5820Fax No.: (770) 4E -5.+73Email: [email protected]

,1.OTIIER OBSER\TERS

Dr Chao-HueiChenChief , Section fNeonatology'I'aichungVeleransGeneralHospitalNo. 160,Sec.3, Chung-Kang d.,TaichunsTel .No. : +EE6-4-2359-2525Fax No.: +886-4-2359-490


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\tfHoWestern Pacific Region

Dr Shang-Liang WuResearch ellou ActingDircctorDivision of Maternal and Child HealthBureau of HealthPromotionTaichuneTe1.No.: +886-4-2255-0177xt.,100Fax No.: +886-4-2251-5234

5. SECRXTARL{T

Dr Tommaso Cavalli-Sforza (ResponsibleOlfi cer)Regional Adviser ir Nutrition and Food Saf'etyWHO Regional Office for the Westem PacificUnited Nations AvenueP.O.Box 29321000Manila,PhilippinesTel. Nos.: (63-2)528 9864 direct);528-E001general)fax No. : (63-2) 21 1036Email: [email protected]

Dr \[arianna Trias (Co-responsibleiltcer)RegionalAdviser n Child andAdolesccnt ealthWHO Regional Office for lhe \VestemPacificUnited Nations AvenueP.O.Box 29321000 \'1ani1a, hilippincsTel .No. : (632)5289E68FaxNo.: (632)5211036L * ^ l ] . + - : ^ ^ * ; . . , . ^ - ^ . - , L ^ l - i

I)r Emmalita J{aialacShort-tennProlessionai.Child HealthWHO Regional Office lor the Westen.r acificUnited Nations AvenueP.O.Box 29321000Manila, PhilippinesTel .No. : (632)5289871FaxNo.: (632)521 1036Emai l : marra lacewpro. i i o . inr


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\ITIO Headquarters

WH O Cambodia

Dr trIassimo N. GhidinelliRegionalAdviser, HIV/AIDS & STIWHO RegionaiOlfice for theWesternPacificUnited Nations AvenueP.O.Box 29321000Manila, PhilippiresTel. No.: +63-2-528-911(GPN 89714)FaxNo.: (632) 2i i036Email: [email protected]

Dr Randa Jarudi SaadehScientistNutrition for Health and DevelopmentWorld Health OrganizationAvenueAppia20, CH-1211Gglqta, SrvitzerlandTei .No. : + '+ -22-791-3315/378FaxNo.: +:11-22-79I-1156Email: [email protected]

Dr RosaConstanzaVallcnasN{edicalOfficerChrld and AdolescentHealth andDevelopnentWorld Health OrganizationAvenueAppia 20, CH-1211Geneva.SwitzerlandTel. No.: +11-22-791-1113Fa xNo.: +.11-22-791-3L1I m " i l 1 ' l l F h " a r a , ' u / h ^ i n f

l'Is La-Ong Tokmoh\utrition TechnicalOffi cerWHO CambodiaNo. t77-179comerPasteur5i) an d25.1P.O.Box, Sangkat haktomoukPhlom Penh,CambodiaTel .No. : ( t55) 23-216610Far No.: (855)23-216211Email: [email protected]'ho.int


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WHO China

\!TIO Philippines

Dr \\'en ChunmeiNational ProfessionalOffi cerChild Health andDevelopmentWHO Chha401 Dongs'2i iplomatic Olfrce Building23, Dongzhimenv'aida ieChaoyangDistrictBeijhe 1000600People'sRepublic of ChinaTel. No.: (8610)6532-7I89Fax No.: (E610)6532-2359Emarl: *'[email protected]'ho.int

Dr Jean-N{arcOliv6\ \ HO Reprcsentat j rin thePh I ippinesWHO PhilippiresNational TubercolosisCentreBuildingSecondFloor,Building 9 Departmentof HeaithSanLazaro Compound,Sta.Cruz 1000, 4ani1aPhilippinesTel .No. : +63-2-528-9761Far No. : -63-2-731-314Email: [email protected],ho.int

]Ir -{l lesandro ellamoTechrricalOfficer\\TJO PhilippiresNational TubercolosisCentreBuildilgSecondFloor, Building 9 Deparlmentof HealthSanLazaroCompound,Sta.Cruz 1000, {anilaPhilippiresTe1.No.: +63-2-528-971Far \o. : +63-2-731-3914Emai l : e l [email protected] io . r t

Dr Ho*ard Sobeltr'IedicalOfficerWHO PhiJippinesNational TubercolosisCentreBuildrngSecond loor. u i ld ing Depanment f Heal the r n T q z a r n | - n m n n r r n dSta.Cmz1000,ManilaPhilippilresTel.No.: +63-2-528-978FaxNo.: +63-2-731-3914Email: [email protected]


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\!TIO Vict Nam

IJNICEF Headquafters

T]NICEFEastAsiaandPacificRcgion

Dr Hoang Thi BangProjectOfficerChild and AdolescentHealthWHO Viet Nam63 Tran Hung Dao StreetHoan Kiem DistrictHa Noi, Viet Nam'l-el.No.: +844-9 3 37 1Fax No.: +844-943-3710Email: xylanders@"'tn.n'pro.ivho.int

\{r Darid ClarkNutrition Specialist Legal)LINICET3 United NationsPiaza,Nerv York, NY 10017,United Statesof AmericaTel. No.: +1 21 232'7 316FaxNo.: +1 2127351105Email: dclark@unicelorg

Dr Str{ \'Ioazzem HossainProgrammeOlficer, Infant FeedingLNICEF3 United Nations Piaza,Nerv York, NY 10017,United Statesof AmericaTel .No. : +1 212FaxNo.: +1 2127351405Email: [email protected]

Dr StephenAt$ oodRegionalAdvisor for Health and NutritionLTNICEF as tAsia andPacilicRcgion19 PhraAtit RoadBangkok. hailand10200Tel. No.: (6 6 2) 356 9111Fax No.: (66 2) 280 3563 o 6:lEmail: [email protected]

Ms. ShanthaBloemenCommunicationOfhcerLTNICEFEast Asia and PacificRegional Olfice19 Phra Atit RoadBangkok, Thailand 10200Tel. No.: (66 2) 356 9401FarEmail: [email protected]


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UNICEI- Cambodia

UNICEF China

UNICEF Philippines

Ms SusanMackayRegionalProgrammeCommunicationI-,NICEFEast Asia and Pacihc RegionalOffice19 Phra Atit RoadBangkok, Thailand 10200Tel .No. : (662)3569206FaxNo.: (66 2) 280 3563 o 6,1Email: [email protected]

\{s Karen CodlingRegronalNutrition Project OificerL IICEF East Asia and Pacific RegionalOffice19 Phra Atit RoadBanqkok, Thailand i 0200Tel. No.: (6 6 2) 3569420Fax No.: (662) 2E03563 o 6.+Email: kcodling@uniceiorgMs Chhin LanA (cicf ent Prnienf Off i cerMaternal and Child HealthLr].IICEFCambodiaCounily Offrce11 Street 5SangkatSraschark,D t . - ^ - p - - L a " - k ^ , 1 ; "Tel.No.: (855 3)42621.1FaxNo.: (85523)126281E , h c ; l r t . - ; . . - ; - a ^ f f t

Dr Lilian Selenje\utrition Managert IICEFChiraCountryOfficc12Sanlitun uBeijing100600People's epublic f ChinaTel.No.:FarNo.: (8610)6532 107Email: [email protected]

Dr Marinus GotinkChief,HealthandNutritionI-NICEFPhilippinesCountryOffice3liF Yuchengco ower,RCBC Plaza6819AyalaAvenue1200MakatiCity, PhilippinesTel .No.:+63-2-9010100FaxNo.: +63-2-9010196Email: [email protected]


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UNICIF Thailand

Dr Martha Ca"vad-anI{ealth Specialist AMH)IINICEF PhilippinesCountry Office31rFYuchengco ov'er,RCBCPlaza6819Ayala Avenue1200Makati Citv, PhilipphesTel .No. : +63-2-9010100FaxNo.: +63-2-9010196Email: mcayad-an@unicefrg

Ms Alexis RodrigoSenior CommunicationAssistantLNICEF Philippires Country Olfice31tF Yuchengco ower,RCBC Plaza6819A1'alaAvenue1200 {akati Citv, PhilippinesTel .No. : +63-2-9010100Far No. : -63-2-9010196Enail : arodrigo!!u nicelorg

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LNICEF Thailand Corurtry Oificc19 Phra Atit RoadChanasongkram, hra Nakon:rBangkok, ThailandTel .No. : (662) 3569488Fax No.: (66-2)281 6032Email: [email protected]

]Is Pornthida PadthongCommunicationsOfficerU\ICEF Thailand Country Of1ice19 Plra Atit RoadChanasongkram, Ira NakomBangkok, ThailandTel. No.: (66 2) 356 948.1Fax o. : (66-2) 816032Email: [email protected]


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LTNICEF Timor-Leste

L-I{ICEF Viet Nam

Ms Jennifer BarakChild Survival and MaternalHealth CareSpecialistLI].{ICEFDili Country OfficeLll.JHouseP.O.Box 212Dili, Timor-LesteTel. No.: +610 72'1 39 7Fax No.: +670-331-3322Email: [email protected]

l{r \oeno Anuno SarmentoSeniorProgramrneAssistant-HealthandNutritionINICEF Dili Country OfficeLN HouseP.O.Box 212Dj1i, Timor-LesteTel. No.: +610-7278755Fax No.: +670-331-3322Email: [email protected]

Mr Nguyen Dinh QuangProjectOfficer.Healthand NutritjonLTNICEFViet Nam Country Office81 A Tran QuocToan,Ha Noi, Viet NamTel.No.: +811-912-5i05FaxNo.: +844-942-5705Email: [email protected]


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Documents

Report : WHO/UNICEF Consultation on Breastfeeding Protection, Promotion and Support