BREASTFEEDING PROMOTION BREASTFEEDING PROMOTION EFFORTS IN MALAYSIA EFFORTS IN MALAYSIA
ROKIAH DONMINISTRY OF HEALTH MALAYSIA
Global Breastfeeding Partners’ ForumOctober 17 - 19, 2010
Penang
CONTENTCONTENT
DemographyOrganisationHealth Care Delivery SystemBreastfeeding StatusPromotional Strategies Challenges
DEMOGRAPHY (2009)DEMOGRAPHY (2009)
Population Total Male Female
Total Population 28,306,700 14,407,200(50.9%)
13,899,400 (49.1%)
Population by Age Group
• Below 15 years 9,014,700 (31.9%)
4,647,100 (32.2%)
4,367,700 (31.4%)
• 15-64 years 18,005,700 (63.6%)
9,157,400 (63.6%)
8,848,300 (63.7%)
• 65 years & above 1,286,200 (4.5%)
602,800(4.2%)
683,500(4.9%)
Maternal Mortality Rate (per 100,000 live births) 28.9 (2008)40.0 (2001)
- 28.9 (2008)40.0 (2001)
Perinatal Mortality Rate (per 1,000 births) 7.4 (2008)3.9 (2000)
7.9 (2008) 6.8 (2008)
Neonatal Mortality Rate (per 1,000 live births) 4.0 (2008) 4.5 (2008) 3.5 (2008)
Infant Mortality Rate (per 1,000 live births) 6.4 (2008)7.5 (2000)
7.0 (2008) 5.7 (2008)
Toddler Mortality Rate (per 1,000 population aged 1-4 years)
0.4 (2008) 0.5 (2008) 0.4 (2008)
Under-5 Mortality Rate (per 1,000 live births) 8.1 (2008) 8.9 (2008) 7.3 (2008)
Life Expectancy at Birth (in years) - 71.56 (2008) 76.40 (2008)
Source : Health Facts 2009
ORGANISATION CHART MINISTRY OF HEALTH MALAYSIA
MINISTER OF HEALTH
•Human Resource
•Manpower Planning & Training
•Management Services
•Competency Development
DEPUTY MINISTER OF HEALTH
PARLIAMENTARY SECRETARY OF HEALTH
SECRETARY GENERAL OF HEALTH
PUBLIC RELATIONS OFFICER
LEGAL ADVISOR
INTERNAL AUDITOR
DEPUTY SECRETARY-GENERAL (MANAGEMENT)
DEPUTY SECRETARY-GENERAL (FINANCE)
•Finance
•Procurement and Privatisation
•Accounts
•Communication & Information Technology
DIRECTOR-GENERAL OF HEALTH
DEPUTY DG OF HEALTH (MEDICAL)
DEPUTY DG OF HEALTH (PUBLIC HEALTH)
DEPUTY DG OF HEALTH (RESEARCH & TECHNICAL
SUPPORT)•Medical Development
•Medical Practice
•Telehealth
•Disease Control
•Dental Services
•Family Health Development
•Nutrition
•Food Safety & Quality Control
• Health Education
• Planning & Development
• Pharmacy Services
• Engineering Services
• National Institute of Health
•Traditional & Complimentary Medicine
13 State Health Directors
INDUSTRIAL HEALTH & CORPORATE POLICY
ORGANISATION CHART OF NUTRITION DIVISIONORGANISATION CHART OF NUTRITION DIVISION
Director
Nutrition Policy & Standard Section
Nutrition Operational Section
Nutrition Promotion
Nutrition Surveillance
Nutrition Rehabilitation
Professional Development
Nutrition Development NPANM/ TWG
Standard & Quality
Infant & Young Child Feeding
Adolescent Nutrition and Schools
Nutrition Information Centre
Research
Nutrition Surveillance
MicronutrientDeficiency
Macronutrient Deficiency
Nutrition & Disease
Adult, Elderly and People with Special Needs
HEALTH SERVICES AT DISTRICT LEVELHEALTH SERVICES AT DISTRICT LEVEL
DISTRICT HEALTH OFFICEDISTRICT HEALTH OFFICE
HEALTH CLINICHEALTH CLINIC
COMMUNITY CLINICS / COMMUNITY CLINICS / KLINIK DESAKLINIK DESA
RURAL HEALTH SERVICES : 2RURAL HEALTH SERVICES : 2--TIER SYSTEMTIER SYSTEM
HEALTH CLINICHEALTH CLINIC15,000 15,000 -- 20,000 POP.20,000 POP.
COMMUNITY CLINICSCOMMUNITY CLINICS/ / KLINIK DESAKLINIK DESA
4,000 POP.4,000 POP.
NUMBER OF HEALTH FACILITIES IN MALAYSIA NUMBER OF HEALTH FACILITIES IN MALAYSIA (2009)(2009)
HEALTH CARE FACILITIES TOTAL
GOVERNMENT (MOH)
• HOSPITALS 130• DISTRICT HEALTH OFFICES 131• HEALTH CLINICS 808• COMMUNITY CLINICS/ KLINIK DESA 1920• MATERNAL & CHILD HEALTH CLINICS 90• MOBILE HEALTH CLINICS 196
PRIVATE (LICENSED)
• HOSPITALS 209• MATERNITY HOMES 21• NURSING HOMES 12
Source : Health Facts 2009
MMR MALAYSIA 1991 - 2008
MMR in 1991 = 44 per 100,000 livebirths
MMR in 2008 = 28.9 per 100,000 livebirths
Source : Department of statistics, Malaysia
EVER BREASTFED TREND EVER BREASTFED TREND IN MALAYSIAIN MALAYSIA
Source : Malaysian Family Life Survey & National Health and Morbidity Survey
COMPARISON WITH OTHER COUNTRIESCOMPARISON WITH OTHER COUNTRIES
Country (Maternity leave) Year % Infants ever breastfed
Malaysia (8 weeks) 2006 95.0
Indonesia 2002/03 95.9
Philippines 2003 86.5
India 1999/98 96.5
Egypt 2003 95.2
Armenia 2000 88.1
United Kingdom (52 weeks) 2005 76.0
Canada (17 weeks) 2006/07 90.3
Sweden (14 weeks) 2007 97.3
Switzerland (8 weeks) 2003 94.0
Source : World Health Organization
22.3%*
EARLY INITIATION OF BREASTFEEDING
Source : National Health and Morbidity Survey II & III
EXCLUSIVE BREASTFEEDING AT 6 MONTHS EXCLUSIVE BREASTFEEDING AT 6 MONTHS COMPARED WITH OTHER COUNTRIESCOMPARED WITH OTHER COUNTRIES
Source : World Health Organization
MATERNITY LEAVE (WEEKS)MATERNITY LEAVE (WEEKS)
Source: ILO Maternity Leave Data Base – accessed on 28 May 2009
BREASTFEEDING PROMOTION
Curriculum Development
Training
Social Support
Baby Friendly Hospital Initiative
Environmental Support
Breastfeeding Education
Mass media advertisement
Code of Ethics for the Marketing of Infant Foods and Related Products
Research
Breastfeeding data collection
• in-service for all health professionals
• teachers
• government• private
• public• mass media
• milk industries
• HMIS• Child Health Card
• maternity leave• mother-support group• legal provision
(Food Act 1983) • employer
• school (2o children)• nursing colleges• in-service• medical school
• building by laws• hospital infrastructure• BP facilities in shopping
centres
Mid 2005
Actions by Ministry of
Health Malaysia
National Breastfeeding Policy (1993) reviewed
September 2005
Revised Malaysian Breastfeeding Policy
announced
2006
Guideline of Infant &
Young Child Feeding
reviewed, in line with new Malaysian
Breastfeeding Policy and RNI (2005)
August 2008
Launch of the National
Lactation Centre and New
Revised Code of Ethics
2010
Review the BFHI
implementation
PROMOTIONAL STRATEGIESPROMOTIONAL STRATEGIES
• Growth monitoring (home-based card)
• Nutrition advice/ talks (individual & groups)
• Nutrition counselling
• Cooking demonstrations (clinics & community)
• Video shows
via
Child health clinicsAntenatal clinicsPostnatal clinicsHome visits for priority cases
Nutrition Education
PROMOTIONAL STRATEGIESPROMOTIONAL STRATEGIES
- Lactation Management Education for health professionals (18/20 hours)
- Breastfeeding Counselling Course for health professionals (40 hours)
- Mother-to-mother support training for breastfeeding mothers
- Post-basic training for nurses (long distance)
- Pre-marital counselling course
- Training of extension workers co-ordinated by the Technical Working Group (Training) under the National Plan of Action for Nutrition of Malaysia (NPANM) – intersectoral collaboration
Training
PROMOTIONAL STRATEGIESPROMOTIONAL STRATEGIES
Introduced 1993Designated 123 government hospitals within MOH
6 private hospitalsConsequences - improvement in maternity careof BFHI - ↑ ever breastfed rates
- ↑ public and policy makers awareness- Improve early initiation of breastfeeding- positive response of public towards the health system- multidisciplinary teamwork- paediatric wards; mothers caring for and nursing infants
Sustenance - monitoring & re-assessment toolsCommittee - BFHI Recognition Committee
Baby-friendly Hospital Initiative (BFHI)
PROMOTIONAL STRATEGIESPROMOTIONAL STRATEGIES
1) Food Regulations 1985 and Food Act 1983 have several provisions to protect infant feeding
- Section 389 Devoted to provisions for Infant Formula (15 subsections) to protect breastfeeding
- Section 390 Canned food for infants and children
- Section 391 Cereal-based food for infants andchildren
Regulatory and ethical measures
PROMOTIONAL STRATEGIESPROMOTIONAL STRATEGIES
2) Code of Ethics for Infant Formula Products1979 (revised 1983, 1985, 1995, 2008)
: Covers the basic principles of marketingand product information of designated productsand complementary foods in Malaysia. It alsoprovide guidelines on ethical practices formanufacturer and distributors of designated products and complementary foods; and health professionals and health personnel in the health care system
: National CommitteeVetting CommitteeDisciplinary CommitteeState Committee
: State Monitoring Team- Health care system- Retail outlets- Child care centre
Scope
Organisation
Monitoring
Regulatory and ethical measures
School Curriculum
Form fourForm four
Form fiveForm five
PROMOTIONAL STRATEGIESPROMOTIONAL STRATEGIES
The Ministry of Education has taken steps to include breastfeeding in a section on infant and child care for the Secondary 4 and 5 in the Physical and Health Education Curriculum
PROMOTIONAL STRATEGIESPROMOTIONAL STRATEGIES
Printed and electronic media to create public awareness on nutrition in line with the thematic Healthy Lifestyle Campaign since May 1991– Leaflets, booklets, pamphlets, flyers, posters– Publication of advertorials, feature articles, quizzes in local
vernacular newspapers and magazines on healthy eating for all age groups
– Radio (interviews and spot announcement)– Television (talk shows, nutrition segments, commercials)– Billboards– Cinema advertisements– Bus panel advertisements– Messages on Ministry of Health vehicles– Portal MyHEALTH (www.myhealth.gov.my)
Media
PROMOTIONAL STRATEGIESPROMOTIONAL STRATEGIES
60 days paid maternity leave↓
1,825 days (5 years) no-pay leave (Pekeliling Perkhidmatan Bil. 15 Tahun 2007)
90 days paid maternity leave (Budget Announcement 2011)7 days paternity leaveBreastfeeding facilities at workplace (Health clinics)Breastfeeding facilities at shopping centre (SOGO, Jaya Jusco)Tax relief for companies that make available child care facilities at workplace (Sime Darby)Active involvement of NGOs → information, support and counselling to mothers (PPPIM, PPPLM)World Breastfeeding Week (1-7 August)
Social Support
PROMOTIONAL STRATEGIESPROMOTIONAL STRATEGIES
Various studies and surveys have been undertaken. These include :
1) The National Health and Morbidity Surveys2) Health Systems Research: “To study the Strengths & Weaknesses
in Implementation of the 10 Steps To Successful Breastfeeding inKluang Hospital
3) A study on the “Knowledge of Doctors & Nurses regarding Breastfeeding: Effect of Lactation Management Education”
4) A study on the “Assessment of the Baby- Friendly Hospital Initiative in 5 General Hospitals using WHO Assessment Tools”
5) A study on the “Breastfeeding Practices in Negeri Sembilan”
Research
CHALLENGESCHALLENGES
Working mothers and breastfeeding– work patterns– facilities for breastfeeding and breast milk expression
Established mother – support groups
BFHI implementation in private hospitals– strategies ?
Role of professional bodies in breastfeeding promotion– eliminate dependency on commercial sources of funds ?
Reported violations of the Code of Ethics for the Marketing of Infant Foods and Related Products– role of international organisations
Thank youThank you