Status of formula feeding, commercial foods, trends, possible
GHG emissions
Name of the Speaker: Dr. S. K. Roy
Chairperson
Bangladesh Breastfeeding Foundation (BBF)
Name of the Country: Bangladesh
Bangladesh
Infant and Young Child Feeding (IYCF) trends in Bangladesh 1993-2007
9
46
29
86
13
45
28
90
17
4659
87
24
42
62
90
4858
71
97
363752
89
4343
7491
0
25
50
75
100P
erc
en
t
BDHS93-94
BDHS96-97
BDHS99-00
BDHS2004
CMNS2005
MICS2006
BDHS2007
Breastfeeding initiation within 1 hour of birthExclusive Breastfeeding Rate <6 monthsComplementary feeding at 6-9 monthsContinued breastfeeding at 20-23 months
IYCF Practices Indicator Status in 2005
(BDHS)Status in 2007
(BDHS)Initiation of breastfeeding within 1 hour
24% 37%
Exclusive Breastfeeding for first 6 months
42% 43%
Median Duration of Breastfeeding
32 Months 32.8 months
Bottle Feeding (< 6 mo.) 22% - <6m
27% - 6-9 m
40.4 of <2 yrs
Complementary Feeding (6 - 9 mo.)
62% 74 %
Exclusive breastfeeding rates remain stagnant in Bangladesh for last 15 years
46
45
46
42
43
40
41
42
43
44
45
46
47
1993-1994 1996-1997 1999-2000 2004 2007
EBF
Trend of nutritional status of <5 children 1996 to 2007
55
45 43
36
18
1013
16
56
48 48 46
0
10
20
30
40
50
60
BDHS 1996-97 BDHS 1999-2000 BDHS 2004 BDHS 2007
Stunting (height for age) Wasting (wt for ht) Underweight (wt for age)
BDHS 2007
BF practices in South Asia
Afghanistan
Afghanista
n
Afghanista
n
Afghanista
n
Afghanistan
Baby Friendly Hospital Initiative
• BFHI launched in 1992 in Bangladesh• Hospital policy developed by BBF and endorsed by
the Govt. in 1992• At present 499 maternity service facilities out of
650 are Baby friendly • 20,000 health care providers have been trained
on BFHI.
Implementation of the International Code
• 1984: BMS (Regulation of Marketing) Ordinance • 1990: BMS (Regulation of Marketing) Amendment
at the national assembly .• 1992: BMS importers signed MOU with MOHFW to
stop free milk supply • 1993: Director, IPHN was appointed as authorized
officer by the MOHFW for the implementation of BMS ordinance.
• 1993: An advisory committee formed for monitoring & implementation of the code.
• 1993: Directive banning BMS advertising in the media issued by the government in December
Implementation of the International Code
• 1993: MOHFW submitted a written request to M/O Commerce to include BMS in list of restricted imports SO What/// delete!
• 1997: Three milk companies sued and were fined by the court. Two companies withdrew product from market..
• 2003: External monitoring is done in 105 hospitals SO What///
• Violation of the code by the milk company still continues unfortunately in collusion with health professionals
Issues hindering optimal infant feeding in Bangladesh
Traditional beliefs /practices:
• 1. Use of prelacteal (honey, mustard oil, sugar water,
plain water)
• 2. Mixed feeding before first 6 months of age (Breast
milk with rice powder??, suzi, cows milk etc.)
• 3. beliefs that milk comes in after 3 days
Our Lacking:• Lack of support to the mother in the community• Lack of skill BF counselor
• Lack of knowledge on BF in the community
• Lack of confidence of the mother
• Lack of family support
• Lack of skilled health service provider in the hospitals
• Lack of program activities
• Lack of proper monitoring system
• Lack of fund
Out Our enemies:
• Aggressive marketing of BMS
• Tricky promotion of BMS
• Unholy allaince with policy makers
Research Findings
References Intervention Breastfeeding status at last assessment,
<6 mo
Haider et al 2000 Peer counselors, home visits up to 15 occasions including 2 in last trimester of pregnancy, 4 in month and every two weeks thereafter up to month 5.
Visit duration 20-40 minutes
Exclusive breastfeeding
Intervention-56%
Control-5%
Examples of Law violation by commercial babyfood companies
including nestle
Questions
How to break the unholy alliance between Companies and policy makers?
Nestle Organized workshop for doctors on the occasion of WBW 09
How to stop the tricky promotion of commercial baby foods?
• Distributing leaflet of Chu. Chu
Silicone Nipple ad inside the
Chu. Chu baby diaper packet
and also using a picture of a
baby with feeding bottle. Using
the slogan ‘Best choice for
your baby’ and has three
different size for the infant (for
1-3 month, 3-6 month and <6
month)
• Advertisement through TV
channels.
How to stop uncontrolled & aggressive marketing of commercial baby
foods?
• Nestle importing
and selling products
having no
registration in
Bangladesh and
does not have any
information in local
Bangla language
GHG in Bangladesh
• 40 Tons Infant formula are imported which will have to emit 612.3 tons of Carbondioxide annually.
Kind of support breastfeeding women need :
Kind of support breastfeeding women need :
1. Support with care, nutrition and information during pregnancy
2. Support at delivery to establish breastfeeding within 1 hr.
3. Follow up support/ visit for exclusive breastfeeding.
4. Crèches and nursing breaks at the work place
5. Protection & restricting Unethical Marketing and Advertising of BMS
1. Support with care, nutrition and information during pregnancy
2. Support at delivery to establish breastfeeding within 1 hr.
3. Follow up support/ visit for exclusive breastfeeding.
4. Crèches and nursing breaks at the work place
5. Protection & restricting Unethical Marketing and Advertising of BMS
Programme Challenges
• Integrating of IYCF activities in different programmes
• Skilled health services provider
• Effective communication materials
• Strategy to protect aggressive marketing of BMS
Some Examples of Poster BBF using on BMS
Powder Milk
Don’t buy illness with your hard
earned money
Powder Milk
Warning
This Product is not sterile (WHO)
Diarrhoea
Pneumonia
Dysentery, Malnutrition
Meningitis
Ear infection, Allergy
Early death
If Survive:
Diabetes & hart diseases
5 prime messages on BF
Give 3 meals and additional 2 meals everyday to the PW & LW
Give colostrum within one hour after birth
EBF from birth to 6 months (180 days) is enough for a child even
no need a drop of water
Give family food after 6 months with BF and continue BF upto 2 yrs
Continue BF & other family foods frequently when baby is sick
Thank you