breastfeeding tsek* tama, sapat, esklusibo

PROTECT INFANT HEALTH. SAVE LIVES.

BREASTFEEDING

TSEK Tama, Sapat, Esklusibo

Contents

1. Situation of Infants and Children

2. Current Evidence for Breastfeeding

3. National & Health Policies

4. National Programs & Strategies

5. Breastfeeding TSEK: Protecting Community Infants & Young Children

The Situation of Infants and Children

1

4

“The State shall protect and promote the right to health of the people and shall instill health consciousness among them.

Philippine Constitution, Art 2, Section 15

The State protects a Child’s right to Life and Good Health

5

Our National Commitment

The Philippines is committed to achieve the Millennium Development Goals

(MGD) by 2015.

One of 4 children, under 5 years, is malnourished

NUTRITIONAL

STATUS

PREVALENCE ESTIMATED

NUMBER

(IN MILLION)*

Underweight 26.2% 3.35

Underheight 27.9% 3.57

Thinness 6.1% 0.78

Overweight 2.0% 0.26

Source: 7th National Nutrition Survey, 2008

• The continued high rates of moderate and severe stunting (30%) and low birthweight (20%) highlight the need for greater attention to improving maternal nutrition and complementary feeding.

The State of the World’s Children 2009

8

Poor Nutritional Status

Predisposes to:

• increased severity and duration of diarrhea attacks

• Increased risk of dying from diarrhea

Ashworth and Feachem. Interventions for the control of diarrhoeal diseases among young children: weaning education.

Bulletin of the World Health Organization, 63 (6): 1115-1127 (1985)

9

Mortality Impact of Underweight

5% reduction in low weight for age by 2005

30% reduction in child mortality

10

Source: Pelletier and Frongillo. 2003. Pooled analysis of data from 59 countries from 1966 to 1996.

Breastfeeding evens the playing field

Breastfeeding is a natural "safety net" against the worst effects of poverty...it is almost as if breastfeeding takes the infant out of poverty for those first few months in order to give the child a fairer start in life and compensate for the injustice of the world into which it was born.

James P. Grant Former Executive Director UNICEF

3

4 Reduce by two

thirds the

under-five

mortality rate

between 1990

and 2015

Key Facts • 7.6 million children under the age of five die

every year (2010 figures).

• More than half of these early child deaths are due to conditions that could be prevented or treated with access to simple, affordable interventions.

• Leading causes of death in under-five children are pneumonia, preterm birth complications, diarrhoea, birth asphyxia and malaria. About one third of all child deaths are linked to malnutrition.

13 Source: WHO. Global Health Observatory (http://www.who.int/gho/child_health/en/index.html)

CAUSES OF UNDER FIVE DEATHS, 2010

1 of 4 Philippine children under five years of age are at risk of infection & death

Source: WHO. Global Health Observatory (http://www.who.int/gho/child_health/en/index.html)

Our newborns are at risk of dying in the first 2 days of life

Strategies

• appropriate home care and timely treatment of complications for newborns

• integrated management of childhood illness for all children under five years old

• expanded program on immunization

• infant and young child feeding

16

Exclusive Breastfeeding Rates by Region

Why breast milk?

Breast milk Artificial Milk

Protein Correct amount

Easy to digest

Partly corrected

Fat Enough essential fatty

acids, lipase to digest

No lipase

Water Enough May need extra

Anti-Infective

Properties Present

Immunizes & Protects

ABSENT

Adapted from: Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993

(WHO/CDR/93.6).

19

“If a new vaccine became available that could prevent one million or more child deaths a year, and that was moreover cheap, safe, administered orally, and required no cold chain, it would become an immediate public health imperative.

Breastfeeding can do all this and more.”

- 1994

Evidence presented in the Series on Child Survival 2003 , Series on Neonatal Survival 2005 , and the Series on Maternal and Child Undernutrition 2008 , clearly pointed out the importance of exclusive breastfeeding for the first six months of life which could save more lives than any other intervention studied while enhancing nutritional status

20

The Clinical Evidence on Exclusive Breastfeeding at Birth to 6 months

2

Effect of Breastfeeding

22

• For the vast majority of infants and young children throughout the world, breastfeeding saves lives prevents morbidity promotes optimal physical and cognitive development reduces the risk of some chronic diseases

• Evidence of the benefits of breastfeeding for mothers is growing as well

Leon-Cava et al. Quantifying the Benefits of Breastfeeding: A Summary of the Evidence. Washington, D.C.: PAHO © 2002

Infant Morbidity and Mortality

• The greatest and most obvious benefits of breastfeeding are for the immediate health and survival of the infant

23

Infant Morbidity and Mortality

• Rates of diarrhea, respiratory tract infections, otitis media, and other infections, as well as deaths due to these diseases, are all lower in breastfed than in non-breastfed infants

• Exclusively breastfed infants have at least 2½ times fewer illness episodes than infants fed breast-milk substitutes.

24 Source: Jones et al., 2003,; Chandra, 1979; Feachem, 1984; and Victora, 1987.

Protection Against Infection

25

INFECTIONS

% REDUCTION

Acute otitis media (exclusive BF 3-6 mos.)

50%

Recurrent otitis media (exclusive BF >6 mos.)

77%

Upper respiratory tract infection (exclusive BF >6 mos.)

64%

Lower respiratory tract infection (exclusive BF >6 mos.)

77%

Gastroenteritis 64%

Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk,

originally published online February 27, 2012

Neonatal Conditions

INFECTIONS

% REDUCTION

Necrotizing enterocolitis 77%

RSV bronchiolitis (exclusive BF >4 mos.)

74%

Sudden Infant Death Syndrome (SIDS) (any > 1 month)

36%

Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk,

originally published online February 27, 2012

Percentage of infants 2-7 months of age reported as experiencing ear infections, by feeding category in

the preceding month in the U.S.

Adapted from: Scariati PD, Grummer-Strawn LM, Fein SB. A longitudinal analysis of infant morbidity

and the extent of breastfeeding in the United States. Pediatrics, 1997, 99(6).

Risk of diarrhea by feeding method for infants aged 0-2 months, Philippines

Adapted from: Popkin BM, Adair L, Akin JS, Black R, et al. Breastfeeding and diarrheal morbidity.

Pediatrics, 1990, 86(6): 874-882.

Type of Feeding

• Hospitalized low birth weight infants who were fed with formula milk had 4 times the incidence of serious illness compared to those infants who were breastfed.

29

Randomized Controlled Trial of Low Birth Weight Hospitalized Neonates comparing type of feeding

vs. percentage with serious illness

• There is a 2-4 fold increase in neonatal mortality rate (NMR) in not receiving colostrum. There is a 5-13% decrease in NMR with exclusive breastfeeding

• Babies who were not breastfed in the first 6 months of their lives are 25 times more likely to die than those who experienced exclusive breastfeeding from the time they were born.

Infant Mortality

Source: Jones et al., 2003,; Chandra, 1979; Feachem, 1984; and Victora, 1987.

• The timing of initiation of breastfeeding is

important as there is a higher risk of death among infants with longer delay in the initiation of breastfeeding.

Early Breastfeeding initiation

Mullany LC, et al. JNutr, 2008; 138(3):599-603.

Delaying Initiation of breastfeeding increases risk of infection-related death

Nepal 2008 N = 22,838 breastfed babies

Relative risks of death from diarrhoeal disease by age and breastfeeding category in Latin America

Adapted from: Betran AP, de Onis M, Lauer JA, Villar J. Ecological study of effect of breast feeding on infant

mortality in Latin America. BMJ, 2001, 323: 1-5.

Relative risks of death from acute respiratory infections by age and breastfeeding category

in Latin America

Adapted from: Betran AP, de Onis M, Lauer JA, Villar J. Ecological study of effect of breast feeding on infant

mortality in Latin America. BMJ, 2001, 323: 1-5.

Protection Against Allergy

36

ILLNESS

% REDUCTION

Atopic dermatitis (negative family history) (exclusive BF > 3 mos.)

27%

Atopic dermatitis (positive family history) (exclusive BF > 3 mos.)

42%

Asthma (atopic family history) (exclusive BF > 3 mos.)

40%

Asthma (no atopic family history) (exclusive BF > 3 mos.)

26%

Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk,

originally published online February 27, 2012

Protection Against Diseases

37

DISEASE

% REDUCTION

Type I diabetes

(exclusive BF > 3 mos.)

30%

Type 2 diabetes

(any)

40%

Leukemia (ALL)

(exclusive BF > 6 mos.)

20%

Leukemia (AML)

(exclusive BF > 6 mos.)

15%

Obesity (any)

24%

Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk,

originally published online February 27, 2012

Breastfeeding decreases the prevalence of obesity in childhood at age five and six years, Germany

Adapted from: von Kries R, Koletzko B, Sauerwald T et al. Breast feeding and

obesity: cross sectional study. BMJ, 1999, 319:147-150.

Breastfeeding increases intelligence

Child Development

• Breastfeeding was associated with significantly higher scores for cognitive development than was formula feeding

• Premature infants derive more benefits from breast milk than do full-term infants

• The benefits of breastfeeding increased with duration

Anderson et al. Breast-feeding and cognitive development: a meta-analysis. Am J Clin Nutr 1999;70:525–35

40

Child Development

Largest randomized trial ever conducted in the area of human lactation (17,046 infants) strongly suggest that with prolonged and exclusive breastfeeding:

• Improvement in cognitive development as measured by IQ (verbal IQ, performance IQ, full-scale IQ)

• Teachers’ academic ratings at age 6.5 years were significantly higher for both reading and writing

Kramer et al. Breastfeeding and Child Cognitive Development :New Evidence From a Large Randomized Trial.

Arch Gen Psychiatry. 2008;65(5):578-584 41

Duration of breastfeeding associated with higher

IQ scores in young adults, Denmark

Adapted from: Mortensen EL, Michaelsen KF, Sanders SA, Reinisch JM. The association between duration of

breastfeeding and adult intelligence. JAMA, 2002, 287: 2365-2371.

43

Benefits of breastfeeding

for the mother

Short-term Benefits

• Decreased post-partum blood loss

• Rapid involution of the uterus

• Decrease in post-partum depression

• Increased child spacing due to lactation amenorrhea

44

Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk, originally published online February 27, 2012

Long-term Benefits • Reduced risk of chronic diseases:

Type 2 diabetes mellitus (no history of gestational DM)

Rheumatoid arthritis

Cardiovascular disease (hypertension, hyperlipidemia)

Breast cancer (primarily premenopausal)

Ovarian cancer

• Significantly decreased rate of child abuse/ neglect

45 Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk, originally published online February 27, 2012

0 1 2 3 4 5 6

Adapted from: Beral V et al. (Collaborative group on hormonal factors in breast cancer).

Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47

epidemiological studies in 30 countries… Lancet 2002; 360: 187-95.

Breast cancer and breastfeeding:

Analysis of data from 47 epidemiological studies

in 30 countries

Risks of artificial feeding

• Interferes with bonding

• More diarrhea and respiratory infections

• Persistent diarrhea

• Malnutrition Vitamin A deficiency

• More likely to die

• More allergy and milk intolerance

• Increased risk of some chronic diseases

• Overweight

• Lower scores on intelligence tests

• May become pregnant sooner

• Increased risk of anemia, ovarian and breast cancer

Mother

Adapted from: Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993 (WHO/CDR/93.6).

Baby

Exclusive Breastfeeding Protects Infant Health & Saves Newborn Lives

Laws & Policies on Exclusive Breastfeeding for 6 Months

3

Key Health Policies Mandate Breastfeeding for Infants & Young Children

• Republic Act 7600 Rooming-in and Breastfeeding Act and IRR

• Republic Act 10028 An Act Providing Incentives to All Government and Private

Health Institutions with Rooming-In and Breastfeeding Practices and For other Purposes

• Executive Order 51, s. 1986 National Code of Marketing of Breastmilk Substitutes and

Products (“The Milk Code”)

DOH Administrative Orders

• 2005-0014 – National Policies on Infant and Young Child Feeding

• 2006-0012 –Implementing Rules and Regulation of E.O. 51, Otherwise known as “The Milk Code,” Relevant International Agreements, Penalizing Violations Thereof, and for Other Purposes

• 2007-0026 – Revitalization of the Mother-Baby Friendly Hospital Initiative in Health Facilities with Maternity and Newborn Care Services

• 2008-0029 - Mother-Baby Friendly Hospitals

• 2009-0025 - Adopting Policies and Guidelines on Essential Newborn Care

• 2010-0010 - Revised Policy on Micronutrient Supplementation to Support Achievement of 2015 MDG Targets to Reduce Under-five and Maternal Deaths and Address Micronutrient Needs of Other Population Groups

Key Health Policies Mandate Breastfeeding for Infants & Young Children

Key Health Policies

Philhealth • No. 12-2005 – Adoption of PhilHealth Benchbook on

Performance Improvement of Health Services

• No. 26-2005 – Requirement for Accredited Hospitals to be “Mother-Baby Friendly Hospitals”

• No. 34-2006 – PhilHealth Newborn Care Package

DILG

National Programs

Promoting Health & Lives of

Infants & Young Children

4

National Infant Young Child Feeding Strategy

2011 – 2016

Source: NCDPC, Department of Health

Children have the right to adequate nutrition and access to safe and nutritious food, and both are essential for fulfilling their right to the highest attainable standard of health. Infant Young Child Feeding Policy (IYCF), 2011-2015

Department of Health

Infant Youth Child Feeding Strategy, 2011-2016

• GOAL

Reduction of child mortality and morbidity through optimal feeding of infants and young children

OUTCOMES By 2016:

• 90 percent of newborns are initiated to breastfeeding within one hour after birth;

• 70 percent of infants are exclusively breastfeed for the first 6 months of life; and

• 95 percent of infants are given timely adequate and safe complementary food starting at 6 months of age.

Since 2008: Mother Newborn Child Health & Nutrition (MNCHN) Service Package

Financing

Health Facilities and Service Packages

Human Resource

Health Products and Pharmaceuticals

Other Support Systems

Pre-Pregnancy Services

Antenatal care Postpartum and Postnatal Care

Care during Delivery

Our Maternal, Newborn and Child Protection Strategy

PRENATAL AT BIRTH EXCLUSIVE FOR 6 MONTHS

SUPPLEMENTARY FOODS FOR 2

YEARS

Health Plan Essential Intrapartum and Newborn Care

in Facilities

“EINC Unang Yakap”

Exclusive Breastfeeding for 6 Months

in Communities

“Breastfeeding TSEK”

Infant and Young Child Feeding

(IYCF) Strategy

Unang Yakap 4&5

Safer, evidence-based, better quality care

for mothers & newborns in all health facilities

Breastfeeding

is the national health strategy to protect infant health & save lives

(DOH, IYCF 2011-2016)

Breastfeeding TSEK: Exclusive Breastfeeding to 6 Months

5

Tama - immediate

and appropriate

breastfeeding within one

hour after birth

• Sapat - mother’s milk

is sufficient ( in

nutrients and quantity)

for the baby up to 6

months

EKsklusibo - exclusive

breastfeeding for 6 months,

just pure mother’s breast

milk only, not even water.

Helping mothers to initiate and to exclusively breastfeed…

needs an Inter-sectoral Response

The MDG-F Joint Program:

• The Breastfeeding TSEK campaign is a component of the Joint Program by the UN Country Team to help the Philippines achieve MDG # 1 and 4

• Supported by the Spanish Government

• It is called the MDG-F 2030: Ensuring Food Security and Nutrition for Children 0-24 months in the Philippines

LGU Policies for

EINC Unang Yakap

& Breastfeeding

TSEK

LGU Allocation of Resources for EINC

Unang Yakap & Breastfeeding TSEK

Mobilization & Advocacy -Mothers -Health Professionals -Private Sector

Building Competence &

Commitment of Health

Professionals & Team TSEK

Health Governance: Unang Yakap & Breastfeeding TSEK

Peer Counselling Scaled Up for Breastfeeding Mother & Babies,

Pre, At-birth and 6 months

Plans & Policies: EINC in

Hospitals & TSEK Plan

LGU Policies for

Breastfeeding

TSEK

LGU Allocation of

Resources to sustain

LGU TSEK

Private Sector Mobilization

& Advocacy

Building Competence &

Commitment of the Team

TSEK Core Group

Breastfeeding TSEK in LGUs

Community Peer Counselling

Scaled Up for Breastfeeding

Mother & Babies

Health Staff develop TSEK

Plan for City Health

Investment Plan

Breastfeeding TSEK in LGUs

Key Action Steps

1) Update LGU Ordinances & Health Policies

2) Train LGU Health Staff & TSEK Peer Counsellors

3) Develop the Breastfeeding TSEK Plan & incorporate into LGU Health Plan

4) Mobilize TSEK Counsellors and build strong community support

5) Mobilize private sector support: private health sector, academe, business,

6) Monitor, Innovate & Sustain Breastfeeding TSEK

Step 1: Formal LGU Support

• LGU Ordinances & Guidelines

• Advocacy with LGU Stakeholders

– Powerpoint presentations and handouts for LCEs and TSEK Peer Counselors for use of CHDs

– Visual promotional materials to be used by Mayors/ LGUs

– Sample press stories, radio scripts for Mayors/LGUs to promote local initiatives on keeping mother and baby safe and healthy

Step 2: Training of Peer Counselors • Training of Peer Counselors (PCs):

A Training Institution , ARUGAAN, was hired to conduct the Peer Counselor’s Training- training design is done and trainer’s reference manual being finalized after the pilot run in 3 cities

PC trainings conducted in Quezon City, Marikina, Pasig, Taguig, Caloocan, Navotas, Parañaque, Pasay, Mandaluyong, Makati - a total of about 1,800 PCs trained

Mentoring done in Quezon City, Marikina, Pasig, Taguig, Caloocan, Navotas, Parañaque,

Training of Peer Counselors

Step 3: Mentoring Done at the Barangay House to House Visits Practicum w/ Mentors

Regular monthly meetings w/ midwives to process (share and learn) experiences in actual counseling

Step 4: Monitoring with TSEKlist Card

Step 5: Mobilizing LGU Partnerships

• Advocacy Kits & Materials

• Joint issuance with DSWD, Dep Ed, DILG, Civil Service

• MOAs with NGOs, civic and professional societies and groups

Step 6: Sustain Breastfeeding TSEK

• Enact LGU policy allocating resources for Breastfeeding TSEK

• Build breastfeeding facilities

• Expand and motivate the TSEK Peer Counsellors

• Strengthen mothers education

• Build capacity of health facilities & LGU health professionals for safe & quality Essential Intrapartum and Newborn Care or “Unang Yakap”

Educate, Create, Support: Doctors, Nurses, Midwives Mothers & Families

Erase Breastfeeding Myths Practice Exclusive Breastfeeding for 6 Months

Proteksyon ng Sanggol.

Pamana ng Buhay.

Alagang Tunay.

THANK YOU