04/19/23WBW 2007 1

World Breastfeeding Week (WBW) 2007

Breastfeeding 1st Hour save ONE Million Babies

SCN WG :BREASTFEEDING and COMPLEMENTARY FEEDING

Arun Gupta on behalf of WABA

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Beginning Breastfeeding within ONE hour :Beginning life with “life”

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Objective

To draw the world’s attention to save ONE million babies with just ONE action, just ONE hour support and just ONE message….

To encourage establishing breastfeeding within ONE hour as key indicator of health progress by all communities locally and globally.

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BFHI 1992

Step 4 was, “Help mothers initiate breastfeeding within a half-hour of birth”

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World Summit for Children Commitments Millennium Development Goals (MDG) 4

to reduce U-5 child mortality 40% of all child deaths are neonates Need to scale action to reduce neonatal

deaths as progress is reported to be slow Almost all deaths in developing countries

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Risk of neonatal mortality according to time of initiation of breastfeeding within ONE hour

0.71.2

2.32.6

4.2

00.5

11.5

22.5

33.5

44.5

With in 1hour

From 1 hourto end of day

1

Day 2 Day 3 After day 3

Pediatrics 2006;117:380-386

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Potential Mechanisms

Suckling shortly after birth have a greater chance of successfully establishing and sustaining breastfeeding throughout infancy.

However, the effect of early initiation persisted after controlling for established neonatal breastfeeding patterns.

Early feeding with non human milk proteins may severely disrupt normal gut function

Rich immune and non-immune components that are important for early gut growth and resistance to infection.

Promotion of warmth and protection may reduce the risk of death from hypothermia.

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Key findings of the study

30% of the study population initiated breastfeeding after day 1 (late initiation)

30% were not exclusively breastfed in the neonatal period

Exclusive breastfeeding was associated with a 4 fold reduction in risk of death when compared to infants who were fed solids or other milk. This confirms previous findings.

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Key findings

Translating these benefits to the whole population of neonates (breastfed and not breastfed) means that 16% of neonatal lives can be saved if all babies were breastfed from day 1, and 22% if breastfeeding were started within the first hour.

Neonatal mortality was also shown to increase markedly as delay in initiation increased.

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Global impact of increases in coverage and promotion of early initiation of breastfeeding in less developed settings. Projected absolute numbers of lives saved and the

proportion of neonatal deaths avoided if 99% of infants initiated breastfeeding during the first hour or during the first day of life. [1]

Only 38 of the 60 countries had data available on initiation of breastfeeding within 1 hour and 1 day of birth.

The neonatal mortality rate for these 38 countries ranged from 15-70/1,000 live births.

[1] Karen M Edmond, Ellie C Bard, Betty R Kirkwood, Meeting the millennium development goals for child survival: global impact of early initiation of breastfeeding on neonatal mortality. (Un published)

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Contd

An additional 2.5 fold reduction in risk of death was demonstrated in babies who survived to day 2 who initiated breastfeeding on the first day of life (early initiation) compared to infants who initiated after the first day of life (late initiation).

This type of effect of early initiation has never been reported.

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Contd…

Neonatal mortality could be reduced by 24% if 99% of infants initiated breastfeeding on day 1 of life and by 31% if 99% of initiation was within the first hour.

Numbers of lives saved were estimated to be 867,000 and 1,117,000 in these two cases."

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1st ONE hour initiation cuts 22% of all neonatal deaths( 0-28 days)Pediatrics 2006;117:380-386

100%15.8%(INDIA)

India: 1.1 M

World : 4 M1 million

If ALL Women start BF

within ONE hour

250,000 babies can be saved in India and ONE MILLION in the world

INITIATION OF BREASTFEEDING within ONE hour

NEONATAL DEATHS SAVED

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Other benefits of ONE hour !!! Skin to skin Warmth Development Less bleeding postpartum

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Oxytocin factor

Role of oxytocin which is best during first 45 minutes

Suckling is at it best and babies are active during first hour

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Where we stand ? Initiation of breastfeeding within ONE hour In 38 countries : 26-52( 36 median) South Asia worst hit , but needed

most

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Why World Breastfeeding Week(WBW):2007 for ONE hour support Should not allow to get it old Too important to ignore Currently this is not a key indicator

in reports like UNICEF SOWC .

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What next

Advocacy for support to mothers during 4th stage of labour

Policy : Coverage, promotion and reporting should improve along with exclusive breastfeeding