Breastfeeding TSEKSlide Presentation Kit

Protect Infant Health.Save Lives.

July 2012

How to Use the

Breastfeeding TSEKSlide Presentation Kit

The Breastfeeding TSEK Slide Presentation Kit was developed for advocating togovernors, mayors, barangay captains and LGU stakeholders in the campaign todisseminate information regarding the benefits of breastfeeding and thenecessity of sustaining the Breastfeeding TSEK Program for the health of ourmothers and their children.

The slide kit contains pictures of the slides in each lecture and the script for eachslide. It also includes suggested comments or questions for the lecturer (initalics) to facilitate audience interaction.

The slide discussion contents are also included within the notes field of eachPowerPoint slide.

SLIDE DISCUSSIONTitle Slide

In this session, we will begin by presenting to you the national situation of our infants and children, and the evidence behind the benefits of breastfeeding.

We will also present the governments policies and programs supporting breastfeeding, and we will focus on the Breastfeeding TSEK Program.

Read slide.

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SLIDE DISCUSSIONRead slide.

This is stated in Article 2, Section 15 of our Constitution.

The Philippines is one of 189 countries who jointly endorsed the Millennium Declaration of 2000 which committed signatories to achieving 8 millennium development goals by the year 2015. Foremost among the MDGs which can impact on the health and survival of our infants and children are MDGs 1 and 4.

The first among the 8 MDGs aims to eradicate extreme poverty and hunger. Target 1C: Halve the proportion of people who suffer from hunger; including the prevalence of underweight children under five years of age and the proportion of population below minimum level of dietary energy consumption.

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SLIDE DISCUSSIONIn the Philippines, 1 out of 4 children who are under 5 years old is malnourished. Read slide.

Source: 7th National Nutrition Survey, 2008

Malnutrition happens early, and develops if the child was not properly fed in infancy and if the mother herself was undernourished. The 1,000 days between a womans pregnancy and her childs 2nd birthday offer a unique window of opportunity to shape healthier and more prosperous futures.

Source: The State of the Worlds Children 2009

A childs poor nutritional status contributes to illness and death, as shown in this study by Ashworth and Feachem.

Source: 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)

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SLIDE DISCUSSIONWhy is it important that we lessen the number of undernourished children? Data gathered from 59 countries showed that a reduction in the number of low birth weight babies will lead to a significant decrease in the number of children dying before they reach their 5th

birthday.

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

Breastfeeding is one of the essential elements of the Department of Healths thrust of Universal Health Care or Kalusugan Pangkalahatan, which seeks to provide universal health coverage as a strategy to improve the healthcare of the poor.

James P. Grant was an American statesman and children's advocate. He served for 15 years as the third executive director of the United Nations International Children's Emergency Fund (UNICEF), with the rank of Under Secretary-General. Read slide.

One of the health targets we are aiming to meet is MDG 4, which is to reduce by two thirds the under-five mortality rate between 1990 and 2015. At present, 82,000 die annually in the country.

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SLIDE DISCUSSIONThe latest information from the WHO states that majority of child deaths are due to preventable causes, or can be treated with simple interventions.

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

These are the causes of Under Five Deaths (as seen in this graph released by WHO in 2010). Neonatal deaths make up more than half of Under 5 deaths, and majority of all deaths were due to preventable causes.

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

This graph shows that 3 out of 4 newborns die in the first week of life, specifically the first 2 days of life.

Source: NDHS 2003, special tabulations

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SLIDE DISCUSSIONWhat can be done to decrease Under Five mortality? Interventions should then: Focus on infancy Use preventive measures Address the whole population Improve infant feeding behaviors

Read slide.

These are the exclusive breastfeeding rates in our countrys regions, as reported in the 2011 Family Health Survey. The national coverage is a low 27.3%, still a long way from the 2015 target of 80%.

Source: 2011 Family Health Survey

Why is breastfeeding the solution?

Breast milk provides high quality nutrients that are easily digested and efficiently used by the babys body. Breast milk also provides all the water a baby needs. There is no need for any additional liquid. Numerous studies indicate that, for infants breastfed exclusively and on demand, the water in the breast milk exceeds water requirements. Colostrum is also rich in antibodies , white cells and Vitamin A, which protects against infection and allergy, and reduces the severity of infections. During infancy, when the babys immune system is not yet fully developed, breastfeeding will protect him from infections.

Adapted from: Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993 (WHO/CDR/93.6).6

SLIDE DISCUSSIONIn an historic editorial, The Lancet hoped a warm chain for breastfeeding could be created, and warned about the ambivalent messages often encouraged by the marketing campaigns of artificial milk manufacturers. The Lancet is the world's leading general medical journal. Read slide.

- Editorial. A warm chain for breastfeeding. Lancet 1994; 344: 123941

In 2003, the Bellagio Study Group on Child Survival put out a ve-article series in the Lancet [1, 47] that was a call to action for all segments of the public health community to bring to the forefront the continuing high rates and unacceptable disparities of child mortality in the world. This was followed in 2005 by a series [811] by the Neonatal Survival Steering Committee that focused attention on the neonate and the burden of morbidity and mortality in this short period of human life after birth. A third series on maternal and child undernutrition followed in 2008. These articles looked at preventive interventions to save childrens lives, and exclusive breastfeeding for 6 months and weaning after 1 year is the most effective intervention, with the potential of preventing more than 1 million infant deaths per year, equal to preventing 13% of the worlds childhood mortality.

What is the evidence behind the benefits of breastfeeding?

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SLIDE DISCUSSIONThis presentation summarizes the most recent published literature on the following topics related to the benefits of breastfeeding: Infant morbidity because of diarrhea, acute respiratory infections, otitis media and earinfections, and other infectious diseases Infant mortality because of diarrhea, acute respiratory infection, and all causes Child development Chronic diseases, particularly obesity, diabetes, and cancer Maternal health effects, with special emphasis on breast and ovarian cancers

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

The evidence shows that breastfeeding is important for the immediate health and survival of the infant.

The incidence of common childhood infections such as diarrhea, respiratory tract infections and otitis media, AND the risk of dying from these infections are all lower in breastfed infants.

Sources: Jones et al. Bellagio Child Survival Study Group. How many child deaths can we prevent this year? Lancet. 2003;362(9377):6571, 2003

Chandra, 1979; Feachem, 1984; and Victora, 1987.

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SLIDE DISCUSSIONThe risks of hospitalization and dying in the first year of life are higher in formula fed infants.

Source: Chen and Rogan. Breastfeeding and the risk of postneonatal death in the United States. Pediatrics 2004 May;113(5):e435-9.

Talayero et al, Full Breastfeeding and Hospitalization as a Result of Infections in the First Year of Life, Pediatrics 2006; 118;e92.

The column on the left lists the infection, and the duration of breastfeeding. The column on the right shows the percentage reduction of the incidence of the disease in exclusively breastfed infants.

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

In preterm infants in the NICU given breastmilk, the incidence of life-threatening illnesses such as necrotizing enterocolitis and respiratory syncitial virus bronchiolitis is also markedly decreased. One case of NEC could be prevented if 10 infants received an exclusive human milk diet, and 1 case of NEC requiring surgery or resulting in death could be prevented if 8 infants received an exclusive human milk diet.

Meta-analyses with a clear definition of degree of breastfeeding and adjusted for confounders and other known risks for sudden infant death syndrome (SIDS) note that breastfeeding is associated with a 36% reduced risk of SIDS.

Sources:Sullivan S, Schanler RJ, Kim JH, et al. An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. J Pediatr. 2010;156(4):562567, e1

Ip S, Chung M, Raman G, et al; Tufts-New England Medical Center Evidence-based Practice Center. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep). 2007;153(153):1186 9

SLIDE DISCUSSIONA study of 1743 mother infant pairs in the United States found a protective effect against otitis media if infants were breastfed compared to infants who were not breastfed. The risk diminished the more breast milk the infant drank (a dose response).

Source: 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).

A study from the Philippines showed that artificially fed babies were up to 17 times more at risk of getting diarrhoea than exclusively breastfed infants. Partially breastfed babies were more likely to have diarrhea than exclusively breastfed babies, but less likely than babies who received no breast milk. It is important to continue breastfeeding during diarrheal episodes because of its nutritional value and the fact that it ensures a more speedy recovery from illness.

Source: Popkin BM, Adair L, Akin JS, Black R, et al. Breastfeeding and diarrheal morbidity. Pediatrics, 1990, 86(6): 874-882.

A landmark study by Dr. Natividad Clavano done in Baguio General Hospital and Medical Center in the 1970s showed the superiority of breastmilk compared to mixed and formula feeding in preventing illness and deaths in newborns.

Source: Clavano N. Mode of Feeding and its Effect on Infant Mortality and Morbidity .J. Trop Ped 28: 287-293. December1982

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SLIDE DISCUSSIONAt that time, in Baguio General Hospital, babies were routinely removed from their mothers at birth, placed in a nursery, and given infant formula (see upper graph, point out the breastfeeding and formula feeding rates), resulting in high rates of infection among these babies (lower graph)

Dr. Clavano instituted a new regimen that allowed mothers and babies to room together, and encouraged women to breastfeed on demand (point out the increase in breastfeeding rates and sharp decline in formula feeding). The results were dramatic: the incidence of oral thrush, diarrhea, clinical sepsis, and death markedly decreased during the intensification of the breastfeeding program.

A randomized controlled trial studied the type of feeding received by low birth weight babies against the risk of serious illness. Those fed exclusively with formula had 4 times the incidence of serious illness compared to those who were given breastmilk.

Source: Narayanan et al. Randomised controlled trial of effect of raw and holder pasteurised human milk and of formula supplements on incidence of neonatal infection. The Lancet, Volume 324, Issue 8412, Pages 1111 - 1113, 17 November 1984.

While this study cannot be replicated anymore (due to ethical considerations since we cannot randomize a baby to receive formula milk only), the result of the study was significant in that it showed that the less breastmilk the baby receives, the higher the risk of serious illness.

Source: Narayanan et al. Randomised controlled trial of effect of raw and holder pasteurised human milk and of formula supplements on incidence of neonatal infection. The Lancet, Volume 324, Issue 8412, Pages 1111 - 1113, 17 November 1984.

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SLIDE DISCUSSIONWe have said that the most important benefit of breastfeeding is the infants immediate survival. Data on the Philippines has shown the following: read slide

Source: Philippine Situational Analysis 2007, p.11Infant and Young Child Feeding Programme

Review. Case Study: The Philippines. UNICEF New York. June 2009.

It is equally important that breastfeeding be started early, as delays in initiation increase the babys risk of dying.

Source: Mullany LC, et al. Breast-Feeding Patterns, Time to initiation, and mortality risk among newborns in Southern Nepal. J Nutr, 2008; 138(3):599-603.

This study was done in Nepal involving 23,000 breastfed babies. It looked at the risk of infection-related death correlated with the time of initiation of breastfeeding (in hours).

If breastfeeding is started within an hour after birth, the risk of infection-related death is 1. If breastfeeding is started after 1 hour but within the 1st 24 hours, the risk doubles to 2 (ex: mother stays in the RR for a few hours). If breastfeeding is started after 3 days, there is a four-fold increase in the risk of infection-related death (ex: mother allows baby to be roomed-in only when she is for discharge already).

Source: Mullany LC, et al. Breast-Feeding Patterns, Time to initiation, and mortality risk among newborns in Southern Nepal. J Nutr, 2008; 138(3):599-603.

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SLIDE DISCUSSIONIn a study on the effects of breastfeeding on infant mortality in Latin America the authors conclude that artificially-fed infants 0-3 months of age were over 14 times more likely to die of diarrheal disease.

Source: 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.

The same study showed that artificially-fed infants 0-3 months of age were 4 times more likely to die of acute respiratory infections than exclusively breastfed infants. Artificially-fed infants 4-11 months of age were almost 2 times more likely to die of both diarrheal disease and acute respiratory infection than partially breastfed infants.

Source: 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.

It has been recognized that early childhood events, including diet, are likely to be important in the development of both childhood and adult diseases. Although atopic diseases have a clear genetic basis, environmental factors, including early infant nutrition, may have an important influence on their development and, thus, present an opportunity to prevent or delay the onset of the disease. There is evidence that breastfeeding for at least 4 months, compared with feeding formula made with intact cow milk protein, prevents or delays the occurrence of atopic dermatitis, cow milk allergy, and wheezing in early childhood.

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

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SLIDE DISCUSSIONIt has been postulated that the mechanism in the development of type 1 diabetes mellitus is the infants exposure to cow milk -lactoglobulin, which is avoided by breastfeeding. A reduction in the incidence of type 2 diabetes mellitus is reported, possibly reflecting the long-term positive effect of breastfeeding on weight control and feeding self-regulation. There is a reduction in leukemia that is correlated with the duration of breastfeeding. Breastfeeding results in a lower BMI and higher high-density lipoprotein concentration in adults. Also, breastfed infants self-regulate intake volume, and the early programming of self-regulation, in turn, affects adult weight gain.

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

A study in Germany found that among 9357 children aged 5 and 6 there was an over 5 times difference in the prevalence of obesity among those children never breastfed compared to those breastfed for over one year. There was a dose effect with the longer an infant had been breastfed the lower prevalence of obesity at the age of 5 and 6.

Source: von Kries R, Koletzko B, Sauerwald T et al. Breast feeding and obesity: cross sectional study. BMJ, 1999,319:147-150.

Long-chain polyunsaturated fatty acids are present in breastmilk, but not in most brands of formula. These are preferentially incorporated into neural cell membranes; structural lipids constitute about 60% of the human brain. The major lipid components include docosahexaenoic(DHA) and arachidonic (AA) acids, which are important for retinal and cortical brain development. AA and DHA accumulate in the brain and retina most rapidly during the last trimester of pregnancy and the first months after birth. Their reserves are limited at birth, especially in pre-term infants, and decline rapidly when lacking in the diet.

Bottle-fed infants have been shown to have lower long-chain polyunsaturated fatty acids in the phospholipids of the cerebral cortex than infants who are fed breastmilk . This is, therefore, a potential mechanism for an effect of breastfeeding on intellectual development. In addition to the chemical properties of breastmilk, breastfeeding enhances the bonding between mother and child, which may contribute to the childs intellectual development.

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SLIDE DISCUSSION

A meta-analysis done by Anderson showed thatbreastfeeding compared to formula feeding correlated with higher scores for cognitive development, and the benefit was higher among low birth weight infants.

Source: Anderson et al. Breast-feeding and cognitive development: a meta-analysis. Am J Clin Nutr 1999;70:52535

The large, randomized Promotion of Breastfeeding Intervention Trial (PROBIT) provided evidence that adjusted outcomes of intelligence scores and teachers ratings are significantly greater in breastfed infants. Significantly positive effects of human milk feeding on long-term neurodevelopment are observed in preterm infants, the population more at risk for these adverse neuro-developmental outcomes.

Source: Kramer et al. Breastfeeding and Child Cognitive Development :New Evidence From a Large Randomized Trial. Arch Gen Psychiatry. 2008;65(5):578-584

A recent long term study in Copenhagen found that duration of breastfeeding was associated with significantly higher IQ scores at 27.2 years. This study also found a positive dose effect.

Source: Mortensen EL, Michaelsen KF, Sanders SA, Reinisch JM. The association between duration of breastfeeding and adult intelligence. JAMA, 2002, 287: 2365-2371.

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SLIDE DISCUSSIONBoth short- and long-term health benefits are gained by mothers who breastfeed.

The oxytocin released during breastfeeding helps the uterus to return to its previous size and helps to reduce postpartum bleeding.

Prospective cohort studies have noted an increase in postpartum depression in mothers who do not breastfeed or who wean early.

During the first six months after birth, if a woman is amenorrheic and fully breastfeeding her infant, she has about 98% protection against another pregnancy.

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

Several studies have also noted an inverse relationship between the cumulative lifetime duration of breastfeeding and the development of chronic maternal illnesses, with the risks for type 2 DM, rheumatoid arthritis and cardiovascular disease being lowered when the duration of breastfeeding is greater than 24 months compared to 12 months.

Cumulative lactation experience also correlates with a reduction in both breast (primarily premenopausal) and ovarian cancer.

A large prospective study on child abuse and neglect perpetuated by mothers found, after correcting for potential confounders, that the rate of abuse/neglect was significantly increased for mothers who did not breastfeed as opposed to those who did.

Source: AAP. Breastfeeding and the Use of Human Milk, originally published online February 27, 2012 16

SLIDE DISCUSSIONA re-analysis of data from 47 epidemiological studies in 30 countries found that the relative risk of breast cancer decreased by 4.3% for every year of breastfeeding.

Source: 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.

Dangers of artificial feeding: read slide.

Lecturer to emphasize the many risks associated with using feeding bottles, water, formula and pacifiers both in the hospital and later when the mother returns home. Stress the fact that we have the responsibility to communicate both the benefits of breastfeeding and the risks of artificial feeding to all mothers.

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

In summary, overwhelming evidence has shown that exclusive breastfeeding protects infant health and saves newborn lives.

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SLIDE DISCUSSIONWhat then are the important feeding behaviors that can save these infants? Strategies that we should adopt should be those that address the following: read slide.

These practices can prevent over 75% of deaths in early infancy and 37% of deaths in the second year.

There are currently government policies and programs in place that specifically espouse these strategic interventions.

Source: WHO Collaborative Study Team on the role of breastfeeding on the prevention of infant mortality. Effect of breast-feeding on infant and child mortality due to infectious disease in less developed countries: a pooled analysis. Lancet, 2000, 355: 451-455.

Here are the laws and policies that promote exclusive breastfeeding for the first six months.

The Milk Code (Executive Order (E.O). 51) was signed by President Cory Aquino in 1986. A couple of years later the DOH prepared a draft Five Year Plan (1988-1992) for Breast-feeding Promotion in the Philippines and in 1992 the Senate approved the Rooming-in and Breastfeeding Act, which served as the legal basis for the Mother Baby Friendly Hospital Initiative (MBFHI).

Highlights of RA 10028: Lactation Station and breastfeeding break in the workplace IYCF/breastfeeding integration into the curriculum August designated as Breastfeeding Month Encouraged hospitals/health facilities to establish Human Milk Bank

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SLIDE DISCUSSION

After very successful and energetic implementation of the MBFHI in the 1990s, compliance began to slip, for the reasons described earlier. In the early 2000s there was little training or assessment activity. Following adoption of the Global Strategy for IYCF and development of the Philippines National Plan of Action for Infant and Young Child Feeding (IYCF), a retrospective study done indicated that the backsliding was substantial. As a result, new guidelines for implementing MBFHI were prepared, using the newly revised global BFHI materials as a basis. In 2007 an Administrative Order on the Revitalization of MBFHI was issued. Work has begun to retrain staff in all the target hospitals, providing them with Certificates of Commitment while they work to achieve mother friendly criteria and mount other hurdles. Hospitals were given two years, until 2010, to become accredited as mother-baby friendly. UNICEF helped to encourage an innovative agreement with the Philippine Health Insurance Corporation (PhilHealth), which will require that hospitals wanting PhilHealth accreditation (and thus financial support) will first need to be designated mother-baby friendly.

In 2008, the MNCHN Strategy was put forward in AO 0029, to reduce maternal and neonatal mortality rates faster from 2007 to 2015 to meet MDG targetsIn an effort to improve maternal and newborn health in the Philippines, DOH issued an administrative order to implement the Essential Newborn Care (ENC) protocol with the goal of rapidly reducing the number of newborn deaths in the Philippines.

The Revised Policy on Micronutrient Supplementation reviewed and updated the previous policy on targettingand prioritization of micronutrient supplementation, with the aim of contributing to the overall improvement of nutritional status of Filipinos.

The PhilHealth Benchbook laid out basic concepts on the value of quality assurance in health care and how continuous quality improvement is supported by accreditation.

In order to ensure the implementation of R.A. 7600 or The Rooming-in and Breastfeeding Act of 1992, PhilHealth required its accredited hospitals to be Mother-Baby Friendly Hospital.

The latest PhilHealth circular on the newborn and maternity care packages have already incorporated the recommendations of the Essential Intrapartum and Newborn Care protocol to offer incentives to health facilities to provide safe and quality care for mothers and newborns. 19

SLIDE DISCUSSION

The Integrated MNCHN Service Package incorporates the following: Health Financing to increase resources using combined financing strategies from DOH, LGUs plus PhilHealth Health Service Delivery health services and interventions including BEmONC and CEmONC Health Regulation - measures and guidelines for health facilities and health staff Governance for Health mechanisms for efficiency, transparency and accountability and prevent opportunities for fraud.

Under the present administration, we have the Aquino Health Agenda (AHA) which added 2 more components: Human Resources for Health ensure access to professional health care providers Health Information establish a modern information system

The various programs under the MNCHN Strategy all seek to give every mother and every child the right access to healthcare from pregnancy through childbirth, the neonatal period and childhood.Read slide.

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SLIDE DISCUSSIONThe evidence-based set of EINC practices provides safe &quality essential maternal & newborn care for a happy birthing experience.

Health Professionals and health facilities will stop practicing unnecessary medicalized practices and use the DOH/WHO protocol for low-risk, evidence-based intrapartum & newborn care that protects and saves lives.

The 4 Core Steps of EINC are:1. Immediate and Thorough Drying2. Skin-to-Skin Contact3. Properly Timed Cord Clamping4. Non-separation of the Newborn from the Mother for

Early Initiation of Breastfeeding

This diagram shows the key interventions and settings of the IYCF Program:

Strategies:1. Partnerships with NGOs and GOs in the

coordination and implementation of the IYCF Program2. Integration of key IYCF action points in the MNCHN

Plan of Action/Strategy3. Harnessing the executive arm of government to

implement and enforce the IYCF related legislations and regulations (EO 51, RA 7200 and RA 10028)

4. Intensified focused activities to create an environment supportive to IYCF practices

5. Engaging the Private Sector and International Organizations to raise funds for the scaling up and support of the IYCF program

The IYCF Strategic Plan of Action upholds the several guiding principles:1. Children have the right to adequate nutrition and access to safe and nutritious food2. Mothers and Infants form a biological and social unit and improved IYCF begins with ensuring the health and nutritional status of women. 3. Almost every woman can breastfeed provided they have accurate information and support from their families, communities and responsible health and non-health related institutions during critical settings and various circumstances including special and emergency situations.4. The national and local government, development partners, NGOs, business sectors, professional groups, academe and other stakeholders acknowledges their responsibilities and form alliances and partnerships for improving IYCF with no conflict of interest.5. Strengthened communication approaches focusing on behavioral and social change is essential for demand generation and community empowerment.

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SLIDE DISCUSSIONThe IYCF strategy seeks to deliver the following outcomes by 2016. Read slide.

Recognizing the need to strengthen breastfeeding in the country, the DOH has embarked on an exclusive breastfeeding campaign, and this is the Breastfeeding TSEK program.

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SLIDE DISCUSSIONOn February 23, 2011, the Department of Health (DOH) launched the exclusive breastfeeding campaign dubbed Breastfeeding TSEK: (Tama, Sapat, Eksklusibo). The primary target of this campaign is the new and expectant mothers in urban areas. This campaign encourages mothers to exclusively breastfeed their babies from birth up to 6 months. Exclusive breastfeeding means that for the first six months from birth, nothing except breast milk will be given to babies. The campaign also aims to establish a supportive community, as well as to promote public consciousness on the health benefits of breastfeeding.

This joint program aims to complement the national government's efforts to promote infant and young child feeding (IYCF), focusing on the creation of an enabling environment where breastfeeding is protected, promoted, and supported by the community as a whole.

Specifically, the joint program's target outcomes are: Increased exclusive breastfeeding rate by 20% annually in 6 joint programme areas Reduced prevalence of undernutrition among 6-24 months old by 3% in 2011 Improved capacities of the national government, local governments, employers and workers, and other stakeholders to formulate, promote, and implement appropriate policies and programs on IYCF

The Department of Health developed a comprehensive framework for Infant and Young Child Feeding the breastfeeding and complementary feeding national program targets the above mentioned settings and this is a key strategy to ensure the success of the program. Thisdiagram shows the many ways that the LGUs can support the Breastfeeding TSEK Program.

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SLIDE DISCUSSIONWhat needs to be done? The following are the key action steps to integrate Breastfeeding TSEK in the local governement setting. Read slide.

Read slide.

Examples of LGU initiatives in the Breastfeeding TSEK campaign.

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SLIDE DISCUSSIONExamples of LGU initiatives in the Breastfeeding TSEK campaign.

Quezon City was the first to embrace the Breastfeeding Welcome Here program with the launching of its very first breastfeeding station located at the Inner Ground floor of Legislative Building, Quezon City Hall on 13 March 2012. Bacolod Chicken Inasal, New Kamameshi House, Tropical Hut Hamburger, Maxs Restaurant, and SeryeCafe Filipino were the first five restaurants in Quezon City who signed up in the Breastfeeding Welcome Here program in support of Breastfeeding TSEK. QC Vice Mayor Joy Belmonte led the hanging of the decals to let people know that breastfeeding is welcomed in these restaurants.

In Pembo, Makati, a peer counseling intervention was developed to target mothers with infants less than 2 months of age who were not exclusively breastfeeding or had difficulty breastfeeding. This was done to counter widespread misinformation and improve breastfeeding. Results showed the number of exclusively formula-fed infants decreased seven-fold, and mixed-fed infants decreased 37%. Overall, of the 148 nonexclusively breastfeeding infants, 69.5% had changed feeding methods after 3 home visits, 76% of whom to exclusive breastfeeding. Community-based peer counseling was associated with a drastic improvement of exclusive breastfeeding practices. This intervention evolved and became sustainable by engaging political figures, cities, and communities throughout the process.

Source: Salud et al. People's Initiative to Counteract Misinformation and Marketing Practices: The Pembo, Philippines, Breastfeeding Experience, 2006 . J Hum Lact. 25(3):341-349.

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SLIDE DISCUSSIONPeer counselor trainings.

Peer counselors also form the core of the breastfeeding support group at the barangay level. Supportive supervision and mentoring by health staff of the peer counselors will help sustain the commitment. The counselors conduct house-to-house visits and holds regular monthly meetings with midwives to process experiences in actual counseling.

The TSEKlist Card is given to the mothers so that they can present this to the health facility where they will give birth, to ensure that the DOH/WHO protocol is followed. It also tracks the feeding practices of the mother in the first 6 months of the babys life.

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SLIDE DISCUSSIONAdvocacy kits and materials are to be issued by the different collaborating government agencies.

The medical and allied professional societies are strong and active bodies that can be engaged to participate in the development of the monitoring scheme within their ranks and in health facilities. They are a good resource in the development of schemes for MBFHI and related technical matters. Working arrangements/contracts may be forged to seal responsibilities and partnerships. Representatives from the professional societies will constitute the Speakers Bureau which will be organized for the information dissemination/awareness campaign on the Milk Code, the Expanded Breastfeeding Promotion Act and the Policies on IYCF.

The following are strategies that can sustain the Breastfeeding TSEK Program in the community.Read slide.

Health professionals should all make a concerted effort to promote breastfeeding and to ensure that the Milk Code is strictly observed.

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SLIDE DISCUSSIONWe should be aware of misleading campaigns that undermine breastfeeding, and we should educate the public accordingly regarding its benefits.

Educational material is available and examples are as follows.

The campaign recognizes outstanding IYCF champions especially in LGUs.

Having all of these in place will ensure that reduction of child mortality and morbidity can be attained through optimal feeding of infants and young children.

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SLIDE DISCUSSIONThank you.

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