PROGRAMMES AND POLICIES FOR PROMOTION OF BREAST FEEDING IN INDIA

Dr Sugandha JauhariJR-2Upgraded department of Community medicine and public health

PROGRAMMES AND POLICIES PROMOTING BREAST FEEDING

1) GLOBAL STRATEGY ON INFANT AND YOUNG CHILD FEEDING(IYCF)

2) BREAST FRIENDLY HOSPITAL INITIATIVE(BFHI)3) INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD

ILLNESS(IMNCI)4) HOME BASED NEWBORN CARE(HBNC)5) MOTHER’S ABSOLUTE AFFECTION PROGRAMME(MAA)6) INFANT MILK SUBSTITUTES(IMS)ACT7) MATERNITY BENEFIT ACT

1.GLOBAL STRATEGY ON INFANT AND YOUNG CHILDFEEDING (IYCF)

To improve – through optimal feeding – the nutritional status, growth and development, thus the survival of infants and young children

Ensure that the health and other relevant sectors protect, promote and support exclusive breastfeeding for six months and continued breastfeeding up to two years of age or beyond, while providing women access to the support they require

Promote timely, adequate, safe, and appropriate complementary feeding with continued breastfeeding

Provide guidance on feeding infants and young children in exceptionally difficult circumstances

RECOMMENDATIONS ON IYCF(AS PER NHM)

Early initiation of breastfeeding; immediately after birth, preferably within one hour.

Exclusive breastfeeding for the first six months of life i. e 180 days (no other foods or fluids, not even water; but allows infant to receive ORS, drops, syrups of vitamins, minerals and medicines when required).

Timely introduction of complementary foods (solid, semisolid or soft foods) after the age of six months i. e 180 days.

Continued breastfeeding for 2 years or beyond. Age appropriate complementary feeding for children 6-23 months,

while continuing breastfeeding. Active feeding for Children during and after illness.

INTERVENTIONS FOR PROMOTING IYCF PRACTICES IN HEALTH SYSTEMS

Actions to promote infant and young child feeding are grouped at three levels:

(1) at health facilities (2) during community outreach activities and (3) during community and home based care.

HEALTH FACILTY

PRIMARY ROLE KEY PRACTICES

ANTENATAL CLINIC

Medical officer, staff nurse, ASHA, Nutrition or ICTC counsellor

• Counselling for early initiation, exclusive breast feeding and Importance of colostrum during third trimester

• Specific counselling if mother is HIV positivePOST NATAL CLINIC

Doctors, staff nurse,TBA/NSSK trained service provider/s conducting delivery,Nutrition Counsellor

• Ensure initiation of breastfeeding within one hour• avoiding pre lacteal feeds • promoting colostrum feeding, establishment of exclusive

BF • Management of breast conditions• Direct observation by the health service provider

for technique and attachment while breast feeding the infant for first time

OUTPATIENT SERVICES/CONSULTATIONSIMMUNISATION CLINICS

Medical officer, staff nurse, ANM(if available)Nutrition or ICTC counsellor

• Ensure exclusive breastfeeding message and complementary feeding messages are reinforced

• Group counselling on IYCF and nutrition during pregnancy and lactation

INPATIENT SERVICES

Medical officer, staff nurse, counsellor

• Monitoring of lactation and breast conditions• Implementation of IMS Act

SPECIAL NEW BORN CARE UNITS

Medical officer, staff nurse, counsellor

• Counselling on breastfeeding/breast milk feeding of low birth weight and preterm babies

• helping mother for cup feeding the baby

COMMUNITY LEVEL

At Routine Immunisation sessions (RI sessions), held at AWC, SUBCENTRE, PHC’s - Group counselling on age appropriate IYCF practices and maternal and child nutrition.

Dada- Dadi/Nana- Nani Sammelan: In addition to using the platform of VHND, Monthly group counselling sessions can be held at each village by ASHA where she does interpersonal communication regarding Infant Young Child Feeding to secondary care givers who are major influencers in child feeding at home such as grandparents (dada- dadi- paternal grandparents; nana-nani maternal grandparents), father or relatives.

2.BABY FRIENDLY HOSPITAL INITIATIVE(BFHI)

The Baby-friendly Hospital Initiative(BFHI),also known as Baby Friendly Initiative (BFI) was launched by WHO and UNICEF in 1991, following the Innocenti Declaration of 1990. 

The initiative is a global effort for improving the role of maternity services to enable mothers to breastfeed babies for the best start in life.

It provide maternity services for protecting, promoting and supporting breastfeeding, in accordance with the International Code of Marketing of Breastmilk Substitutes.

Step 1. Have a written breastfeeding policy that is routinely communicated to all health care staff

Step 2.Train all health-care staff in skills necessary to implement this policy

Step 3. Inform all pregnant women about the benefits of breastfeeding

Step 4. Help mothers initiate breastfeeding within half-hour of birth.

New interpretation of Step 4 in the revised BFHI Global Criteria (2006):

“Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage mothers to recognize when their babies are ready to breastfeed, offering help if needed.”

Step 5. Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants

Step 6. Give newborn infants no food or drink other than breast milk unless medically indicated

There are rare exceptions during which the infant may require other fluids or food in addition to, or in place of, breast milk. The feeding programme of these babies should be determined by qualified health professionals on an individual basis

Step 7. Practice rooming-in — allow mothers and infants to remain together — 24 hours a day.

Rooming-inA hospital arrangement where a mother/baby pair stay in the same room day and night, allowing unlimited contact between

mother and infant

Step 8.Encourage breastfeeding on demand

Breast feeding on demand:Breast feeding whenever the baby or mother wants, with no restrictions on the length or frequency of feeds.

Step 9. Give no artificial teats or pacifiers (also called dummies and soothers) to breastfeeding infants

ALTERNATIVES TO ARTIFICIAL TEATScupspoondropperSyringe

Step 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

FURTHER STRENGTHENING OF BFHI

Monitoring and reassessing already designated facilities Expanding the Initiative to include clinics, health centre, and

paediatric hospitals Provide support for feeding infants and young children in

exceptionally difficult circumstances:- To adapt the BFHI by taking account of HIV/AIDS By ensuring that those responsible for emergency preparedness are

well trained to support appropriate feeding practices consistent with the Initiative’s universal principles

3.INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS(IMNCI)

IMNCI is an evidence based syndromic approach under NRHM. As per IMNCI, Physicians, health and nutrition workers are trained in

management of sick newborns and children. F-IMNCI is the integration of facility based care package with the IMNCI, to

empower the health personnel with the skill to manage new born and childhood illness at the community level as well as health facility level.

One of the component of IMNCI is Home visits for young infants by health worker in order to Promote & support exclusive breastfeeding

4.HOME BASED NEWBORN CARE (HBNC) The main purpose of HBNC is to improve neonatal survival by

training ASHAs on identified aspects of newborn care. Together with the Janani Suraksha Yojana(JSY) and the Janani

Shishu Suraksha Karyakaram (JSSK), the HBNC ensures that mother and newborn have access to services in order to ensure positive health outcomes.

UNDER HBNC,ASHA SHOULD PERFORM THE FOLLOWING ACTIVITIES FOCUSSING ON BREASTFEEDING:- Supporting exclusive breastfeeding through teaching the mother

proper positioning and attachment for initiating and maintaining breastfeeding

Diagnosing and counselling in cases of problems with breastfeeding

Health Promotion and counselling mothers and families on key messages on newborn care which includes discouraging unhealthy practices such as early bottle feeding

5.MOTHER’S ABSOLUTE AFFECTION PROGRAMME(MAA)

. India’s National Nutrition Policy and the National Plan of

Action on Nutrition clearly articulates the role of health sector in promoting breastfeeding through training of health workers.

Similarly, the National Guidelines on Infant and Young Child Feeding 2006 and the Infant Milk Substitutes: Feeding Bottles, and Infant Foods (Regulation of Production, Supply and Distribution) Act 1992, and Amendment Act 2003 also state the role of health care system in ensuring Optimal Infant and Young Child Feeding Practices.

6.IMPLEMENTATION OF THE IMS ACT (Infant Milk Substitutes, Feeding Bottles and

Infants Foods Act,1992) Provides regulation against commercial influence of baby food

industry on people with a view to protect and promote breastfeeding.

Health care providers must not allow the health systems to be used for promotion of any baby foods or companies manufacturing such foods.

The Act also prohibits any kind of direct or indirect benefit to the manufacturers of baby food companies.

7.MATERNITY BENEFIT ACT,1961

Provides maternity leave for twelve weeks Two breastfeeding breaks, until the child attains the age of fifteen

months Paid maternity leaves on average daily wage for a period of eighty

four days In 2008, the central government adopted the recommendations of

the Sixth Pay Commission and gave a generous allowance of 180 days of maternity leave on full pay and paid Child Care Leave for a period of 2 years

States like Tamil Nadu, Andhra Pradesh, Karnataka is following this