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Breastfeeding and health care services
7
Int. J. Gynecol. Obstet., 1990, 31 (Suppl.1): 7-9 International Federation of Gynecology and Obstetrics
Breastfeeding
and health care services
R. Jolly Deputy Executive Director (Programmes), UNICEF, 3 United Nations Plaza, New York, NY 10017 (USA)
Abstract
Breastfeeding increases
Breastfeeding can help prevent the 38,000 daily deaths of infants and young children through its nutritional, immunologic, and sanitary aspects. Nevertheless, it is on the decline in most countries. The World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) have combined to issue guidelines on the role of maternity services in promoting breastfeeding, such as, a hospital breastfeeding policy with roomingin, demand-feeding, and the elimination of bottles and breast milk substitutes. These practices have succeeded in programs around the world and have increased the breastfeeding rate at the same time that infection rates decreased.
However, have we paused to consider why breastfeeding has increased in the most developed countries (USA, Norway, Sweden, Canada, Australia, and New Zealand) in the last 20-30 years? This increase comes despite generally unsupportive hospital environments, the availability of clean water and the fact that breastfeeding was virtually a lost art in these countries 40 years ago. A similar trend has been noted among middle and upper class women in Brazil and Malaysia. An increased awareness of the benefits some of which are outlined below - coupled with mother-to-mother support are most likely to have influenced this increase. Breastfeeding benefits
Introduction Thirty-eight thousand infants and young children continue to die daily, mostly of malnutrition and repeated infections. Two-thirds die before their first birthday. Diarrhea and diarrhea-related complications remain the biggest killer of these children. We are all aware of the evidence continuously accumulating which shows the critical importance of breast milk and breastfeeding in the health and survival of infants and young children everywhere. Yet the practice is threatened, particularly in countries that need it most. The recent UNICEF exercise of reviewing our country program annual reports reveals a decline in the duration of exclusive breastfeeding in country after country. 0020-7292/90/$03.50 0 1990 International Federation of Gynecology and Obstetrics Published and Printed in Ireland
Numerous studies have demonstrated that breast milk is best, not just because the alternative could be unsafe to use or that breast milk is cheaper, but that it is a unique product include enhancing the whose qualities immune system of the infant, protecting against cancer and allergies, and contributing to brain development. When we add to this list the psychological benefits of breastfeeding itself, it becomes almost unforgivable not to take positive steps toward reversing the decline in breastfeeding. I make the distinction between breast milk and breastfeeding because we often preoccupy ourselves with the difficulties in changing infant feeding practices. We consider overcoming the obstacles too costly (such as maternity benefits and training of health Health carepracticesrelated to breastfeeding
workers) and too time-consuming (such as counseling of mothers) and thereby accept too readily the status quo. Let me remind you of the hazards of not breastfeeding in societies where clean water is not readily available and families lack the finances or facilities to sterilize bottles or buy adequate quantities of formula. In such situations, non-breastfeeding in the first 6 months can increase the risk of an infant’s being hospitalized for diarrhea 25-45 times that of an exclusively breastfed infant, as has been shown in Iraq and other countries. This finding is reported by the World Health Organization in its 1986-1987 report of the global Control of Diarrhoeal Diseases Program. Breastfeeding also has benefits for child spacing. In a recent high level meeting of experts in which UNICEF participated, consensus was reached that, in the first 6 months after birth, full breastfeeding coupled with amenorrhea can provide up to 98% protection against pregnancy. WHO/UNICEF
breastfeeding guidelines
In June, 1986, when UNICEF and WHO held a consultation on infant feeding, it was agreed that we know enough about lactation and breastfeeding not only to advocate improved health care practices, but also to work for widescale application of a minimum set of standards that will ensure successful initiation and maintenance of breastfeeding. It is therefore with great pleasure that I present to you guidelines for health care practices and breastfeeding which WHO and UNICEF have been developing over the last 2 years. The guidelines are in the form of a joint WHO/UNICEF statement entitled, Protection, Promotion, and Support of Breastfeeding: The Special Role of Maternity Services (see p. 171). The guidelines seek to put into practice specific recommendations agreed upon by pediatricians, obstetrician and gynecologists, nutritionists, nurses, midwives, and other health care providers in national and international forums. Int J Gynecol Obstet 31 (Suppl I)
These are the main points: - Every facility providing maternity services should develop a policy on breastfeeding, communicate it to all staff, define specific practices to implement the policy, and ensure that all staff are adequately trained in the skills necessary to ensure implement the policy. - Facilities for 24-h rooming-in, initiation of breastfeeding immediately after delivery, and demand-feeding are essential in every maternity ward. - Every pregnant mother should be fully informed about how breast milk is formed, the proper way to nurse a child, and the benefits of breastfeeding. - Harmful practices such as the use of bottles and teats for newborn infants and the use of milk substitutes, milk, water, and other fluids should be eliminated during this early period, and exclusive breastfeeding maintained for at least 4-6 months from birth. The above activities, when fully implemented, will ensure that every mother/infant couple reached prenatally, at birth, and postnatally gets off to a good start. Other support services will then be more effective toward attaining the goal that all mothers breastfeed exclusively for the first 4-6 months and continue, with adequate complementary foods, for up to 2 years or longer. These practices can succeed These standards have been successful in the field and have had a positive impact on the rates of breastfeeding, as well as on the health of infants. We are confident that what we are stating as policy is indeed programmable and can be institutionalized. For example: - In the Philippines, the Dr. Jose Fabella Memorial Hospital was able to change the practice of using prelacteal feeds from 100% to 0 in just 6 months after retraining all staff. - In Kenya, the largest maternity hospital, with 26,000 deliveries per year, no longer uses bottles, even for low birth weight infants.
Breastfeeding and health care services
- In India, the Indian Medical Association has recently communicated to all its members promote and protect the need to breastfeeding within their practices. - In Costa Rica, as a result of rooming-in and early mother-infant interaction, breastfeeding in the San Juan de Dios Hospital became universal. The number of cases of neonatal diarrhea decreased by nearly lOO%, from 18 per 1000 live births, to 0.1 per 1000 in only 4 years. The challenge before all of us is how to move this state of affairs from being a matter of innovative approaches scattered here and there to being the norm for every hospital rather than the exception. Let us not preoccupy ourselves with what has not been done - or what has gone wrong. Rather let us develop a forward-looking strategy on how each one of us can make a change. Ultimately, what counts is whether or not parents that we encounter are assisted to learn the facts and to take the action that is best for their infant. Although the number of couples we reach through maternity services may be small, those parents in turn can carry a message of new ideas on the best way to nurture an infant. Their actions will speak for themselves.
9
The future There is a need for collaboration and an interdisciplinary approach for the promotion, protection, and support of breastfeeding. We hope this workshop is the first of a series of technical consultations that should lead to agreed, comprehensive strategies. We have not ignored the fact that there is a wider spectrum of infant and young child nutrition issues as well as the well-being of society as a whole. These issues will be and, indeed, are being addressed in other forums. Our concerns are indeed part of a wider set of initiatives towards the goal of the virtual elimination of serious malnutrition by the year 2000, which should be a key part of the human goals of the fourth development decade. We cannot, for example, ignore the fact that in the times of economic hardship that many countries in Africa and the America are experiencing, and which contribute to malnutrition, breast milk remains an extremely valuable resource that must not be allowed to disappear. All participants should work not only towards a set of recommendations, but to develop a strategy that we can, together, extend to health care facilities everywhere, and in this way encourage the return of breastfeeding as a normal practice.
Health care practices related to breastfeeding
Int. J. Gynecol. Obstet., 1990, 31 (Suppl.1): 7-9 International Federation of Gynecology and Obstetrics
Breastfeeding
and health care services
R. Jolly Deputy Executive Director (Programmes), UNICEF, 3 United Nations Plaza, New York, NY 10017 (USA)
Abstract
Breastfeeding increases
Breastfeeding can help prevent the 38,000 daily deaths of infants and young children through its nutritional, immunologic, and sanitary aspects. Nevertheless, it is on the decline in most countries. The World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) have combined to issue guidelines on the role of maternity services in promoting breastfeeding, such as, a hospital breastfeeding policy with roomingin, demand-feeding, and the elimination of bottles and breast milk substitutes. These practices have succeeded in programs around the world and have increased the breastfeeding rate at the same time that infection rates decreased.
However, have we paused to consider why breastfeeding has increased in the most developed countries (USA, Norway, Sweden, Canada, Australia, and New Zealand) in the last 20-30 years? This increase comes despite generally unsupportive hospital environments, the availability of clean water and the fact that breastfeeding was virtually a lost art in these countries 40 years ago. A similar trend has been noted among middle and upper class women in Brazil and Malaysia. An increased awareness of the benefits some of which are outlined below - coupled with mother-to-mother support are most likely to have influenced this increase. Breastfeeding benefits
Introduction Thirty-eight thousand infants and young children continue to die daily, mostly of malnutrition and repeated infections. Two-thirds die before their first birthday. Diarrhea and diarrhea-related complications remain the biggest killer of these children. We are all aware of the evidence continuously accumulating which shows the critical importance of breast milk and breastfeeding in the health and survival of infants and young children everywhere. Yet the practice is threatened, particularly in countries that need it most. The recent UNICEF exercise of reviewing our country program annual reports reveals a decline in the duration of exclusive breastfeeding in country after country. 0020-7292/90/$03.50 0 1990 International Federation of Gynecology and Obstetrics Published and Printed in Ireland
Numerous studies have demonstrated that breast milk is best, not just because the alternative could be unsafe to use or that breast milk is cheaper, but that it is a unique product include enhancing the whose qualities immune system of the infant, protecting against cancer and allergies, and contributing to brain development. When we add to this list the psychological benefits of breastfeeding itself, it becomes almost unforgivable not to take positive steps toward reversing the decline in breastfeeding. I make the distinction between breast milk and breastfeeding because we often preoccupy ourselves with the difficulties in changing infant feeding practices. We consider overcoming the obstacles too costly (such as maternity benefits and training of health Health carepracticesrelated to breastfeeding
workers) and too time-consuming (such as counseling of mothers) and thereby accept too readily the status quo. Let me remind you of the hazards of not breastfeeding in societies where clean water is not readily available and families lack the finances or facilities to sterilize bottles or buy adequate quantities of formula. In such situations, non-breastfeeding in the first 6 months can increase the risk of an infant’s being hospitalized for diarrhea 25-45 times that of an exclusively breastfed infant, as has been shown in Iraq and other countries. This finding is reported by the World Health Organization in its 1986-1987 report of the global Control of Diarrhoeal Diseases Program. Breastfeeding also has benefits for child spacing. In a recent high level meeting of experts in which UNICEF participated, consensus was reached that, in the first 6 months after birth, full breastfeeding coupled with amenorrhea can provide up to 98% protection against pregnancy. WHO/UNICEF
breastfeeding guidelines
In June, 1986, when UNICEF and WHO held a consultation on infant feeding, it was agreed that we know enough about lactation and breastfeeding not only to advocate improved health care practices, but also to work for widescale application of a minimum set of standards that will ensure successful initiation and maintenance of breastfeeding. It is therefore with great pleasure that I present to you guidelines for health care practices and breastfeeding which WHO and UNICEF have been developing over the last 2 years. The guidelines are in the form of a joint WHO/UNICEF statement entitled, Protection, Promotion, and Support of Breastfeeding: The Special Role of Maternity Services (see p. 171). The guidelines seek to put into practice specific recommendations agreed upon by pediatricians, obstetrician and gynecologists, nutritionists, nurses, midwives, and other health care providers in national and international forums. Int J Gynecol Obstet 31 (Suppl I)
These are the main points: - Every facility providing maternity services should develop a policy on breastfeeding, communicate it to all staff, define specific practices to implement the policy, and ensure that all staff are adequately trained in the skills necessary to ensure implement the policy. - Facilities for 24-h rooming-in, initiation of breastfeeding immediately after delivery, and demand-feeding are essential in every maternity ward. - Every pregnant mother should be fully informed about how breast milk is formed, the proper way to nurse a child, and the benefits of breastfeeding. - Harmful practices such as the use of bottles and teats for newborn infants and the use of milk substitutes, milk, water, and other fluids should be eliminated during this early period, and exclusive breastfeeding maintained for at least 4-6 months from birth. The above activities, when fully implemented, will ensure that every mother/infant couple reached prenatally, at birth, and postnatally gets off to a good start. Other support services will then be more effective toward attaining the goal that all mothers breastfeed exclusively for the first 4-6 months and continue, with adequate complementary foods, for up to 2 years or longer. These practices can succeed These standards have been successful in the field and have had a positive impact on the rates of breastfeeding, as well as on the health of infants. We are confident that what we are stating as policy is indeed programmable and can be institutionalized. For example: - In the Philippines, the Dr. Jose Fabella Memorial Hospital was able to change the practice of using prelacteal feeds from 100% to 0 in just 6 months after retraining all staff. - In Kenya, the largest maternity hospital, with 26,000 deliveries per year, no longer uses bottles, even for low birth weight infants.
Breastfeeding and health care services
- In India, the Indian Medical Association has recently communicated to all its members promote and protect the need to breastfeeding within their practices. - In Costa Rica, as a result of rooming-in and early mother-infant interaction, breastfeeding in the San Juan de Dios Hospital became universal. The number of cases of neonatal diarrhea decreased by nearly lOO%, from 18 per 1000 live births, to 0.1 per 1000 in only 4 years. The challenge before all of us is how to move this state of affairs from being a matter of innovative approaches scattered here and there to being the norm for every hospital rather than the exception. Let us not preoccupy ourselves with what has not been done - or what has gone wrong. Rather let us develop a forward-looking strategy on how each one of us can make a change. Ultimately, what counts is whether or not parents that we encounter are assisted to learn the facts and to take the action that is best for their infant. Although the number of couples we reach through maternity services may be small, those parents in turn can carry a message of new ideas on the best way to nurture an infant. Their actions will speak for themselves.
9
The future There is a need for collaboration and an interdisciplinary approach for the promotion, protection, and support of breastfeeding. We hope this workshop is the first of a series of technical consultations that should lead to agreed, comprehensive strategies. We have not ignored the fact that there is a wider spectrum of infant and young child nutrition issues as well as the well-being of society as a whole. These issues will be and, indeed, are being addressed in other forums. Our concerns are indeed part of a wider set of initiatives towards the goal of the virtual elimination of serious malnutrition by the year 2000, which should be a key part of the human goals of the fourth development decade. We cannot, for example, ignore the fact that in the times of economic hardship that many countries in Africa and the America are experiencing, and which contribute to malnutrition, breast milk remains an extremely valuable resource that must not be allowed to disappear. All participants should work not only towards a set of recommendations, but to develop a strategy that we can, together, extend to health care facilities everywhere, and in this way encourage the return of breastfeeding as a normal practice.
Health care practices related to breastfeeding