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IPA, ICM, and FIGO joint statement on breastfeeding, including breastfeeding by HIV-infected mothers
International Journal of Gynecology and Obstetrics 114 (2011) 89–90
Contents lists available at ScienceDirect
International Journal of Gynecology and Obstetrics j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / i j g o
FIGO GUIDELINES
IPA, ICM, and FIGO joint statement on breastfeeding, including breastfeeding by HIV-infected mothers FIGO Committee for Safe Motherhood and Newborn Health This joint statement was developed by the FIGO Committee for Safe Motherhood and Newborn Health and endorsed by IPA and ICM. It was approved by the FIGO Executive Board in June 2010. The International Pediatric Association (IPA), the International Confederation of Midwives (ICM), and the International Federation of Gynecology and Obstetrics (FIGO) recommend—in line with WHO— exclusive breastfeeding during the first 6 months of life and continued breastfeeding for up to 2 years and beyond, with appropriate food complements. IPA/ICM/FIGO strongly oppose any coercion or pressures put on women either to breastfeed or to abstain from breastfeeding. Individual human rights have always been to respect the woman's decision while supporting and implementing evidence-based recommendations. IPA/ICM/FIGO strongly support the WHO statement on exclusive breastfeeding and further support the following WHO recommendations: • Breastfeeding should begin within an hour of birth. • Breastfeeding should be "on demand," as often as the child wants, day and night. • Bottles should be avoided. • Early pacifier use has not been linked by good evidence to early weaning but some authorities recommend that early pacifier use be avoided [1,2]. These strong recommendations are supported by several reviews that indicate the positive effects of breastfeeding, including the reduced risk of common childhood illnesses such as diarrhoea and pneumonia—the 2 primary causes of child mortality worldwide. Breast milk is readily available and affordable, which helps to ensure that infants get adequate nutrition [3–5]. In addition, there are long-term benefits for both mothers and their infants. Mothers have a reduced risk of breast cancer, ovarian cancer, and obesity. Moreover, lactational amenorrhea can act as a natural birth control method. The long-term effects for the infant include lower rates of overweight, obesity, and type 2 diabetes [3–5].
who are exclusively breastfed is also determined by sociocultural factors and country policies. The WHO Commission on Social Determinants of Health alerts us to pay greater attention to the factors that shape living conditions, behavior, and therewith health. On the basis of this, IPA/ICM/FIGO promote and support health policies to encourage breastfeeding and to protect mothers and their newborns. IPA/ICM/FIGO: • Emphasize the need to lobby for adherence to the international code to regulate the marketing of breast-milk substitutes [6], which was adopted in 1981 and includes calls for: o All formula labels and information to state the benefits of breastfeeding and the health risks of substitutes. o No promotion of breast-milk substitutes to the general public, or marketed directly or indirectly to pregnant women or to mothers of infants or young children. o No free samples of substitutes to be given to pregnant women, mothers, or their families. o No distribution of free or subsidized substitutes to health workers or facilities. • Commit to act appropriately to articles in the media that give incorrect information on breastfeeding and its health benefits. • Encourage societies to create a positive attitude toward breastfeeding in public places to support mothers. • Will support the adoption of work policies that enable mothers to exclusively breastfeed their infants in line with WHO recommendations. For example: o Country adherence to maternity leave policies to support women for a sufficient period after birth so that they can establish and continue breastfeeding. Currently, WHO recommends a period of at least 16 weeks after delivery to rest and breastfeed [4]. o Time and adequate place at work to breastfeed or express/store milk safely—to support mothers to continue to breastfeed their children. Breastfeeding under special conditions such as HIV infection of the mother
Action on the social determinants of breastfeeding IPA/ICM/FIGO recognize that breastfeeding practices are, to a large extent, determined by the circumstances in which the child is born and raised. Globally, less than 40% of infants younger than 6 months are exclusively breastfed. The gap is wide and ranges from 78% of 3-month-old children being exclusively breastfed in Sweden to less than 20% in many Sub-Saharan countries. The proportion of children
In light of the changing evidence on transmission risks and recommendations on the use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants, we welcome the new recommendations on HIV and infant feeding [7,8]: 1. Balancing HIV protection with protection from other causes of child mortality.
0020-7292/$ – see front matter © 2011 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics. doi:10.1016/j.ijgo.2011.05.001
90
International Journal of Gynecology and Obstetrics 114 (2011) 89–90
2. Integrating HIV interventions into maternal and child health services. 3. Setting national or subnational recommendations, based on evidence, for infant feeding in the context of HIV. 4. Informing mothers known to be HIV infected about infant-feeding alternatives. 5. Supporting mothers known to be HIV infected who wish to breastfeed so that they can do so safely. 6. Providing services to specifically support mothers to appropriately feed their infants. 7. Avoiding harm to infant-feeding practices in the general population. 8. Advising mothers who are HIV uninfected or whose HIV status is unknown. 9. Investing in improvements in infant-feeding practices in the context of HIV. IPA/ICM/FIGO welcome the recommendation that mothers known to be HIV infected should exclusively breastfeed their infants for the first 6 months of life, introducing appropriate complementary food thereafter, and continue breastfeeding for the first 12 months of life. Bottle feeding should be considered the best alternative only when specific conditions are met. The conditions under which bottle feeding is preferred are commonly referred to as AFASS—affordable, feasible, acceptable, sustainable, and safe—and are more specifically described in the new WHO recommendations.
IPA/ICM/FIGO will support the timely implementation of all new recommendations available from WHO for treating pregnant women or newborns to protect their health and to enable HIV-free survival [9]. References [1] O'Connor NR, Tanabe KO, Siadaty MS, Hauck FR. Pacifiers and breastfeeding: a systematic review. Arch Pediatr Adolesc Med 2009;163(4):378–82. [2] Hauck FR, Omojokun OO, Siadaty MS. Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics 2005;116(5):e716–23. [3] World Health Organization. 10 facts on breastfeeding. http://www.who.int/ features/factfiles/breastfeeding/en/. Published July 2009. [4] Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev 2002(1):CD003517. [5] Hoddinott P, Tappin D, Wright C. Breast feeding. BMJ 2008;336(7649):881–7. [6] World Health Organization. International Code of Marketing of Breast-milk Substitutes. http://whqlibdoc.who.int/publications/9241541601.pdf. Published 1981. [7] World Health Organization, Joint United Nations Programme on HIV/AIDS, United Nations Population Fund, United Nations Children's Fund. Guidelines on HIV and infant feeding 2010. Principles and recommendations for infant feeding in the context of HIV and a summary of evidence. http://whqlibdoc.who.int/publications/ 2010/9789241599535_eng.pdf. Published 2010. [8] World Health Organization. Rapid advice: use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants. http://whqlibdoc.who. int/publications/2009/9789241598934_eng.pdf. Published November 2009. Updated June 2010. [9] World Health Organization. PMTCT strategic vision 2010–2015. Preventing mother-to-child transmission of HIV to reach the UNGASS and Millennium Development Goals. http://www.who.int/hiv/pub/mtct/strategic_vision.pdf. Published 2 February 2010.
Contents lists available at ScienceDirect
International Journal of Gynecology and Obstetrics j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / i j g o
FIGO GUIDELINES
IPA, ICM, and FIGO joint statement on breastfeeding, including breastfeeding by HIV-infected mothers FIGO Committee for Safe Motherhood and Newborn Health This joint statement was developed by the FIGO Committee for Safe Motherhood and Newborn Health and endorsed by IPA and ICM. It was approved by the FIGO Executive Board in June 2010. The International Pediatric Association (IPA), the International Confederation of Midwives (ICM), and the International Federation of Gynecology and Obstetrics (FIGO) recommend—in line with WHO— exclusive breastfeeding during the first 6 months of life and continued breastfeeding for up to 2 years and beyond, with appropriate food complements. IPA/ICM/FIGO strongly oppose any coercion or pressures put on women either to breastfeed or to abstain from breastfeeding. Individual human rights have always been to respect the woman's decision while supporting and implementing evidence-based recommendations. IPA/ICM/FIGO strongly support the WHO statement on exclusive breastfeeding and further support the following WHO recommendations: • Breastfeeding should begin within an hour of birth. • Breastfeeding should be "on demand," as often as the child wants, day and night. • Bottles should be avoided. • Early pacifier use has not been linked by good evidence to early weaning but some authorities recommend that early pacifier use be avoided [1,2]. These strong recommendations are supported by several reviews that indicate the positive effects of breastfeeding, including the reduced risk of common childhood illnesses such as diarrhoea and pneumonia—the 2 primary causes of child mortality worldwide. Breast milk is readily available and affordable, which helps to ensure that infants get adequate nutrition [3–5]. In addition, there are long-term benefits for both mothers and their infants. Mothers have a reduced risk of breast cancer, ovarian cancer, and obesity. Moreover, lactational amenorrhea can act as a natural birth control method. The long-term effects for the infant include lower rates of overweight, obesity, and type 2 diabetes [3–5].
who are exclusively breastfed is also determined by sociocultural factors and country policies. The WHO Commission on Social Determinants of Health alerts us to pay greater attention to the factors that shape living conditions, behavior, and therewith health. On the basis of this, IPA/ICM/FIGO promote and support health policies to encourage breastfeeding and to protect mothers and their newborns. IPA/ICM/FIGO: • Emphasize the need to lobby for adherence to the international code to regulate the marketing of breast-milk substitutes [6], which was adopted in 1981 and includes calls for: o All formula labels and information to state the benefits of breastfeeding and the health risks of substitutes. o No promotion of breast-milk substitutes to the general public, or marketed directly or indirectly to pregnant women or to mothers of infants or young children. o No free samples of substitutes to be given to pregnant women, mothers, or their families. o No distribution of free or subsidized substitutes to health workers or facilities. • Commit to act appropriately to articles in the media that give incorrect information on breastfeeding and its health benefits. • Encourage societies to create a positive attitude toward breastfeeding in public places to support mothers. • Will support the adoption of work policies that enable mothers to exclusively breastfeed their infants in line with WHO recommendations. For example: o Country adherence to maternity leave policies to support women for a sufficient period after birth so that they can establish and continue breastfeeding. Currently, WHO recommends a period of at least 16 weeks after delivery to rest and breastfeed [4]. o Time and adequate place at work to breastfeed or express/store milk safely—to support mothers to continue to breastfeed their children. Breastfeeding under special conditions such as HIV infection of the mother
Action on the social determinants of breastfeeding IPA/ICM/FIGO recognize that breastfeeding practices are, to a large extent, determined by the circumstances in which the child is born and raised. Globally, less than 40% of infants younger than 6 months are exclusively breastfed. The gap is wide and ranges from 78% of 3-month-old children being exclusively breastfed in Sweden to less than 20% in many Sub-Saharan countries. The proportion of children
In light of the changing evidence on transmission risks and recommendations on the use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants, we welcome the new recommendations on HIV and infant feeding [7,8]: 1. Balancing HIV protection with protection from other causes of child mortality.
0020-7292/$ – see front matter © 2011 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics. doi:10.1016/j.ijgo.2011.05.001
90
International Journal of Gynecology and Obstetrics 114 (2011) 89–90
2. Integrating HIV interventions into maternal and child health services. 3. Setting national or subnational recommendations, based on evidence, for infant feeding in the context of HIV. 4. Informing mothers known to be HIV infected about infant-feeding alternatives. 5. Supporting mothers known to be HIV infected who wish to breastfeed so that they can do so safely. 6. Providing services to specifically support mothers to appropriately feed their infants. 7. Avoiding harm to infant-feeding practices in the general population. 8. Advising mothers who are HIV uninfected or whose HIV status is unknown. 9. Investing in improvements in infant-feeding practices in the context of HIV. IPA/ICM/FIGO welcome the recommendation that mothers known to be HIV infected should exclusively breastfeed their infants for the first 6 months of life, introducing appropriate complementary food thereafter, and continue breastfeeding for the first 12 months of life. Bottle feeding should be considered the best alternative only when specific conditions are met. The conditions under which bottle feeding is preferred are commonly referred to as AFASS—affordable, feasible, acceptable, sustainable, and safe—and are more specifically described in the new WHO recommendations.
IPA/ICM/FIGO will support the timely implementation of all new recommendations available from WHO for treating pregnant women or newborns to protect their health and to enable HIV-free survival [9]. References [1] O'Connor NR, Tanabe KO, Siadaty MS, Hauck FR. Pacifiers and breastfeeding: a systematic review. Arch Pediatr Adolesc Med 2009;163(4):378–82. [2] Hauck FR, Omojokun OO, Siadaty MS. Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics 2005;116(5):e716–23. [3] World Health Organization. 10 facts on breastfeeding. http://www.who.int/ features/factfiles/breastfeeding/en/. Published July 2009. [4] Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev 2002(1):CD003517. [5] Hoddinott P, Tappin D, Wright C. Breast feeding. BMJ 2008;336(7649):881–7. [6] World Health Organization. International Code of Marketing of Breast-milk Substitutes. http://whqlibdoc.who.int/publications/9241541601.pdf. Published 1981. [7] World Health Organization, Joint United Nations Programme on HIV/AIDS, United Nations Population Fund, United Nations Children's Fund. Guidelines on HIV and infant feeding 2010. Principles and recommendations for infant feeding in the context of HIV and a summary of evidence. http://whqlibdoc.who.int/publications/ 2010/9789241599535_eng.pdf. Published 2010. [8] World Health Organization. Rapid advice: use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants. http://whqlibdoc.who. int/publications/2009/9789241598934_eng.pdf. Published November 2009. Updated June 2010. [9] World Health Organization. PMTCT strategic vision 2010–2015. Preventing mother-to-child transmission of HIV to reach the UNGASS and Millennium Development Goals. http://www.who.int/hiv/pub/mtct/strategic_vision.pdf. Published 2 February 2010.