1 Ensuring optimal breastfeeding and complementary feeding Dr Arun Gupta MD FIAP ICMR New Delhi 23 Feb 2011

2 First year is critical! Malnutrition strikes the most in infancy beginning in 3-4 th month, % 6 months. Goes up and peaks by 18 months, flat curve after that (NFHS 3) Years of life Brain development Underweight (-2sd) NFHS-3 Over 60 million 10 lakh children die during first month, 14 lakhs by 1 year, and 20 lakhs by 5 yrs.

3 Neonatal disorders Diarrhoea Pneumonia Source: Robert et al. LANCET 2003;361: Three Major Killers Breastfeeding is the No. 1 preventive intervention compared to any other intervention Lancet Series on child survival, and now on newborn survival : 2003 and 2004 MOSTLY PREVENTABLE

4 Risk of neonatal mortality according to time of initiation of breastfeeding Pediatrics 2006;117: Six times more risk of death Additional benefits

5 U-5 child deaths (%) saved with key interventions in India Lancet Child Survival Series,2003

6 Deaths attributed to sub-optimal breastfeeding among children

7 1st hour initiation cuts 22% of all newborn deaths 100% 40% 10 Lac Neonatal Deaths 2.5 lac If we enhance initiation of BF within one hour 2.5 lac babies will be saved INITIATION OF BREASTFEEDING NEONATAL DEATHS SAVED Pediatrics 2006;117:

8 Long term Impact of BREASTFEEDING Subjects who were breastfed experienced lower mean blood pressure and total cholesterol, as well as higher performance in intelligence tests. Prevalence of overweight/obesity and type-2 diabetes was lower among breastfed subjects. WHO, 2007

9 Exclusive breastfeeding Reduces HIV Transmission Risk(Lancet 2007)

10 State of breastfeeding within one hour of birth (%) by Districts Source: DLHS Fact Sheets ( mis.nic.in/ui/Reports/DLHSIII/dlhs08_release_1.htm#BR) 155 Lacs out of 260 Lacs born DONOT

11 State of exclusive breastfeeding for the first six months by Districts Source: DLHS Fact Sheets ( mis.nic.in/ui/Reports/DLHSIII/dlhs08_release_1.htm#BR) 140 lacs out of 260 lacs born DONOT

12 Districts Level Performance (Number 534-DLHS 2008) Initiation of BF within 1 hour Exclusive breastfeeding RED YELLOW BLUE19449 GREEN50

13 Trends :Initiation of Breastfeeding Within 1 hour Source: NFHS-3, 2006

14 Breastfeeding patterns by age Source: NFHS-3, 2006

15 Challenges in achieving optimal breastfeeding Lack of programmatic focus on exclusive breastfeeding Lack of skilled capacity among the health workers Interference of formula industry in planning process Lack of maternity benefits for all women

16 Seven Strategies Successful Breastfeeding Education and Training Pre/In service School/college Information Data collection Monitoring Protection of Breastfeeding Code implementation Research Programme and policy evaluation Implementation Support Skilled support Work site support Maternity benefits Coordination Budget Policy Promotion Campaigns Social mobilization

17 What Works – BF Counseling ! What Works – BF Counseling ! Meta-analysis on breastfeeding promotion strategies and feeding patterns Haider BA, Bhutta ZA. Lancet Method of Counseling Increase in Odds of EBF Neonatal Period At Six Months Individual counseling 15 studies 3.45 (95%CI ) p< (95% CI1.18 – 3.15) p< Group Counseling 6 studies 3.88 (95% CI ) p< (95% CI ) p<

18 WHO Growth standards Lactation Counseling by well trained counsellors Helping/ assistance with initiation soon after birth Preventing and resolving lactation problems. The first visit by a lactation counsellor within 24 h of delivery Subsequent visits occurred at 7, 14 and 30 d, and monthly thereafter until the sixth month.

19 Compliance with MGRS feeding criteria by site and overall

20 Work at basics !

21 Prolactin Reflex Secretion continues AFTER feed to produce NEXT feed To increase milk production

22 Oxytocin Reflex For milk ejection 3/3

23 Helping and Hindering the Oxytocin Reflex For milk ejection 3/4

24 Training materials that W.H.O. Provided For specialized counsellors 1993 : Breastfeeding counselling : 5 days 2000 : HIV Infant feeding : Addl. 3 days 2003 : Complementary feeding : Addl. 3 days For lay counsellors 2005: Infant and young child feeding : 5 days.

25 ‘3 in 1’ Training Programme

26 What do you want to achieve? Motivation Preventing and solving the problem of ‘not enough milk’ Building confidence Maintenance of exclusive breastfeeding for the first six months Prevention of breast problems like sore nipples, mastitis ( 13% in various studies) Timely and appropriate complementary feeding after six months along with continued breastfeeding

27 MEP..the minimum essential programme of services SPECIALIST COUNSELLOR with 7 day training to deal with BREASTFEEDING, COMPLEMENTARY FEEDING and infant feeding and HIV Nutrition support to mothers, maternity benefits,IGMSY, Family counselor IYCF by a 3 day training, at birth assistance, home visits 4 in 2 weeks, and then every 2 weeks. Family Cluster of 5-10 Block/PHC District level and above, medical colleges. SPECIALIST COUNSELLOR SPECIALIST COUNSELLOR SPECIALIST COUNSELLOR IN ALL PUBLIC AND PRIVATE HOSPS

28 Thanks !