1. Breastfeeding : Challenges and Opportunities Arun Gupta MD FIAP 2nd National Conference on Breastfeeding and Complementary Feeding (Infant and young Child feeding) DHAKA BANGLADESH 19 August 2006

2. Introduction List some challenges and opportunities Explain how do we convert challenges to opportunities, Growing HIV and prevention of infant HIV as a case for scaling exclusive breastfeeding

3. List MDG 4 achievement HIV High level attention for declaring “breastfeeding education” a public health priority Scaling to 90% early and exclusive breastfeeding Scaling up ORT and Newborn care to 100%

4. MDG 4 The targets of the 1990 Innocenti Declaration and the 2002 Global Strategy for Infant and Young Child Feeding remain the foundation for action. While remarkable progress has been made, much more needs to be done.

5. Challenges Remain ! Shift emphasis from Curative to preventive services Support women employed outside the home, including in the non-formal sector.

6. Prevent infant HIV Look at your PMTCT programmes see how this is addressed: Informed choice on infant feeding How many women get a test and how many who are positive choose Replacement feeding? Are they supported to avoid mixed feeding, challenge is to achieve exclusivity of both either breastfeeding or artificial feeding Aim at HIV free child survival Build populations and communities with high rates of exclusive breastfeeding

7. Exclusive breastfeeding Prevents HIV in infants Early Exclusive Breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. AIDS 2005 19:699-708 Most mothers are either negative or not tested, better prevent transmission as well as ensure HIV free child survival

8. High level attention for declaring “breastfeeding education” a CORE public health priority Lack of adequate understanding with policy makers and programme managers, economists Need serious dialogue and education using breastfeeding education as a prevention ORT as treatment intervention for diarrhea, still the major cause of infant mortality Need to accelerate infant mortality reduction for reaching goals of U-5 child mortality Discuss to dissect 0-12 month period and 13-60 month period of under five mortality and wise allocation of resources. Are we truly using 75% of child health and nutrition resources during first year, analyse and present.

9. Contd: Continuum of care : 4 th stage of labour Acceleration of reduction of infant and neonatal mortality

10. Growing numbers of underweight children and obesity If we reduce infant mortality rate(IMR) by other means and don’t prevent child malnutrition, we will end up having more underdeveloped children and later adults, thus the society as whole

11. Childhood Obesity Global epidemic, alarming increase of prevalence & severity Severe psychosocial & health burdens, huge costs, difficult to treat Primary prevention greatly needed, breastfeeding is the answer other than changing children's’ life style Koletzko B, Chen W, Dietz W, et al. Obesity in children and adolescents world-wide: current views and future directions. JPGN 2002 (August)

12. U-5 child deaths (%) saved with preventive and treatment interventions UNIVERSAL COVERAGE IS THE ANSWER

13. Breastfeeding reduces later risk for overweight and obesity by ≈20-50 %

14. Scaling to 90% early and exclusive breastfeeding Serious Action is needed at ALL levels Call upon your governments to commit financial resources for implementing the Call for Action One to one counselling

15. Scaling up ORT and Newborn care to 100% Link breastfeeding education to these two interventions effectively Given the current trend we ignore breastfeeding the most since it is not delivered like vaccines. Both have a good potential but we end up treating diarrhea that too does not have a wide reach Newborn care like warmth and exclusive breastfeeding need more emphasis.

16. Otherwise ? What’s that …….exclusive breastfeeding ? What’s that….. ORS? Will remain as questions only !

17. Thanks !