who bfi global perspective handout · 2019. 7. 29. · “the 1,000 days between a woman’s...

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BFI ONTARIO EXPO 2015BFI UPDATE

Marianne Brophy ©All rights reserved

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WHO/ UNICEF International: Global Initiatives, Action Plans, Guidelines, Monitoring

International and national implementation overview

BFI implementation – what works?

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BFI Update: Objectives

“The 1,000 days between a woman’s pregnancy and her child’s 2nd birthday offer a unique window of opportunity

to shape healthier & more prosperous futures.

The right nutrition during this 1,000 day window can have a profound impact on a child’s ability

to grow, learn, and rise out of poverty.

It can also shape a society’s long-term health, stability and prosperity.”

http://www.thousanddays.org/about

INFANT FEEDING

Key Facts: Children < 5years Every infant/ child has the right to good nutrition

Undernutrition associated with 45% child deaths

Globally in 2012: Stunted: 162 M & Wasting: 51M

Overweight or obese: 44M

Exclusive breastfeeding 0 – 6m: 38%

Comp foods 6‐23m: 33% ‐ dietary diversity/ frequency

Preventable deaths pa <5y ‐ optimal bf 0‐23m: save 800Khttp://www.who.int/mediacentre/factsheets/fs342/en/

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WHO: Infant and young child feedingFact sheet N°342: Updated Feb 2014

Breastfeeding is very important

Canada 26%

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WHO update on global developments for

GSIYCF & BFHI8th BFHI Country Coordinator’s Network

1. Global Action Plans

2. Global Initiatives

3. Global Guidelines

4. Implementing and Monitoring

Marcus Stahlhofer, Technical OfficerMaternal, Newborn, Child and Adolescent Health

Nutrition for Health and DevelopmentGeneva, Switzerland 6

WHO Actions re Breastfeeding1981 The Code

1990 UN Convention on the Rights of the Child

1991 Innocenti Declaration on the Protection, Promotion and Support of Bf: 1990-2005

Baby-Friendly Hospital Initiative

2000 Millennium Development Declaration

2001 Exclusive bf 0-6m

2002 Global Strategy on Infant and Young Child Feeding

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WHO 2010-2015 Global Strategy for W’s &C’s Health

2010 JuneHalifax G8

Muskoka Initiative$2.85 billion from 2010 to 2015

2010 SeptMDG Summit

Every Woman Every Child Initiative

2014 May67th WHA

Every Newborn Action Plan to end preventable deaths

2014 May Saving Every Woman, Every Child: Within Arm’s Reach$3.5 billion from 2015-2020 (MDG’s)

2014 Sep Global Financing Facility for scaling up health services$200M of the $3.5B

2014 Nov 5th Every Woman, Every Child Accountability Meeting2015 Sept2016-2030

Global Strat. for W, C’s & Adolescent Health

Childhood Stunting<5y: ↓ 40%

Anemia: ↓ 50% - childbearing women

Low birth weight: ↓ 30%

Childhood overweight: ↑0%

Excl. bf. to 6m rate: ↑to 50%

Childhood wasting: ↓/maintain <5%

Targets endorsed by WHA 2012: by 2025

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GSIYCF –BFI

CODE

Conflict of Interest

Capacity 10

http://www.who.int/nutrition/publications/globaltargets2025_policybrief_breastfeeding/en/

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2010 JuneHalifax G8


2010 SeptMDG Summit


2014 May67th WHA


2014 MayToronto Summit

Saving Every Woman, Every Child: Within Arm’s Reach$3.5 billion from 2015-2020 (MDG’s)


Partnership for Maternal, Newborn and Child Health on line portal



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Every Woman, Every Child

http://www.everynewborn.org/Documents/Full-action-plan-EN.pdf

Fig. 6 Every Newborn impact framework

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http://www.everynewborn.org/Documents/Full-action-plan-EN.pdf

1. Strengthen and invest in care during labour, birth and the first day and week of life (>30% still births, 75% newborn & 72% maternal deaths)

2. Improve the quality of maternal and newborn care (high quality, high impact, cost effective, dyad)

3. Reach every woman and every newborn; reduce inequities (HRBA)

4. Harness the power of parents, families and communities (education, information, engagement)

5. Count every newborn – measurement, program tracking and accountability

Every Newborn: Five strategic objectives

Marcus Stahlhofer

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2010 JuneHalifax G8


2010 SeptMDG Summit


2014 May67th WHA


2014 May Saving Every Woman, Every Child: Within Arm’s Reach$3.5 billion from 2015-2020 (MDG’s)


Partnership for Maternal, Newborn and Child Health on line portal



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Global Initiatives: Application of human rights to strengthen accountability for infant and young child nutrition and child health

UN Human Rights Council Resolutions and reports on child’s right to health, and

under‐five mortality Technical guidance on the application of a HRBA to

reducing under‐five mortality and morbidity

UN Committee on the Rights of the Child Systematic reporting on IYCF and marketing of BMS General Comments

Marcus Stahlhofer

Guidelines

Guidelines for protection, promotion and support of breastfeedingOptimal feeding of the low birth‐weight infant for improved outcome of preterm birth

Updated BFHI materials

Marcus Stahlhofer

Guidelines for protection, promotion and support of breastfeeding

Review following WHO Guideline Review Committee guidelines –including invitation for external comments

Update systematic reviews related with optimal practices (including exceptionally difficult circumstances)

Work on recommendations for actions/interventions to protect, promote and support optimal breastfeeding

Timeline: 2014‐2015

Marcus Stahlhofer

Update of BFHI materials

Integration of 2010 guidelines on HIV and infant feeding

Updating includes all Sections

Main changes in the module on HIV

Product expected by 3rd quarter 2014

Marcus Stahlhofer

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Ten Steps: Themes

Policy (1) and Staff Education (2)

Ethical practice (WHO Code)

Seamless continuum of care (3 & 10)

Mother Baby Togetherness (4 & 7)

Practical assistance (5 & 8)

Exclusive breastfeeding at the breast (6 & 9)

Implementation and Monitoring

Marketing of complementary foods for infants and young children

Monitoring the implementation of the International Code of Marketing of Breast‐milk SubstitutesWHO Code report Global Network for Monitoring the Code

Marcus Stahlhofer

Ongoing work in WHO following the World Health Assembly mandate

Secretariat report 2014

Five criteria can be considered to evaluate if promotion is inappropriate:

1. it undermines recommended breastfeeding practices;

2. it contributes to childhood obesity and noncommunicable diseases;

3. the product does not make an appropriate contribution to infant and young child nutrition in the country;

4. it undermines the use of suitable home‐prepared and/or local foods;

5. it is misleading, confusing, or could lead to inappropriate use.

Inappropriate marketing of complementary foods

Marcus Stahlhofer

1st WHO report on Code status in countries

Information received from Member States:

Legislative status

Specific provisions: Age range Prohibition of advertising BMS Prohibition of sales promotion Prohibition of free/low‐cost supplies Prohibition of materials/gifts to health

workers and health facilities Labelling

Functioning implementation and monitoring system

Issues of concern

WHO Report on Status of the International Code of Marketing of Breast‐milk Substitutes

Marcus Stahlhofer

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http://www.who.int/nutrition/topics/seminar_wbw_7aug2014_presentation.pdf

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August 2014: 134 Code-related legislations/ codes in 105 countries

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Work is focusing on the following areas

Baby‐friendly Hospital Initiative

Complementary feeding

Exclusive breastfeeding

Global Strategy for Infant and Young Child Feeding

Intl Code of Marketing of Breast‐Milk Substitutes

WHO Global Data Bank on Infant and Young Child Feeding

http://www.who.int/nutrition/topics/infantfeeding/en/

WHO: Promoting proper feeding for infants and young children

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Summary of the 2014 Country

Reports

Eighth Meeting of BFHI Coordinators: Industrialized Countries, Eastern Europe

and the Commonwealth of Independent States

(CEE/CIS)

June 6 – 8 2014, Vilnius Lithuania

Julie Stufkens

See BCC website for BCC Symposium 2015 presentations

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451 Canadian $ = 0.74 Euro, 0.53 British pounds, 0.78 US $)

20K

UK = €15K

US = €11K

>10K 4 >€10K

<10K

Canada proposed = €5,700

Canada currently = €4,166

16 countries €1K ‐ €10K

<1K 10 countries < €1K

(1 Canadian $ = 0.74 Euro, 0.53 British pounds, 0.78 US $)Fees in Euros

A Canadian Perspective of Baby Friendly InitiativeMichelle LeDrew

See BCC website for BCC Symposium 2015 presentations

BFI Designated Facilities in Canada

BC SK MB ON QC Total

Hospitals 2 1 3 6 12

Birthing Centres 7 7

Community/CLSC 1 16 92 109

Native Health Center 1 1

Total 2 1 1 19 106 129

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BC AB SK MB ON QC NB NS PE NL NT YK NU

P/T Breastfeeding/BFI Policy or Strategy

Y N Y Y Y y Y Y N Y N N N

P/T BF/BFI Committee/Coalition Y Y Y Y Y N Y Y Y Y N N N

P/T Breastfeeding Education Opportunities

Y N Y Y y y Y Y Y Y N N N

P/T BFI Survey - Monitoring of BF(I) Implementation

Y N Y Y Y y Y N N Y Y

Baby-Friendly Designated Facilities

2 N 1 1 15 25 N N N N N N N

Human Milk Bank 1 1 N N 1 1 N N N N N N

P/T Government Financial Support Y N N Y y Y Y Y N Y *

P/T BFI Coordinator and/or Government Lead

Y N Y Y y Y Y Y N Y *

BCC BFI Assessor Y N N N Y Y Y Y N N N N N

BCC BFI Assessor Candidate/ apprentice

Y Y Y Y Y Y Y Y N Y N N N

* In progress

Y Yes

N No

Investigating implementation opportunities

No information

BCC future directions:

P/T Implementation Committee lead in BFI journey toward designation

Assessment Committee arms length support to facilities, building capacity of PT members

Focused attention for hospital facilities

BCC sustainability (financial and governance)

Need for a national BFI Strategy

Code compliance and national formula contracts,

Robust national breastfeeding surveillance system

International accountability

BFI implementation

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Caldeira AP, Goncalves E (2007) Assessment of the impact of implementing the Baby-Friendly Hospital Initiative, Journal of Pediatrics (RioJ) 83, 127–132.

Cattaneo A, Buzzetti R (2001) Effect on rates of breastfeeding of training for the Baby Friendly Hospital Initiative, BMJ 323, pp 1358–1362.

Del Bono E and Rabe B (2012) The effects of breastfeeding on children, mothers and employers, Institute for Social & Economic Research, University of Essex. Working Paper

Figueredo SF, Mattar MJG, Abrão ACFV (2012) Baby-friendly Hospital Initiative – a policy of promoting, protecting and supporting breastfeeding, Acta Paul Enferm. 25(3) pp 459-63.

Kramer MS et al(2001) Promotion of Breastfeeding Intervention Trial (PROBIT):a randomized trial in the Republic of Belarus, Journal of American Medical Association 285, 413–420.eo.

McAndrew F, Thompson J, Fellows L, Large A, Speed M, Renfrew MJ (2012) Infant Feeding Survey 2010, Health and Social Care Information Centre

Multiple interventions including full implem. of the 10 Steps and BFI standards is associated with significant improvements in infant feeding practices within relevant

health care environments

Reduced antenatal care, shorter hospital stays, fewer community visits

Human rights – need to invest in the “Foundation Years” to close the disparity gap

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BFI ‐ Context of Care

Allen G (2011) Early Intervention: Smart Investment, Massive Savings: The Second Independent Report to Her Majesty’s Government Field F (2010) The Foundation Years: preventing poor children becoming poor adults. The report of the Independent Review of Poverty and Life Chances Kennedy I (2010) Getting it right for children and young people: Overcoming cultural barriers in the NHS so as to meet their needs, COI publications. Report for DH by Professor Ian Kennedy WCRF/AICR (2009) Policy and Action for Cancer Prevention: Food, Nutrition, and Physical Activity: a Global Perspective, Washington DC, AICR WHO (2008) Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, WHO (http://www.who.int/social_determinants/thecommission/finalreport/en/index.html)

The benefits of breastfeeding are evidence‐based, but the mechanisms for supporting all women, including those who do not breastfeed, to feel confident in their relationship with their baby require practical and emotional support.

The evidence and rationale for the UNICEF UK Baby Friendly Initiative standardshttp://www.unicef.org.uk/Documents/Baby_Friendly/Research/baby_friendly_evidence_rationale.pdf

UN Convention on the Rights of the Child focus

Early care practices impact future well being of child

Early brain development

Emotional attachment and positive parenting

BFI & Early Childhood Development

Heikkila K, Sacker A, Kelly Y, Renfrew MJ, Quigley M (2011) Breastfeeding and child behaviour in the Millennium Cohort Study, Online First Arch Dis Child 2011, doi:10.1136/adc.2010.201970.Sacker A, Quigley M, Kelly Y (2006) Breastfeeding and Developmental Delay: Findings from the Millennium Cohort Study, Pediatrics, 118: e682-e689 (doi:10.1542?peds.2005-3141).Schore AN (2001) Effects of a secure attachment relationship on right brain development, affect regulation and infant mental health, Infant Mental Health Journal, Vol. 22 (1-2), pp 7-66.Zeedyk MS, Werrity I and Riach C (2008) One year on: perceptions of the lasting benefits of involvement in a parenting support programme, Children & Society, 22, 2 (Mar), pp 99-111.

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Dr. Mark Lysyshyn MHO

Kendell et al. Br J Psychiatry. 1987:150:662

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Bf protects against child abuse

7223 Australian M‐B pairs – 15 yr study

5890: anal. duration of bf/ maltreatment

No maltr., non‐M. & M perpetrated maltr.

512 substantiated maltreatment cases

>60% had 1 or more M‐perp. maltr.

Non‐bf had 4.8 x odds > bf for 4 m

After confounders: remained 2.6 x >

Bf may help protect, particularly neglect

Strathearn et al, Pediatrics 2009;123:483–493

Communities working together change behaviour & implement

multifaceted PH strategies

Chung M, Raman G, Trikalinos T, Lau J, Ip S (2008)Interventions in primary care to promote breastfeeding: an evidence review for the US Preventive Services Task Force, Ann Intern Med, 149:565e82.Dyson L, Renfrew MJ, McCormick F et al (2006) Promotion of Breastfeeding initiation and duration: Evidence into practice briefing HDA/NICE Kennedy I (2010) Getting it right for children and young people: Overcoming cultural barriers in the NHS so as to meet their needs, COI publications. Report for DH by Professor Ian Kennedy NICE (2007) Behaviour change at population, community and individual levels. October. PH Guidance 6NICE (2011) NICE Public Health Guidance 11: Improving the nutrition of pregnant and breastfeeding mothers and children in low-income households, Quick Reference Guide: Maternal and child nutrition WHO (2010) Working with individuals, families and communities to improve maternal and newborn health.Geneva, WHO (http://whqlibdoc.who.int/hq/2010/WHO_MPS_09.04_eng.pdf).

Perinatal care providers and peer volunteers strategically positioned to support individual women at the right time and within this social context.

“If women are nurtured and nourished to care for their infants though a healthy pregnancy and in building safe, strong, emotional bonds with their baby, public health and consequently an individual’s life chances will be given the best possible start.”

RCM (2012) Maternal Emotional Wellbeing and Infant Development: A Good Practice Guide for Midwives (www.rcm.org.uk/EasySiteWeb/GatewayLink.aspx?alId=306309).

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BFI Capacity Thank you!