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New Resolution on Infant and Young Child Nutrition Adopted by the World Health Assembly

At the World Health Assembly in May this year, member states of the World Health Organization adopted by consensus a Resolution providing important new guidelines for the promotion of optimal infant and young child feeding practices. The Resolution reaffirms the support of member states for the protection of breastfeeding, acknowledging “the superiority of breastmilk as the biological norm for nourishing infants, and that a deviation from this norm is associated with increased risks to the health of infants and mothers” and includes a recommendation to “ensure that there are no donations of free or subsidized supplies of breastmilk substitutes and other products covered by the International Code of Marketing of Breastmilk Substitutes in any pan of the health care system”, in an effort to end the longstanding controversy surrounding the provision of free supplies of infant formula as a marketing strategy.

The Resolution also includes a recommendation concerning the introduction of complementary foods urging member states to “foster appropriate complementary feeding practices from the age of about six months, emphasizing continued breastfeeding and frequent feeding with safe and adequate amounts of local foods.”

On the subject of the use of breastmilk substitutes in emergency situations the Resolution urges Member States to “exercise extreme caution when planning, implementing or supporting emergency relief operations, by protecting, promoting and supporting breastfeeding for infants, and ensuring that donated supplies of breastmilk substitutes or other products covered by the scope of the International Code be given only if all the following conditions apply: (a) infants have to be fed on breastmilk substitutes, as outlined in the guidelines concerning the main health and socioeconomic circumstances in which infants have to be fed on breastmilk substitutes; (b) the supply is continued for as long as the infants concerned need it; and (c) the supply is not used as a sales inducement.”

The Resolution also calls on the World Health Organization to complete development of a comprehensive global approach and programme of action to strengthen national capacities for improving infant and young child feeding practices; urge Member States to initiate the Baby-Friendly Hospital Initiative and to support them, at their request, in implementing this Initiative; develop guiding principles for the use of breast-milk substitutes in emergency situations to ensure optimal infant-feeding conditions; and complete the collection of revised reference data and the preparation of guidelines for their use and interpretation for assessing the growth of breastfed infants.

For further information, please contact Dr G. Clugston, Chief, Nutrition Unit (41 22) 791 3326 or 791 3321

(Source: WHO Press Release, 9 May 1994 and Resolution WHA47.5 on Infant and Young Child Nutrition)

Protecting, Promoting & Supporting Breastfeeding - New WHO/UNICEF Training Package for Health Workers

A new training course for health workers on breastfeeding counselling, developed by the World Health Organization’s Programme for the Control of Diarrhoeal Diseases (CDD) with the cooperation of UNICEF received a brief mention in SCN News No. 10 (p.23). A more detailed description of the aims and structure of the course follows.

Breastfeeding is an invaluable resource for the health of both children and mothers, and the WHO Programme for the Control of Diarrhoeal Diseases (CDD) places particular importance on the promotion of breastfeeding due to its role in the prevention of diarrhoea. The Innocenti Declaration of 1990 (see SCN News No6, p.33) laid down a global goal for breastfeeding: “for optimal maternal & child health and nutrition, all women should be enabled to practise exclusive breastfeeding, and all infants should be fed exclusively on breastmilk from birth to 4-6 months of age. Thereafter, children should continue to be breastfed, while receiving appropriate & adequate complementary foods for up to two years of age or beyond”. It has been recognized that a key factor which interferes with this goal being fulfilled is inappropriate health care practices.

The “Ten Steps to Successful Breastfeeding”, set out in the Joint WHO/UNICEF Statement “Protecting, Promoting & Supporting Breastfeeding: The Special Role of Maternity Services” describe the minimum standards of practice for health facilities which provide maternity care and the WHO/UNICEF Baby Friendly Hospital Initiative was launched to encourage hospitals to adopt these standards. Training of health workers is an integral part of this initiative and was also specified as essential in the Innocenti Declaration.

At present, many health workers have not been given the necessary knowledge and skills either during their basic training or subsequently to fulfil their role of improving breastfeeding practices. This course is designed to equip health workers with these skills. It is directed at all health workers who care for mothers & young children in maternity facilities, health centres & hospitals, including nurses, midwives & doctors. It provides basic training enabling them to support optimal breastfeeding practices, and where necessary to help mothers to overcome difficulties.

The course is designed to train 15-20 participants in 5 days or 40 hours. (The course is preceded by a 5 day preparatory period for 4-5 local trainers during the preceding week). The main focus of the course is on development of the clinical and interpersonal skills needed to support mothers to breastfeed successfully. Thirty-three sessions are structured around four two-hour clinical practice sessions. Each clinical session is preceded by classroom sessions in which the skills to be practised with mothers & babies are developed step-by-step through a sequence of lecture, demonstration and exercises, or role-play.

Course materials include: a Director’s Guide - for use by directors when planning & conducting the training course; a Trainer’s Guide - each session is described in detail with clear instructions on how to conduct it (it includes a description of various teaching methods used, and all the exercises including suggested answers); and a Participant’s Manual - following the same pattern as the Trainer’s Guide. It provides summary of key information presented in lectures and all the practical guidelines, checklists & working forms, and a glossary of terms used. It also contains all the written exercises, but without answers. Overhead transparencies, slides, and flipcharts are also provided according to the facilities to be used for training.

The CDD Programme and, it is hoped, UNICEF and other agencies will support the introduction of the course in selected countries. It is hoped, however that following the introductory course, local trainers will be able to replicate the course without necessarily needing additional external assistance.

The course is currently available in English - French, Spanish & Portuguese translations are planned.

For further information please contact the World Health Organization’s Programme for the Control of Diarrhoeal Diseases (CDD), 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. Tel: (41 22) 791 0456 Fax: (41 22) 791 0746.

(Source: “Breastfeeding Counselling: A Training Course” Information Brochure, November 1993.)


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