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Report of the Sub-Committee on Nutrition at its Twenty-Fifth SessionII. Work in Progress: Summary of Discussion and ConclusionsC. Reports of decisions taken in Working GroupsC.4 Breastfeeding and Complementary Feeding -- Report of the Working Group 43. Key recommendations of this Group are:
Full Report of the Meeting of the Working Group on Breastfeeding and Complementary FeedingSaturday 28 March 1998, Oslo, Norway Rapporteur: Felicity Savage, WHO
Ann Herbert of ILO provided a comprehensive overview of maternity protection, which includes the right to maternity leave, cash benefits and medical benefits. She also described the process for the revision of the 1942 Maternity Protection Convention No. 103. Following the ILO report «Maternity Protection at Work» a questionnaire was sent out to all countries requesting views on desirable provisions to protect working women. Replies should be received by 30 June. A first discussion will be held in 1999 on draft instruments as part of the International Labour Conference. Revised drafts will be presented in the year 2000 and be considered for adoption. A copy of the presentation is available on request. The World Alliance for Breastfeeding Action has created a new webpage on the breastfeeding rights of breastfeeding women. The address of the new website is: http://www.elogica.com.br/waba/working.htm Recommendation UNICEF and WHO should remain in contact with ILO and advocate with partners, including counterparts at country level, to become involved in renegotiation of Convention (No. 103) Concerning Maternity Protection (revised 1952) to ensure the protection of breastfeeding rights of working women. 2. The Care Approach Lida Lhotska reported on progress in implementing the Care Approach through regional and national workshops. Emphasis has been placed on identifying links with existing programmes and initiatives such as WHO/UNICEF Integrated Management of Childhood Illness (IMCI) strategy and BFHI. Several countries have indicated their readiness to begin the integration of care into the situation analysis and programming for nutrition, health, women’s rights and early childhood development. Recommendation UNICEF should continue to promote the Care Approach. 3. Complementary Feeding WHO Nutrition Programme reported that the State of the Art Review on Complementary Feeding in Developing Countries will be published in time for the 51st World Health Assembly in May 1998. 4. Code Implementation David Clark provided a brief description of Code implementation around the world, as reported in the 1997 Progress of Nations. He also reported on efforts to involve UNICEF and partners in the CRC reporting process to ensure Code implementation as a practical measure for government’s to fulfil obligations under Article 24 of the Convention. Although more attention is being paid to breastfeeding issues at CRC sessions, more work is required to have Code implementation highlighted as an area of concern. Recommendation UNICEF and WHO should continue to use the process of reporting to the CRC Committee as an opportunity to advocate for full implementation and enforcement of the International Code at national level. 5. Baby-Friendly Hospital Initiative Lida Lhotska presented the latest global total of Baby-Friendly Hospitals - 13,237 in 117 countries. She also introduced the 1997 Progress Report which contains information on such matters as reassessment, evaluation and breastfeeding rates. It also includes a complete set of 1997 BFHI News. Felicity Savage reported on progress introducing breastfeeding counseling training as part of BFHI and as part of the IMCI strategy. 39 countries have now introduced the 40-hour «Breastfeeding Counseling: A Training Course». Breastfeeding counseling is included in the IMCI course for first-level health workers and has been introduced into training of community-level health workers in several countries. Recommendation UNICEF and WHO should continue to implement BFHI and expand breastfeeding counseling further into the community and into pre-service training of health workers. 6. The Economic Value of Breastfeeding Jay Ross of Linkages, the USAID funded project on breastfeeding, complementary feeding and maternal health provided an overview of previous models for assessing the economic value of breastfeeding and introduced a new model developed by Linkages. Information on the model and a copy of the user’s guide can be obtained directly from Linkages. A copy of the presentation "A Policy Analysis Tool for Calculating the Health, Child Spacing and Economic Benefits of Breastfeeding (BOB)" is available on request. Discussion focused on the extent to which these figures had proved effective in advocacy with policy-makers. In many countries they seemed not to counteract an apparent lack of interest in breastfeeding promotion, while in Norway they had apparently been influential. It was noted that gender bias may have played a role in underestimating the importance of the economic contribution that breastfeeding makes at both the household and national level. Recommendation The Policy Analysis Tool for Calculating the Health, Child Spacing and Economic Benefits of Breastfeeding (BOB) The methodology should be made available for use in breastfeeding advocacy, particularly over the internet with a view to stimulating dynamic discussion. 7. HIV and Infant Feeding in the Context of Vertical Transmission Felicity Savage reported on the forthcoming UNAIDS, WHO, UNICEF technical consultation on HIV and infant feeding to be held in Geneva from 20 -22 April. Three documents are to be presented: HIV and Infant Feeding: Guidelines for Decision Makers, HIV and Infant Feeding: a Guide for Health Care Managers and Supervisors, and HIV and Infant Feeding: A Review of HIV Transmission through Breastfeeding. Felicity Savage summarized the main principles contained in the documents, including the importance of voluntary and confidential testing and counseling to identify mothers who may consider replacement feeding, and the importance of counseling being conducted in an environment of strengthened BFHI and breastfeeding counseling programmes. Appropriate follow-up with support for replacement feeding should continue for at least 2 years. David Clark explained that the Code and subsequent relevant WHA resolutions are still of fundamental importance to protect the majority of infants that are born to HIV-negative mothers. In addition the Code protects infants who are artificially fed by ensuring clear instructions and warnings appear on labels and that products are used only on the advice of health professionals. It does not prohibit HIV-positive mothers from receiving subsidized breastmilk substitutes from the state, so long as the distribution does not spillover to the majority of infants that would benefit from breastfeeding. Any system should be sustainable and should not be dependent on donated supplies. The Code does prevent manufacturers from approaching health facilities directly to provide them with free or low-cost supplies, and this particular marketing technique should be prohibited. It leads to the indiscriminate use of breastmilk substitutes and consequent health risks. Lida Lhotska discussed the relevance of BFHI implementation within the context of the HIV pandemic and emphasized its usefulness as an entry point for some of the necessary interventions such as voluntary and confidential HIV counseling and testing. In discussion, the issue of the child’s right to breastfeed was raised, particularly in the context of the physiological continuum necessary for the development of the child. It was also noted that more research is required to find ways to reduce the risk of transmission through breastfeeding, for example by continuing antiretroviral therapy after delivery. Recommendations The working group welcomed the forthcoming Technical Consultation on HIV and Infant Feeding and the production of the documents entitled HIV and Infant Feeding: Guidelines for Decision Makers, HIV and Infant Feeding: a Guide for Health Care Managers and Supervisors, and HIV and Infant Feeding: A Review of HIV Transmission through Breastfeeding. These documents should be widely disseminated to guide countries in the management of infant feeding in the context of the HIV pandemic. Detailed practical guidance is required as a matter of urgency to manage the distribution of breastmilk substitutes for use by infants of HIV positive mothers, in ways that 1) avoid spillover to the majority of infants that would benefit from breastfeeding and 2) comply with the International Code of Marketing of Breast-milk Substitutes and subsequent relevant WHA resolutions. Progress and sustainability of BFHI and Breastfeeding Counseling implementation should be ensured as critical elements in preventing needless decline in breastfeeding rates among HIV negative women and in ensuring a woman’s right to make informed decisions about infant feeding. Relevant agencies should encourage research into ways to reduce the risk of transmission through breastfeeding, for example by continuing antiretroviral therapy after delivery. |
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