Disclaimer
I have no conflict of interest with any milk
representatives / companies. The presentation for this
20-hour Lactation Management Training is a product of
the trainings, seminars, conventions, and researches
related to the subject matter.
I am an advocate of breastfeeding and rooming-in.
Thus, it is with this intent that I am representing the
group that aims to promote optimal nutrition especially
to the under-five age population.
Objectives
• At the end of the session, the participants will
be able to:
– Understand the relevance of the Mother-Baby
Friendly Hospital Initiative
– Enumerate the Ten Steps to Successful
Breastfeeding
– Describe how the RA 7600 and the Philippine
Code of Marketing of Breastmilk Substitutes (E.O.
51) helps to protect breastfeeding
– Support, promote, and encourage breastfeeding in
the workplace
Extra Challenge
Putting improved infant and
young child feeding practices
into the limelight
Magnitude of the Problem
The Philippines
is 1 of 42
countries that
accounts for
90% of child
deaths
82,000 Filipino
infants and
young children
die every year
Magnitude of the Problem
16,000 (20% of the 82,000) child
deaths could be prevented with
exclusive breastfeeding and
appropriate addition of
complementary feeding
Lancet, NEC
Breastfeeding and Appropriate
Infant Feeding prevents
• 16,000 under five deaths
• 1.2million episodes of illness
• 10 million days of illness
• 450,000 health facility consultations
• 36,000 hospital admissions
Economic Burden of Infant Formula
21.5 billion pesos spent every
year on purchase of infant
formula
A totally unnecessary expenditure that has
tremendous socio-economic impact on
Filipino families
Economic Burden of Infant Formula
• 430 million pesos spent on health
care costs (hospitalization, health
facility visits and drugs)
• 1 billion pesos of lost wages every
year to attend sick children
• 320 million pesos for funeral costs
The burden on the poor
• 25% of formula-fed infants are POOR
• This makes their lives even more difficult
with the unnecessary expenditure of
infant formula
The burden on the poor
• Average monthly income of a poor
family of 5 is estimated below 7,280
pesos*
• If the infant in the family is formula
fed this means almost 30% of the
income goes on formula
*NSCB Poverty threshold
11
2003
Why Breastfeed?
Benefits for the child:
• Breastfeeding prevents more than 6 out of 10
deaths
– comparing breastfed to formula fed
• Breastfeeding results in smarter children and
adults. Increased IQ points if no infant formula
• Breastfed children are safer and healthier
• Low risk for diabetes, obesity and cancers later in
life
Why Breastfeed?
Benefits for the breastfeeding mother
• Reducing blood loss after childbirth
• Delays her return to fertility (child spacing)
• Reduces risk for cancers associated with
female organs: breast, ovaries, uterus
The sad facts though…
• Only 1 in 6 (15%) children are exclusively breastfed for the
first 6 months of life
– On the average, infants are exclusively breastfed <1 month
• The median duration for breastfeeding is 11 months
• Two month olds are frequently given foods other than
breastmilk
• Infants born in health facilities or delivered by health
workers are less likely to be breastfed
– Only half of infants initiated breastfeeding within 1 hour after
delivery
Source: NDHS 2003
What could have gone wrong?
• Mothers still have misconceptions regarding
breastfeeding
• Wrong advice from family, friends and
neighbors
• Health care providers not skilled to provide
the necessary support
• “Bottlefeeding more convenient”
• Aggressive marketing of milk formula
Source: Photos taken during monitoring, December 2003
Misconceptions about reasons to stop breastfeeding
Reasons Mothers State For Total Urban Rural
Stopping Breastfeeding
Insufficient milk 25 29.5 20.8
Weaning age 24.8 15.7 33.2
Mother working 14.6 19.2 10.4
Child refused 13.2 13.8 12.5
Nipple / breast problem 5.7 5.7 5.8
Became pregnant 3.3 2.7 4
Mother Ill/ weak 4.7 4.7 4.8
Started using contraception 3.4 3.3 3.5
Child ill / weak 1.8 1.8 2.0
Others 3.3 3.6 2.8
Source: PNSO, 2002 MCHS
The Facts…
Reasons for stopping Breastfeeding Facts About Breastfeeding
Insufficient milk The more breastfeeds the more milk produced
Weaning age Infants ONLY need breastmilk the first 6
months
Mother working With appropriate support working mothers
can give their infants only breastmilk for 6
months
Child refused With appropriate help children can continue
breastfeeding
The Facts…
Facts About Breastfeeding
Reasons for stopping breastfeeding
Nipple / breast problem Appropriate breastfeeding technique helps
prevent problems
Became pregnant
When the mother breastfeeds exclusively has
very slim chance of becoming pregnant
Mother Ill/ weak The breastmilk of a ill mother is still the best
for her baby
Started using contraception There are contraceptives that do not interfere
with breastfeeding
The sick child is going to benefit even more
Child ill / weak from the breastmilk
TYPES OF NIPPLE
National Plan of Action, 2005-2010
GOAL
• Reduce Child Mortality Rate by 2/3 by 2015
OBJECTIVE
• To improve health and nutrition status of
infants and young children
OUTCOME
• To improve exclusive and extended
breastfeeding and complementary feeding
Specific Objectives
• 70% of newborns are initiated to breastfeeding
within one hour after birth
• 60% of infants are exclusively breastfed up to 6
months
• 90% of infants are started on Complementary
Feeding by 6 months of age
• Median duration of breastfeeding is 18 months
Key Messages
Breastfeeding :
• Initiated within 1 hour
• Exclusive for the first 6 months of life
– Only breastmilk and nothing else
• Extended up to two years and beyond
• Complemented at 6 months with
appropriate foods, excluding milk
supplements
Major Action Points
• Transform health workers to become breastfeeding
advocates
• Overcome fads, fallacies and misconceptions
regarding BF and complementary feeding
• Establish supportive home and work environments
• Create community support groups for mothers
• Gain political will and commitment
• Enforce the laws
Republic Act 7600
The Rooming-In and Breastfeeding
Act of 1992
Declaration of Policy
• The State adopts rooming-in as a national
policy to encourage, protect and support the
practice of breastfeeding. It shall create an
environment where basic physical, emotional,
and psychological needs of mothers and
infants are fulfilled through the practice of
rooming-in and breastfeeding.
Declaration of Policy
• Breastfeeding has distinct advantages which benefit
the infant and the mother, including the hospital and
the country that adopt the practice. It is the first
preventive health measure that can be given to the
child at birth. It also enhances mother-infant
relationship. Furthermore, the practice of
breastfeeding could save the country valuable
foreign exchange that may otherwise be used for
milk importation.
Mother-Baby Friendly Hospital
Initiative
• Step 1. Have a written breastfeeding policy
that is routinely communicated to ALL
healthcare staff
• Step 2. Train ALL healthcare staff in skills
necessary to implement this policy.
• Step 3. Inform ALL pregnant women about the
benefits and management of breastfeeding
Mother-Baby Friendly Hospital
Initiative
• Step 1. Have a written breastfeeding policy
that is routinely communicated to ALL
healthcare staff
– General Policy on Rooming-in and Breastfeeding
– Unit specific Policies and Procedures:
Admitting/ER, Ward, DR, NCU, PW, OBW,
Maternity and Child Units
• Step 2. Train ALL healthcare staff in skills necessary to
implement this policy.
• Step 3. Inform ALL pregnant women about the benefits and
management of breastfeeding
Mother-Baby Friendly Hospital
Initiative
• Step 1. Have a written breastfeeding policy
that is routinely communicated to ALL
healthcare staff
• Step 2. Train ALL healthcare staff in skills
necessary to implement this policy.
– 20-hour training: Maternal and Child Services
• 3-hour practicum
– 2-hour orientation: ALL hospital employees
• Step 3. Inform ALL pregnant women about the
benefits and management of breastfeeding
Mother-Baby Friendly Hospital
Initiative
• Step 1. Have a written breastfeeding policy that is
routinely communicated to ALL healthcare staff
• Step 2. Train ALL healthcare staff in skills necessary to
implement this policy.
• Step 3. Inform ALL pregnant women about the
benefits and management of breastfeeding
– Mothers’ class
– Prenatal checkup
– Admission up to discharge
Mother-Baby Friendly Hospital
Initiative
• Step 4. Help mothers initiate breastfeeding
within half hour after birth
– Early skin-to-skin contact
– Essential Intrapartum and Newborn Care protocol
• Step 5. Show mothers how to breastfeed and
maintain lactation, even if they should be separated
from their infants
• Step 6. Give newborn infants no food or drink other
than breastmilk, unless medically indicated.
Mother-Baby Friendly Hospital
Initiative
• Step 4. Help mothers initiate breastfeeding
within half hour after birth
• Step 5. Show mothers how to breastfeed and
maintain lactation, even if they should be
separated from their infants
– Return demonstration: Expressed Breastmilk, Cup
feeding, Syringe feeding, spoon feeding
• Step 6. Give newborn infants no food or drink other
than breastmilk, unless medically indicated.
Mother-Baby Friendly Hospital
Initiative
• Step 4. Help mothers initiate breastfeeding within half hour
after birth
• Step 5. Show mothers how to breastfeed and maintain
lactation, even if they should be separated from their infants
• Step 6. Give newborn infants no food or drink
other than breastmilk, unless medically
indicated.
– Contraindications: Galactosemia, Phenylketonuria,
Maple syrup urine disease
Mother-Baby Friendly Hospital
Initiative
• Step 7. Practice rooming in – allow mothers and
infants to remain together 24 hours a day.
– NSVD: 30 minutes to 1 hour
– CS: 4 to 6 hours
• Step 8. Encourage breastfeeding per demand
• Step 9. Give no artificial teats or pacifiers
(dummies or soothers) to breastfeeding infants.
• Step 10. Foster the establishment of
breastfeeding group and refer mothers to them
on discharge from the clinic or hospital.
Mother-Baby Friendly Hospital
Initiative
• Step 7. Practice rooming in – allow mothers and
infants to remain together 24 hours a day.
• Step 8. Encourage breastfeeding per demand
– When the baby cries, do breastfeeding.
– No longer observed – every 2 hours feeding
• Step 9. Give no artificial teats or pacifiers
(dummies or soothers) to breastfeeding infants.
• Step 10. Foster the establishment of
breastfeeding group and refer mothers to them
on discharge from the clinic or hospital.
Mother-Baby Friendly Hospital
Initiative
• Step 7. Practice rooming in – allow mothers and
infants to remain together 24 hours a day.
• Step 8. Encourage breastfeeding per demand
• Step 9. Give no artificial teats or pacifiers
(dummies or soothers), bottles to breastfeeding
infants.
– Guards: Check for feeding bottles.
– If bottle feeding started outside: Bottlefeeding
regulations.
– Bottle feeding practices must not be visible. Mothers
must be instructed not to show it to other
breastfeeding mothers. Feeding bottles must kept
after.
Mother-Baby Friendly Hospital
Initiative
• Step 10. Foster the establishment of
breastfeeding group and refer mothers to them
on discharge from the clinic or hospital.
– Breastfeeding counselors: List at the station including
the barangay health centers. This must part of the
doctor’s order.
– Contact persons in the hospital must be available to
them upon discharge.
Sanctions
• For all first violations, the offender shall be reprimanded.
In addition, the offender shall be required to undergo
training on lactation management at the nearest
available Lactation Management Training Center.
• For the repetition of the same violation or any of the
provisions of the Rules, withdrawal of the privileges to
practice in the hospital shall be imposed. In addition, the
license to operate the health institution shall be
suspended until such time the health institution complies
with the rules provide therein.
Considered as Violations…
• Selling infant formula and breastmilk
substitutes and related products in the
hospital pharmacy
Regulations
No milk formula shall be kept in the
hospital, especially in the pharmacy except
those purchased for emergency use. In
addition, this milk formula shall not be
displayed and shall be kept in a closed
cabinet.
Considered as Violations…
• Prescription of infant formula to neonates without
valid acceptable medical indication
• Acceptance of gifts, samples, donation of milk and
other supplies from milk companies.
• Display of posters related to infant formula and milk
substitutes by milk companies anywhere in the
health facility
• Conduct of continuing education activities sponsored
by companies manufacturing milk or related
products as covered by E.O. 51 without prior
approval
Challenges: Reasons to stop breastfeeding in the
Philippines
Reasons Mothers State For Total Urban Rural
Stopping Breastfeeding
Insufficient milk 25 29.5 20.8
Weaning age 24.8 15.7 33.2
Mother working 14.6 19.2 10.4
Child refused 13.2 13.8 12.5
Nipple / breast problem 5.7 5.7 5.8
Became pregnant 3.3 2.7 4
Mother Ill/ weak 4.7 4.7 4.8
Started using contraception 3.4 3.3 3.5
Child ill / weak 1.8 1.8 2.0
Others 3.3 3.6 2.8
Source: PNSO, 2002 MCHS
BREASTFEEDING IN
THE WORK PLACE
What could have gone wrong?
In the workplace…
• Short maternity leaves
• Babies not allowed in the workplace
• No breastfeeding breaks
• No breastfeeding room or child care unit
• Not informed about manual expression of
breastmilk
• Not supportive to mothers (gender-bias)
How can we achieve a healthy and bright
future for the Filipino children?
We need to establish mother-baby friendly settings:
• Work places
• Health Facilities
• Schools
• Industry
• Public places
“Landmark Legislation”
First ever in the entire Philippines
The local government of Davao City
made a groundbreaking innovation
in GAD mainstreaming with its
landmark legislation -- the Women
Development Code.
The Code is a comprehensive
instrument to mainstream gender
and development (GAD) in program
planning, implementation, budget
allocation, monitoring and
evaluation in the LGU of Davao City.
Section 42. Gender-Sensitive Physical Plant.
A physical plant appropriate for a gender-sensitive environment
shall be adopted by all offices, agencies and establishments or
companies which shall help prevent sexual harassment, sexual
abuse and other forms of maltreatment in the workplace.
SECTION [Link] Incentives for Business Entities.
The Local Government of Davao City shall provide tax
incentives for business entities:
a) any amount used for the establishment, maintenance and
operation of the child day care support system shall be tax-
deductible;
b) annual tax credit per child regularly served for at least one
year in the Center; and
c) annual tax credit per woman extended with maternity leave
benefits for breast feeding.
Section 14. Facilities and Support Systems for Women.
The Local Government of Davao city shall ensure the safety and health of
women employees. In appropriate cases, it shall require employers to:
a) provide proper seats for women and permit them to use such
seats when they are free from work and during working hours, provided they
can perform their duties in this position without detriment to efficiency;
Violation by private employers shall constitute a fine of P 5,000 and a
b) establish separate toilet rooms, lavatories and lounge for men and
cancellation of business permit or as prescribed by the Court.
provide at least a dressing room for women;
Government unit or agency head of office is liable with the penalty of
three month suspension and a fine of P 1,000.00
c) establish a crèche in a workplace for the benefit of the women employees
therein; and
d) provide breastfeeding centers for women in the workplaces.
Section 18. Increase Maternity Leave Benefits as Incentives
for Breastfeeding Mothers in the Public and Private Sector.
Maternity leave benefits of 90 days shall be extended to all
women employees (public and private) who have rendered at least
one year continuous service, provided that 90 days of the leave period
shall be used for breastfeeding her new-born baby.
Employer who violates this provision shall pay a fine a fine of P 5,000
and a suspension of business permit or license to operate for six
months.
For local department or agency, an administrative sanction to be
imposed to the head of office or employee responsible for the violation
shall be in accordance with Civil Service rules.
What is a Model Breastfeeding Workplace?
• Mothers/families practice
appropriate infant and young child
feeding
• There are policies for:
– Milk Code Enforcement
– Breastfeeding breaks
– Breast milk storage facilities
– Breastfeeding rooms
– Setting up support groups
– Promoting, protecting and
advocating for appropriate
breastfeeding/infant feeding
What is a Model Breastfeeding Workplace?
• There is enforcement of the Milk
Code
– No infant formula in the
Pharmacy
– No milk companies supported
activities
– No health workers promoting
infant formula
– No posters/other related with
baby food products in the
workplace
What is a Model Breastfeeding Workplace?
• Breastfeeding breaks
– Additional breaks should be provided
to allow the mother to express the
milk (20 minutes/break at least 2
additional breaks)
• Breast milk storage facilities
– A refrigerator where the mother can
store the milk and collect it before
leaving the workplace
• Breastfeeding Room
– Physical facilities for breastfeeding
the baby and breast milk expression
What is a Model Breastfeeding Workplace?
Counsellors/workplace support
groups:
– strong link with the health
center/clinic
–existing
–active
–able to monitor, support and
encourage appropriate infant
feeding from pregnancy on
BENEFITS FOR BUSINESSES FROM
SUPPORTING BREASTFEEDING
• Improved retention of female employees after
maternity leave, thereby retaining valuable employee
skills and experience and lessens recruitment and
retraining.
• Earlier return to work by some new mothers.
• Easier transition back to work following maternity
leave.
BENEFITS FOR BUSINESSES FROM
SUPPORTING BREASTFEEDING
• Lower employee absenteeism rates on account of
improved child health.
• Improved employer-employee relations and
greater employee loyalty.
• Enhanced employee morale and productivity.
• Improved company image.
• Be known as a good place to work.
Its time to
take up the
SUPPORT
challenge!
BREASTFEEDING!!!
Let’s start a new
generation of smarter
Filipino children
Resource Notes
• Ms. Chona Dazon, RN – IYCF Coordinator City
Health Office, Davao City
• Mariella S. Castillo, MD, MSc - Maternal &
Child Health Team, WHO Philippines
MOTHER-BABY FRIENDLY HOSPITAL INITIATIVE
Revised, Updated and Expanded for Integrated Care
“Maternity”, 1963, © 2003 Estate of Pablo Picasso/Artists Rights Society (ARS), New York
Session 1
The Mother-Baby Friendly Hospital
Initiative: A Part of the Global Strategy
Session Objectives:
1. State the aim of the WHO/UNICEF Global
Strategy for Infant and Young Child Feeding;
2. Outline the aims of the Mother-Baby Friendly
Hospital Initiative (MBFHI);
3. Describe why MBFHI is important in areas of
high HIV prevalence;
4. Explain how this course can assist this facility at
this time.
5. Review how this course fits with other activities
Effects of poor infant feeding practices:
• About 5500 children die everyday
• Suffer long-term effects:
> impaired development
> malnutrition
> increased infectious / chronic
illness
> rising rates of obesity in
children
Global Strategy for Infant and Young Child Feeding
The aim of the Global Strategy is to improve
– through optimal feeding – the nutritional
status, growth and development, health, and
thus the survival of infants and young children.
It supports exclusive breastfeeding for 6 months,
with timely, adequate, safe and appropriate
complementary feeding, while continuing
breastfeeding for two years and beyond.
It also supports maternal nutrition, and social
and community support.
1/1
1/2
The aim of the
Mother-Baby Friendly Hospital Initiative
To implement the Ten Steps to
Successful Breastfeeding and to
end the distribution of free and
low-cost supplies of breastmilk
substitutes to health facilities.
MBFHI is important in areas of high HIV
prevalence
• Special needs of HIV+ women can be
accommodated.
• WHO/UNICEF policy statement, the right
to information and support.
• Continue to support women who are HIV
(-) or unknown status.
How this course can assist this health facility
• Discuss the Ten Steps and how to
implement them
• Importance of making the facility Mother-
Baby Friendly
• Talk about practices related to marketing
of breastmilk substitutes
• Assessment process
1/3
Course Aims
The aim of this course is that
every staff member will confidently
support mothers with early and
exclusive breastfeeding,
and that this facility moves towards
achieving Mother-Baby friendly
designation.
You will learn & practice
• Communication skills
• Implement 10 steps, abide by the EO 51
• Discuss importance of breastfeeding
• Facilitate skin to skin contact
• Positioning and attachment
• Support BF upon discharged
• Know whom & where to refer
• Seek ways to overcome barriers
How the global strategy fits with other
activities
It is supported by national policies, laws and
programs to promote, protect and support
breastfeeding and protect the rights of
working women to maternity protection.
National programs like:
IYCF / EO 51 / MBFHI / maternity leave laws