World Breastfeeding Week 1-7 August 2007

Posted with compliments of Worldbreastfeedingweek.org

Breastfeeding: The 1st Hour
Early initiation and exclusive breastfeeding for six months can
Save more than ONE million babies!

“It begins at birth. Our very first act after birth is to suck our mother’s…milk. This is an act of affection, of compassion. Without that act, we cannot survive. That’s clear…That’s the way of life. That’s reality.”
Dalai Lama and Howard C. Cutler, The Art of Happiness A Handbook for Living.1998

Objectives:

• To mobilise the world to the potential for saving ONE million babies starting with ONE simple action: allowing the baby to initiate breastfeeding in the first hour of life.


• To promote immediate skin-to-skin contact of the mother and baby and continuing with exclusive breastfeeding for six months .


• To encourage ministers of health and other authorities to include the initiation of breastfeeding in the first hour as a key indicator for preventive health.


• To ensure that families know how important a baby’s first hour is, so that they can make sure that their babies are given this opportunity.


• To support the newly revised and revitalised Baby Friendly Hospital Initiative (BFHI), with its emphasis on integration and expansion, and on the early initiation of breastfeeding.

In the first hour of life, a baby finds her mother’s breast. Together they can do it on their own, when we respect maternal/infant physiology as we provide expert maternal child care.
This is the beginning of a life-sustaining breastfeeding relationship between mother and child.
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Visit http://breastcrawl.org/ to view the video

The Remarkable First Hour of Life
When healthy infants are placed skin-to-skin on their mother’s abdomen and chest immediately after birth, they exhibit remarkable capabilities. They are alert. They can crawl, stimulated by mother’s gentle touch, across her abdomen, reaching her breast.13 They begin to touch and massage the breast. This first gentle touch of a baby’s hand or head at the breast stimulates release of maternal oxytocin,9 thus beginning both the flow of milk and enhancing the feelings of love for the baby. Then the baby smells, mouths and licks the mother’s nipple. Finally, he or she attaches to the breast and feeds. This sequence of events is important for the survival of human young.

Optimal breastfeeding
The WHO/UNICEF Global Strategy for Infant and Young Child Feeding recommends that children breastfeed exclusively for the first 6 months of life, and then continue breastfeeding with adequate complementary food up to 2 years or beyond. Normal initiation of breastfeeding in the first minutes to first hours of life begins with skin-to-skin contact, and helps mothers and infants to achieve optimal breastfeeding. This is required in the BFHI, specifically in Step 4 of the WHO/UNICEF 10 Steps to Successful Breastfeeding.


Breastfeeding Rights
The Convention on the Rights of the Child recognises that every child has the inherent right to life and aims to ensure their survival and development. Breastfeeding within the first hour after delivery helps to ensure child survival. Women have a right to this knowledge and to receive the support that they need to initiate breastfeeding accordingly.

Why is skin-to-skin contact after birth and breastfeeding within the first hour of life so important?

1. The mother’s body helps to keep the baby appropriately warm, which is especially important for small and low birth weight babies.


2. The baby is less stressed, calmer and has steadier breathing and heart rates.


3. The baby is exposed first to the bacteria from the mother which are mostly harmless, or against which the mother’s milk contains protective factors. The mother’s bacteria colonise the baby’s gut and skin and compete with more harmful bacteria from health providers and the environment, and so prevent them from causing infection.


4. The baby receives colostrum for the first feeds – liquid gold, sometimes called the gift of life.


5. Colostrum is rich in immunologically active cells, antibodies and other protective proteins. Thus it serves as the baby’s first immunization. It protects against many infections. It helps to regulate the baby’s own developing immune system
   · It contains growth factors, which help the infant’s intestine to mature and function effectively. This makes it more difficult for micro-organisms and allergens to get into the baby’s body
   · It is rich in Vitamin A, which helps protect the eyes and reduce infection
   · It stimulates the baby to have bowel movements so that meconium is cleared quickly from the gut. This helps get rid of the substances in the baby's body that produce jaundice and therefore may help reduce it
   · It comes in small volumes, just right for the new baby.


6. Touching, mouthing and suckling at the breast stimulates oxytocin release – this is important for many reasons:
   · Oxytocin causes the uterus to contract. This may help delivery of the placenta and reduce maternal bleeding after the birth10
   · Oxytocin stimulates other hormones which cause a mother to feel calm, relaxed, and some would say “in love” with her baby 9
   · Oxytocin stimulates the flow of milk from the breast.


7. Women experience incredible joy with this first meeting of their child! And fathers often share this delight. The process of bonding between mother and baby begins.
   

Overall, skin-to-skin contact and early feeds with colostrum are associated with reduced mortality in the first month of life. They are also associated with increased exclusive breastfeeding and longer duration of breastfeeding in the following months, leading to improved health and reduced mortality later on as well.

Is normal breastfeeding initiation in the first hour all that is needed to guarantee continued exclusive breastfeeding?
Absolutely not! Mothers need continued support to breastfeed exclusively for 6 months. The family, health workers, traditional healers and others in the community are all important contributors to their network of support. Health providers, health visitors and others need clinical training in assessment of breastfeeding, identification of problems, as well as knowledge and skills for helping the mother to resolve difficulties. Follow-up by a health worker within 48-72 hours after the birth, again after one week, and at appropriate times thereafter provides the opportunity to intervene early if there are problems, as well as to reassure the mother when things are going well.

Implementation of the newly revised and revitalised BFHI with its 10 Steps to Successful Breastfeeding along with adherence to The International Code of Marketing of Breast-milk Substitutes and Subsequent World Health Assembly Resolutions provide the support structure needed to protect, promote and support optimal breastfeeding.

The World Alliance for Breastfeeding Action (WABA) is a global network of individuals and organisations concerned with the protection, promotion and support of breastfeeding worldwide based on the Innocenti Declarations, the Ten Links for Nurturing the Future and the WHO/UNICEF Global Strategy for Infant and Young Child Feeding. Its core partners are International Baby Food Action Network (IBFAN), La Leche League International (LLLI), International Lactation Consultant Association (ILCA), Wellstart International and Academy of Breastfeeding Medicine (ABM). WABA is in consultative status with UNICEF and an NGO in Special Consultative Status with the Economic and Social Council of the United Nations (ECOSOC).

More Breastfeeding information:
http://www.waba.org.my/
http://www.worldbreastfeedingweek.org/
http://www.earthbabies.co.za/
http://www.kellymom.com/
http://breastfeeding.blog.motherwear.com/
http://www.lalecheleague.org/SouthAfrica.html

International Nestlé-Free Week

As you probably know, I support the boycott of Nestlé products.
According the the World Health Organisation Authority (WHO) 1.5 million babies die every year as a result of inappropriate feeding. Despite this Nestlé continues to push its baby milks in breach of international standards.
Monitoring by groups on the ground around the world shows Nestlé is responsible for more violations than any other company. That's why it is singled out for boycott action.
If you don't boycott Nestlé already, I ask that you consider looking at the evidence and giving up Nestlé products for one week, at least.
Boycott groups around the world have declared 2-8 July to be International Nestlé-Free Week.
The boycott has forced some changes from the company, but it is still a long way from complying. Campaigners are also working for laws. Nestlé can comply when it is given no choice. It is not being asked to do something that is impossible, but without pressure it continues to put its own profits before infant health and mothers' rights.
You can find out more information and look at the evidence yourself on the Baby Milk Action website at:
http://www.babymilkaction.org/resources/boycott/nestlefree.html
You can sign up there to support the boycott.
It is important to tell Nestlé you will be boycotting it, whether it is just for the week, or until it accepts and acts on the plan put to it by boycott groups for saving infant lives.
You can telephone Nestlé on the freephone number0800 00 00 30 (Not in SA), 086 009 6116 (SA number) or send a message via its websitehttp://www.nestle.com/

Breast has finally topped bottle-feeding – even for babies born to HIV positive mothers

Cross-posted from the HIVAN website (http://www.hivan.org.za/). Originally published by Health-E News Service (www.health-e.org.za).

Author: Kerry Cullinan

For years, there has been a battle over the best way to protect babies born to HIV positive mothers living in poor areas from getting the virus – which has essentially boiled down to a battle between those who advocate breast feeding and those who advocate bottle-feeding with milk formula.

As breastmilk can transmit HIV, global policy was weighted in favour of bottle feeding and HIV positive mothers were discouraged from breastfeeding.

But a big study from KwaZulu-Natal led by Professors Jerry Coovadia and Nigel Rollins and published on Friday (30 March) seems to have finally settled the debate in favour of the breast.

They found that babies who were exclusively breastfed by their HIV positive mothers were at substantially less risk of becoming infected than babies given both breastmilk and formula milk or solids.

This is excellent news for HIV positive mothers living in poor areas without easy access to clean water and effective ways of sterilising bottles.

The formula milk position was all very well in the developed world and middle-class suburbia, where mothers with HIV who opt for bottle-feeding can get clean water to mix the formula.

But it was not geared for rural South Africa or urban informal settlements where the supply of clean water is not guaranteed and where it is simply impractical to boil water every time to sterilise baby bottles.

However, up until now, government’s policy has favoured the bottle by offering mothers with HIV free formula milk.

The proviso was that she had to have access to clean water – but who was checking?

Besides, what poor mother would turn down free milk formula, even if she planned to breastfeed?

In fact, researchers found that most mothers opting for the formula were unemployed and that at least a quarter of them admitted to selling it as they were desperate for income, so there was little benefit to their babies.

For Professors Coovadia, Rollins and colleagues at the Africa Centre for Health and Population Studies and the University of KwaZulu-Natal’s Medical School, offering free formula was a dangerous policy.

HIV positive mothers who opted for the free formula usually ended up both breastfeeding and bottle feeding.But research published in 1999 by Dr Anna Coutsoudis, also from Durban, suggested that this “mixed feeding” was the most dangerous form of feeding for newborn babies with HIV positive mothers.

It damages the mucosal lining of the babies’ intestines, making them vulnerable to the virus.

There was also the added risk of bottlefed babies dying of gastro-intestinal infections caused by dirty water or unsterilised bottles.

In the past, long before the HIV epidemic, Coovadia had been actively involved in campaigns against Nestle and other big companies that were promoting formula milk in this country because babies in poor households were so vulnerable to gastric infections.In addition, the physical benefits of breastmilk on building babies’ immune systems as well as the psychological benefit of breastfeeding in encouraging mother-baby bonding has been well established.

So even in the face of HIV, he and his colleagues were deeply uneasy about breastfeeding being undermined in favour of formula milk precisely because the risk of diarrhoea was high and often fatal for little babies.

They thus painstakingly investigated the risks that the different feeding options being used by over 1 000 HIV positive mothers in KwaZulu-Natal posed for passing HIV on to their babies from birth to six months.

The study was big, initially involving 2 722 HIV positive and negative women at seven rural and two urban sites.

All the women were counselled about the value of exclusive breastfeeding, and the majority opted to do just that.

In addition, all HIV positive mothers were given Nevirapine during labour and their babies at birth.

Their study, which was published in the prestigious Lancet journal, found that the risk of HIV transmission to babies exclusively breastfed by their HIV positive mothers up to the age of six months was 4%.In contrast, babies who were given breastmilk and solids were almost 11 times more likely to get HIV, while babies who had both breast and formula milk had double the risk of HIV infection as those only on the breast.

In addition, deaths among babies who were formula fed were more than double that of exclusively breastfed babies by three months.

Many of these deaths were not related to HIV but were the result of diarrhoea.

Six percent of the babies that were exclusively breastfed were dead by three months of age, while 15% of babies who were given replacement foods were dead.

The Lancet has hailed the study as a “breakthrough”, describing it as “meticulous” and “providing crucial confirmatory evidence” that exclusive breastfeeding poses a low risk of HIV infection for babies.

While a significant number of the babies died during the study, this relates to the fact that 14% of the babies were HIV positive already – either infected while inside their mothers’ wombs or during birth, not through breastmilk.

Three-quarters of the deaths were as a result of AIDS-related illnesses.

Babies were most likely to get HIV if their mothers had advanced HIV infection, associated with low CD4 counts (measure of immunity in the blood) and large amounts of the virus in their blood.

Food for breastfeeding moms

Cross-posted from the HIVAN website (http://www.hivan.org.za/). Originally published by Health-E News Service (www.health-e.org.za).

Author: Kerry Cullinan

Food parcels are finally being offered to HIV positive mothers in KwaZulu-Natal who want to exclusively breastfeed their babies as part of a new government policy.

In the past, positive mothers were advised to either exclusively formula feed or, in cases where there was no supply of clean water, to exclusively breastfeed to protect their babies from getting HIV.

But while free formula milk was dished out, no practical support was offered to those who wanted to breastfeed.

The mothers, particularly those who were poor, tended to see the formula milk as an incentive. They then tended to opt to get the formula milk and feed their babies both breast and formula milk – the most risky feeding choice for passing on HIV.

An exuberant Professor Nigel Rollins, head of the Centre for Maternal and Child Health at the University of KwaZulu-Natal, said he was “delighted” that government had chosen to help HIV positive breastfeeding women meet their increased nutritional needs (of breastfeeding) by offering six months’ worth of food parcels.

The food parcels help to level the playing field as counsellors can now offer HIV positive women either food packages if they choose to breastfeed or free formula for their baby if they have the resources at home to safely prepare and give formula.

“In the past, government policy was weighted in favour of formula feeding, yet research shows that babies of HIV positive mothers who are exclusively breastfed are at far lower risk of getting HIV than babies who are mix-fed both formula and breastmilk,” said Rollins.

Rollins can well feel pleased, as it is largely thanks to him, Professors Jerry Coovadia Anna Coutsoudis and Dr Ruth Bland that government has changed its policy to support and encourage breastfeeding.

As breastmilk can transmit HIV, government has been reluctant in the past to promote it. However, Rollins, Coovadia, Coutsoudis and others have tirelessly conducted a number of studies to show that exclusive breastfeeding posed a relatively small danger to babies of HIV positive mothers. Their latest and most comprehensive study (see adjoining article) quantifies this risk at 4% by the time babies are six months old.In contrast, the risk of HIV for babies who get formula and breastmilk is double this, while the risk for babies who get breastmilk and food is 11 times that of the exclusively breastfed babies.

“In the light of our research, we have been calling for government to review its policy and to offer more tangible support to breastfeeding HIV positive mothers,” said Rollins. The first indication that government had taken note of the research was found in the final draft of government’s new national HIV/AIDS strategic plan, which was adopted at a consultative meeting two weeks’ ago.

The plan announced that HIV positive moms choosing to breastfeed would be offered “nutritional support”. The KwaZulu-Natal health department has moved at lightning speed to implement this change in policy. The food parcels being offered are substantial, consisting of mielie meal, enriched porridge, rice, beans, soya mince, milk, peanut butter, tinned fish, sunflower oil, sugar and salt.

Rollins said that breastfeeding was demanding on all women, but that HIV positive mothers had greater nutritional needs and tended to lose more fat than HIV negative mothers. The health of babies being exclusively breastfed is inextricably tied to the health of their mothers, so the babies will benefit from the food parcels as their mothers will be healthier. In addition, babies are most likely to get HIV when their mothers’ levels of immunity (CD4 count) is low so the food parcels will help to keep mothers healthy and less prone to infections – particularly if boosted with antiretroviral treatment for their mothers.

“In the past, the formula milk was perceived by mothers from poor households as a way to gain financially,” said Rollins. “But over a quarter of the mothers diluted the formula too much, and we found E.coli bacteria (which causes diarrhoea) in almost two-thirds of the bottles that mothers were giving to their babies right there in the clinic.” Researchers also found that at least a quarter of the mothers sold the formula milk as they were desperate for money.

“The food parcels being offered are very substantial and a real asset for women choosing to exclusively breastfeed,” said Rollins. There is, of course, a strong likelihood that the food will be used to feed entire families not just the HIV positive mothers. But at least the benefit will be kept within the family, unlike the sold formula milk. And the breastfeeding mothers will certainly get some of the benefits.