by Donna Walls, RN, BSN, ICCE, IBCLC, ANLC

The World Breastfeeding Trends Initiative was developed by IBFAN (the International Baby Food Action Network) to provide assessment of policy and programs that impact infant and young child feeding, identify gaps and provide recommendations to countries around the world. In the United States the Initiative was sponsored by The Healthy Children Project. The Global Strategy for Infant and Young Child Feeding is a guiding document for the initiative. It was adopted by the World Health Assembly  and UNICEF in 2001 and established as a framework with ten action areas to support optimal infant feeding. The specific objectives are to:

• Raise awareness regarding the main problems affecting infant and young child feeding
• Identify approaches to solution
• Provide a framework of essential interventions
• Increase the commitment of governments, international organizations and other concerned parties for optimal feeding practices for infants and young children
• Create an environment that will enable mothers, families to make and implement informed choices

Another guiding organization is the Baby-Friendly Hospital Initiative (BFHI) which is an initiative by WHO and UNICEF, providing a program to protect, promote and support breastfeeding in hospital and maternity facilities. The initiative follows the ‘Ten Steps for Successful Breastfeeding’ and ensures adherence to the Code of Marketing of Breast-milk Substitutes. According to Victora et al (2016) and Rollins et al (2016) breastfeeding could save 820,000 lives annually,  preventing 13% of all deaths of children under five. Breastfeeding could reduce one third of respiratory infections and about half of all diarrhea episodes in low and middle income countries. Breastfeeding has been shown to improve the health and survival of all children. Globally, optimal infant and young child feeding data shows only 44% of the children born initiate breastfeeding within one hour of birth, only 38% are exclusively breastfed for 6 months, 65% get adequate and appropriate complementary foods at 6-8 months and just 49% continue to breastfeed for at least two years. (WHO, UNICEF) The assessment was developed to establish a baseline of national policies and programs in place to support optimal infant and child feeding. Scores were provided in a colour- coded rating in Red, Yellow, Blue or Green. In this tool, a score of 90% and above is coded green and considered to be maximum achievement. The other three colours in descending order of performance are Blue, Yellow and Red.

The Assessment Indicators

Part 1 included assessment of policies and programs:

1. National Policy, Programme and Coordination
2. Baby Friendly Hospital Initiative
3. Implementation of the International Code of Marketing of Breastmilk Substitutes
4. Maternity Protection
5. Health and Nutrition Care System
6. Mother Support and Community Outreach
7. Information Support
8. Infant Feeding and HIV
9. Infant Feeding During Emergencies
10. Mechanism of Monitoring and Evaluation Systems

Part ll assessed practices:

1. Percentage of babies breastfed within one hour of birth
2. Percentage of babies 0<6 months of age exclusively breastfed in the last 24 hours
3. Babies are breastfed for a median duration of how many months
4. Percentage of breastfed babies less than 6 months old receiving other foods or drinks
5. Percentage of breastfed babies receiving complementary foods at 6-9 months of age

The United States scored very poorly, with a 37.0 on part 1 and a 31.0 on part 11 for a total of 68.0. The summation of the USA scores can be seen in the report. Areas for improvement include: increasing mothers initiating breastfeeding within the first hour after birth, improving exclusive breastfeeding rates through the first 6 months of life and increasing the mean duration of breastfeeding. The U.S. scored high on monitoring systems in place but still has work to do on developing national policies supporting breastfeeding (including maternity protection), encouraging hospitals to become designated as Baby Friendly (including evidence-based education to all health care providers working with pregnant and new mothers), implementing the International Code of Marketing of Breastmilk Substitutes, and developing policies for specific conditions such as HIV and breastfeeding in emergencies. For more information on the WBTI and comparing the US with other countries around the world, go to their website.

References

UNICEF 2015. State of World Children.https://data.unicef.org/resources/the-state-of-the-worlds-children-report-2015-statistical-tables/# ICN 2 Second International Conference. on Nutrition. https://www.fao.org/about/meetings/icn2/en/ WHO & UNICEF 2016. Baby-friendly hospital initiative congress https://www.who.int/nutrition/events/2016_bfhi_congress_24to26oct/en/ Victora CG, Bahl R, Barros AJD, Franca GVA, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC, for the Lancet Breastfeeding Series Group. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387: 475-90 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, on behalf of the Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 387: 491-504. Victora CG, Horta BL, de Mola CL, Quevedo L, Pinheiro RT, Gigante DP, Goncalves H, Barros F. Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth control study from Brazil. Lancet Glob Health 2015; 3: e199-205. https://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(15)70002-1.pdf The Sustainable Development Goals Report 2016.https://unstats.un.org/sdgs/report/2016/The%20Sustainable%20Development%20Goals%20Report%202016.pdf United Nations Children’s Fund, Breastfeeding on the Worldwide Agenda: Findings from a landscape analysis on political commitment for programmes to protect, promote and support breastfeeding, New York, UNICEF, 2013 WHO & UNICEF 2015. Advocacy Strategy Breastfeeding Advocacy Initiative https://apps.who.int/iris/bitstream/10665/152891/1/WHO_NMH_NHD_15.1_eng.pdf?ua=1 Horton S, Shekar M, McDonald C, Mahal A, Brooks JK. Scaling up Nutrition What will it cost? World Bank 2010. https://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/Peer-Reviewed-Publications/ScalingUpNutrition.pdf The World Braestfeeding Costing Initiative. The need to invest in babies 2014. https://www.worldbreastfeedingcosting.org/wbci/TheNeed-to-Invest-in-Babies.pdf The World Braestfeeding Costing Initiative tool 2014. https://www.worldbreastfeedingcosting.org/wbci/WBCi_Ver_1_2016.xlsm Walters D, Horton S, Siregar AYM, Pitriyan P, Hajeebhoy N, Mathisen R, Phan LTH, Rubert C. The cost of not breastfeeding in Southeast Asia.Health Policy and Planning 2016, 1-10. Shekar M, Kakietek J, Eberwein JD, Walters D. An Investment Framework for Nutrition: Reaching the global targets for stunting, anemia, breastfeeding and wasting. World Bank 2016. https://documents.worldbank.org/curated/en/847811475174059972/pdf/108645-REVISEDPUBLIC-1700369-GlobalTargets-Execsum-Web-10-3-16.pdf Alderman, Behrman and Puett 2016; Copenhagen Consensus Center 2015; Hoddinott et al. 2013). Lutter CK and Morrow AL. Protection, Promotion, and Support and Global Trends in Breastfeeding. AdvNutr 2013; 4: 213219