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Successful Breastfeeding in Just Ten Steps

The world celebrates this year’s Breastfeeding Month by recognizing the vital role health facilities play to help improve the rate of breastfeeding in the community. Research shows that hospitals and maternity units can greatly influence a mother’s decision on whether or not to breastfeed her child.

“This year, we are commemorating the 20th anniversary of the Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding. This basically outlines what countries need to do to protect, promote and support breastfeeding,” said Vanessa Tobin, country representative of the UN children’s agency UNICEF.

UNICEF advocates for a breastfeeding culture in the Philippines. Together with other child rights actors, it pushes for exclusive breastfeeding in the first six months of life. Exclusive breastfeeding means feeding the child with only mother’s milk and nothing else, not even water.

Soft, semi-solid and solid food is ideal for babies six months and beyond, while the mother continues breastfeeding. This is called complementary feeding. Complementary feeding gives children the variety of nutrients that they need for their age, and will help them to develop fully into healthy and active individuals.

In response to one of the operational targets of the Innocenti Declaration, UNICEF and the World Health Organization (WHO) launched the Baby-Friendly Hospital Initiative (BFHI) in 1991. The BFHI ensures that all free standing and hospital maternities become centers of breastfeeding support.

A maternity facility is considered 'baby-friendly' when it does not accept free or low-cost breast milk substitutes, feeding bottles or teats, and has implemented these Ten Steps to support successful breastfeeding:

• Have a written breastfeeding policy that is routinely communicated to all health care staff. The Ten Steps call for health facilities to have written policies that are displayed for all to read, indicating that staff is committed to implementing them.
• Train all health care staff in skills necessary to implement this policy. Training at all levels should address the Ten Steps, breastfeeding, counselling, and the International Code. 
• Inform all pregnant women about the benefits and management of breastfeeding. By the time a baby is born, the new mother must be comfortable about breastfeeding, understand its benefits and what she has to do.
• Help mothers initiate breastfeeding within one half-hour of birth. This step now means, for all healthy newborns, skin-to-skin contact from immediately after delivery for at least one hour or until the baby has attached and fed at the breast if this takes longer.
• Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants. Helping mothers to breastfeed effectively with a good technique is a vital step. If infants are separated from their mothers, or are unable to suckle, their mothers need to express their milk. Health workers need skills to help mothers do these things.
• Give newborn infants no food or drink other than breast milk, unless medically indicated. Families and health workers may believe that infants need pre-lacteal feeds of formula or glucose water or other drinks before their mother’s milk “comes in”. This may lead to failure to breastfeed. Infant formula and advertisements in maternities can mislead people on this important point. Breast milk is pure and complete, while giving babies water or other liquids can pose risks due to contaminated water.
• Practice rooming in - that is, allow mothers and infants to remain together 24 hours a day. In many hospitals, newborns are kept in nurseries after delivery. Rooming-in allows mothers and their babies to stay together day and night to bond and to establish breastfeeding.
• Encourage breastfeeding on demand. Babies should feed according to their needs, not a schedule decided by the hospital or mother. Understanding her infant’s feeding cues improved breastfeeding and the mother-child relationship.
• Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants. During the early weeks, the baby’s need to suckle should be satisfied at the breast. Using teats or pacifiers may interfere with suckling and the adjustment of the breast milk supply to the baby’s requirements.
• Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic. Breastfeeding support groups are often part of a community nutrition strategy. Peer counsellors are women from the community, who receive training in breastfeeding support. They often contact mothers in their homes. They are very effective in increasing exclusive breastfeeding.

Drawing attention to these Ten Steps is critical in improving breastfeeding rates. More than 15,000 facilities in 134 countries have been awarded Baby-Friendly status since BFHI began almost 20 years ago. In many areas where hospitals have been designated Baby-Friendly, more mothers are breastfeeding their infants, and child health has improved.

BFHI is gaining ground in Asia, with Thailand being one of 12 developing countries taking the lead in instituting the Ten Steps of baby-friendly practice in as many hospitals as possible. China now has more than 6,000 Baby-Friendly Hospitals and exclusive breastfeeding rose dramatically in the early 90s from 29% to 68% in the mid 90s.

“It’s a totally different scenario in the Philippines where exclusive breastfeeding for infants decreased from 37% in 1998 to 34% in 2003. Use of milk formula and feeding bottles is still a problem. There is much to be done to reverse the effect of bottle feeding and intensive work is necessary to make exclusive breastfeeding the norm in the society,” said Tobin.

Health systems, health care providers and communities must act to make breastfeeding the easy choice for women. Breastfeeding is indeed the best start to life and mothers need everyone’s support to fully enjoy and appreciate their breastfeeding experience.