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Breastfeeding

Background
In both the Dominican Republic and the world, breastfeeding constitutes an essential element of vital importance to ensure the nutritional safety of the child in their first childhood. Breastfeeding contributes to the decrease in malnourishment and at the same time in decreasing the rate of infant deaths during their early childhood. The proper nutrition practices based on scientific proofs are indispensable to achieve and maintain an adequate level of health and nutrition.

Inadequate nutrition and its consequences represent great obstacles towards the sustainable socio-economic development and reduction of poverty. Continuous natural lactation, frequent and by free demand is a significant preventive measure, since the origin of malnourishment constantly lies in an inadequate or interrupted lactation.

Breastfeeding and complementary quality foods at the adequate age, contribute greatly to cognitive development. Also the balancing of the long-chain fatty acids in breast milk, which serve as support for neurological development, exclusive initial breastfeeding and complementary nutrition deal with the lacking of micronutrients and of iron, thus intervenes in the proper neurological development, at the time that they improve tardy academic performance.

The series on Newborn Survival published by the magazine “The Lancet” in 2005, highlights maternal nursing as a profitable intervention and of proven efficiency that can reduce by 13% to 15% infant mortality by reducing incidence and the gravity of infectious diseases, therefore proper complementary nutrition would reduce child mortality by 6%. Of a 50% to 60% mortality rate in children under 5yrs of age is due to malnourishment caused by inadequate complementary foods, to nutrition after an inadequate lactation and LBW (low birth weight).


The micronutrients content in breast milk, especially during exclusive nursing and parting from complementary nutrition, can provide the majority of nutrients in adequate amounts, as well as the necessary levels of protein and carbohydrates. Breastfeeding is linked to a lesser presence of maternal hemorrhaging during post-partum, lesser incidence of breast cancer, ovarian cancer and endometrial cancer, and is also linked to the probability of lesser bone loss during post-menopause.

The production and consumption of breast milk represents an act in full harmony with the environment, since it avoids the accrual of garbage and bottle waist, nipples, formula cans, boxes, sterilization equipment, pollution and unnecessary debris for the environment.

According to the ENDESA results for 2007, 92% of children were once breastfed; independently of exclusively or not; 55% received another aliment prior to nursing; this implies that over half of these babies under 6 months have been receiving other aliments asides breast milk, which means they mix breastfeeding with other foods; 77% uses a bottle thus interfering with the use of same with the mechanism of suction to breastfeeding. The culture of prematurely introducing solid foods is not recommended since it places infants at the risk of illness even death.

Likewise, around 8% (7.8%) of infants aged 0-5mos is being fed exclusively with human milk and barely 12% from 0-3mos receives it. The practice of nursing continues to diminish in the matter that the child advances in age, between 12-13mos only 22% is receiving maternal lactation.

In that same tenor, also identified in ENDESA 2007 that the child mortality rate in our country is 31%. If we increase the exclusive breastfeeding rate we would help contribute to modifying the child mortality rate indicator. Breastfeeding favors spacing between pregnancies, impacting in a positive manner the family economy, likewise this sole intervention in the country could substantially increase the country’s GDP (Gross Domestic Product).

The nation features norms, Law 8-95 on Breastfeeding, and the PAHO/WHO and UNICEF recommend exclusive nursing up until 6mos and with complementary nutrition up until 2yrs or more.

In 2008, a diagnostic study was executed based on the WBTI (World Breastfeeding Trends initiative) in order to explore the real and root causes underlying in the Low Exclusive Maternal Breastfeeding up until six months, perhaps the lowest rate of the region, and implement action to revert the tendency to abandonment of such practice. The IEC indicator (Information, Education, and Communication) revealed great weakness in the implementation of integrated strategies to better the alimenting of children and infants (breastfeeding and complimentary foods)

In this sense, the National Breastfeeding Committee defines as action line, the creation and development of an informative, educational and communication campaign thus contributing to increase the exclusive breastfeeding rate in infants younger than 6mos of age and then complimented by adequate aliments up until 2yrs of age.

For these considerations, UNICEF, in its advisory role to the National Breastfeeding Committee, assumes the technical and financial support for designing and creating the present campaign to be executed by the member institutions of said Committee:

 Ministry of Health with national coverage focused on collective health
 Ministry of Education
 Ministry of Labor
 Ministry of Trade and Industry
 Ministry of Environment
 Ministry of Agriculture
 Ministry of Women
 Ministry of Youth
 Ministry of Culture
 Dominican Institute of Social Security
 Autonomous University of Santo Domingo
 Private Universities
 Dominican Medical College
 Dominican Pediatrics Society
 Dominican Society for Obstetrics and Gynechology
 Dominican Perinatology Society
 PROFAMILIA
 Dominican Association of Registered Nurses
 Dominican Federation of Municipalities
 CONANI
 Project HOPE
 La Leche League International
 Dominican Alimentation Institute
 National Population and Family Council- CONAPOFA
 Caritas Dominicana
 CENISMI
 Order of Malta
World Vision
 Plan International
 Save the Children

And other government entities, NGOs and churches, among them the Pastoral Materno- Infantil, the Administradora de Estancias Infantiles Salud Segura- AEISS so that, in accordance to Law 8-95 on “Maternal Breastfeeding” and its regulation, said campaign be executed nationwide. 

General Objective
Raise and promote awareness nationwide on the BPs and benefits of exclusive maternal breastfeeding up until 6months, and increasing the 7.8% of practicing mothers.

Specific Objectives:

• Scope a population of 100,000 expecting mothers and their families throughout the six main hospitals, in an initial stage.

• Vis-a-vis mobilization with 200,000 families located in the National District, Santo Domingo, San Pedro de Macorís, Santiago, La Vega, San Francisco de Macorís and the five border front provinces.

• Strengthen the capacities and skills in parents and families by assuming optimum nutrition practices (exclusive maternal breastfeeding up until 6mos and parting from 6mos combined maternal lactation with adequate complementary aliments).


• Increasing awareness population-wise about the importance of breastfeeding and the risks involving artificial nourishment.

“Maternal Breastfeeding, the best to ensure the life of your baby”
 
This strategy highlights as its message, that Exclusive Maternal Breastfeeding, is “the best to guarantee the life of your baby”, and it focuses on working with families with children of 0-2yrs, with the interest of promoting survival and child development at a family and community level. Its implementation shall be executed in three phases:

1) Maternal health services at nationwide maternity wards via the Ministry of Public Health and private health care purveyors that commit to becoming child-friendly health facilities;

  2) Social awareness in the communities, including promoter training and

2) Message broadcasting via social communication media.

In a first stage, the principal maternity wards of the country in the National District, Santo Domingo, Santiago, La Vega, San Francisco de Macorís and San Pedro de Macorís will be covered alongside their respective Primary Attention Units (UNAPs) and areas of influence, as well as the border front provinces. In a second phase, the campaign will be implemented nationwide.

The hospitality process
The work at the hospitality level consists in the implementation of the 10 steps of the Baby-Friendly Hospital Initiative -BFHI (*Iniciativa Hospital Amigo de la Niñez -IHAN in Spanish), which feature training of all hospital staff, education for all users on the benefits of maternal nursing, support to mothers on how to breastfeed, early attachment, rooming, and the removal of breast milk substitutes. It is expected that throughout all hospitals involved in the first stage, this campaign reaches a total of 100,000 expecting mothers and their families.

The social awareness process
The National Maternal Breastfeeding Committee features 37 members, among them NGOs, churches and other community-focused organizations, which will play a fundamental role in the social mobilization of local actors.

During the first stage all main areas of influence of the main maternity wards where the Child-friendly Hospital Initiative (*IHAN) is in effect, forming mother-to-mother support groups to thus ensure the same continue maternal breastfeeding once discharged from the hospital.

The support also features training to provincial breastfeeding commissions, formed by government authorities, the media, and civil society organizations, NGOs, nursing counselors and primary attention units.

Social awareness supposes a community labor where a training process will develop with the aid of professionals whom at the same time will train in an initial stage, a total of 2,000 community leaders, whom will work directly with around 200,000 families located in the National District, 
Santo Domingo, San Pedro de Macorís,  Santiago, La Vega, San Francisco de Macorís and the border front provinces. 

This first stage will be executed during the first 6months following the campaign launch and will feature the following visual aids:

Training Curriculum for community counselors
Guide utilized by facilitators to train community counselors in the field of breastfeeding. It features twelve modules on the necessary information for training, featuring a practical participative focus, to all volunteers on the fundamentals and managing of maternal breastfeeding, within an integrated maternal-infant health and nutrition framework.

a) Infomercial (DVD format): 10-minute documentaries featuring health care professionals offering information on maternal breastfeeding, benefits, risks involving artificial alimentation, breastfeeding techniques and population rights, to broadcast in all waiting rooms of health care facilities, to share at community group meetings, among other.

b) Graphic Arts  (Print Material): Set of posters, pamphlets for mothers, personal health care booklet, fathers brochure, flipcharts; all of them focused on the early childhood stage parting from exclusive Maternal Breastfeeding during the first 6months, and breastfeeding combined with complementary aliments parting from 6months as well as nursing techniques.

Intervention via social communication media:
As a supplement and support to the work to be performed in the communities, a package of visual aids has been developed with graphics of emotional focus thus permitting to sensitize and raise awareness in parents with respects to the fundamental role they play in the nourishment of their children.

a) TV  Spots (DVD format): Three (3)  48-second commercials focused on the promotion of exclusive maternal breastfeeding and its benefits.

b) Radio Spots (AUDIO CD ):  Three (3) 45-second radio spots.

The campaign will be broadcast via the mass local media and in the five zones of intervention, groups that work at a community level following up with the tools designed for such purposes and alongside the provincial sub-committees for Maternal Breastfeeding coordinated by provincial health directors and Heads of local hospitals.

Second stage: Will cover the rest of the country promoting the implementation of the CFHI (*IHAN in Spanish), training provincial sub-committees and the broadcasting of all messages via local media located in the provinces.

At the time of culmination of the campaign, the expected result is the achievement of a higher survival rate for children in their early childhood via the proper applying of all alimentation practices.

 

 

 

 

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