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UNICEF’s encouragement of a back to basics approach for maternity hospitals shows early success – yet much work remains to be done

FACT: In every respect breastfeeding is the healthiest method of feeding infant children

FACT: While the majority of mothers begin by breastfeeding their babies many discontinue during the first six months, for a variety of societal reasons

FACT: The right circumstances, awareness and support need to be created for mothers to feel comfortable breastfeeding their children throughout infancy

Mothers have every interest in giving their babies the very best possible start in life.  From day one, that involves breastfeeding, but sometimes that is not always convenient or practical. In 1991 UNICEF and the World Health Organization launched the Baby Friendly Hospital Initiative in a global effort to ensure that all maternity hospitals become centres for breastfeeding support.  An initiative that could take two generations to complete is well under way.

The period from birth to the age of three is a time of rapid growth and development of children and represents a vital opportunity to maximise a child’s strong nutritional and immunological foundation.  Intellectual and physical growth is the most rapid, with the doubling of brain size and the quadrupling of body weight.  If a child is malnourished during these early years, much of the damage is irreversible.  The answer lies in prevention.

Breastfeeding has an extraordinary range of benefits.  It has a profound impact on a child’s survival, health, nutrition and development.  It also contributes to child spacing and maternal health.  Breastfed children have at least six times greater chance of survival in the early months – breastfeeding drastically reduces illnesses and deaths from common infections such as acute respiratory problems and diarrhoea, two major child killers, as well as from other infectious diseases.

Breast milk provides all of the micronutrients and nutrients an infant needs for growth for the first six months, while the interaction between the mother and child during breastfeeding has positive repercussions for life, in terms of reduced chronic disease such as diabetes, obesity, asthma, gastroenteritis and some forms of childhood cancers as well as on behaviour, speech and how the child relates to other people.

If every baby is put skin-to-skin at the breast of its mother immediately following birth, hypothermia would be prevented, saving about 200,000 lives annually.  If every baby were exclusively breastfed for the first six months an estimated 1.3 million additional lives would be saved every year, and millions more would benefit in terms of health, intelligence and productivity.  Breast milk is the perfect food – it contains all the nutrients and micronutrients an infant needs for normal growth during the first six months of life.

Breastfeeding stimulates an infant’s immune system and response to vaccinations, and is continually changing to meet babies’ needs.  Breast milk contains hundreds of health-enhancing cells, proteins, fats and enzymes found nowhere else but in mothers’ milk.

And infants are not the only beneficiaries; breastfeeding has an immediate contribution postpartum because it helps the uterus contract more rapidly, thereby reducing blood loss.  Many consider this the final stage of labour.

In the short term, breastfeeding delays a mother’s return to fertility and in the long term it reduces breast cancer, uterine cancer and ovarian cancer, and protects against weak bones in later life.  Women often feel empowered by breastfeeding, once the routine is established, because the body produces higher levels of prolactin, a relaxing hormone, and oxytocin, a bonding hormone. 

Breastfeeding’s benefits are clear.  So where’s the problem?
For mothers, the advantages of breastfeeding their infant children are clear.  Why then does almost every mother begin by breastfeeding but discontinue some time during that first six months, when breast milk is so vitally important for the child?  How could sweetened condensed milk and processed cow’s milk – “formula” - ever be considered acceptable substitutes for breast milk?

What mother would not hope for the very best start for her child?

For some women, particularly young, single mothers who may have a limited income and education, breastfeeding may not represent the priority it should.  A number of circumstances can conspire against a young mother, such as time, peer group considerations, and the subtly attractive advertising tactics of formula manufacturers.  Furthermore, many first-time mothers who breastfeed have spoken of feelings of isolation and embarrassment in a society that can seem sometimes hostile to the practice.  In some countries it is illegal to discriminate against breastfeeding women, but in many countries no such law exists.  Often the attitude of a new mother’s partner and mother can be a crucial influence on her decision to continue to breastfeed or to begin bottle-feeding.

Formula is no real alternative, yet young mothers speak of being “bombarded” by the persuasive marketing of formula-producing companies.  At its best, it only replaces nutritional components of breast milk.  Breast milk, however, changes in composition according to the time of day, the duration of suckling and the age of the child.  Furthermore, the breastfed infant consumes active living cells from the mother that helps combat disease.

Given the right support and advice, virtually any mother can breastfeed.

The younger the baby, the more difficult is the absorption of foreign substances.  A single feeding of formula will disrupt the living cells and normal bacteria that inhabit the gut, and can cause injuries to the baby’s stomach that can take weeks to recover.  The act of breastfeeding itself stimulates proper growth of the mouth  and jaw, and secretion of hormones for digestion and satiety.

Finally, there are hundreds of other factors in breast milk that you cannot include in formula – everything from bifundus factor, which helps the gut grow and long chain fatty acids that help the brain grow, to hormones and enzymes that aid development.  Studies have shown that breastfed infants do better on intelligence and behaviour tests into adulthood.  There has never been a study that shows any advantage of formula feeding over breastfeeding.

How is UNICEF working to promote, protect and support breastfeeding?
In 1991 UNICEF and the World Health Organization launched the Baby-Friendly Hospital Initiative, in which four operational targets with a five-year timeline were agreed upon.  Such a timeline was ambitious in the extreme; 17 years later, the vastness of the social changes necessary to fully support breastfeeding has become abundantly clear.

Yet the operational targets remain in place, and huge strides have been taken that have resulted in the prevention of millions of infant deaths.  The goals of the BFHI are to:

Improve breastfeeding practices within maternity wards in the health system;
Educate all health workers who were trained in these facilities concerning the importance and basic skills of breastfeeding support; and
Enforce within facilities the principles of the International Code of Marketing of Breast-milk Substitutes.

Since 1991, almost 20,000 maternity hospitals in more than 150 countries have been awarded BFHI status.  To receive this designation, a facility must go through an internal and external review, and must be able to show that it meets ten operational standards.  Even where the designation is not achieved, the efforts put into trying to reach all 10 of the BFH standards can influence hospital and community practices, exposing additional new health personnel to these skills, and creating demand among women and families.

Romania’s Gala 2008: towards a Baby Friendly country
Like children in many other countries, Romanian children fall short of good nutritional standards.  In 2005 UNICEF supported the National Integrated Nutrition Survey which showed poor feeding practices amongst young mothers, with only 16 per cent of infants exclusively breastfed for the first six months of life.  Approximately half the population is unaware that the health benefits of breastfeeding begin on day one; a majority of mothers start to breastfeed at birth, but that figure has halved by the time the baby has become two weeks old.

UNICEF Goodwill Ambassador Nana Mouskouri’s time in Bucharest included a visit to a maternity facility at Pantelimon. Pictured also is Romania’s Minister for Public Health, Eugen Nicolăescu

Of Romania’s more than 200 maternity facilities, ten have received BFH designation.  There is clearly room for improvement, and it was with this in mind that UNICEF teamed with Romania’s national television channel, TVR, to launch a Gala Telethon in May 2008.  The goal was to raise enough funds to support a further 20 maternity facilities to become baby friendly, and it was hoped that that would set the momentum for additional facilities to pursue baby friendly status.

“The Baby Friendly Hospital Initiative is a project that holds a great place in my heart,” said Nana Mouskouri, pictured here with Andreea Marin Bănică at UNICEF’s Gala Telethon

An impressive gathering of Romanian celebrities manned the telephones and entertained throughout the evening; these included Romania’s President Traian Băsescu and Prime Minister Călin Popescu-Tăriceanu, who reinforced his government’s endorsement of the BFHI together with Eugen Nicolăescu, Minister of Public Health.  The drive to raise funds throughout the evening’s Gala was hugely bolstered by a visit from UNICEF Goodwill Ambassador Nana Mouskouri, who was interviewed by Andreea Marin Bănică, Romania’s National Goodwill Ambassador and one of Romania’s most prominent television personalities.  Ms Mouskouri spoke passionately of the importance of the cause.  “Children are the future of the world,” she said, adding that “they come into the world completely innocent.  It is our responsibility to give them the very best start in life that we can.”