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Отчет
03 Октябрь 2018
Социальный мониторинг: региональный отчёт
https://www.unicef.org/eca/ru/%D0%9E%D1%82%D1%87%D0%B5%D1%82%D1%8B/%D1%81%D0%BE%D1%86%D0%B8%D0%B0%D0%BB%D1%8C%D0%BD%D1%8B%D0%B9-%D0%BC%D0%BE%D0%BD%D0%B8%D1%82%D0%BE%D1%80%D0%B8%D0%BD%D0%B3-%D1%80%D0%B5%D0%B3%D0%B8%D0%BE%D0%BD%D0%B0%D0%BB%D1%8C%D0%BD%D1%8B%D0%B9-%D0%BE%D1%82%D1%87%D1%91%D1%82
Согласно данным отчёта "Социальный мониторинг" уязвимые дети больше всего выигрывают, когда страны инвестируют средства в эффективную социальную защиту, включая денежную помощь. В докладе представлены данные о тенденциях и моделях изменения детской бедности и о влиянии социальной защиты на детей в 30 странах и территориях. В нем освещаются…, SOCIAL MONITORSocial protection for child rights and well-being in Central and Eastern Europe, the Caucasus and Central Asia REGIONAL REPORT 2 CHAPTER 1 Analytical framework of social protection for children United Nations Childrens Fund (UNICEF) December 2015 Permission is required to reproduce any part of this publication. Permission will be…
Programme
04 Октябрь 2017
Immunization
https://www.unicef.org/eca/health/immunization
Immunization is a proven and cost-effective public health  intervention, saving the lives of millions of children and protecting millions more from illness and disability.  Immunization is also a wise financial investment - with every $1 invested in immunization returning an estimated $16 in health-care savings and increased economic productivity.  Most countries in Europe and Central Asia have immunization coverage of 95 percent or more for three doses of diphtheria, tetanus and pertussis (DTP), often seen as the measure of national performance on immunization. However, while most national averages for DTP vaccination may be adequate, the regional average is hovering at around 92 percent, a slight decrease from the previous year, which is not high enough to ensure immunity for everyone. Over 70 percent of the region’s unvaccinated infants are from middle income countries, with Ukraine presenting the lowest coverage rate and the greatest challenge. National averages also mask disparities, with Roma children  and those from other ethnic and vulnerable groups, including refugee and migrant children, all lagging behind. Measles outbreaks are a growing problem. Last year there were over 10,000 cases of measles in the region. Despite increased coverage of the first dose of the measles vaccine among children (up from 63 percent in 2000 to 93 percent in 2016) more work is urgently needed, as children are not fully protected against measles unless they receive two doses. Currently, second dose coverage is at 88 percent, which does not provide adequate protection.            In total, over 500,000 children in the region are still not protected against measles - a life-threatening, but easily preventable disease.   There are also concerns about ‘vaccine hesitancy’ – a growing mistrust of immunization among some parents, fuelled by myths and misinformation. Such hesitancy may stem from negative media stories linking a child’s death to immunization without the full facts. It may be influenced by the region’s anti-vaccine movements, which spread anti-immunization messages. Meanwhile, measures to counter vaccine hesitancy and build parental trust in immunization are hampered by a lack of discussion with parents about its importance and the minimal risks.  A baby girl receives her vaccination at a clinic in Serbia. A baby girl receives her vaccination at a clinic in Serbia. Donor support for immunization is falling in some countries that still require such support. Elsewhere, the concern is to ensure financial sustainability for immunization programmes once countries ‘graduate’ from the support provided by Gavi (The Vaccine Alliance). Ongoing reforms in some countries are affecting both the structure and financing of immunization programmes. Some countries, challenged by competing priorities at home and inaccessibly priced vaccines on the global market, experienced several vaccine shortages in 2015–2016, sometimes causing critical disruptions of services. These issues are particularly acute in middle-income countries, many of which self-procure vaccines and continue to face significant challenges in achieving financial sustainability of their immunization programmes. Some countries also lack adequate monitoring of vaccine coverage, which is critical to understand and address any gaps.   As a result of such challenges, the region faces outbreaks of vaccine-preventable disease, such as a polio outbreak in 2015 and an ongoing measles outbreak in Ukraine  – a country where conflict and economic recession have depleted stocks of vaccines and vaccine hesitancy is reducing immunization coverage. There is also an ongoing large measles outbreak in Romania, with over 10,000 cases of the diseases and 38 deaths. During the last five years, measles outbreaks have been registered in Georgia (2013), Kazakhstan (2014), Kyrgyzstan (2015), and Tajikistan (2017). Outbreaks in one country can spread rapidly to others, signalling the interdependence and vulnerability of all countries, whatever their stage of economic development.  
Report
17 Июль 2018
In Focus: Immunization
https://www.unicef.org/eca/reports/focus-immunization
Immunization is one of the world’s most cost-effective public health interventions, saving millions of lives each year, and protecting children from illness and disability. Vaccines have helped to halve the number of child deaths worldwide since 1990 and represent a sound financial investment: every $1 spent on childhood immunizations returns an estimated $44 in economic and social benefits. Despite the achievements of immunization programmes in the Europe and Central Asia Region in recent decades, reported immunization rates are uneven across countries — from as high as 98 percent in Albania to as low as 19 percent in Ukraine. The regional average for Eastern Europe and Central Asia stands at 92 percent, still not high enough to protect all children from preventable diseases. What’s more, there was no improvement in coverage between 2014 and 2016. At national levels, disparities can be shocking, with the most vulnerable children often missing out on immunization. Across the Region, more than half a million children have missed out on their routine measles vaccination, and many countries continue to face outbreaks of vaccine-preventable diseases that threaten the lives and well-being of children. Challenges to immunization include weak political commitment and health systems, ‘vaccine hesitancy,’ and concerns about the financial sustainability of national immunization programmes in middle-income countries. UNICEF knows that the whole Region benefits when ALL countries achieve and maintain high vaccine coverage at both national and sub-national levels. Download file (PDF, 981,23 KB) July 2018
Report
01 Апрель 2013
Tracking anti-vaccination sentiment in Eastern European social media networks
https://www.unicef.org/eca/reports/tracking-anti-vaccination-sentiment-eastern-european-social-media-networks
Page 1 Page 2 A lie can travel halfway around the world while the truth is putting on its shoes. Mark Twains quote is more relevant than ever in times of online communication, where information or misinformation, bundled in bits and bytes, streams around the earth within seconds. SUMMARY DISCLAIMERUNICEF working papers aim to facilitate greater exchange of knowledge and stimulate analytical discussion on an issue. This text has not been edited to official publications standards. Extracts from this paper may be freely reproduced with due acknowledgement. For the purposes of this research, no personal data has been extracted and stored for data collection and analysis. This UNICEF working paper aims to track and analyse online anti-vaccination sentiment in social media networks by examining conversations across social media in English, Russian, Romanian and Polish. The findings support the assumption that parents actively use social networks and blogs to inform their decisions on vaccinating their children. The paper proposes a research model that detects and clusters commonly-used keywords and intensity of user interaction. The end goal is the development of targeted and efficient engagement strategies for health and communication experts in the field as well as for partner organisations. Page 3 CONTENT1. Rationale 2. Introduction 2.1 Social Media: the conversation shift 2.2 Social Media: Fertile ground for anti- vaccination sentiment 2.3 Social Media Monitoring 2.4 Influencers 3. Research Objectives 4. Methodology 4.1 Descriptive and Explorative Research Design 4.2 Data Collection 4.3 Limitations 4.4 Ethical Considerations 5. Empirical Findings 5.1 Networks: Volume and Engagement 5.2 Common Arguments 5.2.1 Religious and Ethical Beliefs 5.2.2 Side Effects 5.2.3 Development Disabilities 5.2.4 Chemicals, Toxins and Unnecessary 5.2.5 Conspiracy Theory, Western Plot and Conflict of Interest 5.3 Influencers 6. Discussion and Recommendations 6.1 Discussion 6.2 Recommendation Acknowledgements Literature Appendix 4 555 78 9 1111121313 1414191920212222 23 252527 313134 Page 4 Over the past few years, the region of Central and Eastern Europe and the Commonwealth of Independent States has been troubled by the rise of a strong anti-vaccine sentiment, particularly via the internet. Wide ranging in origin, motive, source, and specific objectives, this online sentiment has succeeded in influencing the vaccination decisions of young parents, in many instances negatively. A number of factors are at play in this online anti-vaccine sentiment. First, vaccination coverage in this region is generally high. As a result, vaccine-preventable childhood diseases like polio and measles have been absent in most countries for the past few decades. This has led to complacency toward the diseases and has unfortunately made vaccines, rather than the diseases, the focus of debate and discussion. Meanwhile, poorly-managed immunization campaigns in some countries have caused widespread mistrust of vaccines and government vaccination programs. Most countries have run sluggish, high-handed public communication campaigns while avoiding transparent dialogue with the public on possible side effects, coincidental adverse events and other safety issues. Moreover, when new vaccines have been introduced, they have often just exacerbated the publics existing doubts, hesitations or outright resistance. Into this mix, rapid penetration of the internet in the region has provided a powerful, pervasive platform for anti-vaccine messages to be disseminated. Rooted in scientific and pseudo-scientific online sources of information, messages are often manipulated and misinterpreted, undermining the confidence of parents and causing them to question the need for, and efficiency of, vaccines. The result is hesitation towards vaccination, which in large numbers poses a serious threat to the health and rights of children.This paper aims to examine this rapidly growing phenomenon and its global lessons. Depending on the nature of the problem, special strategies need to be developed to tactically address and counter, diffuse or mitigate its impact on ordinary parents. The prevailing approach of most governments in largely ignoring these forces is unlikely to address this growing phenomenon. Governments, international agencies and other partners - in particular the medical community - need to combine forces to identify the source and arguments of these online influences, map the extent to which they control negative decisions, develop more effective communication strategies and ultimately reverse this counterproductive trend. RATIONALE Page 5 The first part of this paper describes how anti-vaccination groups communicate and how social networks connect concerned parents in new ways. The second part emphasizes the role of social media monitoring in strategic communication, based on understanding audience needs. 2.1 Social media: The conversation shifts The rise of social networks has changed both the way we communicate and the way we consume information. Even within the relatively recent internet era, a major evolution has occurred: In the initial phase known as Web 1.0, users by-and-large consumed online information passively. Now, in the age of social media and Web 2.0, the internet is increasingly used for participation, interaction, conversation and community building1. At the same time, conversations or social interactions that used to occur in community centres, streets, markets and households have partly shifted to social media2. Parents, for instance, suddenly have an array of collaborative social media tools with which to create, edit, upload and share opinions with their friends, peers and the wider community. These conversations are recorded, archived and publicly available. 2.2 Social media: Fertile ground for anti-vaccination sentiment In todays information age, anyone with access to the internet can publish their thoughts and opinions. On health matters in particular, the public increasingly searches online for information to support or counter specialised, expert knowledge in medicine3. Due to the open nature of user participation, health messages, concerns and misinformation can spread across the globe in a rapid, efficient manner4. In this way, social media may influence vaccination decisions by delivering both scientific and pseudo-scientific information that alters the perceived personal risk of both vaccine-preventable diseases and vaccination side effects. INTRODUCTION 1 Constantinides et al, 2007 2 Phillips et al, 2009; Brown, 2009 3 Kata, 2012 4 Betsch et al, 2012 Page 6 In addition to this accelerated flow of information (whether accurate or not), social media messages tend to resonate particularly well among users who read or post personal stories that contain high emotional appeal. This holds true for anti-vaccination messages too. In other words, both logistically and qualitatively, social media is intensifying the reach and power of anti-vaccination messages. Negative reactions to vaccines are increasingly being shared across online platforms. All of this leads to a frustrating predicament and critical challenge: Immunizations protect people from deadly, contagious diseases such as measles, whooping cough and polio. But parents influenced by anti-vaccination sentiment often believe vaccines cause autism, brain damage, HIV and other conditions, and have begun refusing them for their children. As a consequence, health workers face misinformed, angry parents, and countries face outbreaks of out-dated diseases and preventable childhood deaths5. Why do anti-vaccination messages resonate with so many parents in the first place? Parental hesitation regarding vaccinations is thought to stem from two key emotions: fear and distrust: Vaccination is a scary act for many children and parents. A biological agent is injected into the child. The way the biological agent works in the childs body is for most people unclear, which appeals to parents fears. The high level of distrust stems from the intersection of government, medicine and pharmaceutical industry. The nature of its act and the fact that vaccinations are mostly compulsory leads to worries among citizens. (Seth Mnookin, 2011) This distrust, along with the interactive nature of social media, suggests an urgent need for health workers to become attuned to arguments and concerns of parents in different locations and of various cultural backgrounds. To achieve more synergistic relationships with an audience, organisations need to shift their communications strategy from getting attention to giving attention6. Compounding this challenge is the fact that some anti-vaccination groups are not merely sceptics or devils advocates, but operate in an organized, deliberate and even ideological manner. These anti-vaccination groups often employ heavy-handed 5 Melnick, 20116 Chaffrey et al, 2008 Page 7 communication tactics when dealing with opponents: they delete critical comments on controlled media channels, such as blogs7 ; they mobilize to complain about scientists and writers critical of their cause; sometimes they go going as far as to take legal action to prohibit the publishing of pro-vaccine material. Governments and organisations aim to keep parents accurately informed about vaccinating their children. As more of the public conversation indeed battle takes place across social media, there is an urgent need to understand this online landscape. This, in turn, requires the use of effective monitoring tools. 2.3 Social media monitoring Social media analysis plays an important strategic role in understanding new forms of user-generated content8 . Indeed, this type of monitoring has become a leading trend in Marketing, PR, political campaigns, financial markets and other sectors. As demand for this kind of data increases, more monitoring tools are becoming available. These tools search social networks for relevant content, and archive the publicly available conversation in a database. Researchers conduct their internet analysis primarily by formulating combinations of keywords that can be placed in relation and weighted for importance. There are four different types of social media monitoring: Monitoring by volume looks at the amount of mentions, views and posts a topic, organization or user receives. Monitoring by channels maps and examines the various networks that users use to exchange content. Monitoring by engagement seeks deeper insight into how many users actually respond, like, share and participate with the content. Monitoring by sentiment analysis is a qualitative approach that uses word libraries to detect positive or negative attitudes by users towards an issue9. The first phase in social media monitoring is listening to what users say, because in order, for instance, to engage effectively with parents on social networks, it is important to know what they are talking about10. 7 Kata, 2012 8 Cooke et al, 2008 9 The approach must employ qualitative analysis as machines are not able to track sarcasm or slang. 10 Kotler et al, 2007 Page 8 Social media monitoring is a young discipline that began just a few years ago, and in its initial phase the practice faced a number of challenges. Data was very complex, so first generation monitoring tools produced results that were unstructured and generally overwhelming11. Even when that data was sorted and structured, organizations struggled to generate actionable management recommendations from it12. Since that time, however, social media professionals and research communities have made steady progress in overcoming the early challenges. 2.4 Influencers Recent studies on social media networks emphasize the central role played by influential individuals in shaping attitudes and disseminating information13. Indeed, it is argued that a group of such influencers is responsible for driving trends, influencing public opinion and recommending products14. One study found that 78% of consumers trusted social peer recommendations, while just 14% trusted advertisements15. Intensive interaction and content sharing through social media means that an audience instinctively determines its own opinion leaders. What makes opinion leaders particularly interesting and important from our perspective is that they add their personal interpretation to the media content and pass it on to their audience. Depending on whether these influencers speak responsibly or not, this can have positive or negative impact on the goal of disseminating accurate information. In his book The Panic Virus, journalist Seth Mnookin offers some examples of controversial influencers: A British gastroenterologist, Andrew Wakefield, entered into the vaccine discourse and alleged that the measles-mumps-rubella vaccine might cause autism. The medical community eventually dispelled his arguments and he lost his medical license. For a decade Wakefield - though not a public health specialist - very successfully disseminated misleading information and garnered a significant social media following. Meanwhile, actress and model Jenny McCarthy has become another self-proclaimed expert on vaccine safety. Through frequent public appearances she has positioned herself as an 11 Wiesenfeld et al, 201012 Owyang et al, 201013 Tsang et al, 2005; Kiss et al, 2008; Bodendorf et al, 201014 Keller and Berry, 200315 Qualman, 2010 Page 9 educated, internet-savvy mother set on challenging the medical establishments information about vaccinations. This, too, has helped fuel the recent growth in anti-vaccination sentiments. The public following and authority gained by Wakefield and McCarthy demonstrate how with the proliferation of online channels and the user as the centre of attention, it becomes difficult for information seekers to differentiate between professional and amateur content16. By the time the record is set straight, trust in immunization is been partly destroyed. Fostering the positive opinion of influencers in communities can have a disproportionately large impact in terms of online reputation17. Though they may not know each other in the real world, and despite ever-expanding advertisement platforms and sources, consumers around the world still place their greatest trust in other consumers18. Audiences listen to opinion leaders because they are known to be independent, credible and loyal to their peers19. Identifying and influencing the influencers of the social media conversation in the region should therefore be part of any effective strategy to reinforce positive messages in the vaccination debate. Though the internet is increasingly used to search for health information, a number of questions about social media and vaccination decisions are still unanswered: Which channels are used by anti-vaccination groups? What are the key arguments and conversation themes? What makes anti-vaccination messages appealing to parents? Who are the opinion leaders in online discussions? What are the best strategies to respond to anti-vaccination arguments? This paper seeks to understand the internal dynamics of anti-vaccination sentiment in social media networks in Eastern RESEARCHOBJECTIVES 16 Cooke et al, 200817 Ryan et al, 200918 Nielsen, 200919 Weiman, 1994 Page 10 Europe20. These insights are expected to help health workers, partners and national governments to develop appropriate response strategies in order to convince the public of the value, effectiveness and safety of vaccinations. The objectives of this research are: 1. To monitor social media networks, consolidate existing data and information from partners. 2. To categorize and analyse conversation themes, based on volume of discussion, influence, engagement and audience demographic as appropriate. 3. To identify influencers in the different language groups and platforms. 4. To contribute to a set of recommended strategies to address specific anti-vaccine sentiment around the various conversation themes. This content analysis is expected to help us understand the motivations and mind sets behind the sentiment, and offer clues that can inform the development of a strategy to effectively address the phenomenon. The research is also expected to help drawing comparisons between the anti-vaccination sentiment phenomenon and similar sentiments expressed against interventions in nutrition, child protection and other areas of UNICEF practice. This paper is supported by UNICEF Department of Communication in New York and UNICEF Regional Office for Central and Eastern Europe and the Commonwealth of Independent States. The region covers 22 countries and territories: Albania, Armenia, Azer-baijan, Belarus, Bosnia & Herzegovina, Bulgaria, Croatia, Georgia, Kazakhstan, Kosovo (UN Administered region), Kyrgyzstan, TFYR Macedonia, Moldova, Montenegro, Roma-nia, The Russian Federation, Serbia, Tajikistan, Turkey, Turkmenistan, Ukraine, Uzbekistan. UNICEF does not have a country programme in the Russia Federation but is in discussions to develop a new mode of engagement. Page 11 In order to assess the dynamics of the anti-vaccination sentiments in the four languages, a systematic mapping and content analysis via social media monitoring is proposed. For the purpose of stakeholder monitoring in social media, a combination of descriptive and exploratory methods in form of quantitative and qualitative observation is proposed. According Wiesenfeld, Bush and Skidar (2010) it is reasonable to combine both methods because social media monitoring offers the richness of qualitative research, with the sample sizes of quantitative research. It may also give the opportunity to overcome problems associated with each research method in order to understand stakeholders dynamics in social media. 4.1 Descriptive and Explorative Research Design The descriptive methodology involves recording the activities of users and events in a systematic manner. Information is recorded as events occur and archived. Descriptive research in this case involves: Figure 1: Research Process for data gathering and analysis. METHODOLOGY 12 Aggregating text from public accessible social networks in in English, Russian, Polish and Romanian language. Cleaning and categorizing the data over time. The data is categorized and analysed into reoccurring conversation themes, based on volume of posts, engagement and audience demographic as appropriate. The exploratory methodology follows the descriptive research to allow for the interpretation of patterns and to provide background understanding of sentiment and attitudes of users. The results of the structured observation will be put into context by the human judgement of the researcher through the participant observation. In this research, the researcher will be a complete observer and will not interact with the users during the participant observation (Saunders et al, 2009). 4.2 Data Collection Traditional sampling techniques such as random, convenience or judgemental sampling are difficult to apply to a fluid social media environment. On top of the social media measurement process, the selected social media channels feed into the sample set. The posts are further categorized into different issue arenas that will be associated with relevant stakeholders. Figure 1 presents the data collection process for monitoring stakeholders in social media.The process contains the following six steps: 1. Channels: The first step of the data collection process involved the selection of relevant social media channels. Social media monitoring is instead generally considered to provide a complete set of all contributors, because tools like Radian6 or Sysomos are designed to capture a wide range of social media channels, such as blogs, forums, Twitter, Tumblr, Youtube and Facebook. 2. Demographics: The software gathered relevant posts that were posted in English, Russian, Polish and Romanian language3 during the period of 1 May and 30 July 2012. Posts could be submitted from all regions worldwide. 3. Context: The quality of data collection is determined by how well the collected data is gathered with regards to formulated searches. Keyword logic and search profiles were employed to filter the data. The full list of keyword combination can be found in Appendix A. 3The approach must employ qualitative analysis as machines are not able to track sarcasm or slang. Page 13 4. Data Collection: Relevant social media mentions that contained an issue-related keyword in relation to a stakeholder-related keyword was archived in the database. The list of relevant mentions was stored chronologically and assigned an ID. The full list of exported information about each mention was stored in a separate EXCEL file. 5. Data Analysis: The empirical application and content analysis of the relevant posts can be found in Chapter 6. 4.3 Limitations There are limitations in terms of reliability and validity of the recorded data. The data collection covers a three-months period. There is a need for caution when generalizing the data because events and evolution of discussions may alter the findings in other time periods. Therefore, limitations in reliability refer to reproducibility of research results. Reliability in the extent to which measures are free from error and therefore provide consistent results, such as the consistency of data availability in social media monitoring, is the second limitations. Quantitative observation has relatively high reliability because it reduces the potential for observer bias and enhances the reliability of data (Malhorta et al, 2007). However, social media monitoring might carry the risk of monitoring bias, as the relevant posts are extracted through keyword logic that is developed by the researcher. The collected data cannot be regarded as complete. For example, the share of Russian-speaking discussions seems to be fairly low compared to the amount of users accessing social media. Governmental control and censorship might also be contributing for lower volumes.The external validity, which is defined as the extent to which the research results are applicable to other research settings (Malhotra et al, 2007), is relatively low. Because of the richness of data, the sampling needs to be based on the experience of the researcher. As a disadvantage, the lack of established sampling technique in social media limits the ability to generalize the findings to other relevant issue arenas or stakeholders in the population. However, the ability to generalize the results was enhanced by careful use of the theoretical terms and relationships in the stakeholder literature (especially Freeman, 1984; Mitchell et al, 1997; Luoma-aho et al, 2010; Owyang et al, 2010). 4.4 Ethical Considerations Monitoring social media conversations raises two important questions about a) the protection of privacy, and b) ethical concerns. The growth of interest in social media monitoring has Page 14 triggered a new debate about ethics, which centers on what is in the public domain and what is not (Poynter, 2010). Privacy is a big issue, and social networking sites are under public criticism for lax attitudes regarding the security and respect of users privacy (Wakefield, 2011). It is the responsibility of the market researcher to protect a respondents identity and not disclose it to external audiences (Malhotra et al, 2007). Social media monitoring offers a rich volume of data, however the Internet is largely unregulated. The data of users around the world is stored on servers in the US and completely available to the US authorities. What might seem legal to the researcher may not necessarily be deemed morally right by society. Public interactions in social media are available for anyone and can be assigned to a personal IP address, geographic location, language, date and even specific computer. For the purposes of this research, no personal data has been extracted. The IP addresses and geographic locations have not been stored in the excel exports as it is not necessary for the purpose of the research. A unique post ID identifies each post. The following findings start with an overview of the networks used by the anti-vaccination community. Trends in volume and engagement are outlined in 5.1. In 5.2, clusters of common belief of the anti-vaccination sentiment are categorized and explained. The importance of influence in the anti-vaccination discussion is illustrated 5.3 because it is critical to understand that communication needs require adjustment to each country or region, which itself can present a challenge. 5.1 Networks: Volume and Engagement During May to July 2012, the researchers recorded messages with anti-vaccination sentiment from 22,349 participants. The majority of participants spoke English, followed by Polish, Russian and Romanian. EMPIRICALFINDINGS Page 15 Figure 2: Participants of anti-vaccination discussions per language. Across all four researched languages, blogs are the most frequently used channel for posting anti-vaccination content in social media. Blog is short for weblog, which is a website normally maintained by an individual (or group of individuals) and updated with regular entries. Entries are typically displayed in chronological order and tagged with relevant keywords and phrases. Blog visitors usually have the opportunity comment and share the content on blogs. Blogs are by far the most important channel in terms of volume of posts in Romanian (86% of all posts) and Polish (85% of all posts). In Russian discussions, 65% of all posts are submitted on blogs and in English nearly half of the anti-vaccination content (47%) is posted on blogs. Facebook is the second largest channel in terms of volume of posts. The social network has a share of 25% in English speaking networks, 13% in Polish, 8% in Romanian, and 5% in Russian channels. Facebook allows users to build personal profiles accessible to other users for exchange of personal content and communication via the Facebook. Twitter, which allows users to send brief (<140 character-long) updates, is the second largest channel in Russian-speaking (24% of the total volume) and fourth with 5% in English-speaking anti-vaccination communities. Other channels to consider are News websites and Forums in which users post comments to engage in discussions about specific topics. Since 68% of all participants in the anti-vaccination discussions during the observed time-period speak English, the dataset is able to reveal more accurate insights into demographics compared to the other languages. Insights in all languages can be found in Appendix 4, while the following analysis focuses on the English Page 16 data set. The English dataset also reveals that blogs have generally the highest rates of mentions (61%), conversations (67%), posts (67%) and interactions (43%). Based on the volume of posts, it is a logical consequence that most engagement takes place on blogs. Engagement is defined as followed: Post: An initial message submitted to a social networking site, i.e. a blog post, Facebook status, tweet, video, etc. Interaction: Any activity created as a direct response to an initial post, i.e. comments, likes, retweets, @replies, etc. Conversation: The sum of a post and all its related interactions. Note: a post with at least one interaction is considered as conversation. Mention: An appearance of search terms in a public social media space. Figure 3: Distribution by channel for Romanian, Russian, English and Polish networks Page 17 Blogs, forums, and Facebook are the leading networks for anti-vaccination discussions in English during the observed time-period. In other words, the anti-vaccination sentiments are expressed on those platforms through posting user-generated content. However, while conversations on forums only makeup 2% of total conversations, they account for 25% of all interactions among users. This indicates a heavily engaged audience. It can Figure 4: Mentions, Conversations, Posts and Interactions per channel. Page 18 be argued that opinions are formed during interactions among users and therefore, it is vital to add pro-vaccination content to the discussions on forums. Similarly, Facebook only contains 9% of conversations, but 21% of interactions. Both channels are important to consider for interactions with the anti-vaccination sentiment even if more posts occur on blogs. Similar findings occur in Forums. Forums are designed to be interactive conversation, where topics are discussed in greater depth. The English dataset is a reflection of this distinguish feature 16% of all posts and 25% of all interaction occur on Forums. The figures show that while the volume of content on Forums is relatively low, the engagement is an important strength that shaped the opinion in the anti-vaccination community. Figure 5 indicates that the data skews towards female audiences when issues such as developmental disabilities (59%), chemicals and toxins (56%) and side effects (54%) are discussed within the anti-vaccination sentiment, whereas men focus on arguments around conspiracy theory (63%) and religious/ethical beliefs (58%). Anti-vaccination social media participants are approximately 56% female and 44% male. Figure 5: Gender comparison in English per argument. Page 19 5.2 Common Arguments The amount of argument-mentions in anti-vaccination sentiment changes significantly by language during the observed time-period. Figure 6 illustrates that conspiracy theory and religious/ethical beliefs are the main topic trends in English, while religious/ethical beliefs drive the majority of discussions in Russian speaking anti-vaccination discussions. Polish anti-vaccination discussions are driven by arguments about side effects and chemicals and toxins in vaccines. The issue of chemicals and toxins is the major driver in Romanian discussions during the observed time-period. The arguments are described in detail in the following sections. The categories are based on keyword strings that were narrowed down over time. Issues should not be regarded in a static way, they might overlap and are interconnected. 5.2.1 Religious and Ethical Beliefs Religious and ethical discussions are especially active in discussion in Russian, with 96% of all anti-vaccination discussions focused on that issue. In English discussions, 32% of all anti-vaccination discussion use religious and ethical arguments. The arguments are less relevant in Polish (5%) and Romanian (0%) speaking anti-vaccination discussions. The main train of thought derives from Figure 6: Allocation of arguments by language for the anti-vaccination sentiment. Page 20 the belief that humans are created just as they should be and external interference is not required. My body was designed by God to be self healing and self regulating and no man will be able to do better than God is a quote by a female blog commentator from the US. Another user states, anything that involves substances that should never belong in a humans body, should not be injected or consumed without that individuals consent. Anti-vaccination advocates believe in homeopathy and alternative medicine. My BodyMy Decision writes a community member from Australia. A broad sentiment that mandatory vaccination is a violation of human rights can also be detected. From an ethical standpoint, the anti-vaccination community claims that it is a basic human right to be free from unwanted medical interventions, like vaccine injections. The same kind of argumentation can be recorded in all four languages. On June 15th 2012, the Polish Parliament voted to change the existing laws on vaccinations. The Act on Preventing and Fighting Infections and Infectious Diseases in Humans and in The Act on National Sanitary Inspection has created controversy among social media users because of it makes vaccination mandatory. The anti-vaccination advocates were sending petitions to the Polish President demanding him to stop the act. The petition received support from some representatives of the Catholic Church, but not an official support from the church as whole. Radio Maryja, the most powerful independent catholic media in the country, also critiqued the act based upon: The argument that vaccines are made based on cell lines derived from the bodies of babies killed by abortion. The notion of unethical activities by campaigning teenagers and women to be vaccinated against HPV infection and it is promoting immoral, and disorderly behaviour in the area of sexuality. 5.2.2 Safety and efficacy Side effects are the most common anti-vaccination theme in Polish networks (28%), but they also play a role in English networks (9%) and Romanian (5%). The argument is mentioned in less than 1% of all anti-vaccination discussions in Russian language. Typically, parents who reach out to online communities because they are unsure about vaccines trigger the discussions about side effects. Individual stories from parents are powerful because they humanize the discussion. One user writes, My baby is 5 months old, not vaccinated and he is going through pertussis right now! Its very scary! I HATE it! I have 3 children, the other 2 were vaccinated but Im scared to vaccinate my baby! Any other mommys new at Page 21 this? This quote reflects a level of fear and uncertainty about the right thing to do, even though the mother has experienced both the effect of vaccines and vaccine-preventable diseases. Another parent writes: My brother, sister in law, and all three kids under the age 5 were vaccinated for whooping cough and they all got it! An argument in a Russian network claims that live vaccines can mutate in the organism and create deadly strains. The fear of side effects leads to discussion about vaccines causing diseases and death. A user from the UK argues, The only way you can get this virus is if it is injected into you. Besides individual stories, argumentation backed by figures without context or sources are equally powerful in fostering fear of vaccines. For example, a member in one English network posts: Vaccinated children have up to 500% more diseases than unvaccinated children. Community members in Russia postulate that vaccinated children get sick 2-5 times more often than non-vaccinated children. For example in Romania, school nurses perform the mandatory vaccination during class, which is seen as a human rights violation and a safety issue. Parents are sceptical about the skills of the school nurses and feel surpassed by authorities in its decision to have children vaccinated. A user in a Polish anti-vaccination community states: I am a mother of two disabled children. When my daughter was five months old, she had a negative reaction to the vaccine, now she has been diagnosed with autism and mental retardation. For 10 years, I did not vaccinate my children and I would not want the right to decide on this matter taken away from me. I am an educated person, and have researched the subject and do not believe in the efficacy or safety of vaccinations. 5.2.3 Developmental Disabilities Another reoccurring argument in the anti-vaccination sentiment claims that vaccines contain toxins and harmful ingredients. Injecting vaccines into the body of a child leads to brain injury and developmental disabilities. This theme is discussed in 15% of all English and Polish speaking anti-vaccination discussions. Development Disabilities was in less than 1% of anti-vaccination discussions mentioned in Russian or Romanian networks. The arguments evolve from sentiment surrounding vaccines posing challenges to the immune system and producing antibodies that may cause autoimmune diseases. Another notable argument is that vaccines are not able to fight off the mutant viruses that develop over time. Across communities, anti-vaccination advocates link vaccines to Page 22 epilepsy, autism and neurodegenerative diseases (Parkinson and Alzheimer). A member of the Polish community writes: Mercury causes developmental disorders in children (including epilepsy and autism), in adults, neurodegenerative diseases (Parkinsons and Alzheimers), and degenerative changes in the reproductive systems of men and women, impairing their ability to reproduce offspring. It is notable that figures are used based on estimates by the author without links to sources. A Russian speaking user notes that vaccinations against pandemic influenza H1N1, also known as swine, can lead to the development of Guillain-Barr syndrome, acute poliradikulita in adults, according to Canadian researchers, published in the journal JAMA. 5.2.4 Chemicals, Toxins and Unnecessary(administration of vaccines) Our doctor has advised us to avoid vaccines in absence of a direct disease risk, since the long-term side effects have not been studied writes a member of an English-speaking community. One common argument recorded in the anti-vaccination sentiment is that studies about risks and impact of vaccinations are insufficient. Vaccines have not been tested enough and have concerns regarding the lack of long-term side effects studies. Another user states that I would really want to know whether and how well vaccine manufacturers test their final vaccine products () and how much contamination they discover. A common belief is that children having a vaccine-preventable illness just need food, water, and sanitation. In Polish communities, members use the example of Scandinavian countries lobbying for a ban of questionable and potentially harmful ingredients in vaccines. The notion that Scandinavian countries banned Thimerosal a long time ago and they have a much lower percentage of children with autism was classified was an important argument for users. Drawing on that example, the most common belief in Polish communities is that mercury may cause autism. A Russian-speaking user concludes, a recent large study confirms the results of other independent observations, which compared vaccinated and unvaccinated children. They all show that vaccinated children suffer 2 to 5 times more often than non-vaccinated children. Sources or links to the recited studies are not provided. 5.2.5 Conspiracy Theory, Western Plot and Conflict of Interest In English-speaking anti-vaccination communities (24%), a strong distrust against governments and pharmaceutical industry is Page 23 recorded. The same applies for Polish (5%), Russian (1%) and Romanian (3%) at a smaller scale. However, the U.S. and western governments are viewed critically when discussing about governments and conflict of interest. In Polish networks excessive vaccinations are seen as promoted by pharmaceutical companies in order to gain profits. The role of the pharmaceutical industry is discussed mostly negatively. The sector is regarded as corrupt marketing machine. An English-speaking user states that: In the vaccine industry, scientific fraud and conflicts of interests are causing a similar cycle of deaths and injuries that is being concealed and denied by regulators and vaccine manufacturers. The industry is viewed as profit-driven and has moved from its original purpose to save lives and protect humans. Romanian discussions directly blame the U.S. for purposefully infecting people with HIV using polio vaccines. Users create a direct link between vaccines and widespread HIV in Romanian orphanages. In the same sense, users claim that vaccines are being used against the Romanian populations. According to members of the anti-vaccination sentiment, vaccines against polio and chickenpox are used in Romania, which are not used in the U.S. anymore. Polish anti-vaccination communities state the examples of swine flu and bird flu two years ago. According to the users, both cases are plots by giant pharmaceutical companies. Some countries desperately bought a huge quantity of vaccines, while Poland acted rationally and did not buy the vaccines, which saved the state budget a couple of billion. The activists are suspicious because the epidemic ended after the new vaccines were purchased by several governments. The distrust against governments is also reflected in conspiracy theories. Patterns in English-speaking communities suggest that immunization is used to control and reduce the world population. One strain of argumentation is that vaccines that are not allowed in developed countries are imported to developing countries in order to reduce population growth. 5.3 Influencers Opinion leaders in anti-vaccination sentiment show varying characteristics across countries. However, they often appear to be well educated in alternative medicine. Some have no college education; others are in the medical field (such as nurses). A high level of volume and interaction can be recorded for influencers. They often subscribe to social channels of homeopaths and Page 24 alternative medicine advocates but they can be found across platforms. The following section lists a range of influencers that are active in different channels or languages: Name Position Facebook Fans Twitter Followers Blog Language Dr. Tennpen-ny The Voice of Reason about Vaccines 36,282 1,475 Yes English The Truth About Vac-cines Answering questions from concerned parents 21,246 N/A Yes English International Medical Council on Vaccination Purpose is to counter the messages asserted by pharmaceutical com-panies, the government and medical agencies that vaccines are safe, effective and harmless 7,983 N/A Yes English The Refusers "Vaccination choice is a fundamental human right." 9,069 12,457 Yes English Mothering Magazine Mothering is the pre-mier community for naturally minded par-ents. 66,504 102,173 Yes English Oglnopo-lskie Sto-warzyszenie Wiedzy o Szczepieniach STOP NOP Protest against new laws for mandatory vaccinations in Poland and against disinforma-tion campaigns about the effectiveness and safety of vaccines. 3,203 N/A Yes Polish STOP Pr-zymusowi Szczepie Petition campaign against new new laws for mandatory vaccina-tions in Poland. 2,866 58 Yes Polish Table 1: Examples of influencers in the anti-vaccination sentiment in social media. Page 25 With respect to the above-mentioned arguments, opinion leaders in the anti-vaccination movement put an emphasis on highlighting negative stories that focus on individual cases. In some cases, they blame outbreaks on shedding vaccinated children who get unvaccinated children sick. The argumentation is based on the conviction that vaccines are unsafe and dont work. A list of common arguments by arguments by influencers per language can be obtained in Appendix B. In this section the research question will be discussed in light of the theoretical and empirical findings. It needs to be noted that the discussion only focuses on engagement with anti-vaccination advocates in the four researched languages. This does not include pro-vaccination movements, medical professionals, partners or others. The discussion will propose a model that illustrates the different drivers of anti-vaccination sentiment based on three elements. The recommendations section builds on the three elements of the model and provides practical advice for communication strategies. 6.1 Discussion In order to develop engagement and messaging strategies for anti-vaccination sentiment, it is vital to have an abstract understanding of what drives users to become suspicious about vaccinations. Based on the findings, the paper proposes a model of anti-vaccination sentiment identification and salience. We classify three main spheres that attribute to a negative sentiment towards vaccine, which help us in the identification of trends within the anti-vaccination sentiment. The classification is illustrated in the following figure: DISCUSSION &RECOMMENDATIONS Page 26 The first attribute is the individual sphere. The main motivations for users to get involved are highly personal matters driven by concern and fear. When it comes to vaccinations, some parents are not sure what the right decision is. Am I a good mother if I do not get my child vaccinated or is it my responsibility as a caring parent to ensure the best protection for my child? Personal testimonies of other parents, especially negative stories, have a huge impact on the parent and fuel the concern. The second element that characterizes the anti-vaccination sentiment is the contextual sphere. The main driver behind the contextual sphere is a distrust of governments, pharmaceutical industry, scientific bodies and international organizations. It seems to be overwhelming for parents to understand the role of the big players. An interesting observation is that users in the contextual sphere do not seem to have a general resentment against vaccines per se but most arguments focus on lack of transparency in the decision processes as well as the potential conflict of interests trigger distrust. The third attribute is labeled as transcendental sphere. Negative attitudes towards vaccinations are derived from idealistic, religious and ethical beliefs. Arguments are rooted in strong beliefs and appear dogmatic, such as God creates us in the most ideal way or a body has its natural balance. Figure 7: Model of anti-vaccination sentiment identification and salience. Page 27 Individual, contextual and transcendental sphere are the key attributes of a member of the anti-vaccination movement. We argue that the various combinations of these attributes are indicators of the salience of members. We can identify four groups that derive from Figure 3. In order to understand salience within anti-vaccination community members, we propose the following classification Core Members are users that apply to all three spheres. They are concerned about side effects, distrust the government and live according to strong religious or ethical beliefs. Intense Members are members that apply to two of the three spheres. For example, a user might have concerns about vaccinations based on an individual sphere and also carry distrust against the pharmaceutical industry. But they are not driven by any idealistic beliefs. Alert Members are users that apply only to one of the three spheres. The doubt about vaccines derives only from one sphere and has human characteristics. They seem to be less convinced of the harm of vaccinations than the other two member groups. There is a fourth group of users, the Non-Members. They simply do not apply to any of the classification. We argue that Alert Members are easier to convince of the necessity of vaccines than Intense Members. Core Members are the hardest to convince, because the arguments against vaccines are based on various foundations. The findings also show that the intensity of argumentation, the interaction and the volume varies between the spheres. Therefore, the next section outlines practical recommendation on how to draft engagement strategies for each sphere. 6.2 Recommendations The following graphic summarizes the framework for the engagement and messaging plan that enables communication officers and health workers to react to the anti-vaccination sentiments. The framework is designed to be customizable for local realities. However, it does provide an overarching guidance for communication and campaigning initiatives. Members of the individual sphere should be approached with an emotional appeal. Users in this sphere go online and search for information in order to make an informed decision. Content that encourages parents to get their children vaccinated needs to be easy to find. Hence, search engine optimization plays an important role in the outreach strategy. Search marketing is used to gain visibility on search engines when users search for terms that relate to immunization. In order to appear on top if the search Page 28 results two general approaches should be considers: Organic search (SEO): When you immunization or vaccines into a search engine like Google or Yahoo!, vthe organic results are displayed in the main space of the results-page. For example, when parents search for information about vaccinations, pro-vaccine information should rank on top of the search engine results. By optimizing websites and posts, organizations and governments can improve the ranking for important search terms and phrases (keywords). Engaging actively in discussion and providing links to pro-vaccination content also helps to increase the visibility in the ranking. Paid search (SEM) enables to buy space in the sponsored area of a search engine. There are a variety of paid search programs, but the most common is called pay-per-click (PPC), meaning the information provider only pays for a listing when a user clicks the ad. The emphasis of the content strategy is to empower parents to ask doctors the right question in order to build confidence for the decision making process. Rather than criticising parents choices not to vaccinate, the messaging should promote an individuals ability to make the world a safer place for children. The communication strategy should also highlight the individual right and responsibility to choose to vaccinate. Through emotional Figure 8: Engagement Matrix for core spheres of the anti-vaccination movement. Page 29 messaging, hesitating parents should receive key information and explain how their choices affect their own children and the ones of others. The communities in the contextual sphere source their scepticism from general distrust against the large players involved in the vaccination industry. The engagement strategy should be based on a rational appeal that focuses on the hard facts of vaccines. It is important to avoid obvious communication tactics. Transparency about vaccines, testing, ingredients, potential side effects, funding and preventable diseases is crucial to reduce distrust. The messaging should also take into account past errors in vaccine campaigns by governments and suppliers in the regions and most importantly focus on the lessons learnt and how processes have been improving since then. Transparency can be built through a multi-channel approach that features the development of vaccines with expert testimonies. Successful cases, such as the near eradication of polio as a global effort, help to reduce distrust as well. This can be backed by official statistics on how infant mortality rates have been reduced over the past 20 years. Countries that generally have a favourable public perception, such as Scandinavian countries,
Report
30 Июль 2018
Capture the moment
https://www.unicef.org/eca/reports/capture-moment
CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING 1 CAPTURETHE MOMENT Early initiation of breastfeeding: The best start for every newborn 2 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING United Nations Childrens Fund (UNICEF) July 2018 Permission is required to reproduce any part of this publication. Permissions will be freely granted to educational or non-profit organizations. Please contact: UNICEF Nutrition Section, Programme Division andData, Analytics and Innovation, Division of Data, Research and Policy3 United Nations PlazaNew York, NY 10017, USA email: nutrition@unicef.org At WHO contact: nutrition@who.int ISBN: 978-92-806-4976-5 For the latest data, please visit:https://data.unicef.org/topic/nutrition/infant-and-young-child-feeding/ Suggested citation:UNICEF, WHO. Capture the Moment Early initiation of breastfeeding: The best start for every newborn. New York: UNICEF; 2018 Notes on the maps in this publication: This map is stylized and not to scale. It does not reflect a position by UNICEF on the legal status of any country or territory or the delimitation of any frontiers. The dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties. In addition, the final boundary between the Sudan and South Sudan has not yet been determined, and the final status of the Abyei area has not yet been determined. Photo credits: On the cover: UNICEF/UNI114722/Pirozzi; page 6: UNICEF/UNI95002/Pirozzi; page 12: UNICEF/UNI11851/Pirozzi; page15: UNICEF/UNI164740/Noorani; page 19: UNICEF/UN0156444/Voronin; page20: UNICEF/UNI94993/Pirozzi; page 23: UNICEF/UN0159224/Naftalin; page 26: UNICEF/UNI180267/Viet Hung; page 29: UNICEF/UNI38775/Pirozzi CAPTURE THEMOMENT Early initiation of breastfeeding: The best start for every newborn 4 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING AcknowledgementsThis report was prepared by UNICEFs Nutrition Section (Programme Division), the Data and Analytics Section (Division of Data, Research and Policy) and the Division of Communication, in collaboration with WHOs Department of Nutrition for Health and Development and the Department of Maternal, Newborn, Child and Adolescent Health. Report team UNICEF, Programme Division: Maaike Arts, France Bgin, Willibald Zeck, Carole Leach-Lemens and Victor M. Aguayo. UNICEF, Division of Data, Research and Policy: Vrinda Mehra, Julia Krasevec, Liliana Carvajal-Aguirre, Tyler A. Porth, Chika Hayashi and MarkHereward. WHO: Laurence Grummer-Strawn, Nigel Rollins, and Francesco Branca. Communication teamUNICEF: Julia DAloisio (editing), Yasmine Hage and Xinyi Ge (fact checking), Nona Reuter (design), Irum Taqi, Guy Taylor and Shushan Mebrahtu (advocacy), Kurtis Cooper and Sabrina Sidhu (media). UNICEF gratefully acknowledges the support of the Bill & Melinda Gates Foundation, UNICEF USA and the Government of the Netherlands. UNICEF and WHO would like to extend special thanks to their partners in the Global Breastfeeding Collective for their breastfeeding advocacy efforts. List of abbreviationsBFHI Baby-friendly Hospital Initiative CHW Community health worker DHS Demographic and Health Survey MICS Multiple Indicator Cluster Survey UNICEF United Nations Childrens Fund WHA World Health Assembly WHO World Health Organization CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING 5 Contents Starting out right 7 Why an early start to breastfeeding matters 8 Early initiation in numbers 10 What the global and regional data tellus 10 Barriers and missed opportunities 13 Skilled birth attendants 13 Institutional deliveries 14 Caesarean sections 16 Supplemental foods or liquids 18 Clearing the path for breastfeeding 21 Lessons from countries 24 What needs to be done? 27 Annexes 29 Annex 1. Countries with largest changes in prevalence of early initiation of breastfeeding between 2005 and 2017 30 Annex 2. Overview of early initiation of breastfeeding rates by country 31 Annex 3. Notes on the data 39 Endnotes 41 6 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING6 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING 7 Starting out right Whether delivery takes place in a hut in a rural village or a hospital in a major city, putting newborns to the breast within the first hour after birth gives them the best chance to survive, grow and develop to their full potential. These benefits make the early initiation of breastfeeding a key measure of essential newborn carein the Every Newborn Action Plan.1 The World Health Organization (WHO) and the United Nations Childrens Fund (UNICEF) recommend that children initiate breastfeeding within the first hour of birth and be exclusively breastfed for the first six months of life meaning no other foods or liquids are provided, including water. From the age of 6 months, children should begin eating safe and adequate complementary foods while continuing to breastfeed for up to two years and beyond.2,3 The early initiation of breastfeeding putting newborns to the breast within the first hour of life is critical to newborn survival and to establishing breastfeeding over the long term. When breastfeeding is delayed after birth, the consequences can be life-threatening and the longer newborns are left waiting, the greater the risk. Improving breastfeeding practices could save the lives of more than 800,000 children under 5 every year, the vast majority of whom are under six months of age. Beyond survival, there is growing evidence that breastfeeding boosts childrens brain development and provides protection against overweight and obesity. Mothers also reap important health benefits from breastfeeding, including a lower risk of breast cancer, ovarian cancer and type 2 diabetes.4 The life-saving protection of breastfeeding is particularly important in humanitarian settings, where access to clean water, adequate sanitation and basic services is often limited. This report presents the global situation of early initiation of breastfeeding and describes trends over the past ten years. Drawing from an analysis of early initiation rates among babies delivered by skilled birth attendants, the report describes key findings and examines the factors that both help and hinder an early start to breastfeeding. The report outlines key learnings from countries where rates of early initiation have improved or deteriorated and concludes with recommendations for policy and programmatic action. No matter where a newborn takes his or her first breath, the desire to give that baby the best start in life is universal. The first hours and days after birth are one of the riskiest periods of a childs life but getting an early start to breastfeeding offers a powerful line ofdefense. 8 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING Why an early start to breastfeeding matters When it comes to breastfeeding, timing is everything. Newborns who are put to their mothers breast within the first hour of life are more likely to survive, while those left waiting face life-threatening consequences. Indeed, the longer newborns wait for the first critical contact with their mother, the greater their risk ofdeath. According to a recent meta-analysis of five studies from four countries, including more than 130,000 breastfed newborns, those who began breastfeeding between 2 and 23 hours after birth had a 33 per cent greater risk of dying compared with those who began breastfeeding within one hour of birth. Among newborns who started breastfeeding 24 hours or more after birth, the risk was more than twice as high (see Figure 1).5 The protective effect of early breastfeeding existed independently of whether or not the children were exclusively breastfed. Children who are not put to the breast within the first hour of life also face a higher risk of common infections. In a study of more than 4,000 children in Tanzania, the delayed initiation of breastfeeding was associated with an increased risk of cough and an almost 50 per cent increased risk of breathing difficulties in the first six months of life, compared with newborns who began breastfeeding within the first hour of birth.6 Babies are born ready to breastfeed. The newborn suckling reflex allows infants to suck, swallow and feed immediately after birth. Putting newborns to the breast necessitates skin-to-skin contact, and this closeness between mother and baby in the moments after delivery provides both short- and long-term benefits. Immediate skin-to-skin contact helps regulate newborns body temperature and allows their bodies to be populated with beneficial bacteria from their mothers skin. These good bacteria provide protection from infectious diseases and help build babies immune systems.7 Suckling at the breast triggers the release of prolactin in the mother, an important hormone that stimulates milk production and helps ensure a continuous food supply for the infant.8 The breastmilk consumed by newborns during the first few days called colostrum is extremely rich in nutrients and antibodies and acts as a childs first vaccine, providing a vital shield of protection against disease and death. Skin-to-skin contact immediately after birth until the end of the first breastfeeding has been shown to extend the duration of breastfeeding, improve the likelihood of babies being breastfed at all in the first months of life, and may also contribute to an increase in exclusive breastfeeding.9 Initiating breastfeeding within the first hour of life is no easy feat: mothers cannot be expected to do it alone. They require adequate support and guidance on positioning and feeding their newborns. The appropriate care of both newborn and mother in the moments after birth is critical to ensuring that breastfeeding not only begins but continues successfully. While a small proportion of women cannot breastfeed for medical reasons, most mothers simply need the right support at the right time to ensure that breastfeeding gets an early start. CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING 9 <1 hour is optimal For newborns, every minute counts Risk of infection and death increases the lo nger th e del ay Breastfeeding <1 hour after birth saves lives and provides benefits that last a lifetime. Waiting 1 day or more increases their risk of death* by more than 2 times. Waiting 2-23 hours increases their risk of death* by 1.3 times. The longer babies need to wait, the greater the risk. 24h2-23h<1h *Risk of death is presented for the first 28 days of life and in comparison to those who initiated in <1 hour. Figure 1. Visualization of the evidence about the importance of initiating breastfeeding within the first hour of life.Source: Smith Emily R, et al. Delayed breastfeeding initiation and infant survival: A systematic review and meta-analysis. PLoS ONE, vol, 12, no. 7, 25 July 2017. 10 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING Early initiation in numbersWhat the global and regional data tellus Most of the worlds newborns are left waiting too long to begin breastfeeding. In 2017 alone, an estimated 78 million newborns had to wait more than one hour to be put to the breast. This means that only about two in five children (42 per cent), the majority born in low- and middle-income countries, were put to the breast within the first hour of life. While this is a slight improvement from 37 per cent in 2005, progress is slow. Early initiation rates vary widely across regions from 35 per cent in the Middle East and North Africa to 65 per cent in Eastern and Southern Africa (see Figure 2). Estimates are not available for any countries in North America or Western Europe (see box 1), highlighting the concerning data gap in many high-income countries. While early initiation rates vary widely across regions, there are no notable differences globally in rates of initiation by the sex of the child, place of residence (rural or urban) or household wealth. <20% 20-39% 40-59% 60-79% 80 No current data No data Country with datafrom 2005-2012 56% 52% 65% 40% 35% 40% 32% 42% Eastern andSouthern Africa Eastern Europeand Central Asia* West andCentral Africa Middle Eastand North Africa* SouthAsia East Asia andthe Pacific Latin America andthe Caribbean* World CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING 11 <20% 20-39% 40-59% 60-79% 80 No current data No data Country with datafrom 2005-2012 56% 52% 65% 40% 35% 40% 32% 42% Eastern andSouthern Africa Eastern Europeand Central Asia* West andCentral Africa Middle Eastand North Africa* SouthAsia East Asia andthe Pacific Latin America andthe Caribbean* World Globally, only two out of five newborns are put to the breast within the first hour of life Figure 2. Per cent of newborns put to the breast within one hour of birth, by country and region, 2017.Source: UNICEF global databases, 2018. For notes on the data, see Annex 3. BOX 1 Breastfeeding initiation in high-income countries The early initiation of breastfeeding benefits every newborn no matter where they live. Yet many high-income countries are failing to track this important indicator of child nutrition. Globally, rates of early initiation of breastfeeding are tracked using data from household surveys, such as Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS). These large-scale surveys assess initiation rates by asking mothers of children under age 2 whether their youngest child was put to the breast within the first hour of life or later. Many low- and middle-income countries undertake such household surveys every four to five years. While many high-income countries track breastfeeding through hospital registries or other data systems, these data are not collected using standard global indicators (such as breastfeeding initiation within the first hour of life) and are therefore not internationally comparable. While it is not possible to report on early initiation rates for the majority of high-income countries, we can report on the number of children who have never been breastfed. In high-income countries, 21 per cent of children are never breastfed, compared with only 4 per cent of children who are never breastfed in low- and middle-income countries.10 This wide gap means that 2.6 million children in high-income countries are missing out completely on the benefits of breastfeeding. 12 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING 13 Globally, the proportion of deliveries assisted by a skilled birth attendant has increased from just over 60 per cent in 2000 to nearly 80 per cent in 2016.12 Despite the potential for skilled birth attendants to support breastfeeding initiation, this is not always the case in practice. UNICEFs 2016 report, From the First Hour of Life, showed that the presence of a medical doctor, nurse or midwife did not support the early initiation of breastfeeding in many low- and middle-income countries. In Europe and Central Asia, for example, where almost all births are attended by skilled providers, only 65 per cent of infants delivered by a skilled health provider began breastfeeding within the first hour of life. And in South Asia, the early initiation rate in the presence of a skilled provider was much lower, at 34 per cent.13 According to findings from a review of the latest data between 2010 and 2017 on birth assistance and the timing of breastfeeding initiation in 74 countries, early initiation rates were found to be somewhat similar whether the newborn was delivered with the support of a skilled or unskilled provider. Only 48 per cent of newborns delivered by a skilled birth attendant and 44 per cent of newborns delivered by an unskilled attendant began breastfeeding within the first hour of birth. These findings tell a story of missed opportunities. There is great potential for skilled birth attendants to support mothers in initiating breastfeeding immediately after birth; but better training and support are needed to help them seize these critical moments. Barriers and missed opportunities Why are newborns missing out on breastfeeding in the first hour of life and what obstacles stand in their way? In some cases, outdated practices in health facilities mean that mothers and babies are separated immediately after birth and support and guidance on optimal breastfeeding is limited. In others, the lack of knowledge about breastfeeding after a caesarean section, or cultural practices that involve feeding newborns supplemental foods or drinks, candelay newborns first critical contact withtheir mother.11 In the context of public health and nutrition programmes, missed opportunities refer to moments where mothers and children fail to receive key life-saving interventions, despite having contact with a health provider. Today, more births take place in health institutions with skilled providers than ever before. Yet, most newborns are still not being put to the breast within the first hour of life. These low global rates of early initiation of breastfeeding are evidence of a massive missed opportunityworldwide. Skilled birth attendants Having a skilled attendant present at birth is crucial for the survival and well-being of mother and baby and a measure of the quality of care received. A mothers contact with skilled providers during pregnancy and delivery can provide her with the support needed to carry out the recommended breastfeeding practices, including initiation of breastfeeding within the first hour after birth. 14 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING Figure 3. Trends in per cent of infants put to the breast within one hour of birth, by change in institutional delivery rate, 2005 and 2017. The lines on the bars represent confidence intervals. Source: UNICEF Global databases 2018. For notes on the data, see Annex 3. Institutional deliveries Over the past decade, the global rate of institutional deliveries has been rising, with three quarters of all deliveries (75 per cent) now occurring in health facilities. Institutional deliveries take place in a health facility, such as a maternity clinic or a hospital, and are usually performed under the supervision of a skilled birth attendant, suggesting a certain standard of care. However, supporting mothers to bring babies to the breast is not always a routine intervention after birth, and the increase in institutional deliveries has not always translated into improvements in the rate of early initiation of breastfeeding. In a subset of 58 countries with trend data available for both the place of delivery and the rate of early initiation of breastfeeding, the increase in institutional deliveries (from 53 per cent in 2005 to 71 per cent in 2017) is greater than the rise in early initiation rates over the same period (from 45 per cent to 51 per cent). These figures reflect a missed opportunity to support mothers and newborns in initiating breastfeeding immediately after birth. The only significant improvement in early initiation rates since 2005 can be seen among the group of countries where institutional deliveries increased by more than 20 percentage points (see Figure 3). The rise in breastfeeding initiation rates among this group of countries is primarily driven by low-income countries, where early initiation rates increased by 15 percentage points, compared with an increase of 8 percentage points in lower- middle-income countries. While this increase in early initiation rates is 2017 2005Per cent of newborns put to the breast within one hour of birth Change in institutional delivery rate, 20052017 Minimal/No increase<10 percentage point Moderate increase10 to 19 percentage point Large increase20 percentage point 0 10 20 30 40 50 60Percentage Early initiation rates have only improved significantly among the group of countries with a large increase in institutional deliveries 15 16 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING important, the rate of early initiation in countries with rising numbers of institutional deliveries is still discouragingly low, with only half of newborns being put to breast in the first hour of life. The effect of increasing institutional delivery rates on early initiation of breastfeeding depends on national and facility-based policies on the care of mothers and newborns, as well as the skills and commitment of the health professionals working in these facilities. An increase in institutional deliveries can improve early initiation rates when national or facility-based policies emphasize immediate skin-to-skin contact and provide staff trained to support. However, an increase in institutional deliveries can also negatively influence rates of early initiation if staff members are not appropriately trained and facilities maintain outdated policies and practices that create barriers for breastfeeding such as separating newborns and mothers without medical justification or routinely providing liquids or foods to the newborn.14 Caesarean sections Globally, caesarean sections have increased from an average of 13 per cent in 2005 to more than 20 per cent in 2017. All regions have witnessed a large increase in rates of caesarean sections, apart from Sub-Saharan Africa, where rates have remained somewhat unchanged.15 Access to surgical deliveries, where medically needed, is a critical part of ensuring safer deliveries for newborns and their mothers. Yet the rising rates of elective caesarean section worldwide have had consequences on the early initiation of breastfeeding. Several studies show that surgical deliveries can reduce the likelihood of immediate skin-to-skin contact and the early initiation of breastfeeding.16,17,18 In one study, women who ultimately delivered by caesarean section after an unsuccessful trial of labour were more likely to initiate breastfeeding within the first hour after birth than women with a scheduled repeat caesarean section.*,19 An analysis of key factors linked to early initiation rates among babies delivered by a skilled birth attendant showed that the type of delivery can significantly affect when the newborn is put to the breast. Consistently, across all 51 countries studied, early initiation rates among newborns delivered by vaginal birth were more than twice as high as early initiation rates among newborns delivered by caesarean section (see Figure 4). A statistically significant difference was seen in all but 4 of the 51 countries studied. These findings are concerning because immediate skin-to-skin contact and the initiation of breastfeeding are especially important for babies born by caesarean section. The close contact between mother and baby protects newborns with good bacteria from their mothers body a critical step in developing the babys gut health and immune system.20 With a vaginal delivery, this process likely occurs in the birth canal. There is some evidence that immediate or early skin-to-skin contact after a caesarean section can help increase early breastfeeding initiation and decrease the time to the first breastfeed.21 * Repeat caesarean section refers to a caesarean section in a woman whose previous delivery was via caesarean section. MalawiRwanda KyrgyzstanMozambique NamibiaBurundi HondurasMyanmar ZimbabweZambiaTurkeyNiger LesothoTogo CambodiaPeru KenyaLiberiaGhana United Republic of TanzaniaDominican Republic NepalEthiopiaUganda BeninDemocratic Republic of the Congo BangladeshPhilippines YemenTajikistanIndonesia AngolaSierra Leone HaitiGambia IndiaMexico Burkina FasoCameroon AfghanistanNigeria ArmeniaEgypt ComorosGabon Cte d'IvoireSenegal CongoJordan PakistanGuinea Percentage Caesarean sectionVaginal delivery 0 20 40 60 80 100 Figure 4. Per cent of newborns put to the breast within one hour of birth, by type of delivery (vaginal delivery or caesarean section), by country, 2017.Source: UNICEF Global databases 2018. For notes on the data, see Annex 3. In nearly every country, early initiation rates are significantly lower among newborns delivered by caesarean section 17 18 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING With the right support, most newborns delivered by caesarean section can be put to the breast within the first hour after birth. However, in practice, women who deliver by caesarean section often face important challenges in initiating breastfeeding, such as managing the effects of anesthesia, recovering from surgery and finding help to hold the baby safely. Key actions to facilitate skin-to-skin contact and initiation of breastfeeding immediately after birth include having an appropriate policy and protocol in the maternity facility, building the skills of staff and involving fathers in breastfeeding support.22 Figure 5. Per cent of newborns put to the breast within one hour of birth, by type of supplemental feeding in the first three days of life, by World Bank country-income grouping, 2017.Source: UNICEF Global databases 2018. For notes on the data, see Annex 3. Breastmilk only Non-milk-based (e.g., water, sugar water, tea, honey) Milk-based (e.g., infant formula, animal milk) 0 10 20 30 40 50 60 70 80 Low-incomecountries Lower-middleincome countries Upper-middleincome countries Allcountries n=18 n=21 n=6 n=45 Perc enta geSupplemental foods or liquids Giving newborns foods or drinks in the first days of life is common in many parts of the world and is often linked to cultural norms, family practices and health system policies and procedures that are not based on scientific evidence. These practices and procedures vary by country and may include discarding colostrum or having an elder family member give the newborn a specific food or liquid, such as honey, or having a health professional routinely give the newborn a specific liquid, such as sugar water or infant formula. These practices can delay a newborns first critical contact with his or her mother.23, 24 ,25 Early initiation rates are nearly twice as high among newborns whoreceive only breastmilk, compared with newborns who receive milk-based supplemental feeds in the first three days of life CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING 19 Figure 5 shows that among newborns who received milk-based liquids in the first three days after birth, nearly two in three babies waited one hour or longer to be put to the breast. This finding is based on an analysis of 51 countries with available data on the timing of initiation and the receipt of liquids and foods other than breastmilk. Conversely, close to 60 per cent of newborns receiving only breastmilk in their first days of life were put to the breast within the first hour. The rates of early initiation were slightly better among newborns receiving water-based supplementary feeds than among newborns receiving other supplementary feeds, but still significantly lower than among newborns receiving only breastmilk. 20 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING 21 programme and policy-related factors that improve the chances of optimal breastfeeding practices, including starting breastfeeding in the first hour of life.27 The analysis found that a combination of interventions had the greatest impact on the early initiation of breastfeeding, leading to a significant 85 per cent increase in rates. These interventions comprised the home and family environment (peer support, one-to-one counselling, home visits or telephone and home support by father or grandparent) and health systems and services (including the BFHI). Access to antenatal care, where mothers are counselled about the initiation of breastfeeding, also has a positive effect on its practice.28, 29, 30, 31 The more antenatal visits and professional antenatal care a mother receives, the greater the probability that she will initiate breastfeeding within the first hour of her childs life. There is a need to better institutionalize the protection, promotion and support of breastfeeding in maternity facilities, particularly in the first days of life. A systematic review of the Baby-friendly Hospital Initiative (BFHI) in 19 countries showed that facilities adherence to the BFHIs Ten Steps to Successful Breastfeeding can increase breastfeeding rates, including theearly initiation of breastfeeding (see box 2). Efforts to avoid supplementing newborns with liquids or foods other than breast milk (step 6) were crucial to successful breastfeeding outcomes. This may be because of the detrimental impact of supplements on breastfeeding success, or because carrying out this step requires other steps to be in place, including having a policy to support breastfeeding and putting the newborn to the mothers breast in the first hour of life.26 Breastfeeding can be challenging to learn, particularly in the first moments after birth. But having the right policies, programmes and people in place provides a strong support network for mothers. A systematic review and meta-analysis conducted in 2015 identified Clearing the path for breastfeeding 22 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING The Baby-friendly Hospital Initiative, launched in 1991 and updated in 2018, ensures adequate protection, promotion and support for breastfeeding in facilities providing maternity and newborn care. The BFHIs Ten Steps to Successful Breastfeeding are key to improving the early initiation of breastfeeding and to supporting optimal breastfeeding practices more generally. The updated BFHI guidance emphasizes the importance of integrating the Ten Steps into other initiatives to improve the quality of care around birth and encourages countries to achieve sustainable, universal coverage of breastfeeding interventions. Critical management procedures 1a. Comply fully with the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly (WHA) resolutions (the Code). 1b. Have a written infant feeding policy that is routinely communicated to staff and parents. 1c. Establish ongoing monitoring and data management systems. 2. Ensure staff has sufficient knowledge, competence and skills to support breastfeeding. Key clinical practices 3. Discuss the importance and management of breastfeeding with pregnant women and their families. 4. Facilitate immediate and uninterrupted skin-to-skin contact and support mothers to initiate breastfeeding as soon as possible after birth. 5. Support mothers to initiate and maintain breastfeeding and manage common difficulties. 6. Do not provide breastfed newborns any food or fluids other than breast milk, unless medically indicated. 7. Enable mothers and their infants to remain together and to practise rooming-in 24 hours a day. 8. Support mothers to recognize and respond to their infants cues for feeding. 9. Counsel mothers on the drawbacks of feeding bottles, teats and pacifiers. 10. Coordinate discharge so that parents and their infants have timely access to ongoing support and care. BOX 2 The Baby-friendly Hospital Initiative Ten Steps to Successful Breastfeeding(revised 2018) 23 24 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING Tracking the performance of breastfeeding programmes at country level provides evidence of successes and challenges in improving the early initiation of breastfeeding. The examples below, drawn from the experiences of UNICEF country offices, offer important learnings for countries. In Cambodia, an increase in the rates of early initiation of breastfeeding from 6 per cent in 1998 to 63 per cent in 2014 appears to be the result of awareness raising and promotional campaigns in communities, along with investments in improved quality of care around the time of delivery. The percentage of deliveries by a skilled birth attendant increased from 44 per cent in 2005 to 89 per cent in 2014, while institutional deliveries increased from 22 per cent to 83 per cent during the same period. Between 2000 and 2010, the use of supplements in the first three days after birth decreased considerably from 93 per cent to 15 per cent in public facilities, from 91 per cent in 2000 to 34 per cent in 2010 in private facilities and from 94 per cent to 21 per cent for home deliveries.32 In the Dominican Republic, while caesarean section rates almost doubled, increasing from 31 per cent in 2002 to 58 per cent in 2014, the rate of early initiation of breastfeeding decreased from 62 per cent to 38 per cent during the same period. Since 2014, the Ministry of Health and its partners have increased support for the Mothers and Newborns in Good Care initiative, which integrates the promotion, protection and support of breastfeeding as a part of the evidence-based interventions to reduce preventable maternal and newborn deaths. Monitoring the BFHI standards and the Code remains a challenge, particularly in private facilities, where about 40 per cent of deliveries take place, and where 86 per cent of deliveries take place via caesarean section. In Egypt, caesarean section rates more than doubled between 2005 and 2014, increasing from 20 per cent to 52 per cent. During the same period, rates of early initiation of breastfeeding decreased from 40 per cent in 2005 to 27 per cent in 2014. While support for the early initiation of breastfeeding is available in facilities implementing the BFHI where staff are trained and practices are monitored, there are many facilities that are not baby-friendly and lack trained staff and adequate monitoringsystems. In Montenegro, standard postdelivery practices include a two-hour observation period during which breastfeeding is not usually initiated. While the rate of caesarean sections increased from 12 per cent in 200733 to 20 per cent in 2013,34 the rates of early initiation of breastfeeding decreased from 25 per cent in 2005 to 14 per cent in 2013.35 Lessons from countries CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING 25 The government and its partners are currently working to build the capacities of health professionals, with a focus on breastfeeding. The promotion of breastfeeding and baby-friendly hospitals is also done though social media.Plans are underway for a national BFHI programme to be initiated shortly in all maternity wards of the country. In Rwanda, the proportion of deliveries with skilled birth attendants increased from 39 per cent in 2005 to 91 per cent in 2014, with nearly all births in health facilities being assisted by skilled birth attendants. At the same time, the country implemented an intensive and sustained communication campaign on feeding practices, including early initiation of breastfeeding and the BFHI. This resulted in increased awareness about breastfeeding among decision-makers, leaders and communities, and increased investments in building the capacities of community health workers to support breastfeeding. Rwanda now has 45,000 community health workers who counsel mothers about adequate feeding practices and safe deliveries. The rates of early initiation of breastfeeding also increased from 64 per cent in 2005 to 81 per cent in 2014. Between 2010 and 2013, the rate of caesarean sections nearly doubled from 7 per cent to 15 per cent, yet this jump did not impact early initiation. This finding reveals the power of establishing a cadre of well-trained health professionals to support early initiation. In Serbia, there was a steady decline in early initiation rates from 17 per cent in 2005 to just under 8 per cent in 2010. Based on these findings, the government took measures to improve the quality of care around birth and the Ministry of Health and its partners increased support to the BFHI, engaged neonatologists in discussions about improving the BFHI, organized events for pediatricians and other specialists and collaborated with mother support groups. By 2014, the rate of early initiation of breastfeeding had increased to 51 per cent in the country. By 2017, Serbia had integrated the BFHI criteria into its hospital accreditation standards, making the programme more sustainable and easier to scale-up to universal coverage. In Viet Nam, the rate of early initiation of breastfeeding decreased from 44 per cent in 2006 to 27 per cent in 2014, in the context of near universal institutional deliveries (which reached 94 per cent in 2014, while caesarean section rates rose from 10 per cent in 2002 to 28 per cent in 2014). In response, the Ministry of Health approved national Guidelines for essential care of the mother and newborn during and immediately after a caesarean section in November 2016.36 The guidelines emphasize skin-to-skin contact immediately after birth and support for the initiation of breastfeeding within the first hour after birth. 26 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING 27 What needs to be done? Too many newborns are not put to the breast in the first hour of life. While access to maternity facilities and skilled birth attendants at delivery have the potential to improve childrens and mothers chances of survival and wellbeing, the quality of care provided is often inadequate and missed opportunities leave far too many newborns waiting for the first critical contact with their mother. The early introduction of supplementary foods and liquids and non-indicated caesarean sections are inappropriate practices that may neglect or disrupt support for the early initiation of breastfeeding. National and facility policies to support breastfeeding around the time of birth are inadequate and the capacities of skilled birth attendants are often insufficient. The following recommendations for action, applicable in development and humanitarian settings, are based on the Global Breastfeeding Collectives framework of key policy actions for improving breastfeeding:37 1) Increase funding to strengthen the protection, promotion and support of breastfeeding programmes, including for interventions impacting the early initiation of breastfeeding. 2) Fully implement the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly Resolutions through strong legal measures that are enforced and independently monitored by organizations free from conflicts of interest. This includes monitoring the compliance of health professionals and health facilities. 3) Enhance the quality of care in facilities by establishing policies on immediate skin-to-skin contact and early initiation of breastfeeding after birth as part of national policies on maternal and newborn care, along with other evidence-based recommendations, including those in the WHO/UNICEF Ten Steps to Successful Breastfeeding.38,39, 40,41 Support for the early initiation of breastfeeding should be reflected in all newborn care policies and cover all situations, including caesarean sections and small and pre-term newborns. National policies should discourage the provision of foods or liquids to breastfed newborns in the first days of life, unless such items are needed for medical reasons. Governments and health professionals need to work together to reduce unnecessary caesarean sections through a combination of improved policies and appropriate incentive schemes. Giving all newborns an early start to breastfeeding requires action on the part of multiple actors particularly governments, health care institutions and health care workers. 28 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING Support for skin-to-skin contact and early initiation of breastfeeding should be integrated into the pre-service training of health care workers, including those targeting physicians, nurses, midwives and other birth attendants. In-service capacity building to bridge knowledge and skills gaps needs to be supported where needed. 4) Improve access to skilled breastfeeding counselling for all mothers, wherever they deliver their babies. Health professionals should prepare and counsel women undergoing a caesarean section on initiating breastfeeding. 5) Strengthen links between health facilities and communities, and encourage community networks that protect, promote and support breastfeeding. Through behaviour change strategies, encourage mothers and families to demand support for the early initiation of breastfeeding from birth attendants through behavioural change communication strategies. Establish and support social accountability systems in which mothers and families can provide feedback about the quality of care and hold providers accountable. 6) Develop monitoring systems that track the progress of policies, programmes and funding towards improving early initiation of breastfeeding. This includes both ensuring the availability of country level data on early initiation of breastfeeding and data on enabling factors, such as the number of maternity facilities implementing the Ten Steps. Facilities should monitor their own practices in this area as part of quality improvement approach. Support for improving the early initiation of breastfeeding is a life-saving intervention, with the power to protect newborns when they are most vulnerable. Mothers and newborns who get an early start to breastfeeding are more likely to continue breastfeeding, paving the way for a successful breastfeeding relationship throughout the critical first years of a childslife. Governments, policy makers and health providers must together do much more to protect, promote and support the early initiation of breastfeeding. By strengthening the capacities of health workers, adopting protective policies and making mothers and newborns a priority, we can capture the moment and give every newborn the best startto life. Annexes 30 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING Perc enta ge Countries where prevalence ofearly intiation has gone up Countries where prevalence ofearly intiation has gone down 68.7 36.6 53.0 41.6 50.8 21.117.5 19.6 60.5 38.1 44.0 26.5 37.2 18.6 25.0 14.4 0 10 20 30 40 50 60 70 Baseline estimate Latest estimate MontenegroJordanViet NamDominicanRepublic BurkinaFaso SerbiaBelarusGeorgia ANNEX 1.Countries with largest changes in prevalence of early initiation of breastfeeding between 2005 and 2017 Trends in per cent of newborns put to the breast within one hour of birth, by country, around 2005 and around 2017.Source: UNICEF Global databases 2018. For notes on the data, see Annex 3. CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING 31 Countries and territoriesLatest estimatei Baseline estimate for trend ii Trendiii CategoryYear Early initiation of breastfeeding (%) Rank iv Year Early initiation of breastfeeding (%) Afghanistan 2015 40.9 57 Albania 2008 43.4 Algeria 2012 35.7 2006 49.5 Andorra no data Angola 2015 48.3 50 2007 54.9 Anguilla no data Antigua and Barbuda no data Argentina 2011 52.7 Armenia 2015 40.9 58 2005 32.2 Australia no data Austria no data Azerbaijan 2013 19.7 74 2006 30.7 Bahamas no data Legend for categories: Increase: 8 percentage point increase Minimal/no change: <8 percentage point change Decrease: 8 percentage point decrease ANNEX 2.Overview of early initiation of breastfeeding rates by country i Latest estimate refers to the most recent estimate from 2000 onwards availale in the UNICEF global database. Regional aggregates and rank were based on countries with recent estimates (2013-2018) only. Trends were presented if a baseline point between 2003 and 2008 was available in addition to a recent (2012-2018) estimate. ii A baseline estimate is presented if the latest estimate was between 2012 and 2018 and if a point between 2003 and 2008 was also available; else blank. iii Trends are presented for a subset of 77 countries with a recent (2012-2018) latest estimate and where a baseline (2003-2008) was also available. iv Rank based on a subset of 76 countries with recent (2013-2018) data. 32 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING Countries and territoriesLatest estimatei Baseline estimate for trend ii Trendiii CategoryYear Early initiation of breastfeeding (%) Rank iv Year Early initiation of breastfeeding (%) Bahrain no data Bangladesh 2014 50.8 43 2006 35.6 Barbados 2012 40.3 Belarus 2012 53.0 2005 21.1 Belgium no data Belize 2015 68.3 20 2006 50.4 Benin 2014 46.6 53 2006 54.1 Bhutan 2015 77.9 9 Bolivia (Plurinational State of) 2016 55.0 33 2008 62.8 Bosnia and Herzegovina 2011 42.3 Botswana 2007 40.0 Brazil 2006 42.9 British Virgin Islands no data Brunei Darussalam no data Bulgaria no data Burkina Faso 2014 41.6 55 2006 19.6 Burundi 2016 85.0 3 Cabo Verde 2005 72.7 Cambodia 2014 62.6 26 2005 35.5 Cameroon 2014 31.2 67 2006 19.6 Canada no data Central African Republic 2010 43.5 Chad 2014 23.0 73 2004 32.4 Chile no data China 2013 26.4 71 2008 41.0 Colombia 2009 63.4 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING 33 Countries and territoriesLatest estimatei Baseline estimate for trend ii Trendiii CategoryYear Early initiation of breastfeeding (%) Rank iv Year Early initiation of breastfeeding (%) Comoros 2012 33.7 Congo 2014 25.3 72 2005 34.4 Cook Islands no data Costa Rica 2011 59.6 Cte dIvoire 2016 36.6 63 2006 24.9 Croatia no data Cuba 2014 47.9 51 2006 70.2 Cyprus no data Czechia no data Democratic Peoples Republic of Korea 2012 28.1 Democratic Republic of the Congo 2013 51.9 39 2007 48.0 Denmark no data Djibouti 2012 52.0 Dominica no data Dominican Republic 2014 38.1 62 2007 60.5 Ecuador 2012 54.6 Egypt 2014 27.1 69 2005 40.1 El Salvador 2014 42.0 54 2008 32.8 Equatorial Guinea no data Eritrea 2010 93.1 Estonia no data Eswatini 2014 48.3 49 2006 59.1 Ethiopia 2016 73.3 14 2005 66.2 Fiji 2004 57.3 Finland no data France no data Gabon 2012 32.3 34 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING Countries and territoriesLatest estimatei Baseline estimate for trend ii Trendiii CategoryYear Early initiation of breastfeeding (%) Rank iv Year Early initiation of breastfeeding (%) Gambia 2013 51.5 40 2005 47.7 Georgia 2012 68.7 2005 36.6 Germany no data Ghana 2014 55.6 32 2006 35.2 Greece no data Grenada no data Guatemala 2014 63.1 25 2008 55.5 Guinea 2016 33.9 64 2005 37.9 Guinea-Bissau 2014 33.7 65 2006 22.6 Guyana 2014 49.2 48 2006 43.1 Haiti 2012 46.7 2005 42.9 Holy See no data Honduras 2011 63.8 Hungary no data Iceland no data India 2015 41.5 56 2005 23.1 Indonesia 2012 49.3 2007 40.2 Iran (Islamic Republic of) 2010 68.7 Iraq 2011 42.8 Ireland no data Israel no data Italy no data Jamaica 2011 64.7 Japan no data Jordan 2012 18.6 2007 37.2 Kazakhstan 2015 83.3 4 2006 64.2 Kenya 2014 62.2 27 2003 49.6 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING 35 Countries and territoriesLatest estimatei Baseline estimate for trend ii Trendiii CategoryYear Early initiation of breastfeeding (%) Rank iv Year Early initiation of breastfeeding (%) Kiribati no data Kuwait no data Kyrgyzstan 2014 82.5 5 2005 64.7 Lao Peoples Democratic Republic 2011 39.1 Latvia no data Lebanon 2004 41.3 Lesotho 2014 65.3 24 2004 56.8 Liberia 2013 61.2 29 2006 66.2 Libya no data Liechtenstein no data Lithuania no data Luxembourg no data Madagascar 2012 65.8 2003 60.6 Malawi 2015 76.2 11 2006 58.3 Malaysia no data Maldives 2009 60.5 Mali 2015 53.2 37 2006 44.4 Malta no data Marshall Islands 2007 72.5 Mauritania 2015 61.8 28 2007 44.3 Mauritius no data Mexico 2015 51.0 42 Micronesia (Federated States of) no data Monaco no data Mongolia 2013 71.1 16 2005 77.5 Montenegro 2013 14.4 76 2005 25.0 Montserrat no data 36 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING Countries and territoriesLatest estimatei Baseline estimate for trend ii Trendiii CategoryYear Early initiation of breastfeeding (%) Rank iv Year Early initiation of breastfeeding (%) Morocco 2010 26.8 Mozambique 2013 69.0 18 2003 63.8 Myanmar 2015 66.8 21 Namibia 2013 71.2 15 2006 67.3 Nauru 2007 76.4 Nepal 2016 54.9 34 2006 35.5 Netherlands no data New Zealand no data Nicaragua 2011 54.4 Niger 2012 52.9 2006 46.6 Nigeria 2016 32.8 66 2007 29.9 Niue no data Norway no data Oman 2014 71.1 17 Pakistan 2013 18.0 75 2006 25.9 Palau no data Panama 2013 47.0 52 Papua New Guinea no data Paraguay 2016 49.5 47 2008 47.1 Peru 2016 54.8 35 2003 47.4 Philippines 2013 49.7 46 2003 46.0 Poland no data Portugal no data Qatar 2012 33.5 Republic of Korea no data Republic of Moldova 2012 60.9 2005 66.6 Romania 2004 57.7 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING 37 Countries and territoriesLatest estimatei Baseline estimate for trend ii Trendiii CategoryYear Early initiation of breastfeeding (%) Rank iv Year Early initiation of breastfeeding (%) Russian Federation 2011 25.0 Rwanda 2014 80.5 7 2005 63.9 Saint Kitts and Nevis no data Saint Lucia 2012 49.6 Saint Vincent and the Grenadines no data Samoa 2014 81.4 6 San Marino no data Sao Tome and Principe 2014 38.3 61 2006 35.3 Saudi Arabia no data Senegal 2016 29.4 68 2005 22.6 Serbia 2014 50.8 44 2005 17.5 Seychelles no data Sierra Leone 2013 53.8 36 2005 33.1 Singapore no data Slovakia no data Slovenia no data Solomon Islands 2015 78.9 8 2006 75.0 Somalia 2009 23.4 South Africa 2003 61.1 South Sudan 2010 50.5 Spain no data Sri Lanka 2016 90.3 1 2006 79.9 State of Palestine 2014 40.8 59 2006 64.6 Sudan 2014 68.7 19 Suriname 2010 44.7 Sweden no data Switzerland no data 38 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING Countries and territoriesLatest estimatei Baseline estimate for trend ii Trendiii CategoryYear Early initiation of breastfeeding (%) Rank iv Year Early initiation of breastfeeding (%) Syrian Arab Republic 2009 45.5 Tajikistan 2012 49.6 2005 60.9 Thailand 2015 39.9 60 2005 49.6The former Yugoslav Republic of Macedonia 2011 21.0 Timor-Leste 2016 75.2 12 2003 46.9 Togo 2013 60.6 30 2006 35.8 Tokelau no data Tonga 2012 79.1 Trinidad and Tobago 2006 41.2 Tunisia 2011 39.9 Turkey 2013 49.9 45 2003 52.3 Turkmenistan 2015 73.4 13 2006 59.8 Turks and Caicos Islands no data Tuvalu 2007 15.0 Uganda 2016 66.1 22 2006 41.8 Ukraine 2012 65.7 2005 35.9 United Arab Emirates no data United Kingdom no data United Republic of Tanzania 2015 51.3 41 2004 57.6 United States no data Uruguay 2013 76.5 10 Uzbekistan 2006 67.1 Vanuatu 2013 85.4 2 2007 71.9 Venezuela (Bolivarian Republic of) no data Viet Nam 2013 26.5 70 2006 44.0 Yemen 2013 52.7 38 2006 29.6 Zambia 2013 65.8 23 2007 55.6 Zimbabwe 2015 57.6 31 2005 68.2 CAPTURE THE MOMENT: EARLY INITIATION OF BREASTFEEDING 39 ANNEX 3.Notes on the data A. General Notes A.1 Early Initiation of Breastfeeding: Indicator DefinitionNumerator:
Report
01 Декабрь 2014
Social Monitor Regional Report
https://www.unicef.org/eca/reports/social-monitor-regional-report
Vulnerable children benefit the most when countries invest in effective social protection, including cash assistance, according to The Social Monitor . The report consolidates evidence on trends and patterns of change in child poverty and the impact of social protection on children in 30 countries and territories.  It highlights key challenges in…, SOCIAL MONITORSocial protection for child rights and well-being in Central and Eastern Europe, the Caucasus and Central Asia REGIONAL REPORT 2 CHAPTER 1 Analytical framework of social protection for children United Nations Childrens Fund (UNICEF) December 2015 Permission is required to reproduce any part of this publication. Permission will be…

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