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FAQ - Breastfeeding, BFHI and the Code of Marketing of Breast-milk Substitutes

1. Why is breastfeeding so important for a baby?

Breastfeeding confers a huge range of benefits on both mother and child. The rapid period of growth between birth and three years is a unique opportunity to provide a child with a strong nutritional foundation and immune system.

Breast-milk contains hundreds of health-enhancing cells, proteins, fats, hormones and enzymes that are not available anywhere else, and which increase a baby’s survival chances at least six fold in the early months. An exclusively breastfed child gains protection against a raft of health problems, including diarrheal diseases, upper respiratory infections, hypothermia and even the transmission of HIV. If every baby were exclusively breastfed for six months, an estimated 1.3 million additional lives would be saved each year. And the benefits last way beyond childhood, reducing subsequent incidences of chronic disease, such as diabetes and cancers.

The World Health Organization and UNICEF recommend exclusive breastfeeding for six months followed by the introduction of appropriate complementary feeding with continued breastfeeding for up to two years of age or beyond.

2. What about social benefits?

Research shows that breastfeeding reduces the chances of a mother abandoning her baby, which are four-fold higher for premature and underweight infants. The earlier breastfeeding begins and the longer it lasts, the greater the level of mother-child bonding. Throughout life, this improves the child’s behaviour, emotional development, intelligence, speech, inter-personal skills and productivity.

3. Are there any benefits for the mother?

Many. After childbirth, breastfeeding helps the uterus contract more rapidly, thereby reducing blood loss. Hormones released through breastfeeding promote relaxation and bonding, and in the long term it reduces the likelihood of contracting breast, uterine and ovarian cancer.

4. But what’s wrong with formula?

The best formula can only imitate a minority of the nutritional components of breast-milk. Breast-milk changes with the time of the day, the duration of suckling and the age of the child. The infant gets active living cells from the mother that help combat disease. On top of that, in the first few months, it is hard for the baby’s gut to absorb foreign substances. Even a small amount of formula can cause micro-injuries. And then there are the risks of improper preparation, which can lead to severe infectious diseases.

5. How many children are breastfed?

The rates of initial breastfeeding are high with over 90 per cent of women worldwide beginning; however, in some settings breastfeeding then drops off rapidly. In Romania, only 12,6 % of Romanian mothers breastfeed exclusively for the first six months as recommended by the World Health Organization and UNICEF.

6. How is UNICEF working to promote breastfeeding?

Through two projects: the Baby Friendly Hospital Initiative, and International Code of Marketing of Breast-milk Substitutes.

7. What is the Baby Friendly Hospital Initiative?

It is basically about trying to make sure that maternity wards provide a friendly and encouraging environment that equips new mothers to give their babies the best care possible. Launched in 1991 by UNICEF and the World Health Organization, the BFHI aims to ensure that all maternity wards promote breastfeeding. The facility must not accept free or low-cost breast-milk substitutes, bottles or teats, and must implement ten steps. These involve informing pregnant women about breastfeeding and its benefits and helping them get started straight after childbirth, training staff and offering ‘rooming in’ – facilities that allow new mothers to stay with their children for 24 hours a day. This should replace the harmful and old-fashioned practice of removing the babies from their mothers for hours or sometimes days, which limits bonding.

8. How much progress has been made?

Since the launch of BFHI, more than 20,000 facilities in 152 countries have been designated Baby-Friendly, with a profound effect on child health.

In Romania, UNICEF is providing technical assistance and support to help 40 maternity facilities become Baby Friendly Hospitals. The focus is the improvement of the nutritional status of the infant, in the hope that other health interventions (national programs on mother and child health, on reproductive health, family planning programs including free contraceptives for disadvantaged people, IEC campaigns) and social protection (new laws and practices in child protection) will lower child abandonment in maternity wards.

Baby Friendly Hospitals have been shown to be effective in preventing child abandonment. Despite the lack of official statistics, anecdotal data show a decrease in the number of abandoned infants in Baby Friendly Hospitals. However, the trend has partly reversed in some county maternities since the beginning of the economic crisis.
Following evaluation in 2009, 23 maternity hospitals were certified as Baby Friendly Hospitals. Currently there are 25 such certified hospitals, including one private one and 15 more in various stages of implementation of the requirements of the Ten Steps. More than one third of Romania’s infants are born in maternity facilities active in the BFHI every year.

9. And what’s the International Code of Marketing of Breast-milk Substitutes?

Adopted by the World Health Assembly in May, 1981, it tries to counter the aggressive and often inappropriate marketing of breast-milk substitutes identified by the World Health Assembly as a significant factor contributing to the alarming decline in breastfeeding and the associated increased malnutrition, morbidity and mortality among young infants worldwide. UNICEF has worked with legislators and lawyers to get the Code, which covers a range of marketing aspects and aspects of formula, adopted into law in more countries.

At a local level, UNICEF has been working with the Ministry of Health since 2001, when law proposal No 321 was written, to integrate Code provisions into Romanian legislation, and since 2004 it has assisted in the writing of several Code-based law proposals.

10. More specifically, what is UNICEF aiming to achieve?

UNICEF hopes the law will be adopted and secondary legislation put in place with clear provisions about responsibilities, penalties, law enforcement structures, budget allocations for law enforcement and incurred costs. Once the law is in force, it should create an environment that protects, promotes and supports breastfeeding by removing the commercial pressure on mothers when they decide how they will feed their babies and the pressure on medical staff to recommend a specific brand of breast-milk substitute. The ultimate aim is to promote breastfeeding.

11. How many Romanian children do you estimate will be saved through this project?

That is very hard to estimate because we don’t yet have exact data on the number of children who die because they are not breastfed, not least because lack of breastfeeding affects the child on so many levels – immune, cognitive, emotional – each of which contributes to infant mortality. But international data show that 13 percent of under-1 infant deaths are preventable through breastfeeding.

Moreover, a lot of evidence shows that where the marketing of breast-milk substitutes is not regulated, breastfeeding and illness rates reach alarming numbers. Even more worrying is the fact that these issues affect vulnerable people the most: children from poor families, with teenage mothers, from rural or remote geographical areas.

12. More generally, what is the nutritional status of children in Romania?

Far from ideal. According to data from 2010, things are better than they were five or six years ago, but weaning, bottle-feeding and the introduction of complementary foods still occur too soon. The average age of introducing bottle-feeding was 4.2 months, and only 12.6 per cent of infants aged up to five months were exclusively breastfed. The median age of weaning is 6.6 months, a notable improvement from 2003 when it was 4.1 months.

The average age of an infant’s food diversification is quite early, at just over four months, and in many cases this is not done with adequate foods or in the right quantity. In addition to many side effects of early weaning, and a very low level of exclusive breastfeeding after four months, signs of anaemia and malnutrition are increasingly visible. Inadequate infant feeding, early weaning, inappropriate weaning foods, introduction of breast-milk substitutes, including cow’s milk, and poor maternal nutrition, all worsen the health of children in Romania.

Measures taken so far by the Ministry of Health with international support have seen infant mortality drop to almost one third of the figure at the end of 1989. But Romanian figures are still much higher than the European average. In Romania, 12 children per 1,000 live births die before they turn five.

13. What will these measures cost the state?

Currently, there are no specific data available in Romania to answer this question. However, international data (from the US and Australia) show that a child who is not breastfed costs the healthcare system between USD 450 and USD 850 extra in their first year of life, plus the costs of the parents’ leave from work.

On the medium and long term, lack of exclusive breastfeeding burdens society with additional costs (money lost in terms of additional healthcare or parents’ days off). We also have to keep in mind the costs of patients suffering from breast or ovarian cancer, cardiovascular diseases, type 2 diabetes and obesity.




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