BREASTFEEDING

TSEK
Tama, Sapat, Esklusibo

PROTECT INFANT HEALTH. SAVE LIVES.

Contents
1. Situation of Infants and Children
2. Current Evidence for Breastfeeding
3. National & Health Policies
4. National Programs & Strategies
5. Breastfeeding TSEK:
Protecting Community Infants &
Young Children

The Situation of Infants and Children

The State protects a

Childs right to Life
and Good Health
The State shall protect
and promote the right to
health of the people and
shall instill health
consciousness among
them.
Philippine Constitution, Art 2, Section 15

Our National Commitment

The Philippines is committed to achieve

the Millennium Development Goals
(MGD) by 2015.

One of 4 children, under 5 years, is malnourished

NUTRITIONAL
STATUS

PREVALENCE

ESTIMATED
NUMBER
(IN MILLION)*

Underweight

26.2%

3.35

Underheight

27.9%

3.57

Thinness

6.1%

0.78

Overweight

2.0%

0.26

Source: 7th National Nutrition Survey, 2008

 The continued high rates of moderate and

severe stunting (30%) and low birthweight
(20%) highlight the need for greater attention
to improving maternal nutrition and
complementary feeding.

The State of the Worlds Children 2009

8

Poor Nutritional Status

Predisposes to:
increased severity and duration of
diarrhea attacks
Increased risk of dying from diarrhea

Ashworth and Feachem. Interventions for the control of diarrhoeal diseases among young children: weaning education.
Bulletin of the World Health Organization, 63 (6): 1115-1127 (1985)
9

Mortality Impact of Underweight

5% reduction in low weight for age
by 2005

30% reduction in child mortality

Source: Pelletier and Frongillo. 2003. Pooled analysis of data from 59 countries from 1966 to 1996.
10

Breastfeeding evens the playing field

Breastfeeding is a natural "safety net"
against the worst effects of poverty...it is
almost as if breastfeeding takes the infant
out of poverty for those first few months
in order to give the child a fairer start in
life and compensate for the injustice of
the world into which it was born.
James P. Grant
Former Executive Director UNICEF
3

4
Reduce by two
thirds the
under-five
mortality rate
between 1990
and 2015

Key Facts
7.6 million children under the age of five die
every year (2010 figures).
More than half of these early child deaths are
due to conditions that could be prevented or
treated with access to simple, affordable
interventions.
Leading causes of death in under-five children
are pneumonia, preterm birth complications,
diarrhoea, birth asphyxia and malaria. About
one third of all child deaths are linked to
malnutrition.
Source: WHO. Global Health Observatory (http://www.who.int/gho/child_health/en/index.html)

13

1 of 4 Philippine children under five years of age

are at risk of infection & death
CAUSES OF UNDER FIVE DEATHS, 2010

Source: WHO. Global Health Observatory (http://www.who.int/gho/child_health/en/index.html)

Our newborns are at risk of dying

in the first 2 days of life

Strategies
appropriate home care and timely
treatment of complications for newborns
integrated management of childhood
illness for all children under five years old
expanded program on immunization
infant and young child feeding

16

Exclusive Breastfeeding Rates by Region

Why breast milk?

Breast milk

Artificial Milk

Protein

Correct amount
Easy to digest

Fat

Enough essential fatty No lipase

acids, lipase to digest

Water

Enough

Anti-Infective
Properties

Present
ABSENT
Immunizes & Protects

Partly corrected

May need extra

Adapted from: Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993
(WHO/CDR/93.6).

If a new vaccine became available that could

prevent one million or more child deaths a
year, and that was moreover cheap, safe,
administered orally, and required no cold
chain, it would become an immediate public
health imperative.
Breastfeeding can do all this and more.
- 1994
19

Evidence presented in the Series on Child

Survival 2003 , Series on Neonatal Survival
2005 , and the Series on Maternal and Child
Undernutrition 2008 , clearly pointed out
the importance of exclusive breastfeeding
for the first six months of life which could
save more lives than any other intervention
studied while enhancing nutritional status
20

The Clinical Evidence on Exclusive

Breastfeeding at Birth to 6 months

Effect of Breastfeeding
For the vast majority of infants and young
children throughout the world, breastfeeding
saves lives
prevents morbidity
promotes optimal physical and cognitive
development
reduces the risk of some chronic diseases
Evidence of the benefits of breastfeeding for
mothers is growing as well
Leon-Cava et al. Quantifying the Benefits of Breastfeeding: A Summary of the Evidence. Washington, D.C.: PAHO 2002
22

Infant Morbidity and Mortality

The greatest and most obvious
benefits of breastfeeding are for
the immediate health and survival
of the infant

23

Infant Morbidity and Mortality

Rates of diarrhea, respiratory tract infections,
otitis media, and other infections, as well as
deaths due to these diseases, are all lower in
breastfed than in non-breastfed infants
Exclusively breastfed infants have at least 2
times fewer illness episodes than infants fed
breast-milk substitutes.

Source: Jones et al., 2003,; Chandra, 1979; Feachem, 1984; and Victora, 1987.

24

Protection Against Infection

INFECTIONS

% REDUCTION

Acute otitis media

(exclusive BF 3-6 mos.)

50%

Recurrent otitis media

77%

(exclusive BF >6 mos.)

Upper respiratory tract infection

64%

(exclusive BF >6 mos.)

Lower respiratory tract infection

77%

(exclusive BF >6 mos.)

Gastroenteritis

64%

Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk,
originally published online February 27, 2012

25

Neonatal Conditions
INFECTIONS

% REDUCTION

Necrotizing enterocolitis

77%

RSV bronchiolitis

74%

(exclusive BF >4 mos.)

Sudden Infant Death Syndrome (SIDS)

36%

(any > 1 month)

Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk,
originally published online February 27, 2012

Percentage of infants 2-7 months of age reported as

experiencing ear infections, by feeding category in
the preceding month in the U.S.

Adapted from: Scariati PD, Grummer-Strawn LM, Fein SB. A longitudinal analysis of infant morbidity
and the extent of breastfeeding in the United States. Pediatrics, 1997, 99(6).

Risk of diarrhea by feeding method

for infants aged 0-2 months, Philippines

Adapted from: Popkin BM, Adair L, Akin JS, Black R, et al. Breastfeeding and diarrheal morbidity.
Pediatrics, 1990, 86(6): 874-882.

Type of Feeding
Hospitalized low birth weight infants who were
fed with formula milk had 4 times the
incidence of serious illness compared to those
infants who were breastfed.

29

Randomized Controlled Trial of Low Birth Weight

Hospitalized Neonates comparing type of feeding
vs. percentage with serious illness

Infant Mortality
There is a 2-4 fold increase in neonatal
mortality rate (NMR) in not receiving
colostrum. There is a 5-13% decrease in NMR
with exclusive breastfeeding
Babies who were not breastfed in the first 6
months of their lives are 25 times more likely
to die than those who experienced exclusive
breastfeeding from the time they were born.
Source: Jones et al., 2003,; Chandra, 1979; Feachem, 1984; and Victora, 1987.

Early Breastfeeding initiation

The timing of initiation of breastfeeding is
important as there is a higher risk of
death among infants with longer delay in
the initiation of breastfeeding.

Mullany LC, et al. JNutr, 2008; 138(3):599-603.

Delaying Initiation of breastfeeding increases

risk of infection-related death
Nepal 2008

N = 22,838 breastfed babies

Relative risks of death from diarrhoeal disease

by age and breastfeeding category in Latin America

Adapted from: Betran AP, de Onis M, Lauer JA, Villar J. Ecological study of effect of breast feeding on infant
mortality in Latin America. BMJ, 2001, 323: 1-5.

Relative risks of death from acute respiratory

infections by age and breastfeeding category
in Latin America

Adapted from: Betran AP, de Onis M, Lauer JA, Villar J. Ecological study of effect of breast feeding on infant
mortality in Latin America. BMJ, 2001, 323: 1-5.

Protection Against Allergy

ILLNESS

% REDUCTION

Atopic dermatitis (negative family history)

(exclusive BF > 3 mos.)

27%

Atopic dermatitis (positive family history)

42%

(exclusive BF > 3 mos.)

Asthma (atopic family history)

40%

(exclusive BF > 3 mos.)

Asthma (no atopic family history)

26%

(exclusive BF > 3 mos.)

Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk,
originally published online February 27, 2012

36

Protection Against Diseases

DISEASE

% REDUCTION

Type I diabetes
(exclusive BF > 3 mos.)

30%

Type 2 diabetes
(any)

40%

Leukemia (ALL)
(exclusive BF > 6 mos.)

20%

Leukemia (AML)
(exclusive BF > 6 mos.)

15%

Obesity
(any)

24%

Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk,
originally published online February 27, 2012

37

Breastfeeding decreases the prevalence

of obesity in childhood at age five and six years, Germany

Adapted from: von Kries R, Koletzko B, Sauerwald T et al. Breast feeding and
obesity: cross sectional study. BMJ, 1999, 319:147-150.

Breastfeeding increases intelligence

Child Development
Breastfeeding was associated with significantly
higher scores for cognitive development than
was formula feeding
Premature infants derive more benefits from
breast milk than do full-term infants
The benefits of breastfeeding increased with
duration

Anderson et al. Breast-feeding and cognitive development: a meta-analysis. Am J Clin Nutr 1999;70:52535
40

Child Development
Largest randomized trial ever conducted in the
area of human lactation (17,046 infants)
strongly suggest that with prolonged and
exclusive breastfeeding:
Improvement in cognitive development as
measured by IQ (verbal IQ, performance IQ,
full-scale IQ)
Teachers academic ratings at age 6.5 years
were significantly higher for both reading and
writing
Kramer et al. Breastfeeding and Child Cognitive Development :New Evidence From a Large Randomized Trial.
Arch Gen Psychiatry. 2008;65(5):578-584

41

Duration of breastfeeding associated with higher

IQ scores in young adults, Denmark

Adapted from: Mortensen EL, Michaelsen KF, Sanders SA, Reinisch JM. The association between duration of
breastfeeding and adult intelligence. JAMA, 2002, 287: 2365-2371.

Benefits of breastfeeding
for the mother

43

Short-term Benefits

Decreased post-partum blood loss

Rapid involution of the uterus
Decrease in post-partum depression
Increased child spacing due to lactation
amenorrhea

Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk, originally published online
February 27, 2012
44

Long-term Benefits
Reduced risk of chronic diseases:

Type 2 diabetes mellitus (no history of gestational

DM)
Rheumatoid arthritis
Cardiovascular disease (hypertension,
hyperlipidemia)
Breast cancer (primarily premenopausal)
Ovarian cancer

Significantly decreased rate of child abuse/

neglect
Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk, originally published online
45
February 27, 2012

Breast cancer and breastfeeding:

Analysis of data from 47 epidemiological studies
in 30 countries

Adapted from: Beral V et al. (Collaborative group on hormonal factors in breast cancer).
Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47
epidemiological studies in 30 countries Lancet 2002; 360: 187-95.

Risks of artificial feeding

Baby

Interferes with bonding

More diarrhea and

respiratory infections
Persistent diarrhea

Malnutrition
Vitamin A deficiency
More likely to die

More allergy and

milk intolerance
Increased risk of some
chronic diseases
Overweight

Lower scores on
intelligence tests

Mother

Increased risk of anemia,

ovarian and breast cancer

May become pregnant

sooner

Adapted from: Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993 (WHO/CDR/93.6).

Exclusive
Breastfeeding
Protects Infant
Health & Saves
Newborn Lives

Laws & Policies on

Exclusive Breastfeeding for 6 Months

Key Health Policies Mandate Breastfeeding

for Infants & Young Children
Republic Act 7600
Rooming-in and Breastfeeding Act and IRR

Republic Act 10028

An Act Providing Incentives to All Government and Private
Health Institutions with Rooming-In and Breastfeeding
Practices and For other Purposes

Executive Order 51, s. 1986

National Code of Marketing of Breastmilk Substitutes and
Products (The Milk Code)

Key Health Policies Mandate Breastfeeding

for Infants & Young Children
DOH Administrative Orders
2005-0014 National Policies on Infant and Young Child Feeding
2006-0012 Implementing Rules and Regulation of E.O. 51, Otherwise known
as The Milk Code, Relevant International Agreements, Penalizing Violations
Thereof, and for Other Purposes
2007-0026 Revitalization of the Mother-Baby Friendly Hospital Initiative
in Health Facilities with Maternity and Newborn Care Services
2008-0029 - Mother-Baby Friendly Hospitals
2009-0025 - Adopting Policies and Guidelines on Essential Newborn Care

2010-0010 - Revised Policy on Micronutrient Supplementation to Support

Achievement of 2015 MDG Targets to Reduce Under-five and Maternal Deaths
and Address Micronutrient Needs of Other Population Groups

Key Health Policies

Philhealth
No. 12-2005 Adoption of PhilHealth Benchbook on
Performance Improvement of Health Services
No. 26-2005 Requirement for Accredited Hospitals to be
Mother-Baby Friendly Hospitals
No. 34-2006 PhilHealth Newborn Care Package

DILG

National Programs
Promoting Health & Lives of
Infants & Young Children

National Infant Young Child Feeding Strategy

2011 2016

Source: NCDPC, Department of Health

Children have the right to adequate

nutrition and access to safe and
nutritious food, and both are essential
for fulfilling their right to the highest
attainable standard of health.

Infant Young Child Feeding Policy (IYCF), 2011-2015

Department of Health

Infant Youth Child Feeding Strategy, 2011-2016

GOAL
Reduction of
child mortality
and morbidity
through optimal
feeding of
infants and
young children

OUTCOMES By 2016:
90 percent of newborns are initiated to
breastfeeding within one hour after
birth;
70 percent of infants are exclusively
breastfeed for the first 6 months of life;
and
95 percent of infants are given timely
adequate and safe complementary food
starting at 6 months of age.

Since 2008: Mother Newborn Child Health &

Nutrition (MNCHN) Service Package
Financing
Health Facilities and Service Packages
Human Resource
Health Products and Pharmaceuticals
Other Support Systems

Postpartum
Pre-Pregnancy
Antenatal care and Postnatal
Services
Care

Care during
Delivery

Our Maternal, Newborn and Child

Protection Strategy
PRENATAL

AT BIRTH

EXCLUSIVE FOR 6
MONTHS

SUPPLEMENTARY
FOODS FOR 2
YEARS

Health Plan

Essential
Intrapartum and
Newborn Care
in Facilities

Exclusive
Breastfeeding
for 6 Months
in Communities

Infant and Young

Child Feeding
(IYCF) Strategy

EINC Unang
Yakap

Breastfeeding
TSEK

Unang Yakap 4&5

Safer, evidence-based,
better quality care
for mothers & newborns
in all health facilities

Breastfeeding
is the national
health strategy
to protect
infant health
& save lives
(DOH, IYCF 2011-2016)

Breastfeeding TSEK:
Exclusive Breastfeeding to 6
Months

Tama - immediate
and appropriate
breastfeeding within one
hour after birth

Sapat - mothers milk EKsklusibo - exclusive

is sufficient ( in
nutrients and quantity)
for the baby up to 6
months

breastfeeding for 6 months,

just pure mothers breast
milk only, not even water.

Helping mothers to initiate and to

exclusively breastfeed
needs an Inter-sectoral Response
The MDG-F Joint Program:
The Breastfeeding TSEK campaign is a component
of the Joint Program by the UN Country Team to
help the Philippines achieve MDG # 1 and 4
Supported by the Spanish Government
It is called the MDG-F 2030: Ensuring Food Security
and Nutrition for Children 0-24 months in the
Philippines

Health Governance: Unang Yakap & Breastfeeding TSEK

LGU Policies for
EINC Unang Yakap
& Breastfeeding
TSEK

Mobilization & Advocacy

-Mothers
-Health Professionals
-Private Sector
Building Competence &
Commitment of Health
Professionals & Team TSEK
LGU Allocation of Resources for EINC
Unang Yakap & Breastfeeding TSEK
Plans & Policies: EINC in
Hospitals & TSEK Plan
Peer Counselling Scaled Up for
Breastfeeding Mother & Babies,
Pre, At-birth and 6 months

Breastfeeding TSEK in LGUs

LGU Policies for
Breastfeeding
TSEK

Private Sector Mobilization

& Advocacy
Building Competence &
Commitment of the Team
TSEK Core Group
LGU Allocation of
Resources to sustain
LGU TSEK
Health Staff develop TSEK
Plan for City Health
Investment Plan

Community Peer Counselling

Scaled Up for Breastfeeding
Mother & Babies

Breastfeeding TSEK in LGUs

Key Action Steps

1) Update LGU Ordinances & Health Policies
2) Train LGU Health Staff & TSEK Peer Counsellors
3) Develop the Breastfeeding TSEK Plan &
incorporate into LGU Health Plan
4) Mobilize TSEK Counsellors and build strong
community support
5) Mobilize private sector support: private health
sector, academe, business,
6) Monitor, Innovate & Sustain Breastfeeding TSEK

Step 1: Formal LGU Support

LGU Ordinances & Guidelines
Advocacy with LGU Stakeholders
Powerpoint presentations and handouts for LCEs
and TSEK Peer Counselors for use of CHDs
Visual promotional materials to be used by
Mayors/ LGUs
Sample press stories, radio scripts for
Mayors/LGUs to promote local initiatives on
keeping mother and baby safe and healthy

Step 2: Training of Peer Counselors

Training of Peer Counselors (PCs):
A Training Institution , ARUGAAN, was hired to
conduct the Peer Counselors Training- training design
is done and trainers reference manual being finalized
after the pilot run in 3 cities
PC trainings conducted in Quezon City, Marikina,
Pasig, Taguig, Caloocan, Navotas, Paraaque, Pasay,
Mandaluyong, Makati - a total of about 1,800 PCs
trained
Mentoring done in Quezon City, Marikina, Pasig,
Taguig, Caloocan, Navotas, Paraaque,

Training of Peer Counselors

Step 3: Mentoring Done at the Barangay

House to House Visits
Practicum w/ Mentors

Regular monthly meetings w/ midwives

to process (share and learn) experiences
in actual counseling

Step 4: Monitoring with TSEKlist Card

Step 5: Mobilizing LGU Partnerships

Advocacy Kits & Materials

Joint issuance with DSWD,

Dep Ed, DILG, Civil Service
MOAs with NGOs, civic and
professional societies and
groups

Step 6: Sustain Breastfeeding TSEK

Enact LGU policy allocating resources for
Breastfeeding TSEK
Build breastfeeding facilities
Expand and motivate the TSEK Peer
Counsellors
Strengthen mothers education
Build capacity of health facilities & LGU
health professionals for safe & quality
Essential Intrapartum and Newborn Care
or Unang Yakap

Educate, Create, Support:

Doctors, Nurses, Midwives
Mothers & Families

Erase Breastfeeding Myths

Practice Exclusive Breastfeeding for 6 Months

Proteksyon ng Sanggol.
Pamana ng Buhay.
Alagang Tunay.

THANK YOU