Global Strategy on Infant and

Young Child Feeding

Jean-Marc Olivé, MD, MPH
WHO Representative of the Philippines

Office of the WHO Representative in the Philippines

Objective: To Promote Appropriate Infant
and Young Child Feeding Practices
• Exclusive Breastfeeding 0-6 months
east

• Continued Breastfeeding with safe

and appropriate complementary
– 6 months—2 years or beyond

• Breastfeeding in difficult
circumstances:
– Malnutrition
– HIV
– LBW
– Emergencies...

Office of the WHO Representative in the Philippines

What is the evidence for these
recommendations?

Office of the WHO Representative in the Philippines

Major causes of death among children
under five, world 2000
Pneumonia
Other 20%
29%

Deaths
associated with Diarrhoea
undernutrition 12%
60%
Malaria
8%
Perinatal Measles
22% HIV/AIDS 5%
4%
Sources:
For cause-specific mortality:
For deaths associated with malnutrition: Caulfield LE, Black RE. Malnutrition and
EIP/WHO
the global burden of disease: underweight and cause-specific mortality. Paper in
preparation.

Office of the WHO Representative in the Philippines

Effect of breastfeeding on mortality
Relative reduction
• WHO pooled analysis, 2000
– Any vs. no BF
• <2 mo 76%
• 6-8 mo 41%
• 12-15 mo 37%
• Arifeen et al., 2001 (<12 mo)
– Exclusive vs. partial/no BF 75%
• Bahl, Kirkwood et al., unpublished
(<6 mo)
– Predominant vs. no BF 90%
– Predominant vs. partial BF 65%

Office of the WHO Representative in the Philippines

 Effect of breastfeeding on
neurodevelopment
• Meta-analysis of 28 studies (Anderson et al
1999): higher cognitive function in breastfed
compared with formula fed infants
– Normal birth weight: 2.66 points

– Low birth weight: 5.18 points

Office of the WHO Representative in the Philippines

 Possible long term effects of
breastfeeding
• Evidence that breastfeeding during infancy
may be associated with lower:
– Mean systolic blood pressure during childhood and
adolescence
– Mean total serum cholesterol in adult life
– Risk of obesity during childhood and adolescence
– Risk of diabetes/glucose intolerance

Office of the WHO Representative in the Philippines

 Trends
• The past 20 years have seen limited
improvements in feeding practices
❖ Breastfeeding rates improved in few countries
❖ stagnant or dropping in many
❖ Exclusive breastfeeding at 6 months of age low
❖ BFHI has slowed
❖Many gains lost
❖ International Code incompletely implemented
❖ Few countries with adequate maternity protection

Office of the WHO Representative in the Philippines

 Exclusive breastfeeding at <6 months
% exclusively breastfed (0-6 months)
60

50 46
42 AFR N=65
40 AMR N=24
33 34
EMR N=17
30 25 EUR N=57
23 23
SEAR N=13
20 WPR N=19
Global N=195
10

0
AFR AMR EMR EUR SEAR WPR GLOBAL

Office of the WHO Representative in the Philippines

 Breastfeeding Rates at 0-1, 2-3 and 4-5 Months of Age
from 1993, 1998 and 2003 NDHS

100%
90%
80%
70%
60%
Percentage

1993
50% 1998
40% 2003
30%
20%
10%
0%
0-1 2-3 4-5
Age (months)

Office of the WHO Representative in the Philippines

 Continuing Breastfeeding Rate 12-15 months

100
88 87
79
80

67 67
AFR N=65
60 AMR N=24
EMR N=17
49
47 EUR N=57
SEAR N=13
40 WPR N=19
Global N=195

20

0
AFR AMR EMR EUR SEAR WPR GLOBAL

Office of the WHO Representative in the Philippines

 Reasons for Sub-optimal Feeding
Practices
• Insufficient commitment and implementation
of comprehensive IYCF policies

• Misinformation, marketing and promotion of

breast milk substitutes

• Mistaken cultural, health and medical beliefs

Office of the WHO Representative in the Philippines

 Reasons for Sub-optimal Feeding
Practices
• Inadequate training of health workers
and lack of skilled support

• Non-supportive environments at work, in

public places and in the community

• Insufficient links with community

Office of the WHO Representative in the Philippines

 Global Strategy
on Infant and Young Child Feeding

CAH NHD
Office of the WHO Representative in the Philippines
 Aim
As inappropriate feeding is responsible
for at least one-third of malnutrition:
• To improve appropriate feeding of infants and
young children
• To increase the commitment of governments,
society groups and international organizations to
promote the health and nutrition of children

Office of the WHO Representative in the Philippines

 About the Strategy

• Integrated, comprehensive approach; built

on previous achievements
• Grounded in Science
• Participatory, bringing together many
stakeholders
• Highlights the Urgency

Office of the WHO Representative in the Philippines

Operational Areas To Promote, Protect and
Support Appropriate IYCF Practices

Legi sla tion & Polic y

Improv in g famil y
Improv in g Hea lth
&
Sys tem s
com munit y pra cti ces

Office of the WHO Representative in the Philippines

 Guidelines and Tools Available for
Local Adaptation
Developing & strengthening policies
• Global Strategy for IYCF
• International Code
• HIV/IF policy

Office of the WHO Representative in the Philippines

 Guidelines and Tools Available for
Local Adaptation
Improving family & community practices
– Food box- IMCI
– C-IMCI planning guidelines
– Lay/peer counselling guidelines
– BFC course
– CFC course
– HIVC course

Office of the WHO Representative in the Philippines

 Guidelines and Tools Available for
Local Adaptation
Improving Health Systems
• BFHI monitoring and reassessment tool
• Referral Care Manual
• Indicators for assessing breastfeeding
practices
• Hospital Administrators Course
• HIV/IF guidelines

Office of the WHO Representative in the Philippines

 Guidelines and Tools Available for
Local Adaptation
Improving Health Systems
– BFC course
– HIVC course
– CFC course
– Training on management of severe malnutrition
– Training on infant feeding in emergencies
– Training in IMCI
– Pre-service education material

Office of the WHO Representative in the Philippines

 Examples of Elements within Operational
Areas
Developing & strengthening policies
– Code
– Codex
– Maternity protection at work
– HIV and infant feeding
– other

Office of the WHO Representative in the Philippines

Examples of Elements within Operational
Areas
Improving family & community practices
– Public awareness of the benefits of IYCF
– Elimination of adverse commercial influences and
misinformation
– Lay and peer counselling
– BF support groups
– Community support to HIV + mothers
– Improvement of workplace support

Office of the WHO Representative in the Philippines

Achieving the Objectives of IYCF strategy: Operational
Targets
• Appoint a national coordinator, establish a multi-
sectoral national committee
• Develop, implement, monitor and evaluate a
comprehensive policy on infant and young child
feeding
• Effect the principles of the International Code of
Marketing of Breast milk Substitutes
• Enact legislation to protect working women and
enforce its implementation

Office of the WHO Representative in the Philippines

Achieving the Objectives of IYCF strategy: Operational
Targets
• Ensure that the health and other sectors protect,
promote and support
– exclusive and continued breastfeeding
– timely, adequate, safe and appropriate complementary
feeding with continued breastfeeding
• .. and, provide guidance on feeding in exceptionally
difficult circumstances
• Ensure that every facility providing maternity services
fully practices the Ten Steps

Office of the WHO Representative in the Philippines

 Achieving Involvement and Co-ordination
of many sectors/stakeholders
National authorities
BF/CF counsellorsPaediatricians Achieving a
International agencies common goal
Obstetricians
Nutritionists
Midwives
BFHI advocates
IMCI implementation team
Lactation consultants
Pre-service educators
HIV-prevention & care advocates
Code advocates In-service trainers
Research groups Community-based Organizations

Office of the WHO Representative in the Philippines