Audrey once observed that “..we’ve exported a kind of medical care and medical education–and the formula that goes with it.” and that in Indonesia, it was common to see billboards rising out of rice paddies, bearing advertisements for formula. In Guatemala and other Central American countries, a ‘formula room’ (often paid for by companies that produce the baby milk substitutes) was considered by some hospitals to be necessary.
It was to address this challenge, the ‘sensitive physiology’, to help mothers overcome the anxiety, worry and tiredness that may be barriers to successful breastfeeding, that Audrey dedicated her life.
The world has become a better place due to the work and life of Audrey Naylor and many who have followed her footsteps. We share our sadness with all who knew and loved her.
Audrey’s interest in this area had been awakened by Paul Fleiss, a dedicated paediatrician. “I always remember the first time I met him at the series of seminars he gave in 1976-1977 with Kittie Frantz. They changed my life forever! I went back and taught the maternity nurses in SD some of what I had learned in these seminars and that was the beginning of the 10 Steps and Baby Friendly.”
This all began in 1980 at the University of California Medical Center in San Diego (UCSD). Audrey, a paediatrician and UCSD faculty member and Ruth Wester, a Pediatric Nurse Practitioner were responsible for newborn examinations and for teaching mothers, house officers and medical students about newborn care. It became clear to them that changes were needed and they developed a series of in-service sessions to assess the postpartum care that normal infants and their mothers were receiving. From this they developed recommendations for changes that would be more supportive of lactation physiology and newborn needs.
Start of Wellstart International
In 1983, Audrey and Ruth left UCSD and created Wellstart International as an independent non-profit organization to educate health care professionals and to provide services to breastfeeding families. Wellstart began month long courses in Lactation Management Education for multidisciplinary teams of faculty and Ministry of Health leaders from many countries, which were supported by USAID.
The Ten Steps
In 1987, Margaret Kyenkya, the UNICEF Senior Technical Advisor for Nutrition spent some time at Wellstart as a visiting faculty member. The idea of developing a global model maternity and infant feeding policy emerged. This led to further discussions within UNICEF and the Nutrition Unit of the World Health Organization, and meetings of international experts. The outcome was the 1989 Joint WHO/UNICEF Publication “Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services” in which the Ten Steps first appears.
An informal group called the Interagency Group for Action on Breastfeeding (IGAB) consisting
of representatives from UNICEF, WHO, the Swedish International Development Cooperation Agency (SIDA) and United States Agency for International Development (USAID), came together to map out a global strategy for breastfeeding promotion. This ultimately led to the Innocenti Declaration on 1 August 1990 and the inclusion of breastfeeding in the nutrition plan of the of the World Summit for Children.
Turning ideas into action
The following year in 1991, Audrey was invited to participate in discussions to operationalize the Innocenti Declaration. Audrey contributed greatly to two important outcomes: an award for hospitals that actually practiced the Ten Steps, which later became the Baby-Friendly Hospital Initiative (BFHI), and the launch of the World Alliance for Breastfeeding Action (WABA).
Following this, Wellstart with support from UNICEF, developed an assessment tool for the BFHI which was used globally for over ten years.
In February of 1992, a team of 37 professionals from around the world spent 10 days together learning to use the new tools as well as to train others to use them., and to introduce the BFHI in their own countries. Since its inception the BFHI has been implemented by more than 152 countries around the world. The initiative has proven impact, increasing the likelihood of babies being breastfed.
Audrey’s original and fundamental interest was the training of physicians and the improvement of medical school teaching on breastfeeding. Wellstart ran workshops for medical school faculty members in several countries, to help them develop their own curricula; and wrote Lactation Management Self Study Modules for medical students at different levels to enable them to teach themselves.
Audrey was a Founding Member of the Academy of Breastfeeding Medicine, which is a Core Partner of WABA, and dedicated to informing and educating physicians globally. When she started her career, there was a mere handful of physicians interested in breastfeeding; now there are many, in many countries.
Family memories: some personal tributes from the WABA family
Valued friend, adviser and colleague
– Dr Felicity Savage Chairperson of WABA
I first got to know Audrey at the meetings which led up to the Innocenti Declaration, the development of the Baby-Friendly Hospital Initiative and the formation of WABA; but had earlier learnt of her inspiring work through the Wellstart associates who were promoting and teaching about breastfeeding. They were in many countries, but particularly for me in Indonesia, Thailand and Kenya, where I was working, and becoming interested in the subject myself. I remember Audrey visiting the Institute of Child Health in London, at the beginning of the BFHI, sitting outside in a rare moment of sunshine, discussing how to assess the “10 Steps”, and giving me valuable advice on planning the first Breastfeeding Policy and Practice course to be held there in 1992. Throughout the 1990’s, she was a regular adviser to WHO, where I was then working, supporting and contributing a great deal to the breastfeeding work. Later Audrey became a member of the Steering Committee and Board of Directors of WABA, where she continued to make a great contribution, guiding us as an experienced manager of an international organisation, as an expert in the field, a leader and a visionary.
The last time I met Audrey was when I visited her and Ruth in their new home in Vermont. Her hospitality was as always extraordinary, and it happened to be hallowe’en, which she loved to celebrate, with amazing decorations all over the house and garden, and a ready welcome for neighbours children.
Her influence has been truly global, and will be remembered for many years. She was much loved and will be sorely missed.
Message from Anwar Fazal, Chairperson Emeritus, WABA
Audrey was with WABA from the start – its concept, it birth, its nurturing and its growth to a global force, a network of networks, and leadership in the Breastfeeding landscape, particularly with World Breastfeeding Week and capacity building.
Her contributions to the Innocenti Declaration and developing and operationalising the Baby Friendly Hospital Initiative and its Ten Steps was a global changemaker in hospitals and doing what the late UNICEF Director, Jim Grant, said we should do as a priority at our inaugural WABA Committee meeting in the basement of the HQ of UNICEF in New York ..challenge the Cathedrals of health he said ….change them and breastfeeding will get back to being the norm!
Audrey was systematic and principled and with the dedicated institution she created -WELLSTART INTERNATIONAL – she gave us an amazing global network of trained and committed practitioners and multipliers in over 50 countries….and the closest dedicated initiative we have had that could be a World Breastfeeding College.
I had the joy of visiting WELLSTART in San Diego, California in the first year of our birth to discuss collaboration and getting to know her wonderful team and lovely place. She made such an impact on Military wives (San Diego is a big military naval base) that they gave her a Medal for her work with them in promoting ,protecting and supporting Breastfeeding. She also started in that city the first dedicated lactation clinic in USA!
She also carried with her a sense of humour and I will never forget how at one of the global conferences she was introduced as an illustrious paediatrician, professor and advocate …and up came to the stage a red-nosed clown….the laughter and excitement in the crowd was like happy babies wing their hand legs in joy. As she was meticulous in everything she did, she actually went for training and a Certified Clown…probably the only one in the whole movement!
Audrey served as a member of the WABA Steering Committee for many year and was also elected to be the Chairperson of the WABA International Advisory Council jointly with Dr Raj Anand of India, another icon. And she will never be forgotten – she gifted the world excellent self- learning modules which can be down loaded free by any university, or by trainers or individuals.
With those available anytime, anywhere by anyone, Audrey will forever be with us and continue to nourish the Breastfeeding landscape .
Thank you, Audrey for your support and your friendship. And thank you for the gift of the red noses to help me in getting my grandchildren to laugh. I still use them and will think of you every time I do.
No nonsense teacher, leader, trainer, speaker, yet full of heart and soul
– Sarah Amin, former Executive Director, WABA
Audrey was among the very few leading international sought after trainers in breastfeeding lactation management and supported thousands of doctors and health professionals in learning the skills and the art of supporting mothers to breastfeed! Most government officials in the health and nutrition area involved in mother and child health and lactation knew her. She was a shinning star for the movement over the decades.
I came to know Audrey later in her life, and one thing that I will take away with me was the “clown” in Audrey! She decided to learn clowning in her golden years as yet another way of reaching the hearts of people. Today, I still keep several of her red noses as she showed me how to clown around a more serious breastfeeding crowd. A clown is funny, but a clown is also seriously pursuing and uplifting the deepest sense of people’s spirit!
Love and blessings!
Rest in peace Audrey Naylor
Message from Maryse Arendt, WABA Steering Committee
In 1983 when Audrey Naylor started Wellstart International in San Diego I was making my first breastfeeding experiences with my daughter. Later I worked with persons she trained on my national level to start BFHI in Luxemburg and in european and international fora to advance breastfeeding protection, promotion and support. Much later I had the chance to meet her in person. I still remember the red-nose the distributed to participants as an ice –breaker and kept it since then as a souvenir! Our responsibility is to keep the breastfeeding movement alive, create supportive environments and protect breastfeeding, this will be the best way to remember her and honor her engagement!
Message from Dr. Raj Anand
“Some Hoard. Others Share”. Audrey obviously belonged to the group of people who loved to share and share freely. No wonder, her course on breastfeeding was made available to the whole world for free. Hats off to you dear Audrey. We shall miss you.