Complementary Feeding & Foods

Internationally agreed recommendations for optimal feeding of infants and young children advocate exclusive breastfeeding for the first six months of life, followed by complementary feeding and continued breastfeeding for up to two years or beyond. From 6 months, infants need additional foods alongside continued breastfeeding. This is termed complementary feeding because the aim is to give other foods and drinks to ‘complement’, as in ‘make complete’, the nutrients provided by human milk. ‘Complementary feeding’ supersedes the term ‘weaning’ which implies weaning off breastmilk rather than adding to it. Appropriate CF is an advocacy issue because of lack of understanding and misinformation through the promotion of commercially produced follow-up and growing up milks. These types of milk formulae undermine the preferred complementary feeding patterns based on locally produced sustainable home-based foods, and continued breastfeeding 6-24+ months. They may actually displace breastfeeding.

Ready to Use Foods

RUTF is a generic term including different types of commercial foods, such as spreads or compressed products suitable for the feeding of severely malnourished children 6-24 months. However, it is usually referring to a peanut paste with milk powder, sugar and micronutrients, and the brand MOST COMMONLY USED IS "Plumpy Nut" produced by Nutriset of France. The programmes to treat severely malnourished children using 'Ready to use therapeutic foods' (RUTF)has led to wider promotion of similar foods for the prevention of malnutrition in children under two years of age. This is of concern because MANY protocols on the use of RUTFs pay little, if any attention, to breastfeeding under 6 months and EVEN LESS to human milk for the 6-24+ month old. This is a dangerous because of the possibility of displacement of bf, local foods, etc .It is important to note that there is a push to introduce this and RUTF earlier than six months because of the high incidence of malnutrition including SAM in the below six months age group. Also, it impacts ON breastfeeding programmes as the money allocated to nutrition often goes to RUTF rather than for prevention and promotion of exclusive breastfeeding, continued bf, good complementary feeding.

Wider use of these FORTIFIED 'Ready to Use Foods' (RUF) without proper training, care and appropriate guidance may undermine and displace breastfeeding and the use of customary family foods. While RUTFs IS effective for the treatment of Severe Acute Malnutrition, the use of diverse foods in adequate quantities have also shown to be effective. The IDEA THAT they SHOULD BE PROMOTED WITH NUTRITION CLAIMS TO THE GENERAL PUBLIC FOR THE PREVENTION OF malnutrition in young children is a serious concern. The promotion of commercial foods including spreads and compressed products to treat and/or prevent malnutrition will likely lead to the widespread use and dependence on these products. This will undermine local foods, healthy feeding habits and skills, challenging sustainable livelihoods, development, the environment and local economies, particularly in resource poor countries.

Infant Feeding in Emergencies

An emergency is an extraordinary and extreme situation that immediately puts the health and survival of a population at risk. IFE focuses on the protection and support of safe and appropriate feeding of infants and young children in emergencies. It addresses both emergency preparedness and a timely and appropriate humanitarian response in the event of an emergency, to safeguard the survival, health, growth and development of infants and young children. Breastfeeding is a shield that protects and provides infants optimum protection in the risk-laden environment. Breastmilk is the one safe and secure source of food for babies, instantly available, providing active protection against illness and keeping an infant warm and close to his/her mother. Breastfeeding advocates need to be vigilant during emergencies particularly when mass donations of formulas are haphazardly and freely given out to women. Such actions undermine the confidence in breastfeeding women. It also increases the risk of formula feeding when unsanitary conditions make artificial feeding even more difficult. Women need additional support in the form of counseling, space, preferential food distribution etc. in emergencies to enable them to breastfeed optimally.

Ethics & Conflics of Interest

There is a huge ethical dimension in breastfeeding advocacy- from the kind of sponsors we may have, the kinds of association we have made, the kinds of advice we give women, to our own personal code of ethics. WABA does not accept sponsorship of any kind from companies producing breastmilk substitutes, related equipment and complementary foods due to the obvious conflict of interest. We are also concerned about creating potential conflict of interest if health professionals and breastfeeding advocates/counselors receive funds or sponsorship from manufacturers of breast pumps and other breastfeeding aids and devices. Health professionals and breastfeeding counselors need to remain unbiased when they give professional advice to women. The employment of devices should be confined to situations where there is reasonable evidence that they will protect, preserve and enhance breastmilk production and ultimately assist mothers to breastfeed effectively. Recommendation of a product should be determined by its known effectiveness and appropriateness for the woman being advised, and counseling should include information on possible harmful effects. There should be no possibility of commercial influence on this advice.

BFHI

The Innocenti Declaration (1990) On the Protection, Promotion and Support of Breastfeeding outlined what countries should do to support breastfeeding. The signatories pledged to achieve four operational targets by the year 1995. One of the targets was to ensure that every facility providing maternity services fully practices all of the Ten Steps set out in the joint WHO/UNICEF statement “Protecting, promoting and supporting breastfeeding: the special role of maternity services.” These targets were endorsed by the WHO Global Strategy for Infant and Young Child Feeding in 2002, by the second Innocenti Declaration in 2005 and again in 2010 by the 63rd World Health Assembly Resolution on Infant and Young Child Nutrition. The Global Criteria based on the Ten Steps form the basis of the Baby-friendly Hospital Initiative (BFHI) worldwide. Recent studies show that the more of the Ten Steps are implemented, the more likely women are able to achieve their breastfeeding intentions. Sustaining pressure to maintain BFHI standards and ensuring the private health sector also becomes baby-friendly are key advocacy goals. WABA supports and promotes the implementation of the WHO Expanded BFHI which also includes mother- friendly elements across the continuum of care.

Women and Work

The issue of Women and Work is about enabling women to successfully combine their reproductive and productive roles. It is a health issue, a women’s issue, an economic issue, a labour issue, and a human rights issue. The breastfeeding movement works together with trade unions, women's groups, the ILO, employers, governments and other stakeholders to implement minimum standards for maternity protection as set out by the International Labour Organisation (ILO ) and other measures to protect women working in the informal sector.

Mother, Father and Community Support

Mother support is any support provided to women for the purpose of improving breastfeeding practices for both mother and baby. The support needed varies from woman to woman but generally includes encouragement, accurate and timely information, humane care during childbirth, advice, reassurance, affirmation, hands-on assistance, and practical tips. Moral and social support is needed from many persons in different places. Women need the support of professional health providers, employers, friends, family and the community at large. The role of fathers in supporting women to breastfeed optimally has been shown to be important and their role needs to be nurtured. To strengthen global advocacy for mother support sign the GIMS +5 statement.

Gender and Men

Breastfeeding is an important part of women's reproduction and benefits women's health. Women have the right to breastfeed as enshrined in the Convention on the Elimination of all Forms of Discrimination against Women (CEDAW) and the Convention on the Rights of the Child (CRC). Breastfeeding is also about men, their role in the family decision making influence and gender relations with women. As with other issues concerning women's health and sexuality, breastfeeding takes place in a gendered world. Hence, breastfeeding promotion programmes should take into account the gendered context of women's lives and keep women’s interest at the forefront of our cause. Breastfeeding and child rearing are particularly difficult for the majority of the world's women, marginalized by poverty, violence, poor nutritional status, job insecurities and gender inequalities. WABA aims to create an enabling environment where men, particularly fathers, participate actively and share responsibilities with women in optimally caring for their infants and young children, through advocacy, education and capacity building thus, contributing to a just gender equal and healthy society.

Breastfeeding and Environment

Chemical contaminants are causing harm to children and families. Environmental activists, breastfeeding groups and health advocates worldwide are calling for the elimination of toxic chemicals in the environment. The contamination of breastmilk is one symptom of the environmental contamination in our communities. Responsibility for this problem belongs to the industrial sources of contamination, not to breastfeeding women. The individual decision to breastfeed must be promoted and protected while working collectively towards eliminating the chemicals that contaminate the food, water, air and products we use.

Studies have shown that breastfeeding, even in a contaminated environment, has a positive impact on the development of children as compared to those who are artificially fed. Breastfeeding supports infant growth and health as well as maternal health in ways that breastmilk substitutes cannot. Indeed, breastmilk contains substances that help the child develop a stronger immune system and other protections against environmental pollutants and pathogens.

HIV & Infant Feeding

The HIV/AIDS pandemic affects millions of women and children around the world. The impact on families and communities especially in poor settings is tremendous. One of the modes of transmission from woman to her child is through breastfeeding/breastmilk and this has caused much alarm and confusion, since breastfeeding also saves lives. The Lancet series on Child Survival estimated that 13% of all deaths could be prevented by optimal breastfeeding. There is a need to balance the risks of HIV transmission and consequent mortality with the risks of mortality due to not being breastfed, in essence, improving HIV-free survival. Global guidelines on Infant feeding in HIV has been constantly revised from time to time based on the findings of ongoing research. The 2010 guidelines now emphasizes on providing antiretroviral drugs to the pregnant and lactating women and their infants , using different regimens based on CD4 counts of the woman, and provide exclusive breastfeeding to the infant. The risk of transmission is lowest for those exclusively breastfed from birth and together with antiretrovirals will improve the infant’s chances of surviving while remaining HIV free.

WABA works with UN agencies, breastfeeding groups and other interest groups including HIV&AIDS, women, and sexual and reproductive health groups, towards better maternal, child and community survival and well-being by promoting the WHO guidelines and other information on how to support women to practice exclusive breastfeeding.