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ILCA Statement on WHA Resolution on Infant and Young Child Feeding

All families deserve public health policies designed to improve their health and well-being that are free from corporate interests. This is why the International Lactation Consultant Association® (ILCA®) calls upon governments to protect, promote and support breastfeeding. This includes holding businesses accountable for misleading marketing practices that unfairly target vulnerable women and children and directly impact breastfeeding.

This statement is in response to events reported by the New York Times. The article, “Opposition to Breast-Feeding Resolution by U.S. Stuns World Health Officials” reported on U.S.-delegation opposition to a resolution that aimed to call upon member states to strengthen promotion, protection and support for breastfeeding.

The resolution was to be introduced by Ecuador and “expected to be approved quickly and easily by the hundreds of government delegates who had gathered . . . ” According to the article, Ecuador unexpectedly withdrew the resolution in response to threats made by delegates representing the United States. “The Americans were blunt: If Ecuador refused to drop the resolution, Washington would unleash punishing trade measures and withdraw crucial military aid. The Ecuadorean government quickly acquiesced.”

Ultimately, a weaker resolution was adopted after being introduced by Russia. These actions took place at the World Health Assembly in Geneva in May 2018.

The proposed resolution included a number of key protections for breastfeeding families, including strengthening efforts to reduce predatory marketing of breastmilk substitutes and providing additional supports for families in emergencies. To be clear, it did not deny families access to breast milk substitutes.

As an organization, ILCA envisions “world health transformed by skilled lactation care;” a world in which human beings have every opportunity to thrive through breastfeeding. As such, ILCA stands in support of The Code and subsequent resolutions. ILCA also stands in unwavering support of families everywhere, to make decisions that are best for their families. When breast milk substitutes are desired or required, International Board Certified Lactation Consultants® (IBCLCs®) and other skilled lactation professionals are qualified to assist families in the safe preparation, storage and feeding according to WHO guidelines. For parents choosing to breastfeed, this means navigating a host of unique challenges to the breastfeeding family. Challenges may be clinical but also social. Social policies such as adequate maternity leave and the right to breastfeed or express milk in the workplace work in favor of breastfeeding continuation whereas the absence of supportive and protective policies work against breastfeeding continuation.

The NYT article sheds light on how corporate interest interferes with public health policy designed to improve health and well-being. The article also highlights the role that governments have to promote, protect and support breastfeeding rather than side with businesses to support corporate gains. ILCA strongly supports systems and structures that shift the responsibility for breastfeeding success away from parents and toward social policies that make breastfeeding easier, not more difficult.

As frontline health professionals, IBCLCs and other lactation caregivers around the globe know first-hand the challenges that families face in providing their children with the best nutritional start to life. Therefore, ILCA calls upon governments to protect, promote and support breastfeeding.

ILCA has for many years provided representation at key meetings like the WHA, and will continue to do so. ILCA stands with other global allies and urges its members and partners to continue to advocate for policies that strengthen the promotion, protection and support of breastfeeding at the government level. ILCA urges skilled lactation professionals all over the world to continue to provide individualized specialized clinical care to families while advocating at the local/regional/country level for policies that support the families in our care.

On behalf of the Board of Directors,

 

 

 

Michele Griswold, PhD, MPH, RN, IBCLC

ILCA President

2

2018 Baby-Friendly Hospital Initiative (BFHI) Revised Implementation Guidance

The document commonly known as the “Ten Steps” has recently been updated. ILCA has been actively advocating on behalf of the lactation community throughout the revision process. Below is a open letter to the community with an update on the revisions. ILCA would like to extend significant gratitude to the volunteers who have devoted many, many hours to this effort.

Dear Colleagues,

After months of thoughtful and productive discussion with our five global breastfeeding promotion organizations, on April 11, 2018, the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) released the final version of the Implementation Guidance: Protecting, promoting, and supporting breastfeeding in facilities providing maternity and newborn services: the revised Baby-friendly Hospital Initiative 2018. The final document is highly responsive to the recommendations made by our organizations, and we congratulate the WHO and UNICEF on a successful launch.

We strongly agree with the WHO and UNICEF that “breastfeeding is a vital component of realizing every child’s right to the highest attainable standard of health, while respecting every mother’s right to make an informed decision about how to feed her baby, based on complete, evidence-based information, free from commercial interests, and the necessary support to enable her to carry out her decision.”

We also concur that “the first few hours and days of a newborn’s life are a critical window for establishing lactation and providing mothers with the support they need to breastfeed successfully” and that the “core purpose of the Baby-Friendly Hospital Initiative (BFHI) is to ensure that mothers and newborns receive timely and appropriate care before and during their stay in a facility providing maternity and newborn services, to enable the establishment of optimal feeding of newborns, which promotes their health and development.”

We applaud the full application of the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly Resolutions (the International Code), comprehensive, evidence-based infant feeding policies and ongoing internal monitoring of adherence to relevant clinical practices being incorporated into Step One.

We stand united with the WHO and UNICEF on the goal of scaling up to universal BFHI coverage and ensuring its sustainability over time.

BACKGROUND

Motivated by deep concerns about the uneven and relatively low global adoption of the BFHI, the WHO and UNICEF undertook the important tasks of evaluating the strengths and weaknesses of the initiative and charting a course to revitalize both the overall initiative and the global standards. It was an enormous undertaking.

An initial draft of their new proposed approach was released for public comment on October 11, 2017.  Our five organizations came together and, at the invitation of the WHO and UNICEF, shared our collective expertise and worked with them to recommend changes in some areas that were not fully addressed in the proposal and further develop the guidance.

We would like to thank the WHO and UNICEF for their openness and willingness to engage in discussions and undertake the extra effort required to incorporate our recommendations.  During the 6-month period of meetings, all parties worked together with the mutual goal of strengthening the guidance to empower countries to scale up to universal adoption.

HIGHLIGHTS OF KEY HIGH-LEVEL RECOMMENDATIONS

  • Governments should become involved in the national implementation of the BFHI and should undertake efforts to integrate international standards into national systems.
  • Professional organizations responsible for pre-service education should incorporate the evidence and practices embodied in the Ten Steps to Successful Breastfeeding (the Ten Steps) into their curricula.
  • Efforts should be undertaken to draw public attention to the importance of breastfeeding, the risks of formulas and the practices that will help to protect, promote and support breastfeeding.
  • Efforts should be undertaken to protect breastfeeding, families and staff from commercial marketing and unethical pressures.
  • BFHI should be integrated into other interventions, existing international and/or national programs, and coordinated with efforts to support breastfeeding in communities and the workplace.
  • For those countries that currently have a well-functioning designation program able to reach the majority of facilities providing maternity and newborn services nationwide, this new guidance should not be viewed as a reason to discontinue a successful program.

HIGHLIGHTS OF KEY COMPONENTS OF THE GUIDANCE

  • Stresses the importance of exclusive breastfeeding for six months to provide the nurturing, nutrients and energy needed for physical and neurological growth and development.
  • Includes a clear set of global criteria, with the option to tailor for applicability to national standards.
  • Retains the Ten Steps in their original order and subject matter. Includes wording changes that are more generalized and designed to allow for the future incorporation of new and/or updated evidence. Explains the intent of each of the steps and offers clear guidance for their implementation.
  • Acknowledges the contribution of each of the ten steps to improving the support for breastfeeding, and stresses the need for all ten steps to be implemented as a package in order to attain an optimal impact on breastfeeding practices.
  • Provides updated guidance for the safe implementation of practices and monitoring of patients. Reminds health care providers of the importance of individualized attention and care.
  • Describes the importance of mother-friendly birth practices and the impact of birth practices on breastfeeding. Stresses the importance of healthcare professionals being knowledgeable about those practices and their responsibility for educating mothers. Refers them to other WHO guidelines for more details on the specific practices.
  • Stresses the importance of breastfeeding and/or breast milk feeding for all infants cared for in a facility by including some guidelines, indicators and standards for providing breastfeeding support for preterm infants in addition to the guidelines, indicators and standards that have been traditionally included for healthy term infants.
  • Sets a mandate for the evidence and practices embodied in the Ten Steps to be included in health care pre-service curricula while retaining the need to continue with in-service education until this is accomplished and several classes have graduated and entered into practice.
  • Explains the responsibility of healthcare facilities and professionals for implementing the International Code and places it prominently in Step 1, setting the stage for the International Code to be embodied in all aspects of patient care.
  • Stresses the importance of and proposes systems for monitoring and sustaining the practices.
  • Provides clearly defined indicators that are easy to assess and will allow for comparisons between countries. Retains all indicators at the 80% level.
  • Acknowledges the importance of public recognition, such as accreditation, as a key driver for change. Points to the need for external evaluation or assessment as one of the key principles of quality improvement and acknowledges the process of becoming Baby-friendly as transformative, with impacts pertaining to the entire environment around infant feeding.  This included the care being more patient centered; staff attitudes and skill levels about infant feeding improving dramatically; the use of infant formula and newborn nurseries being significantly reduced. States that the quality of care for breastfeeding clearly improved in facilities designated as “baby-friendly”.
  • Offers robust guidance for additional quality improvement options for countries where the traditional accreditation options are beyond reach.
  • Reinforces the role of facilities providing maternity and newborn services of identifying appropriate community resources for continued and consistent breastfeeding support that is culturally and socially sensitive to the needs of families. Reminds facilities they have a responsibility to engage with the surrounding community to enhance such resources.

 

Call to Action:

Given the responsiveness of this document to the concerns raised around the initial 2017 draft, we now call upon all those working with families on infant and young child feeding to band together, support its goals, and work within your countries to implement it in the most effective manner.

Next Steps:

We are working to ensure that a provision is included in a resolution for the upcoming World Health Assembly (WHA) to request the Director General of WHO to work in collaboration with UNICEF to develop tools for training, monitoring, and advocacy on the Baby-Friendly Hospital Initiative to assist Member States with implementation. We will continue to monitor the progress of the resolution, the development of tools, and implementation of the BFHI guidance.

Thank you.

 

Sincerely,

Trish MacEnroe
Coordinator
Baby-Friendly Hospital Initiative Network of Industrialized Nations, Central and Eastern European Nations and Independent States (BFHI Network)

Elisabeth Sterken
Co-chair IBFAN Global Council
International Baby Food Action Network (IBFAN)

Michele Griswold
President
International Lactation Consultant Association (ILCA)

Ann Calandro
Chair
La Leche League International (LLLI)

Felicity Savage
Chairperson
World Alliance for Breastfeeding Action (WABA)

 

Additional translations of this blog post are available in Spanish, Italian, French, and Japanese.

2

Iniciativa Hospital Amigo De Los Niños Y Las Niñas 2018 (IHAN) Guia Revisada De Implementacion

Estimados colegas,

Tras meses de profundo y productivo debate entre nuestras cinco organizaciones mundiales de promoción de la lactancia materna, el 11 de abril de 2018, la Organización Mundial de la Salud (OMS) y el Fondo de las Naciones Unidas para la Infancia (UNICEF) publicaron la versión final de la Guía de Implementación: Proteger, promover y apoyar la lactancia materna en instituciones que brindan servicios de maternidad y neonatología: la Iniciativa Hospital Amigo de los Niños y las Niñas 2018 revisada. El documento final responde en gran medida a las recomendaciones formuladas por nuestras organizaciones y felicitamos a la OMS y al UNICEF por el éxito de su lanzamiento.

Estamos completamente de acuerdo con la OMS y UNICEF en que “La lactancia materna es un componente vital para hacer realidad el derecho de todos los niños y niñas a gozar del más alto nivel posible de salud, al tiempo que se respeta el derecho de todas las madres a tomar una decisión informada sobre cómo alimentar a su bebé, basada en información completa y basada en la evidencia, libre de intereses comerciales, y el apoyo necesario para que pueda llevar a cabo su decisión”.

También estamos de acuerdo en que “las primeras horas y días en la vida de un recién nacido son una ventana crítica para establecer la lactancia y proporcionar a las madres el apoyo que necesitan para amamantar con éxito” y que “el propósito central de la Iniciativa Hospital Amigo de los niños y las niñas (IHAN) es asegurar que las madres y los recién nacidos reciban atención oportuna y apropiada antes y durante su estancia en una institución que proporciona servicios de maternidad y neonatología, que permita el establecimiento de una alimentación óptima para los recién nacidos, lo que promueve su salud y desarrollo.”

Aplaudimos la plena aplicación del Código Internacional de Comercialización de Sucedáneos de Leche Materna y Resoluciones relacionadas de la Asamblea Mundial de la Salud (el Código Internacional), la incorporación en el Primer Paso de políticas integrales de alimentación infantil basadas en la evidencia y la monitorización continuada de la observancia de las prácticas clínicas relevantes.

Nos alineamos con OMS y UNICEF en su objetivo de ampliar a universal la cobertura de la IHAN para las instituciones de salud materno infantil y garantizar su sostenibilidad en el tiempo.

ANTECEDENTES

Motivados por la profunda preocupación ante la adopción desigual y relativamente baja de la IHAN en todo el mundo, la OMS y el UNICEF emprendieron la importante tarea de evaluar las fortalezas y debilidades de la IHAN y trazar un rumbo para revitalizar tanto la iniciativa como los estándares globales. Una tarea ingente.

l 11 de octubre de 2017 se abrió un periodo de comentario público sobre el primer borrador con propuestas de un nuevo enfoque. Nuestras cinco organizaciones se reunieron y atendiendo a la invitación de la OMS y el UNICEF, compartieron experiencia y trabajaron conjuntamente para aportar a un mayor desarrollo de la guía y recomendar cambios en determinadas áreas no abordadas plenamente por la propuesta.

Deseamos agradecer a la OMS y al UNICEF su apertura y disposición para el debate y haber realizado el necesario esfuerzo adicional para incorporar nuestras recomendaciones. Durante el período de seis meses en que se celebraron las reuniones, todas las partes trabajaron conjuntamente con el objetivo común de fortalecer la guía para empoderar a los países hasta alcanzar la adopción universal.

RECOMENDACIONES PRINCIPALES: ASPECTOS DESTACADOS.

  • Los gobiernos deben involucrarse en la aplicación nacional de la IHAN y realizar esfuerzos para integrar los Criterios Globales en los sistemas nacionales de salud.
  • Las organizaciones profesionales responsables de la educación pre-grado deben incorporar en sus planes de estudio las evidencias y prácticas concernientes a los Diez Pasos para una feliz Lactancia Materna (los Diez Pasos).
  • Se deben realizar esfuerzos para atraer a la atención pública la importancia de la lactancia materna, los riesgos de las fórmulas y las prácticas que ayudaran a proteger, promover y apoyar la lactancia materna.
  • Se deben realizar esfuerzos para proteger a la lactancia materna, las familias y los trabajadores de las presión y las prácticas no éticas de la industria.
  • La IHAN debe ser integrada en otras intervenciones y programas internacionales y/o nacionales ya existentes, y coordinarla con otros esfuerzos de apoyo a la lactancia materna en las comunidades y lugares de trabajo.
  • En aquellos países que actualmente cuentan con un programa de acreditación que funciona correctamente y capaz de llegar a la mayoría de los centros que prestan servicios de maternidad y neonatología del país, esta nueva guía no debe ser considerada una razón para interrumpir un programa con éxito.

GUIA DE IMPLEMENTACION: ASPECTOS DESTACADOS DE LAS PRINCIPALES RECOMENDACIONES

  • Destaca la importancia de la lactancia materna exclusiva durante 6 meses para proporcionar la nutrición y la energía necesarios para el crecimiento y el desarrollo físico y neurológico.
  • Incluye un conjunto claro de criterios globales, con la opción de adaptar la aplicabilidad a las normas nacionales.
  • Mantiene los Diez Pasos en su orden y tema original. Incluye cambios de redacción más generalizados y diseñados para permitir la incorporación futura de pruebas nuevas y/o actualizadas. Explica la intención de cada uno de los pasos y ofrece una guía clara para su implementación.
  • Reconoce la contribución de cada uno de los Diez Pasos a la mejora del apoyo a la lactancia materna, y subraya la necesidad de que para lograr un impacto óptimo en las prácticas de lactancia materna, los Diez Pasos se implementen como un todo.
  • Proporciona una guía actualizada para la implementación segura de las prácticas y el seguimiento de los pacientes. Recuerda a los proveedores de salud la importancia de la atención y el cuidado individualizados.
  • Describe la importancia de las prácticas de parto amigables con la madre y el impacto de las mismas sobre la lactancia materna. Destaca la importancia de que los profesionales de la salud conozcan estas prácticas y su responsabilidad en la educación de las madres. Les remite a otras guías de la OMS para más detalles sobre las prácticas específicas.
  • Destaca la importancia de la lactancia materna y/o la leche materna para todos los lactantes atendidos en una institución, mediante la inclusión de directrices, indicadores y normas para la prestación de apoyo a la lactancia materna de los lactantes prematuros, además de las directrices, indicadores y normas que tradicionalmente se han incluido para los lactantes a término sanos.
  • Establece un mandato para que la evidencia y las prácticas incorporadas en los Diez Pasos sean incluidas en los planes de estudio de pre-grado de las profesiones sanitarias, manteniendo la necesidad de continuar con la educación post grado hasta que esto se logre y varias generaciones se hayan graduado y estén trabajando.
  • Explica la responsabilidad de las instituciones de salud y de los profesionales de la salud en la implementación del Código Internacional y lo coloca en un lugar pre eminente en el Paso 1, sentando las bases para que el Código Internacional se incorpore en todos los aspectos de la atención al paciente.
  • Propone sistemas para monitorizar y asegurar la sostenibilidad de las prácticas y destaca la importancia de las mismas.
  • Proporciona indicadores claramente definidos fáciles de evaluar y permitirán comparaciones entre países. Mantiene todos los indicadores al nivel del 80%.
  • Reconoce la importancia de medidas de reconocimiento público, como la acreditación, como motor clave del cambio. Señala la necesidad de una evaluación o valoración externa como uno de los principios clave de la mejora de la calidad y reconoce que el proceso de convertirse en “IHAN” es transformador, con repercusiones en todo el entorno de la alimentación infantil. Esto incluye que la atención se centra más en el paciente; que las actitudes y los niveles de destreza del personal con respecto a la alimentación infantil mejoran drásticamente; y que se reduzca significativamente el uso de fórmulas para lactantes y de las “nido” para recién nacidos. Afirma que la calidad de la atención de la lactancia materna mejora significativamente en las instituciones IHAN.
  • Ofrece una guía sólida para opciones adicionales de mejora de la calidad para países donde las opciones tradicionales de acreditación están fuera de alcance.
  • Refuerza el papel de las instalaciones que proporcionan servicios de maternidad y neonatología en la identificación de recursos comunitarios apropiados para un apoyo continuo y consistente a la lactancia materna que sea cultural y socialmente sensible a las necesidades de las familias. Recuerda a los establecimientos que tienen la responsabilidad de involucrarse con la comunidad para mejorar dichos recursos.

Llamada a la acción:

Dada la receptividad de este documento a las preocupaciones planteadas en torno al borrador inicial de 2017, hacemos ahora un llamamiento a todos los involucrados en la alimentación de lactantes y niños y niñas pequeños, que trabajan con las familias, para que se unidos, apoyen sus objetivos y trabajen dentro de sus países para implementarlo de la manera más eficaz posible.

Siguientes Pasos:

Estamos trabajando para asegurar que se incluya una disposición en una resolución de la próxima Asamblea Mundial de la Salud, que solicite al Director General de la OMS que trabaje en colaboración con UNICEF para desarrollar herramientas para la capacitación, el monitoreo y la promoción de la Iniciativa de Hospitales Amigos de los Niños que ayuden a los Estados Miembros con la implementación. Continuaremos monitorizando el progreso de la resolución, el desarrollo de herramientas y la implementación de la guía IHAN.

Gracias.

Sinceramente,

Trish MacEnroe
Coordinadora
Red IHAN de las Naciones Industrializadas, las Naciones de Europa Central y Oriental y los Estados Independientes (BFHI network)

Elisabeth Sterken
Copresidenta del Consejo Mundial de IBFAN
Red Internacional de Acción para la Alimentación Infantil (IBFAN)

Michele Griswold
Presidenta
Asociación Internacional de Consultores en Lactancia (ILCA)

Ann Calandro
Presidenta
Liga Internacional de la Leche (LLLI)

Felicity Savage
Presidenta
Alianza Mundial para la Acción pro Lactancia Materna (WABA)

Las traducciones adicionales de esta comunicación están disponibles en inglés, italiano, francés, y japonés.

 

 

2

2018 Initiative Hôpitaux Amis Des Bébés (IHAB) Nouvelles Lignes Directrices

Chères collègues,

Après plusieurs mois de réflexions et de discussions productives avec nos cinq organisations internationales en promotion de l’allaitement, l’OMS et l’UNICEF ont publié la version finale des lignes directrices pour les IHAB, le 11 avril 2018, Implementation Guidance: Protecting, promoting, and supporting breastfeeding in facilities providing maternity and newborn services: the revised Baby-friendly Hospital Initiative 2018. Le document final reflète très clairement les recommandations apportées par nos cinq organisations et nous félicitons l’OMS et l’UNICEF pour cette publication réussie.

Nous sommes entièrement en accord avec l’OMS et l’UNICEF que “l’allaitement représente un élément essentiel pour que soit reconnu pour tout enfant le droit fondamental au plus haut niveau de santé, tout en respectant le droit de la mère de prendre une décision éclairée sur la façon de nourrir son enfant. Cette décision doit être prise en se fiant à une information complète, basée sur des données probantes et libre de tout intérêt commercial. Le soutien nécessaire doit aussi être présent pour l’aider à actualiser sa décision.”

Nous sommes aussi de l’avis de l’OMS et de l’UNICEF lorsqu’ils affirment que “les premières heures et les premiers jours d’un nouveau-né sont critiques pour l’initiation de la lactation et pour soutenir les mères à allaiter avec succès” et que “le but de l’IHAB est de s’assurer que les mères et les nouveau-nés reçoivent les soins appropriés et en temps requis, avant et pendant leur séjour en maternité, en vue de faciliter la meilleure nutrition possible pour favoriser la santé et le développement des bébés.”

Nous nous réjouissons du fait que la condition 1 comprend dorénavant l’application complète du Code international de commercialisation des substituts du lait maternel (le Code international) et les résolutions subséquentes de l’Assemblée mondiale de la santé (AMS) qui le concernent, de même que des politiques complètes de nutrition de l’enfant basées sur des données probantes et le monitoring des pratiques cliniques liées à ces politiques.

Nous unissons nos voix à celles de l’OMS et de l’UNICEF pour que l’IHAB soit implantée partout dans le monde et que sa durabilité soit assurée au fil du temps.

CONTEXTE

Préoccupés par l’adoption inégale et assez faible de l’IHAB au niveau mondial, l’OMS et l’UNICEF ont entrepris d’évaluer les forces et les faiblesses de l’Initiative et de la revitaliser ainsi que les critères internationaux qui s’y rattachent. C’était une lourde tâche.

Des lignes directrices ont d’abord été proposées pour critique publique en octobre 2017. Nos cinq organisations se sont réunies et, à l’invitation de l’OMS et l’UNICEF, ont partagé leurs expertises en vue de bonifier ce premier jet dans lequel certains aspects n’avaient pas été touchés en profondeur.

Nous désirons remercier l’OMS et l’UNICEF pour leur ouverture et leur intérêt à poursuivre les discussions avec nous et à intégrer nos recommandations dans ce premier jet. Nous nous sommes attelés à la tâche tous ensemble durant 6 mois pour renforcer les lignes directrices en vue de permettre aux pays d’évoluer vers une adoption universelle de l’IHAB.

Traduction libre par Louise Dumas, Comité canadien pour l’allaitement; texte original en anglais “2018 Baby-Friendly Hospital Initiative (BFHI) Revised Implementation Guidance” du 11 avril 2018.

FAITS SAILLANTS DES RECOMMANDATIONS PRINCIPALES

Les gouvernements doivent s’impliquer dans l’implantation nationale de l’IHAB en plus de s’efforcer à intégrer les critères internationaux dans leurs systèmes nationaux.

Les responsables de la formation initiale des professionnels de la santé doivent intégrer dans leur curricula les évidences et la pratiques cliniques sous-jacentes aux Dix conditions pour le succès de l’allaitement (les Dix conditions).

Il faut attirer l’attention du public quant à l’importance de l’allaitement, des risques des substituts du lait maternel et des pratiques qui aident la protection, l’encouragement et le soutien à l’allaitement. Des efforts doivent être entrepris pour protéger l’allaitement, les familles et les travailleurs de la santé des pressions et de la commercialisation non-éthiques exercées par les compagnies de substituts du lait maternel. L’IHAB doit être intégrée dans d’autres interventions et programmes nationaux ou internationaux, en vue de coordonner les efforts pour le soutien de l’allaitement dans les communautés et les lieux de travail.

Les pays ayant développé un programme de reconnaissance et de certification pour tous les établissements de santé prodiguant des soins et services périnatals n’ont pas à cesser ces activités si elles sont productives. Ce n’est pas le but des lignes directrices actuelles.

FAITS SAILLANTS EN REGARD DES PRINCIPAUX ÉLÉMENTS DES LIGNES DIRECTRICES

Mettent l’accent sur l’exclusivité de l’allaitement pour les 6 premiers mois en vue de prodiguer à la fois les soins, les nutriments et l’énergie nécessaires à une croissance et à un développement physique et neurologique optimal.

Incluent une liste de critères internationaux clairs qui peuvent aussi être adaptés selon les standards des différents pays.

Maintiennent les Dix conditions dans leur ordre original de même que les sujets touchés dans chaque condition. Le langage utilisé permettra leur mise à jour éventuelle lors de la publication de nouvelles données probantes. Chaque condition est bien expliquée et contient une orientation claire quant à son implantation.

Reconnaissent la contribution de chaque condition dans l’amélioration du soutien à l’allaitement et soulignent le besoin d’implanter les Dix conditions comme un tout pour obtenir un meilleur impact sur les pratiques lies à l’allaitement.

Fournissent des directives claires pour l’implantation sécuritaires des pratiques et pour le monitoring de celles-ci. Rappellent aux professionnels de la santé l’importance des soins attentifs individualisés.

Décrivent l’importance des pratiques favorables aux mères (Mother-Friendly) et leur impact sur l’allaitement. Mettent l’accent sur l’importance pour les professionnels de la santé de bien connaître ces pratiques et leur responsabilité d’en informer les mères. Réfèrent aux autres lignes directrices en vigueur à l’OMS pour plus de détails concernant ces pratiques.

Soulignent l’importance de l’allaitement et/ou du lait maternel pour tous les bébés soignés dans un établissement, en incluant des directives, des indicateurs et des standards pour le soutien aux bébés prématurés.

Traduction libre par Louise Dumas, Comité canadien pour l’allaitement; texte original en anglais “2018 Baby-Friendly Hospital Initiative

(BFHI) Revised Implementation Guidance” du 11 avril 2018 en plus de directives, d’indicateurs et de standards qui ont toujours fait partie de l’initiative pour les nouveau-nés à terme.

Définissent un mandat clair quant à l’intégration des évidences et des pratiques sous-jacentes aux Dix conditions dans la formation initiale des professionnels de la santé, tout en poursuivant pour le moment l’éducation continue et ce, jusqu’à ce que plusieurs nouveaux gradués ainsi formés soient entrés en milieu clinique au cours des années.

Expliquent les responsabilités des établissements de santé et des professionnels de la santé dans l’implantation du Code international maintenant partie intégrante de la condition 1, décrivant ainsi les bases pour l’adoption du Code international dans tous les aspects des soins aux patients. Soulignent l’importance de la surveillance continue des pratiques et proposent des systèmes pour en assurer la pérennité.

Fournissent des indicateurs clairement définis et faciles à évaluer qui permettent les comparaisons entre les pays. Conservent le niveau de passage à 80% pour tous les indicateurs.

Admettent l’importance de la reconnaissance publique telle la certification, comme élément-clé de changement. Soulignent l’importance de d’évaluation externe comme principe de base pour améliorer la qualité des interventions. Reconnaissent la valeur transformative du processus menant à la certification Ami des bébés sur tout l’environnement lié à la nutrition infantile, entre autres des soins davantage centrés sur le patient, des soignants démontrant des attitudes et des habiletés bonifiées en nutrition infantile, un recours moins fréquent aux substituts du lait maternel et un nombre important de pouponnières fermées. Stipulent que la qualité des soins en regard de l’allaitement évolue grandement quand les maternités sont certifiées Ami des bébés. Offrent des alternatives solides pour améliorer la qualité des soins autrement que par la certification dans les pays où cette option n’est pas envisageable.

Renforcent le rôle des établissements de santé dans l’identification de ressources communautaires appropriées, culturellement et socialement acceptables pour les familles en vue d’un soutien conséquent en allaitement. Rappellent à ces établissements qu’ils ont la responsabilité de s’engager dans leur communauté pour améliorer l’offre de ressources appropriées.

Ce que vous pouvez faire

Étant donné que ce document répond maintenant aux préoccupations que nous avions exprimées suite à la publication d’octobre 2017, nous demandons à toutes les personnes oeuvrant auprès des familles au niveau de la nutrition des nouveau-nés et des jeunes enfants, de se rallier autour de ces Lignes directrices, d’en soutenir les objectifs et de travailler pour l’implanter dans tous les pays de la façon la plus efficace possible.

Prochaines étapes Nous travaillons à nous assurer que la résolution qui sera déposée à l’AMS en mai prochain demandera au Directeur général de l’OMS de travailler en collaboration avec l’UNICEF au développement d’outils pour la formation, la surveillance et la défense de l’IHAB en vue d’assister les états membres à l’implanter dans leur pays respectif. Nous continuerons à suivre le cheminement de cette résolution, le développement des outils requis en vue de l’implantation des lignes directrices sur l’IHAB.

Merci.

Respectueusement vôtre,

Trish MacEnroe
Coordonnatrice
Baby-Friendly Hospital Initiative Network of Industrialized Nations, Central and Eastern European Nations and
Independent States (BFHI Network)

Elisabeth Sterken
Vice-présidente
International Baby Food Action Network (IBFAN)

Michele Griswold
Présidente
Association internationale des consultantes en lactation (ILCA)

Ann Calandro
Présidente
La Ligue La Leche Internationale (LLLI)
Felicity Savage
Présidente
World Alliance for Breastfeeding Action (WABA)

Des traductions supplémentaires de cette communication sont disponibles en anglais, italien, espagnol, et japonais.


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Iniziativa Ospedale Amico Dei Bambini (BFHI) 2018 Guida All’Applicazione Revisionata

Cari Colleghi,

Dopo mesi di discussioni approfondite e proficue con le nostre cinque organizzazioni internazionali che promuovono l’allattamento, il giorno 11 aprile 2018 l’Organizzazione Mondiale della Sanità (OMS) ed il Fondo delle Nazioni Unite per l’Infanzia (UNICEF) hanno pubblicato la versione definitiva della Implementation Guidance: Protecting, promoting, and supporting breastfeeding in facilities providing maternity and newborn services: the revised Baby-friendly Hospital Initiative 2018  (“Guida all’Applicazione: Proteggere, promuovere e sostenere l’allattamento in strutture che offrono servizi per la maternità e per I neonati, l’Iniziativa Ospedale Amico dei Bambini 2018”). Il documento finale riflette in gran parte le raccomandazioni formulate dalle nostre organizzazioni e ci congratuliamo con l’OMS e l’UNICEF per il lancio ben riuscito.

Siamo pienamente d’accordo on l’OMS e l’UNICEF che “l’allattamento rappresenta una componente vitale del diritto di ogni bambino di godere del miglior stato di salute possibile, nel rispetto del diritto di ogni madre di prendere una decisione informata su come alimentare suo figlio, basata su informazioni complete sostenute da prove di efficacia, libere da interessi commerciali, e con il sostegno necessario che le permette di portare a termine la sua decisione.”

Concordiamo anche che “le prime ore ed i primi giorni di vita di un neonato formano una finestra temporale critica per stabilire la lattazione e per fornire alle madri il sostegno necessario per allattare con successo” e che lo “scopo fondamentale dell’Iniziativa Ospedali Amici dei Bambini (BFHI) è di assicurare che le madri ed i loro bambini ricevano un’assistenza tempestiva ed appropriata prima e dopo il ricovero in una struttura che offre servizi per la maternità e per I neonati, per consentire l’instaurarsi di un’alimentazione ottimale dei neonati, che promuova la loro salute ed il loro sviluppo.”

Ci congratuliamo per l’inserimento nel Passo 1 del pieno rispetto del Codice Internazionale sulla Commercializzazione dei Sostituti del Latte Materno e le pertinenti Risoluzioni dell’Assemblea Mondiale della Sanità (il Codice Internazionale), di tutte le politiche relative all’alimentazione dei neonati e dei bambini basate sulle prove di efficacia e del monitoraggio interno costante delle relative pratiche cliniche.

Ci uniamo all’OMS e all’UNICEF per raggiungere l’obiettivo della copertura universale della BFHI e per garantirne la sostenibilità nel tempo.

IL CONTESTO

Preoccupati  per il disomogeneo, e relativamente basso, tasso di adozione globale della BFHI, l’OMS e l’UNICEF hanno deciso di valutarne i punti di forza e le criticità e tracciare un percorso per rivitalizzare sia l’iniziativa in generale che gli standard globali. È stata un’impresa enorme.

Una bozza iniziale del nuovo approccio proposto è stata rilasciata per un commento pubblico l’11 ottobre 2017. Le nostre cinque organizzazioni si sono riunite e, su invito dell’OMS e dell’UNICEF, hanno messo a disposizione la propria esperienza e collaborazione  per  modificare alcune parti che non erano state prese pienamente in considerazione nella bozza e per sviluppare ulteriormente la guida.

Vogliamo ringraziare l’OMS e l’UNICEF per la loro apertura e disponibilità al confronto e per il grande lavoro che l’integrazione  delle nostre raccomandazioni ha richiesto. In sei mesi di riunioni, tutte le parti hanno collaborato con l’obiettivo comune di rafforzare la guida per consentire a tutti i paesi di raggiungere l’adozione universale dell’iniziativa.

PUNTI SALIENTI DELLE PRINCIPALI RACCOMANDAZIONI

  • I governi dovrebbero essere coinvolti nell’attuazione nazionale della BFHI e dovrebbero impegnarsi a integrare gli standard internazionali nei sistemi nazionali.
  • Gli enti responsabili per la formazione pre-laurea dovrebbero incorporare nei propri curricula le prove di efficacia e le pratiche rappresentate dai Dieci Passi per un allattamento efficace (i Dieci Passi).
  • Sforzi andrebbero intrapresi per attirare l’attenzione pubblica sull’importanza dell’allattamento, sui rischi della formula e sulle pratiche che aiutano a proteggere, promuovere e sostenere l’allattamento.
  • Sforzi andrebbero intrapresi per proteggere l’allattamento, le famiglie e gli operatori dal marketing commerciale e dalle pressioni non etiche.
  • La BFHI dovrebbe essere integrata in altri interventi, in programmi internazionali e/o nazionali esistenti e coordinata con gli sforzi per sostenere l’allattamento nella comunità e nei luoghi di lavoro.
  • Per quei paesi che attualmente dispongono di un programma di riconoscimento ben funzionante in grado di raggiungere la maggior parte delle strutture che forniscono servizi di maternità e per neonati a livello nazionale, questa nuova guida non dovrebbe essere vista come un motivo per interrompere un programma di successo.

PUNTI SALIENTI DEI COMPONENTI CHIAVE DELLA GUIDA

  • Enfatizza l’importanza dell’allattamento esclusivo per 6 mesi per fornire il nutrimento, i nutrienti e l’energia necessari per lo sviluppo e la crescita fisici e neurologici.
  • Comprende un insieme di criteri globali chiari, con la possibilità di adeguarli al contesto nazionale.
  • Mantiene i Dieci Passi nell’ordine originale e con i contenuti tematici di ognuno. Modifica la loro formulazione per renderla più generica e consentire l’integrazione futura di prove di efficacia nuove e/o aggiornate. Spiega lo scopo di ognuno dei passi ed offre indicazioni chiare per l’attuazione.
  • Riconosce il contributo di ognuno dei dieci passi nel migliorare il sostegno per l’allattamento, e sottolinea la necessità che tutti i dieci passi vengano implementati come un pacchetto di interventi al fine di realizzare un impatto ottimale sulle pratiche riguardanti l’allattamento.
  • Fornisce una guida aggiornata per l’attuazione sicura delle pratiche e del monitoraggio dei pazienti. Ricorda agli operatori sanitari l’importanza di un’attenzione e di un’assistenza personalizzata.
  • Descrive l’importanza delle Cure Amiche della Madre e dell’impatto delle pratiche del travaglio/parto sull’allattamento. Ribadisce l’importanza delle conoscenze degli operatori su queste pratiche e la loro responsabilità di condividere queste informazioni con le madri. Rimanda ad altre linee guida OMS per ulteriori dettagli sulle specifiche pratiche.
  • Evidenzia l’importanza dell’allattamento e/o dell’alimentazione con latte materno per tutti i bambini ricoverati nella struttura, includendo alcune linee guida, indicatori e standard per fornire un sostegno ai neonati pretermine in aggiunta alle linee guida, gli indicatori e gli standard che sono stati storicamente indirizzati ai nati a termine sani.
  • Dà un mandato affinché le prove di efficacia e le pratiche contenute nei Dieci Passi vengano incluse nei programmi di formazione pre-laurea, mentre la formazione continua post laurea prosegue finché non si raggiunga una massa critica di nuovi professionisti formati che si sono laureati ed abbiano preso servizio.
  • Spiega le responsabilità delle strutture e degli operatori sanitari per il rispetto del Codice Internazionale, collocandolo in primo piano nel Passo 1, ponendo le basi perché il Codice Internazionale venga inserito in tutti gli aspetti dell’assistenza.
  • Propone e sottolinea l’importanza dei sistemi per monitorare e sostenere le pratiche.
  • Fornisce degli indicatori ben definiti che sono di facile valutazione e che permetteranno un confronto fra paesi. Mantiene tutti gli indicatori minimi all’80%.
  • Riconosce l’importanza di un riconoscimento pubblico, come l’accreditamento, come fattore fondamentale per il cambiamento. Indica la necessità di una valutazione esterna come uno dei principi chiave in un percorso di miglioramento della qualità e riconosce la natura trasformativa del percorso per diventare Baby-friendly, con effetti che si estendono all’intero ambito attorno all’alimentazione infantile. Questi comprendono un’assistenza più centrata sulle famiglie, un miglioramento netto negli atteggiamenti e nelle competenze degli operatori nei confronti dell’alimentazione infantile, una riduzione significativa dell’uso dei sostituti del latte materno e dello spazio “nido” del reparto. Dichiara che la qualità dell’assistenza riguardante l’allattamento migliora nettamente nelle strutture riconosciute “Amiche dei Bambini”.
  • Offre una guida robusta per percorsi di miglioramento della qualità alternativi in quei paesi dove l’opzione di un accreditamento tradizionale non è fattibile.
  • Rafforza il ruolo delle strutture che offrono servizi di maternità e per neonati nell’identificare le risorse appropriate disponibili sul territorio per un sostegno continuativo e consistente all’allattamento, che sia culturalmente e socialmente sensibile ai bisogni delle famiglie. Ricorda alle strutture la loro responsabilità di interagire con il territorio locale per potenziare tali risorse.

Cosa potete fare

Visto che questo documento ha dato risposta alle preoccupazioni sorte attorno alla bozza iniziale del 2017, chiediamo adesso a tutte le persone che lavorano con le famiglie nell’ambito dell’alimentazione dei neonati e dei bambini di unirsi, di sostenere i suoi obiettivi, e di lavorare all’interno dei singoli paesi per attuarlo nella maniera più efficace.

Prossimi Passi

Stiamo lavorando affinché venga inserita una clausola in una Risoluzione per la prossima Assemblea Mondiale della Sanità che chiede al Direttore Generale dell’OMS di lavorare in collaborazione con l’UNICEF per sviluppare degli strumenti per la formazione, per il monitoraggio e per l’advocacy sull’Iniziativa Ospedale Amico dei Bambini per aiutare gli Stati Membri nell’attuazione. Continueremo a seguire il percorso della Risoluzione, lo sviluppo degli strumenti e l’attuazione della guida.

Grazie.

Sinceramente,

Trish MacEnroe
Coordinator Baby-Friendly Hospital Initiative Network of Industrialized Nations, Central and Eastern European Nations and Independent States (BFHI Network)

Elisabeth Sterken
Co-chair IBFAN Global Council
International Baby Food Action Network (IBFAN)

Michele Griswold
President International Lactation Consultant Association (ILCA)

Ann Calandro
Chair La Leche League International (LLLI)

Felicity Savage
Chairperson World Alliance for Breastfeeding Action (WABA)

Altre traduzioni di questo post sono disponibili in inglese, spagnolo, francese, e giapponese.

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ILCA, ABM, and WABA Joint Statement for the Commission on the Status of Women (CSW62)

ILCA participates with the Commission on the Status of Women (CSW), a functional commission of the United Nations Economic and Social Council (ECOSOC). It is a global policy-making body dedicated exclusively to promoting gender equality and the empowerment of women.

Every year, representatives of Member States, United Nations entities and non-governmental organizations in consultative status with ECOSOC gather at United Nations Headquarters in New York for the Commission’s annual session. This year, CSW62 takes place from 12-23 March. The theme for this year’s session is “Challenges and opportunities in achieving gender equality and the empowerment of rural women and girls.”

Attending CSW is an opportunity for ILCA to influence policy makers and governments, and to network with other organizations working toward similar goals. ILCA’s UN Liaisons, Geri Fitzgerald and Lisa Mandell, in collaboration with the Academy of Breastfeeding Medicine (ABM) and World Alliance for Breastfeeding Action (WABA), developed the following statement to distribute at CSW. This statement was further ratified by 1000 Days, Helen Keller International, International Baby Food Action Network (IBFAN), and Training and Assistance for Health and Nutrition Foundation (TAHN). Lisa Mandell attended CSW62 on 12-13 March and distributed the statement to many people; she was also able to bring breastfeeding and the need for skilled lactation support to the attention of speakers in several sessions, and she attended a Town Hall meeting with the UN Secretary-General, António Guterres. Geri Fitzgerald will attend CSW62 on 19 March to further ILCA’s networking by attending sessions sponsored by the WHO, UNAIDS, UN Women, Zambia, Denmark and PAHO.

The statement is below:

Empowerment of rural women and girls: How breastfeeding and skilled lactation support can empower rural women and improve health outcomes

Breastfeeding empowers women, including rural women and girls, to provide their children with optimal nutrition, improve child survival, and promote long-term health for both mother and child. Breastfeeding is the foundation of life.

There are two important and relevant documents which address the means to empower women and girls in this context:

  1. The Draft Agreed Conclusions prepared by the CSW62 Bureau highlights importance of implementing economic and social policies for the empowerment of rural women and girls. This document identifies the critical need to increase access to quality care before, during, and after childbirth.
  2. The Sustainable Development Goals include ensuring access by infants to safe, nutritious, and sufficient food (2.1); ending all forms of malnutrition and achieving targets on stunting and wasting in children under 5 years of age (2.2); addressing the nutritional needs of lactating women (2.2); reducing neonatal mortality (3.2); ensuring access to reproductive health-care services (3.7); and recognizing and valuing unpaid care provided by women and girls (5.4).

It is critical that breastfeeding and skilled lactation support are included in policies designed to achieve the above goals.  As the cornerstone of any comprehensive policy designed to improve the health and well-being of childbearing women and their children, breastfeeding can save lives and improve long-term health of the entire community.

Breastfeeding according to World Health Organization (WHO) recommendations has the capacity to save over 800,000 infant lives per year. Human milk is always clean, readily available, requires no access to fuel, clean water, or electricity, and is environmentally sustainable. Human milk provides reliable and sustainable nutrition for optimal growth of infants, while protecting the infant from infection and food insecurity in risky environments. An infant who is not breastfed for the first 6 months of life is 14 times more likely to die compared with an infant who receives human milk only. Infants not breastfed have a higher risk of many diseases. Infants whose mothers lack adequate breastfeeding support are at risk for premature weaning. Women who breastfeed for a shorter duration or not at all are at higher risk of many diseases, and they experience shorter birth intervals with resulting negative health outcomes.

These negative consequences of not breastfeeding have a higher impact among rural women and their children.

  • Rural women have poor access to health care. When health care providers offer skilled support for breastfeeding, initiation and duration rates increase.
  • Rural women and their infants are at increased risk of disease, and have less access to fuel, clean water, and electricity needed to prepare alternatives to human milk.

By improving health outcomes from day 1, the goal of empowering women and girls is attainable.  Lactation support to improve breastfeeding initiation and duration is a critical step toward reaching this goal.  Actions to advance breastfeeding as part of nutrition, food security and poverty reduction strategies galvanize efforts to achieve sustainable development goals.

Therefore, we recommend and urge governments, health ministers and political leaders to invest in the future of rural women and girls by developing policies for sustainable practices that increase access to quality care, including skilled breastfeeding support, before, during, and after childbirth.

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Creating a Local Task Force to Address Nursing in Public

By Robin Kaplan, M.Ed., IBCLC

Screenshot 2015-01-05 10.33.05

Editors Note: Robin Kaplan, M.Ed., IBCLC, is an IBCLC in private practice in California, USA. She has developed a program for supporting families who breastfeed in public. Robin shares the impetus for her work, some how-to tips for creating programs in your own community, and an opportunity to learn more in this week’s Lactation Matters:

I’ve never considered myself an activist. Sure, there are many things that I am passionate about, but usually I am the person offering quiet support to a cause, not standing with the megaphone. That all changed when I was contacted on my Facebook page by a mother who had been harassed in a local courthouse because she had been breastfeeding her baby. What transpired was something I never expected. It has turned into a community venture to stop nursing in public (NIP) harassment in San Diego, California, USA.

The mother who contacted me recounted the incident where a bailiff had thrown her out of a courtroom full of people simply because she had been breastfeeding. I was outraged! How could someone, especially a government employee, feel like it was okay to publicly humiliate this woman for breastfeeding her baby in a public place? I felt compelled to assist this mother in changing this situation and help her to regain some of the self-esteem that had been squashed in such a insulting manner. I consulted with Best for Babes, Breastfeed LA, and several other IBCLCs to formulate a plan on how to remedy this wrongdoing. Based on everyone’s experiences, we concluded that the most progress could be made by corresponding in a professional, non-threatening manner with the person who could actually implement positive changes. After countless emails, hours on the phone, and finally a meeting with the Commander of the Court Services Bureau, we arrived at an acceptable solution to the situation. The mother was written a letter of formal apology from the San Diego Police Department, the bailiff was under investigation and the entire staff of the San Diego Police Department was given an informal training on the rights of breastfeeding mothers and how to protect these rights at all times. We were pleased with the outcome of our efforts.

Next thing I knew, I was being contacted by other local families who had experienced harassment for nursing in public. It was like the flood gates had been opened! I thought San Diego was a fairly progressive and tolerant city, but apparently this wasn’t always the case. It was time to take my newfound advocacy to the next level.

NIPlogo_color BIG-2In April 2013, in collaboration with several local mothers, the San Diego Nursing in Public (SDNIP) Task Force was created. The goals of the SDNIP Task Force were:

  • To educate our local community about the California laws that protect a mother’s right to breastfeed in public.
  • To provide support and guidance to mothers who have faced harassment or discrimination for breastfeeding in public.
  • To provide resources that empower mothers, by educating them on their civil right to breastfeed in public and how to handle an NIP harassment incident.
  • To empower business owners, by providing resources that they can integrate into their employee handbooks and training materials so that they and their staff are compliant with the CA law.
At the Poway Nurse-In

At the Poway Nurse-In

Currently, our SDNIP Task Force webpage hosts a collection of resources to support the above goals. Since April 2013, the SDNIP Task Force has helped to resolve seven local nursing in public harassment incidents. Some were very public, such as the incidents at a local LA Fitness and with the Poway School District. Others were resolved quietly, at the request of the family involved.

Recently, it became apparent that by providing more online resources and guidance, the task of resolving these types of situations could become a more collaborative process between the SDNIP Task Force and the aggrieved families. In my experience, those who experience NIP harassment have difficulty figuring out where to begin or whom to contact to remedy their situations. By providing the most effective language to use in the most effective formats, any NIP Task Force can guide a family in the right direction. That way, they can take the power of resolving the situation into their own hands, while still having the confidence that the full force of the NIP Task Force would be behind them if any further action was needed.

We thought that the best way to accomplish these new goals and disseminate this updated information would be to host something like a town-hall meeting. So, on January 15, 2015, from 4-4:30pm PST, we will host our first SDNIP Task Force Town Hall Meeting on Google+ Hangout On Air. If you are unable to watch the Town Hall Meeting live, we will also place its recording on our website and YouTube channel the following day. During our Town Hall meeting we plan to explain the steps in which a mother can resolve a NIP harassment incident, enlist a group of core volunteers to assist with expanding the SDNIP Task Force resources, as well as provide information for others who wish to start a Nursing in Public Task Force in their own community. We hope you will join us. Hopefully joining our town hall meeting will inspire the nursing in public advocate deep inside of you!

How are you working to support breastfeeding families in your community?

RobinRobin Kaplan received training to be a Certified Lactation Educator and an International Board Certified Lactation Consultant from UCSD. She holds a Masters in Education from UCLA, a multiple-subjects teacher credential from UCLA, and a BA in Psychology from Washington University in St. Louis, MO. In 2009, Robin started her own business, the San Diego Breastfeeding Center, where she offers in-home and in-office breastfeeding consultations, free weekly support groups, breastfeeding classes, and online support through her business blog.  In addition to her private practice, Robin was the founding co-editor of the International Lactation Consultant Association’s (ILCA) blog, Lactation Matters, and a regular contributor to ILCA’s E-Globe newsletter.  She also is the host/producer of The Boob Group online radio show.  Robin lives in her native San Diego, where she enjoys cooking, hiking, trying new trendy restaurants, and traveling with her family.

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USDA Child Nutrition Program and Breastfed Toddlers in Day-Care

By Laura Spitzfaden, LLLL, IBCLC

Under the USDA Child Nutrition Program guidelines, infants and children 1 year of age and older, who are in licensed day-care programs, must be offered fluid cow’s milk (or approved alternative milk) in order for their day-care providers to be reimbursed for their meals. This is in conflict with what is best for employed mothers of breastfed toddlers and their day-care providers, who have limited breastfeeding friendly options under these guidelines.

iStock_000016831831SmallMany employed mothers, knowing that their breastmilk provides excellent nutrition, antibodies, and a sense of security for their older babies, continue to breastfeed when they are with their babies, even if they no longer express milk while they are at work. A breastfed baby, who is 1 year of age or older and eating nutrient dense solids, needs approximately 15 ounces of breastmilk each day to meet child nutrition standards. If a mother and baby breastfeed at least 3–4 times daily, the baby will receive age-appropriate amounts of milk and will not need a milk-substitute when separated from the their mother.

In order to support the breastfeeding relationship, a day-care provider may choose not to be reimbursed for the meals the breastfed child consumes that do not include milk, however this option is economically punitive to the provider and may affect how much they charge for their services. In order to take the burden off the day-care provider, the mother may send food from home for the child to consume at day-care but this creates extra work and expense for the mother. Alternatively, the mother’s own expressed breastmilk may be served at meals. This satisfies the milk requirement under the USDA Child Nutrition Program, but continued breastmilk expression may be unnecessarily burdensome for the mother of an older baby who doesn’t need this extra milk.

Expressing breastmilk takes a great deal of dedication and time; pump-weaning can be a welcome relief for the employed breastfeeding mother of an older baby. No longer does she have to cart her pump to and from work or have to scramble to accommodate for the occasional misplaced or broken pump part. Break times become actual breaks and lunches can be enjoyed without the hassle of setting up a pump, expressing and storing milk, and cleaning pump parts.

If a breastfeeding mother allows cow’s milk or other alternative milks to be offered at her child’s meals, she may risk their breastfeeding relationship. One mother who had pump- weaned but whose toddler continued to breastfeed when they were together writes, “when I got to that point with [my daughter], she just stopped getting milk at daycare. She is getting enough mama milk straight from the source when we are together. She just drinks water at daycare. We didn’t originally do it that way—we gave her cow’s milk for a couple of days—then she drastically reduced nursing, so I took her off of cow’s milk. She went back to nursing like normal.”

The Healthy, Hunger-Free Kids Act of 2010 states “In the case of children who cannot consume fluid milk due to medical or other special dietary needs, other than a disability, the caregiver may serve non-dairy beverages in lieu of fluid milk….If a non-dairy milk substitute is served that does not meet the nutritional standards outlined in Title 7 CFR 210.10(m)(3), then the meal is not reimbursable.” According to Kelley Knapp, MS RD from the California Department of Education Nutrition Services Division, there is another option in USDA’s Child Nutrition Programs. The child’s physician can fill out a form, “…stating that the child cannot receive milk due to a disability.” In this case, the toddler may be offered a physician-determined alternative (e.g. water or juice) with meals and the meal may still be reimbursable.

These options do not address the unique needs of the breastfed toddler who does not have a disability or a medical condition, but just doesn’t need additional milk in their diet. It doesn’t address the concern that offering non-human milk to a breastfed toddler can reduce the amount of breastmilk that is consumed and replace it with an inferior substitute that is linked to allergy and obesity.

Employed mothers should not have to continue to express milk for their children past the age when it is needed and they should not have to jump through hoops for their children to continue to enjoy a health promoting breastfeeding relationship. Day-care providers should not have to take an economic hit in order to support their breastfeeding clients. It is imperative that this gap in the USDA food program be closed, so that we may continue to support breastfeeding mothers, their babies, and their care providers, whether their breastfeeding relationships are measured in terms of months or years.

References:

Child & Adult Care Food Program Reimbursable Meals and Snacks

Long-Term Breastfeeding: Nourishment or Nurturance? Kathleen M. Buckley, PhD, RN, IBCLC, J Hum Lact November 2001 17: 304-312

Breastfeeding Past Infancy Fact Sheet

Feeding Infants: A Guide for Use in the Child Nutrition Programs, Chapter 3

USDA FCS INSTRUCTION 783-7 Food and Nutrition Service REV. 1 Milk Requirement Child Nutrition Programs

The Healthy, Hunger-Free Kids Act of 2010, Public Law 111-296, Section 221.17(g); USDA Policy Memo CACFP 21-2011-REVISED; USDA Policy Memo CACFP 04-2010 Fluid Milk and Fluid Milk Substitutions (Revised)

Child Nutrition Programs PHYSICIAN STATEMENT FOR FOOD SUBSTITUTION

LauraLaura Spitzfaden is a private practice IBCLC in Charlotte, Michigan. She has been a La Leche League Leader since 1998 and an associate area professional liaison (AAPL) for La Leche League since 2012. She has three children whom she breastfed for a total of 10 years. Laura has a passion for helping moms to reach their own breastfeeding goals and has created an informational breastfeeding website dedicated to providing moms with accessible breastfeeding help and resources so they may solve some of their own breastfeeding difficulties. She has written many articles on breastfeeding topics including, bed-sharing, milk-sharing, tongue and lip-tie, birth practices and milk-supply and provides these articles freely, to support breastfeeding moms and their babies.

Laura has a special interest in early childhood development and has worked in preschools and her own child-care business, creating hands-on, science based curriculums for toddlers, preschoolers and young 5’s. She has also presented multiple science workshops for young children and for adults who work with young children and has worked in a children’s science museum in exhibit development. Additionally, Laura has a love of dance and has studied tap, jazz, lyrical, modern and ballet and performs each year with The Community Dance Project.

© 2013 Laura Spitzfaden, LLLL, IBCLC

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Reflections from a Former Chris Mulford ILCA-WABA Fellow

The International Lactation Consultant Association® (ILCA®) and the World Alliance for Breastfeeding Action (WABA) are pleased to once again jointly sponsor the exciting opportunity for a Fellowship to travel and work with WABA on outreach and advocacy projects at their headquartersin Penang, Malaysia. ILCA has designated this annual Fellowship, the 6th to be awarded, as the Chris Mulford WABA ILCA Fellowship. Chris had been an ILCA member and helped to guide the birth and growth ofthe profession with a gentle spirit and wise leadership. Chris first joined WABA in 1996 at the first WABA Global Forum in Bangkok and became a long term volunteer for WABA. She worked mainly on Women and Work and Gender issues, bringing many achievements in supporting working women to breastfeed globally. She also paved the way for the first WABA‐ILCA Fellowship, in 2007, by being an exemplar of a Fellow. At Lactation Matters, we are proud to highlight this post, by Denise Fisher, a recent fellow, about her experiences in Malaysia with WABA.

For more information about applying to become a Fellow, please see this document. The deadline for applications is October 22, 2013.

By Denise Fisher AM, MMP, BN, IBCLC

In 2010, I was honored to be selected the Fellow to work with the World Alliance for Breastfeeding Action (WABA) staff on several projects to support breastfeeding worldwide.

WABA’s home office is in Penang. Penang has been called the Jewel of the Orient, and is a beautiful island off the coast of Malaysia. Malaysia is a bustling melting pot of races and religions where Malays, Indians, Chinese, and other ethnic groups live together harmoniously. Because of this multiculturalism, this tropical paradise has also made Malaysia a gastronomical paradise, and even the Malays from Kuala Lumpur will tell you that Penang is the place for the best food.

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I was incredibly excited to be given the opportunity for this fellowship to not only continue my passion for promoting breastfeeding, but to do it in such a fascinating country.

Now, while I was working on a purely volunteer basis, I was aware that ILCA® and WABA had invested financially in my travel and accommodation, and my family and work colleagues back home were also putting in big-time for me in my absence; so while the temptation was to spend many hours on the beach, I was keen to be able to help WABA as much as possible. I was given several projects to complete. They select projects that are in line with your interests and skills, so needless to say mine were either internet-related or education-related.

The biggest project was the establishment of the Breastfeeding Gateway. We worked as a small team to establish it in time to be launched for WABA’s 20th birthday celebrations. The goal of this Gateway is to provide you with all the quality information about a topic in one easy collection.  For example, you may be asked at work to develop a policy on an HIV-positive mother breastfeeding. You only need click on the HIV heading in the Gateway to open a page with links to all the quality information sites relevant to HIV on the internet, saving you hours of searching. This is perfect for students too – so easy. I loved helping to create this resource – it was such fun to work together on it.

Another project I had was to go to one of the local hospitals and film a mother doing skin-to-skin care and have baby self-attach. As a midwife, the opportunity to visit the maternity unit was one not to be missed, and then we had the most delightful mother, with a very obliging newborn who did exactly what he was supposed to (phew!).

Presenting a full-day workshop for the medical and nursing staff at the local university was pretty nerve-wracking, but on the day it all went smoothly and everyone was happy. Doing a workshop for the mother support group that had been established by a previous WABA/ILCA Fellow was much less stressful and I got to cuddle babies!

IMG_6511It wasn’t all work though. The WABA staff welcomed me into their lives and social events, and were all very friendly. I still keep in contact with some of them. I’ve been told I have to come back when the durian are fruiting (!). A young intern from America was working there at the same time I was, so both being visitors to the island, we spent our leisure time exploring – most memorable was the bicycle tour through Georgetown (the capital of Penang). You think traffic is bad where you live – wait until you’ve ridden a bike through the streets of an Asian city! This was a history and food tour – we went to lots of the historical sites (Georgetown is a UNESCO World Heritage Site) and our guides (two lovely young men) told us about living and working in Penang now, and what it was like for their parents and grandparents. And then there was the food – they took us to each of the places that was famous for each of the dishes Penang is famous for – lucky we did lots of riding to work it off. Another tour I did with my son was a guided taxi ride around the island. It truly is a tropical paradise.

Since my time in Penang, I’ve become one of a select group who get to meet up at the ILCA conference and talk about the good old days – the former WABA/ILCA Fellows! And even better, this year ILCA decided to honor us with a special Fellow’s pin. Based on my wonderful experience which was so personally and professionally rewarding I’d encourage everyone to consider applying for this yearly fellowship. You won’t regret it.

IMG_6093Denise is a registered nurse, midwife practitioner, and lactation consultant who has worked in education for many years. In recognition of her services to health professional education, specifically in the mother and baby area, Denise was inducted as a Member of Australia last year. Recognizing that the internet was the way of the future, Denise and her team created Health e-Learning in 2000, followed by the very popular GOLD conferences, to provide breastfeeding education for lactation consultants and other health professionals. She is now the Director of Step2 Education, a company that delivers Baby Friendly education to hospitals worldwide. Denise is married to Steve and mother to 3 beautiful young adults – James, Nicholas and Laura, and lives outside a little country town in Queensland, Australia.

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New Families Need Community Support: Beyond Talk into Action

By Jane I. Honikman

I was pregnant, single and alone.  I gave birth in a foreign country, and never saw my baby.  I had no emotional support. 

I was married, and was finally pregnant.  I gave birth, away from my extended family, but with a supportive husband.  We had no emotional support. 

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Photo by familymwr via Flickr Creative Commons

It is these contrasting, yet similar experiences which have motivated me to become passionate about improving the outcomes for babies and their parents.

After the birth of our second child, my friends and I co-founded Postpartum Education for Parents (PEP).  It was conceived from our own needs as struggling young parents, removed from our families, and inundated with professional advice.  What we lacked was a supportive environment where we could share our highs and lows each week, and not be judged or criticized when we admitted to being overwhelmed, scared, or inadequate.  It was about making friends, learning about community resources, and gaining confidence as new parents.

We launched the first ever warmline, staffed entirely by trained parent volunteers, 24 hours per day, 7 days per week.  It has been available since July 1, 1977.  I took the first shift that day and received the first call.  I was an ordinary mother actively listening to the needs of another ordinary parent.  We offered free emotional support to other new families.  PEP became our local community’s way to help ease the adjustment of developing families.

We know that communities are human systems where we live, work, learn, pray, and play together.  We tend to gather together based on our cultural values and with a common purpose. It is during pregnancy that the first shift in emotional needs occurs. The arrival of the newborn does interrupt a new parent’s existing community, as well as a good night’s sleep.  Social connections, our networks, exist within each community, yet how do expectant and new families find or create them?  In general, our networks help us find employment, friendship, and provide emotional support and comfort.  We may relish these natural human interactions, take them for granted, or in some cases, ignore them.  Then, the new baby arrives.   The need for community support takes on a different meaning. 

I want to emphasize the importance of community based social support.  Researchers have found that we are healthier and happier when surrounded by supportive peers, family, and friends.   It is with a social support network that we feel a sense of belonging and more secure.  As new parents increase their self-worth by not being isolated and struggling alone, the baby will feel this as well.

Connections between people are also called social capital.  We invest in material goods (physical capital), and value education (human capital).   It is critical that our social networks for new families are consciously created.  Academic scholars have shown that our psychological well-being benefits by having a network of supportive relationships.  Even if a new family has relatives living nearby when a baby arrives, making friends with others experiencing the same life event is vital.

All new parents will experience a wide range of physical and emotional challenges.  The transition from being single, becoming a couple, and then a family cannot happen without many changes.  PEP refers to these as “special circumstances”.   This list consists of every possible “less than easy or wonderful” situation.  For example, had I given birth after PEP was established I would have called the Warmline for emotional support after our son was born.  I would been connected with a volunteer who had had difficulty breastfeeding, who had also supplemented with formula.  I would have been encouraged to join a new parent discussion group where I would have shared how inadequate I felt as a mother.  My peers would also be new parents and eventually I would have felt secure enough to share that I’d placed my first baby for adoption.

My personal journey through parenthood would have been smoother had I had professional support as well as good friends.  Unfortunately, my depression went undiagnosed far too long.  It is ironic that although I had become involved with world leaders in the field of maternal mental health, it took decades to overcome my own denial.

There are many therapists, doctors, and educators who want to work with expectant and new families.  Their role as professionals in pregnancy and postpartum social support networks is to serve as advisors to trained peer volunteers.  A paid childbirth or lactation assistant is not the same as someone who has “been there” and offers empathetic comfort. A support group that is led by a professional is important to deal with stress and illness but it does not substitute for peer to peer support.  In all circumstances, however, they are definitely essential parts of community support.  When a PEP volunteer hears from a Warmline caller about a situation beyond the listeners’ capacity, the caller is referred to his or her own doctor, other professionals, and/or organizations listed in the PEP Community Resource Guide.

Families need and deserve supportive communities to bond with their peers as well as reach out to professional services.  Over the decades, studies consistently show that for good health and emotional well-being we need each other. We know that social interactions are needed for optimum physical and mental health.  The baby and the parents will build lasting friendships, strong personal relationships, and social ties in a community that offers this opportunity.

How supportive is your community for new parents?  Don’t wait for someone else to initiate what might work.  Start asking your friends, peers, family members and work colleagues if they’d like to explore the possibility of a social support network in your community.  You can replicate PEP in your community. It won’t look exactly like PEP. That is impossible since each community is unique. It all starts with a few friends who understand the importance of building a social support network.  Your efforts will be rewarded by meeting the needs of your own new families.

As Margaret Mead wisely said “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever does.”

MINOLTA DIGITAL CAMERAJane Honikman, M.S., is a Postpartum Parent Support  Consultant from Santa Barbara, California. In 1977, she co-founded Postpartum Education for Parents (PEP). She founded Postpartum Support International (PSI) in 1987. She lectures internationally on the role of social support and the emotional health of families. Her book, Community Support for New Families: A Guide to Organizing a Postpartum Parent Support Network in Your  Community, is available from Praeclarus Press

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