WHO: Facts for Life: Supporting Breastfeeding

As a Breastfeeding Activist and Advocate (Yes, I'm a Lactivist) I talk about the World Health Organizations (WHO) breastfeeding recommendations all the time.  I'm sure that many of us can recite in our sleep:
"Exclusive Breastfeeding for the first 6 months of life and for Breastfeeding to continue for up to two years and beyond"
But what else does WHO have to say about breastfeeding? About the dangers of using Infant Formulas and the roll that advertising/marketing plays in the undermining of Breastfeeding?  I thought you'd never ask!  I went searching and I've found this:  The World Health Organizations Facts for Life booklet.  The Booklet covers topics such as pregnancy & childbirth, breastfeeding, early childhood development, and nutrition, but I've just focused on the Breastfeeding section here.  To read the entire pdf document please click HERE

*I'm sorry about the formatting, I've tried to fix it several times and, well, it hates me and refuses to be fixed.... by me anyway.*

Breastmilk alone is the best food and drink for an infant for the first six
months of life. No other food or drink, not even water, is usually needed
during this period.

SUPPORTING INFORMATION
Breastmilk is the best food a young child can have. It promotes optimal
growth and development and protects against illness. Breastmilk contains the
perfect balance of nutrients for a baby, unlike infant formula, powdered milk
or animal milk.
The baby does not need water or other drinks or foods (such as tea, juice,
sugar water, gripe water, rice water, other milks, formula or porridge) during
the first six months. Even in hot, dry climates, breastmilk fully meets a baby’s
need for fluids.
Breastmilk is easy for the baby to digest. A baby has difficulty digesting
animal milks, and formula is digested much more slowly than breastmilk.
Compared to other options, breastmilk nourishes the baby more efficiently.
Breastmilk protects against illness because it contains antibodies that transfer
the mother’s immunity or resistance to disease to the child. No other milks
contain these antibodies.
Giving a baby under 6 months of age any liquids or foods other than
breastmilk increases the risk of diarrhoea and other illnesses. Water and other
liquids or foods may be contaminated, which can cause diarrhoea.
A baby who takes water or other liquids or foods in the first six months
suckles less on the breast. This slows down breastmilk production.
If regular weighing shows that a breastfed baby under 6 months of age is not
growing well:
● The mother may need help to improve the way the baby takes the
breast into the mouth to ensure good attachment so the baby can suckle
effectively.
● The baby may need more opportunities to breastfeed. The baby should
breastfeed on demand, day and night, at least eight times during a
24-hour period. The baby should be allowed to breastfeed until she or he
releases the breast and looks satisfied and sleepy. This shows that the
baby has had all she or he wants from that breast. The baby should then
be offered the other breast and may or may not want it. The baby should
be kept on the breast until she or he has finished suckling.
● A low-birthweight baby may need frequent pauses during breastfeeding.
● The baby may be ill and should be checked by a trained health worker.
● The baby may be getting water or other fluids, which can reduce the
intake of breastmilk. The mother may need guidance on how to reduce
and eliminate other fluids and to increase and give only breastmilk.
Feeding a baby only with breastmilk and on demand during the first six
months can help to delay the return of the mother’s menstruation. This may
help to delay the next pregnancy. However, there is some possibility – less
than 2 per cent – that a mother can become pregnant before her periods
return. This becomes increasingly likely after six months.

 Newborn babies should be given to the mother to hold immediately after
delivery. They should have skin-to-skin contact with the mother and begin
breastfeeding within one hour of birth.

SUPPORTING INFORMATION
Skin-to-skin contact and breastfeeding soon after birth stimulate production
of the mother’s breastmilk. Breastfeeding also helps the mother’s womb
contract, which reduces the risk of heavy bleeding or infection and helps to
expel the placenta (afterbirth).
Colostrum, the thick yellowish milk the mother produces in the first few
days after giving birth, is the perfect food for newborn babies. It is very
nutritious and full of antibodies that help protect the baby against infections.
Sometimes mothers are advised not to feed colostrum to their babies. This
advice is incorrect. Newborns benefit from colostrum.

The newborn needs no other food or drink while the mother’s milk supply is
coming in and breastfeeding is being fully established. Giving any other food
or drink may slow the production of milk. It can also increase the chance of
diarrhoea and other infections. The milk produced by the mother is nutritious
and the right amount for the newborn. The baby should breastfeed as often as
she or he wants.
A baby who has problems suckling in the first few days should be kept
close to the mother, offered the breast frequently, helped to take the breast
and given breastmilk expressed directly into the mouth or fed expressed
breastmilk from a clean cup (not from a bottle). The mother should receive
help to improve the baby’s attachment and suckling, and should also be
shown how to express breastmilk, if necessary.
A mother’s own milk is best for low-birthweight babies. However, not all
of these infants are able to feed from the breast in the first days of life. For
them, other options are available. In order of preference, they are: expressed
breastmilk (from the mother); donor breastmilk (only if the donor is HIV-tested
and the milk is correctly heat-treated); and infant formula. All of these should
be given by cup, spoon or paladai (a cup feeding device), or medical tubes
used by a trained health worker in a health facility.
Heat-treated breastmilk involves heating expressed breastmilk (enough for
one or two feeds) in a small pan or in a metal container standing in a pan of
water until it comes to a boil. The milk is then left to cool in a clean, covered
container before it is fed to the baby by cup. A trained health worker can
provide further guidance on expressing and heat-treating breastmilk.
It is best for the mother and her baby to stay together in the same room
immediately after birth. If a mother gives birth in a hospital or clinic, she is
entitled to have her baby near her, 24 hours a day. She should insist that no
formula or water be given to her baby if she is breastfeeding.

Almost every mother can breastfeed successfully. Breastfeeding the baby
frequently causes production of more milk. The baby should breastfeed at
least eight times daily, day and night, and on demand.

A mother’s breasts make as much milk as the baby wants. If the baby
suckles more, more milk is produced. Almost every mother can successfully
breastfeed and produce enough milk when:
● she breastfeeds exclusively
● the baby is in a good position and is well attached to the breast, with the
breast well in the baby’s mouth
● the baby feeds as often and for as long as she or he wants, including
during the night, and is kept on the breast until she or he has finished
suckling. The baby should finish feeding from one breast before being fed
from the other breast.
Holding the baby in a good position makes it easier for the baby to take the
breast well into the mouth and suckle.
Signs that the baby is in a good position for breastfeeding are:
● the baby’s head and body are in line
● the baby is close to the mother’s body
● the baby’s whole body is turned towards the mother
● the baby is relaxed, happy and suckling.
Holding the baby in a poor position can cause difficulties such as:
● sore and cracked nipples
● the baby does not receive enough milk
● the baby refuses to feed.
Signs that the baby is well attached:
● more of the dark skin around the mother’s nipple (areola) can be seen
above the baby’s mouth than below it
● the baby’s mouth is wide open
● the baby’s lower lip is turned outward
● the baby’s chin is touching the mother’s breast.
Signs that the baby is suckling well:
● the baby takes long, deep sucks
● the cheeks are round when suckling
● the baby releases the breast when finished.
Generally, the mother does not feel any pain in her breast when
breastfeeding.
From birth, the baby should breastfeed whenever she or he wants. A baby
should be fed on demand at least eight times in a 24-hour period, during
both the day and the night. If a newborn sleeps more than three hours after
breastfeeding, she or he may be gently awakened and offered the breast.
Crying is not a sign that the baby needs other foods or drinks. It normally
means the baby wants to be held and cuddled more, the baby’s diaper or
nappy needs changing, or the baby is too hot or cold. Some babies need
to suckle the breast for comfort. More suckling produces more breastmilk,
which helps satisfy the baby’s feeding needs. If the baby cries a lot and does
not settle after feeding and being cuddled, the mother may need additional
breastfeeding support or the baby might not be well. A trained health worker
should be consulted.
Using pacifiers, dummies or bottles can interfere with establishing
breastfeeding in the baby’s first months of life, as the sucking action for these
is different from suckling at the breast. The baby may become used to the
bottle teat or pacifier and refuse the breast. This may cause less suckling time
at the breast, which reduces milk production. Pacifiers and bottle teats may
become contaminated, increasing a baby’s risk of illness.
Mothers who fear they do not have enough breastmilk often give their babies
other food or drink in the first few months of life. This causes the baby to
suckle less often, so less breastmilk is produced. The mother will produce
more milk if she does not give the child other food or liquids and if she
breastfeeds often.
Mothers need to be reassured that they can feed their babies under 6 months
of age properly with breastmilk alone, and they need to be shown how to
do it. All mothers, especially those lacking the confidence to breastfeed,
need encouragement and support from the child’s father and their families,
neighbours, friends, health workers, employers and women’s organizations.
A mother who has undergone a Caesarean birth may require extra help to
begin breastfeeding her baby.
Skilled birth attendants can raise awareness and understanding about
the benefits of breastfeeding. They should support mothers to initiate and
continue breastfeeding and help fathers and other family members accept
breastfeeding as a natural and nutritious practice that protects the life of
the baby.

Breastfeeding helps protect babies and young children against dangerous
illnesses. It also creates a special bond between mother and child.

SUPPORTING INFORMATION
Breastmilk is a baby’s ‘first immunization’. It helps to protect against
diarrhoea, ear and chest infections, and other health problems. The protection
is greatest when breastmilk alone is given for the first six months and when
breastfeeding continues along with other foods well into the second year and
beyond. No other milks, foods or supplements can provide the protection
of breastmilk.
Breastfeeding helps a mother and baby form a close, loving relationship –
a process called bonding. The close contact and attention help infants feel
secure and loved, which is important for their growth and development.
The father and other family members can help by encouraging the mother
to rest quietly while she breastfeeds the baby. They can also make sure the
mother has enough nutritious food and help with household tasks and caring
for older children.

 Bottle feeding and giving a baby breastmilk substitutes such as infant
formula or animal milk can threaten the baby’s health and survival. If
a woman cannot breastfeed her infant, the baby can be fed expressed
breastmilk or, if necessary, a quality breastmilk substitute from an ordinary
clean cup.

SUPPORTING INFORMATION
Babies who do not receive breastmilk do not receive protection from illnesses
provided by the mother’s antibodies and other components that come in her
milk. These babies are more likely to get diarrhoea and respiratory and ear
infections. Diarrhoea and respiratory infections, such as pneumonia, can be
deadly in babies and young children.
Feeding the baby breastmilk substitutes can cause poor growth or illness if
(1) too much or too little water is added, (2) the water is not from a safe
source and/or (3) the bottles and teats are not cleaned properly. Powdered
breastmilk substitutes may contain harmful bacteria that can cause illness.
Studies suggest that children fed breastmilk substitutes, as compared to
breastfed children, are at greater risk of childhood obesity and some chronic
illnesses, such as heart disease, later in life.
Feeding the baby breastmilk substitutes can be expensive and particularly
risky if parents cannot afford to buy enough of a quality breastmilk substitute.
For example, to feed one baby for the first six months requires 20 kilograms
(about 40 tins) of infant formula. Trained health workers should inform all
parents considering the use of breastmilk substitutes about the costs.
If it is necessary to feed the baby with formula, it is important to boil clean
drinking water first and then add the hot water to the powdered formula. The
water should not be added after it has cooled down. The directions for mixing
should be carefully followed. This ensures that the right amounts of formula
and safe water are mixed and that the process is hygienic. Before giving the
formula to the baby, the mother, father or other caregiver must make sure it
is not too hot.

Animal milk and infant formula go bad if left at room temperature (around
20–25 degrees Celsius) for more than two hours. Breastmilk can be stored
for up to eight hours at room temperature without going bad. Of course, it is
better to safely store all types of milk in a clean, covered container, preferably
in a refrigerator.
Cup feeding is safer than bottle feeding because the cup can be easily cleaned
with soap and water. Cup feeding also provides some of the contact and
stimulation the baby needs, since the person has to hold the baby. Feeding
with a cup does not cause problems with suckling at the breast.
The best food for a baby who cannot be breastfed directly is milk expressed
from the mother’s breast, given from a clean, open cup. Even newborn
babies can be fed with an open cup. If it is necessary to feed a baby with
a nutritionally adequate breastmilk substitute, it should be fed to the baby
by cup.

A woman employed away from her home can continue to breastfeed her
child. She should breastfeed as often as possible when she is with the infant
and express her breastmilk when they are apart so that another caregiver can
feed it to the baby in a clean and safe way.

SUPPORTING INFORMATION
If a mother cannot be with her baby during working hours, she should
breastfeed often when they are together. With frequent breastfeeding, she will
continue to produce breastmilk.
If a woman cannot breastfeed at her workplace, she can express her milk
two or three times during the workday and refrigerate it or store it at room
temperature for up to eight hours in a clean, covered container. The expressed
milk can be given to the child by another caregiver from a clean cup.
Families and communities can encourage employers to provide paid
maternity leave, creches, and the time and a suitable place for women to
breastfeed or express and store their milk. The place should be clean, safe and
private. It should have clean water available for washing hands and utensils.

 After 6 months of age, when babies begin to eat foods, breastfeeding should
continue for up to two years and beyond because it is an important source of
nutrition, energy and protection from illness.

SUPPORTING INFORMATION
Breastmilk remains an important source of energy, protein and other
nutrients such as vitamin A and iron, even when babies begin to consume
additional foods after 6 months of age. Breastmilk helps protect a child
against disease for as long as the child breastfeeds.
It is recommended that a mother continue to breastfeed her child up to
two years and beyond – as long as she and the child wish to continue.
Breastfeeding can comfort a child who is upset and is an important source of
nourishment during a child’s illness.

Message from WHO: Importance of Breastfeeding

Message from the WHO on the importance of breastfeeding to saving childrens lives:

Note for the Media WHO/16

30 July 2010

Breastfeeding Key to Saving Children’s Lives

Ten steps to successful breastfeeding highlighted during World Breastfeeding Week

Geneva | Friday 30 July 2010 -- During World Breastfeeding Week, celebrated from 1 to 7 August in more than 170 countries, the World Health Organization (WHO) reiterates its call on health facilities and health workers to implement ten steps to help mothers breastfeed successfully and improve their babies’ health and chances of survival.

Breast milk is the ideal food for newborns and infants. It is safe, gives babies the nutrients they need for healthy development and contains antibodies that help protect infants from common childhood illnesses. While exclusive breastfeeding for the first six months of life is on the rise in many countries, further improvement of breastfeeding rates is critical to improve the nutrition and the health of infants and children. For a variety of reasons, including the lack of breastfeeding counselling, still too many mothers stop exclusive breastfeeding within a few weeks after delivery.
“It is estimated that around 35% of infants aged 0 to 6 months are exclusively breastfed in the world today,” says Dr Elizabeth Mason, Director of WHO's Department of Child and Adolescent Health and Development. “But if all babies and young children were breastfed exclusively for their first six months of life and then given nutritious complementary food with continued breastfeeding up to two years of age, the lives of an additional 1.5 million children under five would be saved every year.”
The “Ten Steps to Successful Breastfeeding” were developed by WHO and UNICEF to ensure maternity services are providing the right start for every infant and the necessary support for mothers to breastfeed. Today this check-list is used by hospitals in more than 150 countries.
The Ten Steps for health facilities to take towards ensuring successful breastfeeding are as follows:

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in the skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within half an hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants.
6. Give newborn infants no food or drink other than breast milk unless medically indicated.
7. Practise “rooming in” allowing mothers and infants to remain together 24 hours a day.
8. Encourage breastfeeding on demand whenever the baby is hungry.
9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

Malnutrition is responsible for one-third of the 8.8 million deaths annually among children under five. It can be a direct cause of death but is also the most important single risk factor for disease in young children. Over two thirds of these deaths, which are often associated with inappropriate feeding practices such as bottle-feeding or untimely and inadequate complementary foods, occur during the first months of life.
“Increasing breastfeeding rates is a key component of the plan to improve infant and young child nutrition,” says Randa Saadeh, Coordinator of the Nutrition in the Life Course unit at WHO. “A renewed effort to make more hospitals ‘baby friendly’ has the potential to give millions more babies a healthy start in life.”

For further information, please contact:

Marie-Agnes Heine, Communications Officer, Department of Making Pregnancy Safer, WHO
Tel: +41 22 791 2710, Mobile: +41 794 495 784, Email: heinem@who.int

Randa Jarudi Saadeh, Coordinator, Nutrition in the Life Course Unit, Department of Nutrition for Health and Development, WHO.
Tel: +41 22 791 3315, Mobile: +41 79 475 5530, Email: saadehr@who.int

Notes to editors:

For more information on World Breastfeeding Week go to: http://worldbreastfeedingweek.org/

All WHO information can be found at : www.who.int

World Breatfeeding Week

In Canada World Breastfeeding Week is celebrated from October 1 to 7.
INFACT Canada will be uploading fact sheets and other promotional tools to celebrate the Week on our website at www.infactcanada.ca.

Elisabeth Sterken
Director INFACT Canada

World Health Assembly May 2010

World Health Assembly (WHA) May 17 to 21, 2010

Every year several members of the International Baby Food Action Network (IBFAN), attend the World Health Assembly (WHA) to advocate for the passage of global policies to advance infant and young child nutrition and health. This year there were two key items of importance for governments and those working to improve infant and young child nutrition and the protection of breastfeeding on the agenda of the WHA. Firstly revised and strengthened resolutions on Infant and young child nutrition WHA 63 Agenda item 11.6 and secondly, agenda item 11.9 dealing with the Marketing of foods and non-alcoholic beverages to children to reduce intakes of foods high in trans-fatty acids, saturated fats, salt and added sugars.

Canada’s lack of protection of infant optimal infant and young child nutrition remains shameful. We have little or no regulatory, monitoring and enforcement mechanisms in place to protect pregnant women, new mothers and families from the very aggressive, misleading and deceptive marketing by the infant formula and baby foods manufacturers and distributors.
The marketing of junk foods and drinks to children is yet another area that must be adequately regulated in order to safeguard children from the impact of foods and drinks high in saturated fats, trans-fatty acids, salt and added sugars. Currently the Province of Quebec is the only Canadian jurisdiction restricting junk food marketing to children. While monitoring and enforcement remain issues of concern regarding the Quebec legislation, the regulations can provide a model for what provinces and territorial governments can do to protect children’s nutrition and health. The health and cost benefits will be staggering!

WHA 63 Agenda item 11.6

Infant and young child nutrition

The resolution urges governments and the baby foods industries to strengthen their efforts to implement the Global Strategy on Infant and Young Child Feeding, The Baby Friendly Hospital Initiative and the International Code of Marketing of Breastmilk Substitutes. Some key provisions:

(2) to strengthen and expedite the sustainable implementation of the Global Strategy for infant and young child feeding including emphasis on giving effect to the aim and principles of the International Code of Marketing of Breast-milk Substitutes, and the implementation of the Baby-friendly Hospital Initiative;
(3) to develop and/or strengthen legislative, regulatory and/or other effective measures to control the marketing of breastmilk substitutes in order to give effect to the International Code of Marketing of Breastmilk Substitutes and relevant resolution adopted by the World Health Assembly;
(4) to end inappropriate promotion of food for infants and young children and to ensure that nutrition and health claims shall not be permitted for foods for infants and young children, except where specifically provided for, in relevant Codex Alimentarius standards or national legislation;
(5) to develop or review current policy frameworks addressing the double burden of malnutrition and to include in the framework childhood obesity and food security and allocate adequate human and financial resources to ensure their implementation;

WHA 63 Agenda item 11.9

Marketing of foods and non-alcoholic beverages to children

Recognizing that unhealthy diets is one of the main risk factors for noncommunicable diseases and that the risks presented by unhealthy diets start in childhood and build up throughout life;
Cognizant of the research that shows that food advertising to children is extensive and other forms of marketing of food to children are widespread across the world;
Recognizing that a significant amount of this marketing is for foods with a high content of fat, sugar or salt and that television advertising influences children’s food preferences, purchase requests and consumption patterns;
URGES Member States:
(1) to take all necessary measures to implement the recommendations on the marketing of foods and non-alcoholic beverages to children, while taking into account existing legislation and policies, as appropriate;

The WHA adopted a set of recommendations for policy development and specific marketing restrictions for governments to implement, enforce and monitor.

RECOMMENDATION 1. The policy aim should be to reduce the impact on children of marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt.
RECOMMENDATION 2. Given that the effectiveness of marketing is a function of exposure and power, the overall policy objective should be to reduce both the exposure of children to, and power of, marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt.
RECOMMENDATION 3. To achieve the policy aim and objective, Member States should consider different approaches, i.e. stepwise or comprehensive, to reduce marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt, to children.
RECOMMENDATION 4. Governments should set clear definitions for the key components of the policy, thereby allowing for a standard implementation process. Thesetting of clear definitions would facilitate uniform implementation, irrespective of the implementing body. When setting the key definitions Member States need to identify and address any specific national challenges so as to derive the maximal impact of the policy.
RECOMMENDATION 5. Settings where children gather should be free from all forms of marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt. Such settings include, but are not limited to, nurseries, schools, school grounds and pre-school centres, playgrounds, family and child clinics and paediatric services and during any sporting and cultural activities that are held on these premises.
RECOMMENDATION 6. Governments should be the key stakeholders in the development of policy and provide leadership, through a multistakeholder platform, for implementation, monitoring and evaluation. In setting the national policy framework, governments may choose to allocate defined roles to other stakeholders, while protecting the public interest and avoiding conflict of interest.
RECOMMENDATION 7. Considering resources, benefits and burdens of all stakeholders involved, Member States should consider the most effective approach to reduce marketing to children of foods high in saturated fats, trans-fatty acids, free sugars, or salt. Any approach selected should be set within a framework developed to achieve the policy objective.
RECOMMENDATION 8. Member States should cooperate to put in place the means necessary to reduce the impact of cross-border marketing (in-flowing and out-flowing) of foods high in saturated fats, trans-fatty acids, free sugars, or salt to children in order to achieve the highest possible impact of any national policy.
RECOMMENDATION 9. The policy framework should specify enforcement mechanisms and establish systems for their implementation. In this respect, the framework should include clear definitions of sanctions and could include a system for reporting complaints.
RECOMMENDATION 10. All policy frameworks should include a monitoring system to ensure compliance with the objectives set out in the national policy, using clearly defined indicators.
RECOMMENDATION 11. The policy frameworks should also include a system to evaluate the impact and effectiveness of the policy on the overall aim, using clearly defined indicators.
RECOMMENDATION 12. Member States are encouraged to identify existing information on the extent, nature and effects of food marketing to children in their country. They are also encouraged to support further research in this area, especially research focused on implementation and evaluation of policies to reduce the impact on children of marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt.

Elisabeth Sterken
Director INFACT Canada
esterken@infactcanada.ca

Help INFACT Canada to promote, protect and support breastfeeding.