BREASTFEEDING

TSEK
Tama, Sapat, Esklusibo

PROTECT INFANT HEALTH. SAVE LIVES.

 Contents

1. Situation of Infants and Children

2. Current Evidence for Breastfeeding
3. National & Health Policies
4. National Programs & Strategies
5. Breastfeeding TSEK:
Protecting Community Infants &
Young Children
 1

The Situation of Infants and Children

The State protects a
Childs right to Life
and Good Health
The State shall protect
and promote the right to
health of the people and
shall instill health
consciousness among
them.

Philippine Constitution, Art 2, Section 15

4
Our National Commitment

The Philippines is committed to achieve

the Millennium Development Goals
(MGD) by 2015.

5
One of 4 children, under 5 years, is malnourished

NUTRITIONAL PREVALENCE ESTIMATED

STATUS NUMBER
(IN MILLION)*
Underweight 26.2% 3.35
Underheight 27.9% 3.57
Thinness 6.1% 0.78
Overweight 2.0% 0.26
Source: 7th National Nutrition Survey, 2008
 The continued high rates of moderate and
severe stunting (30%) and low birthweight
(20%) highlight the need for greater attention
to improving maternal nutrition and
complementary feeding.

The State of the Worlds Children 2009

8
 Poor Nutritional Status
Predisposes to:
increased severity and duration of
diarrhea attacks
Increased risk of dying from diarrhea

Ashworth and Feachem. Interventions for the control of diarrhoeal diseases among young children: weaning education.
Bulletin of the World Health Organization, 63 (6): 1115-1127 (1985)

9
Mortality Impact of Underweight

5% reduction in low weight for age

by 2005

30% reduction in child mortality

Source: Pelletier and Frongillo. 2003. Pooled analysis of data from 59 countries from 1966 to 1996.

10
Breastfeeding evens the playing field
Breastfeeding is a natural "safety net"
against the worst effects of poverty...it is
almost as if breastfeeding takes the infant
out of poverty for those first few months
in order to give the child a fairer start in
life and compensate for the injustice of
the world into which it was born.
James P. Grant
Former Executive Director UNICEF

3
 4
Reduce by two
thirds the
under-five
mortality rate
between 1990
and 2015
 Key Facts
7.6 million children under the age of five die
every year (2010 figures).
More than half of these early child deaths are
due to conditions that could be prevented or
treated with access to simple, affordable
interventions.
Leading causes of death in under-five children
are pneumonia, preterm birth complications,
diarrhoea, birth asphyxia and malaria. About
one third of all child deaths are linked to
malnutrition.
13
Source: WHO. Global Health Observatory (http://www.who.int/gho/child_health/en/index.html)
1 of 4 Philippine children under five years of age
are at risk of infection & death
CAUSES OF UNDER FIVE DEATHS, 2010

Source: WHO. Global Health Observatory (http://www.who.int/gho/child_health/en/index.html)

Our newborns are at risk of dying
in the first 2 days of life
 Strategies
appropriate home care and timely
treatment of complications for newborns
integrated management of childhood
illness for all children under five years old
expanded program on immunization
infant and young child feeding

16
Exclusive Breastfeeding Rates by Region
 Why breast milk?

Breast milk Artificial Milk

Protein Correct amount Partly corrected
Easy to digest
Fat Enough essential fatty No lipase
acids, lipase to digest

Water Enough May need extra

Anti-Infective Present ABSENT
Properties Immunizes & Protects
Adapted from: Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993
(WHO/CDR/93.6).
If a new vaccine became available that could
prevent one million or more child deaths a
year, and that was moreover cheap, safe,
administered orally, and required no cold
chain, it would become an immediate public
health imperative.
Breastfeeding can do all this and more.
- 1994
19
Evidence presented in the Series on Child
Survival 2003 , Series on Neonatal Survival
2005 , and the Series on Maternal and Child
Undernutrition 2008 , clearly pointed out
the importance of exclusive breastfeeding
for the first six months of life which could
save more lives than any other intervention
studied while enhancing nutritional status
20
 2

The Clinical Evidence on Exclusive

Breastfeeding at Birth to 6 months
 Effect of Breastfeeding
For the vast majority of infants and young
children throughout the world, breastfeeding
saves lives
prevents morbidity
promotes optimal physical and cognitive
development
reduces the risk of some chronic diseases
Evidence of the benefits of breastfeeding for
mothers is growing as well
Leon-Cava et al. Quantifying the Benefits of Breastfeeding: A Summary of the Evidence. Washington, D.C.: PAHO 2002
22
 Infant Morbidity and Mortality

The greatest and most obvious

benefits of breastfeeding are for
the immediate health and survival
of the infant

23
 Infant Morbidity and Mortality
Rates of diarrhea, respiratory tract infections,
otitis media, and other infections, as well as
deaths due to these diseases, are all lower in
breastfed than in non-breastfed infants
Exclusively breastfed infants have at least 2
times fewer illness episodes than infants fed
breast-milk substitutes.

Source: Jones et al., 2003,; Chandra, 1979; Feachem, 1984; and Victora, 1987.
24
 Protection Against Infection
INFECTIONS % REDUCTION

Acute otitis media 50%

(exclusive BF 3-6 mos.)
Recurrent otitis media 77%
(exclusive BF >6 mos.)
Upper respiratory tract infection 64%
(exclusive BF >6 mos.)
Lower respiratory tract infection 77%
(exclusive BF >6 mos.)
Gastroenteritis 64%

Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk,
originally published online February 27, 2012

25
 Neonatal Conditions
INFECTIONS % REDUCTION

Necrotizing enterocolitis 77%

RSV bronchiolitis 74%
(exclusive BF >4 mos.)
Sudden Infant Death Syndrome (SIDS) 36%
(any > 1 month)

Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk,
originally published online February 27, 2012
 Percentage of infants 2-7 months of age reported as
experiencing ear infections, by feeding category in
the preceding month in the U.S.

Adapted from: Scariati PD, Grummer-Strawn LM, Fein SB. A longitudinal analysis of infant morbidity
and the extent of breastfeeding in the United States. Pediatrics, 1997, 99(6).
 Risk of diarrhea by feeding method
for infants aged 0-2 months, Philippines

Adapted from: Popkin BM, Adair L, Akin JS, Black R, et al. Breastfeeding and diarrheal morbidity.
Pediatrics, 1990, 86(6): 874-882.
 Type of Feeding

Hospitalized low birth weight infants who were

fed with formula milk had 4 times the
incidence of serious illness compared to those
infants who were breastfed.

29
Randomized Controlled Trial of Low Birth Weight
Hospitalized Neonates comparing type of feeding
vs. percentage with serious illness
 Infant Mortality
There is a 2-4 fold increase in neonatal
mortality rate (NMR) in not receiving
colostrum. There is a 5-13% decrease in NMR
with exclusive breastfeeding
Babies who were not breastfed in the first 6
months of their lives are 25 times more likely
to die than those who experienced exclusive
breastfeeding from the time they were born.
Source: Jones et al., 2003,; Chandra, 1979; Feachem, 1984; and Victora, 1987.
 Early Breastfeeding initiation

The timing of initiation of breastfeeding is

important as there is a higher risk of
death among infants with longer delay in
the initiation of breastfeeding.

Mullany LC, et al. JNutr, 2008; 138(3):599-603.

Delaying Initiation of breastfeeding increases
risk of infection-related death
Nepal 2008 N = 22,838 breastfed babies
 Relative risks of death from diarrhoeal disease
by age and breastfeeding category in Latin America

Adapted from: Betran AP, de Onis M, Lauer JA, Villar J. Ecological study of effect of breast feeding on infant
mortality in Latin America. BMJ, 2001, 323: 1-5.
 Relative risks of death from acute respiratory
infections by age and breastfeeding category
in Latin America

Adapted from: Betran AP, de Onis M, Lauer JA, Villar J. Ecological study of effect of breast feeding on infant
mortality in Latin America. BMJ, 2001, 323: 1-5.
 Protection Against Allergy

ILLNESS % REDUCTION

Atopic dermatitis (negative family history) 27%

(exclusive BF > 3 mos.)
Atopic dermatitis (positive family history) 42%
(exclusive BF > 3 mos.)
Asthma (atopic family history) 40%
(exclusive BF > 3 mos.)
Asthma (no atopic family history) 26%
(exclusive BF > 3 mos.)

Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk,
originally published online February 27, 2012

36
 Protection Against Diseases
DISEASE % REDUCTION

Type I diabetes 30%

(exclusive BF > 3 mos.)
Type 2 diabetes 40%
(any)
Leukemia (ALL) 20%
(exclusive BF > 6 mos.)
Leukemia (AML) 15%
(exclusive BF > 6 mos.)
Obesity 24%
(any)

Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk,
originally published online February 27, 2012
37
 Breastfeeding decreases the prevalence
of obesity in childhood at age five and six years, Germany

Adapted from: von Kries R, Koletzko B, Sauerwald T et al. Breast feeding and
obesity: cross sectional study. BMJ, 1999, 319:147-150.
Breastfeeding increases intelligence
 Child Development
Breastfeeding was associated with significantly
higher scores for cognitive development than
was formula feeding
Premature infants derive more benefits from
breast milk than do full-term infants
The benefits of breastfeeding increased with
duration

Anderson et al. Breast-feeding and cognitive development: a meta-analysis. Am J Clin Nutr 1999;70:52535

40
 Child Development
Largest randomized trial ever conducted in the
area of human lactation (17,046 infants)
strongly suggest that with prolonged and
exclusive breastfeeding:
Improvement in cognitive development as
measured by IQ (verbal IQ, performance IQ,
full-scale IQ)
Teachers academic ratings at age 6.5 years
were significantly higher for both reading and
writing
Kramer et al. Breastfeeding and Child Cognitive Development :New Evidence From a Large Randomized Trial.
Arch Gen Psychiatry. 2008;65(5):578-584
41
Duration of breastfeeding associated with higher
IQ scores in young adults, Denmark

Adapted from: Mortensen EL, Michaelsen KF, Sanders SA, Reinisch JM. The association between duration of
breastfeeding and adult intelligence. JAMA, 2002, 287: 2365-2371.
Benefits of breastfeeding
for the mother

43
 Short-term Benefits

Decreased post-partum blood loss

Rapid involution of the uterus
Decrease in post-partum depression
Increased child spacing due to lactation
amenorrhea

Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk, originally published online
February 27, 2012
44
 Long-term Benefits
Reduced risk of chronic diseases:
Type 2 diabetes mellitus (no history of gestational
DM)
Rheumatoid arthritis
Cardiovascular disease (hypertension,
hyperlipidemia)
Breast cancer (primarily premenopausal)
Ovarian cancer

Significantly decreased rate of child abuse/

neglect
Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk, originally published online
February 27, 2012 45
 Breast cancer and breastfeeding:
Analysis of data from 47 epidemiological studies
in 30 countries

0 1 2 3 4 5 6

Adapted from: Beral V et al. (Collaborative group on hormonal factors in breast cancer).
Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47
epidemiological studies in 30 countries Lancet 2002; 360: 187-95.
 Risks of artificial feeding
Baby
Interferes with bonding More allergy and
milk intolerance
More diarrhea and
respiratory infections Increased risk of some
chronic diseases
Persistent diarrhea
Overweight
Malnutrition
Vitamin A deficiency Lower scores on
intelligence tests
More likely to die
Mother
Increased risk of anemia, May become pregnant
ovarian and breast cancer sooner
Adapted from: Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993 (WHO/CDR/93.6).
Exclusive
Breastfeeding
Protects Infant
Health & Saves
Newborn Lives
 3

Laws & Policies on

Exclusive Breastfeeding for 6 Months
Key Health Policies Mandate Breastfeeding
for Infants & Young Children
Republic Act 7600
Rooming-in and Breastfeeding Act and IRR

Republic Act 10028

An Act Providing Incentives to All Government and Private
Health Institutions with Rooming-In and Breastfeeding
Practices and For other Purposes

Executive Order 51, s. 1986

National Code of Marketing of Breastmilk Substitutes and
Products (The Milk Code)
 Key Health Policies Mandate Breastfeeding
for Infants & Young Children
DOH Administrative Orders
2005-0014 National Policies on Infant and Young Child Feeding
2006-0012 Implementing Rules and Regulation of E.O. 51, Otherwise known
as The Milk Code, Relevant International Agreements, Penalizing Violations
Thereof, and for Other Purposes
2007-0026 Revitalization of the Mother-Baby Friendly Hospital Initiative
in Health Facilities with Maternity and Newborn Care Services
2008-0029 - Mother-Baby Friendly Hospitals

2009-0025 - Adopting Policies and Guidelines on Essential Newborn Care

2010-0010 - Revised Policy on Micronutrient Supplementation to Support
Achievement of 2015 MDG Targets to Reduce Under-five and Maternal Deaths
and Address Micronutrient Needs of Other Population Groups
 Key Health Policies

Philhealth
No. 12-2005 Adoption of PhilHealth Benchbook on
Performance Improvement of Health Services
No. 26-2005 Requirement for Accredited Hospitals to be
Mother-Baby Friendly Hospitals
No. 34-2006 PhilHealth Newborn Care Package
DILG
 4

National Programs
Promoting Health & Lives of
Infants & Young Children
National Infant Young Child Feeding Strategy
2011 2016

Source: NCDPC, Department of Health

Children have the right to adequate
nutrition and access to safe and
nutritious food, and both are essential
for fulfilling their right to the highest
attainable standard of health.

Infant Young Child Feeding Policy (IYCF), 2011-2015

Department of Health
Infant Youth Child Feeding Strategy, 2011-2016

GOAL OUTCOMES By 2016:

90 percent of newborns are initiated to
Reduction of breastfeeding within one hour after
birth;
child mortality
and morbidity
through optimal 70 percent of infants are exclusively
feeding of breastfeed for the first 6 months of life;
infants and and
young children
95 percent of infants are given timely
adequate and safe complementary food
starting at 6 months of age.
Since 2008: Mother Newborn Child Health &
Nutrition (MNCHN) Service Package
Financing
Health Facilities and Service Packages
Human Resource
Health Products and Pharmaceuticals
Other Support Systems

Postpartum
Pre-Pregnancy Care during
Antenatal care and Postnatal
Services Delivery
Care
Our Maternal, Newborn and Child
Protection Strategy
PRENATAL AT BIRTH EXCLUSIVE FOR 6 SUPPLEMENTARY
MONTHS FOODS FOR 2
YEARS
Health Plan Essential Exclusive Infant and Young
Intrapartum and Breastfeeding Child Feeding
Newborn Care for 6 Months (IYCF) Strategy
in Facilities in Communities

EINC Unang Breastfeeding

Yakap TSEK
 Unang Yakap 4&5
Safer, evidence-based,
better quality care
for mothers & newborns
in all health facilities
Breastfeeding
is the national
health strategy
to protect
infant health
& save lives

(DOH, IYCF 2011-2016)

 5

Breastfeeding TSEK:
Exclusive Breastfeeding to 6
Months
Tama - immediate Sapat - mothers milk EKsklusibo - exclusive
and appropriate is sufficient ( in breastfeeding for 6 months,
breastfeeding within one nutrients and quantity) just pure mothers breast
hour after birth for the baby up to 6 milk only, not even water.
months
Helping mothers to initiate and to
exclusively breastfeed
needs an Inter-sectoral Response
The MDG-F Joint Program:
The Breastfeeding TSEK campaign is a component
of the Joint Program by the UN Country Team to
help the Philippines achieve MDG # 1 and 4
Supported by the Spanish Government
It is called the MDG-F 2030: Ensuring Food Security
and Nutrition for Children 0-24 months in the
Philippines
Health Governance: Unang Yakap & Breastfeeding TSEK

LGU Policies for

EINC Unang Yakap
& Breastfeeding
TSEK
Mobilization & Advocacy
-Mothers
-Health Professionals
-Private Sector
Building Competence &
Commitment of Health
Professionals & Team TSEK
LGU Allocation of Resources for EINC
Unang Yakap & Breastfeeding TSEK
Plans & Policies: EINC in
Hospitals & TSEK Plan

Peer Counselling Scaled Up for

Breastfeeding Mother & Babies,
Pre, At-birth and 6 months
 Breastfeeding TSEK in LGUs
LGU Policies for
Breastfeeding
TSEK

Private Sector Mobilization

& Advocacy
Building Competence &
Commitment of the Team
TSEK Core Group
LGU Allocation of
Resources to sustain
LGU TSEK

Health Staff develop TSEK

Plan for City Health
Investment Plan

Community Peer Counselling

Scaled Up for Breastfeeding
Mother & Babies
 Breastfeeding TSEK in LGUs
Key Action Steps
1) Update LGU Ordinances & Health Policies
2) Train LGU Health Staff & TSEK Peer Counsellors
3) Develop the Breastfeeding TSEK Plan &
incorporate into LGU Health Plan
4) Mobilize TSEK Counsellors and build strong
community support
5) Mobilize private sector support: private health
sector, academe, business,
6) Monitor, Innovate & Sustain Breastfeeding TSEK
 Step 1: Formal LGU Support
LGU Ordinances & Guidelines
Advocacy with LGU Stakeholders
Powerpoint presentations and handouts for LCEs
and TSEK Peer Counselors for use of CHDs
Visual promotional materials to be used by
Mayors/ LGUs
Sample press stories, radio scripts for
Mayors/LGUs to promote local initiatives on
keeping mother and baby safe and healthy
Step 2: Training of Peer Counselors
Training of Peer Counselors (PCs):
A Training Institution , ARUGAAN, was hired to

conduct the Peer Counselors Training- training design

is done and trainers reference manual being finalized
after the pilot run in 3 cities
PC trainings conducted in Quezon City, Marikina,

Pasig, Taguig, Caloocan, Navotas, Paraaque, Pasay,

Mandaluyong, Makati - a total of about 1,800 PCs
trained
Mentoring done in Quezon City, Marikina, Pasig,

Taguig, Caloocan, Navotas, Paraaque,

Training of Peer Counselors
Step 3: Mentoring Done at the Barangay
House to House Visits Regular monthly meetings w/ midwives
Practicum w/ Mentors to process (share and learn) experiences
in actual counseling
Step 4: Monitoring with TSEKlist Card
Step 5: Mobilizing LGU Partnerships

Advocacy Kits & Materials

Joint issuance with DSWD,
Dep Ed, DILG, Civil Service
MOAs with NGOs, civic and
professional societies and
groups
Step 6: Sustain Breastfeeding TSEK
Enact LGU policy allocating resources for
Breastfeeding TSEK
Build breastfeeding facilities
Expand and motivate the TSEK Peer
Counsellors
Strengthen mothers education
Build capacity of health facilities & LGU
health professionals for safe & quality
Essential Intrapartum and Newborn Care
or Unang Yakap
Educate, Create, Support:
Doctors, Nurses, Midwives
Mothers & Families
 Erase Breastfeeding Myths
Practice Exclusive Breastfeeding for 6 Months
Proteksyon ng Sanggol.
Pamana ng Buhay.
Alagang Tunay.
THANK YOU