Research COMPLIANCE ON THE IMPLEMENTATION OF THE BABY-FRIENDLY PROGRA AUTHOR : MARIE DEGREE : MASTER ADVISER : DR. POROLITA A.

MISSION CHRISTINE OF NACUA ARTS IN MERCADO NURSING

INTRODUCTION One of the major issues today is the decreasing practice of breastfeeding. Based on 2006 National Demographic and Health Survey conducted by the National Statistics Office (NSO), about 60.5 percent of mothers with children aged less than two months reported having breastfed, their youngest child. The same survey showed that the practice of exclusive breastfeeding declined by 17.1 % as the baby reached three months old. Reasons for not breastfeeding are: not enough milk-31%, nipple/breast problem- 17 %, child refused- 12 %, child ill/dead- 11 %, others 5 %. Maternal and child health is one of the major focuses of health practices in the country today. To have healthy children, it is important to promote the health of the childbearing mother, her family from the time they are born and the community where they live in. Although mother and child are of two separate entities, maternal and child health are made one full scope in practice. This is so, because mothers are the ones who play a major role in promoting and protecting the health of the next generation. In Barangay Inayawan, according to the Rural Health Midwife, the reasons for the mother why they shift breastfeeding to bottle or mix feeding are: mother is working or need for mother to work outside the home; mothers perception of insufficient milk flow; another pregnancy; mother is busy; sick or weak; breast or nipple problems and mothers choice or the child prefers milk formula. Barangay Inayawan was chosen because the researcher observed that mothers in this barangay who were 0-6 months post-partum did not practice exclusive breastfeeding. The researcher wanted to impart the importance and benefits of exclusive breast feeding and emphasize it to them. Since, the researcher is also a resident of Barangay Inayawan, near the Barangay Health Center, the researcher can give brochure to mothers entailing exclusive breastfeeding, its importance and benefits. Furthermore, the researcher can accessibly monitor if the mothers are practicing breastfeeding and provide reinforcement if needed.

PROBLEM This study determined the level of compliance on the implementation of the Baby-Friendly Program in Barangay Inayawan, Cebu City. The findings of which served as basis for a proposed brochure for breastfeeding mothers.

Specifically, it answered the following inquiries: 1. What is the profile of the mothers in terms of: 1.1 age; 1.2 educational attainment; 1.3 number of children; 1.4 availment of service of health center and; and

1.5 age of breastfeeding infants? 2. What is the profile of health care providers in terms of 2.1 age; 2.2 educational attainment; and 2.3 length of service? 3. What is the level of the compliance on the implementation of the breastfeeding program as perceived by the health care providers and mothers in terms: 3.1 rooming - in practice; 3.2 latching on; 3.3 breastfeeding practices; and 3.4 breastfeeding community support group? 4. Is there a significant difference between the perceptions of the mothers and the health care providers on the compliance of the implementation of baby-Friendly Program? 5. What brochure for breastfeeding mothers can be proposed based on the findings of the study? Research Design This study utilized the descriptive method of research to determine the compliance on the implementation of the Baby-Friendly Program in Barangay Inayawan, Cebu City. FINDINGS Most mothers were high school graduates with 1-3 numbers of children. They availed of the health services rendered in the health center once a month . They had babies aged 0-3 months being breastfed. Most of the health care providers were college level. Majority had more than ten years in service. There was a high level of compliance on the implementation of the baby-friendly program as perceived by the mothers and the health care providers. where rooming-in practices, latching-on practices. There was also a high compliance on breastfeeding practices and breastfeeding community support. CONCLUSION Mothers availed the services of the health center in their barangay. Health care providers complied with the protocols mandated by the Department of Health. Both mothers and health care providers had the same perceptions that Barangay Inayawan has a high level of compliance on the implementation of the Baby Friendly Program as prescribed by the Department of Health, with regard to rooming-in, latching-on, breastfeeding practices and community support group.

RECOMMENDATIONS

From the facts presented in the study, the following recommendations are made:

1. Disseminate the brochure to the breastfeeding mothers with 0-6 months old infants, health care workers and students. 2. Health care team should continue to encourage the mothers to breastfeed their babies in order to protect the child from diseases and boost their immune system. 3. There should be more campaign to disseminate information regarding the provision of artificial nipple or pacifier as this is a continuing practice with no known benefits to breastfeeding. 4. Barangay health center should sustain the organized breastfeeding support group to maximize its good potential effect to the society. 5. There is a need to emphasize that infants must be breastfeed on demand to properly nourish them and meet their dietary requirements 6. Mothers should be referred to breastfeeding support group who can assist them in their effective performance as a lactating mother. 7. It is imperative that fathers be involved and active participants in the child-rearing and BabyFriendly Program as a whole. 8. Further studies should be conducted to validate the assumptions and provide substantial basis to improve the Baby- Friendly Program.

BIBLIOGRAPHY

1. Books:

Alligood, Martha and Tomey, Ann Marinner. (2002) Nursing Theorists And Their Work. 5thEdition. USA: Mosby. Baker, Susan and Roberta R. Henry, (2002) Parents Guide to Nutrition. Philadelphia: J.B. Lippincott Company. Ball, Vane W. and Ruth C. Binaler, (2003) Pediatric Nursing Caring For Children. Third Edition. Broadribb, Violet (2000) Maternal & Child Nursing. Philadelphia: J.B. Lippincott Company, Second Edition. Cameron, Margaret and Yngue Hofvander (2001) Manual Feeding Infants and Young Children. New York Oxford Medical Publications. Third Edition. George, Julia B. Nursing Theories. Fourth Edition. 1995 Helsing, Elizabeth and King F. Savage. (2000) Breastfeeding in Practice. New York: Oxford University Pres. Loudermik, Deitra Leonard. Maternity & Womens Health Care. 8th Edition, 2004. Pilleteri, Adele. Maternal and child Health Nursing: Care of the Childbearing and Childrearing Family. 5th ed, 2007. Potter and Perry. Fundamentals of Nursing (2001). Lippincott. Fifth Edition. Wardlaw, Gordon M. (2003) Contemporary Nutrition: Issues & Insights. Fifth Edition.

2. Journals:

Barrameda, Vanessa (2006). How to Wean your Child.Health.Care Vol 4 No. 5 Keeler, Mariane. (April 2005) I want to work and Breastfeed My Baby at the Same Time,Womans Today, Vol. 7. Plachta, Laura (February 2005). Section on Breastfeeding.American Academy Pediatrics Columbus Childrens Hospital.

Purohit, Dilip M.M.D., and Wagner, Carol M.D. (June 2000), Clinical Aspects of Human Milk & Lactation. Clinics in Perinatology, Vol. 26, No. 2 Tacio, Henrylito D. (June 2004) Breastfeeding an Endangered Practice. Health and Home.

3. Related Studies

Maneja, Emil Agustin J. Effectiveness of the Baby Friendly Program among The Selected barangay in Cebu City. Southwestern University.Cebu City.April 2007. Panerio, Wilbert J. Implementation of Breastfeeding Program in Relation to Knowledge and Practice Level of Mothers: Basis for a Proposed Program.Cebu Institute of Technology, November 2007.

4. Internet

Riordan, (2004) Breastfeeding and Human Lactation. www.babyfriendly.sa.gov.au accessed on October 3, 2007 Thomas, John. (August 2001) Nurturing Child Breastfeeding www.healthymoms.com.auaccessed on March 16, 2007 5. Other Sources Through

Abellanosa, Judith C.( 2007, October 03) Personal Interview http://swugradschool.com/research/64

Welcome to the Child Protection Monitoring and Evaluation Reference Group (MERG) Website MONDAY, SEPTEMBER 13, 2010 AT 10:15AM

 UNICEF/PAKA2008-1179/Kohdayar Marri Overview: Monitoring and evaluation (M&E) and evidence-based research are critical at project/programme, national and international levels for determining the scale of child protection violations, identifying vulnerable groups, ascertaining risk factors and protective assets and mechanisms, informing policy and programming, and ensuring accountability at all levels. The move to a systems approach in child protection, consistent with similar and historic shifts in the health and education sectors, also implies a need for more evidence-based child protection. While M&E and research in child protection is extremely important, it requires much improvement, as highlighted by numerous reports including a child protection meta-evaluation carried out by UNICEF in 2008 and an inter-agency global review of evaluations of community based approaches in child protection consolidated in 2010. In November 2008, Save the Children and UNICEF organised an interagency roundtable meeting on child protection M&E to review current practice in the sector and to discuss ways to facilitate coordination and strengthening of monitoring and evaluation across agencies. A Monitoring and Evaluation Reference Group (MERG) was presented as one model of improving the coordination of M&E initiatives among child protection partners and across thematic areas, and providing technical guidance on the development of indicators, tools and methodologies to improve the evidence base of the sector. In other sectors, such as HIV/AIDS and Health, MERGs have proven to be very successful in strengthening M&E by bringing together strong partnerships and ensuring focused work in this area. Given the initial positive response of organizations working across this sector to the idea of a Child Protection MERG, Save the Children and UNICEF hosted a planning meeting from 21-22 July 2010 at the UNICEF Innocenti Research Centre in Florence, Italy to activate a Child Protection MERG. The meeting involved M&E and programme representatives from a range of organizations including CARE, ILO, Oak Foundation, Save the Children, UNFPA, UNHCR, UNICEF, USAID, and World Vision. At the close of the meeting, the CP MERG was officially established and the following were key outcomes of the two-day discussions: 1) The draft Terms of Reference for the CP MERG was revised. All organizations agreed that the MERG

should produce concrete, practical M&E tools and methods that are grounded in field based work. The structure will be relatively informal, with Save the Children and UNICEF acting as co-chairs and fulfilling joint Secretariat functions during this initial year of operation. There will be a core group of members from operational organizations, with a balance between programme and M&E experts and geographical representation. The core group will meet annually to decide on the MERG work plan and review and endorse MERG products. An Academic Advisory Body will also be constituted and invited to attend the MERG meetings and provide technical advice on the work plan and products. Technical working groups (TWGs) will be formed as needed to deliver concrete products that the MERG members deem are needed to improve M&E practice in the sector. TWGs will consist of relevant technical experts in monitoring and evaluation, including from academic institutions, and will be chaired by a MERG member. The Terms of Reference for the Child Protection MERG is in final edits and will be posted on this site shortly. 2) A list of short term work priorities that the MERG should focus on over the next two years was

developed. One person/organization is currently leading the development of a concept note for each piece of work, with inputs being provided from a wider group. This includes:

Inventory and assessment of existing tools and methods to measure violence against children, leading to development of standard guidelines (led by Claudia Cappa/UNICEF) Review of existing population based data sets across the sector, beginning with birth registration, and identification of gaps (led by Nathan Morrow/World Vision) Collation and assessment of methods to monitor the incidence of children out of home care in emergency and development contexts (led by Bill Bell and Sarah Lilley/Save the Children) Identification of promising M&E tools that could be completed and validated and their use promoted, drawing on the mapping of child protection M&E tools completed by Columbia University in preparation for the MERG planning meeting (led by Sam Bickel/UNICEF).

Technical working groups will then be convened around each priority area and will report on progress to the co-chairs of the MERG. As we have learned from other MERGs, any successful MERG relies on strong partnerships. In child protection, there is a pressing need to significantly improve the evidence base of the sector and this has been clearly expressed by a range of actors at global, regional, national, and project/programme levels. The most effective way forward is not in the form of individual disconnected initiatives, but rather by establishing partnerships and pooling knowledge, expertise and skills to review, validate and produce methods and tools that can take the evidence base of child protection to the next level. If there is an additional piece of work that you think the CP MERG should focus on and your organization would like to take this forward, we would be delighted to hear from you so that we can explore this further. We also welcome suggestions of any additional organizations, experts or institutions, including from the Global South, that you feel may be well-suited to becoming part of the MERG. Please contactcpmerg@gmail.com with your ideas or suggestions or for additional information.

The Philippine Pilot Study of the Child Friendly Community Participatory Assessment Tools

The Philippine Pilot Study of the Child Friendly Community Participatory Assessment Tools The Philippine pilot study was conducted by Marita Concepcion Castro Guevara (project research associate), Ana Maria Felisa Galang Mayor (project research assistant), and Mary Racelis (project consultant). This report presents the methodology (Chapter 1), research instruments (Chapter 2), and findings (Chapter 3) of the Philippine pilot study, as well as the research teams evaluation of the research tools and recommendations for their improvement (Chapters IV and V) prior to introducing them for use in 2010 by cities in 11 countries. By Marita Concepcion Castro and Ana Maria Felisa Galang Mayor and Mary RacelisPublished Oct 22, 2010 What do ordinary citizenschildren and adults alikethink of their community? Are their views taken into account in any critical assessment of it? Are they aware of their rights including and especially those of childrens? Do children and the larger community have a direct voice in the development of local programs, regulations/laws, and budgets? And do they have any say in the improvement of municipal level government structures? The Child Friendly Communities and Cities (CFC) Research Initiative aims to address the above concerns. An international project involving Childwatch International, the Innocenti Research Centre (IRC) of the United Nations Childrens Fund (UNICEF), the Childrens Environments Research Group (CERG) of the City University of New York, and the Bernard van Leer Foundation, the CFC Research Initiative seeks to enhance the child friendly programs of communities and cities by improving their capacity for gathering and using data on the conditions of children. This is being done through an international critical review of existing systems of assessment and monitoring of child friendliness; and the development and testing of new methods that engage children, adolescents, and parents in participatory processes. The primary practical products from the project will be a package of tools and an associated set of indicators that can be used and modified by communities and cities to assess and monitor which childrens rights (to survival, development, protection, participation) are being fulfilled, and to what degree. The resulting baseline data can then assist communities and cities in developing a local plan of action and advocacy that comprehensively fulfills childrens rights. In this phase of the research, the Bernard Van Leer Foundation has awarded Childwatch International funding to pilot the Child Friendly Community assessment and monitoring tools developed by the CERG. Pilot studies to test and refine the methodology for the global study were conducted from May to July 2009 in Brazil (Rio de Janeiro, Sao Paolo) and the Philippines (Metro Manila). These pilots aimed to test the research tools, provide feedback on which aspects of the methodology work best and which need improvement, and offer recommendations for the revision of the tools for future use.