TRAINING OF TRAINERS

ON ESSENTIAL MATERNAL & NEONATAL CARE

AND LACTATION MANAGEMENT

Department of Health Regional Office VI

July 2 – 6, 2018
Palmas Del Mar, Bacolod City, Negros Occidental
 Session # 1:

MBFHI: A PART OF THE GLOBAL

STRATEGY FOR IYCF
Name of Speaker
Designation
Affiliation
 Disclosure Statement
• I declare no conflict of interest with any proprietary
entity producing health care goods or services
consumed by, or used on, patients.

• I declare no financial relationships with the

manufacturer(s) of any commercial product(s) and
or provider(s) of commercial services discussed in
CME activities.

Integrated Approach on Essential Maternal & Neonatal Care

And Lactation Management Training
OBJECTIVES
On completion of this session, participants will be able to:
1. State the aim of the WHO/UNICEF Global Strategy for
Infant and Young Child Feeding
2. Outline the aims of the Baby-friendly Hospital Initiative
(BFHI).
3. Describe why BFHI is important in areas of high HIV
prevalence.
4. Explain how this course can assist this facility at this time.
5. Review how this course fits with other activities.

Total session time 30 minutes

Integrated Approach on Essential Maternal & Neonatal Care

And Lactation Management Training
KEY FACTS
• Every infant and child has the right to good nutrition
according to the Convention on the Rights of the Child
(CRC).

• Undernutrition is associated with 45% of child deaths.

• Globally in 2013
• 161.5 million children under 5 were estimated to be stunted
• 50.8 million were estimated to have low weight-for-height, and
• 41.7 million were overweight or obese.
(Source: WHO July 2015 Media Center)

Integrated Approach on Essential Maternal & Neonatal Care

And Lactation Management Training
KEY FACTS
• About 36% of infants 0 to 6 months old are exclusively
breastfed.

• Few children receive nutritionally adequate and safe

complementary foods;

• In many countries less than a fourth of infants 6–23

months of age meet the criteria of dietary diversity and
feeding frequency that are appropriate for their age.

(Source: WHO July 2015 Media Center)

Integrated Approach on Essential Maternal & Neonatal Care

And Lactation Management Training
KEY FACTS
• About 800 000 children's lives could be
saved every year among children under 5, if
all children 0–23 months were optimally
breastfed1 .

(Source: WHO July 2015 Media Center)

Integrated Approach on Essential Maternal & Neonatal Care

And Lactation Management Training
 Reducing Newborn Deaths –
A Public Health Priority
Every 2 minutes, 1 newborn dies

• 209,000 neonatal
deaths in the Western
Pacific Region every
year

• 1 dot represents 100 neonatal deaths

•WHO Global Health Observatory, 2011

Global distribution of deaths among children under
age 5 and among newborns, by cause, 2015

Integrated Approach on Essential Maternal & Neonatal Care

And Lactation Management Training
Causes of Neonatal Deaths, 2010
Prematurity 27%

Asphyxia 26%

Infection (Sepsis+Pneumonia) 10%

Congenital Anomalies 9%

Neonatal Tetanus 2%

Diarrhea 2%

Other Conditions

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

Integrated Approach on Essential Maternal & Neonatal Care

And Lactation Management Training
Philippines 2013 Health and Nutrition Status

Source: 2013 National Demographic and Health Survey, Philippine Statistics Authority

Integrated Approach on Essential Maternal & Neonatal Care

And Lactation Management Training
Philippines 2013 Health and Nutrition Status

Integrated Approach on Essential Maternal & Neonatal Care

And Lactation Management Training
Philippines 2013 Health and Nutrition Status

Integrated Approach on Essential Maternal & Neonatal Care

And Lactation Management Training
 Neonatal Mortality Rates Across
Socio-Economic Classes
25
Number of Deaths per 1000 livebirths

21
20
20 19 19 19

15 15 15 15 15
15
13 13

10
10 9
8

0
Lowest Second Middle Fourth Highest
2003 2008 2013
NDHS 2003, 2008, 2013
Integrated Approach on Essential Maternal & Neonatal Care
And Lactation Management Training
 Infant Mortality Rates Across
Socio-Economic Classes
45 42
40
40
Number of Deaths per 1000 livebirths

36
35 32
30 29
26
24
25 22 22 23 21
20 19
17
15
15 13

10

0
Lowest Second Middle Fourth Highest
2003 2008 2013
NDHS 2003, 2008, 2013
Integrated Approach on Essential Maternal & Neonatal Care
And Lactation Management Training
 Under-Five Mortality Rates Across
Socio-Economic Classes
70 66
Number of Deaths per 1000 livebirths

59
60
52
50 47

40 38
33 32 32
30 26 27
22 23 21
20 17 17

10

0
Lowest Second Middle Fourth Highest
2003 2008 2013
NDHS 2003, 2008, 2013
Integrated Approach on Essential Maternal & Neonatal Care
And Lactation Management Training
Trends in the prevalence of malnutrition, 0 – 5.0 years
old (0– 60 months): Philippines, 1989 - 2013

Source: 2013 National Nutrition Survey, DOST-Food and Nutrition Research Institute
Integrated Approach on Essential Maternal & Neonatal Care
And Lactation Management Training
Prevalence of malnourished children, 0 – 5.0 years old
(0– 60 months): Philippines, 2008 – 2013

Source: 2013 National Nutrition Survey, DOST-Food and Nutrition Research Institute
Integrated Approach on Essential Maternal & Neonatal Care
And Lactation Management Training
Global Strategy for Infant and
Young Child Feeding (IYCF)
• About 5500 children die every
day because of poor infant
feeding practices
• Many children suffer from the
long-term effects from poor
infant feeding practices
• Rising rates of obesity linked
with lack of breastfeeding

Ask participants: What are the effects on

families, communities and health services
from poor infant feeding practices?
 WHO and UNICEF Global Strategy for
Infant and Young Child Feeding (IYCF)

AIM:
To improve – through optimal feeding – the
nutritional status, growth and development,
health, and thus the survival of infants and
young children.

• It supports exclusive breastfeeding for 6 months, followed by

timely, adequate, safe, and appropriate complementary feeding,
while continuing breastfeeding for two years and beyond
• It also supports maternal nutrition, and social and community
support
(Mother) Baby-Friendly Hospital
Initiative: (M)BFHI
• The MBFHI is a global initiative of the
WHO and UNICEF that aims to give
every baby the best start in life by
creating a health care environment
that supports breastfeeding as the
norm.

• The initiative was launched in 1991

and by the end of 2007 more than
20,000 health facilities worldwide has
been officially designated baby-
friendly
(Mother) Baby-Friendly Hospital
Initiative: (M)BFHI
• The Initiative includes a global
assessment and accreditation
scheme that recognizes the
achievements of health facilities
whose practices support
breastfeeding and encourages
health facilities with less than
optimal practices to improve
COC / COA in Western Visayas

Integrated Approach on Essential Maternal & Neonatal Care

And Lactation Management Training
 (Mother) Baby-Friendly Hospital
Initiative: (M)BFHI

The aim of the MBFHI is to implement the Ten

Steps to Successful Breastfeeding and end the
distribution of free and low-cost supplies of
breast milk substitutes to health facilities

Integrated Approach on Essential Maternal & Neonatal Care

And Lactation Management Training
(Mother) Baby-Friendly Hospital
Initiative: (M)BFHI
• The MBFHI provides a framework
for enabling mothers to acquire the
skills they need to breastfeed
exclusively for 6 months and
continue breastfeeding with the
addition of complementary foods
for 2 years or beyond.
(Mother) Baby-Friendly Hospital
Initiative: (M)BFHI
• A baby-friendly hospital also assists
mothers who are not breastfeeding
to make informed decisions and to
care for their babies as well as
possible.

• The Global Strategy calls for further

implementation of BFHI, for
breastfeeding in the curriculum for
health worker training, and for
better data on breastfeeding.
 MBFHI is important in areas of
high HIV prevalence
• Some people are confused about the role of BFHI in
areas where there is a high prevalence of HIV infection
in mothers.

• The WHO/UNICEF/UNAIDS policy statement on HIC and

infant feeding states that, “mothers have a right to
information and support that will enable them to make
fully informed decisions about infant feeding.

• It is important to continue to support breastfeeding for

women who are HIV-negative or of unknown HIV
status.

Integrated Approach on Essential Maternal & Neonatal Care

And Lactation Management Training
 How this course can assist this
health facility?
• During this course, we will discuss what the Ten
Steps mean, how to implement them, and the
importance to staff in making a health facility
Mother-Baby-Friendly
• Talk about practices related to marketing of
breastmilk substitutes
• Process of assessment

(Show participants the Ten Steps to Successful Breastfeeding)

Integrated Approach on Essential Maternal & Neonatal Care

And Lactation Management Training
 Step 1. Have a written policy that is
routinely communicated to all
health care staff.
• A policy helps to:
- Ensure consistent, effective care for mothers and babies
- Provide a standard of practice that can be measured
- Support actions

• A policy is not a treatment protocol or a standard of

care.

• “Policy” means that all staff agree to follow the

protocols and standards, and that staff are required
to do so by those in authority.
 TEN STEPS TO SUCCESSFUL BREASTFEEDING
(A Joing WHO/UNICEF Statement, 1989)
Every facility providing maternity services and care for newborn infants should:
1. Have a written breastfeeding policy that is routinely communicated to all health care
staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within a half-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 - allow mothers and infants to remain together - 24 hours a day.
8. Encourage breastfeeding on demand.
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.

Integrated Approach on Essential Maternal & Neonatal Care

And Lactation Management Training
 Step 2. Train all health care staff in
skills necessary to implement the
policy.
• The aim of this course is that every staff member
will confidently support mothers with early and
exclusive breastfeeding, and that this facility moves
towards achieving mother-baby-friendly
designation
 Goal of this Course
Use communication skills to talk with pregnant women,
mothers, and co-workers:

• Implement the Ten Steps to Successful Breastfeeding

and abide by the International Code of Marketing of
Breast-milk Substitutes;
• Discuss with a pregnant woman the importance of
breastfeeding and outline practices that support the
initiation of breastfeeding;
• Facilitate skin-to-skin contact and early initiation of
breastfeeding;
• Assist a mother to learn the skills of positioning and
attaching her baby as well as the skill of hand
expression;

Integrated Approach on Essential Maternal & Neonatal Care

And Lactation Management Training
 Goal of this Course
Use communication skills to talk with pregnant women,
mothers, and co-workers:

• Discuss with a mother how to find support for

breastfeeding after she returns home;
• Outline what needs to be discussed with a mother who
is not breastfeeding and know to whom to refer this
mother for further assistance with feeding her baby:
• Identify practices that support and those that interfere
with breastfeeding;
• Work with co-workers to highlight barriers to
breastfeeding and seek ways to overcome those
barriers.
Integrated Approach on Essential Maternal & Neonatal Care
And Lactation Management Training
How the Global Strategy for IYCF
Fits Other Activities?
• The Global Strategy is supported
by national policies, laws and
programmes to promote, protect
and support breastfeeding, and
protect the rights of working
women to maternity protection.
• DOH National Program for IYCF, and
newborn care
• RA 10028 (amending RA 7600) and
EO 51
• AO 2007-0026 MBFHI Revitalization,
AO 2009-0025

Integrated Approach on Essential Maternal & Neonatal Care

And Lactation Management Training
 IN SUMMARY…
• The Global Strategy of Infant and Young Child Feeding
builds on existing programmes to assist optimal
nutrition and thus give children a health start in life.
• The Mother-Baby-friendly Hospital Initiative (MBFHI)
involves Ten Steps as well as protection from marketing
of breast-milk substitutes, to help provide a supportive
health facility.
• Support for exclusive breastfeeding and BFHI continue
to be important everywhere
• Participation in this course can help to ensure that you
are confident in your skills in breastfeeding support and
that best practice is consistent in the health facility
 KNOWLEDGE CHECK
• A colleague asks you why this course is taking place
and how it would help mothers and babies that you
care for. What will you reply?
Madamo nga
Salamat!