Status of formula feeding,
commercial foods, trends, possible
GHG emissions
Name of the Country: Bangladesh
Name of the Speaker: Dr. S. K. Roy
Chairperson
Bangladesh Breastfeeding Foundation (BBF)
Bangladesh
Infant and Young Child Feeding (IYCF) trends in
Bangladesh 1993-2007
100
90
86
87
71
Percent
75
50
97
90
46
45
29
25
9
59
46
91
74
52
43
37
36
43
24
28
13
62 58
42 48
89
17
0
BDHS BDHS BDHS BDHS CMNS MICS BDHS
93-94 96-97 99-00 2004 2005 2006 2007
Breastfeeding initiation within 1 hour of birth
Exclusive Breastfeeding Rate <6 months
Complementary feeding at 6-9 months
Continued breastfeeding at 20-23 months
IYCF Practices
Indicator
Status in 2005
(BDHS)
Status in 2007
(BDHS)
Initiation of breastfeeding 24%
within 1 hour
37%
Exclusive Breastfeeding
for first 6 months
42%
43%
Median Duration of
Breastfeeding
32 Months
32.8 months
Bottle Feeding (< 6 mo.)
22% - <6m
27% - 6-9 m
40.4 of <2 yrs
Complementary Feeding
(6 - 9 mo.)
62%
74 %
Exclusive breastfeeding rates remain stagnant
in Bangladesh for last 15 years
EBF
47
46
46
46
45
45
44
43
43
42
42
41
40
1993-1994
1996-1997
1999-2000
2004
2007
Trend of nutritional status of <5 children 1996 to
2007
Stunting (height for age)
60
Wasting (w t for ht)
Underw eight (w t for age)
56
55
50
48
45
48
46
43
36
40
30
18
20
10
13
16
10
0
BDHS 1996-97
BDHS 2007
BDHS 1999-2000
BDHS 2004
BDHS 2007
BF practices in South Asia
Baby Friendly Hospital Initiative
• BFHI launched in 1992 in Bangladesh
• Hospital policy developed by BBF and endorsed by
the Govt. in 1992
• At present 499 maternity service facilities out of
650 are Baby friendly
• 20,000 health care providers have been trained
on BFHI.
Implementation of the International Code
• 1984: BMS (Regulation of Marketing) Ordinance
• 1990: BMS (Regulation of Marketing) Amendment
at the national assembly .
• 1992: BMS importers signed MOU with MOHFW to
stop free milk supply
• 1993: Director, IPHN was appointed as authorized
officer by the MOHFW for the implementation of
BMS ordinance.
• 1993: An advisory committee formed for monitoring
& implementation of the code.
• 1993: Directive banning BMS advertising in the
media issued by the government in December
Implementation of the International Code
• 1993: MOHFW submitted a written request
to M/O Commerce to include BMS in list of
restricted imports SO What/// delete!
• 1997: Three milk companies sued and
were fined by the court. Two companies
withdrew product from market..
• 2003: External monitoring is done in 105
hospitals SO What///
• Violation of the code by the milk
company still continues
unfortunately in collusion with
health professionals
Issues hindering optimal infant feeding in
Bangladesh
Traditional beliefs /practices:
•
1. Use of prelacteal (honey, mustard oil, sugar water,
plain water)
•
2. Mixed feeding before first 6 months of age (Breast
milk with rice powder??, suzi, cows milk etc.)
•
3. beliefs that milk comes in after 3 days
Our Lacking:
•
•
Lack of support to the mother in the community
Lack of skill BF counselor
•
Lack of knowledge on BF in the community
•
Lack of confidence of the mother
•
Lack of family support
•
Lack of skilled health service provider in the hospitals
•
Lack of program activities
•
Lack of proper monitoring system
•
Lack of fund
Out Our enemies:
•
Aggressive marketing of BMS
•
Tricky promotion of BMS
•
Unholy allaince with policy makers
Research Findings
References
Intervention
Haider et al 2000 Peer counselors, home visits
up to 15 occasions including
2 in last trimester of
pregnancy, 4 in month and
every two weeks thereafter up
to month 5.
Visit duration 20-40 minutes
Breastfeeding status
at last assessment,
<6 mo
Exclusive
breastfeeding
Intervention-56%
Control-5%
Examples of Law violation by
commercial babyfood companies
including nestle
Questions
How to break the unholy alliance
between Companies and policy
makers?
Nestle Organized workshop for doctors on the occasion
of WBW 09
How to stop the tricky promotion of
commercial baby foods?
•
Distributing leaflet of Chu. Chu
Silicone Nipple ad inside the
Chu. Chu baby diaper packet
and also using a picture of a
baby with feeding bottle. Using
the slogan ‘Best choice for
your baby’ and has three
different size for the infant (for
1-3 month, 3-6 month and <6
month)
•
Advertisement through TV
channels.
How to stop uncontrolled & aggressive
marketing of commercial baby
foods?
• Nestle importing
and selling products
having no
registration in
Bangladesh and
does not have any
information in local
Bangla language
GHG in Bangladesh
• 40 Tons Infant formula are imported
which will have to emit 612.3 tons of
Carbondioxide annually.
Kind of support breastfeeding
women need :
1. Support with care, nutrition and information during
pregnancy
2. Support at delivery to establish breastfeeding
within 1 hr.
3. Follow up support/ visit for exclusive
breastfeeding.
4. Crèches and nursing breaks at the work place
5. Protection & restricting Unethical Marketing and
Advertising of BMS
Programme Challenges
• Integrating of IYCF activities in different
programmes
• Skilled health services provider
• Effective communication materials
• Strategy to protect aggressive marketing of
BMS
Some Examples of Poster BBF using
on BMS
Powder Milk
Don’t buy illness with
your hard
earned money
Powder Milk
Warning
This Product is
not sterile (WHO)
Diarrhoea
Pneumonia
Dysentery, Malnutrition
Meningitis
Ear infection, Allergy
Early death
If Survive:
Diabetes & hart diseases
5 prime messages on BF
Give 3 meals and additional
2 meals everyday to the PW & LW
Give colostrum within
one hour after birth
EBF from birth to 6 months (180 days)
is enough for a child even
no need a drop of water
Give family food after
6 months with BF and
continue BF upto 2 yrs
Continue BF & other family
foods frequently
when baby is sick
Thank you