Global Strategy On Infant and Young
Child Feeding
State of Implementation
in the context of MDG4
Country: Bangladesh
Presentation By. Ranjit Kumar Biswas
Executive Director of National Nutrition
Programme
Mortality Rates
Indicator
Status 1990
Target 2015
Status 2007
Under Five
Population
17% (BBS
1991)
151
50
18 million
11.6 % (MICS
2006)
88
Under Five
Mortality
IMR
94
32
NMR
52
65 (BDHS
2004)
41
Per 1000 Live Births
Child, Infant & Neonatal Mortality Reduction Trends
(Source: Demographic and Health Surveys)
200
180
160
140
120
100
80
60
40
20
0
Significant progress, but stagnation since mid-nineties
173
152
139
117
75
1982-86
105
63
1985-89
133
116
96
60
1987-91
87
82
52
48
1989-93
1992-96
Reference Period
U5MR
Source: Bangladesh Demographic & Health
Surveys
IMR
NMR
94
88
66
65
42
41
1995-99
1999-2003
MDG 4 Tracking
Indicator
Coverage Level
DPT immunization (DPT3)
94% (CES 2006)
Measles immunization
89% CES 2006)
Use of improved drinking water facility 98% (MICS 2006)
Use of improved sanitation facility
39% (MICS 2006)
Skilled attendant at delivery
20% (MICS 2006)
TT protection at birth
55% (MICS 2006)
ORT for Diarrhea
70 % (MICS 2006)
IYCF Practices
Indicator
Status in 2005
Status in 2007
Initiation of breastfeeding
within 1 hour
24% (BDHS 2004)
36% (MICS 2006)
Exclusive Breastfeeding
for first 6 months
42% (BDHS 2004)
58% (CMNS 2005)
Median Duration of
Breastfeeding
32 Months (BDHS
2004)
Bottle Feeding (< 6 mo.)
22% - <6m
27% - 6-9 m
(BDHS 2004)
Complementary Feeding
(6 - 9 mo.)
62% (BDHS 2004)
52 % (MICS 2006)
IYCF Policies and Programs
Action taken during 2006-2007 after the assessment in 2005
National Strategy for IYCF formulated
and launched in 2007
Baby Friendly Hospital Initiative
• BFHI launched in 1992
• Hospital policy developed by BBF
and endorsed by the Govt. in 1992
• At present 498 maternity service
facilities out of 650 are transformed
into BFH.
• 20,000 health care providers have
been trained on BFHI.
Revitalization of BFHI
• A regular meeting of BFHI committee.
• Regular training for the maternity staffs (Doctor &
Nurse) on BF management
• Training of the Aya and Ward boy of the hospitals
• Regular antenatal counseling
• Banning of artificial milk, bottle and tits in the hospital.
• Hanging of 15 principle and regular discuss it with the
hospital staff
• Educate mother for EBF for 6 months and introduce CF
after 6 months with continuation of BF upto 2 years.
Revitalization of BFHI
• A system developed on Record keeping for the
number of EBF babies and recorded within
MIS.
• Mother was taught on milk expression
• LMC corner was established
• During discharge from hospital mother was
advised to exclusively breastfed their babies
for 6 months and referred to LMC for followup.
Implementation of the International Code
• 1984: BMS (Regulation of Marketing) Ordinance
• 1990: BMS (Regulation of Marketing)
Amendment at the national assembly .
• 1992: BMS importers had MOU with MOHFW to
stop free milk supply
• 1993: An authorized officer was appointed by the
MOHFW (Director, IPHN) for the purposes of
BMS ordinance in July.
• 1993: An advisory committee formed and
gazetted 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
• 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
• 2007: Review for amendment ongoing
Violation of the code by the milk company still
continues
Maternity Protection
• Government order issued for extension
of maternity leave from 3 months to 4
months
• Limited Crèche established in the
Govt and private sector.
• Government approved exclusive
breastfeeding (EBF) up to 6 months
Health and Nutrition Care
• National Nutrition Program (NNP) under the
Ministry of Health and Family Welfare has been
implementing the nutrition activities in 105 sub
districts of 34 districts of 6 divisions..
• Total Community Nutrition Centre 23246
• Total Community Nutrition Promotors 23246
• Total Community Nutrition Organizer 2243
• Total Field Supervisor 584 provide services at the
field level under guidance of Upazila manager,
concerned NGO officials and NNP officials.
NNP status
• Colostrums feeding almost universal .
• More than 97.5 percent children started
complementary feeding after 6 months of
age
Supplementary feeding for Women and
Children in 105 NNP Upazilas, January,2007
Target Group
Registered
Received Food
Supple.
Pregnant Mother
Lactating Mother
3,13,148
2,52,526
47,686
3,920
Under 2 Children
Severe Malnutrition
Growth Faltered
Relapsed
11,87,654
84,792
1,03,987
7,039
Community Outreach
• NNP covering 105 (out of 480) subdistrict 20 %
• Another 63 by January 2008
Community Based Mother Support
Group
• Trained 105 core trainers of
MSG formation in 53 NNP
UZ
• Provided refresher training
for 63 core trainers in 31 UZ
• Provided training for 3515
CNO/CNPs on MSG in 16
UZ
• Oriented 3222 MSG in 15
upazilas
• Developed resource book and
training booklet for MSG
formation
Information Support
• Inter personal Counseling (NNP, MOHFW,
NGOs)
• Web site of BBF
• IT centre services at BBF
• BCC materials production ,distribution and supply
from BBF.
• Billboards
• Electronic medias
• News & mass media
Infant Feeding During Emergencies
• Joint Statement GOB-WHO-UNICEF (Aug
2007)
• Joint statement BBF-WHO-UNICEF (Nov
2007) - Sidr
Infant Feeding During
Emergencies
• Preparing guideline for ensuring optimal
feeding for IYCF during emergency
• Awareness materials on IYCF was
distributed for the health providers/workers
to give support to the pregnant and lactating
mother to the devastating area.
Infant Feeding and HIV
• Prevalence of HIV infection is as low as 1%-2.5% among
the high risk groups
• Prevalence of HIV raised to 4% among drug users (Dec
2003)
• A total of 363 HIV cases has so far been detected in the
country (Dec 2003)
• In low income countries such as Bangladesh replacement
feeding is very rarely “acceptable, feasible, affordable,
sustainable and safe”(The joint United Nations Program
on HIV/AIDS/WHO/UNICEF guidelines, 2001)
• PTCT strategy under formulation
Monitoring and Evaluation
• BDHS
• MICS
• CMNS
• NNP MIS
• BBF
• IYCF Activities of NNP (Nutrition
Package 2006-2010)
Protection, Promotion and support
of IYCF
• IYCF activities cut across both ABCN and
national level nutrition services.
• IPC and BCC within ABCN services
• Initiation of BF within half an hour of delivery,
promotion of optimum breast-feeding, EBF for
first six months (180 days), followed by
introduction of ACF on completion of six months.
• Scaling up and sustaining BFHI.
Continue
• Support activities for enforcement of the
law on the marketing and distribution of
breast milk substitutes
• Promote and campaign for breast feeding
intensively on a national scale
• Awareness creation about disadvantages of
formula / Bottle-feeding
Continue
• Mother support activities up to the
community level for ANC, PNC, EBF, ACF,
MN.
• Ensure the proper adaptation and
dissemination of WHO/ UNICEF/ UNAIDS
Guidelines on BF and other relevant issues.
• Greater focus will be given to IYCF and to
Baby Friendly Community Initiative.
Thank You