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How to increase the duration and prevalence of breastfeeding
Many factors influence how women feed their children and how long they breastfeed them. These include traditional methods of medical care, the influence of family and friends, the living environment (urban or rural), socio-economic situation, employment and place of work, pressure from commercial interests, knowledge of breastmilk substitutes and their availability. Sociocultural factors also influence opinions and attitudes, as well as actions related to breastfeeding (see Chapter 9).
The concepts of women about feeding infants are often formed before they become pregnant or have a baby. These concepts may vary depending on nationality, marital status and age (68, 69) and previous experience, including how the woman herself was nursed when she was a child (70). The father and grandmothers of the child are particularly powerful forces influencing the decision of the mother to breastfeed, and the way a pregnant woman perceives her partner's attitude to breastfeeding can also influence her decision. At the time of birth, an important influence comes from the mother’s peers — girlfriends, sisters, and other female relatives (71), as well as male partners (72).
Breastfeeding rates are also influenced by cultural beliefs, which vary between different countries and within the same country. These differences cannot be explained solely by socio-economic factors. To improve the beginning and duration of breastfeeding, it is very important to take into account local views and traditions, but changing society’s perception of how to best feed infants and young children is a difficult task. Health education programs that promote the benefits of breastfeeding should be aimed at both men and women at all levels of society in order to bring about changes in people's perceptions about the social acceptability of breastfeeding in private as well as in public places and in cultural views to this problem. In health education programs in schools, it is necessary to emphasize the benefits of breastfeeding and emphasize that the breast is an organ of baby food.
The Baby-Friendly Hospital Initiative
The current practice of working in hospitals is often at odds with the recommendations on how best to achieve successful breastfeeding. Presented in Box 3 “Ten steps to
Box 3. Ten steps towards successful breastfeeding.
1. Have a written policy on breastfeeding, which is constantly communicated to all medical personnel.
2. To train all health care workers in the skills necessary for the practical implementation of this policy.
3. Inform all pregnant women about the benefits of breastfeeding and how to breastfeed.
4. Helping mothers to begin breastfeeding for half an hour after the baby is born.
5. Show mothers how to breastfeed and how to maintain lactation even in cases when they have to be separated from their children.
6. Not to give newborns any food and drink, except for breast milk, except in cases of medical indications.
7 Practice round-the-clock cohabitation in the same ward of mothers and children.
8. Encourage breastfeeding at the request of the baby.
9. Do not give to breastfed babies nipples or pacifiers.
10. Encourage the creation of breastfeeding support groups and send mothers to these groups when they leave the hospital or clinic.
the paths to successful breastfeeding ”form the foundation of the Baby-Friendly Hospital Initiative, which was widely launched by UNICEF and WHO in 1992 (73). They summarize the principles of operation of maternity homes and wards, which are necessary to create favorable conditions for women who want to breastfeed their children, and thus achieve improvements in the prevalence and duration of breastfeeding. The initiative also prohibits the delivery of free and cheap infant formula to hospitals and demands to stop the promotion and promotion of infant formula and artificial feeding. In order to become a child-friendly hospital, each institution involved in childbirth and maternity care and newborn care must implement these ten steps in practice.
In an effort to strengthen this initiative, the Forty-fifth World Health Assembly in 1992 urged Member States to encourage and support all public and private health facilities providing obstetrics and maternity services in turning them into “child-friendly” ". It must be recognized that mothers who choose not to breastfeed will also benefit from child-friendly working principles, for example, close skin contact, staying in the same room and feeding the baby on demand.
The impact of the implementation of the Initiative on the duration of breastfeeding and the prevalence of infection was studied in a large-scale study in Belarus (MS Kramer, personal communication, 1999). Most hospitals were randomly divided into two groups: where the Initiative is implemented, and where traditional principles of operation are maintained.
The central place in the realization of the goals of the “Child-Friendly Hospital” Initiative is the preparation and development of qualifications. It is expected that all hospital staff and all social workers who work with the community will show a positive attitude towards breastfeeding and will be able to provide consistent and accurate advice and advice in a language that is accessible and understandable to parents. The decision to breastfeed a woman is significantly influenced by health workers, and mothers should receive ongoing support, encouragement and advice in their decision to breastfeed, and the determination to breastfeed can continue for the second year of life and longer, in accordance with current WHO / UNICEF. There is evidence that clearly shows that the conflicting advice given by physicians, accompanied by an early cessation of breastfeeding. In order to guarantee consistency and consistency of information, it is necessary with the help of parents to develop a local policy regarding the nutrition of children. In addition, governments were called upon to implement the provisions of the International Code of Marketing of Breast Milk (74) and subsequent World Health Assembly resolutions relevant to this issue, and firms that produce breast-milk substitutes were urged to adhere to these provisions (the full text of rules and resolutions relevant to this issue is given in Appendix 1). In addition, the provisions of the Code should be well known to health professionals, since tsya a number of obligations arising from this document (75).
The code was adopted by the World Health Assembly in 1981 as a “minimum requirement” and should be included in the legislation “fully and completely” “in all countries”. The set of rules does not aim to put an end to the presence or sale of breast milk substitutes, but at the same time it aims to stop activities aimed at convincing people of the need to use them. Most importantly, he also protects children who are fed these products, ensuring that labels do not cause harm and that decisions are made on the basis of truly independent medical advice. The main provisions of the set of rules are presented in Box 4.
Since 1981, the World Health Assembly has adopted eight resolutions clarifying and strengthening the provisions of the Code of Practice. The most important provisions of these resolutions provide that:
• feed formulas for infants of older age are not needed, and supplemental feeding should not be introduced too early;
• barriers to breastfeeding should be removed in the health services, at work and in the community;
• The practice of introducing complementary foods from about 6 months of age should be encouraged, emphasizing the importance of continued breastfeeding and the use of local foods;
• there should be no free or subsidized supply of breast milk substitutes at any level in the health care system;
Box 4. The main provisions of the World Health Assembly resolutions on the International Code of Marketing of Breast-milk Substitutes
1. It is not allowed to advertise any breastmilk substitutes (any products sold or submitted as a substitute for breastmilk) or baby bottles or nipples.
2. It is not allowed to distribute free samples to mothers or to give them free or reduced prices for stocks of similar products.
3. Advertising and promotion of products in health care facilities, or with their help and participation, is not allowed.
4. No contact is allowed between sales staff and mothers (the presence in the health care system of nursing maternity education staff or nutritionists who are paid by companies to provide counseling or training).
5. It is not allowed to transfer gifts or personal samples to medical workers or members of their families.
6. Products must be labeled in the appropriate language, words or pictures that idealize artificial feeding (pictures of children or statements about health benefits) are not allowed.
7 Medical professionals should only be provided with scientific and factual information.
8. Governments must ensure that objective and consistent information is provided on infant and young child feeding.
9. All information on artificial feeding of infants, including labels, should clearly explain the benefits of breastfeeding and warn about the costs and dangers of artificial feeding.
10. Advertising and promotion of unsuitable products, such as sweetened condensed milk, as feeding products for infants, is not allowed.
11. All products must be of high quality and take into account the climatic and storage conditions in the country in which they are to be used.
12. Producers and distributors must comply with the requirements of the Code of Rules [and all resolutions], regardless of any state action to implement it.
• The state should ensure that financial support provided to professionals working in the field of infant and young child health does not create a conflict of interest;
• The state should ensure genuinely independent control over the observance of the provisions of the Code and subsequent resolutions related to this issue;
• The marketing of complementary foods should not undermine exceptional and long-term breastfeeding.
These resolutions have the same status as the Code, and should be interpreted as one document.
European Union member countries and countries intending to join the Union must harmonize their national legislation with Union legislation, including the directive of the European Commission on Nutrient Formula and Infant Formula for Infant Children (76). The directives give instructions to countries to translate their provisions into national legislation, but these instructions are not always absolute, leaving some freedom for states to make decisions. Compared to the Code, the European Directive contains less stringent requirements for product labeling. It applies only to infant formula and infant formula, rather than breast milk substitutes, bottles and nipples, and allows for some forms of promotional activities, such as advertising in special infants and scientific publications. editions. Therefore, some countries that are preparing to join the EU, fear that the adoption of more stringent provisions of the Code of Regulations will endanger their future membership in the European Union. Incidentally, although the European directive contains binding language, it allows member states to adopt more restrictive advertising provisions, and there are positive examples in Denmark and Luxembourg.
Permanent breastfeeding support
Knowledge is only one of a number of factors that can affect the mother’s intention to breastfeed, and in themselves they may not have much effect. Those who have not yet made a decision or are undecided can be affected by information about the benefits of breastfeeding, but an increasing public support can also be an effective means of influence, which can enable women to decide to breastfeed and make their decision.
Continuing support for breastfeeding can be provided in different ways. Traditionally, in most societies, the help that a woman needs is provided by her family members and her inner circle, although actions and methods are not always optimal. But in many countries, women generally have no positive role models in which they can learn breastfeeding skills. As society’s life changes, particularly as a result of urbanization, support from health workers or from girlfriends, such as mothers, as well as from the father of the child, is becoming increasingly important. Evidence suggests that breastfeeding for the recommended period is consistently associated with support and approval from the male partner and the mother (77).
That is why associations of professional specialists and groups of mothers in the same position are important, and these associations should be developed to provide support, protection and promotion of breastfeeding. There is an urgent need to attract the potential of local groups and consultants, since they, to a greater extent than the official health services, may be able to provide the frequent individual assistance that mothers need to build their confidence and to overcome difficulties. There are extremely active mother support networks all over Western Europe, organized by the mothers themselves, some of which are now spreading to Eastern Europe. Policy makers should identify potential support systems among the public, such as the church and local community organizations, and turn them into focal points for coordinating the activities of parent support groups. In addition, to achieve the goals set out in the Innocenti Declaration (66), states should develop a national breastfeeding policy, including legislation to protect the rights of working women to breastfeed. This legislation should cover issues such as maternity leave and child care, as well as ways to create more favorable conditions for breastfeeding for women at work, for example, providing the opportunity to leave the child in the nursery and have sufficiently long breaks to feed and care for the child. .
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How to increase the duration and prevalence of breastfeeding
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