Transcript Key messages

Contributing factors to poor infant
feeding practices in SA
• Longstanding cultural practices of early
introduction of other fluids and foods
• Support of formula milk through the PEM
scheme
• Lack of legalization of the Code of
Marketing of Breastmilk Substitutes
• Provision of formula milk through PMTCT
• Lack of breastfeeding promotion
Key messages
• Mixed feeding is common
amongst HIV positive and
negative women
• Formula feeding choices are
not based on AFASS
assessments
•Counselling is weak – difficulties of presenting two
options
•There is now evidence from Africa showing that in
the presence of ARVs, breastfeeding results in
greater child survival compared with avoiding
breastfeeding
Comparison of two delivery systems
(BFHI vs BFHI + 10 home visits)
Exclusive
% breastfeeding
100
Pre-intervention
Hospitals trained: no home visits
Hospitals trained + Home visits
80
60
40
20
0
1
10
30
60
90
120
150
180
Age (days)
Coutinho et al Lancet 2005
Can we continue to promote “two
choices”
• Are the two choices ‘equivalent’?current evidence suggests not!
• The balance has shifted
• Has the time come when the current
policy causes more harm?
What is needed?
• Implement a national media and communication campaign
for health workers and the general public promoting
breastfeeding as a key intervention to reduce child
mortality
• Communicate the benefits of exclusive breastfeeding for
the first 6 months in HIV-positive and HIV-negative women
• Train all health workers in the above, including doctors,
nurses, dieticians and community health workers during
initial training and reinforced during in service training.
• Rapidly increase the proportion of hospitals with Baby
Friendly status
• Employ breastfeeding counsellors in health facilities and
at community level using savings from removal of formula.
• Train existing community health workers to support
breastfeeding and establish a system of home visits to
women postpartum for lactation support
What is needed?
• Legally enforce the Code of Marketing of
Breastmilk Substitutes
• Avoid using formula milk in health facilities
• No advertising of formula in health facilities.
• Restrict advertising/promotion of formula,
including at professional conferences.
• Review the current policy of provision of free
formula milk to HIV-positive women