Update on BFHI in CEE/CIS

1. Update on BFHI in CEE/CIS Code workshop, Tirana4 July 2007 Arnold Timmer, Nutrition Specialist UNICEF Regional Office CEE/CIS, Geneva

2. BFHI origin • In 1991 WHO and UNICEF launched the Baby-Friendly Hospital Initiative (BFHI). The Initiative was launched to support one of the Innocenti Declaration’s primary objectives Ensure that every facility providing maternity services fully practises all 10 of the ‘Ten Steps to Successful Breastfeeding’ set out in the joint WHO/UNICEF statement, Protecting, Promoting and Supporting Breast-feeding’

3. BFHI aims • A maternity facility can be designated 'Baby-Friendly' when it does not accept free or low-cost supplies of breastmilk substitutes, feeding bottles or teats, does not advertise or promote any products within the scope of the International Code and has implemented the 10 Steps to successful breastfeeding • Ensures all mothers assisted to start breastfeeding early, within the first hour following the birth of the child, • Mother and baby stay together in the maternity hospital • Mother receive counselling support • Follow-up after discharge from the maternity takes place

4. 2006 Renewed call for BFHI • Implement and revitalize the initiative reflecting new developments in infant and child care: • research and the experience gathered over the first years of the BFHI • to reinforce the International Code of Marketing of Breast-Milk Substitutes • to support mothers who are not breastfeeding • to provide modules on HIV and infant feeding and mother-friendly care • to give more guidance for monitoring and reassessment

5. Global BFHI progress: 20,000 in 152 countries

6. Progress in CEE/CIS until 1996 • 110 hospitals designated Baby-Friendly between 1993 and 1996, half of these (56) were in Turkey, • however in some countries no hospitals had been designated Baby-Friendly by 1996 • importance International Code recognized across the region however few effective governmental mechanisms in place to control free or low-cost supplies of breastmilk substitutes. • National Breastfeeding Committees been put in place in almost every country, though the specific budget allocations needed for the implementation are small

7. Progress in CEE/CIS until 1996 • regional and international training courses organized and replicated national/sub-national in most countries; proportion staff trained at Maternal and Child Health (MCH) level relatively small • Many mass media campaigns involving television, radio and the press were organized in several countries of the region • In 1996, a small number of countries in the region had routine monitoring systems and no country-specific evaluations had been carried out

8. Progress in CEE/CIS until 2006

9. Progress in CEE/CIS until 2006 • 1336 (out of 6988) Baby-Friendly hospitals in the region • Increased in 10 countries, decreased only in Romania • 5 countries have proportion of BFHI facilities > 80% (Macedonia 93 %) • 4 countries > 50% • considerable progress in last two years – 776 in 2004  1336 in 2006 especially Russia, Turkey, Azerbaijan, Ukraine

10. % of BF facilities - % of births in BFHs in 2006

11. East Asia & Pacific  43% World  36% Exclusive breastfeeding rate (< 6 months)

12. Innovations: Turkey – baby friendly provinces • BFHI programme decentralized to provincial level, mobilizing all health staff and society with the goal of creating baby-friendly provinces • At least 20% of the maternity hospitals BF: • Training health workers, availability of breastfeeding counselling services, ban on advertisement breastmilk substitutes; introduction complementary foods at six months; relevant information to pharmacists • Award to governor of the province support from outside health • Health staff beyond hospital staff, focus on large hospitals, support from high levels

13. Innovations: Armenia- Baby-friendly Polyclinics BFPI • Expand BFHI to polyclinic, adapt 10 steps • All training, IEC material, tools adapted • Mothers support groups actively engaged in educating and supporting mothers in polyclinics • BF rates increased • 8 polyclinics included so far • Lesson: Follow up after discharge from hospital in polyclinic

14. Ukraine - BFHI include PMTCT and prevention of abandonment of newborns in hospital • Expand to include PMTCT and HIV+ child care • Child abandonment and discrimination reduced, attitude of staff • HIV+ mothers no more separated in “infection” section • 10% of BFH in Ukraine now expanded • Lessons: need to expand further to antenatal clinics, children hospitals and family medical centers, foundation for successful PMTCT, friendliness of hospital goes beyond 10 steps

15. Bosnia and Herzegovina- Expansion from hospitals to Early Childhood Development • National action plan ECD with focus on IYCN, focus on IDPs and Roma • Schools for future parents and parents support groups and outreach, close to BFH • Training of health staff on maternal and child care • Holistic focus on child development • Parent support groups were established in 21 health centres and were integrated and linked to BFH • Lesson: BFH to be part of ECD policy and across activities in maternities: immunization, PMTCT,

16. Russian Federation- Decentralizing BFHI to the Regional level • Regional BF centers and link with Ministry of Public Health and Social Development and Center for Promotion & Support BF (SPC) • SPC support regional centers and train managers/maternity staff, provide consultation and assistance to maternity and child care facilities, preparing and disseminating informational and methodological brochures, analyzing breastfeeding trends, and interacting with the mass media and public association of Media • Programme active in 40 regions of the 7 federal districts • 240 baby-friendly certified programmes • Lesson: decentralize BFHI when health services are decentralized

17. Macedonia- Using emergency funds to promote BFHI • Rehabilitation of maternity wards, furniture supply and equipment, training and assessments • 100 mother support groups established, materials (Welcome to Life package including BF), commission for BF promotion established, child birth education classes • By 2002 28 of 29 maternity facilities baby friendly covering 90% of births • Lesson: opportunities to integrate BFHI into other activities - scale up BFHI in a short period of time

18. Romania- Integration with the MCH programme • Integration BFHI in national MCH Programmes, training of trainers and networks, organisation of national annual BFHI workshops • In 2003 National Strategy for Breastfeeding Promotion • local trainers training staff in each maternity; UNICEF 18 hour course supplemented with extra modules on communication skills for health workers and breastfeeding management at PHC level • National BFHI workshops to exchange, review, evaluate, monitor • Lessons: official recognition of BFHI eg National Strategy, strong Committee for Breastfeeding to ensure BFHI standards, permanent training plan in each maternity, active breastfeeding coordinator

19. Challenges and future directions • Goal: move from a stand-alone initiative to integration into a comprehensive package to address the needs of early childhood • Challenges • Commitment and staff turnover • Sustainability  integration into certification and QC for health institutions; budget allocation • Confusion re HIV/AIDS – CEE/CIS countries adopted replacement feeding not in line with global policy • Revitalize BFHI – government ownership; improving skills health care providers  counselling • Extending care to the mother and baby into the community