Breast feeding promotion in Sri Lanka

1. Breast feeding promotion in Sri Lanka Dr.R.Kesavan Ministry of Health Sri Lanka National Consultant/ Emergency Medical Care WHO/Sri Lanka

2. Sri Lanka - VITAL STATISTICS • Estimated Population (‘000),2005*19652 • Percentage of  0-4 Population ,2003* 8.8 • Percentage of  10-24Population  ,2003*28.3 • Percentage of  60+ Population,2003*9.3 • Sex Ratio of Population, 2006*99.1 • Crude Birth Rate, 2006*18.5 • Crude Death Rate, 2006*5.8 • Rate of Natural Increase, 2004*1.3

3. Life Expectancy For Males71.9 years • Life Expectancy For Females 76.4 years • Literacy Rate of Males 92.6 • Literacy Rate of Females 89.7 • Infant Mortality Rate11.2(1000  live births) • Neonatal Mortality Rate10.6 /1000  live births • Maternal Mortality Rate1.9 /10000  live births • No of Married Women Per Midwife 576 • No of  Persons Per Medical Officer 2500 • No of Pupil Per Teacher 22

4. Health and Nutritional Status • The social policies introduced on the eve of political independence in the 1940s promoted free health services that were made increasingly available to women in all economic strata. • This island-wide network of health services, especially maternity and child health services established over four decades ago, has contributed significantly to the improvement in the health status of women.

5. Since independence in 1948, to the 1990s, the crude death rate fell from 21.9/1,000 to 5.6/1,000, • Maternal mortality rate from 16.5/1,000 to 0.14/1,000, • Infant mortality rate from 140/1,000 to 17.2/1,000. • Life expectancy has risen from 43.6 years and 41.6 years to 70.1years and 74.8 years for men and women, respectively. • Crude birth rate declined from 36.1/1,000 to 18.5/1,000, • Fertility rate has declined to 2.2, and contraceptive prevalence is around 60 percent.

6. Female mortality rate was lower than male mortality rate and the male/female population ratio was 100:101 in 1992. • There has been very little decline in morbidity. • The incidence of diarrhea, dysentery, respiratory diseases, is relatively high, and new threats to health and life have increased hypertension, breast and cervical cancers, suicide, and sexually transmitted diseases including

7. INTERNATIONAL BREAST-FEEDING WEEK COMMEMORATED FROM AUGUST 01 TO 07 Monday, 06 August 2007 • The Ministry of Healthcare and Nutrition has inaugurated an awareness program for the pregnant women and mothers to encourage breast feeding under the theme of "Long life by breast-feeding within one hour from the time of child-birth", during the International Breast-Feeding Week  from August 1 to 7. • .

8. By this awareness program it has been intensified to encourage breast-feeding to develop nourishment for the children, good attachment between mother and the child, preventing from infectious disease and developing intelligence

9. It has been emphasized that the child should be breast-fed within half an hour  from the time of birth for 6  months without giving any other food.

10. It has been educated to breast-feed for  2 years with other spare meals after 6 months to  make the child healthy, intelligent, and psychologically well balanced, useful person to the society. It has been specified that the colostrums in the breast milk prevent the child from infections and other diseases.

12. What is needed is to create an awareness of the importance of the breast feeding among the modern youth (Mrs Amara Peeris)

13. Sri Lanka: High rate of breastfeeding`We are fortunate that 98 percent of our mothers belong to the ever breast fed category. This had resulted in producing a healthy child. There is no major difference in urban and rural mothers regarding breast feeding. However, educating them regarding the benefits will be an effective way to promote breast feeding` (Mrs Amara Peeris)

15. 6. National Policy, Programme and Coordination -7 • 7. Baby Friendly Hospital Initiative-6 • Concerns percentage BFHI hospitals, training, standard monitoring, assessment and reassessment systems Concerns national policy, plan of action, funding and coordination issues. • 8. Implementation of the International Code-7 Concerns implementation of the Code as law, monitored and enforced.- • 9. Maternity Protection-6 Concerns paid maternity leave, paid breastfeeding break, national legislation encouraging work site • accommodation for breastfeeding and/or childcare and ratification of ILO MPC No 183. • .

16. 10. Health and Nutrition Care-8 Concerns health provider schools and pre-service education programmes, standards and guidelines for • mother-friendly childbirth procedures, in-service training programmes. • 11. Community Outreach-8 Concerns skilled counseling services on infant and young child feeding, and its access to all women. (During pregnancy and after birth) • 12. Information Support-9 Concerns national IEC strategy for improving infant and young child feeding, actively implemented at local levels.

17. 13. Infant Feeding and HIV-6 to address infant feeding and HIV issue and on-going monitoring of the • effects of interventions on infant feeding practices and health outcomes for mothers and infants. • 14. Infant Feeding during Emergencies-10 • Concerns policy and programme on infant and young child feeding in emergencies and material on IYCF in • emergencies integrated into pre-service and in-service training for emergency management. • 15. Monitoring and Evaluation-5 • Concerns monitoring, management and information system (MIS) as part of the planning and management

18. Breast feeding in the estate population • A cross-sectional questionnaire survey, using the current status method for the assessment of breastfeeding, was conducted among women working in the plantations in Sri Lanka. • The exclusive breastfeeding rate was 32.4 per cent. The mothers' return to work and the feeling of having insufficient milk were significantly and negatively associated with exclusive breastfeeding. Women will sometimes start with powdered milk several weeks before going back to work, suggesting that work itself is not the only reason for introducing powdered milk.

19. Promotion of breast feeding in conflict areas • Almost 200000 IDPs were in the temporary camps for one year • Mainly in eastern and Northern provinces of Sri Lanka • All were due to the present War

20. Promotion of breast feeding in conflict areas • Measures to promote Exclusive Breast feeding initiative was taken by all possible means • Government sectors were mainly responsible for MCH • WHO, UNFPA , UNICE supported the government system • INGOO and NGOO contributed

21. Promotion of breast feeding in conflict areas • The Department of Health promoted through their existing system of network , Midwifes and Health volunteers at the grass root • WHO , UNFPA ,UNICEF supported • INGOO and NGOO like Sarvodaya Womens Movement was dedicated in the initiative

22. Promotion of breast feeding in conflict areas

23. Promotion of breast feeding in conflict areas methods used • IEC • Government guide lines in maternal and child nutrition • Close supervision by the midwifes and Health volunteers • Monitoring of the supply of the food and milk food items

24. Promotion of breast feeding in conflict areas methods used

25. Promotion of breast feeding in conflict areas methods used

26. Promotion of breast feeding in conflict areas • SWOT Analysis

27. Promotion of breast feeding in conflict areas/Strengths • Strong network of the government and partners on the issue • Most of the mothers had no alternatives other than breast feeding

28. Promotion of breast feeding in conflict areas/Weakness • Lack of food for the mothers • Emotional disturbances • Lack of privacy for feeding in the tents • Not enough fluids for the mother in a very hot weather

29. Promotion of breast feeding in conflict areas/opportunities • Good support from the UN agencies and the INGOO/NGOO • Volunteers could be recruited easily • A good platform for the IEC • A good situation for monitoring and supervision

30. Promotion of breast feeding in conflict areas/threats • Trade factors trying to exploit the situation • Some NGOO/INGOO possibly supporting traders indirectly • Unstable situations sometimes demoralize the caregivers and volunteers

31. Promotion of breast feeding in conflict areas • Good news • The trend of exclusive beast feeding in conflict areas is increasing • No outbreaks of any pediatric diseases

32. Thank you