The scope of the decree includes infant formula as well as follow-on formula, “growing-up” milks, and “toddler formula” for children up to 36 months of age, following the recommendations of World Health Assembly Resolution 69.9.
The decree also includes guidance on labelling breastmilk substitutes, prohibitions on actions that create conflicts of interest with health workers, as well as other safeguards based on the International Code, similar legal measures in the ASEAN region, and the country’s own experience with harmful BMS marketing.
Around the world, COVID-19 has radically affected public health delivery, placing unprecedented stress on health systems that in many countries are under-resourced and ill-equipped.
As the pandemic has upended daily life, Alive & Thrive has worked with government and other partners to design effective responses, providing technical assistance regarding breastfeeding and the maintenance of essential MIYCN services.
As the pandemic unfolded, guidance evolved regarding breastfeeding. The first guidance, issued in February, came from the China Consensus and called for separating mothers and their infants due to the risk of infection.
But by mid-March, experts agreed that breastfeeding did not pose a significant risk of transmission. The fast-evolving situation called for concerted efforts to ensure governments and their partners were providing consistent, accurate information.
An A&T review of guidance documents from around the world confirmed that guidance varied. Results were shared with stakeholders, including during a global webinar.
A&T’s participation in bodies that advise governments in the countries where it works facilitated the rapid sharing of the latest WHO guidance. And in one case – that of human milk banking – A&T supported the forming of a global online network of HMB stakeholders that is now leading efforts to promote the use of human milk banks, including issuing a call to action.
“The strengthening of human milk bank systems is required to ensure that safe provision of donor milk remains an essential component of early and essential newborn care during routine care or emergency scenarios, such as natural disasters and pandemics” – From the Call to Action of the Virtual Communication Network of milk bank leaders
In Niger, the Technical Group on Nutrition, an advisory body comprising nutrition partners including A&T, supported the development of IYCF guidance documents that emphasized the importance of early initiation of breastfeeding, exclusive breastfeeding, appropriate foods for complementary feeding and breastfeeding to the age of 2 years.
The group also supported a joint statement on child nutrition with UNICEF and the Directorate of Nutrition, calling for concerted efforts across the health system and the private and public sectors to share the latest COVID-19-related breastfeeding guidance. It also included alerts regarding the marketing of breastmilk substitutes which, anecdotally, appears to have increased during the pandemic across A&T’s program countries.
At the same time, the A&T Southeast Asia office provided supportive evidence and updated references for breastfeeding to the National Nutrition Cluster in the Philippines, the Scaling-Up Nutrition Civil Society Alliance in Viet Nam and to partner hospitals. And in Nigeria, A&T supported the National Agency for Food and Drug Administration and Control (NAFDAC) to raise awareness via the media of the WHO guidance and the BMS Code.
In Madagascar, A&T also provided guidance regarding BMS Code enforcement and assisted in the planning of activities to enforce the Code. In India, A&T supported national professional associations to disseminate information on breastfeeding through a three-day webinar that reached over 700 medical professionals on breastfeeding and COVID-19, focusing similarly on BMS Code violations, referred to in the country as the Infant Milk Substitutes (IMS) Act.
Health system response and MIYCN program maintenance
Technical assistance also helped health systems respond and supported governments to maintain MIYCN services, a critical need in light of an expected spike in malnutrition globally, particularly in West Africa.
After it became clear that COVID-19 led to significant declines in people seeking services at health facilities, the Government of Ethiopia established a national task force. As members, A&T’s experts devised and then supported the government to conduct rapid assessment checklists to assess MIYCN service delivery status and provide guidance for frontline workers to continue non-COVID-19 services.
“Most health facilities’ services were significantly disrupted,” said Dr. Abdulaziz Oumer, A&T Country Director. “Some facilities had closed due to lack of personal protective equipment and mothers stopped coming for services due to the panic.”
The assessments provided insights on the scope of the problem and led to a concerted media campaign and delivery of personal protective equipment. The effort also led to the development of a focused action plan to strengthen antenatal care, post-natal care, delivery, and child health and nutrition services.
Swift response in Southeast Asia helped hospitals maintain early and essential newborn care despite the surge in COVID-19 cases, which initially filled hospitals to capacity. In a presentation during a WHO webinar, A&T Southeast Asia’s team discussed the technical assistance it provided to the hospitals to set up separate areas to treat suspected COVID-19 cases, implement measures to manage admissions, and adopt social distancing, among other strategies.
In India and Bangladesh technical support to government and partners on MIYCN during COVID-19, in close collaboration with UNICEF, USAID, the World Health Organization and the World Bank included, disseminating materials on breastfeeding; information on safely initiating complementary feeding, and and guidance on continuing nutrition services during COVID-19.
In Burkina Faso, A&T worked directly with the Ministry of Health to develop materials and radio advertisements on IYCF and COVID-19 and collaborated with community radios to discuss COVID-19 and IYCF in six health regions, sharing knowledge and information and answering listeners’ questions during live call-in shows.
During outbreaks of contagious illnesses, the fear that infected mothers will transmit the disease to their newborns often becomes a concern. Initially, public health experts advised that COVID-19-infected mothers be separated from their nursing infants.
Research to date shows that mothers with COVID-19 do not pass it to their infants through breastmilk. An Alive & Thrive review of guidance documents around the world showed that the initial guidance spread widely.
A&T reviewed 33 guidance documents issued around the world between March 1 and April 30, 2020. The analysis revealed considerable diversity in recommendations related to postpartum maternal and newborn care and was presented during “COVID-19 – Ensuring Safe Breastfeeding and Newborn Care: Lessons from Countries,” a global webinar hosted in early July by the Nurturing Care Coordinating Group: UNICEF, WHO, the World Bank Group, the Partnership for Maternal, Newborn and Child Health, and the Early Childhood Development Action Network.
This unpublished research showed that:
Fewer than one in three guidance documents recommended skin-to-skin contact for babies of mothers with suspected or confirmed COVID-19
Many guidance documents recommended isolating mothers with confirmed or suspected COVID-19 from their newborns
Most guidance documents recommended the provision of expressed breastmilk when mothers’ own milk was unavailable, while few mentioned donor human milk
Few guidance documents addressed the need for psychological support for separated mothers and infants
The differences seen in the review of guidance documents can be traced to the differences in guidance issued by various authorities as the pandemic unfolded.
In February, the China Consensus, US Centers for Disease Control and the American College of Obstetricians and Gynecologists separately recommended separation of mothers and infants and prohibition of or impediments to breastfeeding. By March, however, the Royal College of Midwives and the World Health Organization separately recommended mothers and infants be kept together with breastfeeding explicitly supported.
The guidance urging separating mothers and infants echoed the response to the HIV/AIDS epidemic in the 1980’s, a coincidence that did not go unnoticed.
Every year, World Breastfeeding Week features thousands of activities worldwide to promote the importance of breastfeeding. A&T supports activities in every country we work in and at the global level as well.
Let’s make #2020WBW trend on social media! Join us on Twitter and Facebook to learn more about these activities and to share your activities.
Below is a selection of activities for 2020 World Breastfeeding Week from across the A&T initiative. Many, many more activities are planned – go to Twitter to learn about and share others!
Southeast Asia: Designation of a Center of Excellence for Breastfeeding and launch of the Human Milk Bank (HMB) and launch of the Little Sun IYCF Counseling Clinic in Quang Ninh Obstetrics and Pediatrics Hospital, the first hospital in Northern Vietnam to be both designated a Centre of Excellence and launch an HMB. The Vietnam Ministry of Health will be in attendance, and photos can be found here. Learn more about the Centers of Excellence initiative.
Southeast Asia: Launch of the Human Milk Bank (HMB) network service in Quang Nam province in Viet Nam. The Human Milk Bank network service will extend HMB services to other provinces, enabling more donors and recipients to benefit from the HMB.
Ethiopia: TV and Radio spots which promote breastfeeding will be disseminated through national, regional, and local media and news outlets.
India: A&T Staff and India Country Director Sebanti Ghosh and A&T South Asia Regional Director Thomas Forissier will speak in a global webinar on breastfeeding by one of India’s leading universities, Maharaja Sayajirao University of Baroda, together with UNICEF, the Gates Foundation, the Breastfeeding Promotion Network of India and Nutrition International. Register here; please note that times indicated are in India Standard Time. Click here to read the full program.
Southeast Asia: Launch of the social media fanpage for the #6la campaign. The “6 months mother’s milk is all you need” campaign” has been coordinated by Alive & Thrive, UNICEF and the Ministry of Health and Sports in Myanmar to combat the aspirational marketing of formula brands and show that exclusive breastfeeding for the first 6 months is best for mothers, babies, families and national well-being.
Burkina Faso: Representative from the Government Ministry of Health will be on Burkina national TV during the Sunday news, promoting the Stronger With Breastmilk Only campaign, which promotes exclusive breastfeeding in Francophone West Africa.
Ethiopia: Distribution of facemasks to protect against COVID-19 featuring breastfeeding promotion messages to beneficiaries.
India: The Breast Committee of the Federation of Obstetrics & Gynecological Societies of India is hosting a webinar to celebrate World Breastfeeding Week. Register here.
Nigeria: A&T and the Nigeria Federal Ministry of Health hosting a webinar on Breastfeeding and the Environment: Linkages and opportunities in Nigeria. Along with A&T and the Ministry of Health, speakers include Action against Hunger, Nutrition Society of Nigeria, National Agency for Food and Drug Administration and Control. 6PM West Africa Time (GMT+1). Register here.
Southeast Asia: Designation of three new Centers of Excellence for Breastfeeding in Quang Nam Province, Viet Nam. See the map of hospitals in Viet Nam that have signed up for the initiative.
India: The Global Virtual Symposium on MIYCN continues online, featuring a variety of speakers. Register here; keep in mind that the times indicated are in India Standard Time. Click here to read the full program.
Nigeria: Media roundtables in Lagos to highlight breastfeeding, World Breastfeeding Week, and contextualize IYCF in the COVID-19 era. The first is geared towards state and technical stakeholders, to discuss breastfeeding issues and sustainable IYCF practices in terms of COVID-19 and climate change; the roundtable will be attended by the State Ministry of Health and the Lagos State Health Service Commission. The second roundtable is for community stakeholders and beneficiaries, such as mothers who exclusively breastfeed, service providers, traditional birth attendants, and breastfeeding guardians.
Nigeria: Media roundtable in Kano State, with state media, to highlight the importance of breastfeeding amid a time of COVID-19 and climate change. In attendance will be His Excellency the Governor of Kano State, as well as the state’s Information and Health commissioners.
Southeast Asia: Video premiere, from A&T and our partner UNICEF, to raise awareness for workplace lactation support in Southeast Asia.
Global: Global leaders will discuss why investment in skilled breastfeeding support is essential to achieving equitable health outcomes in “Achieving health equity: providing skilled breastfeeding support universally,” a webinar sponsored by the Global Breastfeeding Collective, WHO and UNICEF. The audience will include funders, implementing organizations and national government level leaders. The webinar will be conducted in English with simultaneous interpretation in French, Spanish, Arabic, and Russian. Learn more and register here.
Southeast Asia: #healthierbabies #healthierplanet TikTok dance challenge where mothers, families and young people will cover a dancing compilation, initiated by a famous dancer. This activity promotes the key messages that everyone can get involved in promoting breastfeeding and that supporting breastfeeding is protecting their own planet.
India: A webinar including private sector doctors and the Indian government continues a series that engages professional associations on maternal, infant and young child nutrition. The webinar engages CARE, Federation of Obstetrics & Gynecological Societies of India, and the Indian Academy of Pediatrics.
Nigeria: The Nigeria Breastfeeding Assembly and Alive & Thrive are hosting a webinar, “Protecting, Promoting and Supporting Breastfeeding in the context of COVID-19.” The webinar at 3pm West Africa Time (GMT+1) will center on how to ensure and achieve optimum breastfeeding of Nigerian children in the face of the current global pandemic. Register here.
Southeast Asia: Advocacy meeting with the Vietnam General Confederation of Labor to advocate for policy changes requiring lactation rooms in workplaces in Hanoi city and Dong Nai province. In attendance will be the General Federation of Labor, Women Union, UN Women, GIZ, Care International, SUN CSA Viet Nam, and popular media outlets from Viet Nam.
Nigeria: Stakeholders are invited to a webinar, “The Role of Critical Stakeholders in Improving Exclusive Breastfeeding Practices in Kaduna State,” at 10 a.m. West Africa Time (GMT+1). Register in advance for this webinar. After registering, you will receive a confirmation email containing information about joining the webinar.
Nigeria: Key resource persons within the Nutrition & IYCF sectors in Lagos state will appear on live TV programs over 3 days – August 3, 5, and 7 – to discuss breastfeeding and the environment and advertise the Start Strong/Zero water campaign. The three TV programs are: 1) Guides to planet-friendly breastfeeding practices in a developing country like Nigeria, 2) “Breastfeeding: Nature’s drink with superior packaging” and 3) Starting Children strong on the world’s healthiest fast food: Breastmilk
Burkina Faso: Representatives from A&T and UNICEF will talk about the Stronger With Breastmilk Only Campaign, which promotes exclusive breastfeeding in Francophone West Africa, on a TV show.
In June, the Government of Burkina Faso launched the Stronger With Breastmilk Only campaign, with support from UNICEF, the World Bank, the PRSS (Health Services Reinforcement Project) of the Government of Burkina Faso, and Alive & Thrive, aiming to raise awareness of the importance of exclusive breastfeeding. Due to COVID-19 restrictions, the campaign was launched online: a Zoom webinar, Facebook Live broadcast, social media posts, and reports in national and regional media delivered the campaign’s messages.
Several other countries will launch the Stronger With Breastmilk Only campaign during World Breastfeeding Week in August. This video from UNICEF offers some insight on the need for the campaign.
“This campaign challenges all stakeholders to focus on advocacy and communication in all its forms,” said Professor Léonie Claudine Lougue Sorgho, Minister of Health. “We can all promote exclusive breastfeeding as a member of the family unit and community, as a healthcare worker, and as communication, education or other development professionals by using the most powerful necessary tool: our voice.”
The Stronger With Breastmilk Only campaign seeks to mobilize partners, businesses, communities and families to ensure that mothers receive the appropriate information and support they need to adopt exclusive breastfeeding and thus give their children the best start in life.
In Burkina Faso, 4 in 10 infants receive fluids and food in addition to breast milk during their first six months of life, which contributes to malnutrition, illness and even death of children.
“Breast milk is an infant’s first vaccine and its best source of nutrients,” said Dr. Anne Vincent, UNICEF Representative in Burkina Faso. “Encouraging and helping mothers to give exclusively breastmilk, without water, for the first six months of their lives is a challenge which requires the support of not only medical personnel and political decisionmakers, but also the private sector and communities and families.”
To keep babies under the age of six months healthy, scientific data recommends giving them only breast milk on demand (day and night). Breast milk contains all the water and nutrients necessary for a child’s good growth. Infants who receive fluids and food in addition to breast milk before the age of six months are at increased risk of diarrhea, respiratory infections and undernutrition. The risk of death is up to three times higher than among those who are exclusively breastfed.
The lack of exclusive breastfeeding comes at a considerable cost. In addition to the thousands of preventable child deaths, stunted growth and reduced cognitive capacity of hundreds of thousands of children, the absence of breastfeeding costs more than 116 billion CFA francs per year in Burkina Faso.
The Tanoto Foundation and Alive & Thrive will continue their cooperation in support of the Government of Indonesia’s national stunting reduction strategy by supporting the implementation of a social and behavior change communication (SBCC) strategy, the organizations announced in July.
“We are very pleased to be able to continue this collaboration as part of our contribution to help the Government of Indonesia achieve its target of reducing the stunting prevalence to below 20% by 2024,” said Eddy Henry, Tanoto Foundation’s Head of Early Childhood Education and Development. “Through the study on maternal, infant, and young children nutrition and early childhood development practices, we have gained many important findings. These findings become the basis to develop community-based SBCC solutions that will address nutrition problems faced by the community.”
“Alive & Thrive and Tanoto Foundation are helping the Government of Indonesia to take appropriate steps to reduce the burden of stunting and ensure Indonesian children grow well and lead healthy and productive lives,” said Roger Mathisen, Program Director of the Alive & Thrive Southeast Asia office.
Stunting is a very serious issue in Indonesia. According to the 2019 Survey on the Nutrition Status of Children Under the Age of 5 (SSBGI), one of four Indonesian children under the age of 5 is stunted. Stunting is not only making them more susceptible to disease and infection, but also impairs their mental and physical development. Stunting impacts children’s future by reducing educational achievement and increasing the risk of poverty as they grow older.
Seeking to address this problem, in 2017 the Government of Indonesia launched the National Stunting Reduction Movement, making addressing stunting during children’s first 1,000 days of life a national priority. Alive & Thrive has been providing technical assistance to the government in developing social and behavior change communication campaign materials that have become an integral part of the government’s efforts to reduce stunting.
The Tanoto Foundation-Alive & Thrive collaboration supports both central and local governments to use the insights and findings of “Exploring Maternal, Infant, and Young Child Nutrition & Early Childhood Development Practices in Indonesia,” a study conducted in 2019 with funding from the Tanoto Foundation. This study aimed to find practical recommendations in relation with social and behavioral change communication on infant and children’s nutrition.
The study was conducted in six districts in Indonesia located in South Kalimantan, West Sulawesi, East Nusa Tenggara, Maluku, West Sumatra, and West Java and provides input to the Government in developing communication for social and related changes related to breastfeeding, complementary feeding, maternal nutrition, and early childhood development. Using an immersion approach, the study deepened understanding of the local behaviors and practices and formulated recommendations for improvement.
People from around the world came together virtually through a video and photo mosaic to celebrate the World Day of Human Milk Donation in May. The event lauded the work of 700 human milk banks operating in 65 countries and thanked mothers for their gift of human milk.
Donor milk allows mothers to get the time and support they need to establish their own milk supply and breastfeed their babies. The COVID-19 pandemic has made increasing awareness of human milk banks more important than ever because it has made recruiting donors more difficult and even raised questions about the safety of donor milk.
The Human Milk Bank Donation UK, Alive & Thrive and the Global Alliance of Milk Banks and Associations (GAMBA), a new virtual collaborative network of 80 human milk bank leaders worldwide, jointly facilitated the World Day of Human Milk Donation campaign. The campaign involved more than 7,000 people whose efforts made #Everydropmakesadifference a trending hashtag on social media.
A&T also joined a call to action of GAMBA members on the use of human milk banks in response to the COVID-19 pandemic published in The Lancet.
Alive & Thrive is pleased to join partners around the world to celebrate World Day of Human Milk Donation. The photo mosaic featured in the video below is a tribute to human milk donors and professionals working together across the world to promote human milk donation.
Globally, an estimated 15 million babies are born prematurely every year and prematurity is the leading cause of death in children under 5. Making safe, pasteurized donor milk available to all at-risk, sick, and premature infants worldwide without access to their own mothers’ milk saves lives. Donor milk can also act as a bridge to support mothers who need time and help to be able to establish their own milk supply and breastfeed their babies.
This year, milk bank leaders have come together to build a global alliance to enable sharing of optimal practices in milk banking, which is especially important during the unprecedented challenges faced during the COVID-19 pandemic.
“The gift of breastmilk lies at the heart of the work of human milk banks” said Gillian Weaver, Co-Founder of the Human Milk Foundation and a leader of the Global Alliance of Milk Banks and Associations. “Almost 700 milk banks operate in 65 countries around the world. On this special day, all who support and benefit from their work can come together to celebrate the unique donation that milk donors make to other mothers and their premature sick infants. Every drop really does make a difference!”
“A human milk bank is an essential component of breastfeeding-friendly health systems, giving all at-risk infants access to the benefits of breast milk when they need it most.” said Roger Mathisen, Program Director of Alive & Thrive’s Southeast Asia office. “The global alliance now has more than 80 members from 36 countries who have come together to create a global milk bank movement in support of breastfeeding.”
Faced with little or no breastfeeding support in their workplaces, women may leave the workforce, choose not to breastfeed their infants, or use unsafe or unsanitary spaces to breastfeed – each option potentially leading to significant negative outcomes. The ministries’ approvals came after pilot testing, training, and monitoring in three worksites (two private businesses and one government office).
All three of the worksites currently have operational lactation support programs including breastfeeding spaces and breaks. A&T is working with UNICEF to finalize a dissemination plan for the materials.
Additionally, A&T is facilitating the development of a team of core trainers for decision and policy makers in collaboration with the Business Coalition for Gender Equality, and for working mothers in collaboration with the Yangon Regional Health Department. Roll out of the tools to additional worksites is planned for the duration of 2020.
Representatives of the ministries of health in Burkina Faso, Niger and Senegal met health officials, communication experts, and community authorities during a six-day visit to Nigeria organized and conducted by Alive & Thrive.
The exchange visit allowed the delegations to learn more about the “Start Strong/Zero Water” awareness-raising campaign and about conceiving and launching such national campaigns on infant and young child and maternal nutrition. To date, thousands of radio and TV ads have been broadcast in 11 states, reaching millions of women. Several radio and TV stations donated broadcast time to air the ads and a YouTube channel was set up with A&T support.
The delegations visited health facilities in Lagos and Kaduna where they met facility and community health workers, pregnant women and mothers of children under two years. They also met the advertising firm that developed campaign materials with A&T and the Government of Nigeria, and met the First Lady of Kaduna, a strong supporter of the campaign who explained how she led the Kaduna State government and key stakeholders to work with A&T on the campaign.
They specifically discussed who participated in developing and launching the campaign, the principal partners involved in implementing the campaign, the challenges encountered during implementation, the different channels and approaches used, and the campaign’s most effective strategies.