In response to concerns about the use of infant formula in environments where lack of breast feeding resulted in large numbers of infant who became severely ill or died, a grassroots global initiative took hold in the 1970s to promote international and national efforts to protect, promote, and support breast feeding. These efforts culminated in 1981 with the nearly unanimous adoption by the World Health Assembly (WHA) of the International Code of Marketing of Breast-Milk Substitutes. This document and subsequent relevant WHA resolutions, collectively known as the Code, provide guidelines for the marketing of breast milk substitutes, bottles, and teats. To ensure infant feeding decisions free from the influence of marketing pressures, the Code provides guidelines on a number of issues associated with increases in formula feeding, including direct promotion to the public, donations to health care institutions, free supplies to mothers, and the use of baby images on labels that glorify bottle feeding. Its implementation is monitored by a 2-year reporting cycle by countries to the WHA and by the International Code Documentation Centre in Penang, Malaysia. Despite continued violations by infant food companies and the lack of enforcement in many developed countries, the Code has provided an important tool for regulating and monitoring the infant food industry to ensure that its marketing practices do not undermine breast feeding.
The 1990 Innocenti Declaration, which set four operational targets that all governments should achieve by 1995, was endorsed by the 45th WHA. These targets included appointment of a national breast feeding coordinator and establishment of a multisectoral national breast feeding committee; ensuring that all health facilities providing maternity services fully practice the 10 steps to successful breast feeding (Table 1) set out in the WHO/UNICEF statement; taking action to give effect to the Code; and enacting imaginative legislation to protect the breast feeding rights of working women. This declaration provided the basis for the WHO/UNICEF Baby Friendly Hospital Initiative (BFHI), which was developed in 1991, piloted in 12 countries, and inaugurated as a global initiative in 1992. BFHI promotes hospital practices consistent with early initiation, an environment conducive to BF, appropriate clinical management of BF, and compliance
Table 1 WHO/UNICEF 10 steps to successful breast feeding
Step 1. Have a written breast-feeding policy that is routinely communicated to all health care staff.
Step 2. Train all health care staff in skills necessary to implement this policy.
Step 3. Inform all pregnant women about the benefits and management of breast feeding.
Step 4. Help mothers initiate breast feeding within a half-hour of birth.
Step 5. Show mothers how to breast feed and how to maintain lactation even if they should be separated from their infants.
Step 6. Give newborn infants no food or drink other than breast milk, unless medically indicated.
Step 7. Practice rooming-in—allow mothers and infants to remain together—24 h a day.
Step 8. Encourage breast feeding on demand.
Step 9. Give no artificial teats or pacifiers (also called dummies or smoothers) to breast feeding infants.
Step 10. Foster the establishment of breast feeding support groups and refer mothers to them on discharge from the hospital or clinic.
with certain key provision of the Code, such as no donations of free or subsidized infant formula. Certification is awarded to hospitals that comply with a set of standardized Baby Friendly criteria developed by WHO and UNICEF. Worldwide, nearly 20 000 hospitals are certified as Baby Friendly.
At the same time that the Code and BHFI were being implemented, numerous projects worked to develop training materials in lactation management and counseling skills and provided funding for widespread dissemination of training courses. National governments also actively implemented campaigns to promote breast feeding. In Latin America, these efforts are likely responsible for a resurgence of breast feeding.
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For many years, scientists have been playing out the ingredients that make breast milk the perfect food for babies. They've discovered to day over 200 close compounds to fight infection, help the immune system mature, aid in digestion, and support brain growth - nature made properties that science simply cannot copy. The important long term benefits of breast feeding include reduced risk of asthma, allergies, obesity, and some forms of childhood cancer. The more that scientists continue to learn, the better breast milk looks.