Save the Children’s new report “Superfood for Babies: How overcoming barriers to breastfeeding will save children’s lives”.

Main messages

1) Mothers everywhere should have access to information that allows them to make an informed choice about breastfeeding, and the support they need to breastfeed should they choose to.
2) Breastfeeding is critical to preventing malnutrition and saving children’s lives in the developing world. Breastfeeding immediately after birth could help save 830,000 newborn babies from dying a year, and exclusive breastfeeding for six months could save even more babies and children.
3) In the U.S. there are benefits to breastfeeding, but it is not the same matter of life and death and mothers should feel supported in their choice, whatever it is. However, U.S. moms who choose to breastfeed don’t always get the support—including in hospitals or the workplace –that they need.
4) Save the Children’s new report finds there are four major barriers to breastfeeding and we need to support moms who choose to breastfeed to overcome these – especially in developing countries where it can save their babies’ lives.
– Please go to http://www.savethechildren.org/1000-days and sign a petition to help mothers around the world get more support around breastfeeding and lifesaving nutrition for their babies.

• More detailed messages and examples of 4 major barriers below
• Full report: www.savethechildren.org/BF-report
• Our call to action – sign the petition: www.savethechildren.org/1000-days
• Landing page: www.savethechildren.org/superfood where you can refer people to links to the report, the press release and photo and video.
• (The video on the landing page is of actress Isla Fisher reporting on Brazil’s success in fighting child mortality through supporting breastfeeding)
• TIME cover parody.… Remember this notorious Time magazine breastfeeding cover? We have a parody, where instead of “Are you Mom Enough?” we ask “Are we supporting moms enough?”

• Recent CDC statement on how more U.S. moms are breastfeeding but still don’t always get the support they need if they choose to breastfeed:
http://www.cdc.gov/media/releases/2013/p0207_breast_feeding.html
• Only 6.7 % of births in the US occur in “Baby-Friendly” facilities that meet international guidelines for supporting breastfeeding. These facilities can be found here:
http://www.babyfriendlyusa.org/find-facilities/list-of-designated-facilities–by-state
• Hospitals working toward “Baby-Friendly” status through CDC initiative can be found here:
http://www.nichq.org/our_projects/cdcbreastfeeding_participating_teams.html

Some more detail:

• The fight to reduce child mortality is advancing. The annual death toll is still far too high, but it’s dropped from 12 million a year in 1990 to under 7 million now.
• But reducing malnutrition has been harder, and malnutrition is a major driver of child deaths in the developing world – it leads to more than 2 million child deaths a year.
• We need to ramp up our efforts in this area and breastfeeding is key to succeeding.
• Breastfeeding not only protects against malnutrition, it strengthens babies’ immune systems.
• Save the Children’s new report “Superfood for Babies” looks at how hundreds of thousands of babies lives a year could be saved through breastfeeding and what it will take to get there.
• The report finds that starting breastfeeding earlier can make a big difference.
• The colostrum (first milk) jump-starts a baby’s immune system, and more often leads to extended breastfeeding.
• Based on the best available studies on immediate breastfeeding in Ghana and Nepal, we estimate that as many as 830,000 babies could be saved a year if all moms breastfed in the first hour after birth.
• Even more babies could be saved if all of these moms breastfed exclusively for six months.
• So why isn’t this happening? Breastfeeding rates have actually stagnated around the world over the last 20 years – and remain below 40% globally.
• We investigated and found four major barriers to breastfeeding around the world: 1) cultural and community pressures 2) the health worker shortage 3) lack of maternity legislation, and 4) aggressive marketing of breast-milk substitutes – or formula. (see below for examples you like)
• While not the same matter of life and death for babies here, breastfeeding benefits moms and babies here as well. Those include helping premature babies’ stomachs develop properly, and lowering the risk of obesity.
• Some of the barriers our report discusses affect American moms as well.
• Only 6.7% of U.S. births occur in designated 154 “Baby-Friendly” facilities that meet international recommendations for supporting breastfeeding, and the U.S. has the weakest levels of maternity legislation in the industrialized world.
• All women deserve the support they need to breastfeed should they choose to.
• And we all can do something to help babies in the developing world survive.
• Please go to http://www.savethechildren.org/1000-days and sign our petition to help mothers around the world get more support around breastfeeding and lifesaving nutrition for their babies.
• Save the Children is calling on Secretary of State Kerry to recommit to the 1,000 Days Partnership that expires in June. Since 2010, this international partnership has already helped countries such as Indonesia, Ethiopia, Bangladesh and Tanzania develop strategies around fighting childhood malnutrition through supporting breastfeeding and other important steps.
• 1,000 days is the critical time from pregnancy and a child’s second birthday where there are the best chances to prevent malnutrition. Supporting moms to breastfeed must be central to these efforts.

Here are the four major barriers the report found moms face in breastfeeding with some of the examples given in the report:

1. Cultural and community pressures

– Many cultures discard the colostrum. In India this often relates to religious belief, but also that it is thick, unclean and the removal helped the child suckle more easily. In Afghanistan, people believe it should be discarded because it’s been in the breast for 9-10 months. In Niger, tradition says that colostrum is dangerous for infants and should be thrown away.
– Belief that babies should drink something else before starting breastfeeding – including water, herbal tea, sugared water, animal milk, ghee. These substances actually reduce the appetite an thirst of the baby that are essential to suckle effectively. In India, there’s a belief it helps remove the meconium (dark first stool)
– Many women not empowered to make their own health decisions – in a Sierra Leone survey 47% reported this was the case.
– Save the Children works with fathers, with mothers in law, and even religious leaders to overcome these barriers. For instance, in the Philippines, our programs refer to verses from the Koran and quote Muslim leaders who assert that Mohammed was wet-nursed. In Ethiopia, our “Alive & Thrive” program uses TV ads making farming analogies to link good infant feeding practices to farming practices that fathers are familiar with. One husband remarked during the research for the project: “What I can do for my crops and cattle, I can do for my children.”

2. Global health worker shortage

– The World Health Organization has estimated the global health worker shortage at more than 3 million
– One third of moms give birth with no skilled health worker present
– For this report, Save the Children analyzed data in 44 countries and found that women who had a skilled attendant present at birth were twice as likely initiate breastfeeding within the first hour.
– The Baby-Friendly Hospital Initiative launched by WHO and UNICEF in 1991 to implement practices that protect, promote and support breastfeeding. Facilities must implement “10 steps to successful breastfeeding” to get the designation.
– More than 20,000 hospitals in 156 countries have achieved this status, but it is stagnation.
– In the US only 6.7% of births take place in “baby-friendly” hospitals or birthing centers. It is up though from 2.9% in 2007.
– http://www.babyfriendlyusa.org/find-facilities/list-of-designated-facilities–by-state

3. Lack of maternity legislation

– For this report Save the Children commissioned research to look at maternity protection in the 36 low-income countries with the highest number of malnourished children.
– It looked at whether maternity leave met the International Labor Organization (ILO) minimum standards (14 weeks leave moving toward a recommended 18), financial protections and policies to accommodate breastfeeding women at work.
– Only Vietnam met 18 weeks (6 months) leave. Only 10 countries exceeded 14 weeks.
– Most of the 38 industrialized countries provide the recommended 2/3 pay during maternity leave, 5 countries provide between 30 (Japan) and 60 (Czech Republic) percent. In Australia and Denmark, maternity leave is funded by employers, but in the US there is no requirement at all that women be paid while on maternity leave, although some employers choose to.
– Women working in the informal sector (street vending, domestic work etc) need financial protections if they are too breastfeed and maintain their families. India, for example, has started providing conditional cash transfers to these women while their babies are under 6 months old. Save the Children includes such transfers in its Myanmar programs as well.
– In the U.S. Through our campaign for healthy kids, Save the Children has advocated for legislation at the state level to support breastfeeding mothers. Successes include:
– 2011 legislation passed in Louisiana requiring state buildings to provide suitable spaces (that are not a bathroom) for breastfeeding, which went into effect July 1, 2012.
– 2011 legislation passed in Tennessee, striking language requiring children to be under 12 months old in order for mothers to be allowed to breastfeed in public, which went into effective July 1, 2011.
– 2010 legislation passed in Arizona requiring private areas for breast feeding as part of childcare regulation reform.

4. Aggressive marketing of breast-milk substitutes

– The global baby food industry is estimated to be worth more than $36 billion and that figure is predicted to rise by 31% by 2015. Formula accounts for the majority of the industry – $25 billion.
– The International Code of Marketing Breast-milk Substitutes (“The Code”) was created by the World Health Assembly in 1981 and has been updated numerous times since. It is a set of minimum standards to promote and protect breastfeeding and ensure breast-milk substitutes are used safely if needed.
– Provisions include no advertising of breast-milk substitutes or promotional materials, no free samples to mothers, their families or health workers, no gifts to health workers, labels must state the superiority of breastfeeding and give a warning about health hazards, no pictures of infants or other pictures idealizing the use of formula, no direct contact with moms by marketing personnel.
– Save the Children researched practices in a dozen countries for this report and performed original polling in Pakistan and China.
– In our China survey – 40% of mothers interviewed had been contacted directly by baby food company representatives.
– In our nationally representative Gallup poll in Pakistan, 1/3 of health professionals said they’d been visiting by a representative of breast-milk substitute companies and 1/10 of health professionals said their health facility had received free samples of formula, nipple or bottles.
– In Sri Lanka, an int’l watchdog group (IBFAN) found that breast-milk substitute companies operate an incentives scheme for midwives, including offers of money and foreign travel in return for selling formula.

Photos (Copyright Save the Children)