DRAFT

(wP)NUT/ICP,N 1-E
UT/2.2/00 Englishonly

Repofiseriesnumber:RS/2007/GE/27(PHL)

R,EPORT

\YHO/UNICEFCONSULTATIONON BREASTFEEDINGPROTECTION,
PRO},IOTIONAND SUPPORT

by:
Convened

WHO I]EALTH ORGANIZATION

REGIONALOFFICEFORTHE WESTERNPACIFIC

UN]TEDNATIONSCHILDREN'SFUND
REGIONALOFFICEFOREASTASIA AND PACIFIC

Manila, Philippines
20 22 June2007

Not for sale

Printed and distributed by:

World Health Organizatton

Regional Office for the Westem Pacific
Manila, Philippines

August2010
 NOTE

The views expressed in this reporlarethoseof thc participantsin the WHO/UNICEF

Consultationon Breastfeeding Protection,Promotionand Supporland do not
necessarilyreflectthe policiesofthc Organization.

This report has been preparedby the World Health OrganizationRegional Officc {br
tl.reWestem Pacific for govemmentsof Member Statesin the Region and for those
who parricipatedin the WHO/LNICEF Consultationon BreastfeedingProtection,
Promotion and Support.which was held in Manila, Philippines,fi'om
20 to 22 June2007.
 SUMMARY

In spite ofrvhat is knos'n about the greatbenefits olbreastfeedingthat accrue

to children, mothers,families and society-and the risks of diseaseand morbidity
associatedwith bottle-feeding-the practiceofbreastfeedingcontinuesto declinein
many parts of the Asia and Pacific region. Breastfeedingcompeteslor mother's time,
especiallytime sheneedsto eam income lor the family, and breastmilk is being made
to competeagainstbreast-milk substitutes.The clear inferiority of the substitutesis
being maskedby very aggressivemarketing efforts of companiesselling them. These
campaignsoften provide inaccurateinformation as well as incentivesto health
workers and professionalsin clear violation ofthe national and intemationalcodes
and agreementsfor marketingbreast-milk substifutes. Thesetacticshaveundemined
the efforts of govemments,nongovenmental organizations(]iGOs), individuals, and
internationalorganizationsto provide mothersand families with accurateinformation
to help them make the right choicesfor their children and themselves.The aggressive
marketing of substituteshas also made it very difhcult for concemedhdividuals and
organizationsto ffeate environmentsthat protect, promote and supportbreastfeeding.

To addresstheseand related issues,a consultationon breastfeedingprotection,

promotion and supportu'as organizedby the WHO Regional Office for the
Westem Pacific and the Unitcd Nations Children's Fund GTNICEF)RegionalOffice
for EastAsia and Pacific. Parlicipantsfiom Australia, Cambodia,
the Peopie'sRepublicof China,Fiji, Indonesia,Japan,the Lao People'sDemocratic
Republic, Malaysia, \{ongolia, New Zealand,PapuaNerv Guinea,the Philippines,
Samoa,Singapore,SolomonIslands.Thailand,Timor-Leste,Vanuatu,andViet Nam
met in Manila, Philippines.frorn 20 to 22 Jttne200l . The consultationwas designed
to strengthenthe regional netrl'ork n'ith new and better tools and human and
knowledge resourcesfor expandingand sustainingthe region's breastfeedingculture.

The consultationobjectiveswere to: sharesuccessfulexperiencesand lessons

leamt, and to analyseconstraintsto improving breastfeeding;discussthe slatusof the
Baby-Friendly Hospital lnitiative (BFHI) and future stepsneededto strengthenand
sustainthe initiative; review the statusof the adoption and implementationofthe
intemational and national codesfor marketing breast-milk substitutes,and identifu
actionsthat will improve their effective implementation;and identifu innovative ways
to promote a breastfeedingculture and discouragea bottle-feedingculture.

The three-dayu orkshop was divided into hvo main parts u'hich were prefaced
by presentationsand discussionson breastfeedingin the context of the Regional Child
Survival Strategy,the economicsof breastfeeding,and country situation analyses(and
available data tools). The first part aimed at creating an enablingenvironment
(personal,societaland political) for breastfeedingby sharingexperiences,looking for
ways to strengthenBFHI, improving health worker skills, and effectively using
communicationtools to transfom behaviour. The Cambodiacasestudy rvas
presented. The secondparl ofthe consultationfocused on preventing a bottle-feeding
culture from proliferating. The Philippine story was presentedas an examplewhich
led to extensivediscussionson how to better monitor and implement codesof
marketing of breast-milk substitutes. Technical updateson breastfeedingrn
emergencies,breastfeedingand HIV, breastleedingthe lorv-birth-rveightbaby, the
long-term effects ofbreastfeedingand breastfeedingbeyond six months concludedthe
presentatlons.

Througlrout emphasis
thecon:ultation. wasp)acedon theneedto idenLifl
actionsthat participantsv'ould commit to taking after the consultation. Therefore,to
concludethe workshop,lists of recommendationsand suggestedactionsrvcre
compiled (basedon discussionsover the threedays) and organizedunder the
following areas:breastfeedingeconomics;use of data,communicationand advocacy,
strengtheningthe BFHI; creatingan enablingenvironment;increasinghealthworker
skills; and implementationof the Code of Marketing of Breastmilk Substitutes.

The participantsu'ere expectedto retum to their respeclivecountriesand to

usetheselists-as well as personallists that they rvereaskedto prepare-to guide
them through a courseof action that would strengthenand expandthe breastfeeding
culture in their countries. With knowledgegainedfrom the consultationand the
conlections madervith fellorv parlicipants,resourcepersonsand representatives of
national and intemational organizations,participantsrvereexpectedto become
effective drivers in their presentand future spheresofinfluence.
 CONTENTS

1.1 Background . . . . . . . . . . .. . . . . . . . . . . . . .I .
1.2 Objectives ........ I
1.3 Organization . . . . . . . . . . . . . . . . . ' . . . . . .2. .
1.1 Participants, resourcepersons,obsen'ers,lrepresentati ve agencies.
a n dm e m b e rosf t h es e c r e t a r i a t .........................2

2 . P R O C E E D T N G. .S. . . . . . . . . . . . . .................3
..

2.1 Prcliminaries . . . . . . . . . . . . . . . . . . . . . . . r. . .
2.2 Part 1: Crcatingan enablingenvironmentfor breestfeeding ..... . ... 5
2.3 Part2: Preventing culturc
a bottle-feeding ...........12

3 . C O N C L U S I O N .S. . . . . . . . . . . . . . .................20

4.ACKNOWLEDGEMENTS ....................22

ANNEXES:

ANNEX 1 - PROGRAMMEOF ACTIVITIES

ANNEX 2 - ADVISERS,RESOURCE
L]S]' OF TEN4POR-A.RY
PERSONS, OBSERVERS,AGENCYREPRESENTATIVES
AND SECRETARIAT

ANNEX 3 - PROBLEMN4ATRIX

A N N E X4 . RECON,IMENDATIONS ACTIONS
AND SUGGESTED

Key words

Child nutrition / Inlant nutrition / Asia / Pacific Islands/ Breastfecding

 1. INTRODUCTION

1.1 Backsround

In the Westem Pacific Region, around2100 children under age five die every
day from cornmonpreventableand treatableconditionsincluding diarrhoea,
pneumoniaand perinatal events. \\{HO and LNICEF have developedthe Regional
Child Survival Strategy,which was endorsedby the WHO Regional Committeein
2005 to place child health higher on political, economicand health agendasin
Member States. The regional strategyfocuseson the implementationof an essential
packagefor child survival that includesbreastfeedingas the single most effective
nrar.anfiara ;-f-^,^-r;^-

The IntemationalCodeof Marketingof BreasfMilk Substitutes, the Innoccnti

Declaration,and the BFHI are the most significant actionssupportcdby WHO and
LINICEF to promote and protect breastfeeding.ln the 25 yearssince the bidh of the
Code and 15 yearsfrom the launching of the BFHI, breastfeedingrates and duration
still need to improve. Breastfeedingrateshave been on the declinein nost
developingcountriesin the region where or y about one third of infants lessthan
six months old are exclusivelybreastfed. The aggressivemarketing and advertising
strategiesof the milk industry producing infant and fol low-on formula have thwarled
the early and promising gains of the BFHI and made the nationally adoptedmeasures
for regulatingbreast-milk substitutesinsufficient. Hospitals that have been certified
as "baby-friendly" have often failed to strictly follorv the 10 stepsrequiredby t1.re
BFHI over the long term, and a systemfor regularassessmcnt needsto be
incorporatedinto quality assurancesystemsof routmc health service. At the same
time, it is increasinglyrecognizedthat rvomenneed supportfor breastfeedingwithin
their own communities.

WHO and LTIIICEFconveneda consultationto discusscommon issuesand

challengesrelatedto BFHI and tire implementationof the Intemational Code of
Marketing of BreasGMilk Substitutes,and to identi|/ strategicactions that will
promote a "breastfeedingculture" and discouragea "bottle-feeding culfure" among
mothers and within the health community, with ful1 health systemsupport.

1.2 Obiectives

The consultationobjectivesrvereto:

(1) sharesuccessful experiences andlessonsleamt,andto analyse

constraints
to improvingbreastfeeding;
(2) discussthe statusof theBFHI andfuturestepsneededto strengthen
andsustaintheinitiative;
(3) reviewthe statusof the adoptionandimplementation of the
intemationalandnationalcodesof marketingof breastmilk
andidentifli actionsthat will improvetheir effective
substitutes,
imolementation: and
 -2-

(1) identifu imovative ways to promote a breastfeedingculture and

discouragea bottle-feedingculture.

1.3 Organization

Vieu'ing breastleedingin the contextofthe RegionalChild Survival Strategy,

looking at possibiervaysto measrre the economicvalue of breastfeeding,and
analysingavailablecountry data for settingcountry actionpriorities, primed the
pafiicipantsfor the two main parts of the consultation. hr Part 1, group and plenary
discussionson ways to createan enablingenvironmentfor breastfeedingby
improving BFHI and heaith q,orker ski11sand performance,and changingbehaviours
rvith effective communicationtools" followed a presentationon the successfulbaby-
lriendly community initiative (BFCI) in Cambodia. In Parl 2, participantsu'ere urged
to think ofnew ways to prevent a bottle-feedingculture from proliferatrng. The
currentbattle in the Philippines' SupremeCourt (and in the media) over the expansion
of the coverageof the Milk Code and the launch of LNICEF's docurnenlaryForntula
for Disaster: Violationsof the Philippine Milk Code provideda real-time action
framervorkfor in-depth discussionson u'ays to monitor and enforccthe Code,the
importanceof "doing dre homervork" (including technicalupdates)for advocacy,and
the needto make clear commitmentsto achievetarsets.(SeeAnnex I for the detailed
programmeof activities)

l..1 Parlicipants.resourceperso
ofthe secretariat

Represerrlatir
esfrom the fo)lowingMemberStates panicipated in rhe
consultation:Australia(1), Cambodia(3), China (5), Fiji (2), lndonesia(1), Japan(1),
the Lao People'sDemocraticRepublic(2), Malaysia(1), N4ongolia (3), NervZealand
(2), PapuaNeu' Guinea(3), the Philippines(5), Samoa(1), Singapore(3), Solomon
Islands(1), Thailand(3), Timor-Leste(2), Vanuatu(1), andViet Nam (4).

The resourcepersonswere Ms Ali Maclaine of EmergencyNutrition Nehl'ork

(United Kingdom), Dr Audrey Naylor of Wellstart lntematior.ral(United Statesof
America), Dr Marina FerreiraRea of the Institute of Health of SdoPaulo (Brazil),
Dr Julie Smith of the Australian ResearchCouncil (Australia), and Ms Ycong Joo
Kean of the IntemationalBaby Food Action Network (IBFAN)/Intemational Code
DocumentationCentre(ICDC) Penang(Malaysia).

Obsen-ersincluded representativesfiom the DevelopmentAction for Wonen-

Trade Union Congressof the Philippines,Employers' Confederationof the
Philippines,Peopleof the Philippines lor BreastleedingCoalition/ARUGAAN,
Philippine Senate,United StatesAgency for InternationalDevelopmentPhilippines,
lntemational Labour Organization Philippines,and the United StatesCentersfor
DiseaseControl and Prevention.Other observersincluded representativesfrom the
TaichungVeteransGeneralHospital and the Bureau of Health Promotion in
Taichung.
 -J-

The secretariatwas composedofrepresentativesof WHO Headquartersand

offices of the Westem Pacific Region, Cambodia,China, Philippines and Viet Nam,
and UNICEF Headquartersand offices of the East Asia and Pacrfic Region in
Cambodia,China, the Philippines,Thailand, Timor-Leste,and Viet Nam.

SeeArmex 2 for the completelist of participants.

2. PROCEEDINGS
t.l Preliminaries

2.1,.1 Opening

Dr Shigeru Omi, WHO RegionalDirector for the Westem Pacific, openedthe

consultationby outlining the benefitsofbreastfeedingand then askingwhy these
benefits are not being taken advantageof-as shown in declining breastfeedingrates
in the region and horv u'e might ensurethat the benefits are not lost. He cited the
WHO and l-tNICEF's Global Stralegyon lnfant and Young Child Feeding(IYCF) as
identifoing responsiblegroupsand the roles they must play for promoting, protecting
and supportingbreastfeeding.To reversenegativetrendsin breastfeedingrates,
Dr Orni called for "radical solutions" that would in olve strengtheningBFHI
nonitoring, expandingsupporl for breastfeedingbeyond hospitals,and using the
media in a comprehensivecommunicationstratcgyto promote breastfeeding.

Scientific evidencetells us that breastfeedingis the single most effective intervention

to prevent child deaths:and that all rvomen.with very ferv exceptions,are able to
breastfeed-if enco and suDDorted. -Dr Shrseru Omi

Dr StephenJ. At*'ood. Regional Advisor for Health and Nutrition LTNICEF

EastAsia and Pacific Region,rvelcomedthe participantson behalfof the Regional
Director of the LTNICEFEastAsia and Pacific Regional Office. He askedrvhy
breastfeedingcontinuesto be a subject so impodant as to require continuous\\{HO
and LINICEF collaboration.a consultationof expertsacrossthe region rvith resource
personsfiom aroundthe world and media-grabbingattention. His ansrver:"u'e rviil
be discussingnothing short of life and death." He suggestedthat adequatepolitical
commitment, community educationand communication,counsellingfor u'omen and
families, and minimized or arrestedinfluence of interestgroupswith agendasin
conflict with breastfeedingsupporlrnay be parl of the "secret" to raising breastfeeding
rates. Dr Atwood challengedthe participantsto act courageouslyand to hold eachto
"personal action that can be translatedinto changefin] institutions, communitiesand
households."

Participantsintroducedthemselvesand electedoffice bearcrsfor the

Consultation: Ms Rokiah Don (Ministry of Health, Malaysia) as chairperson,
Dr Yolanda Oliveros (Departmentof Health, Philippines) as Vice-chair, and
ProfessorColin Binns (Curtin University of Technology,Australia); and
Dr Dai Yaohua (Capital Institute of Paediatrics,People's Republic of China) as
raooorteurs.
 -1-

Dr TommasoCavalli-Sforza,RegionalAdviser in Nutr-itionand Food Safety,

WHO RegionalOffice for the Westem Pacific, reviewedthe agendaand introduced
the "Reporl Book." Each participantreceiveda blank booklet andwas urged,after
eachsession,to note on one pagethe recomrnendations that arosefiom the
discussions.On the facing page,parlicipantss'ere to list actionsthey intendedto take
basedon theserecommendations.ln the final session,pafiicipantsu'ould then
identifl' the most impofiant actionsto which they rvould comnit to doing in their
respectivecountriesand offices. Aly suggestionsto modifu this tool were q'elcomed.

essentialfor child survivalanddevelopment

2.1.2 Breastfeeding:

Dr Marianna Trias, RegionalAdviser:in Child and AdolescentHealth, WHO

Regional Office lor the Westem Pacific, s'ith Dr Atu'ood, presentedissuesrelatedto
breastfeedingwithin the context of the WHOiUNICEF RegionalChild Survival
Strategy. Basically, to improve child sun'iva1in the region the \\TIO/LTNICEF
strategycalls for scalingup efTortsthrough greaterpolitical rvil1and the provision of
more financial resources.(Govemmentbudgct ailocationto child health in tl.reregion
is the least amongall regionsof the uorld.) Dr Trias pointed out that breastfeedingis
part ofthe essentialpackagefor child sun'ival and the recommendationsin the
strategyfor protecting,promoting and supportingbreastfeedingcanbe appliedin all
settingsthroughoutthe region. Sheinformed the participantsthat WHO has
publisheda planning guide to help countriestranslatethe globa1and regional strategy
into national strategiesand policy and action plans.

Dr Julie Smith, Australiur ResearchCouncil Fellow, shorvcdhorv putting a

dollar value on breastmilk makesr,isible its contribution to the economyas rvell as
the costofnot protecting.promotingar.idsupporlingit. Shesuggcsted that economic
analysesbasedon do1larvaluesand costscan help motivatepolicy-makersto protect
breastmilk and alsohelp bring aboutbetterunderstanding ofthe economicand
financial incentivesu'omen and fanilies flace. A clcarerunderstandingofthese
issues,sheasserted, is neededto lormulateeffectivestratesies to improre
breastfeeding practices. Dr Smith concludedthat "Govcmrnent action can restoreand
protectbreastfeedingas the nonn (e.g.Nom'ay)" and presenteda five-point action
plan:
. have funding agreementsrvith health systeminstitutionsto include BFHI;
. provide incentir.esfor health prolessionalsto improve outcomeson
breastfeeding;
o raisemarketing and community support to match commercialmarketing and
promotion budgets;
. implement paid matemity leave and othcr breastfeeding-fiiendlyworkpiace
practicesand policies;
. include mothers' milk production in food statisticsand GDP.

ln Nodhem Europe,supporlivenational policies meannearly all mothersare still

breastfeedingat six months comparedwith less than haif in this region. We could do
this here if the rvill is there and if we listen to producers(women) about what gets in
the wav ofbreastfi
Policy-makersmay respondmore to costsof illness,becauseit imposesmore direct
and politically visible costson the health systemthan babiesdying.

Emerging literaturehighlights that feedinghuman infants on bovine milk is one of the

biggestuncontrolled experimentsin human history, and the results finfant deaths,
chronic diseases,obesity] are onlyjust now becoming evidentin the data.
-Dr Julie Smith. excerptsfrom TJteEcononticsof BreastJbedittg -..

Ms Karen Codling, RegionalNutrition Project Officer of the L'-I'IICEFEast

Asia and Pacific Regional Ofhce, and Dr SN4Moazzem Hossain,LINICEF
ProgrammeOfficer for Infant Feeding,guided the participantsthrough the Country
Situation Analysis exercise. From the Problem Matrix (Annex 3) producedby the
parlicipants,it was evident that complementaryfeedingbelore six months,BFHI
rgassessment, and Code implementationwere cross-countrypriority areasof concem:
ald late complementaryfeeding and the absenceofNGOs s'ere not considered
problemsby most countries. In addition,the follorving gencralobsen'ationson using
data for comparisonsresultedflon-rthe activity:
. it is important to ensurethat you are comparinglike with like;
o it is imnonant to know the definitions and methodologiesused;
. sometimessamplesizesare srnall and you cannotcompareresultswith the
results of previous (larger) sun'eys;
. oompansonsasrosscountrymay not be meaningful (dependson dataused);
o it is best to use one good sourcefor comparing acrosscountries;DHS and
MICS are the most standardizedsources.

Dr Hossainpresenteda tutorial on lnterpreting Data from Area Grapl.rsof

Infant FeedingPattemsby Age. He shorvedhorv areagraphscould be usedto quickly
displayproblemsand changesandhou,they could alsobe usedfor designing
interventions. He usessoftwarervrth g'hich areagraphscanbe producedin one hour
a{ler data is provided.

2.2 Part 1: creatins an enabling environmentfor breastfeeding

2.2.1 Casestudy:Cambodia

Ms Svay Sary, IYCF Coordinatorof the CambodianMinistry of Health,

presentedCambodia'sachievements from 2000 to 2005: 490%increasein exclusive
breastfeeding,threefold increasein breastfeedinginitiation rvithin one hour (87% of
new-bom babies)and within one day (90% ofnerv-bom babies),and improvementin
complementaryfeeding practices. The improvement in exclusivebreastfeeding
practicesu'as due to a large decreasein the practice ofgiving water to infants.
Govemment leadershipplayed a large part in the successofbreastfeedingpromotion
by supportingkey interventions-training, multimedia campaigns,community-based
interventions(one fifth of villages are implementing the Baby-Friendly Communities
Initiative, or BFCI), and the BFHI. Ms Sary concludedher presentationwith lessons
leamt (e.g. relevanceof community initiatives), challengesfaced (e.g. supporl of
working mothers), and further action to be taken: expandBFHI and BFCI, strengthen
 -6-

policy and legislation,and continuetraining and comrnunicationprogrammes.

Discussionsthat follou.ed revealedthat from 2004 to 2007, BFCI coveragegrervfrom
35 to 2000 villages. The Cambodianstrategyin the past feu'years hasbeento focus
on promoting exclusivebreastfeeding,and this year, emphasis(through a television
campaignand roundtablediscussions,for example)wiil be placed on early initiation.
The multimedia campaign*'as seento havebeenhighly elfective and samplesof the
television advertisementsu'ere shownto the oarticioants.

2.2.2 Baby-FriendlyHospitalInitiative

Dr Marina FerreiraRea, SeniorResearcherof the Instifute of Health of

SdoPaulo, definedthe objectivesof BFHI as implementingthe Ten Stepsto
Successful Breastfeeding andrejectingdonationsoffiee and low-costsuppliesof
breast-milk substitutesin the health facility. She cited studiesliom aroundthe rvorld
that confirm: BFHI is important for starling (United Kingdom) and continuing
(Srveden)breastfeeding,to achieveexclusivebreastfeeding(Brazil, Bela:us,
Switzerland)and to reducemorbiditl' (Belarus,an important study). Sheemphasized
the imporlanceof training to standardizeBFHI in hospitals,of Step.{ wllch is norv
interpreted"as placing babiesin skin-to-skin contactu,ith their mothersirnmediately
following birth at leastfor onehour...." and ofproviding communitysupporlfor
breastfeeding mothers(Step l0). Dr Reapointedout the major revisionsto the BFHI
global criteria and tools and informed the pafiicipantsthat updatedmaterials(except
Section5 for extemal assessors)are availableon the Intemet by searchingin
httpllwrllw.u!&elqe .

In the discussionthat fol1ou'edDr Rea'spresentation. panicipantssharcd

experiencesin their own and other countries. Issuesrangedfiom coverage(are
China's7000baby-friendlyhospitalssignihcantin termsofpercontageofall Chinese
hospitalsor percentageof all babiesdeliveredin Chinesehospitals?)to the use of
Wellstarl Intemational'straining and monitoring software(it helps thosealready
wanting to becomebaby-friendly but horv do rve convincehospitalsthat arenot
interestedin becorningbaby-fliendly to change'l)to the number ofsteps that should
be implemented("a11or nothing" or "someis betterthannone"?).

Gencral issuesrvere also raisedregardrngmonitoring, coverageandthe need

to recertifl, backslidinghospitals. Suggestionson how to addresstheseissues
included:
r using extemal professionalassociationsfor monitoring (successfullydone in
India);
r involving communitiesin rronitoring hospitalsand having them certified;
o using nervtechnology fbr monitoring (e g. using an SMS hotiine to reporl
violations and make queries);
o addressingunderlying reasonswhy hospitalsresist becomingbaby-friendly
(e.g.the pressureto be profit-oriented,to kecppaying momsrestedin
.^--i.,^+^ L^^-:.^l^\,
Prrv4rs rrusprLdrsrr
r making BFHI accreditationa necessarycondition for hospital accreditation
by govemment;
 providing policy-makerswith more evidenceof the benefits of BFHI, such
as how it reducesmorbidity and mortality;
having BFHI hospitalspost their annualcertification statuson a ueb site for
fu1l disclosure;
makingdaracollection moresystematic.

The efficacy ofBFHI is clearbut only a small number ofhospitals havebeen

accreditedconsideringhow long BFHI hasbeenaround:in 15 years,20 000 hospitals.
What a shame!\\rhen are we going to get the exponentialjump? We can't usea linear
approach.What's u'rong? We have to grapplewith the issue.
-Dr SteohenJ. Ahvood

Dr Atu'ood askedfor volunteersto form two groupsof five memberseach,

one group to defendand the other to opposethe follorving statement:

It's been 15 years,only 20 000 hospitals.I'm sorry.BFHI hashad its chance.

It's time to stopthis initiative.

The folJouing arguments(in summary)were put forv'ard by the opposing

panels:

-\gree $ ith statement:stop BFHI D i s a g . r e\ el i l b s t a t e m e t r tp: r o c e e d$ i l h B F I I I

BFHI puts an extra burden on resourcesand on
hospitals; sustainability(and starting) is a problem
and expensive-hosDitals can't afford d1is.
BFHI is a)readyin place,numbersale adequate,
fbcus on other programmes.
BFHI has not made much of a difference.
Better to put efforts in corunudty initiarives: in
c o u D L r i el i .l e C a m b o d i u
a L e r em o c ru o m e ne i r e
birth at home, should scaleup BFCI instead.some
countriesrvith BFCI and no BFHI have reduced
child mofialitv .
N4odelmothers and traditional birth attendants
(TBAs) deliverhg door-to-doormessagesare
more effective than BFHL
Trainhg and educationcan be done u,ithout
BFHI; TBAs and mid\r'ives can be fained.
Most BFHI hospitalshave not been reassessed,
how can we be sure it $'ill $'ork? Arguments lor
BFHI are subjective.
BFHI hcludes the Code of Marketing and is
aeainsttade in this globalized world.
It is difficult for hospitalsto implement BFHI
becauseof facilitiesneededfor roomilg in.
moth€m not wantins to breastfeed.
Using formula is a choice.
BFHI is cost-saYing; the costofBFHI is paid off
eventuallv.
Need to re\,italizebreastfeedingil societyor else
it rrill disappearard be repiacedby bottlc
fecdirg.
Tbe problem is in implementation;let's hx BFHI
before endilg it.
It is impoftant filr mothers to havc skilled workers
(such as il hospitals)presentduring deliveries -
mothers' lives arc also imporlant; needto work to
:trengthenhosprrals'Iurk ro comnounities.
\4others $'ho want to breastfeedin hospitalswiil
not be suppodedwithout BFHI.
BFHI helps maintain training; BFHI educates
(peoplewili continue smoking if u'e don't put up
barriers).
In New Zealand,20% ofbabies are exclusively
brea'Lledaiicr fiie yearsof Bl HI. l\i. \\as
achieveu d i l h r e a s s e s s m eonf h
l o . p i t a l st:b i si s
evidence.
Breast-milk substituteswouid proliferate if BFHI
ended.
\!fIO and UI.IICEF have developedgood tools to
implemert BFHI; changesbehg askedof
hospitalsare basedon physiology.
The "choice" to use formula may not be an
infomed choice; there is no choice about
breastfeeding,the choice is whether 1obecome
Dregnaotor not.
 -8-

Dr Rea concludedher presentationon BFHI with lessonsleamt (e.g.many

BFHI hospitalshave revededto pre-BFHI conditions)and suggestedthat more could
be leamt by" for example,irnproving self-monitoring,avoiding "politics" in
certification,reviewing the mechanicsof externalassessment,and making BFHI part
of the country health systemstructure.

To end the sessionon BFHI, the plenary suggestedfurther actionsthat could

be taken:
r move into the community where the problem is;
. show an increasein BFHI co\,erage;set a target for the region u'e may be
focusing on the wrong target;
o focus on national govemments get BFHI into national legislationand into
the national health system-if a hospital is not BFHI-certified, it doesn't
openits doors;incorporateBFHI aspart of a system,not a progran.me;
o fgotemments should] set standards;this \\'ay, evenprivatc hospitalscan
eventuallybe madebaby-lriendly;
o m a k e r h e -i <
. .<- -r ,r -n. rl cr h; l
o look furlher into rvhat can be done rvilh BFHI and find more creativervays
to implement the initiativc: the u'ay BFHI is implementedis key and is
dependenton us health prof-essionals.

2.2.3 lncreasinghealth rvorker skills and improving performancefor breastfeeding

Dr Randa Saadeh,Scientistfor Nutrition for Health and Developmentof the

World Health Organization,explainedthe rationalefor the currentemphasison
training as a way to addressthe many gapshighlighted in the Global Strategyfor
IYCF, the Innocenti Declaration2005, and the planning guide on the implcmentation
of the Global Strategy. Key training courseson IYCF are listed and describedin a
pamphlet,rvhich Dr Saadehdistributedalong *'ith a CD lor eachcountry. Dr Saadeh
cautronedparticipantsthat before introducing any courses,a comprehensivetraining
plan mustbe prepared,rvhichincludesactionstepsandidentrfiestrainees.She
highlighted the integratedcourselor fYCF Counseilingwhich u'asbasedon and
brought togetherprevious counsellingcourses,and was updatedwith nerv evidence
and lints with the Global Strategy. The intcgratedcourseaddressesthe urgent need
to efficiently train large numbersofpeople.

Dr Audrey Naylor, Presidentand Chief Executive Officer of Wellstar1

Intemational,presentedways to sfengthen preseruicecuricula by first identiffing
how the health professionacts as barriersto breastfeeding.Thesebarrier include
healthprofessionals-when they believe that infant formula is "just as good" or even
betterthan human milk as a result of the infant formula industry's very aggressive
marketing effor1s and the lack ofknowledge ofhealth workers on the benefits of
breastfeeding,the physiology oflactation, and the skills to help mothers,babies,and
thcir flamilies. Dr Naylor proposedthat preserwiceeducationcould be effective in
helping to overcomethesebarriers in ways that are sustainable,far-reaching,cost-
effective,and transformational,from assessmentto implementationto monitoring and
evaluation. Sheidentified elementsthat increasethe successoforeserwiceeduoation
 -v-

which include, lormal approvalby the institution, faculty involvementin planaing, a

muitidisciplinary leadershipteam, and a coordinatorwho is given time for the
responsibility. Dr Naylor also recommendedthe use of the LacrarionManagentettt
Curriculwn; A Faculty Guidefor Schoolsof Medicine, Nursing' and lt'un'ition (1'" ed.-
L999) a:ndLactation Managernerzt Selfstudy Modules,Level 1-

The group assignment,presentedby Dr Naylor, involved having three groups

developrecommendationson an issueassignedto thcm. The issueswere: for Group
1, how to integratein-servicetraining as part of a country fYCF strategy;for Group 2,
horv to changepreservicecuriculum to include basic lactationmanagement;and for
Group 3, innovative ("out of the box") ways to train other than face-to-face.The
group repofiing sessionwas chairedby Dr Yoianda Oliveros.

Group 1: Challengesfaced by a country in implementing a trainng

programmeinclude the cost of the programme,the lack of trainers,the length of the
course(five daysmay be too long). and horv to train difierent groupsusing standards.
To integratethe training programrne,the country t'ould have to increaseits budgetfor
training. It could then train one ttainer for every institution, train one trainer at the
regional level, and l.roldregular annualtraining programmes. Therewould be one
standardcoursefor training the trainers. Different tools (DVDs, CD-ROMs, paid
online courses)could be used for different participants(e.g. doctors,peer
counsellors). Training coursescan also be taught in phases(althoughthis could
increasetrzurspodationand logistical costsfor participants).

Group 2: For a country to changea presen'icecurriculum to include basic

lactation management,its Ministry of Health *'ould have to rvork with the Ministry of
Education.Medical schoolsu'ouid need to championtheseissuesand chairsof
obstetricsand paediatricsrvould need to be involr'ed. Professionalsocietieswould
also needto be involved to pressuretl.reschoolsto changetheir curriculum. (In
SolomonIslands,the messageis taughtin secondaryschools.)

In Malaysia,the NationalPlanof Action for Nutrition has,since1992,

included breastfeedingeducation. The plan is implementedby collaboratingagcncies
through a national coordinatingcommittec under the Nutrition and Food Safety
Council chairedby the Minister of Health. The Ministry of Women's Affairs (a
powerful ministry) also supporlspresen'iceeducation.

Dr Atu ood challenged\!T{O and LINICEF to give all professionalstaff a

back-to-schools'eek. Al1 stalIwould go back to the institution where they camefrom
and rekindle o1drelationshipsrvhlie championingbreastfeedingand other issues.

Filling holes in existing courses,tapping professionalassociations,s1'nergising

messagesfrom WHO and LNICEF to training and educationalinstitutions,and
translatingmessagesfor community practitionerswere also suggested.

Group 3: The constraintsof face-to-facetraining identified by the group were

expense,time away lrom jobs, barriers from environmentalfactorsbeing ignored, and
the uncertaintyof attaining desiredresults. A combination of methodologiesand
modes of following up should be used for breastfeedingtraining. Trainers should go
 -10-

to the community where experiencesarerichest to reinforcethe link with the

community. A supportiveenvironmentand programmedcommunicationusing
standardizedmessagesshouldhelp give the community confidenceto share
experiences.Trainersshouldprovide continuoussupportand lollow up. Trainers
could penetratethe community with messagesusing techlology, e.g.telephone
counselling,e-mail,radio,SMS messages, distanceleaming,teleconferencing.
CD-ROMs.

Other suggestionsand comments.

. Mothers of low-birth-weight babies,rvho spendmuch time in the hospital

and leam a lot, canpasson that leaming and be askedto help othermothers.
o Australia has a Lactation ResourceCentrertn by the Australian
BreastfeedingAssociationu'hich archivesscientific articleson
breastfeedingissues. This knou4cdgeis combinedrvith knowledgefrom the
community for training breastfeedingcounsellors. Thereis also a strong
online training component.
o Norway has a breastfeedingcompetencyoentreu'ith advocacyand media
components.
o WHO hasdevelopedan Integrated\4anagement ofChildhood Illness
(IMCI) tool which can modify IYCF training to becotnea computerized
courseand a distance-leamingnodule.
o Need to increasecommunicationbetweenmothersand clinicians. A study
found that mothersthink clinicians are imporlant in decisionsregarding
breastfeedingbut clinicians don't think it is their role to influence suci.i
decisions;clinicians said that they taiked aboutbreastfeedingrvith nothers
but rnother said that clinicians did not provide enoughinformation.
. Someplacescannolbe reachcd b1 clectronicmeans:usceleclronic
communicationfor sorneareasso that you can use your time and resources
to reachlessaccessible areas.

2.2.1 Comrnunication
and socialmobilization

Ms SusanMackay, Regional ProgrammeCommunicationSpecialistof the

LINICEF EastAsia and Pacific Regional Office, presented"Only Mother's Milk!
Hamessingthe Pos,erof Communicationfor Change." Ms Mackay usedexamples
liom a remote village in the Lao People'sDemocraticRepublic and liom the
Philippines (an excerptfrom the LINICEF documentary"Formula for Disaster") to
shou'the effectsof infant-formula advertisingand emphasizedthe needto be able to
match industry marketing effor1su'ith advertisingfor mothcr's milk. Cambodia's
television spots,for example,u'ere fundedby the United Kingdom's Departmentfor
lntemational Developmentand developedby the BBC World Serv'iceTrust and thc
Ministry of Health, and were basedon much researchand pretestingand produced
s'ith much talent. Other materialsincluded a television soapoperawith breastfeeding
storiesand radio phone-in programmes. Ms Mackay elaboratedon the fo11os'ing
suggestlons:
o develop a framervorkfor monitoring and measuringimpact (needto use a
scient
ific approach to communication):
 - 11-

. engagethe power of the community (usepadicipatory methodologies);

r get creatir.e(bombardrvith ail kinds of media; use Createtoolbox).

Ms -Vackaymadethe follorring comments

h answer10questions. and
e , ' 1 , ' l i t in n a l a r r o o F e t i ^ r l e '

o Make argumentssimple enough;"creatives" will then lift the argumentsto

anotherlevel;
r Be clever about who we use as spokespersons; u'ork on clanty-thsre's a
real resistance of cleverpeopleto soundsimplc;
o The messageis so compelling,we don't haveto do n-ruch to it;
o Be strategic:use the right tool for the right market (e.g.the Philippine
Supreme Coufl "(\ cnt"):
o There is a lot of pro bono ir.rterest.
We should get togetheras a region and
prove to donorsthat u'e can get results and they can get a lot for the money
they invest.

We have to be as good as the new media. We have greatproductsand u'c can sell
them just as u'e1las others do. How can u'e get as good as they finfant fbnnula
marketers]are? Ms SusanMacka

into practice
2.2.5 Translatinglessons(from previoussessions)

Participantswere askedby Dr Ats,ood to fonn three concentriccircles to

discussthree leveis at u'hich a supportiveenvironment for breastfeedingcan be
created.The inner circle (1) v.ascomposedofpersonswith dircctpersonal
experiencervith breastfeedingrvho discussedthe creationof tl.teinterior environtlent
for the breastfeedingmother. \{embers of the rniddle circle (2) discussedthe creation
of the enviroru.nentin societyfor breastfeeding.The outer circle's (3) members
discussedthe creationof the political environmentfor breastfeeding.

Circle 1 (interior enr..ironnent):education,govemmentbenefits,income

support(ob, non-discrimination in law), role model, doctor'ssupport,optionto use a
midwife" hospital and health rvorker support,husband'ssuppofi, mother's suppoft,
smiling people,privacy, peaceand quiet, time, accessto baby, peer suppoft,place to
expressmr1k,accommodatingworkplaces,someoneto explain the pain u'ith a
personaltouch, family supportand absenceof temptation (no fonnula).

Circle 2 (societalenvironment):spacewithin the work environment,

altemative scheduleoptions, patemity leaves,community awarenessto value mothers,
community and peer support,health u'orker suppod, u.orker federationssuppoft,
prenatalcounsellingfor fathersand grandfathers,non-traditionalpartnerssuppod,
bab1,caf6s and other physical "havens",visible supporl in commercialplaces(e.g.
decalsin storessuppofting breastfeeding),and awardsand incentives.

Circle 3 (political environment):matemity protection (guaranteedincome, six

months matemity leave,job security,breastfeedingand child carefacilities in
workplaces),protection from the social concept that formula feedingis the norm and
misinformation about formula, startbreastfeedingeducationin secondaryschools and
legislateto requirebreastfeedingeducation,regulation and accreditationofhospitals,
patemity leave and flexible schedules,formula only by prescriptionand not available
in retail outletsand only through pharmaciesfor motherswho carurotbreastfeed,tax
rebatesfor breastfeeding-friendlys,orkplacesand breastfeedingpolicy.

2.3 Pa:12: Preventinea bottle-feedingculture

2.3.1 Philippinestoryhighlights

Dr YolandaOliveros,DirectorIV of the NationalCenterfor Disease

Preventionand Control (Deparlmentof Health, Philippines),prescnted"Reversingthe
Bottle-FeedingCulture in the Philippines." ln the Philippines,almosttrvo thirds of
deathsin children lessthan age 5 occur in thc first 6 months afterbirth. Ofthese, 9 out
of 10 deathsoccurin infantsnot exclusivelybreastled.Lr spiteoftheserealities,
breastleedinginitiation and exclusivebreastfeedingrates continueto decline,tvhile
the economicburdenof using infant formula remainsheavy (5'165million, plus
relatedcostslor caring for sick and dying children). The Philippine responsehas
taken the form ofan IYCF National Plan of Action and Policy (N4ay2005)to ensure
that rvherevermothersare, they receivebreastfeedingsupporl. l-ocal and
intemationalpartnershave been tappedto help the govemmentimplementthe plan.
u'hich receiveda boost from the AcceleratedHunger Mitigation Programof the
govemment(June2007 to December2008). The latter provides for IYCF training to
cover 75%oof all barangays(villages). Tnpartnershipwith employer andretailer
groups,the govemmenthas also set up somemothet-and-baby-fi:iendly rvorkplaces
andmalls.

An attemptby the Departmentof Health to strengthenthe National Code of

Marketing by revising its implementingmles and regulationshasresultedin a battle
with the milk companiesin the SupremeCourt and on the streetsof Manila. Milk
companiesspentnearly$ 100million in 2006 for marketingand adverlising
breast-milk substitutesin the Philippines (but only $.16million in the United States).
The industry useshealth facilities for promoting their productsand blatantly violates
the Milk Code. The battle ragesalong many fronts: for example,the American
Chamberof Commerce,endorsedby the United Statesembassyin the Philippines,
wrote to PresidentGloria Macapagal-Arroyoon behalf of the milk companies.
Relatedto this issueis the effoft of the govemmentto revive the Mother-Baby-
Friendly Hospital lnitiative (\{BFHI). \VtLile82% of govemment and private
hospitalsareaccredited,compliancervith Steps1 to 10 is uneven. To overcornethese
barriers,the govemmenthas revisedthe MBFHI policies (June2007) and u'ill hold
national and local seminarsand training. This year, MBFHI compliancehas also been
made a requirementfor a hospital to be accreditedby the Philippine Health Insurance
programme.

2.3.2 Codeof Marketingof Breast-MilkSubstitutes

Mr David Clark, Nutrition Specialist(legal) for IINICEF, and

Ms Yeong Joo Kean, Legal Advisor for IBFAN/ICDC Penang,reportedon and raised
issuesregardingthe Intemational Code of Marketing of Breast-Mi1kSubstitutesin the
Asia-Pacific region. They showedthat with 36.6% market share,the Asia-Pacific
region is a huge market for the baby-food industry and, as a result, marketingin the
region is far s'orsethan in any other region in the world. They presentederamplesof
Code violations in all forms. They also presentedthe statusofCode in countriesof
the region-as a iaw, as voluntary codes,as a draft, amongothers-and the problems
of implementationin eachgroup. Growing concemsregardingthe Code are
inappropriatefunding (such as sponsorshipby milk companiesofhealth
professionals'events)and the intrinsic contaminationof infant formula (public is not
sufficiently informed and milk companiesdo not comply with the requirementto
inform them ofrisks).

Companiesrvill do rvhateverthey can get awalr with. The region's larvsarenot

sufficientlystrong. -Mr DavidClark

For the group activity, six groupsrverefotmed and tu'o groupseashwere

assignedto one of threescenarios.

Scenario 1 entailedmilk companiesdefendingthcir materialsfor health

workers to inform them about new infant formulas, and Food and Drug
Administration (FDA) representativesreviewing the materialsto seeif they cornply
with the Code. Group 2 representedthe milk companies,Group 1 representedFDA.

Group 2 pointed out that the materialssay that they are for medical
prolessionalsonly, use scier.rtificdata rvith recent references,and include a statement
thalbreaslmilk is bestlor babies.

Group 1 pointed out s,ords,images,data and claims on the materialsthat $'ere

not factual. promotional, or not backedb1,evidence.They found referencesto be old,
irelevant, or hard to read, and an attribution to be incorect. Fufther, the statementin
supporl ofbreastfeedingis smallerin tlpe than statementspromoting the product (not
a balancedpresentation).One of the materialshad no notice on whom it u'as for.

Mr Clark pointed out that this exerciseshows that the Code is r.rotcompletely
clear. The Nan (Nestle) material is more compliant with the Code but not all claims
are substantiated.The other piece \vas more clearly unscientific and not facfuai and
clearlypromotional.

Scenario 2 had representatives(Group 3) ftom an infant food company

claiming that the las, on the Code hampersprogrammesto prevent the transmissionof
HIV to children, violates a mother's right to information on infant feedlng,and is an
obstacleto providing free infant formula to HIV positive women who needit. Group
4 representedthe Ministry of Health and defendedthe law againstthesespecific
accusations.

Infant Formula Companv (Group 3) Ministrv of Eealth (Group 4)

HfV virus can be tuaDsmittedtlrough breast The interestofindusty is to protect lts
rnilk- mothersneed safe altematives.This law shareholders'irterests, not those of mothers.
preventsthis.
Article 5.1 bars advertising-this conflicts
prhciple of fiee speech.
This law (Code) is 26 years old. Massrve The object ofthe Code remainsvalid: to promote,
developmentsi! terms oftechnoloey and support ard Drotectbreastfeediag.Evidence
 14-

scientific evidenceshowsour oew formulas are as shows that infant formula may not be safeand
closeas possibleto breastmilk. There are not the breastmilk is still tbe best.World Health
samerisks any more from formula feedilg u,e AssemblyResolution59.21 (2006) statesthe risk
needclose co acl s'ith healt! professionalsto ofinfant formula and condcmnspondered millt.
keep them up to date-ow productscomply with
thc quality standardssetbv Codex.
The larvi. prelenringu( from proliding free
suppliesto the hospirals,when tbe Code allo$-sit
underarlicle6.6.
\VIIA calls for informed decisionmaking by HIV Govenunentis custodianofthe Code and it is the
positive mothers.and the lar.prer.ents us from responsibilityof gol'ernmentto give mothers
:hdringtbe I]ece5sary tnforuratiotr. il lormat ion.
Anicle 24 2(c) ofCRC obliges go\.emmentto \!-IlA Resolution59.21 (2006) statesthe risk of
combat diseaseand malnutrition tbrough readily infant lormula and condemnspowderedmilk.
availabletechnologyand tlrrough the provision of
adeouatenutdtious foods.
There is no needto repealthe law.

Mr Clark remindedthe participantsthat the WHA is clear: donationsand lorv-

cost productsto healthworkers are not allo\\'ed. He pointed out that the Codeis n-rore
relevantin the context of HfV becauseit makes surethat infar.itformula is prepared
properly and is given on medical advice;it also protectsinfants of HIV positive
u,omen. With regardto ambiguitiesin the Code,N{r Clark recommendedthat
goven'mentsshould adopt good legislationto addressthem.

\\re have to be prcparedto defendthe Code s'ith evidence,references,etc.We har-eto

knorv more than e\,'ervoneelse.\\re haveto know our sfulTcold.
-Dr Atrvood

Under Scenario 3, Group 6 representeda formula companyoffering to

sponsora paediatricsconferenceand donatesomeof its profitsto the association ifit
endorsesthe company's formula. Group 5 represcntedthe exeoutile board ofthe
National PaediatricAssociationu'hich must decideto acceptthe offer or not in light
of the lntemational Code.

Group6 citedseveralarticies(e.g.7.5, 7 .2, 7.3) to shorvu'hy sponsorship of a

conference rl,ouldnot violatethe Code.They also citedArticles7.1, 8.2 and.1.3to
supporttheir interpretationof the Code as allowing them to fund and be a parlnerof
the breastfeedingcampaign. Finally, they cited Articles 9, 10 and 7.3, to justifl' the
correctness of the association'sendorsement of their product.

Group 5 declined Group 6's offer on the basisthat acceptingsponsorshipfrom

a milk companywould undemrinethe association'sresponsibilityto adhereto the
Milk Code and promote breastfeeding.In their vicw, rejecting the offer avoids
enteringa possibleconflict-of-interestsituation,as acceptingfinancial supportand
other incentiveswould createconflicts of interest.

Mr Clark agreedthat for a professionalhealth associationto endorsea product

is a violation of the Code and govemmentsshould be on the lookout for conflicts of
interest. The sponsorshipof conferencesis not clear in the Code and countriesagain
need to clarifu theseissuesin their laws. Dr Cavalli-Sforzasuggestedannotatingthe
Code to updateit. Mr Clark also infomed the participantsthat IINICEF is organizing
a regional Code u'orkshopto start settingup a regional network.

Cb allenges
Very linle 1orno1<lstematicmonitorirgand
eniorcement;violations are rampantin the region
but no compa:lieshar,ebeenbrougbt before tle
law; Code suspendedin Thailand sirce 1997.
Health care systemused by companiesto promote
their productsl sponsorship.
SuggestedStrategies
Stepup efficiency and collimitment; rmplove
skills (trairing and techdcal supportin lar'
makilg, nonitoring); *ork on regional
cooperation:cohesivepoiicies; exchangeof ideas,
experience,jrrfon-rrationon Code measuresand
on IYCF.
Steera$ay &om dependenceon ildustry.
Find neg'advocacy platforms: HR approach,
economic arguments.risk ofartificial feedhg

For an effective monitoring of the Code, Dr Smith presentedthe following

proposeddivisionof responsibilities:

OFWHOCODE
IVIONITORING

groups/NGOs
Consumers/lVlothers
Roes:Informing
consumers
conrpLainis
Collecilng
Adv0cacy

Statistic;l
Agency
ofcomplaints
Roes:Recording/registration
Collating data
andanalYse

Health Ministry
authorityi of Heatth
Roles:Acqulring/channe foreducauon
I ngresources of public
andhealthprofessionals
onWHOCode
andenforcement
ofcomplaints
nvesiigation of compliance
Reportingandadvice agencies
togovefnment/internalional
Initationofdraft!pdated
instruments
to ensureongoing implementaiion
effective

Legisiators
Roles:Revewreports
Enact
andupdate ateinstruments
appropr effective
to ensure ofWH0Code
implementation

International
a'gencies/NGOs
global
Roles:Revjew andregionaltrends andcompliance
lnenforcement
Update WHOCode
ComrLlcateto 'esporsib
e aJ!-oriies

Selectedcommentsfrom the discussion:

Dr Rea: The industry knows how to use the Code well. The industry people are
the most preparedand have the best arguments.
Dr Smith: Never underestimatethe power of public shaming.
Ms Yeong: Govemmentsmust take responsibility. You cannotabdicate.
Dr Rea: We have more allies than we think. They may just not know about the
Code.
Dr Smith: Consumersneed to be mobilized.
Mr iellamo: We need to engageother groups,not necessarilyin health.
Ms Codling: We should commit to training.
 -16-

Dr Hossain: If 1'ouseesomething,say something(from the US Deparlmentof

HomelandSecurity).

Should codeviolationsbe postedon a United Nations web site?

-\fter the Clark/Yeongpresentation,a discussionensuedregardingthe posting

of Code violations on the WHO u'eb site. This is horv, in summary,it unfolded:

Ms Don: Malal'sia inlorns WHO,TNICEF of violations hoping they can

help, but it hasn't happenedyet.
WHO and LTNICEFshould considerrespondingto requests
Dr Cavalli-Sforza:
receivedlrom countriesto publicize Code violations,by putting
thesecomplaintsin the public domain, tLn'oughtheir rvebsites.
Dr Saadeh: That is not the role of WHO but of govemments.
Dr Atu'ood: Whv doesn'tLNICEF nublishviolations?
Dr Smith: From a community organizationstandpoint,q'e endorsethe
recommendation to put violationson a UnitedNationsrvebsite.
Ms Don: \\rl{O and UI'ICEF should settlethe issueof rvhat to do ivith
rts of violations.

2.3.3 Technicalupdates

Ms Ali Nlaclainesho.,r'edhow breastfeedingin emergenciesneedsto be

protected,promoted and supponed(mandatedby Arlicle 25 of'the Conventionof the
Rightsofthe Child ands'ithin the scopeof the Global Strategyon IYCF) because
infants and young children aremost r,ulnerablein emergenciesand exposedto the
higli risks associatedwith artificial feeding. Child morbidity and crudemortality can
increaseby 20% in as 1ittle as nl'o u'eeksin emergencies.In one emergency,it was
found tl.ratinlants rvho are not breastfedq'ere 50 times morc likely to be admittedto
hospital rvith dianhoeaand 8.5 times nore likely 1odie. Furlhennore,fonnula,
bottles and teatsare often brought rnto elrergency areas. Often, this fonnula is in the
wrong language,near its "use b1" date, or are specializedor medicalizedfomrulas
that arefreely distributedto all mothersrvith no guidance. A study ofbreastfeeding
practicesafter an earthquakein Indoncsiarevealedthat one month after the
eafihquakemany more infants (almost 15% n-rore),u'ho rverebeing breastfedbefore
the earthquake,rverebeing fcd formula by motherswho had receiveddonations
during the emergency.Data also shorveda dramaticincreasein the prevalenceof
dianhoeain infants and children under age 2 after the earthquake-with the dianhoea
rate double for thosewho receivedformula. than for those who did not.

Training and referencematerialson IYCF in emergencies(IFE) are available

online (wv'w.emonline.net), il print, or on CD. The OperationalGuidancebooklet
has alsojust beenupdated(Version2.1, February2007). The bookletis a
nontechnicaldocumentwith a basic set of "dos" and "don'ts," zmdwould be useful
for all levels of staffof national govemments,United Nations agencies,NGOs and
donors. A regional IFE meeting will be held in lndonesia,6 8 November 2007, to
determinepractical stepsand a strategyto supportIFE. Stepsto take include:
 -17-

translateand distributekey IFE material-especially the Operational

Guidancebooklet;
investigateyour country's IYCF policies, guidelinesand materialsfor IFE;
a i,lentifir l-ev nlerrerc'

a providecountryand regionalorientationand training:

a ensurekey players attendthe regional IFE rneetingin lndonesia.

Donationsof breast-milk substitutesor bottles and teatsshouldnot be acceptedin

emergencies at all.
Operational Guidanceon Infant and YoungChild Feedittg in Entergencies,Y2.1
(February
i007)

Dr S\4 Moazzem Hossain,Infant FeedingAdvisor to LNICEF, presentedan

updateon HIV and infant feeding. The United Nations recommendationslor
breastfeedingfor HfV negativervomen or HIV statusunknown, is exclusive
breastfeedingfor six nonths and continuedbreastfeedingfor t$'o .vearsor beyond.
The most appropriateinfant feeding option for HIV exposedinfants (rvith IIIV
positive mothers)dependson individual circumstances,including considerationof
counselling and support. United Nations guidelinesstatethat "when
health ser-vices,
replacementfeedingis acceptable,feasible,affordable,sustainableand safe (AIASS)'
avoidanceof all breastfeedingby HIV infected mothersis recomluended.Otherwise,
exclusivebreastleedingis recommendedduring the first months oflife, and
breastfeedingshould be discontinuedas soon as conditions are in place, taking into
account1ocalcircurnstances,the individual woman's situation,and risks of
replacementfeeding."

To help HIV positivemothersmakethe bestchoice,they shouldreceive

counsellingthat includes infonlation aboutthe risks and benefits ofvanous infant
feeding options, and guidancein selectingthe most suitableoption for their situations.
A study shou'edthat early (0-3 nonths) mixed breastfeedingis a risk factor for
postnataltransmissionand that early breastfeedingcessationcould prevent a sizeable
proporlion of postnatalHfV transmission(68% of all postnatalHIV infections
occuned after age 6 months). Another study showedthat early mortality (through age
7 months) is higher in fbrmula-fed than breastfedHIV positive inf'antson AZT; the
predominantcausesofinlant deathare diarrhoealdiseaseand pneumonia.The samc
study showed,ho*'ever, that HIV inlectron at 7 and 18 months is higher in breastfed
than formula-fed infants, despite6 months of AZT, and at 18 months there is no
differencein mortality and HIV infection betweenfonltula and breastfedinfants.

Govemmentsand other stakeholdersshould revitalize breastfeedingprotection,

promotion and support in the generalpopulation. They should also actively support
HIV infected motherswho chooseto exclusively breastfeed,and take measuresto
make replacementfeeding saferfor HIV infected women who choosethat option.
-United Nations recommendation2006

Dr RosaConstanzaVallenas,Medical Officer for Child and Adolescent

Health and Developmentof WHO, discussedthe long-term effects of breastfeeding.
fugorous study has shown that breastfeedingis good for everyoneand gives credence
 _ 16 _

to the early origins hlpothesis that factorsaffecting the loetus and the 1'ounghave
longJasting effectsand areimportant causesofchronic diseasessuch ashlpertension,
diabetesand ischemicheart disease.Having beenbreastfed,modestlyreducesblood
pressure,someu'hatreducestotal serumcholesterol,and reducesby 22% the risk of
being overu'ei-ehtor obese.Breastfeedingsignificantly reduces(by 37%) the risk of
deveiopingtlpe 2 diabetes,raisingcognitivedevelopmentscoresby 4.9 points,andis
positively associatedwith educationalattaimnent.

Dr Vallenasalso reportedon the feeding of lorv-birth-weight(LBW) hfants

LBW being the direct causeof 27o/oof the l million neonataldeathsthat occur each
year. LBW infants should be breastfedor fed expressedmother's mi1k, donor human
milk, or pre-tern infant fomrula (not standardfonnula). They shouldbe fed with a
1-lln rcthPr tllan q h^frl,.

Resourceson theseissuescanbe found on http:/,'wr.q..rvho.intic1.ri1d-adolescent-

health/ iications,/nu1.r itron.iitm

Dr RandaSaadeh,Scientistfor Nutrition for HealtirandDevelopmentof

WHO, prcsented"Breastfeeding BeyondSix Months." Shereporledthat for
complementaryfeeding, a revierv of cxistir.rgmaterial was done and a good set of
indicatorsfor complementaryfeedingis being developed(now, only one general
indicator erists). Dr Saadchprescntcddataon the curent situationin the region (by
country) in terms of the median duration of breastfeeding,continuedbreastfeedingat
12-15monthsand20-23 months.complernentary feeding,andtimely initiationof
complementary feeding.Shealsolepodedon updateson recommended practices:
. exclusivebreastfeedingfor 6 months, rvith ongoing breastfeedingup to 2
yearsor beyond;
. appropriatecomplementaryfeeding of tl.rebreastfedchild (guiding
principles);
. appropriatefeeding of the non-breastfedchild age 6-2,{ months.

Dr Saadehpresenteddata sho*,ing that after exclusivebreastfeedingand

insecticide-treatedmaterials,continuedbreastfeedingrvith complernentaryfeeding is
the most effective way of reducingunder-5mortality. CompLetrentaryfeeding
rcducesthe expectedpercentage ofunder-5morlality by 6%. Shealsoprovided
information on the energyrequirementsof children from all intake (including breast
milk) and liom complementaryfoods, the averagerecommendedmeal flrcquency,the
feedingofchildren during and after ilLness,and other guiding principles for feeding
breastfedand non-breastfedchildren.

2.3.4 Generaldiscussionon technical issuesrelatedto breastfeeding

Dr Naylor moderatedthis discussionwhich included questionson:

o positive effects ofbreastfeedingon rvomenin emergencysituations;
r feasibilityof implementingAFASS for childrenof HIV positivemothersin
the Asia-Pacific region (it's different for eachmother);
e definition of"exclusive breastfeeding"(doesit include "predominant
breastfeeding?);
 -19-

effect of anaesthesia from caesareansectionon oxytocin or prolactin;

frequencyof mixed feeding for this region;
definition of timely complementaryfeeding;
effect of continuousbreastfeedingduring pregnancyon the amountof
colostrumfor the newbom infant;
reduction of the incidenceofchild abuseinvolving breastfedchildren (a study
in Australia showedthat abuseby mothersis more likely to be doneby those
who are away &om their babiesfor 20 hours a day and did not breastfleed).

2.3.5 Recommendations
and sussestedactions

Dr Atwood sumrlarized the recommendationsand suggestedactionsthat arose

{iom all the discussionsand presentedtheseto the plenary for review andrevision.
The hnal version ofthis document,incorporatingal1changesagreedon by all
is Annex 4 ofthis report(seealso section3:
participantsof the consultation,
Conclusions). The recomrnendationsand suggestedactionsrvcre organizedunderthe
follorvingheadings:
o Brea.tfeeding Economics
. Useof Data.Communication- andAdr ocacy
. BFHI
. Creatingan Enabling Environment
o IncreasingHealth Worker Ski11s
o Code of Marketing

2.3.6 Closingceremony

Dr Richard A. Nesbit, as Acting RegionalDirector of the WHO Regional

Office for the Westem Pacific, re-emphasizedthe importanceof this consultation,
consideringthat breastfeedingis under threatin the Asia Pacific region with
breastf'eedingratesdeclining and industry continuingto introduce substitutes.He
pointed out that many partnersand stakeholdershave come together at this
consultationand have producedtangible outcomesin the fomr of recommendations.
All participantsshould feel a part of the netrvorkofpeople and organizationsfor
breastfeedrngin the region and globally. Each is expectedto implement the actions
and recommendationsagreedupon at this meeting in his or her country. Each is a
driver of the effofts that touch all parls ofsociety and everyoneneedsto u'ork
together. Dr Nesbit affirmed continuedsupporl frorn WHO and LTNICEFand that
theseorganizationss.ill continueto collaborateon theseeffor1s.He thankedal1the
contributors,resourcepersonsand oticers ofthe consultation.

Ms Don thankeda1lparticipantsfor the very enriching consultationwhich

gave everyonethe opporfunity to shareexperiencesfrom their countries.Sheurged all
to bring the conclusionsand recommendationsto their countriesas a guide and
expressedthe wish to seesomeparticipantsin Penangfor the IBFAN meeting.
 -20 -

3. CONCLUSIONS

In relation to breastfeedingeconomics,it was recommendedthat pafticipants

take stepsto increasethe visibility ofthe economicvalue ofbreastfeedingand the
health costsattributedto artificially fed infants. They u'ere alsourgcd to use available
datato show u'omen's time investmentin breastfeedingand horv competitionfiom
bab.v-foodproducersand employersreducesthe practiceof breastfeeding.Actions to
take included advocatingthe inclusion ofbreast milk in nationalproductionstatistics;
working rvith nutrition economiststo develop argumentsfor emplol'mentequity rvith
paid matemity leave; and implerientation of BFHI by shou'ingsavingsto the health
systemfiom breastfeeding.Intemationaland researchorganizationsareto gatherdata
to link industry marketingwith declining breastfeedingrates. PROFILES\\'as cited
as a useful tool for calculatingthe benefitsofbreastfeeding.

In using data.communicationand advocacy,recommendationsmade to:

IYCF "l'ere
practices;
use WHO indicatorsand definitions rvhen using evidence to support
locus on priorities (seeAnnex 3); promotebreastfeedingir.rpopular culture by citing
benefitsof breastfeeding,as u'el1as risks from not breastfeeding;usedatato establish
natior.ralgoals; and to establisha strongerlink to the Rcgional Child Sun'ival
Strategy.Suggested actionsinciuded:WHO/INICEF to help countriesdo IYCF
sunreys;participantsto commit to a timetable for addressingpriority problems
(Alnex 3); and LNICEFAITIO to help countriesfind funding for breastfeeding
communication plans.

To strengthenthe BFHI, recommendationsincluded: improving monitoring of

hospitals;making BFHI part ofthe country hcalth-systemstructure;and extending
BFHI to the community. Actions to take included: WHOiLNICEF to disseminatethe
new BFHI package;LfNICEF Country Offices to map technologicalreach fbr
altematenonitoring tools; participantsto advocatewith ministries of healthfor BFHI
certification as standardfor all hospitals;participantsto revicw the Cambodia
experienceand visit Cambodiato understandBFCI; WHO/UNICEF and govenmcnts
to committo BFHI ccdificationof ail hospitalsby 2015;parlicipantsto rvorkrvith
NGOs and profcssionalsocietiesfor BFHI extemal relieu's; and participantsto
supportgovemmentsto developa s'eb site to sho\\'statusof BFHI every year.

For creatingan enablingenr,ironment,recommendationsu'ere: guaranteequiet

spacesfor breastfeedingwomen; improve accessof working nothers to their babies
during n.orking hours, increaseaccessofbreastfeedingmothersto supportivepcrsons
and groups;guaranteeaccessto accurateknowledge on breastfeeding:ensure
adequatematemity and patemity leave, a guaranteedincome, andjob securtty;make
changesin society and educationalsystemsto crcatea breastfeeding-positive culture;
implement national regulationsto control marketing of breast-milk substitutes;and
advocatefor breastfeedingfrom a u'otnen's and child's rights pcrspective. Actions to
achievetheserecommendationsinclude: reviewing the statusofpresent legislation for
matemity protection and meetingwith influential goverunent olficials aboutthis (and
also lor advocacy);exploring possiblelinks with appropriatcworkers' and employers'
associationsfor changesin the workplace for breastfeeding;adl ocating with
ministries ofeducation for inclusion ofbreastfeeding educationin primary and
secondaryeducation,basedon a draft curriculum outline; and interviewing mothers of
 -21 -

LBW babieswhile they are in the hospitalsto find out ifthey can become
breastfeeding
advocates.

To increasehealth worker skills, recommendationsincluded: strengtheningthe

complementarityofpreservice and in-servicctraining for various aspectsofthe
Global Strategy;adaptingpresen'icetraining to diflerent educationalcultures;using a
combinationof online and face-to-facetraining; linking rvith professionalsocieties;
and promoting integated coursesendorsedby WHO'tNICEF. Participantsu'ere
askedto take actionsthat included: reporling the resultsof this meetingto senior
representativesof govemment; and exploring knowledgetransferto online
communitiesby various media. \\TIO and LTNICEFwere taskedu'ith joining IMCI
and IYCF training curriculum: finding rvaysto more clearly lint breastfeedingand the
Regional Child Sunival Strategythroughthe Regional Comrnitteemceting; investing
in the developmcntof interactiveCD training programmes;and n orking u ith
govemmentsto deveiop a clear and detailedtraining plan for all relevantl.realth
u'orkers,and to seekbudget for this.

In relationto the Code ofN4arketing,the recomnendationsrvere:to build

capacityin Codeinplementation; improve monitoring of Code colrrplianceand
violation;increase understanding by healthoi"licialsand u'orkersofconflicts of
interest,improve knou'ledge ofrelevant groupson the Code; producean annotated
version of the Code; increasetrade and labour organizationinvolr,ement. To achieve
thesegoals:organizations areto suppoftpanicipatior.r(includingof senior
management) in the I-TNICEF-funded tlainingin NoYemberat IBFAN-ICDC Penang,
Malaysia,on the Code;WHO/TJNICEFto lacilitateregionalcooperationand
IBFAN-ICDC to draft an annotatedand updatedguide for use of the
r.retw'orking;
Code; \\TIO,UNICEF to strongl-vpromote instirution of fu1l larvs supportrngtl.reCode
in selectedcountries;UNICEF to shareorientationmoduleson the Code; parlicipants
to acceptpersonalresponsibilit-vlor tl.ioroughself-kr.rouledgeofthe Code and related
issues;WHOTTNICEFto supporlsovemmentsin establishing codcsof conductfor
healthprofessionals on issuesrelatedto the Code;WHO/LINICEF/IBFANto develop
a way to pubficizereponson the Codefor public use;and all to rcvicw the statusof
nationalmonitoringsl.stemsof Codecomplianceandviolations.

SeeAmer 4 lor the completeRecommendationsand SuggestedActions

document.

4. ACKNOWLEDGEMENTS

The contributionof the follo$'ingagencies

to fundingthis consultation
is
gratefuliyacknowledged: JapanMinistryof Health,Programme for Technology
Transfer,andAusAID.
 ANNEX 1

@
WORLD HEAI-TII ORGANIZATION
REGIONAL OFFICE FOR TI{E WESTERNPACIFIC
unicef@l
UNITED NATIONS CHILDREN'S FLIND
REGIO\AL OFFICEFOR EAST ASIA AND PACIFIC

\IfIO/UNICEF CONSLLTATION ON
\\?R/IC P,l'{UT/2.2/001,^IIJT(2.
2007.1
BREASTFEEDNGPROTECTION, 19June2007
PRONIOTIONA}iD SUPPORT ENGLISHONLY

Manila,Philippines
20-22 June2007

PROGRAMME OF ACTI\'ITIES

Wednesday'20 June 2007

08:00- 08:30 Registration

08:30 - 09:00 Opening

09:00 09:30 CoffeeBreak

09:30 10:30 Breastfeeding:essentialfor child sun'ivaland development

10:30- 12:00 Countrysituationanalysis

12:00- 13:30 Lunch andpressconference

Part I ; Creatingan enablingenvironntent

for breastJbeding

13:30- 14:00 Casestudyin Cambodia

Presentation:

1.1:00 15:30 HospitalInitiative(BFHI)

Baby-Friendly

15:30- 16:00 CoffeeBreak

16:00- 17:00 Strengths ofBFHI (Paneldiscussion)

andweaknesses

17:00- 17:30 Thetutureof BFHI

71'.30 lnformalReception
 Thursday,2l June2007

08:30 10:30 healthu'orkerskrllsandimproi'ingperformance

Increasing for
breastfeeding

10:30 11:00 CoffeeBreak

11:00- 12:00 Communication

andsocialmobilization

12:00 13:00 Lunch

l3:00 1zt:30 Translating (fromprer,ious

lessons intopractice
sessions)

Pdrt 2: Preyenting a bottle feeding cLtlhtre

14:30- 15:00 Philippilestoryhighlights

15:00- 15:30 CoffeeBreak

15:30- 17:00 Codeofrnarketing

ofbreastmilk
substitutes

Friday, 22 June 2007

08:00 10:00 (Groupu'ork)

scenarios
Discussionof the Codeimplen.rentation

10:00 10:]5 CoffecBreak

10:15- 11:00 Reportfrom the six groupsand shortdiscussions

l1:00 12:00 Discussionof practicalstepsto improveCodeimpler.nentation

and enlorcement

12:00 13:00 Lunch

13:00- 14:00 Techr-rical

updates

14:00 15:00 Generaldiscussionon techdcal issuesrelatedto breastfeeding

I 5:00 15:30 CoffeeBrcak

15:30- 16:15 Futureplans

16:15- 17:00 Generalconclusionsandrecommendations

17:00- 17:30 Workshopevaluation

1 7 : 3 0- 1 8 : 0 0 Closine
 AN-I{EX 2

ADVISERS,RESOURCE
LIST OFTEMPOR-ARY PE.RSONS,
AGENCIES,
OBSERVERS/REPRTSENTATIVE
AND MEMBERSOF THE SECRETARLAT

1. TEMPORA,RY A.DVISERS

Dr ChanphengBanchith
Deputy Chief, ObstetricDepartment
Mahosot Hospital
N4inistryof Health
Ban Dong PalaneThong
Vientiane, Lao Peopie'sDemocratic Republic
Tel. No.: +856 20 560086
Fax No.: +856 21 21.2828
Email: abanjit@hotmail.com

Dr Juanita Basilio
\4edrcal Officer VII, Division Chief
Child Health and Development
Departmentof Health (DOII)
Sanl.azaroCompound,Sta.Cruz,
\{anila, Philippines
T e l .\ o . :
Far No.: +63-2-7117t46
Email: nitzbasilio,hotrlail.com;mchslgldoh.gov.ph

ProfessorColin Binns
Prolessor,SchoolofPublic Health
C u r t i nL n i r ; r s i t y o f I e c \ n o l o g 1 '
G P OB o r U 1 9 8 7
Penh,WA 6845
Australia
Tel. No.: +61 8 9266 2952
F a xN o . : + 6 1 8 9 2 6 62 9 5 8
Email: C.Binis@curtin.edu.au

N{s Vicenta Borja

S u p e ni s i n gH c a l t hP r o g r a mO f f i c e r
National Center fbr Disease
Preventionand Control
Deparlment of Health (DOFI)
San Lazaro Compound, Sta.Cruz,
Manila, Phrlippines
Tel. No.: +63-2-7329956
F a xN o . : + 6 3 - 2 - 7 1 1 6 1 3 0
Email: bessiebo{a@hotmail.com
Dr llary Chea
IYCF ProgramCoordinator
National Matemal and C1lld Health Center
French Street,SrasChak. Daun Penh
PhnomPenh,Cambodia
Tel. No-: (855) 12 892-266
F a xN o . : ( E 5 5 )2 3 4 2 8 - 3 8 8
Email: marychea1967@yahoo.com

Dr Chua l{ei Chien

Consuitant,Paediatrician
Depaftnlent of Neonatology
KK Women'sand Children'sHospital
100 Bukit Timah Road
Singapqe-Zg!99
T e l .N o . : + 6 5 - 6 3 9 . 1 1 2 2 8
Far No.: +65-62919079
Email: chua.mei.chien@kkh.cora.sg

f)r Dai Yaohua

ProfessorandChaiman
Depaftmentof Child Health
Capital lnstitute of Paediatrics
2 Ya Bao Road
Bciihg 100020,
People'sRepublicol Chira
T e l .N o . : + E 6 - 1 0 - 3 5 6631 6 9
F a r N o . : + 8 6 - 1 0 - E 5 6220 2 5
Enarl: th.dai@)263.net

Dr Elel'r'n del Castillo

\{edical SpccialistIV
Chief Trainirg Oiilcer for Medical and
Drtrnredinel freir ir o Prno-rrnr

Dr JoseFabellaNlemorialHospital
Sta.Cnrz,\4anila
Philippines
Tei. \o.: +63-2-734556
i
F a xN o . :
Email:
Dr Ding Bing
OperationDirector, Joy Media Project
Information Office Deparlmentof GeneralAdministration
\{inistry of Health
No. I Xizhimenwai Nanlu
XichengDistrict, i 00044Beijins
People'sRepublic of China
T e l .N o . : 0 1 0 - 58 6 9 1 9 5 7
F a r N o . : 0 1 0 - 58 6 9 3 2 3 7
Email: bjdingbing@gmail.com

lIs Rokiah Don

Prilcipal AssistantDrector
F a r n i ) yH e a l r hD e r e l o p m e nD
t ir ision
N4inistryof Health,
62590,Putrarava
Malaysia
Tel. No.: +60-3-8888.1083
Fax No.: +60-3-88884647
Email: rokiah@moh.gov.my

Dr Tarua Dale Frank

S p e ci al i s LV e d i c a lO f f i c e rP a ; d i a t r i c i o n
GorokaGeneralHospital
P . O .B o x 3 9 2
Goroka EasternIlighlands Province
Goroka,PapuaNcrv Guinea
Tel. No.: +615-1322117
Far No.: +675-7321081
Email:

Dr RegzmaaGongor
Focal Point and Researcherfor Breastfeedmg
Public Health Institule
Nutrition RescarchCenter
PeaceStreet,17, Bayarzurkh District
Ulaanbaatar14-04-61, Mongolia
Tel- No.: +976-998-49'7 48
Fax No.:
Email: mingee_a@yahoo.com
Ms lfaria Imaculada Guterres
National Coordinator.National BreasdeedingAssociation
Alola Foundation
PO Box 3,
!j]!, Timor-Leste
'728
Tel. No.: +670 3591
Far No.:
Email: nbfa@alolaloundation.org

Dr Yupayong Hangchaovanich
Deputy Chair
Thai BreastfeedingCentre
Bangkok, Thailand
T e l .N o . : = 6 6 - 2 - 6 5 9 5 8 1 0
F a xN o . : - 6 6 - 2 - 8 9 1 8 - 1 2 3
Email: lupayong_h@l.vahoo. com

\{s Rosemarl' Kafa

\ l a r v m aal n d( h r l dH e a l r '\ru t r i t i o t : t r L
Ministry of Healthand\{edical Senices
P.O.Box 3.19
Honiara, SolomonIslands
T e i .N o . : + 6 7 7 - 2 8 1 6 9
Fax No.: +677-2.1260
Email:

lIs Azizan Nisha Khan

Chief Dietician and t.'utritionist
l{inistry of Health
88 Amy Street,Toorak
Bor 2223
Govt Building
S u ra . F i ji
Tel. No.: +619-3346117
Far No.: +679-3306163
En.iaii: nlhan@hca1th.gov.1j

]Ir Pak Kresnarvan

Head,Sub-Directorate of Food Consumption
D i r e c t o r a toef C o m m u ni t ) N u t r i t i c , n
Directorale Generalof Community Heafth
\{inistry of I Iealth
Jaka4q,Indonesia
T e l .N o . : + 6 2 - 2 1 - 5 2 7 7 1 5 2
F a xN o . : + 6 2 - 2 1 - 5 2 1 0 1 7 6
Email: kresnawan@gizi.nel
tr{s Lina Lauru
GeneralNurse
ShefaProvincial Healrh Office
Private Mail Bag 9009
Port \rila, Vanuatu
T e l -N o . : + 6 7 8 - 2 5 3 5 6
Far No.:
Email:

NIs LuscyaneRai Ligabalaru

SeniorLegal Ofhcer
N4inistryof Health
88 Amy Street,Toorak
Bor 2223
Gort Building
Suva,Fiji
Tel. No.: +6'79-3306177
F a xN o . : + 6 7 9 - 3 3 0 6 1 6 3
Email: lligabalavu@gor,net.gov.l

lIr Rathanak Lim

Deputy Dfuector
Depafiment of Drugs and Food
,lzlBFStreet221, Depo Il I oulkok
Phnom Penh
Cambodia
. o . : ( 8 5 5 )1 1 4 6 3 3 3 3
T e 1N
Far No.:
Email:

\Is Georginal{arau
Scientific Olfi cer Q.{utrition)
Dir.ision of Health
P . O .B o x 4 2
Lorengau,ManusProvince
PapuaNeu' Guinea
Tel. No.: +675-47091841 4709781
Fax No.: +675-470903 8
Email:
IIr Sopon llekthon
Deputy Director General
Departmcntof Health
N{inistry of Public Health
Tiwanont Road, Muang Nontaburi District
Banekok, Thailand
Tel. No.: +66-2-590.1006
Fax No.: +66-2-590.1005
Emarl: mekrhon@hotmail.com

Dr Darid N{okela
Chief Paediatrician
Port X{oresbyGeneralHospital
Free\{ai1 Bag
Boroko. NCD
PapuaNew Guinea
Te]. No.: +675-3248200
Far No.: +675-32503.12
Iimail: liealthsec@health.gov.pg

Dr Nguyen Mai Huong

Technical Officer
ReproductiveHealth Depallment
Ministry of Health
l3 8A Giang Vo Street
IIa Noi, Viet \.-am
Tel. No.: -84-4-8233802
Fax No.: + 84-,tr-8.16.1060
f m a i l : m ai l u o n g r ha r a h o o . c o n

\Is Ngul en Thi Hoa Binh

Director
\Vomen. AIDS and ReproductiveHealth Centre
Vietnam Women'sUniol
39 Hang Chuoi street
Ha Noi, Vict Nam
Tel. No.: +8.1-.1-97235
12
Fax No_: +8,1-,1-972,1103
Email: ngtbihoabinh@yahoo.com

Dr Nguyen Thi Lam

Deputy Director
National Institute of Nutrition
48-B Tang Bat Ho Street
Ha Noi, Viet Nam
T e l .N o . : + 8 4 - 4 - 9 7 1 3 0 8 6
F a xN o . : + 8 4 - 4 - 9 7 1 7E85
Email: nguyenthilamnin@yahoo.com
Dr Yolanda Oliveros
Director fV
National Centerfor DiseasePreventionand Control
Depafiment of Health
SanLazaro Compound,Sta.Cruz,
\'Ianila, Philippines
T e l .N o . : - 6 3 - 2 - 7 4 3 8 3 0]1o c . 1 7 0 0 / 1 7 0 1
Fax No.:
Email:

l{s Cynthia Pang

Erecutir,e Committce Member (Education)
Association for BreastfeedhgAdvocacy (ABAS-Singapore)
SeniorLactation Consultant
KK \\''omen'sand Childr-en'sHospital
100Bukit Timah Road
Sin eapeIq.Z29E99
T e l .N o . : + 6 5 - 9 6 3 1 0 6 8 7
F a xN o . : + 6 5 - 6 2 9 3 7 9 3 3
Email: clnthia.pang.pc@kkh.com.sg

Dr Khamseng Philavong
F o c a lP o r t f o r B r e a s t f e e d i r g . \ c t i r i t i e s
- \ l a t e m aal r d C h i l d H e a h l rD i r i ' i o n
Ministry of Heaith
Vientiane
Lao People'sDemocraticRepublic
T e l .N o . :
Far No.: -856-21-,152562
Email:

\lr Pi Xiaolin
D;..;^"1 qrrff \,fFfrhcr

Commodity and Service SupervisionDepartment

China ConsumersAssociation
11iF \'lachilery Mansion
No. 248 Guanganmen$'aiStreet.
Y,,onurr Tli ctrinf Reiii,ro

People'sRepublicof Cl ina
Tel. No.:
Far No.:
Email: he11o3
15@VlP.sohu.net
trIr Niphon Popattanachai
n.,.',r.' q-^.-r"^, n--F'.1
Food and Drug Administfation
\{inistry olPublic Health
TirvanontRoad,\{uang Nontaburi District
Banekok, Thailand
Tel. No.: +66-2-5907009
Far No.: +66-2-5907197
Emaii: niphon@fda.rnoph. go.th

N[r JoshuaRamos
Deputy Director
R,, re:,, of Fnnd,nrl Dn,oc

Civic Drive, Filin\,est ColporateCit.v

tr{untinlupa,Philippiries
Tel. No.: +63-2-8.125606
F a r N o . : - 6 3 - 2 - 8 0 7 E 5i 1
Email:

\'Is Suafai Salima

Nutritionist
n-^.-r-.--r ^ F Tf-" lrh

PrivateMail Bag,
{g!4, Samoa
T e l .N o . : - 6 8 5 - 2 1 2 1 2
Fax \o.: +685-21,140
E-mail:

Dr Gansukh Sandagdorj
Headof HospitalAccreditationUnit
National Centerlor Health DeYelopment,
NIinistry ofllcalth
EnkhtaivanStreet-13B
Ulaanbaatar-2I -06-,U, Xlongolia
Tel. \o.: +916-11-329129
F a xN o . : + 9 7 6 - 11 - 3 2 0 6 3 3
Emaii: gansukh nchd.nn or gan6676@yahoo.oom
N[s Svay Sary
IYCF Coordinator
National Nutrition Program
National Matemal and Cblld Health Center
\4inistry of Health
French Street,SangkatSrahChak
Khan Daun Pe
PhnornPenh,Cambodia
T e l .N o . : + 8 5 5 - 1 2 - 7 7 8 7 0 6
F a xN o . : + E 5 5 - 2 3 ' 7 2 4 2 6 7
Email:nurririon a on ine.com.kl

f{s Christine Stervafi

Senior Advisor Q.trutntion)
Non CommunicableDiseasesPolicY
Public Health Drectorate
\'finistry of Health
I'O Box 5013
Wellireton, Nerv Zealand
T e 1N. o . : + 6 . 10 4 8 1 6 3 9 3 9
F a x N o . : + 6 . 10 4 8 1 6 2 1 9 1
Emaii: christhe stewart@moh.go\t nz

NIs Julie Stufkens

Coordinator
\ e r r Z e al a n dB r e a . t f e e d i nAgu t h o r i t y
PO Box 20-45,1
Bisliopdale.Christchurch85-1i,
Nerv Zealand
Tel . )io .: + 61 33 572072 ext 202
Fax No.: -6.1 33 5'/2074
Email : julie@nzba.co-nz

Dr llidemi Takimoto
Chief, Section of Matemal and Child Health
Deparlment of Health Promotion and Research
National Institute of Public Health
2-3-6 Mrnami, Wako City,
Saitama3510197,Japan
'l'el.
N o . : + 8 1 - 4 8 - 4 5 8 611
Fax o.: +81-48-4693517
N
Email: thidemi@niph.gojp
\Is Karin Tan
Nutritionist, Nutrition Department
Health PromotionBoard
3 SecondHospital Avenue
Sinsapore168937
Tel. No.: +65 64353827
Far No.: +65 6,13 83609
Email: karir_tan@hpb.gov.sg

Dr Tran Quang Trung

Director, Deparlmentof Inspection
\linistry of Health
1,18AGiangVo Street
Ha Noi, Viet Nam
T e 1N. o.: -84-4-8434816
Far No.: -84-.1-273231 I
Email: hangdk(@yahoo.com

Dr ShagdarUrantsetseg
Food HygieneInspector
The StateSpecializedInspectionAgcncy
Barilgachdiir talbai-i 3
Chingeltei du$'eg,
Ulaanbaatar 21-i 2-38, Mongolia
. o.: +976-11-263766
T e 1N
F a xN o . : + 9 7 6 - 11 - 2 6 3 4 5 8
Email: shinee e@hotmail.con

Vs. llisliza Vital

Project Officer IntegratedN{anagenentof
ChildhoodIllnesses
\{imstry of Health Tinor-Leste
Rua Caicoli,PO Bor 374
D!i, Timor-Leste
'I'el.
\o.: +670-7336628
F a r N o . :+ 6 7 0 - 3 3 2 5 1 8 9
Email:
Dr Zhang Deling
Deputy Counsel
Departmentof Matemal and Child Health Care
and Community Health
Mirristry of Health
No. 1 Xizhimenwai Nanlu
Xicheng District,
100044Beitine
People'sRepublic of China
T e l .N o . : + 8 6 -l 0 - 6E 7 9 - 2 3 0 , +
Fax No.: -86-10-6819-2321
Email: Zhangdy@moh.gov.cn

Dr Zhang Ruijuan
Deputy Dkector
SchoolofPublic Health
\{edical Coliege of Xi'an JiaotongUniversity
No. 76 Yanta West Road,
Xi'an,
People'sRepublicof China
T e l .N o . : + 8 6 - 2 9 - 8 2 6 5 - 5 1 0 1
Far No.: +86-29-8265-5032
Email: zhangrj@xjtu.edu.cn

2. RESOTB.CEPERSONS

Dr Audrey Naylor
Presidentand Chief Executive Olficer
Wellstart lntemational
85 Westview Drive
Sheibume,VT 05482
United Statesof America
T e l . N o . : ( 8 0 2 )9 8 5 - 5 1 6 0
Fax No.
Email: naylor@rvellstart.orgi AJNaylor@aol.com

Dr l{arina Ferreira Rea

Senior Ilesearcher(
InstitueofHealth, SES SauPaulo
Rua JoaoMoura, 328 ap. 122,
05,112-001 Slo Paulo
Braztl
Tel. No.:55-11-32932254
Fax No. : 55-1 1-38912329
F-"il -"-i&ccat,,<h l'r
 Dr Julie Smith
Australian ResearchCouncil
Fellow
Australian PostdoctoralFellog','Resealch

Australian Centrefor EconomicResearchon Health

CoilegeofN4edicineandlfealth SciencesBuilding
62, cnr Mills and EgglestonRoads
The Australian Nalional Universiff
Canberra,ACT 0200
,\ustralia
Tel. No.: +61 26125 5620
Far No.: +61 2 61250710
Email: julie.smith@anu.edu.au

lls Yeong Joo Kean

Legal Advisor
IBFAN/ICDC Penang
P . O .B o x 1 9 , 1 0 7 0 0
Penane,\Ialaysia
T e l .N o . : - 6 0 - 4 - 8 9 05 7 9 9
F a xN o . : + 6 0 - 4 - 8 9 0 7291
E-maii: iblanpg@tm.net.my

\Is AIi }laclaine

ConsultantPublic Health Nutritiolrist
Emergency),lutrition Netu ork
Infant and Young Child L-eedhgin
Emergencies CoreGroup
2. AlerandraRoad
South\Voodfbrd,I-ondon
El8 1PZ.UnitedKin,sdom
Tel. No.: +.14(0)20S9E95735
Fax No.: +.1,+(0)20E9897559
Email:ql!_n_qS-1Ai!C@!!ltie!tCtrn;naclaines@laol.com

3. OBSER\'ERS / RI,PRESENTATTVXS OF AGENCIES

Development
Actionfor Ms CarmenSolinap
\Vomen Chairyerson,Development Action lor Women
TradeUnion Congressof the Philippines(DA\IN-TUCP)
TUCP-PGEACompund
Masaya& MaharlikaSts.Diliman,
1101OuezonCit)',Philippines
Tel.No.: (.632)
9211551
FaxNo.: (632)9219758
Email:
Employer's N{s Dang Buenaventura
Confederationofthe CorporateSocialResponsibilityDepartment
Philippines @COP) Employer'sConfederationof the Philippines(ECOP)
2,F ECC Building,
355 Sen. Gil Puyat Avenue Extension,
MalaulttY. Phil iPPirec
Tei. No.: 890-4845I 890-4E47| 899-0'+11
FaxNo.:895-8623
Email:

International Labour IIs Hilda Tidalgo

Organization - SubregionalOffice for South-EastAsia and the Pacific
Philippines Intemational Labour Organization
l9th Floor, Yuchengco Torver
RCBC Plaza,
68i9AyalaAvenue
N{akati Citv, PhiliPPires
Tel. No.: +63-2-5809920
Fax No.: +63-2-5809999
Email: tidalgoh@ilomni.org.Ph

Peopleofthe Philippines \Is Ines Fernandez

for Breastfeeding People ofthe Phiippines lor Breastfeeding
Coalition /.{RUGAAN Coalition / ARUGAAN
P.O. Box 231,Universityof Philippincs
Diliman 1101,OuezonCitv
Philipphes
T e l .N o . : + 6 3 2 - 4 2 6 - 3 9 1 E
Far No.: +632-922-5189
a mozcom.com
F r n ai l : a r u s a a n

Philippine Senate Dr Vi\ian Eustaquio

O f f i c eo f S e n a t oPr i a C a l e t an o
Conmittee on Health and Demography
Philippi:re Senate
5F, Rrn. 505 GSISBldg.,
Fhancial Center,Roxas Blvd., PasayCity
T e l .N o . : + 6 3 - 2 - 5 5 2 6 6 8 3
Fax No.: -63-2-5526684
Emarl:
 Ms llarvic Anne Felipe
Legislative Staff
Office of SenatorPia Cayetano
Committee on Health and Demography
Philippine Senate
5I, Rm. 505 GSISBldg.,
Filancial Center,Roxas Blr.d., PasayCrty
Tel. \o.: -63-2-5526683
Far No.: +63-2-5526684
Email:

USAID Philippines Ms Ma. Paz de Sagun

Deputy Chief
USAID/Philippines
P.O. Box EA.123.1000Emita,
N4ani1a, Philippincs
T e l .N o . : + 6 3 ( 2 ) 5 5 2 - 9 8 0 0
Fax No.: +63 (2) 552-9399
E m a i l : p d e s a e ran u'ard.:or

U.S. Centersfor Disease Dr Ruox ei Li

ControlandPrevention MedicalEpidemiologist
Division of Nutrition and Physical Activity
National Centerior Chronic DiseasePrevention
and Health Promotion
Centersfor DiseaseControl and Prer cntion
4770 Bulord Highway, NE, MS;'K-2.1
Atlanta GA 30341-3717
United Statesof America
Tel. No.: (770)488-5820
Fax No.: (770),4E8-5.+73
Email: ril6@cdc.gov

,1.OTIIER OBSER\TERS

Dr Chao-Huei Chen
Chief , SectionofNeonatology
'I'aichung
VeleransGeneralHospital
No. 160, Sec.3, Chung-KangRd.,
Taichuns
T e l .N o . : + E E 6 - 4 - 2 3 5 9 - 2 5 2 5
Fax No.: +8 86-4-2359-49 80
 Dr Shang-Liang Wu
ResearchFellou Acting Dircctor
Division of Maternal and Child Health
Bureau of Health Promotion
Taichune
Te1.No.: +8 86-4-2255-0177 ext.,100
Fax No.: +886-4-2251-5234

5. SECRXTARL{T

\tfHo Dr Tommaso Cavalli-Sforza (ResponsibleOlfi cer)

Western Pacific Region Regional Adviser ir Nutrition and Food Saf'ety
WHO Regional Office for the Westem Pacific
United Nations Avenue
P . O .B o x 2 9 3 2
1000Manila,Philippines
Tel. Nos.: (63-2) 528 9864 (direct);528-E001(general)
f a x N o . : ( 6 3 - 2 )5 2 1 1 0 3 6
Email: cavalli-sforza@wpro.who.int

Dr \[arianna Trias (Co-responsible Oiltcer)

RegionalAdviser in Child and AdolesccntHealth
WHO Regional Office for lhe \Vestem Pacific
United Nations Avenue
P . O .B o x 2 9 3 2
1000 \'1ani1a,Philippincs
T e l .N o . : ( 6 3 2 )5 2 8 9 E 6 8
F a x N o . : ( 6 3 2 )5 2 1 1 0 3 6
L*^l]. +-:^^* ;..,.^-^ .-,L^ l-i

I)r Emmalita J{aialac

Short-tenn Prolessionai.Child Health
WHO Regional Office lor the Westen.rPacific
United Nations Avenue
P . O .B o x 2 9 3 2
1000Manila, Philippines
T e l . N o . : ( 6 3 2 )5 2 8 9 8 7 1
F a xN o . : ( 6 3 2 )5 2 1 1 0 3 6
E m a i l : m a r r a l a caew p r o . i ih o . i n r
 Dr trIassimo N. Ghidinelli
RegionalAdviser, HIV/AIDS & STI
WHO RegionaiOlfice for the WesternPacific
United Nations Avenue
P . O .B o x 2 9 3 2
1000Manila, Philippires
Tel. No.: +63-2-528-91 11 (GPN 89714)
F a xN o . : ( 6 3 2 )5 2 i i 0 3 6
Email: ghidinellim@wpro.n ho.int

\ITIO Headquarters Dr Randa Jarudi Saadeh

Scientist
Nutrition for Health and Development
World Health Organization
AvenueAppia 20, CH-1211
Gglqta, Srvitzerland
T e i .N o . : + ' +1 - 2 2 - 7 9 1 - 3 3 1 58/738
F a xN o . : + : 1 1 - 2 2 - 7 9 I - 1 1 5 6
Email: saadelr@who.ilt

Dr Rosa ConstanzaVallcnas
N{edicalOfficer
Chrld and AdolescentHealth and Developnent
World Health Organization
AvenueAppia 20, CH-1211
Geneva.Switzerland
Tel. No.: +11-22-791-1113
Fax No.: +.11-22-791-3L11
Im"il 1'llFh"ara,'u/h^ inf

WHO Cambodia l'Is La-Ong Tokmoh

\utrition Technical Offi cer
WHO Cambodia
No. t77-179comerPasteur(5i) and25.1
P.O.Box, SangkatChaktomouk
Phlom Penh,Cambodia
T e l .N o . : ( t 5 5 ) 2 3 - 2 1 6 6 1 0
Far No.: (855) 23-216211
Email: tokmohl@cam.rvpro.u'ho.int
WHO China Dr \\'en Chunmei
National ProfessionalOffi cer
Child Health and Development
WHO Chha
401 Dongs'2i liplomatic Olfrce Building
23, Dongzhimenv'aida jie
ChaoyangDistrict
Beijhe 1000600
People'sRepublic of China
Tel. No.: (8610)6532-7I89
Fax No.: (E610)6532-2359
Emarl: *'enc@chn.wpro.u'ho.int

\!TIO Philippines Dr Jean-N{arc Oliv6

\ \ H O R e p r c s e n t aet jirn t h e P h I i p p i n e s
WHO Philippires
National TubercolosisCentreBuilding
SecondFloor, Building 9 Departmentof Heaith
SanLazaro Compound,
Sta.Cruz 1000,\4ani1a
Philippines
T e l .N o . : + 6 3 - 2 - 5 2 8 - 9 7 6 1
F a r N o . : - 6 3 - 2 - 7 3 1 -931 4
Email: olivej@phl.rvpro.u,ho.int

]Ir -{llesandroIellamo
TechrricalOfficer
\\TJO Philippires
National TubercolosisCentreBuildilg
SecondFloor, Building 9 Deparlmentof Health
SanLazaro Compound,
Sta.Cruz 1000,\{anila
Philippires
Te1.No.: +63-2-528-971 4
Far \o.: +63-2-731-3914
Email: iellamoa@ p h j . w p r o . rbi o . r t

Dr Ho*ard Sobel
tr'IedicalOfficer
WHO PhiJippines
National TubercolosisCentreBuildrng
S e c o n dF l o o r .B u i l d i n g9 D e p a n m e not f H e a l t h
ern T qzarn |-nmnnrrnd

Sta.Cmz 1000,Manila
Philippilres
Tel.No.: +63-2-528-97
68
FaxNo.: +63-2-731-3914
Email: sobelh@pbl.wpro.who.int
\!TIO Vict Nam Dr Hoang Thi Bang
Project Officer
Child and AdolescentHealth
WHO Viet Nam
63 Tran Hung Dao Street
Hoan Kiem District
Ha Noi, Viet Nam
'l-el.
No.: +844-943 -3731
Fax No.: +844-943-3710
Email: xylanders@"'tn.n'pro.ivho.int

IJNICEF Headquafters \{r Darid Clark

Nutrition Specialist(Legal)
LINICET
3 United NationsPiaza,
Nerv York, NY 10017,
United Statesof America
Tel. No.: +1 212 32'77316
F a x N o . : + 1 2 1 2 7 3 51 1 0 5
Email: dclark@unicelorg

Dr Str{ \'Ioazzem Hossain

ProgrammeOlficer, Infant Feeding
LNICEF
3 United Nations Piaza,
Nerv York, NY 10017,
United Statesof America
T e l .N o . : + 1 2 1 2
F a xN o . : + 1 2 1 2 7 3 51 4 0 5
Email: smhossain@unicef.org

T]NICEF Dr StephenAt$ ood

EastAsia and Pacific Regional Advisor for Health and Nutrition
Rcgion LTNICEFEastAsia andPacilicRcgion
19 PhraAtit Road
Bangkok.l hailand10200
Tel. No.: (66 2) 356 9111
Fax No.: (66 2) 280 3563to 6:l
Email: satu-ood@unicef.org

Ms. ShanthaBloemen
Communication Ofhcer
LTNICEFEast Asia and Pacific Regional Olfice
19 Phra Atit Road
Bangkok, Thailand 10200
Tel. No.: (66 2) 356 9401
Far
Email: sbloemcn@unicef.org
 Ms SusanMackay
RegionalProgrammeCommunication
I-,NICEF East Asia and Pacihc RegionalOffice
19 Phra Atit Road
Bangkok, Thailand 10200
T e l .N o . : ( 6 6 2 ) 3 5 6 9 2 0 6
Fax No.: (66 2) 280 3563to 6,1
Email: smackay@unicef.org

\{s Karen Codling

RegronalNutrition Project Oificer
L IICEF East Asia and Pacific RegionalOffice
19 Phra Atit Road
Banqkok, Thailand i 0200
Tel. No.: (66 2) 356 9420
Fax No.: (66 2) 2E0 3563to 6.+
Email: kcodling@uniceiorg

UNICEI- Cambodia Ms Chhin Lan

A (cicf ent Prnienf Offi cer

Maternal and Child Health

Lr].IICEF CambodiaCounily Offrce
11 Street75
SangkatSraschark,
Dt.-^- p--L a"-k^,1;"

Tel.No.: (85523)42621.1
FaxNo.: (85523) 126281
E,hc;l rt.-;..-;-a€^fft

UNICEF China Dr Lilian Selenje

\utrition Manager
t IICEF Chira CountryOfficc
12 SanlitunLu
Beijing100600
People's Republicof China
Tel.No.:
Far No.: (8610)65323107
Email: lselenje@unicef.org

UNICEF Philippines Dr Marinus Gotink

Chief,HealthandNutrition
I-NICEF PhilippinesCountryOffice
3liF YuchengcoTower,RCBC Plaza
6819AyalaAvenue
1200Makati City, Philippines
Tel.No.: +63-2-9010100
FaxNo.: +63-2-9010196
Email: mgotink@unicef.org
 Dr Martha Ca"vad-an
I{ealth Specialist(AMH)
IINICEF PhilippinesCountry Office
31rFYuchengcoTov'er,RCBC Plaza
6819Ayala Avenue
1200Makati Citv, Philipphes
T e l .N o . : + 6 3 - 2 - 9 0 1 0 1 0 0
F a xN o . : + 6 3 - 2 - 9 0 1 0 1 9 6
Email: mcayad-an@unicef org

Ms Alexis Rodrigo
Senior CommunicationAssistant
LNICEF Philippires Country Olfice
31tF YuchengcoTower, RCBC Plaza
6819A1'alaAvenue
1200\{akati Citv, Philippines
T e l .N o . : + 6 3 - 2 - 9 0 1 0 1 0 0
Far No.: -63-2-9010196
Enail : arodrigo!!unicelorg

UNICIF Thailand }llr .{ndrew \{orris

f)anrrfv Pahracanfqfil.r

LNICEF Thailand Corurtry Oificc

19 Phra Atit Road
Chanasongkram,Phra Nakon:r
Bangkok, Thailand
T e l .N o . : ( 6 6 2 ) 3 5 69 4 8 8
Fax No.: (66-2)281 6032
Email: anorris@unicei.org

]Is Pornthida Padthong

CommunicationsOfficer
U\ICEF Thailand Country Of1ice
19 Plra Atit Road
Chanasongkram,PIra Nakom
Bangkok, Thailand
Tel. No.: (66 2) 356 948.1
F a x\ o . : ( 6 6 - 2 )2 8 1 6 0 3 2
Email: ppadthong@unicef.org
LTNICEF Timor-Leste Ms Jennifer Barak
Child Survival and Maternal Health Care Specialist
LI].{ICEFDili Country Office
Lll.JHouse
P . O .B o x 2 1 2
Dili, Timor-Leste
Tel. No.: + 610-72'1-3987
Fax No.: +670-331-3322
Email: jbarak@unicef.org

l{r \oeno Anuno Sarmento

Senior ProgramrneAssistant-HealthandNutrition
INICEF Dili Country Office
LN House
P . O .B o x 2 1 2
Dj1i, Timor-Leste
Tel. No.: +610-727-8755
Fax No.: +670-331-3322
Email: nsarmento@unicei. org

L-I{ICEF Viet Nam Mr Nguyen Dinh Quang

ProjectOfficer. Healthand Nutritjon
LTNICEFViet Nam Country Office
81 A Tran Quoc Toan,
Ha Noi, Viet Nam
Tel. No.: +811-912-5i05
Fax No.: +844-942-5705
Email: nsarmento@unicef.org
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 BABY-FRIENDLY HOSPITAL D{ITLATI\TE(BFEI)
Recommendations
1 . Improve monitorirg of baby-friendly
hospitalsthrough a combination ofself-
and cornmunity-basedmonitoring with
Jessfrequentextemalmonitoring<r ery i
to 3 years.
lnclude BFHI asparl ofthe country health
system stmcture.
3 . Extend prhciples ofBFHI to health
facilities and the communit-v.
1 . Standardisethe implementationolthe nerv
BFHI guidelines.
Actions
1 . WHO/LTNICEFto ensure$'ide
disseminationofthe new BFHI package,
alrd encouragecountriesto usethe self
appraisaland monitoring tools.
TNICEF CounL.yOffices (with IT
support)to map the tecbrological reach of
altematenronitoringcbaruels(e.9.e-mai1.
SN1S.inrerner;for monitoring[-CF
Code indicatorsin the country.
3 . Advocate v,ith MOH to establishBFHI
certification as standardfor all hospitals
and as a requirementfor timelimited
(2-.vear)hospital accreditation.
.+. A11participantsto review the Cambodia
breastfeedingexperienceandlor arrangea
country visit to understaadthe lessonsof
the baby-&iendly communiry initiative.
5 . \\TIOI'LNICEI and govemmentpartners
comrnit to achievingbaby-fiiendly
. e n i f i c o r j c ni n l l l h o . p i t a l -L na l l c o u n L r i e s
in the regionby 2015. (UseTatal
Materni 4) Ho spttals as denomirator)
6 . Work \l,ith accreditedNGOs and/or
professionalsocictiesto expandthe ability
ro \ cndu,I thi BFH erternalrer ierrs.
7 . Suppofi go!en'lmentsto developa
\\'ebsite rvherestatusofBFIII is reported
and revieq ed each year.
 CREATI\-G AN ENABLING ENVIRON}IENT
Recommendations
1. Guaranteebreastfeedhgwomen a space
that is personallyand mentally quiet and
non-distracting.
2. Improve the access ofa u'orking
her breastfeedingbaby duriag working
hours.
3. Increaseher accessto supportiverole
modelsu,ho will ofler her personalized,
cadng support(mother,husband,friend,
mother-to-mothersupportgroups).
-4. Guaranteeher accessto accurate
knor.ledge and understandhgof
breastfbeding.
5. Ensureadequatematernity leave (6
months),a guaranteedincome. a]idjob
secudty to support breastfeeding.
6. Ensureadequatepatenity leave.
7. Make necessarychangesin societyand in
educationalsystemsto createa
breastfeeding-positive culture.
8. Implementnatjonal regulationsto cootrol
r n a r k e t i nogf b r c a . t - r u l ks u b : u t u L cl o-
protcct coDmunities and lamilies fiom
misinformation.
9. Ad1'ocatefor breastfeedingfrom a
women's rights and child's rights
perspectil'e.
I|{CREASI\iG HEALTH-\{OITKER SKII,LS
Recommendafions
l. Strengthenthe complernentarill'of
preserviceand in-sen ice fainirg for
Yariousaspectsofthe Global Strategy
including BFHI, suppon, and coun-selling
skills.
2. Adapt preserr''icetraining to different
educ"riona cul l r u r co
' f n r e d i c i n en.u r . i n ! .
midrvifery, nutrition. and public health.
J. Increase.cale.reduceco.t. rnd improre
efficiency of in senice raining by using a
combinationof online and face-to-face
taining methods.
.1. Lid< with professionalsocietiesto get
more breastfeedingcontent into post-
graduateeducationalprogrammes(e.g.,
residencies,master'sprogrammes,etc.).
5. Widen dissemirationanduse of a "model
chapter"and relatedmatedals.
6. Promotethe use ofintegnted courses
endorsedby WHOrI-NICEF.
Actiols
1. Upon retlrm, review statusofpresent
legislationfor matenrityprotectionand
antidiscriminationlegislation.Arange
molher to meetirgs u'ith appropriate(ilrfluential)
miaistry counterpans.
2. Organizea meetingr''ith $'omen and nen
in ministriesof b1'luenceto examine
potential for breastfeedingadvocacy.
3. Educateourselveson the ability and
willingness ofnational and local tade
union and employer groupsto inl-luence
legislationand changesin the u'orkllace
for breastfeeding.
,1. Createa draft curriculum outlhe (or use
"model chapter" and relatedn1ate als
with evidencebase)on breastfeedingand
parentirg in schoolsand commu ties
l i r c l u d i n gp r c n a t arli s i t s )a n du . e i t L .
adyqcate$'ith the \4inistry ofEducatloD
for ilclusion in prirnary and secondary
scl'roolcurriculum.
: . Inten ie$'mothers of low birth \r''eight
babiesduring extendedhospitaLisation to
evaluatetheir willingness to become
community breastfeedhgadvocates.
Actions
1. Upon retum. reporl to the senior
representativcsof govemmeotthe results
of tlis meeting in order to explorc ways to
mainstreambreastfeedingmaterial into
exlstlngcouISes.
2. T\\'o countriesto agreeto explore
knorv)edgetranslerto "online"
conmunities by urultirnediaroutes(e.g.,
intemet, e-rnarl,radio. r'idco, phone, Slr{S,
CD-ROM, distanceleaming,tele-
conferelcing, etc.), as coutplementto
face-to-facehaining.
3. WHO,LI I.IICEF to join ln€grated
N4anagement ol Childhood Illness with
in{bnt and young child feeding(IYCF)
training curriculum.
1. \\TIO/INICEF to developa clearer
demonstmtionofthe link b€t\i'een
breastfeedbgand the RegionalChild
Survival Strategyto presentat the
Regional Commitlee meetrog.
5 . WHO,'LNICEF to invcst in the
developmentof interactiveCD traidng
programmesfor various aspectsoffYCF.
6 . WHO,{-t{ICEF to $'ork with governments
to develop a detailedtraining plan for
relevantbealtbworkcr. anJ seekbudget.
 CODE OF \{ARKETD{G OF BREASTN{ILK SLBSTITUTES
Recommendations Actions
i. Build capaciryin Code implementation. 1 . Organizationsshould supporlparticipation
J. JmproremonitorirgofCode conrplrance at the UNICEF-tunded training ir
and violarion at all levels. November at IBFAN-ICDC Pena:rg,
3. Explain and increasethe understaadingby N{alaysiaon the Code ofN{arketing of
health officials and urcrkersat all levels of Breast-Milk Substitutes.Encouragese or
importanceof avoiding conflicts of managementparticipation.
interest. 2 . \\'llOitNICEF to use oppofutrity of this
4. Improve klowledge of lalmakers, trdLningto facjlitateregionalcooperation
communities,medical societies, and netn'orkilg.
erc..on rlerr re(pon(ibilin
out'sL/\'es/.:/ 3 . Wll O,{-INICEF.in collaborationwith
*,ith regard to the Code. rclevantNGOs such as IBFAN-ICDC to
( Ttrhr^r p fpai^n,t .^^hpn1j^r draft an annotatedaod updatedguideline
6. Producean annotatedversion oftle Code for useofthe Code.
incorporatingre'o1ution..clarii in g 1 . \\,llOilNICEF to stongly promote
articles that uould facilitate its use. institution of full la$'s supponingthe
-.
I n c r e a . er r c r l e r i r r o l r c m e n tb 5 Codc in selectedcountries.
establishingtraining and orientatron LINICEF to sbareorientationmoduleson
programmeswith trade or other labour the Codc for use at subnationailevel rn
orgarizations. order lo -hcilitate Code a*'arenessand
impro!ed nro!rtonng.
6 . A11participantsto rhoroughlyreview the
Code and relatedissues,and an'ange
meetings\,r'ithcolleaguesto reviclt
lessonslcamed lrom dris conference
\\,TIOTLNICEF to suppofi governmentto
establishCodesofconductfor health
pr\ f('(ionals in br.'a.tfeeding promotion.
thc Code,avoidanceofconflictsof
interest.Provide training for health
l'orkers on thcsetesporr'sibilities.
3 . \\'HO LNICEF/ IBFAN to revie$'national
ler el monitoringsystemsof Code
c o n r p l r a o cacn dr i o l a t i o n .o. n dd e re l o pr
method,processof sharinglessonslearned.
9 . \\TIOiLNICEF, in collaborationwilh
relevantNGOs such as IBFAN-ICDC, to
explore new rvaysto encourageinfant
formula companies'compliancet'ith the
Code, e.g. rvaysofmaking Code
Yiolationsreponed by countriesbetter
kno$11to the public, av'arenessraishg
with media, reporting to the \\4I4.