No. 1 - WHO Global Strategy for Infant and Young Child Feeding

This document was approved by the AOM Board of Directors on February 18, 2004.

AOM Position

The Association of Ontario Midwives strongly supports the WHO Global Strategy for Infant and Young Child Feeding.

Midwives will inform their clients about the benefits of breastfeeding, while at the same time supporting the role of the mother as the primary decision-maker.

The AOM encourages the Ontario Ministry of Health and Long-Term Care, other health professionals and hospitals to consider actions that they can take in support of the Global Strategy, including the Baby-Friendly Hospital Initiative.

The AOM encourages the Canadian Association of Midwives to explore ways support the Global Strategy at the federal level.

The AOM supports World Breastfeeding Week in early October.

Background

The Global Strategy for Infant and Young Child Feeding was endorsed by the World Health Organization (WHO) and UNICEF in 2002.  The purpose of this strategy is to revitalize efforts to promote, protect and support appropriate approaches to feeding.

While supporting a woman in her choices, midwives in Ontario are strong advocates of breastfeeding and will work with their clients to understand the many demonstrated benefits of breastfeeding and encourage successful breastfeeding.  In 2002/03, breastfeeding amongst Ontario midwifery clients was nearly universal, at 97%.  This is a significantly higher rate of breastfeeding than non-midwifery clients.

It is widely understood that breastfeeding is the best start in life for all babies, but is particularly critical for lower income families in Canada and elsewhere.

The WHO Global Strategy is an overall framework on breastfeeding.  It incorporates earlier initiatives, including the WHO Code of Marketing of Breastmilk Substitutes and the Baby Friendly Hospital Initiative (BFHI).

At the 2000 AGM, midwives passed a resolution to work toward implementation of the WHO Code of Marketing of Breastmilk Substitutes and the BFHI.

The resolution, as passed, reads:

• Be it resolved that the Association of Ontario Midwives, as a professional organization, endorse and promote both the WHO Code of Marketing Breastmilk Substitutes and the WHO/Unicef Baby Friendly Hospital Initiative (BFHI);
• Be it further resolved that the AOM, as a member of the Canadian Association of Midwives (CAM), request that CAM explore ways to endorse and support the WHO Code at the federal level;
• Be it further resolved that the AOM lobby the provincial Ministry of Health and Long-Term Care to endorse the BHFI;
• Further, be it resolved that midwives, in their professional capacity as members of staff of hospitals, support work to implement the BFHI in their communities.

The 2002/03 AOM strategic plan established the direction to establish one to two positions on issues relevant to midwifery and the broader issues related to the health of women and their infants.

In November 2003, Health Canada established the Expert Advisory Panel on Exclusive Breastfeeding to make recommendations to Health Canada on the development of a statement regarding the duration of exclusive breastfeeding.

Summary of WHO Global Strategy

The Global Strategy for Infant and Child Feeding (paragraph 10) states that:

"Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers.  As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health.  Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond.  Exclusive breastfeeding from birth is possible except for a few medical conditions, and unrestricted breastfeeding results in ample milk production."

The strategy is intended as a guide for action.  The aim of the strategy is to "improve - through optimal feeding - the nutritional status, growth and development, health and thus the survival of infants and young children."  The specific objectives of the strategy are to raise awareness of the challenges in promoting breastfeeding, increase the commitment to optimal feeding practices, and create an environment supporting informed choices about optimal feeding practices.

The contents of the strategy includes promoting appropriate feeding for infants and young children; exercising other feeding options; feeding in exceptionally difficult circumstances; and improving feeding practices.

The strategy calls on professional associations to:

• Promote education and training supporting breastfeeding, including exclusive and continued breastfeeding and complementary feeding.
• Promote "baby friendly" status by maternity hospitals, consistent with the 1989 "ten steps to successful breastfeeding".
• Encouraging community support groups and referring mothers to them.

The full 37-page strategy can be found online at:
http://www.who.int/child-adolescent-health/New_Publications/NUTRITION/gs_iycf.pdf

Summary of the Baby Friendly Hospital Initiative

The BFHI advocates that hospitals adopt a 10-step approach to promoting breastfeeding:

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within one half-hour of birth.
5. Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants.
6. Give newborn infants no food or drink other than breastmilk, unless medically indicated.
7. Practice rooming in that is, allow mothers and infants to remain together 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no pacifiers or soothers to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

BFHI in Canada is administered by the Breastfeeding Committee for Canada.  So far, only two hospitals in Canada have been designated.