Breastfeeding TSEK

Slide Presentation Kit

Protect Infant Health.
Save Lives.
July 2012

How to Use the

Breastfeeding TSEK
Slide Presentation Kit
The Breastfeeding TSEK Slide Presentation Kit was developed for advocating to
governors, mayors, barangay captains and LGU stakeholders in the campaign to
disseminate information regarding the benefits of breastfeeding and the
necessity of sustaining the Breastfeeding TSEK Program for the health of our
mothers and their children.
The slide kit contains pictures of the slides in each lecture and the script for each
slide. It also includes suggested comments or questions for the lecturer (in
italics) to facilitate audience interaction.
The slide discussion contents are also included within the notes field of each
PowerPoint slide.

SLIDE

DISCUSSION
Title Slide

In this session, we will begin by presenting to you the

national situation of our infants and children, and the
evidence behind the benefits of breastfeeding.
We will also present the governments policies and
programs supporting breastfeeding, and we will focus on
the Breastfeeding TSEK Program.

Read slide.

SLIDE

DISCUSSION
Read slide.
This is stated in Article 2, Section 15 of our Constitution.

The Philippines is one of 189 countries who jointly

endorsed the Millennium Declaration of 2000 which
committed signatories to achieving 8 millennium
development goals by the year 2015. Foremost among the
MDGs which can impact on the health and survival of our
infants and children are MDGs 1 and 4.

The first among the 8 MDGs aims to eradicate extreme

poverty and hunger. Target 1C: Halve the proportion of
people who suffer from hunger; including the prevalence
of underweight children under five years of age and the
proportion of population below minimum level of dietary
energy consumption.

SLIDE

DISCUSSION
In the Philippines, 1 out of 4 children who are under 5
years old is malnourished. Read slide.
Source: 7th National Nutrition Survey, 2008

Malnutrition happens early, and develops if the child was

not properly fed in infancy and if the mother herself was
undernourished. The 1,000 days between a womans
pregnancy and her childs 2nd birthday offer a unique
window of opportunity to shape healthier and more
prosperous futures.
Source: The State of the Worlds Children 2009

A childs poor nutritional status contributes to illness and

death, as shown in this study by Ashworth and Feachem.
Source: Ashworth and Feachem. Interventions for the
control of diarrhoeal diseases among young children:
weaning education. Bulletin of the World Health
Organization, 63 (6): 1115-1127 (1985)

SLIDE

DISCUSSION
Why is it important that we lessen the number of
undernourished children? Data gathered from 59
countries showed that a reduction in the number of low
birth weight babies will lead to a significant decrease in
the number of children dying before they reach their 5th
birthday.
Source: Pelletier and Frongillo. 2003. Pooled analysis of
data from 59 countries from 1966 to 1996.

Breastfeeding is one of the essential elements of the

Department of Healths thrust of Universal Health Care or
Kalusugan Pangkalahatan, which seeks to provide
universal health coverage as a strategy to improve the
healthcare of the poor.
James P. Grant was an American statesman and children's
advocate. He served for 15 years as the third executive
director of the United Nations International Children's
Emergency Fund (UNICEF), with the rank of Under
Secretary-General. Read slide.

One of the health targets we are aiming to meet is MDG 4,

which is to reduce by two thirds the under-five mortality
rate between 1990 and 2015. At present, 82,000 die
annually in the country.

SLIDE

DISCUSSION
The latest information from the WHO states that majority
of child deaths are due to preventable causes, or can be
treated with simple interventions.
Source: WHO. Global Health Observatory
(http://www.who.int/gho/child_health/en/index.html)

These are the causes of Under Five Deaths (as seen in this
graph released by WHO in 2010). Neonatal deaths make
up more than half of Under 5 deaths, and majority of all
deaths were due to preventable causes.

Source: WHO. Global Health Observatory

(http://www.who.int/gho/child_health/en/index.html)

This graph shows that 3 out of 4 newborns die in the first

week of life, specifically the first 2 days of life.
Source: NDHS 2003, special tabulations

SLIDE

DISCUSSION
What can be done to decrease Under Five mortality?
Interventions should then:
Focus on infancy
Use preventive measures
Address the whole population
Improve infant feeding behaviors
Read slide.

These are the exclusive breastfeeding rates in our

countrys regions, as reported in the 2011 Family Health
Survey. The national coverage is a low 27.3%, still a long
way from the 2015 target of 80%.

Source: 2011 Family Health Survey

Why is breastfeeding the solution?

Breast milk provides high quality nutrients that are easily
digested and efficiently used by the babys body. Breast
milk also provides all the water a baby needs. There is no
need for any additional liquid. Numerous studies indicate
that, for infants breastfed exclusively and on demand, the
water in the breast milk exceeds water requirements.
Colostrum is also rich in antibodies , white cells and
Vitamin A, which protects against infection and allergy,
and reduces the severity of infections. During infancy,
when the babys immune system is not yet fully
developed, breastfeeding will protect him from infections.
Adapted from: Breastfeeding counselling: A training course.
Geneva, World Health Organization, 1993 (WHO/CDR/93.6).6

SLIDE

DISCUSSION
In an historic editorial, The Lancet hoped a warm chain for
breastfeeding could be created, and warned about the
ambivalent messages often encouraged by the marketing
campaigns of artificial milk manufacturers. The Lancet is
the world's leading general medical journal. Read slide.

- Editorial. A warm chain for breastfeeding. Lancet 1994;

344: 123941

In 2003, the Bellagio Study Group on Child Survival put out

a ve-article series in the Lancet [1, 47] that was a call
to action for all segments of the public health community
to bring to the forefront the continuing high rates and
unacceptable disparities of child mortality in the world.
This was followed in 2005 by a series [811] by the
Neonatal Survival Steering Committee that focused
attention on the neonate and the burden of morbidity and
mortality in this short period of human life after birth. A
third series on maternal and child undernutrition followed
in 2008. These articles looked at preventive interventions
to save childrens lives, and exclusive breastfeeding for 6
months and weaning after 1 year is the most effective
intervention, with the potential of preventing more than 1
million infant deaths per year, equal to preventing 13% of
the worlds childhood mortality.

What is the evidence behind the benefits of

breastfeeding?

SLIDE

DISCUSSION
This presentation summarizes the most recent published
literature on the following topics related to the benefits of
breastfeeding:
Infant morbidity because of diarrhea, acute respiratory
infections, otitis media and ear
infections, and other infectious diseases
Infant mortality because of diarrhea, acute respiratory
infection, and all causes
Child development
Chronic diseases, particularly obesity, diabetes, and
cancer
Maternal health effects, with special emphasis on breast
and ovarian cancers
Source: Leon-Cava et al. Quantifying the Benefits of
Breastfeeding: A Summary of the Evidence. Washington,
D.C.: PAHO 2002

The evidence shows that breastfeeding is important for

the immediate health and survival of the infant.

The incidence of common childhood infections such as

diarrhea, respiratory tract infections and otitis media, AND
the risk of dying from these infections are all lower in
breastfed infants.
Sources: Jones et al. Bellagio Child Survival Study Group.
How many child deaths can we prevent this year? Lancet.
2003;362(9377):6571, 2003
Chandra, 1979; Feachem, 1984; and Victora,
1987.

SLIDE

DISCUSSION
The risks of hospitalization and dying in the first year of
life are higher in formula fed infants.
Source: Chen and Rogan. Breastfeeding and the risk of
postneonatal death in the United States. Pediatrics 2004
May;113(5):e435-9.
Talayero et al, Full Breastfeeding and
Hospitalization as a Result of Infections in the First Year of
Life, Pediatrics 2006; 118;e92.

The column on the left lists the infection, and the duration
of breastfeeding. The column on the right shows the
percentage reduction of the incidence of the disease in
exclusively breastfed infants.
Source: American Academy of Pediatrics Policy
Statement: Breastfeeding and the Use of Human Milk,
originally published online February 27, 2012

In preterm infants in the NICU given breastmilk, the

incidence of life-threatening illnesses such as necrotizing
enterocolitis and respiratory syncitial virus bronchiolitis is
also markedly decreased. One case of NEC could be
prevented if 10 infants received an exclusive human milk
diet, and 1 case of NEC requiring surgery or resulting in
death could be prevented if 8 infants received an exclusive
human milk diet.
Meta-analyses with a clear definition of degree of
breastfeeding and adjusted for confounders and other
known risks for sudden infant death syndrome (SIDS) note
that breastfeeding is associated with a 36% reduced risk of
SIDS.
Sources:
Sullivan S, Schanler RJ, Kim JH, et al. An exclusively human milk-based
diet is associated with a lower rate of necrotizing enterocolitis than a
diet of human milk and bovine milk-based products. J Pediatr.
2010;156(4):562567, e1
Ip S, Chung M, Raman G, et al; Tufts-New England Medical Center
Evidence-based Practice Center. Breastfeeding and maternal and infant
health outcomes in developed countries. Evid Rep Technol Assess (Full
Rep). 2007;153(153):1186
9

SLIDE

DISCUSSION
A study of 1743 mother infant pairs in the United States
found a protective effect against otitis media if infants
were breastfed compared to infants who were not
breastfed. The risk diminished the more breast milk the
infant drank (a dose response).
Source: Scariati PD, Grummer-Strawn LM, Fein SB. A
longitudinal analysis of infant morbidity and the extent of
breastfeeding in the United States. Pediatrics, 1997, 99(6).

A study from the Philippines showed that artificially fed

babies were up to 17 times more at risk of getting
diarrhoea than exclusively breastfed infants. Partially
breastfed babies were more likely to have diarrhea than
exclusively breastfed babies, but less likely than babies
who received no breast milk. It is important to continue
breastfeeding during diarrheal episodes because of its
nutritional value and the fact that it ensures a more
speedy recovery from illness.
Source: Popkin BM, Adair L, Akin JS, Black R, et al.
Breastfeeding and diarrheal morbidity. Pediatrics, 1990,
86(6): 874-882.

A landmark study by Dr. Natividad Clavano done in Baguio

General Hospital and Medical Center in the 1970s showed
the superiority of breastmilk compared to mixed and
formula feeding in preventing illness and deaths in
newborns.
Source: Clavano N. Mode of Feeding and its Effect on
Infant Mortality and Morbidity .J. Trop Ped 28: 287-293.
December1982

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SLIDE

DISCUSSION
At that time, in Baguio General Hospital, babies were
routinely removed from their mothers at birth, placed in a
nursery, and given infant formula (see upper graph, point
out the breastfeeding and formula feeding rates), resulting
in high rates of infection among these babies (lower
graph)
Dr. Clavano instituted a new regimen that allowed
mothers and babies to room together, and encouraged
women to breastfeed on demand (point out the increase
in breastfeeding rates and sharp decline in formula
feeding). The results were dramatic: the incidence of oral
thrush, diarrhea, clinical sepsis, and death markedly
decreased during the intensification of the breastfeeding
program.

A randomized controlled trial studied the type of feeding

received by low birth weight babies against the risk of
serious illness. Those fed exclusively with formula had 4
times the incidence of serious illness compared to those
who were given breastmilk.
Source: Narayanan et al. Randomised controlled trial of
effect of raw and holder pasteurised human milk and of
formula supplements on incidence of neonatal infection.
The Lancet, Volume 324, Issue 8412, Pages 1111 - 1113,
17 November 1984.

While this study cannot be replicated anymore (due to

ethical considerations since we cannot randomize a baby
to receive formula milk only), the result of the study was
significant in that it showed that the less breastmilk the
baby receives, the higher the risk of serious illness.
Source: Narayanan et al. Randomised controlled trial of
effect of raw and holder pasteurised human milk and of
formula supplements on incidence of neonatal infection.
The Lancet, Volume 324, Issue 8412, Pages 1111 - 1113,
17 November 1984.

11

SLIDE

DISCUSSION
We have said that the most important benefit of
breastfeeding is the infants immediate survival. Data on
the Philippines has shown the following: read slide
Source: Philippine Situational Analysis 2007, p.11
Infant and Young Child Feeding Programme
Review. Case Study: The Philippines. UNICEF New York.
June 2009.

It is equally important that breastfeeding be started early,

as delays in initiation increase the babys risk of dying.
Source: Mullany LC, et al. Breast-Feeding Patterns, Time to
initiation, and mortality risk among newborns in Southern
Nepal. J Nutr, 2008; 138(3):599-603.

This study was done in Nepal involving 23,000 breastfed

babies. It looked at the risk of infection-related death
correlated with the time of initiation of breastfeeding (in
hours).
If breastfeeding is started within an hour after birth, the
risk of infection-related death is 1. If breastfeeding is
started after 1 hour but within the 1st 24 hours, the risk
doubles to 2 (ex: mother stays in the RR for a few hours).
If breastfeeding is started after 3 days, there is a four-fold
increase in the risk of infection-related death (ex: mother
allows baby to be roomed-in only when she is for
discharge already).
Source: Mullany LC, et al. Breast-Feeding Patterns, Time to
initiation, and mortality risk among newborns in Southern
Nepal. J Nutr, 2008; 138(3):599-603.

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SLIDE

DISCUSSION
In a study on the effects of breastfeeding on infant
mortality in Latin America the authors conclude that
artificially-fed infants 0-3 months of age were over 14
times more likely to die of diarrheal disease.
Source: Betran AP, de Onis M, Lauer JA, Villar J. Ecological
study of effect of breast feeding on infant mortality in
Latin America. BMJ, 2001, 323: 1-5.

The same study showed that artificially-fed infants 0-3

months of age were 4 times more likely to die of acute
respiratory infections than exclusively breastfed infants.
Artificially-fed infants 4-11 months of age were almost 2
times more likely to die of both diarrheal disease and
acute respiratory infection than partially breastfed infants.
Source: Betran AP, de Onis M, Lauer JA, Villar J. Ecological
study of effect of breast feeding on infant mortality in
Latin America. BMJ, 2001, 323: 1-5.

It has been recognized that early childhood events,

including diet, are likely to be important in the
development of both childhood and adult diseases.
Although atopic diseases have a clear genetic basis,
environmental factors, including early infant nutrition,
may have an important influence on their development
and, thus, present an opportunity to prevent or delay the
onset of the disease. There is evidence that breastfeeding
for at least 4 months, compared with feeding formula
made with intact cow milk protein, prevents or delays the
occurrence of atopic dermatitis, cow milk allergy, and
wheezing in early childhood.
Source: American Academy of Pediatrics Policy
Statement: Breastfeeding and the Use of Human Milk,
originally published online February 27, 2012

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SLIDE

DISCUSSION
It has been postulated that the mechanism in the
development of type 1 diabetes mellitus is the infants
exposure to cow milk -lactoglobulin, which is avoided by
breastfeeding. A reduction in the incidence of type 2
diabetes mellitus is reported, possibly reflecting the longterm positive effect of breastfeeding on weight control
and feeding self-regulation.
There is a reduction in leukemia that is correlated with the
duration of breastfeeding. Breastfeeding results in a lower
BMI and higher high-density lipoprotein concentration in
adults. Also, breastfed infants self-regulate intake volume,
and the early programming of self-regulation, in turn,
affects adult weight gain.
Source: American Academy of Pediatrics Policy Statement:
Breastfeeding and the Use of Human Milk, originally published online
February 27, 2012

A study in Germany found that among 9357 children aged

5 and 6 there was an over 5 times difference in the
prevalence of obesity among those children never
breastfed compared to those breastfed for over one year.
There was a dose effect with the longer an infant had
been breastfed the lower prevalence of obesity at the age
of 5 and 6.

Source: von Kries R, Koletzko B, Sauerwald T et al. Breast

feeding and obesity: cross sectional study. BMJ, 1999,
319:147-150.

Long-chain polyunsaturated fatty acids are present in

breastmilk, but not in most brands of formula. These are
preferentially incorporated into neural cell membranes;
structural lipids constitute about 60% of the human brain.
The major lipid components include docosahexaenoic
(DHA) and arachidonic (AA) acids, which are important for
retinal and cortical brain development. AA and DHA
accumulate in the brain and retina most rapidly during the
last trimester of pregnancy and the first months after
birth. Their reserves are limited at birth, especially in preterm infants, and decline rapidly when lacking in the diet.
Bottle-fed infants have been shown to have lower longchain polyunsaturated fatty acids in the phospholipids of
the cerebral cortex than infants who are fed breastmilk .
This is, therefore, a potential mechanism for an effect of
breastfeeding on intellectual development.
In addition to the chemical properties of breastmilk,
breastfeeding enhances the bonding between mother and
child, which may contribute to the childs intellectual
development.

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SLIDE

DISCUSSION
A meta-analysis done by Anderson showed that
breastfeeding compared to formula feeding correlated
with higher scores for cognitive development, and the
benefit was higher among low birth weight infants.
Source: Anderson et al. Breast-feeding and cognitive
development: a meta-analysis. Am J Clin Nutr
1999;70:52535

The large, randomized Promotion of Breastfeeding

Intervention Trial (PROBIT) provided evidence that
adjusted outcomes of intelligence scores and teachers
ratings are significantly greater in breastfed infants.
Significantly positive effects of human milk feeding on
long-term neurodevelopment are observed in preterm
infants, the population more at risk for these adverse
neuro-developmental outcomes.
Source: Kramer et al. Breastfeeding and Child Cognitive
Development :New Evidence From a Large Randomized
Trial. Arch Gen Psychiatry. 2008;65(5):578-584

A recent long term study in Copenhagen found that

duration of breastfeeding was associated with significantly
higher IQ scores at 27.2 years. This study also found a
positive dose effect.
Source: Mortensen EL, Michaelsen KF, Sanders SA,
Reinisch JM. The association between duration of
breastfeeding and adult intelligence. JAMA, 2002, 287:
2365-2371.

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SLIDE

DISCUSSION
Both short- and long-term health benefits are gained by
mothers who breastfeed.

The oxytocin released during breastfeeding helps the

uterus to return to its previous size and helps to reduce
postpartum bleeding.
Prospective cohort studies have noted an increase in
postpartum depression in mothers who do not breastfeed
or who wean early.
During the first six months after birth, if a woman is
amenorrheic and fully breastfeeding her infant, she has
about 98% protection against another pregnancy.
Source: American Academy of Pediatrics Policy
Statement: Breastfeeding and the Use of Human Milk,
originally published online February 27, 2012
Several studies have also noted an inverse relationship
between the cumulative lifetime duration of breastfeeding
and the development of chronic maternal illnesses, with
the risks for type 2 DM, rheumatoid arthritis and
cardiovascular disease being lowered when the duration
of breastfeeding is greater than 24 months compared to
12 months.
Cumulative lactation experience also correlates with a
reduction in both breast (primarily premenopausal) and
ovarian cancer.
A large prospective study on child abuse and neglect
perpetuated by mothers found, after correcting for
potential confounders, that the rate of abuse/neglect was
significantly increased for mothers who did not breastfeed
as opposed to those who did.
Source: AAP. Breastfeeding and the Use of Human Milk,
originally published online February 27, 2012

16

SLIDE

DISCUSSION
A re-analysis of data from 47 epidemiological studies in 30
countries found that the relative risk of breast cancer
decreased by 4.3% for every year of breastfeeding.
Source: Beral V et al. (Collaborative group on hormonal
factors in breast cancer). Breast cancer and breastfeeding:
collaborative reanalysis of individual data from 47
epidemiological studies in 30 countries Lancet 2002;
360: 187-95.

Dangers of artificial feeding: read slide.

Lecturer to emphasize the many risks associated with using
feeding bottles, water, formula and pacifiers both in the
hospital and later when the mother returns home. Stress
the fact that we have the responsibility to communicate
both the benefits of breastfeeding and the risks of artificial
feeding to all mothers.

Source: Breastfeeding counselling: A training course.

Geneva, World Health Organization, 1993
(WHO/CDR/93.6)

In summary, overwhelming evidence has shown that

exclusive breastfeeding protects infant health and saves
newborn lives.

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SLIDE

DISCUSSION
What then are the important feeding behaviors that can
save these infants? Strategies that we should adopt
should be those that address the following: read slide.
These practices can prevent over 75% of deaths in early
infancy and 37% of deaths in the second year.
There are currently government policies and programs in
place that specifically espouse these strategic
interventions.
Source: WHO Collaborative Study Team on the role of
breastfeeding on the prevention of infant mortality. Effect
of breast-feeding on infant and child mortality due to
infectious disease in less developed countries: a pooled
analysis. Lancet, 2000, 355: 451-455.

Here are the laws and policies that promote exclusive

breastfeeding for the first six months.

The Milk Code (Executive Order (E.O). 51) was signed by

President Cory Aquino in 1986. A couple of years later the
DOH prepared a draft Five Year Plan (1988-1992) for
Breast-feeding Promotion in the Philippines and in 1992
the Senate approved the Rooming-in and Breastfeeding
Act, which served as the legal basis for the Mother Baby
Friendly Hospital Initiative (MBFHI).
Highlights of RA 10028:
Lactation Station and breastfeeding break in the
workplace
IYCF/breastfeeding integration into the curriculum
August designated as Breastfeeding Month
Encouraged hospitals/health facilities to establish Human
Milk Bank

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SLIDE

DISCUSSION
After very successful and energetic implementation of the
MBFHI in the 1990s, compliance began to slip, for the
reasons described earlier. In the early 2000s there was
little training or assessment activity. Following adoption of
the Global Strategy for IYCF and development of the
Philippines National Plan of Action for Infant and Young
Child Feeding (IYCF), a retrospective study done indicated
that the backsliding was substantial. As a result, new
guidelines for implementing MBFHI were prepared, using
the newly revised global BFHI materials as a basis.
In 2007 an Administrative Order on the Revitalization of
MBFHI was issued. Work has begun to retrain staff in all
the target hospitals, providing them with Certificates of
Commitment while they work to achieve mother
friendly criteria and mount other hurdles. Hospitals were
given two years, until 2010, to become accredited as
mother-baby friendly. UNICEF helped to encourage an
innovative agreement with the Philippine Health Insurance
Corporation (PhilHealth), which will require that hospitals
wanting PhilHealth accreditation (and thus financial
support) will first need to be designated mother-baby
friendly.
In 2008, the MNCHN Strategy was put forward in AO 0029,
to reduce maternal and neonatal mortality rates faster
from 2007 to 2015 to meet MDG targets
In an effort to improve maternal and newborn health in
the Philippines, DOH issued an administrative order to
implement the Essential Newborn Care (ENC) protocol
with the goal of rapidly reducing the number of newborn
deaths in the Philippines.
The Revised Policy on Micronutrient Supplementation
reviewed and updated the previous policy on targetting
and prioritization of micronutrient supplementation, with
the aim of contributing to the overall improvement of
nutritional status of Filipinos.
The PhilHealth Benchbook laid out basic concepts on the
value of quality assurance in health care and how
continuous quality improvement is supported by
accreditation.
In order to ensure the implementation of R.A. 7600 or
The Rooming-in and Breastfeeding Act of 1992,
PhilHealth required its accredited hospitals to be MotherBaby Friendly Hospital.
The latest PhilHealth circular on the newborn and
maternity care packages have already incorporated the
recommendations of the Essential Intrapartum and
Newborn Care protocol to offer incentives to health
facilities to provide safe and quality care for mothers and
19
newborns.

SLIDE

DISCUSSION

The Integrated MNCHN Service Package incorporates the

following:
Health Financing to increase resources using combined
financing strategies from DOH, LGUs plus PhilHealth
Health Service Delivery health services and
interventions including BEmONC and CEmONC
Health Regulation - measures and guidelines for health
facilities and health staff
Governance for Health mechanisms for efficiency,
transparency and accountability and prevent opportunities
for fraud.
Under the present administration, we have the Aquino
Health Agenda (AHA) which added 2 more components:
Human Resources for Health ensure access to
professional health care providers
Health Information establish a modern information
system
The various programs under the MNCHN Strategy all seek
to give every mother and every child the right access to
healthcare from pregnancy through childbirth, the
neonatal period and childhood.
Read slide.

20

SLIDE

DISCUSSION
The evidence-based set of EINC practices provides safe &
quality essential maternal & newborn care for a happy
birthing experience.
Health Professionals and health facilities will stop
practicing unnecessary medicalized practices and use the
DOH/WHO protocol for low-risk, evidence-based
intrapartum & newborn care that protects and saves lives.

The 4 Core Steps of EINC are:

1. Immediate and Thorough Drying
2. Skin-to-Skin Contact
3. Properly Timed Cord Clamping
4. Non-separation of the Newborn from the Mother for
Early Initiation of Breastfeeding
This diagram shows the key interventions and settings of
the IYCF Program:
Strategies:
1. Partnerships with NGOs and GOs in the
coordination and implementation of the IYCF Program
2. Integration of key IYCF action points in the MNCHN
Plan of Action/Strategy
3. Harnessing the executive arm of government to
implement and enforce the IYCF related legislations
and regulations (EO 51, RA 7200 and RA 10028)
4. Intensified focused activities to create an
environment supportive to IYCF practices
5. Engaging the Private Sector and
International Organizations to raise funds for the
scaling up and support of the IYCF program
The IYCF Strategic Plan of Action upholds the several
guiding principles:
1. Children have the right to adequate nutrition and access
to safe and nutritious food
2. Mothers and Infants form a biological and social unit
and improved IYCF begins with ensuring the health and
nutritional status of women.
3. Almost every woman can breastfeed provided they
have accurate information and support from their families,
communities and responsible health and non-health
related institutions during critical settings and various
circumstances including special and emergency situations.
4. The national and local government, development
partners, NGOs, business sectors, professional groups,
academe and other stakeholders acknowledges their
responsibilities and form alliances and partnerships for
improving IYCF with no conflict of interest.
5. Strengthened communication approaches focusing on
behavioral and social change is essential for demand
21
generation and community empowerment.

SLIDE

DISCUSSION
The IYCF strategy seeks to deliver the following outcomes
by 2016. Read slide.

Recognizing the need to strengthen breastfeeding in the

country, the DOH has embarked on an exclusive
breastfeeding campaign, and this is the Breastfeeding
TSEK program.

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SLIDE

DISCUSSION
On February 23, 2011, the Department of Health (DOH)
launched the exclusive breastfeeding campaign dubbed
Breastfeeding TSEK: (Tama, Sapat, Eksklusibo). The
primary target of this campaign is the new and expectant
mothers in urban areas. This campaign encourages
mothers to exclusively breastfeed their babies from birth
up to 6 months. Exclusive breastfeeding means that for
the first six months from birth, nothing except breast milk
will be given to babies. The campaign also aims to
establish a supportive community, as well as to promote
public consciousness on the health benefits of
breastfeeding.

This joint program aims to complement the national

government's efforts to promote infant and young child
feeding (IYCF), focusing on the creation of an enabling
environment where breastfeeding is
protected, promoted, and supported by the community as
a whole.
Specifically, the joint program's target outcomes are:
Increased exclusive breastfeeding rate by 20% annually
in 6 joint programme areas
Reduced prevalence of undernutrition among 6-24
months old by 3% in 2011
Improved capacities of the national government, local
governments, employers and workers, and other
stakeholders to formulate, promote, and implement
appropriate policies and programs on IYCF

The Department of Health developed a comprehensive

framework for Infant and Young Child Feeding the
breastfeeding and complementary feeding national
program targets the above mentioned settings and this is
a key strategy to ensure the success of the program. This
diagram shows the many ways that the LGUs can support
the Breastfeeding TSEK Program.

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SLIDE

DISCUSSION
What needs to be done? The following are the key action
steps to integrate Breastfeeding TSEK in the local
governement setting. Read slide.

Read slide.

Examples of LGU initiatives in the Breastfeeding TSEK

campaign.

24

SLIDE

DISCUSSION
Examples of LGU initiatives in the Breastfeeding TSEK
campaign.

Quezon City was the first to embrace the Breastfeeding

Welcome Here program with the launching of its very
first breastfeeding station located at the Inner Ground
floor of Legislative Building, Quezon City Hall on 13 March
2012. Bacolod Chicken Inasal, New Kamameshi House,
Tropical Hut Hamburger, Maxs Restaurant, and Serye
Cafe Filipino were the first five restaurants in Quezon City
who signed up in the Breastfeeding Welcome Here
program in support of Breastfeeding TSEK. QC Vice Mayor
Joy Belmonte led the hanging of the decals to let people
know that breastfeeding is welcomed in these restaurants.

In Pembo, Makati, a peer counseling intervention was

developed to target mothers with infants less than 2
months of age who were not exclusively breastfeeding or
had difficulty breastfeeding. This was done to counter
widespread misinformation and improve breastfeeding.
Results showed the number of exclusively formula-fed
infants decreased seven-fold, and mixed-fed infants
decreased 37%. Overall, of the 148 nonexclusively
breastfeeding infants, 69.5% had changed feeding
methods after 3 home visits, 76% of whom to exclusive
breastfeeding. Community-based peer counseling was
associated with a drastic improvement of exclusive
breastfeeding practices. This intervention evolved and
became sustainable by engaging political figures, cities,
and communities throughout the process.
Source: Salud et al. People's Initiative to Counteract
Misinformation and Marketing Practices: The Pembo,
Philippines, Breastfeeding Experience, 2006 . J Hum Lact.
25(3):341-349.

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DISCUSSION
Peer counselor trainings.

Peer counselors also form the core of the breastfeeding

support group at the barangay level. Supportive
supervision and mentoring by health staff of the peer
counselors will help sustain the commitment. The
counselors conduct house-to-house visits and holds
regular monthly meetings with midwives to process
experiences in actual counseling.

The TSEKlist Card is given to the mothers so that they can

present this to the health facility where they will give
birth, to ensure that the DOH/WHO protocol is followed.
It also tracks the feeding practices of the mother in the
first 6 months of the babys life.

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SLIDE

DISCUSSION
Advocacy kits and materials are to be issued by the
different collaborating government agencies.
The medical and allied professional societies are strong
and active bodies that can be engaged to participate in
the development of the monitoring scheme within their
ranks and in health facilities. They are a good resource in
the development of schemes for MBFHI and related
technical matters. Working arrangements/contracts may
be forged to seal responsibilities and partnerships.
Representatives from the professional societies will
constitute the Speakers Bureau which will be organized
for the information dissemination/awareness campaign on
the Milk Code, the Expanded Breastfeeding Promotion Act
and the Policies on IYCF.

The following are strategies that can sustain the

Breastfeeding TSEK Program in the community.
Read slide.

Health professionals should all make a concerted effort to

promote breastfeeding and to ensure that the Milk Code is
strictly observed.

27

SLIDE

DISCUSSION
We should be aware of misleading campaigns that
undermine breastfeeding, and we should educate the
public accordingly regarding its benefits.

Educational material is available and examples are as

follows.

The campaign recognizes outstanding IYCF champions

especially in LGUs.
Having all of these in place will ensure that reduction of
child mortality and morbidity can be attained through
optimal feeding of infants and young children.

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SLIDE

DISCUSSION
Thank you.

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