::: O.N.G. RUANDI :::

A woman’s choice about how best to feed her child is a personal one. However, as no woman lives in isolation, her decision is influenced by many factors. Family members, health workers, the media, religious institutions, social traditions, the work place and her own education can all have a bearing on her decision to breastfeed - as well as her ability to continue breastfeeding for the optimal length of time.

Every woman should be able to count on full support from those around her to enable her to initiate and sustain breastfeeding. It is the responsibility of the entire community to see that the best possible nutrition and health is available to all of its members, beginning with its youngest.

A community is the people nearby - in the family, neighbourhood, at work, and in the town. People all around join to support the breastfeeding mother. Your community can be a vehicle for change.

Women feel supported when the community welcomes them to breastfeed in public, provides help to overcome difficulties, offers facilities to breastfeed at the work place; and when health professionals take an ethical stand against the promotion of breastmilk substitutes and use their influence to support women to breastfeed.

The theme for World Breastfeeding Week 1996, Breastfeeding: A Community Responsibility provides an opportunity for us all to evaluate our own communities and the attitudes expressed, to see if
we are indeed supportive of breastfeeding. In this action folder, designed to give you some solid ideas about WBW activities that you can organise in your own community, we will explore the Triple-A model for advocacy.

First, ASSESS, or look at the situation around you. Talk to people about how infant feeding decisions are made - talk not only with mothers, but with health workers and family members. Find out just
how far support for breastfeeding goes in health care facilities and in the work place. Try to establish how much people really understand aboutthe importance of breastfeeding, not just for the child and the mother, but for the entire community.

Once you have gathered your impressions, ANALYSE or think about what you have discovered. Are there gaps? Contradictions? Is there misinformation? Prejudice? Also look at your positive findings. Are there any areas that work very well? What makes them so successful? Which practices or people help mothers to
breastfeed?

Design activities based on what you have found. If mis-information exists, organise training programmes to set it right. If support groups for breastfeeding mothers do not exist, see if you or a local organisation might start one. Talk to decision-makers in health facilities, religious and educational institutions and government to point out the gaps and work with them to design ways to fill the gaps.

Talk about breastfeeding and listen to what is said. Look around your community. Everybody from shopkeepers to religious leaders, factory owners to policy makers can help to ensure that children
can benefit from breastfeeding. The following sectors of your community can play a role in influencing attitudes and promoting child health.

Talk to people to learn about how they see breastfeeding. Use the questions in the next section as a guideline, though you may choose to modify the questions to suit your particular situation.
The sample questions are designed to help you gather information, perhaps by making up a checklist or writing down your observations. The “assessment process” tells you what is going on. In conducting
this exploration, refrain from judgment. You will have time for this in the analysis phase.

How do young people learn about breastfeeding?
How early do the influences begin?
Do dolls in children’s pre-school play area come with bottles?
Do secondary schools and colleges cover breastfeeding in biology or health classes?
Is there support for young mothers who continue to attend school?

What we know...

Most children are not exposed to breastfeeding or any form of breastfeeding instruction in school. A teenage mother will receive little support in breastfeeding from her school. Medical curriculum generally gives little or no attention to the science and practice of breastfeeding.

Family

Do family members understand the need to help with household chores when a mother is breastfeeding?
Do they realise that a breastfeeding mother needs extra food and extra rest?
Do grandmothers and mothers-in-law appreciate and support the decision made by mothers to breastfeed?
Do fathers understand that there are many opportunities for bonding in addition to feeding an infant, such as bathing, cuddling and burping?

What we know...

A survey of 115 UK mothers has shown that the partner’s attitude to breastfeeding is the biggest factor influencing feeding decisions.
If the father approved of breastfeeding, three quarters of infants were totally breastfed; if the father was indifferent or disapproving, the proportion fell to less than 10%.
Other members of the family and friends, a new mother’s mother may also have a positive influence by being supportive.
Breastfeeding improves household food security. Breastfeeding is total food security for infants up to about six months of age.
An important calculation which has often been ignored, is that of the contribution to the world’s food supply of human milk. Millions of tonnes of additional breastmilk would be produced if infants were breastfed in their first 4-6 months and were continued to be breastfed, right through their second year.

Restaurants • Business • Public Places

Does a women feel comfortable breastfeeding her baby in public eg. in buses, shopping centres?
Do waiters and owners in restaurants understand that babies too must have their meals?
Do shops selling breastmilk substitutes have any understanding of the Code?

What we know...

Breastfeeding in public is often met with disapproval.
Breastfeeding is a woman’s right and a child’s right. Creative steps to make it acceptable are vital. In 1994, UNICEF commended a US restaurant for encouraging women to breastfeed.
At the Soekarno International Airport in Jakarta, Indonesia, the feeding bottle symbol has been replaced with an image of a breastfeeding mother.
A bank in Brazil produced a credit card for members of the National Pediatric Society featuring a colour photograph of a breastfeeding infant.

What we know...

Radio, television and newspapers have powerful influence on our opinions and relationships with others. We can work with the media to create supportive environments for breastfeeding.
In Slovakia, a magazine called Child has agreed to publish one article about breastfeeding in each issue provided by the NGO, Pro Vita.
In South Africa, a cartoon booklet ‘Maria’s New Baby’ designed to promote the benefits of breastfeeding has been adapted into radio script.
In Sweden, sports celebrities are helping to promote breastfeeding with a famous hockey player and his family appearing on a poster with the caption “Breastfeeding: the best goal!”
Some parents and family magazines no longer advertise breastmilk substitutes, although images of bottles are slower to disappear.

Health Facilities • Health Workers

Are the hospitals and maternity clinics in your community baby-friendly?
Is breastfeeding discussed at pre-natal programmes?
How informed are members of the staff? Is there any post-natal support for breastfeeding, particularly once a woman has returned to her home?
Does the hospital accept free supplies of breastmilk substitutes or distribute sample to mothers?
Can a woman who is having trouble breastfeeding turn to the health facility for help?

What we know...

To date, more than 4000 hospitals throughout the world are baby-friendly and 170 countries participate in the Baby-Friendly Hospital Initiative (BFHI).
Initiation of breastfeeding soon after birth is crucial for successful breastfeeding and requires the full support of health personnel attending birth. Possibly the single most disabling factor for breastfeeding mothers is the lack of support from health professionals coupled with the lack of accurate information and sometimes just plain misinformation.
Hospital practices and routines often interfere with the establishment of breastfeeding.
Health professionals have not been taught how lactation works, how to help women “latchon” their babies so nipples don’t get damaged or how to solve brestfeeding problems.
Well-meaning hospital staff, doctors and pharmacists may give new mothers gift packs with formula samples, bottles, teats and formula-company produced ‘breastfeeding’ information. Along with samples comes a not-so subtle message that breastfeeding women also should use ‘formula’.

Social Groups • Clubs • Organisations

Do any clubs or social organisations in your community offer breastfeeding support?
How are breastfeeding support groups promoted?

What we know...

Step 10 of the “Ten Steps to Successful Breastfeeding” is “Help start breastfeeding support groups and refer mothers to them”.
La Leche League International started in 1956 when a group of seven women got together to discuss their breastfeeding experiences. Today, support groups like La Leche League, Susu Mamas, IBFAN groups and ILCA provide crucial support to mothers outside of the health system. La Leche League has more than 8,000 certified leaders who reach over 100,000 women each month in more than 60 countries.
In Norway, where close to 100% of mothers initiate breastfeeding, and more than 80% of babies are exclusively breastfed at three months, mother support groups are an important complement to the services of health care institutions.

Religious Institutions

Is breastfeeding understood and supported by religious leaders? If so, which ones?
How does the institution encourage breastfeeding support groups?
Does it lend its space or help organise meetings?
Are breastfeeding women made to feel welcome at religious services?

What we know...

Breastfeeding is approved as a family planning method in many cultures and religions. In Buddhist tradition, the father is responsible for providing the best nutrition for the mother while she is breastfeeding. The Quran specifies that a baby be breastfed for two years and that the health of the mother be a priority in the family..

Government

Is there a national breastfeeding committee?
Does the Ministry of Health have any policies regarding breastfeeding?
Do welfare mothers receive support for breastfeeding in the form of extra food?

What we know...

The Innocenti Declaration called upon all governments to appoint a national breastfeeding coordinator and to establish a “multisectoral national breastfeeding committee composed of representatives from relevant government departments, non-governmental organisations and health professional associations".
The International Code of Marketing of Breastmilk Substitutes requires that there be no words or pictures idealising artificial feeding, including pictures of infants on labels of products.
In India, one of 24 countries to have implemented the Code, the Infant Milk Substitutes, Feeding Bottles and Infant Foods Act came into effect in 1993 and aims to regulate distribution and promotion of these products to ensure they do not interfere with breastfeeding.

Work Place

How mother-friendly is the work place?
Is there an on-site or nearby creche?
Are women allowed breaks for breastfeeding?
Are clean and private facilities available for women who want to express milk?

What we know...

The International Labour Office’s minimum standards require 12 weeks of maternity leave with cash benefits amounting to at least 66% of previous earnings, prohibition of dismissal during maternity leave, and once a woman has returned to work, two half-hour breastfeeding breaks during each working day.
The 1990 ‘Innocenti Declaration’ and 1995 ‘Platform for Action’ from the UN World Conference on Women, called on all governments to protect the breastfeeding rights of working women.
Employers in countries such as Guatemala, Swaziland and Mauritius have set up creches for breastfed babies setting an example to other employers to become mother-friendly work places.

The goal of a baby-friendly community will be reached through a series of actions, education and public awareness, changes in the work place, eliminating the damaging influence of infant formula promotion. These larger goals can be helped by activities that you can undertake in your own community.

Promotions and correct information in the community can increase
family and friends knowledge about breastfeeding. Supporting a
breastfeeding mother can include:

This action folder was produced by Renee Hefti, UNICEF
New York, WABA Information Task Force and the WABA
Secretariat. Many thanks to all who reviewed this folder, and
specially to UNICEF for its support to WABA.