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  1. 1
    357666
    Peer Reviewed

    The Baby-Friendly Hospital Initiative 20 years on: facts, progress, and the way forward.

    Saadeh RJ

    Journal of Human Lactation. 2012 Aug; 28(3):272-5.

    The BFHI provides a framework for addressing the major factors that have contributed to the erosion of breastfeeding, that is, maternity care practices that interfere with breastfeeding. Until practices improve, attempts to promote breastfeeding outside the health service will be impeded. Although inappropriate maternity care cannot be held solely responsible for low exclusive breastfeeding rates and short breastfeeding duration, appropriate care may be a prerequisite for raising them. In many industrialized countries, BFHI activities were slow to start. Over the past 10 years and as the evidence was becoming increasingly solid and the commitment of health workers and decision makers has become stronger, considerable efforts are being made in most industrialized countries to implement the BFHI. However, coordinators of the BFHI in industrialized countries face obstacles to successful implementation that appear unique to these countries. Problems reported include opposition from the health care establishment, lack of support from national authorities, and lack of awareness or acceptance of the need for the initiative among government departments, the health care system, and parents. It is worth highlighting these facts to enable the BFHI coordinators in these countries to make well-designed and targeted plans with achievable objectives. Strengthening and scaling up the BFHI is an undisputed way to reduce infant mortality and improve quality of care for mothers and children. The BFHI has had great impact on breastfeeding practices. Reflecting new infant feeding research findings and recommendations, the tools and courses used to change hospital practices in line with Baby-Friendly criteria are available and ready to be used and implemented. Governments should ensure that all personnel who are involved in health, nutrition, child survival, or maternal health are fully informed and energized to take advantage of an environment that is conducive to revitalizing the BFHI; incorporate the basic competencies for protection, promotion, and support of optimal infant and young child feeding, including the BFHI, into all health-worker curricula, whether facility- or community-based health workers; and recognize that the BFHI has a major role to play in child survival and more so in the context of HIV/AIDS. The World Health Organization and UNICEF strongly recommend using this new set of materials to ensure solid and full implementation of the BFHI global criteria and sustain progress already made. It is one way of improving child health and survival, and it is moving ahead to put the Global Strategy for Infant and Young Child Feeding in place, thus moving steadily to achieving the Millennium Development Goals.
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  2. 2
    031138

    WHO Programme in Maternal and Child Health and Family Planning. Report of the second meeting of the WHO Programme Advisory Committee in Maternal and Child Health, Geneva, 21-25 November 1983.

    World Health Organization [WHO]. Division of Family Health. Maternal and Child Health Unit

    [Unpublished] 1984. 95 p. (MCH/84.5)

    The objectives of the 2nd meeting of the Program Advisory Committee (PAC) for the World Health Organization's (WHO's) Program in Maternal and Child Health, including Family Planning (MCH/FP) were to 1) assess the MCH/FP program's achievements since the 1st PAC meeting in June, 1982, 2) determine the level of scientific and financial resources available for the program, and 3) to examine the role of traditional birth attendants (TBAs) in the delivery of MCH/FP services. The committee reviewed the activities and targets of the program's 4 major areas (pregnancy and perinatal care, child health, growth, and development, adolescent health, and family planning and infertility), and developed a series of recommendations for each of these areas. Specific recommendations were also made for each of the major program areas in reference to the analysis and dessimination of information and to the development and use of appropriate health technologies. Upon reviewing the role of TBAs in the delivery of MCH/FP services, PAC recommended that all barriers to TBA utilization be removed and that training for TBAs should be improved and expanded. PAC's examination of financial support for MCH/FP activities revealed that for a sample of 26 countries, the average annual amount allocated to MCH activities was less than US$3/child or woman. This low level of funding must be taken into account when setting program targets. International funding agencies did indicate their willingness to increase funding levels for MCH programs. The appendices included 1) a list of participants, 2) an annotated agenda, 3) detailed information on the proposed activities of the program's headquarters for 1986-87, and 4) a description of the the function, organizational structure, and technical management of the MCH/FP program. Also included in the appendices was an overview of the current status of MCH and a series of tables providing information on infant, child, and maternal health indicators. Specifically, the tables provided information by region and by country on maternal, child, and infant mortality; causes of child deaths; maternal health care coverage; contraceptive prevalence; infant and child malnutrition; the number of low weight births; adolescent health; teenage births; breast feeding prevalence and duration; and the proportion of women and children in the population.
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  3. 3
    006162

    The role of the health sector in the development of national and international food and nutrition policies and plans, with special reference to combating malnutrition, 13th Plenary Meeting, 24 May 1978.

    World Health Assembly

    Geneva, WHA, 1978 May 24. 10 p. (WHA31.47/WHA34.22)

    The 31st World Health Assembly (WHA) has considered the Director General's report on the role of the health sector in the development of national and international food and nutrition policies and plans and endorses the functions of the health sector in this field. The WHA is convinced that malnutrition is 1 of the major impediments to realizing the goal of health for all by the year 2000, and that new approaches based on clearly defined priorities and maximum utilization of local resources are needed for a more effective action to combat malnutrition. The WHA recommends that Member States give the highest priority to stimulating permanent multisector coordination of nutrition policies and programs and to preventing malnutrition in pregnant women, lactating women, infants, and children by doing the following: 1) supporting and promoting breast feeding with educational activities to the general public, 2) legislative and social actions to facilitate breastfeeding by working mothers, 3) implementing the necessary promotional and facilitating measures in the health services and regulating inappropriate sales promotion of infant foods that can be used to replace breast milk, 5) ensuring timely supplementation and appropriate weaning practices and the feeding of young children with the maximum utilization of locally available and acceptable foods, and 6) conducting, if necessary, action oriented research to support this approach and the training of personnel for its promotion. Governments and multilateral and bilateral organizations and agencies are urged to support the proposed programs of research and development in nutrition through their technical and scientific institutions and workers and by financial contributions. A copy of the international code of marketing of breastmilk substitutes is included. The 11 articles of the code cover the following: aim and scope of the code, definitions, information and education, the general public and mothers, health care systems, health workers, persons employed by manufacturers and distributors, labelling, quality, and implementation and monitoring.
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  4. 4
    115385

    Breast-feeding: the technical basis and recommendations for action.

    Saadeh RJ; Labbok MH; Cooney KA; Koniz-Booher P

    Geneva, Switzerland, World Health Organization [WHO], 1993. vii, 119 p. (WHO/NUT/MCH/93.1)

    This World Health Organization (WHO) publication was prepared to provide current technical information and recommendations to policymakers and program planners involved in the promotion of breast feeding. This book summarizes the discussions and recommendations that grew out of the 1990 WHO/UNICEF Technical Meeting on breast feeding. The first chapter presents a technical overview of global breast-feeding prevalence and trends for each WHO region (Africa, the Americas, the Eastern Mediterranean, Europe, Southeast Asia, and the Western Pacific). Chapter 2 looks at the practices related to breast feeding in maternity care services and in postnatal services. The implementation of programmatic changes to support breast feeding as well as cost issues are also considered. The third chapter provides a technical overview of lactation management training as well as a comment on program implementation. Chapter 4 considers the role of breast-feeding support groups from a technical and implementation viewpoint. Chapter 5 is devoted to issues of information, education, and communication in support of breast feeding as well as examples of program implementation in Brazil, Iran, Guatemala, Australia, and Kenya. Specific problems in implementation are also covered. The final chapter discusses breast feeding in working situations and covers such issues as maternity and child care entitlements on the international, national, community, and individual levels as well as cost issues. Each chapter contains specific recommendations, referrals for further reading, and references (if applicable). The Innocenti Declaration on the Protection, Promotion, and Support of Breastfeeding is annexed to the volume.
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  5. 5
    077002
    Peer Reviewed

    Reproductive health: a global overview.

    Fathalla MF

    ANNALS OF THE NEW YORK ACADEMY OF SCIENCES. 1991; 626:1-10.

    WHO defines reproductive health as people having the ability to reproduce, to regulate fertility, and to practice and enjoy sexual relationships. It also means safe pregnancy, child birth, contraceptives, and sex. Procreation should include a successful outcome as indicated by infant and child survival, growth, and healthy development. 60-80 million infertile couples live in the world. Core infertility, i.e., unpreventable and untreatable infertility, ranges from 3% to 5%. Sexually transmitted diseases, aseptic abortion, or puerperal infection are common causes of acquired infertility. Sub-Saharan Africa has the highest prevalence of acquired infertility. In 1983, the world contraceptive use rate stood at 51% with the developed countries having the highest rate (70%) and Africa the lowest rate (14%). About 40 countries in Africa and the Arabian Peninsula practice female circumcision. The percent of low birth weight infants is greater in developing countries than in developed countries (17% vs. 6.8%). Intrauterine growth retardation is responsible for most low birth weight infants in developing countries while in developed countries it is premature birth. About 15 million infants and children die each year. Maternal mortality risk is highest in developing countries especially those in Africa (1:21) and lowest in developed countries (1:9850). Sexually transmitted diseases continue to be a major problem in the world especially in developing countries. Chlamydia afflicts 50 million people each year. The proportion of women with AIDS is growing so that between the 1980s and 1990s it will grow between 25% and 50%. More available contraceptive choices enhance safety in fertility regulation. Socioeconomic conditions that determine reproductive health are poverty, literacy, and women's status. Sexual behavior, reproductive behavior, breast feeding, and smoking are life style determinants of reproductive health. Availability, utilization, and efficiency of health care services and level of medical knowledge also determine women's reproductive health.
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  6. 6
    055652

    Breastfeeding as an intervention within diarrhea diseases control programs: WHO/CDD activities.

    Hogan R; Martines J

    In: Proceedings of the Interagency Workshop on Health Care Practices Related to Breastfeeding, December 7-9, 1988, Leavey Conference Center, Georgetown University, Washington, D.C., edited by Miriam Labbok and Margaret McDonald with Mark Belsey, Peter Greaves, Ted Greiner, Margaret Kyenkya-Isabirye, Chloe O'Gara, James Shelton. [Washington, D.C., Georgetown University Medical Center, Institute for International Studies in Natural Family Planning, 1988]. 13 p.. (USAID Contract No. DPE-3040-A-00-5064-00)

    The World Health Organization's (WHO's) Control of Diarrheal Diseases Program (CDD) is seeking ways to prevent diarrhea and has identified breastfeeding as an important factor. CDD has developed activities in both its research and services components. In the research component, results from recent studies, some of which received support from the program, have shown the strong protective effect of breastfeeding against diarrheal morbidity and mortality. Exclusively breastfed infants are at lower risk of experiencing diarrhea than infants who are partially breastfed, and those who are partially breastfed are at lower risk than those who are not breastfed. Breastfeeding, which also may reduce the severity of the diarrheal illness, has a powerful effect on the risk of diarrhea-associated death. CDD's priorities for research support in the area of infant feeding were reviewed at an April 1988 meeting. Further research that the program feels is needed falls into 2 broad categories: trials of hospital and community-based interventions that aim to promote exclusive breastfeeding in the 1st 4-6 months of life; and evaluation of approaches for implementing tested breastfeeding promotion interventions in the context of national diarrheal disease control programs. CDD's services component has as its basic responsibility collaboration with countries in developing national control programs. It applies the results of research and involves activities in planning, oral rehydration solution (ORS) supply, training, communication, monitoring, and evaluation. It is in the area of training that specific recommendations on breastfeeding have been made. These recommendations are outlined. The training courses are being used to train approximately 5000 supervisory and management staff a year. The program plans to monitor the effectiveness of the training and develop future activities based on that information.
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  7. 7
    055657

    Technical Working Group D report: government and donor support for breastfeeding in health and health-related programs.

    Dabbs C

    In: Proceedings of the Interagency Workshop on Health Care Practices Related to Breastfeeding, December 7-9, 1988, Leavey Conference Center, Georgetown University, Washington, D.C., edited by Miriam Labbok and Margaret McDonald with Mark Belsey, Peter Greaves, Ted Greiner, Margaret Kyenkya-Isabirye, Chloe O'Gara, James Shelton. [Washington, D.C., Georgetown University Medical Center, Institute for International Studies in Natural Family Planning, 1988]. 3 p.. (USAID Contract No. DPE-3040-A-00-5064-00)

    The focus of the working group was to design a general strategy for government and donor support for breastfeeding promotion in health-related and other nonmaternity health programs. As a start, it is important to examine the reasons why government and donor agencies accept or reject programs to support. 3 steps must be followed for governments to accept breastfeeding: statistics showing declines in breastfeeding within the country need to be gathered; the benefits to the country of promoting breastfeeding would have to be demonstrated; and the link between increased breastfeeding and the decrease in child morbidity and mortality also would have to be demonstrated along with the fact that breastfeeding promotion programs can be done. Both economic arguments and data are necessary. For donor agencies to accept and promote breastfeeding enthusiastically, the benefits of breastfeeding should be shown to be synergistic with benefits from other donor priorities. 2 particular gaps in breastfeeding promotion that would be likely to garner donor support are training and communications. Regional centers for breastfeeding information, advanced training, even newsletter publication would be invaluable. Further, donor agencies could support projects like a review of textbooks and the effective distribution of donor publications.
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  8. 8
    055654

    Breastfeeding promotion in family planning programs.

    Jennings VH

    In: Proceedings of the Interagency Workshop on Health Care Practices Related to Breastfeeding, December 7-9, 1988, Leavey Conference Center, Georgetown University, Washington, D.C., edited by Miriam Labbok and Margaret McDonald with Mark Belsey, Peter Greaves, Ted Greiner, Margaret Kyenkya-Isabirye, Chloe O'Gara, James Shelton. [Washington, D.C., Georgetown University Medical Center, Institute for International Studies in Natural Family Planning, 1988]. 7 p.. (USAID Contract No. DPE-3040-A-00-5064-00)

    The US Agency for International Development (USAID) and the Institute for International Studies in Natural Family Planning are at work to find ways to remove barriers to family planning breastfeeding promotion efforts. Barriers include lack of or conflicting measures of program success along with lack of information on the breastfeeding/fertility relationship. The 2 organizations have taken the following steps to assist family planning organizations to increase their promotion and support of breastfeeding: identify current activities and potential barriers to breastfeeding promotion; develop guidelines for breastfeeding support and promotion; assess feasibility and impact of the guidelines; and disseminate the guidelines. Much remains to be done to integrate family planning and breastfeeding. The keys to success are: generating and communicating information which can be used readily by both the population and health policymakers in family planning programs; developing and disseminating guidelines and prototype materials which can be adapted to program needs; identifying, implementing, and evaluating programmatic ways to promote breastfeeding in community and clinical settings; and involving the population community -- at the local, national, and international levels, and in research, service delivery, policy, and training -- in an ongoing dialogue about the relationship of family planning and breastfeeding.
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  9. 9
    046823

    The state of the world's children 1988.

    Grant JP

    Oxford, England, Oxford University Press, 1988. [9], 86 p.

    The 1988 UNICEF report on the world's children contains chapters describing the multi-sectorial alliance to support child health, the current emphasis on ORT and immunization, the effect of recession on vulnerable children, family rights to knowledge of basic health facts, and support for women in the developing world. Each chapter is illustrated by graphs. There are side panels on programs in specific countries, including Senegal, Syria, Colombia, Bangladesh, Turkey, India, Honduras, Japan and Southern Africa, and highlighted programs including immunization, AIDS, ORT, breast-feeding and tobacco as a test of health. The SAARC is a new regional organization of southern Asian countries committed to immunization and other health goals. Tables of health statistics of the world's nations, divided into 4 groups by "Under 5 Mortality Rate" present basic indicators, nutrition/malnutrition data, health information, education, literacy and media data, demographic indicators, economic indicators and data pertaining to women. The absolute numbers of child deaths had fallen to 16 million in 1980, from 25 million in 1950. Saving children's lives will not exacerbate the population problem because, realizing that their children will survive, families will have fewer children. Furthermore, the methods used to reduce mortality, such as breast feeding and empowerment of families to control their lives, are known to reduce fertility.
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  10. 10
    023378

    The WHO Diarrhoeal Diseases Control Program: the practical application of oral rehydration therapy.

    Merson MH

    [Unpublished] 1983. Presented at the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C. 11 p.

    3 aspects of oral rehydration therapy (ORT) have to be considered in evaluating its potential importance as a priority primary health care intervention. First, studies have proven that ORT is safe and effective. Second, the World Health Organization (WHO) and UNICEF have established a recommended approach to ORT delivery. This includes early therapy in the home with appropriate household solutions, use of OR salts (ORS) for treatment of dehydration at health centers and hospitals and by village health workers, and the provision of backup support with intravenous therapy at larger health centers and hospitals. A universal rehydration solution has been adopted as well, consisting of sodium chloride 3.5 gm, sodium bicarbonate 2.5 gm, potassium chloride 1.5 gm, dissolved in 1 liter of water; this solution is also appropriate for maintenance although its sodium concentration may be too high for use in infants. Studies have shown that dehydrated infants receiving a solution lacking potassium had prolonged hypokalemia compared with those receiving ORS solution. It is now known from experience in many countries that ORT using ORS solution can be readily implemented in health facilities and has also been shown to lead to a signicant decline in the use of intravenous fluids and case-fatality rates in hospitals and health centers. In Calcutta the efficacy of a solution made from cooked rice powder was compared in dehydrated infants with the standard ORS solution and one to which glycine was added. Both the rice-based ORS and that containing glycine resulted in a 40% decrease in stool output compared with the standard ORS solution; thus it might be possible to achieve a good result by using a rehydration solution that enhances fluid absorption in the intestine. Almost all typical home remedies for diarrhea lack the needed potassium chloride and sodium bicarbonate and are therefore not ideal but can be used in situations where ORS is not available. The 3rd aspect of ORT is its relationship to other factors in clinical management, namely the replacement of calories lost during the diarrhea episode. A recent WHO study estimated that in 1980 there were up to 1 billion diarrheal illnesses resulting in 4.6 million deaths in Africa, Asia, and Latin America, and that the highest incidence and mortality rates were in the 1st 2 years of life. The WHO diarrheal disease control program has 2 components, health services and research. In the health services area, the maternal and child health and environmental health strategies promote exclusive breastfeeding for the 1st 4-6 months of life, and continued breastfeeding up to at least 2 years of age, and the addition of locally available semisolid foods from age 4-6 months, as well as the use of clean water and hygienic food practices. Health education and information materials are also being produced.
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