Childhood

WASHINGTON, June 22 /U.S. Newswire/ -- An Academy for Educational Development project significantly improved child health in five countries, as measured by double-digit gains in key breastfeeding practices.

Geneva - Some 90 million girls are being excluded from primary schools around the world because of outdated stereotypes defining a female's place as in the home and social pressures for early marriage, the United Nations said.

Aim: To assess the quality of counselling provided to mothers through the programme to prevent mother-to-child transmission (PMTCT) of HIV in South Africa.

Dr Libertina Amathila, Minister of Health and Social Services has launched the National Policy on Infant and Young Child Feeding in Windhoek.

More and more children in southern Africa have been orphaned by AIDS. Most are cared for by their extended families and many have to move to a new community. Researchers from UK's Brunel University look at how orphans cope with these changes and identify ways to support successful migration of AIDS orphans.

Executive Summary ----------------- In South Africas public sector maternity services, injectable progestogen-only contraceptives (POCs) have been typically administered immediately after delivery to women choosing to use these methods. POCs are hormonal methods, which contain a progestogen similar to the natural hormone that a womans body makes. POCs have been approved as a safe and effective contraceptive method by major international regulatory bodies such as the Federal Drug Administration (FDA) of USA, and the International Planned Parenthood Federation (IPPF) as well as locally, by the South African Medicine Control Council. In South Africa, POCs are on the Essential Drug List for Primary Health Care. This has become a popular contraceptive method amongst many women all over the world, in particular in South Africa, where it comprises 49% of current method use. A series of studies arose in response to the draft South African National Contraceptive Guidelines (1999), which recommended that women be advised to delay use of POCs until six weeks postpartum. This recommendation followed the international guidelines of the WHO and the IPPF, which were based on theoretical concerns that the early transfer of small amounts of hormones to the infant through breastmilk, may affect its growth development. The studies sought to investigate the feasibility of recommending this delay in POC administration, taking into account both the mothers risk of pregnancy in the early postpartum period and her ability to return to a health service at six weeks post-delivery, to initiate a method of contraception. Studies were conducted in 2000 in Gugulethu, which is an urban area in Cape Town and in 2001, in Stellenbosch in the rural Western Cape. A further need arose to investigate and explore these issues in an area where conditions would be different to the Western Cape. Hence, a similar study was conducted in a rural area of the Eastern Cape. A site where the Health Systems Trust, active as the Initiative for Sub-District Support (ISDS) was chosen as a study area. For the purpose of this research we undertook an extensive literature review of the effects of the use of POCs on breastfed infants in the postpartum period. This literature review did not find any scientific evidence to support possible adverse effects on the infant. In addition, a quantitative survey was conducted amongst 346 women attending the child health clinic (CHC) and amongst 346 women attending the antenatal clinic (ANC) at St Patricks Hospital, in Bizana in the Eastern Cape. The women were interviewed to determine contraceptive knowledge and contraceptive use, practices concerning contraceptive use pregnancy risk in the early postpartum period knowledge of the time they are likely to become pregnant, the feasibility of delaying POC initiation access to contraceptive services with regards to time, transport and costs and breastfeeding practices and patterns of sexual activity in the postpartum period. The results of the survey were as follows: Most women were able to access health services without difficulty. Contraceptive use was low, at 29%. Six percent of women may be at risk of becoming pregnant, as they were not exclusively breastfeeding and were sexually active within the first six weeks, postpartum. Seventy-eight percent and 75% at the CHC and ANC respectively, lacked good knowledge about the time they were most fertile. Most women did not regard exclusive breastfeeding as a reliable method of contraception (40% and 47%, at the CHC and ANC respectively). Disturbingly, nearly 20% of the women experienced difficulties if they refused sexual intercourse with their husbands or partners. A workshop was held with stakeholders (Health Systems Trust and health service providers) in February 2003. The purpose of the workshop was to report on the findings in order to make recommendations regarding ways in which to improve the quality of contraceptive and other reproductive health services provided. This final report has been written on the basis of the study findings as well as feedback during this workshop. The National Contraceptive Policy Guidelines, published subsequent to this study, have been amended from the original draft and recommend that women be given a choice about the timing of post-partum POC initiation, after appropriate counselling. Arising from this study, it is further recommended that effective implementation of the guidelines require that providers counsel women appropriately about the theoretical risks of immediate post-delivery POC initiation and assist women in their assessments of postpartum pregnancy risk (i.e. their intentions regarding and ability to negotiate resumption of sexual relations their ability to use barrier method contraceptives the feasibility of exclusive breastfeeding for at least six weeks post-delivery and the feasibility of visiting a clinic six weeks postpartum to initiate a contraceptive method). POCs should be available immediately after delivery for women who choose not to delay initiation of sexual activity or for those who have no choice in delaying sexual activity. The provision of adequate information will assist women in making informed choices with respect to their reproductive health.

The Infant Feeding Association has expressed deep concerns over proposed new legislation which, in the interests of promoting breast feeding, will restrict the dissemination of information about formula or bottle feeding and will apply to product labels, advertisements and promotional material, educational material and editorial content in magazines and other media. If you're a new mom and you cannot breast feed your baby due to health reasons, you may need to start feeding your baby infant foodstuffs (formula) from a bottle. If you're a new mom and you need to go back to work, leaving your baby in a daycare facility or with a nanny or grandmother, you will either need to express milk to feed baby, or you will need to give baby formula via a bottle. What if you cannot have access to any information about formula or bottle feeding? Where do you find your information on how much and what type? From magazines? Infant foodstuff advertising? Bottle-feeding advertisements? Consumer help lines? As of next year, this type of information may be banned by a new government proposal. The proposed legislation will attempt to encourage breast-feeding by limiting access to information on bottle-feeding. The Minister of Health has drafted a white paper regarding foodstuffs (formula) for infants and young children and this could become legislation next year. With this proposed legislation, the minister has targeted labels on formula and infant feeding containers, advertisements and promotional material, educational material and editorial content in magazines and other media. What does this new legislation propose? Some of the points include: 1. Labeling on formula containers is not to show illustrations, diagrams, or graphics. 2. Formula labels are not to provide any nutritional or health information. 3. Bottle, teat and dummy labels must include a statement that cup feeding is safer for infants. 4. Manufacturers may not sell, sample or advertise products in a health establishment. 5. There may be no direct or indirect contact with the public through print media, TV, radio or the Internet. 6. No help line details may be displayed on formula labels. 7. Manufacturers may not pay for, donate or distribute educational material to health establishments. 8. Media will be curtailed in their coverage of issues relating to bottle-feeding. While the Infant Feeding Association is aware of and appreciates the benefits of breastfeeding, this legislation does pose some serious problems to South African society, and most specifically to women and children: 1. The labeling regulations suggested in the new legislation are confusing to both consumer and healthcare worker, thereby posing an even greater health risk to babies. 2. The legislation makes no mention of HIV+ mothers and the high risk of mother-to-child transmission with breastfeeding. 3. The regulations imply that without access to bottle-feeding information, mothers will have to breastfeed for the first two years of their child's life. This means that for the first few months, every two hours, a woman should be with her child in order to breastfeed. Where does this leave the country's working mothers? Is the government suggesting that women stay home instead of work? In a country where gender equality is finally becoming realized, this takes us two steps backwards. 4. The proposed Act does not take into account women who are unable to breastfeed. Neither does it consider babies who are orphaned and who do not have access to breastfeeding at all. In a country where Aids orphans are a reality, can this prejudice be allowed? 5. With the new labeling and packaging requirements, the cost of formula will increase, making it even more difficult for already cash-strapped mothers to feed their babies. 6. The price increase will also make it un-viable for top quality products to do business in South Africa, opening the gap for cheaper, inferior quality products. 7. The prohibition of advertising and the curtailment of media coverage denies mothers their right to information - information that is vital to the health and survival of their babies. 8. The prohibition of education material means that there is even less education and information in a country where we need more. 9. The curtailing of media coverage contravenes the basic right to freedom of speech in the press. 10. The legislation is stifling the growth of the infant food market, which may result in large scale job loss through restrictions on marketing. A country with already high unemployment statistics can surely not afford this? 11. The legislation suggests that in order to prevent nipple-confusion, cup feeding for babies should be promoted over bottle-feeding. According to the South African Paediatric Association's research, this suggestion is not valid. This legislation has not yet been promulgated and is currently at White Paper stage, put out for comment until the 26 December 2003. After which time, it goes forward to be drafted into a Bill and thereafter becomes legislation. It is clear that research into issues such as HIV and working women have not been considered in the drafting of this bill. We need to educate people in South Africa, giving them more options, not deprive them of choice, forcing them into a direction that, for lifestyle, health or other reasons may not be possible. What happens to a country when the government legislation contravenes the basic rights and freedoms of the people, embedded in the constitution? Is this paternalistic approach not reminiscent of the apartheid era? What we need is more, not less education. We need magazine articles, media coverage and help lines that supply accurate information and advice to the people of South Africa. We have to contest this issue in order to get the government to modify such restrictive and unrealistic legislation. The media and the public need to rally together to fight for the future mothers and babies of South Africa. (Issued by: IFA sourced through biz-community) Links //\// For more information on the regulations regarding Food Stuffs for Infants and Young Children, please contact us at: www.babyassist.co.za; ifa@baby.co.za; or call Wendy Pratt on (011) 648-7820. To read a summary of the proposed Regulations Relating to Foodstuffs for Infants and Young Children visit www.babyassist.co.za/regulations/summary.htm. Other related: Breastfeeding Ads Delayed by a Dispute Over Content http://www.nytimes.com/2003/12/04/business/media/04adcol.html Getting abreast of baby feed formulas, Sunday Tribune http://www.iol.co.za/index.php?click_id=125&art_id=qw1070175603133T655&s...

The Gelukspan Hospital, near Mafikeng, has become the first health institution to be accredited the Baby Friendly Hospital Initiative (BFHI) status in the North West. Though situated in the poverty stricken area of Gelukspan, the provincial health department said the presence of a Kangaroo Mother Care Unit in the hospital was one of the key success factors in its accreditation. The Baby Friendly Initiative is an international programme of the World Health Organisation (WHO) and the United Nations Children's Fund (UNICEF), recognising hospitals and birth centres that have taken steps to provide an optimal environment for the promotion, protection and support for breastfeeding. South Africa adopted the programme in 1994, based on the WHO/UNICEF Ten Steps to Successful Breastfeeding, in response to declining breastfeeding rates, especially in sub-Saharan Africa. Among others, the steps include that the facility must have a written breastfeeding policy with staff trained to show mothers how to breastfeed, encourage the practice, give no food or drink to newborns other than breast milk and foster the establishment of support groups in this regard.If a hospital complies with the ten steps, it is then declared a BFHI. Dr Sefularo added that he was proud of the management, staff and the hospital board of Gelukspan Hospital. He also added that he hoped the hospital was an example to other hospitals and it would encourage other centers in the province to reach such heights. (Source: BuaNews (Pretoria 15 October, 2003)