IBFAN AFRICA

The global Breastfeeding Initiative for Child Survival (gBICS): a key intervention to reduce child mortality and improve children’s health.


The global Breastfeeding Initiative for Child Survival is a worldwide civil society-driven initiative aiming to accelerate progress in attaining the health-related Millennium Development Goals (MDGs) by 2015, especially Goal 4, reduction of child mortality, by scaling up early, exclusive and continued breastfeeding.

The Goal of the gBICS Programme is to ensure that breastfeeding protection, promotion and support be further recognised as an essential and effective strategic set of interventions to reduce child mortality and improve children’s health.
The Purpose of the gBICS Programme is to contribute to reduction in child malnutrition and improvement in infant and young child survival, health and development through improved infant feeding practices.

Why do we need the gBICS?

The UNICEF 2008 report on Tracking Progress in Maternal, Newborn & Child Survival concluded that early initiation and exclusive breastfeeding are some of the “nutritional indicators that require social and behavioural changes in order to improve” .
The gBICS is a programme designed to have an impact on social habits and modify behaviour by presenting the complex reality of infant feeding as an enticing invitation to decision makers and stakeholders to participate in a collective endeavour: building a home fit for breastfeeding.

Why is civil society the moving force behind the gBICS?

The mobilising power of NGOs

The gBICS aims at being considered as a development partner with governments in the field of infant and young child feeding, especially in the countries with the highest burden of maternal and child mortality. The gBICS is already a joint Programme with the two largest networks of breastfeeding advocates: IBFAN and the World Alliance for Breastfeeding Action, WABA. The gBICS foresees that other influential actors will join in, particularly those highly skilled in one to one counselling: La Leche League, the International Lactation Consultants and the professional associations of midwives, nurses and medical doctors. These actors, like IBFAN, are already Core Partners in WABA and will thus bring their own resources to join the coordinated action. Through their large networks and outreach to international and national NGOs, IBFAN and its organisational partner, WABA, can mobilise public opinion and the media to bring pressure on governments to take action to achieve the health-related MDGs.

Avoidance of conflict of interest

The participating NGOs bring particular value-added to the gBICS through their firm stand on the need to avoid or carefully manage conflicts of interests. The influence of the baby food industry in research, the medical profession and in policy-setting is pervasive, both through direct sponsorship and the through Public-Private for profit Partnerships (PPfpPs). In this sense, one of the principles proclaimed by the gBICS is:

> The need to protect the public interest. Policies and programmes on infant and young child feeding can be designed, developed and implemented in the public interest only if professionals and institutions/organizations responsible for them engage in informed decision-making. This means applying principles of transparency and putting safeguards in place that eliminate unacceptable conflicts of interests and also permit to manage appropriately those that cannot be avoided. Avoidance and/or adequate management of conflicts of interests apply equally to protection of integrity of scientific research, objectivity of professional education and quality of care/counseling/advice. We thus also analyze situations of conflicts of interests created by corporate sponsorship of conferences, meetings, workshops and call on organizers to critically reflect on sources of financing that create conflicts of interests.

The need to assess before taking action:

The World Breastfeeding Trends initiative (WBTi) is an action-oriented assessment tool designed to have a positive impact on infant and young child feeding policies and practices by launching a participatory process in each country.
 
The gBICS uses the Results and Reports of the WBTi to organise and galvanise action at national level. Publication of these country assessments of the State of Breastfeeding is followed by public debate to assign priorities in the areas that need improvement and action. The outcome focuses on a set of recommendations of measurable results that will be monitored and re-assessed to see the extent in which the priority areas for action show any real improvement. The gBICS acts in conformity with the findings of the Countdown to 2015 report.

The global Breastfeeding Initiative for Child Survival (gBICS): a symbolic house to protect infant health

By using the model of a house (or other form of dwelling – why not a nomad’s yurt?) the gBICS aims to demonstrate the need for a series of elements to be in place, so that the construction stands firm. It is made of three floors or stories, with firm foundations and with a protective roof made of comprehensive national policies and programmes.

Please Click on the diagram below to ENLARGE IT 

Built on solid rock
The gBICS is grounded in a human rights-based approach . This means that all planned activities and intended results are anchored in the human rights approach. The rights-based approach identifies the rights holders, duty bearers and agents of accountability in the area of infant and young child health and nutrition. This means that the gBICS house is built on the solid rock of government obligations, rather than on the shifting sands of charitable intent.

Built on firm foundations and framework

The foundations of the gBICS are formed by the WHO and UNICEF Global Strategy for Infant and Young Child Feeding (GSIYCF or GS). 
The framework of the gBICS house is formed by international recommendations and Conventions, which confer the protection of the rule of law when these are implemented into national legislation that can be enforced and monitored.
This is the international architectural framework that the UN family of international organizations has adopted. It is essential to maintain this strong framework of international instruments to protect, promote and support breastfeeding. It is important to prevent any weakening of this international framework which forms the basis of national policies and programmes.

Building team

The gBICS needs a team of builders working together to achieve results.  These are advocacy and action groups in civil society who are working with national authorities in each country to transform the international framework into a house with stories and rooms – a real home for breastfeeding. 

Building process
The three stories or floors of the gBICS house are: 

• Protecting breastfeeding by overcoming obstacles through eliminating commercial pressures, and establishing a legal framework to curb violations of the International Code of Marketing of Breastmilk Substitutes and enact legislation on maternity protection at work;

• Promoting breastfeeding requires reliable and impartial information which positions breastfeeding as a norm for feeding infants and clearly explains the risks of artificial feeding;

• Supporting breastfeeding requires skilled breastfeeding counselling as well as peer, workplace and community support.


On each floor there are five symbolic rooms, representing the national action that must be taken by national authorities to fulfil the right of every child to the highest standard of health.

The Protection of optimal infant feeding practices forms the ground floor:

• Implementing, enforcing and monitoring the International Code of Marketing of Breastmilk Substitutes and its subsequent relevant resolutions;

• Participating in the work of the Codex Alimentarius Commission to develop food standards and guidelines protecting the health of consumers;

• Protecting working mothers through legislation on maternity Protection at work. Returning to work is the first main reason for mothers to stop breastfeeding their infants. Stronger maternity protection laws are needed worldwide if the WHO recommendation of exclusive breastfeeding for six months is to be respected;

• Scaling up the Baby Friendly Hospital Initiative (BFHI), which plays a crucial role in improving early initiation and sustained duration of breastfeeding and protects mothers against the practice of the infant formula industry: providing free or low cost supplies to maternity wards and hospitals ;

• Implementing the Operational Guidance and Guidelines on infant feeding in exceptionally difficult circumstances, including emergencies and the context of HIV / AIDS transmission

Promotion of optimal infant feeding forms the first floor.

• Social Mobilisation, in particular the World Breastfeeding Week coordinated by the World Alliance for Breastfeeding Action (WABA) and implemented worldwide by IBFAN groups;

• Information: Many of the activities of IBFAN aim to promote optimal breastfeeding and infant feeding practices through information, education and communication campaigns.  IBFAN’s national level activities traditionally include promotion of breastfeeding by inducing cultural change that will make it the norm.

• Raising Awareness of the need to re-establish a breastfeeding culture

• Training and Capacity-building in all areas related to infant feeding, from the International Code of Marketing of Breastmilk Substitutes to the risks of artificial feeding to counselling

• Advocacy Campaigns

Support for optimal infant feeding forms the second floor.

• Counselling, including mother to mother support and peer counselling

• Family and father support


• Workplace:  This room includes support for working mothers with crèches and breastfeeding facilities at the workplace

• Supportive health care practices in hospitals and health centres

• Special contexts including infant feeding counselling in emergencies and in the context of HIV
 
The World Breastfeeding Trends initiative (WBTi) serves the building team as a lens

The WBTI serves as a lens or a magnifying glass in the gBICS building process to identify priority areas for action at national level – the rooms that need to be built. The people who can make a difference look in detail at the situation of infant feeding and examine together the gaps in policy and practice – they identify what works and what does not work, propose recommendations for improvement and publish these at the national and international level.

This lens underlines the role of information and particularly of the new information technologies such as Internet in the process. The State of the World’s Breastfeeding is a dynamic Web Portal for the WBTi. It presents information from diverse sources in a unified way, readily accessible to all. Apart from the standard search engine feature, it provides space to users to register and generate reports like bar, pie, table, line & map based on the country WBTi Infant and Young Child Feeding assessment. It has an administration panel to enter country assessment findings provided by the country. It has a facility in its panel to manage countries and regions manually. It provides a web portal with pages for each country displaying information about 15 key breastfeeding indicators. It is also open and interactive, by providing the training materials that are necessary to do a WBTi national assessment.

We invite the reader of this proposal to visit:  www.worldbreastfeedingtrends.org and evaluate the content.  Country reports, which correspond to country assessment and debate, are available for a significant amount of the 68 priority countries identified by the Countdown to 2015 . More countries will follow soon, provided that sufficient funds are available.

The roof of the gBICS is provided by comprehensive national policies and programmes identified by the process at national level of assessing and assigning priorities, resources and a plan of action. These national policies and programmes are based on international human rights instruments; thus governments have an obligation to commit human and financial resources.