Episódio 2 - Semana Mundial de Aleitamento Materno (SMAM) - Como as pessoas podem apoiar e a atuação do BLH do IFF/Fiocruz

A Semana Mundial de Aleitamento Materno (SMAM), celebrada de 1 a 7 de agosto, coloca anualmente em debate temas relevantes em prol da promoção, apoio e proteção ao aleitamento materno. “Possibilitando a amamentação: fazendo a diferença para mães e pais que trabalham” é o slogan deste ano. Embora a amamentação seja tradicionalmente considerada domínio da mãe, quando os pais, famílias e a sociedade a apoiam, as taxas aumentam. Diante disso, adotar uma abordagem inclusiva sobre o aleitamento materno que agregue pais, amigos, familiares, colegas de trabalho e comunidade é fundamental para criar um entorno propício, que permita que as mães amamentem de forma otimizada. Nesse contexto, convidamos a coordenadora da Assistência do Banco de Leite Humano do IFF/Fiocruz, Danielle Aparecida da Silva, para falar mais sobre o tema.

Revival of the mother-baby friendly initiative (MBFI) in South Africa: towards a quality improvement project.

BACKGROUND: The discontinuation of "Mother-Baby Friendly" accreditation, coupled with the impact of the COVID-19 pandemic, has contributed to reduced breastfeeding rates observed in parts of South Africa. Consequently, the Child, Youth and School Health cluster of the National Department of Health, with support from the World Health Organization and United Nations Children's Fund, organised a Mother-Baby Friendly initiative revitalisation workshop. METHODS: Held in Johannesburg, South Africa, on June 29-30, 2022, the workshop brought together local and international breastfeeding promotion experts to engage on issues related to the revitalisation of the Mother-Baby Friendly Initiative. The workshop included presentations and group sessions aimed at setting expectations, evaluating the Ten Steps to Successful Breastfeeding, and developing actionable revitalisation strategies. RESULTS: Inadequate monitoring of the Mother-Baby Friendly Initiative implementation and adherence to the Ten Steps was identified as a major implementation bottleneck. Participants identified steps ten (coordinating discharge so that parents and their infants have timely access to ongoing support and care), five (supporting mothers to initiate and maintain breastfeeding and manage common difficulties), and two (ensuring that staff have sufficient knowledge, competence, and skills to support breastfeeding) of the Baby-Friendly Hospital Initiative as the most difficult to implement. Step seven (enabling mothers and their infants to remain together and to practise rooming-in 24 h a day) was the least difficult to implement. Workshop participants identified the following proposed solutions to revitalise breastfeeding promotion: strengthening capacity building and mentorship, improving monitoring and accountability measures, and certification of facilities meeting the initiative's standards. CONCLUSION: Current breastfeeding policies and practices must be evaluated by the National Department of Health in collaboration with provincial and private representatives of the initiative to effectively revitalise the Mother-Baby Friendly Initiative. Moreover, an integrative monitoring framework must be developed through stakeholder engagement, role clarification, and ownership. While collaboration between the private and public sectors is required to promote training and communication within healthcare facilities and communities.

Perspective: Supporting Maternal Efforts to Provide Optimal Infant Nutrition in the Post-Partum Setting.

Supporting optimal newborn nutrition and the positive maternal-infant relationship while encouraging safe sleep practices are essential components of maternal and newborn care in the hospital setting following birth. Breastfeeding is widely recognized as the best practice to support the nutritional needs and well-being of the infant, and recommendations have been developed by the WHO, the American Academy of Pediatrics (AAP), and the United States Centers for Disease Control to encourage and successfully support breastfeeding efforts before hospital discharge. The 10 Steps to Successful Breastfeeding, developed and promoted by the WHO, form the basis of the Baby-Friendly Hospital Initiative (BFHI) and have become the international framework for public health initiatives to promote breastfeeding. An evaluation of hospital performance implementing the 10 steps through the process of "Baby-Friendly Designation" (BFD) has been suggested by many breastfeeding advocates as the optimal pathway to attain the goals of the BFHI. However, the WHO has recognized that BFD may not be an appropriate goal in all settings, and indicated, as part of their updated 2018 guidance, that "facilities may make changes in their policies and procedures to obtain the designation, but these changes are not always sustainable, especially when there are no regular monitoring systems in place." In addition, unintended associated issues regarding newborn safety and maternal dissatisfaction with some of the 10 steps have emerged. This perspective discusses the challenges faced by hospitals attempting to implement the BFHI 10 steps and suggests potential solutions to make progress in those efforts with or without BFD and also the efforts needed to support formula feedings when appropriate.

Effectiveness of a breastfeeding promotion intervention model based on Society ecosystems Theory for maternal women: a study protocol of randomized controlled trial.

BACKGROUND: Breastfeeding is recognized internationally as the most scientific and effective way to feed infants and young children. According to the World Health Organization in 2022, the exclusive breastfeeding rate within 6 months is 34.1% in China, which is still far from the goal of "more than 60% exclusive breastfeeding rate of infants within 6 months" by 2030 required by China's State Council. It is necessary to promote breastfeeding and provide maternal breastfeeding guidance to increase exclusive breastfeeding. Factors influencing breastfeeding can be explained by the society ecosystems theory, distributed in macro, mezzo and micro systems. The interventions focused on breastfeeding promotion are mainly carried out in the health systems and services, home and family environment, community environment, work environment, policy environment or a combination of these facilities. But there is sparse research on integrating resources in the macro, mezzo and micro systems of maternal breastfeeding processes to promote breastfeeding behavior. A randomized controlled trial will test the effect of a breastfeeding promotion intervention model based on the society ecosystems theory versus usual prenatal and postnatal care on maternal and infant health and the exclusive breastfeeding rate at 6 months. METHODS/DESIGN: The study is a single-blind, parallel design, randomized controlled trial with an intervention group (n = 109) and a control group (n = 109) that compares the effect of a breastfeeding promotion intervention model based on the society ecosystems theory with usual prenatal and postnatal care. The intervention covers macro- (policy, culture), mezzo- (family-hospital-community) and micro- (biological, psychological and social) systems of the maternal breastfeeding process. Infant feeding patterns, neonatal morbidity and physical and mental health of antenatal and postpartum women will be collected at baseline (28 to 35 weeks of gestation), 1-, 4-, and 6-month postpartum. DISCUSSION: This is a multifaceted, multifactorial, and multi-environmental breastfeeding promotion strategy to help mothers and their families learn breastfeeding knowledge and skills. The study provides a new modality for adding breastfeeding interventions to prenatal and postnatal care for healthcare providers in the hospital and the community. TRIAL REGISTRATION: Chinese Clinical Trial Registry at www.chictr.org.cn , ChiCTR2300075795.

Maternal education and support during breastfeeding can increase maternal breastfeeding self-efficacy, promote breastfeeding behaviors, and improve maternal and infant health outcomes. The interventions focused on breastfeeding promotion are mainly carried out in the health systems and services, home and family environment, community environment, work environment, policy environment or a combination of any of these facilities. But there is sparse research on integrating in multifaceted, multifactorial, and multi-environmental resources of maternal breastfeeding processes to help pregnant women and their families learn breastfeeding knowledge and skills. The current study optimizes the existing breastfeeding promotion intervention program and construct a breastfeeding promotion intervention program to correct the public's perception of breastfeeding, increase breastfeeding self-efficacy and improve breastfeeding behavior, thus increasing the breastfeeding duration and improving maternal and infant outcomes. The program includes presenting breastfeeding-related policies and support facilities; prenatal educational sessions combined with theories and skills on breastfeeding, development of lactation, infants feeding and cares for maternal families; postnatal hands-on instruction and WeChat group peer support from hospital; home visits, group counseling and experience sharing from community and one-on-one personalized counseling throughout the intervention. The present study will be conducted to evaluate the effect of breastfeeding promotion intervention including prenatal and postnatal care on the breastfeeding duration, breastfeeding attitudes, knowledge, and self-efficacy, maternal and infant health.

História da rBLH (2010)

Esse vídeo é a versão compacta do Documentário sobre a Rede de Bancos de Leite Humano (rBLH-BR e rBLH Ibero-americana), no V Congresso Brasileiro de Bancos de Leite Humano, I Congresso Iberoamericano de Bancos de Leite Humano, Fórum de Cooperação Internacional em Bancos de Leite Humano - ABC/Fiocruz 2010, Brasília/DF, que teve como tema central o compromisso dos Bancos de Leite Humano com os Objetivos de Desenvolvimento do Milênio (ODM). Confira parte da história da Rede de Bancos de Leite Humano, que atua como estratégia de promoção do aleitamento materno e saúde da mulher e da criança.

O regresso ao trabalho e o aleitamento materno podem caminhar juntos, e você tem direitos que garantem essa união

A edição do Agosto Dourado, e a Sociedade Brasileira de Pediatria (SBP) preparou uma programação especial para estimular a prática da amamentação em todo o País. Desta vez, a campanha segue o mote “Possibilitando a amamentação: fazendo a diferença para mães e pais que trabalham”, da Semana Mundial do Aleitamento Materno (SMAM) 2023.

Sofia Quintero Romero: Protection and Support of Breastfeeding With a Feminist and Social Justice Lens.

Sofia Quintero Romero graduated as a medical doctor at Universidad del Rosario, Bogotà, Colombia, in 1977. She spent a compulsory rural year working in a remote indigenous community in the Sierra Nevada de Santa Marta in Columbia. In 1979 she worked in Bolivia for Terre des Hommes and Oxfam, evaluating their health projects with the Aymara Indians and in the tin mines. She had to leave Colombia for political reasons and went to England, where she obtained, in 1981, an MSc in Community Health at the London School of Hygiene & Tropical Medicine (LSHTM). That's where she met her husband, Adriano Cattaneo. She then worked in Mozambique and Nicaragua where she was in charge of maternal and child health services at the regional level. Since 1990, she devoted her time to the protection, promotion, and support of breastfeeding. Sofia obtained a PhD in Maternal and Child Health at the University of Bologna, Italy, and a Diploma in Breastfeeding Theory and Practice at the Child Health Institute in London UK. She taught hundreds of breastfeeding courses for health professionals and peer counsellors in Italy and in dozens of countries abroad, using the World Health Organization/United Nations Children's Fund (WHO/UNICEF) manuals. In the past 15 years, she changed her approach for breastfeeding education to biological nurturing. Sofia has been a member of the International Baby Food Action Network (IBFAN) since 1992 and coordinated the Nestlé Boycott in Italy. She retired in 2018.

Agosto Dourado SBP: campanha em prol do aleitamento materno debaterá os direitos das mães trabalhadoras que amamentam

A Sociedade Brasileira de Pediatria (SBP) está mobilizada em uma programação especial para estimular a prática da amamentação em todo o País. Neste ano de 2023, a campanha seguirá o mote “Possibilitando a amamentação: fazendo a diferença para mães e pais que trabalham”, da Semana Mundial do Aleitamento Materno (SMAM) 2023.

Semana Mundial de Aleitamento Materno 2023 terá como tema central os pais que trabalham

Com o slogan “Possibilitando a amamentação: fazendo a diferença para mães e pais que trabalham” (Enabling breastfeeding: Making a difference for working parentes, no original), a Aliança Mundial para Ação de Aleitamento Materno (WABA, em inglês) divulgou o tema e metas da Semana Mundial de Aleitamento Materno 2023.

Gearing to success with national breastfeeding programmes: The Becoming Breastfeeding Friendly (BBF) initiative experience.

Evidence-based policy toolboxes are essential for decision makers to effectively invest in and scale up maternal-child health and nutrition programs, and breastfeeding is no exception. This special issue focuses on the experiences implementing the Becoming Breastfeeding Friendly (BBF) toolbox in England, Scotland, and Wales. BBF is an initiative that includes a toolbox for decision making based on the Complex Adaptive System-based Breastfeeding Gear Model. The BBF initiative experience in Great Britain presented in this special issue illustrates how versatile BBF is as it can be readily adapted to the specific application context. In this instance one country, England was trained by the Yale School of Public Health team that developed BBF. England, in turn, trained and assisted Scotland and Wales with the implementation and oversight of BBF in those countries. The positive experience implementing BBF in Great Britain is fully consistent with findings related to this initiative in other countries with contrasting economic, social, political and health care systems; including Germany, Ghana, Mexico, Myanmar, and Samoa. In all instances BBF has led to breastfeeding policy improvements with strong implications for enabling breastfeeding environments including maternity benefits, workforce development, the Baby Friendly Hospital Initiative and behavior change communication campaigns. In conclusion, BBF is a powerful tool to help guide the effective scaling up of evidence-based programmes to advance breastfeeding protection, promotion and support globally.

Becoming breastfeeding friendly in Wales: Recommendations for scaling up breastfeeding support.

Breastfeeding and the provision of human milk is established as protecting infant and maternal health. However, breastfeeding rates in many countries, including Wales, are low. Given the significant health, economic and environmental impacts of this, the need to strengthen breastfeeding promotion, protection and support is paramount. As part of this, the becoming breastfeeding friendly: a guide to global scale-up (BBF) initiative sets out a methodology to enable countries to assess their readiness to scale up breastfeeding protection, promotion and support by gathering data and scoring progress under eight areas, termed 'gears', shown to be essential for large-scale change. Recently, Wales took part in the BBF initiative. A cross-sector committee, including stakeholders from Universities, Welsh Government, Public Health Wales and Health Boards alongside critical friends scored Wales' support for breastfeeding across the eight gears. The overall score for Wales was 1.1 out of a possible 0-3, representing a moderate scaling up the environment for breastfeeding. Six gears were rated in the moderate gear strength category and two ('Promotion' and 'Advocacy') in the weak gear strength category. Gaps in breastfeeding support were identified and 31 recommendations covering six themes for change were put forward. These included a strategic action plan, consistent and long-term funding, a nuanced, cocreated engagement and promotion framework, strengthened education and training, robust monitoring and evaluation mechanisms and ensuring maternity rights and the International Code of Marketing of Breastmilk Substitute are upheld. Taken together, the analysis and recommendations present a clear vision for protecting and not merely promoting breastfeeding in Wales.

Becoming breastfeeding friendly in Great Britain-Does implementation science work?

The Becoming Breastfeeding Friendly (BBF) in Great Britain study was conducted during 2017-2019 comprising three country studies: BBF England, Wales and Scotland. It was part of an international project being coordinated during the same period by the Yale School of Public Health across five world regions to inform countries and guide policies to improve the environment for the promotion, protection and support of breastfeeding. This paper reports on the application of the BBF process that is based on an implementation science approach, across the countries that constitute Great Britain (England, Wales and Scotland). The process involves assessing 54 benchmarks across eight interlocking gears that drive a country's 'engine' towards a sustainable policy approach to supporting, promoting and protecting breastfeeding. It takes a consensus-oriented approach to the evaluation of benchmarks and the development of recommendations. This paper provides a critical overview of how the process was conducted, the findings and recommendations that emerged and how these were managed. We draw on critical theory as a theoretical framework for explaining the different outcomes for each country and some considerations for future action.

Implementing two national responsibilities of the revised UNICEF/WHO Baby-Friendly Hospital Initiative: A two-country case study.

The 2018 implementation guidance for the Baby-Friendly Hospital Initiative (BFHI) recommends institutionalising the ten Steps through nine national responsibilities for universal coverage and sustainability. As countries adapt BFHI programmes to this paradigm shift away from traditional designation programmes, documenting and sharing policy and programme experience are critical and currently sparse. This qualitative case study included desk reviews of published and grey literature on BFHI programming, national plans and policy documents specific to the selected national responsibilities for universal coverage and key informant (KI) interviews across a range of actors. In the Kyrgyz Republic, the case study explored responsibility 5, development and implementation of incentives and/or sanctions, and responsibility 6 in Malawi, providing technical assistance (TA). In both countries, the three sustainability responsibilities (national monitoring [7] communication and advocacy [8] and financing [9]) as they relate to the universal coverage of the targeted responsibilities were also explored. Thirty-eight respondents in the Kyrgyz Republic described approaches that were used in the health system, including BFHI designation plaques, performance-based financing and financial sanctions. However, currently, there are no formal incentives and sanctions. In Malawi, TA was utilised for national planning and to introduce quality improvement processes. Forty-seven respondents mostly described provisions of TA in building and strengthening the capacity of providers. More programmatic evidence to demonstrate which types of incentives or sanctions can be effective and sustained and more documentation of how TA is provided across multiple aspects of implementation are needed as countries institutionalise BFHI.

Scaling up breastfeeding in England through the Becoming Breastfeeding Friendly initiative (BBF).

Breastfeeding is the most accessible and cost-effective activity available to public health and has been shown to be one of the most effective preventive measures mothers can take to protect their children's health. Despite the well-documented benefits, the UK has one of the lowest breastfeeding rates in the world. The Becoming Breastfeeding Friendly (BBF) toolkit was developed through highly structured technical and academic collaboration, led by Yale University. It provides an evidence-based process to help countries assess their breastfeeding status and readiness to scale up, and identifies concrete measures countries can take to sustainably increase breastfeeding rates, based on data-driven recommendations. BBF is grounded in the Breastfeeding Gear Model complex adaptive systems framework which is made up of eight simultaneous conditions that sustain breastfeeding. In 2018, a committee of multi-agency stakeholders implemented the BBF process in England, collecting evidence to score the 'gear' components of England's breastfeeding environment against 54 benchmarks. The Training and Programme Delivery gear received the highest score, attributable to existing learning outcomes for health professionals and practitioners, peer supporters and specialist services, although there is a need for greater coordination and integration. The lowest scores were given for Promotion and Coordination, Goals and Monitoring due to the lack of a dedicated national strategy for breastfeeding and poor sharing of localised strategies and programmes. The process generated clear recommendations highlighting the need for more robust routine infant feeding data collection and reporting, and the necessity for strengthening leadership, monitoring and oversight to scale up and sustain breastfeeding.

O conceito teórico "espaço para amamentar" retratado nas campanhas da semana mundial de aleitamento materno / El concepto teórico de "Espacio para amamantar" retratado en las campañas de la Semana Mundial de Lactancia Materna / The theoretical concept of "Breastfeeding space" portrayed in the World Breastfeeding Week campaigns

Objetivo: analisar como os espaços para amamentar são retratados nos cartazes da campanha nacional de aleitamento materno, à luz da Teoria Interativa da Amamentação. Método: estudo documental realizado em cinco etapas pelo referencial metodológico de Análise Semiótica de Imagens Paradas por Gemma Penn. Os materiais escolhidos como amostra foram as imagens temáticas das campanhas da Semana Mundial de Aleitamento Materno no Brasil. Resultados: observa-se que a maioria das mulheres estava amamentando em espaços públicos. Destaca-se a abordagem ao direito da mulher trabalhadora e aspectos referentes à pandemia da COVID-19. Conclusão: o espaço em que ocorre o processo de amamentação é retratado de forma diversa quanto ao ambiente físico. No que se refere ao conceito teórico "espaço para amamentar", que inclui os gestos, posturas e comportamento dos que o ocupam, as campanhas se mostraram limitadas.

Objective: to analyze how breastfeeding spaces are portrayed in the posters from the National Breastfeeding Campaign, in the light of the Interactive Theory of Breastfeeding. Method: a documentary study carried out in five stages using the Semiotic Analysis of Still Images methodological framework by Gemma Penn. The materials chosen as sample were the thematic images from the World Breastfeeding Week campaigns in Brazil. Results: it was observed that most of the women breastfed in public spaces. The approach to working women's rights and several aspects referring to the COVID-19 pandemic stand out. Conclusion: the space where the breastfeeding process takes place is portrayed in various ways in terms of the physical environment. With regard to the theoretical concept of "Breastfeeding space", which includes the gestures, postures and behaviors of those who occupy it, the campaigns proved to be limited.

Objetivo: analizar de qué manera se retratan los espacios para amamantar en los pósteres de la campaña nacional de lactancia materna, a la luz de la Teoría Interactiva de la Lactancia Materna. Método: estudio documental realizado en cinco etapas conforme al marco metodológico del Análisis Semiótico de Imágenes Fijas de Gemma Penn. Los materiales elegidos como muestra fueron las imágenes temáticas de las campañas de la Semana Mundial de Lactancia Materna en Brasil. Resultados: se observa que la mayoría de las mujeres amamantaba en espacios públicos. Se destacan el enfoque con respecto a los derechos de las mujeres trabajadoras y aspectos referentes a la pandemia de COVID-19. Conclusión: el espacio en el que tiene lugar el proceso de lactancia se retrata de diversas maneras en cuanto al ambiente físico. En lo que refiere al concepto teórico de "Espacio para amamantar", que incluye los gestos, las posturas y las conductas de quienes lo ocupan, las campañas demostraron ciertas limitaciones.

SBP AmamentAÇÃO

Edição número 28/2022, SBP AmamentAÇÃO, informativo anual da Sociedade Brasileira de Pediatria (SBP), atualiza e engaja os pediatras brasileiros e traz para os leitores entrevista exclusiva, documentos científicos com importantes atualizações sobre o tema e um resumo dos principais eventos realizados em diversos estados do País. Edição especial com o resumo das ações da SBP realizadas em prol do aleitamento materno no Brasil, durante a Semana Mundial de Aleitamento Materno (SMAM) e Agosto Dourado.

How much does it cost to implement the Baby-Friendly Hospital Initiative training step in the United States and Mexico?

The Baby-Friendly Hospital Initiative (BFHI) has been shown to increase breastfeeding rates, improving maternal and child health and driving down healthcare costs via the benefits of breastfeeding. Despite its clear public health and economic benefits, one key challenge of implementing the BFHI is procuring funding to sustain the program. To address this need and help healthcare stakeholders advocate for funds, we developed a structured method to estimate the first-year cost of implementing BFHI staff training, using the United States (US) and Mexico as case studies. The method used a hospital system-wide costing approach, rather than costing an individual hospital, to estimate the average per birth BFHI staff training costs in US and Mexican hospitals with greater than 500 annual births. It was designed to utilize publicly available data. Therefore, we used the 2014 American Hospital Association dataset (n = 1401 hospitals) and the 2018 Mexican Social Security Institute dataset (n = 154 hospitals). Based on our review of the literature, we identified three key training costs and modelled scenarios via an econometric approach to assess the sensitivity of the estimates based on hospital size, level of obstetric care, and training duration and intensity. Our results indicated that BFHI staff training costs ranged from USD 7.27-125.39 per birth in the US and from PPP 2.68-6.14 per birth in Mexico, depending on hospital size and technological capacity. Estimates differed between countries because the US had more hospital staff per birth and higher staff salaries than Mexico. Future studies should examine whether similar, publicly available data exists in other countries to test if our method can be replicated or adapted for use in additional settings. Healthcare stakeholders can better advocate for the funding to implement the entire BFHI program if they are able to generate informed cost estimates for training as we did here.

Agosto Dourado 2022: fortalecer a amamentação, educando e apoiando

Tema proposto pelo WABA (World Alliance for Breastfeeding Action) para a Semana Mundial de Aleitamento Materno 2022 é fortalecer a amamentação, educando e apoiando. A educação, com transformação dos sistemas existentes em políticas nacionais baseadas em evidências, ajuda a garantir instalações de saúde amigas da amamentação, comunidades e locais de trabalho de apoio, restaurando e melhorando as taxas de amamentação, nutrição e saúde, tanto em curto como em longo prazo.

Cooperação entre a ENSP e a Rede Brasileira de Bancos de Leite Humano

A Escola Nacional de Saúde Pública Sergio Arouca (ENSP/Fiocruz) e a Rede Brasileira de Bancos de Leite Humano (rBHL/IFF/Fiocruz) estão desenvolvendo uma cooperação a fim de promover a efetivação do aleitamento materno para toda a população, em especial para as pessoas com deficiência, em respeito à diversidade humana.