Young Child Undernutrition: Crucial to Prioritize Nutrition Interventions in the First 1000 Days of Life.

The implications of young childhood undernutrition on health, development and productivity are grave. In the last two decades, global and Indian studies on undernutrition in under five years have concluded that stunting and underweight rate increases steadily between 0-24 mo, and then stabilises. The available evidence highlights the significance of concentrating interventions to tackle child undernutrition in the first 1000 d of life, which should aim at universal coverage of essential nutrition interventions (ENIs) and maternal-child health care package comprising maternal nutrition care, adoption of appropriate infant and young child feeding practices (IYCF), iron-folic acid supplementation, immunization, deworming, appropriate management of childhood illness etc. Additionally, it is critical to address context specific nutrition sensitive measures such as socio-economic empowerment of women, preventing domestic violence, adolescent conception, appropriate water -sanitation-hygiene and family planning services etc. Mapping of the 'at risk' households having a member falling in the 1000 d window needs special attention and is central to the ongoing efforts in India through the National Nutrition Mission/ POSHAN Abhiyaan. However, for effective implementation, there is an urgent need to consider to shift the lead responsibility of ENIs in the first 1000 d of life to the health care system in India and strategize to integrate maternal nutrition care interventions and establishing of IYCF practices by ensuring optimum use of contacts with antenatal care and routine child immunization services.

The World Breastfeeding Trends Initiative: Implementation of the Global Strategy for Infant and Young Child Feeding in 84 countries.

Breastfeeding could save the lives of more than 820,000 children and 20,000 women. Worldwide, despite evidence of the importance of both, only 42% women begin breastfeeding within an hour of birth, and 41% practice exclusive breastfeeding. In 2002, to mobilise action and support optimal breastfeeding, the World Health Assembly adopted the Global Strategy for Infant and Young Child Feeding. The WHO identified the need to assess implementation of policies and programmes at the national level and provided an assessment tool. International Baby Food Action Network Asia adapted the tool to launch the World Breastfeeding Trends Initiative (WBTi). The WBTi facilitates measurement of the status of implementation of policy and programmes, and stimulates local action towards positive changes. Results of assessments from 84 countries reveal lack of attention to policy in almost all areas. Repeat WBTi assessments allowed us to analyse trends that showed positive changes towards strengthening the policy and programmes to support women to be successful in breastfeeding.

Conflict of interest in public health: should there be a law to prevent it?

"Conflict of interest", now being commonly cited, is a set of circumstances that creates a risk that professional judgement or actions regarding a primary interest will be unduly influenced by a secondary interest. Conflict of interest situations can be institutional or personal, and can stem from financial or other interests including post-employment opportunities or during public -private partnerships. Conflicts of interest in the creation of public policy, especially health or nutrition related policies such as the vaccine policy, tobacco control, and research related to health, can have negative impact on the lives of millions of people. While the UN Convention Against Corruption, to which India is a signatory, identifies conflict of interest as often being a precursor to corruption, there is no serious action being taken in this direction by the Indian government, in spite of the fact there are instances of serious nature coming to light that affect our peoples lives. If conflict of interest situations are allowed to continue especially in health policy it could be detrimental to millions of people; therefore, it would be in public interest that India enacts a law to prevent conflict of interest in the making of public policies, comprehensive enough to include financial and institutional conflicts of interest.

'Negotiating the tensions of having to attach and detach concurrently': a qualitative study on combining breastfeeding and employment in public education and health sectors in New Delhi, India.

OBJECTIVE: the aim of this study was to explore the factors involved in combining breastfeeding and employment in the context of six months of maternity leave in India. DESIGN: qualitative semi-structured interviews were conducted and analysed using a Grounded Theory approach. SETTING: Health and Education sectors in New Delhi, India. PARTICIPANTS: 20 first-time mothers with one 8-12 month-old infant and who had returned to work after six months׳ maternity leave. MEASUREMENTS AND FINDINGS: the interviews followed a pre-tested guide with a vignette, one key question and six thematic areas; intentions, strategies, barriers, facilitators, actual experiences and appraisal of combining breastfeeding and employment. Probing covered pre-pregnancy, pregnancy, maternity leave, the transition and return to work. This study revealed a model of how employed women negotiate the tensions of concurrently having to attach and detach from their infant, work, and family. Women managed competing interests to ensure trusted care and nutrition at home; facing workplace conditions; and meeting roles and responsibilities in the family. In order to navigate these tensions, they used various satisficing actions of both an anticipatory and troubleshooting nature. KEY CONCLUSION: in spite of a relatively generous maternity leave of six months available to these women, several individual, familial and workplace factors interacted to both hinder and facilitate the process of combining breastfeeding and employment. Tension, negotiation and compromise are inherent to the process. IMPLICATIONS FOR PRACTICE: antenatal and postnatal interventions providing information and support for working mothers need to address factors at the individual, family and workplace levels in addition to the provision of paid maternity leave to enable the successful combination of breastfeeding and employment.

The status of policy and programmes on infant and young child feeding in 40 countries.

Optimal breastfeeding not only saves the lives of children under 5 years, but also improves children's quality of life. In spite of proven benefits and repeated emphasis, the rate of exclusive breastfeeding among children less than 6 months of age is only 36% globally. The Global Strategy for Infant and Young Child Feeding provided a framework for action in 10 areas, and identified the need to assess the implementation of policies and programmes in order to identify gaps and to take action to bridge them. We have utilized the World Breastfeeding Trends Initiative (WBTi) tool to make such an assessment. The WBTi has been introduced in 81 countries and 40 of these had completed their assessment by April 2011. Their findings point out specific gaps in both the policy and programmes in all 10 areas of action identified by the tool. This shows that countries need to work in a co-ordinated manner, with clear plans and committed financial resources, to address gaps in all 10 areas of action. This can result in strong advocacy efforts as well as consensus-based action for the effective implementation of the Global Strategy for Infant and Young Child Feeding to enhance rates of optimal feeding practices.