主な参考文献 IBFAN(2019)/母乳育児支援ネットワーク訳(2021)乳児の健康を守るために:保健医療従事者のための「母乳代用品のマーケティングに関する国際規準」ガイド, 母乳育児支援ネットワーク.
United Nations Convention on the Rights of the Child, Committee on the Rights of the Child. (2019) Concluding observations on the combined fourth and fifth periodic reports of Japan, 5 March 2019.
UNICEF/WHO (2009)赤ちゃんとお母さんにやさしい母乳育児支援 ベーシックコース, 医学書院.
WHO (2016) Guidance on ending the inappropriate promotion of foods for infants and young children.
WHO/UNICEF/IBFAN.(2022) Marketing of breast-milk substitutes: national implementation of the international code, status report.
On the Protection, Promotion and Support of Breastfeeding.
Breastfeeding is a unique process that:
Provides ideal nutrition for infants and contributes to their healthy growth and development Reduces incidence and severity of infectious diseases, thereby lowering infant morbidity and mortality Contributes to women’s health by reducing the risk of breast and ovarian cancer, and by increasing the spacing between pregnancies Provides social and economic benefits to the family and the nation Provides most women with a sense of satisfaction when successfully carried out
and that Recent Research has found that:
these benefits increase with increased exclusiveness of breastfeeding during the first six months of life, and thereafter with increased duration of breastfeeding with complementary foods, and programme intervention can result in positive changes in breastfeeding behaviour
WE THEREFORE DECLARE THAT:
●As a global goal for optimal maternal and child health and nutrition, all women should be enabled to practise exclusive breastfeeding and all infants should be fed exclusively on breastmilk from birth to 4-6 months of age. Thereafter, children should continue to be breastfed, while receiving appropriate and adequate complementary foods, for up to two years of age or beyond. This child-feeding ideal is to be achieved by creating an appropriate environment of awareness and support so that women can breastfeed in this manner.
●Attainment of this goal requires, in many countries, the reinforcement of a “breastfeeding culture” and its vigorous defence against incursions of a “bottle-feeding culture”. This requires commitment and advocacy for social mobilization, utilizing to the full the prestige and authority of acknowledged leaders of society in all walks of life.
●Efforts should be made to increase women’s confidence in their ability to breastfeed. Such empowerment involves the removal of constraints and influences that manipulate perceptions and behaviour towards breastfeeding, often by subtle and indirect means. This requires sensitivity, continued vigilance, and a responsive and comprehensive communications strategy involving all media and addressed to all levels of society. Furthermore, obstacles to breastfeeding within the health system, the workplace and the community must be eliminated.
●Measures should be taken to ensure that women are adequately nourished for their optimal health and that of their families. Furthermore, ensuring that all women also have access to family planning information and services allows them to sustain breastfeeding and avoid shortened birth intervals that may compromise their health and nutritional status, and that of their children.
●All governments should develop national breastfeeding policies and set appropriate national targets for the 1990s. They should establish a national system for monitoring the attainment of their targets, and they should develop indicators such as the prevalence of exclusively breastfed infants at discharge from maternity services, and the prevalence of exclusively breastfed infants at four months of age.
●National authorities are further urged to integrate their breastfeeding policies into their overall health and development policies. In so doing they should reinforce all actions that protect, promote and support breastfeeding within complementary programmes such as prenatal and perinatal care, nutrition, family planning services, and prevention and treatment of common maternal and childhood diseases. All healthcare staff should be trained in the skills necessary to implement these breastfeeding policies. OPERATIONAL TARGETS
All governments by the year 1995 should have:
Appointed a national breastfeeding coordinator of appropriate authority, and established a multisectoral national breastfeeding committee composed of representatives from relevant government departments, non-governmental organizations, and health professional associations.
Ensured that every facility providing maternity services fully practises all ten of the Ten Steps to Successful Breastfeeding set out in the joint WHO/UNICEF statement “Protecting, promoting and supporting breastfeeding: the special role of maternity services”.
Taken action to give effect to the principles and aim of all Articles of the International Code of Marketing of Breast-Milk Substitutes and subsequent relevant World Health Assembly resolutions in their entirety; and enacted imaginative legislation protecting the breastfeeding rights of working women and established means for its enforcement
WE ALSO CALL UPON INTERNATIONAL ORGANIZATIONS TO:
Draw up action strategies for protecting, promoting and supporting breastfeeding, including global monitoring and evaluation of their strategies
Support national situation analyses and surveys and the development of national goals and targets for action; and
Encourage and support national authorities in planning, implementing, monitoring and evaluating their breastfeeding policies
The Innocenti Declaration was produced and adopted by participants at the WHO/UNICEF policymakers’ meeting on “Breastfeeding in the 1990s: A Global Initiative, co-sponsored by the United States Agency for International Development (A.I.D.) and the Swedish International Development Authority (SIDA), held at the Spedale degli Innocenti, Florence, Italy, on 30 July – 1 August 1990. The Declaration reflects the content of the original background document for the meeting and the views expressed in group and plenary sessions.
Ardythe Morrow et al. The Lancet 1999. Vol 353 pages 1226-31
ベラルーシでは、16の「赤ちゃんにやさしい病院」で出産したお母さんの43%が、生後３ヵ月の時点で母乳だけで育てていましたが、そうでない15の病院では母乳だけのお母さんは６％しかいませんでした。Kramer MS, et al. Journal of the American Medical Association 2001; vol 285:pages 413-20
ボリビア、ギニア、インド、ニカラグアでは、Save the Children やCAREといったNGOが医療・保健従事者やコミュニティ・ワーカー（地域で支援する人たち）をトレーニングすることで、祖母や父親、男性グループやお母さんどうしのサポートグループをも巻き込んで、地域の支援運動を展開しました。ギニアでは、母乳だけで赤ちゃんを育てる比率は11%から44%まで増加しました。インドでは41%から71％、ニカラグアでは10%から50%に増加しています。ボリビアでは、 ラパスの低所得地区における地域活動にサポートグループが加わると、下痢の罹患率は半分になり、生後６ヵ月未満の赤ちゃんが母乳だけで育てられる割合は75%以上にまで増えました
Save the Children final evaluation, Mandiana Prefecture, Guinea.CARE India, Nicaragua and Bolivia, Final Evaluation of Child Survival Projects, 2002 and 2003.
1. WHO/UNICEF Global Strategy for Infant and Young Child Feeding. 2002
World Health Organization, Geneva
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2001 World Health Organization, Geneva WHO/FCH/CAH/01.23, and WHO/NHD/01.08
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Acta Pediatrica 1999; 88:42-6
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of the evidence. 2002 The LINKAGES Project, Academy for Educational Development
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in Contraception, 1994, 10(2):93-109
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Child Health and Development, World Health Organization WHO/CHD/98.9
11. Woolridge MW. The “anatomy” of infant sucking. Midwifery
1986, pages 164-171
12. Kroeger,M. Impact of birthing practices on breastfeeding: protecting
the mother and baby continuum. 2004 Jones and Bartlett
13. Coutsoudis A, Pillay K, Kuhn L. Spooner E, Tsai Wei-Yann and Coovadia
HM for the South African Vitamin A Study Group. Method of feeding and transmission
of HIV-1 from mothers to children by 15 months of age: prospective cohort
study from Durban, South Africa. AIDS 2001; 15:379-387
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WHO/UNICEF Breastfeeding Counselling: a training course. WHO/CDR/93.3-6
World Health Organization training course materials and technical documents and
LINKAGES ToT for mother support groups （pdfファイル）
La Leche League International: useful information on many practical aspects
of breastfeeding ラ・レーチェ・リーグ日本
Breastfeeding Women at Work