On the Protection, Promotion and Support of Breastfeeding.
RECOGNISING THAT:
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 2. The optimal duration of exclusive breastfeeding: A systematic review. 2001 World Health Organization, Geneva WHO/FCH/CAH/01.23, and WHO/NHD/01.08 3. Butte NF, Lopez-Alarcon MG, Garza C. Nutritional adequacy of exclusive breastfeeding for the term infant during the first 6 months of life. 2002 World Health Organization, Geneva 4. Indicators for assessing breastfeeding practices. World Health Organisation, Geneva WHO/CDD/SER/91.14 5. Hanson LA, Human milk and host defence: immediate and long-term effects. Acta Pediatrica 1999; 88:42-6 6. Leon-Cava, Natalia. Quantifying the benefits of breastfeeding: A summary of the evidence. 2002 The LINKAGES Project, Academy for Educational Development 7. Prentice A. Constituents of human milk. Food and Nutrition Bulletin 1996; 17(4). 305-312 8. Martines J, Rae M, de Zoysa I. Breastfeeding in the first six months. No need for extra fluids. British Medical Journal 1992 (304):1068-1069 9. Labbok M. The lactational amenorrhoea method (LAM). A postpartum introductory family planning method with policy and programme implications. Advances in Contraception, 1994, 10(2):93-109 10. Evidence for the Ten Steps to Successful Breastfeeding. Division of 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 14. Hypoglycaemia of the newborn: A review of the literature. World Health Organization, Division of Child Health and Development. WHO/CHD/97.1
医療・保健従事者、地域やお母さんのサポートグループのための情報源―困ったときはこちらへ
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 「母乳だけで赤ちゃんを育てること」に関する情報や支援をさらに詳しく知りたい方は、地域のユニセフ事務所や委員会にご連絡ください。詳細はユニセフのウェブサイトをご覧ください。<www.unisef.org/infobycountry/index.html>
「FAO/WHO合同食品規格委員会(コーデックス委員会)」(www.codexalimen-tarius.net/)は、乳児用食品も含めた食品の基準を定めるWHO/FAO の合同計画です。(注 FAO:国連食糧農業機関Food and Agriculture Organization of the United Nations)食品の公正な貿易を保障し、消費者の健康を保護するためのものです。しかしながら、この委員会は食品企業に強く影響されています。
世界母乳育児行動連盟 (WABA) www.waba.org.my International Baby Food Action Network 国際乳児用食品行動ネットワーク(IBFAN) www.ibfan.org La Leche League International ラ・レーチェ・リーグ・インターナショナル(LLLI) www.lalecheleague.org ラ・レーチェ・リーグ日本(LLL日本) www.llljapan.org International Lactation Consultant Association 国際ラクテーション・コンサルタント協会(ILCA) www.ilca.org 日本ラクテーション・コンサルタント協会(JALC) www.jalc-net.jp Academy of Breastfeeding Medicine 母乳育児医学アカデミー(ABM) www.bfmed.org
‘We the People’ or ‘We the Corporations’?, 『(仮題)私たちは市民か企業か?』Judith Richter, IBFAN/GIFA, 2003
Alternatives to Economic Globalisation (A Better World is Possible), 『(仮題)経済のグローバル化への代替手段 (よりよい世界は可能です)』The International Forum on Globalisation, Berrett-Koehler Publishers, Inc, November 2002
Holding Corporations Accountable: Corporate Conduct, International Codes and Citizen Action, 『(仮題)企業に責任を問い続けて:企業経営:国際規準と市民活動』Judith Richter, Zed Books, 2001