SEE ALSO malnutrition; Maternal, Newborn and Child Health; social movements; women’s health
The baby friendly initiative aims at improving the care of pregnant women, mothers and newborns at maternity and other health care facilities to promote and support breastfeeding (UNICEF, 2014).
The baby friendly initiative is a global effort for improving the role of maternity services to enable mothers to breast feed their babies. It offers advice, standards of practice, accreditation and the training of counsellors to encourage higher rates of the breastfeeding practice (UNICEF, 2014). Breastfeeding is the natural way of providing young infants with the nutrients they need for healthy growth and development. Exclusive breastfeeding is recommended up to six months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. Breastfeeding can decrease the severity of diarrhoea and reduce the risk of hospitalization and mortality due to respiratory infection. The World Health Organization recommends that breastfeeding should begin within one hour of birth and should continue on demand, as often as the child wants day and night (WHO, 2013).
The breastfeeding movement emerged in response to the growing popularity of bottle feeding using artificial baby milk. This does not contain the antibodies found in breast milk and when not properly prepared, there are risks arising from the use of unsafe water and unsterilized equipment or the potential presence of bacteria in powdered artificial baby milk. Malnutrition can result from over-diluting artificial baby milk, and if it becomes unavailable, a return to breastfeeding may not be an option due to diminished breast milk production. The breastfeeding movement has challenged multinational corporations, influenced international policy, educated and supported breastfeeding women.
In the 1960s, the artificial baby milk industry embarked on an aggressive marketing campaign in the developing world. The breastfeeding movement gained momentum to organize a boycott of artificial baby milk products throughout the United States and was soon emulated in Europe, Canada, New Zealand and Australia. The World Health Assembly adopted the International Code of Marketing Infant Formula in May 1981, the first international code for transnational corporations. The code stated that companies should accurately label their products, minimize advertising, avoid distributing free samples to mothers and maintain high quality standards. Due to corporate lobbying, the code was passed as a recommendation (which is more difficult to enforce) rather than as a regulation. In response, various grassroots organizations soon formed the International Baby Food Action Network (IBFAN) to promote the code and monitor the artificial baby milk industry’s compliance. In 1984, the boycott was suspended but after numerous warnings, the boycott was resumed again in 1988 due to grievous code violations (Metoyer, 2007).
Under the baby friendly initiative hospitals and maternity facilities can be accredited as being ‘baby friendly’ when they do not accept free or low-cost breast milk substitutes, feeding bottles or teats, and have implemented ten steps to support successful breastfeeding:
1.Have a written breastfeeding policy that is routinely communicated to all health care staff;
2.Train all health care staff in skills necessary to implement this policy;
3.Inform all pregnant women about the benefits and management of breastfeeding;
4.Help mothers initiate breastfeeding within one-and-half hour of birth;
5.Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants;
6.Give newborn infants no food or drink other than breast milk unless medically indicated;
7.Practice rooming-in, a procedure to allow mothers and infants to remain together 24 hours a day;
8.Encourage breastfeeding on demand;
9.Give no artificial teats or pacifiers to breastfeeding infants;
10.Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from a health care setting (UNICEF, 2014).
Breastfeeding has to be learned and some women do encounter difficulties, such as nipple pain, and the anxiety that there is not enough milk and when support is not available to help them overcome these issues they can resort to bottle feeding. Bottle feeding is an expensive option, especially in developing countries, and can have negative economic and health consequences for poor families.
KEY TEXTS
•Pollard, M. (2011) Evidence-Based Care for Breastfeeding Mothers: A Resource for Midwives and Allied Healthcare Professionals (London: Routledge)
•UNICEF (2014) ‘The Baby Friendly Initiative’. Available at www.unicef.org.uk/babyfriendly. Accessed 10 February 2014
•World Health Organization (2013) Short-Term Effects of Breastfeeding: A Systematic Review on the Benefits of Breastfeeding on Diarrhoea and Pneumonia Mortality (Geneva: World Health Organization)
SEE ALSO addiction; autonomy; health promotion; knowledge, attitude and practice; lifestyle; peer education; tobacco control
Behaviour change is the process of enabling others to achieve an action, for example, in regard to health behaviour, by an individual, and regardless of actual or perceived health status. The purpose is to promote, protect or maintain health and well-being (WHO, 1998).
The behavioural approach has been central to public health campaigns especially in regard to smoking cessation, alcohol misuse and physical inactivity. These campaigns have focused on providing people with knowledge and skills to help them to adopt a healthier lifestyle. Theories that explain individual health behaviour change include the health belief approach, theories of reasoned action, the stages of change approach and the social cognitive theory. These theories use health education and the importance of self-belief in one’s ability to change behaviour, the development of personal skills and the importance of perceived norms and social influences on the individual, such as the role of family, friends and peer groups (Nutbeam, Harris and Wise, 2010). The behaviour change approach has several moral problems. First, it is overly paternalistic and often disregards the individual’s own perception of what is important. Furthermore, the behaviour change approach can lead to ‘victim blaming’ and stigmatization, and to increased inequalities in health, as its focus is on individual behaviours instead of the ‘causes of the causes’ of poor health.
Behaviour Change Communication is an intervention to promote positive health behaviours that are appropriate to people’s settings (UNDP, 2002). Behaviour Change Communication is closely related to Information Education and Communication, health education and health communication. However, it is different from other instructional methods of communication because it is target specific and systematically considers the following in its design: the vulnerability/risk factor of the target group; the conflict and obstacles in the way to the desired change in behaviour; type of message and communication media which can best reach the target group; type of resources available; and assessment of existing knowledge of the target group about the issue (UNDP, 2002).
The ideological foundation for Behaviour Change Communication is based on the assumption that before individuals and communities can change their behaviours, they must first understand basic facts about a particular health issue, adopt key attitudes and learn a set of skills. They must also perceive their environment as supporting their behaviour change and the maintenance of safe behaviours, as well as being supportive of seeking appropriate treatment for prevention, care and support. This process has been identified as having a number of key steps centred around the provision and acceptance of new information and skills including pre-knowledge, becoming more knowledgeable, having a positive attitude towards the new knowledge, intending to take action to change behaviour, practicing and advocating the behaviour (Corcoran, 2013).
Behaviour Change Communication has relied upon top-down, one-directional methods, such as the mass media, and this may have contributed to a gap between knowledge and practice (UNICEF, 2001). In Vietnam, for example, 99% of people interviewed nationally were found to be aware of the link between iodine deficiency and goitre following a mass media campaign. However, supplementary iodized salt intake in some regions, such as the Mekong Delta, remained lower (68%) than the national average intake (77%) (National Iodine Deficiency Disorder Control Program, 2000).The causes of the gap between knowledge and practice were inadequate audience segmentation, weak message content and poor communication materials. The gap can be prevented by employing strategies that create a two-way communication between the recipient and a ‘significant other’ source of information (e.g. a family member or a health professional). A two-way communication creates a dialogue in which barriers to resolving health problems can be identified and actions to address the issue can be planned. To be effective, Behaviour Change Communication must therefore use strategies that involve the development of a dialogue with the intended target audience, for example, by using one-to-one communication, self-help groups and health literacy.
Social and Behaviour Change Communication is a contemporary adaptation of Behaviour Change Communication within a socio-ecological context, including enabling environments, service delivery systems, communities and individuals. The approach identifies behavioural pathways and then uses communication strategies including digital media, broadcast media, community mobilization, interpersonal communication and advocacy to influence social norms as well as individual behaviours (Center for Communication Programs, 2014).
Almost every behaviour or activity by an individual has an impact on his or her health but to assume that communicating information will lead to people behaving more healthily is incorrect because knowledge does not necessarily lead to a desirable change in health behaviour.
KEY TEXTS
•Nutbeam, D., Harris, E. and Wise, M. (2010) Theory in a Nutshell. A Practical Guide to Health Promotion Theories. 3rd edn (London: McGraw-Hill)
•Simons-Morton, B., McLeroy, K. C. and Wendel, M. L. (2011) Behavior Theory in Health Promotion Practice and Research (New York: Jones & Bartlett Learning)
•UNDP (2002) ‘Communication Behaviour Change Tools’, Entertainment-Education, 1: pp. 1–6