BREASTFEEDING

The definition of the word “substitute” implies something that has properties similar to those of another thing and may replace it with a lesser degree of quality, or an imitation of lesser quality than the original.
A human milk substitute is any food marketed as a partial or total substitute for breast milk, and the elements for its administration, whether or not they are suitable for that purpose.
The International Code of Marketing of Human Milk Substitutes applies to marketing strategies for the following milk substitute products:

The International Code of Substitutes consists of a set of recommendations aimed at regulating the aggressive and improper marketing of human milk substitutes, bottles and teats, which compete with breastfeeding.
In 1981, the 34th World Health Assembly adopted the International Code of Marketing of Human Milk Substitutes as a minimum requirement to protect and promote adequate feeding of infants and young children.

Having a written breastfeeding policy allows to:

- Make the various actors at the facilities agree to comply with practices that favor breastfeeding.
- Make the medical and nursing staff take ownership of the topic.
- Have recommendations applicable to specific environments.
- Monitor, evaluate and obtain data on breastfeeding practices and their effects, e.g., through audits.
- Exchange views within and outside the institution, involving more actors, sharing experiences and facilitating the replication of good practices.

The development of the breastfeeding policy varies broadly; it should include breastfeeding experts and avoid commercial links with products and companies regulated by the International Code of Human Milk Substitutes.

A committee including high-level representation from all stakeholders may be appointed to develop the policy. Once the necessary agreements are reached, the committee should continue to monitor the proper implementation of the policy.

Standards and policies to strengthen breastfeeding at birthing facilities should be written. This feature is important to sustain unanimity of criteria in practices.

Furthermore, the policy should consider the 10 steps set forth by the World Health Organization for successful breastfeeding, i.e.

- available for consultation by all personnel

- visibly displayed in all areas of the hospital

- written in the language(s) most frequently understood by patients and staff.

Early skin-to-skin contact and early breastfeeding are two closely linked interventions that should be carried out immediately after birth.
Immediate and prolonged skin-to-skin contact facilitates lactation, enriches the microbiome of newborns, prevents hypothermia and hypoglycemia, and stabilizes respiratory function.
Early suckling at the breast stimulates lactogenesis II (activation of milk secretion) and transfers colostrum, rich in immunoactive substances, especially important for those born prematurely.

The hospitalization of premature, small and/or sick newborns poses multiple challenges to breastfeeding, including:

In neonatal hospitalization areas, the unrestricted admission of mothers and fathers facilitates close contact with their newborns, the development of bonding and the provision of care for which they will be primarily responsible after discharge.

When a child is born prematurely, some things are important to initiate and sustain the mother’s milk production:

- In the birthing area:
• Immediate, direct and continuous skin-to-skin contact, whenever clinically possible.
• Extraction of colostrum for administration into the newborn’s oropharynx.

The theme of Breastfeeding Week 2023 is “Let's make breastfeeding and work work”.