By Bernadine Rodrigo Recently, Sri Lanka rose to the top as the number one country (out of 97) in support of breastfeeding women, according to the World Breastfeeding Trends initiative (WBTi) of the World Health Organisation (WHO). This, of course, is something which not only the women of the country can be proud of, but is also certainly something which gives the country great dignity in the international forum, portraying it as a nation which cares for the health of the women who nurture the future generations. What the WBTi said is that the infant and young child feeding (IYCF) policy framework is strong in Sri Lanka, and is a well-organised programme from the national level which communicates with the district level. The Maternal and Child Nutrition Subcommittee, chaired by the Deputy Director General of Health Services, meets once every two months, which is rather frequently – an indicator of how truly interested and invested they are. Similarly, the Technical Advisory Committee on Newborn and Child Health (TACNCH) meets every other month under the chairmanship of the same deputy general. The WBTi also said that there are provisions to include other sectors important to IYCF at the Nutrition Steering Committee (the highest body chaired by the Secretary to Health) meeting which takes place quarterly. Their criticisms are minimal and are more advisory. One piece of advice was that the implementation of the policy and programme needs to be strengthened. The Ministry, in fact, is already working on this and has said that efforts are ongoing to obtain a separate line of finance for the sustainability of the programme for maternal and child services. “Cadre revisions, projections, recruitment, and training are being streamlined to ensure adequate healthcare is provided at the community level,” they assured. The WBTi mentioned that the country is doing well in achieving Baby-friendly Hospital Initiative (BFHI) targets by implementing 10 steps to successful breastfeeding, both in quantity and quality. Here, they list a few aspects of the initiative that need improvement. “A 40-hour breastfeeding counselling course is the standard course for hospital staff and a five-and-a-half day IYCF course is the standard course for field staff. It is mandatory that all staff caring for mothers and newborns in the hospital are trained in the 40-hour breastfeeding counselling course and in the field, in the IYCF course. “All 10 steps of the BFHI, including the mother-friendly initiative components and baby-friendly field clinics, have been incorporated into the system in Sri Lanka. It is not practical and cost effective to have only a BFHI assessment and accreditation system for Sri Lanka. Therefore, the country has decided to monitor it along with their usual hospital monitoring system by the hospital directors, which is monitored at the hospital directors’ meeting (monthly, chaired by the Director General of Health Services), maternal and child healthcare (MCH) supervision in the hospitals by the MOMCH (District MCH Manager), and are reviewed at the maternal child health reviews of the districts that are conducted quarterly by the districts and annually by national-level staff. “In addition to this, quality assessment tools for a quality assurance system for hospitals are being developed and it would include the BFHI as an essential component in the assessment,” they said. Sri Lanka’s gaps identified by WBTi 1. A system for external assessment is not fully systematised. WBTi said that the BFHI assessment and accreditation is already incorporated into the hospital accreditation system. However, what they would prefer is for the system to be scaled up nationally, and be annually reviewed under the quality improvement programme 2. Law enforcement of the Breastfeeding Code needs to be strengthened 3. There are discrepancies in maternity benefits among the government sector, private sector, formal sector, and informal sector, thus affecting those breastfeeding over six months, and the continuation of breastfeeding. Discrepancies in maternity benefits among the government sector, private sector, formal sector, and informal sector have to be addressed and rectified via liaison with the Department of Labour, Employers’ Federation, private sector partners, and community organisations 4. A higher bottle feeding rate among infants despite high breastfeeding rates warrants the exploration of causes and intervention 5. Information education and communication (IEC) material on breastfeeding is not adequately targeted, e.g. working mothers’ key recommendations. The WBTi recommends the development of IEC material of all suitable forms (video, audio, websites, Facebook posts, leaflets, posters, etc.) on breastfeeding and complementary feeding, based on the requirements of the clientele However, Sri Lanka has scored very well in all the assessments done by the WBTi, with the lowest score awarded to a country being six. SL’s points of assessment •National policy, programme, and co-ordination – 10/10 •Baby-friendly Hospital Initiative – 10/10 •Implementation of the International Code – 7/10 •Maternity protection – 6/10 •Health and nutrition care systems – 10/10 •Mother support and community outreach – 10/10 •Information support – 8/10 •Infant feeding and HIV – 10/10 •Infant feeding during emergencies – 10/10 •Monitoring and evaluation – 10/10 The situation at home is what matters Likewise, the Health Ministry of Sri Lanka too has conducted their own research and said that over the years, there has been a very steady decline in the lack of nutrition amongst infants who are breastfed in this country. However, while the child is protected very well and although the mother is certainly cared for by the looks of it, Dr. Romanie Fernando, an obstetrics and gynaecology specialist, said that the support system for mothers who have given birth are lacking at a household level. The hospital tries to do what they can. However, according to Dr. Fernando, it is the situation at home that matters. Although the breastfeeding situation seems under control in our country, according to Dr. Fernando, the trauma majority of the mothers undergo while giving birth without affectionate care is what could lead to anything dangerous such as postpartum depression. Physical health wise, however, it can be seen that the medical professionals in Sri Lanka are extremely talented individuals, said Dr. Fernando. Any difficulties that come up with breastfeeding in a physical context can be sorted out well by a majority of our local professionals. Hence, while keeping note of the few improvements which must be made, it would not be a crime to feel a little joy that our country has become something close to a haven for women undergoing such a great deal of stress.