Cristiano Boccolini, PhD, M.S. is a researcher at the Oswaldo Cruz Foundation in Rio de Janeiro, Brazil. He will be presenting Breastfeeding in Brazil: The evolution of breastfeeding policies and the research agenda– how science and policy-making can walk together at Healthy Children’s 22nd Annual International Breastfeeding Conference in Orlando, Fla. Read on!
Q: How did you become interested in maternal child health and breastfeeding?
A: In 1999 I graduated in Nutrition Sciences with a major in clinical nutrition, specifically to treat intensive care unit patients. When I started working in a hospital, I had to cover a colleague for a brief period at the maternity wing, and I never left this position thereafter. I fell in love with the tiny newborn cries and with the joy that radiated from the new mothers. I also felt so good to help mothers initiating breastfeeding by giving support in this critical moment, and the results of my work were so instantaneous, that it changed my mind. Since then I have decided to dedicate my efforts to work with health promotion instead of treating critical illness.
Q: Your current research focuses on breastfeeding patterns in the first days of life. What is the most fascinating thing you’ve discovered through this research?
Breastfeeding in the first days of life is fascinating, because it can shape the success and duration of breastfeeding, promote mother and child bonding, and also can improve the newborn health by providing essential immunonutrients to protect their not-yet-mature immune system. The two fascinating things I have found is that the mothers are almost completely dependent, and rely on to a high degree, of the hospital health staff during the first hours of life. The staff have a crucial role to ensure the timely initiation of breastfeeding.
The second interesting finding is that developing countries can save thousands of newborns by promoting breastfeeding in the first hour of life, and my research shows that the most vulnerable countries, with mortality rates above 30 deaths per thousand births, are more sensitive to reduce neonatal mortality due to this practice.
Q: What kind of breastfeeding promotion have you found to be the most successful in Rio de Janeiro?
A: Beside all the natural beauties of Rio de Janeiro landscapes, we also have appealing work on breastfeeding promotion, protection and support that associates simultaneously more than one action/program and goes beyond hospitals, involving primary health care units and the society.
The results are the continuous increase of breastfeeding rates. Our managers and health practitioners, in all levels of attention, work on a perspective to integrate the international programs, like Baby Friendly Hospital Initiative, Kangaroo Mother Care, International Breastfeeding Code monitoring and World Breastfeeding Week, with national and local initiatives, such as Human Milk Banking, Breastfeeding Friendly Primary Care Initiative (IUBAAM,) among others.
The involvement of the society is also fundamental, by participating on public breastfeeding acts (called ‘mamaço’ here), with hundreds of participants every year, and in several actions related to breastfeeding promotion.
We have a breastfeeding policy that covers several programs and actions to promote, support and protect breastfeeding, and it is difficult to say what program has more success. Our health professionals’ commitment is the reason for the success of all these programs, improving our yearly breastfeeding rates.
Q: Please tell me about the success of the Breastfeeding Friendly Primary Care Initiative (IUBAAM) in Brazil.
A: The IUBAAM is what we call a ‘Carioca’ invention (word designated to the local inhabitants of Rio de Janeiro) and is based on the adaptation to the primary health care units of the “Ten Steps to Successful Breastfeeding.” It was created in 1999 based on a systematic review conducted by professor Maria Inês Couto de Oliveira that aimed to understand: what were the most effective ways to extend breastfeeding duration of mothers assisted at the primary health care units (De Oliveira et al, 2001).
Since then, it has been implemented by the Rio de Janeiro Secretary of State for Health in hundreds of health units across the state, and has been adopted by other states and cities as well, improving breastfeeding rates.
To be certificated as IUBAAM, the health care unit must have all their professionals qualified in a 24 hour long immersion course, and during the certification process not only the professionals are questioned, but also the mothers are randomly interviewed to be sure that the knowledge has been correctly transmitted to all.
In my opinion, the success of this initiative is related not only to the quality of the course material and the necessity of immersion in disciplines related to breastfeeding techniques and counselling, but also in the accountability related to this training: all the professionals trained have the commitment to be “multipliers,” assuming the task to give this course to their colleagues, optimising, this way, the human resources and making everyone accountable.
At the national level we have a complementary action called ‘Feeding and Breastfeeding Network’ (“Rede Amamenta e Alimenta Brasil,”) dedicated to engage the primary health care units in breastfeeding and complementary feeding actions, which is in implementation process since 2013 and has been evaluated since then.
De Oliveira MIC, Camacho LAB, Tedstone, AE. Extending breastfeeding duration through primary care: a systematic review of prenatal and postnatal interventions. Journal of Human Lactation 2001; 17(4): 326-343.
Q: What suggestions do you have to help make the transition from medical research to policy and practice more efficient?
A: The case of IUBAAM and Brazilian Human Milk Banking (HMB) are an example of how we can shorten the time lapse among medical research and practice. Professor Maria Inês Couto was a health practitioner who decided to do her PhD thesis based on her breastfeeding work at Rio de Janeiro Secretary of State for Health, and even before she finished her PhD training and published her papers, she translated her findings in action by creating IUBAAM with her co-workers.
The other example is HMB in Brazil. Because Professor João Aprígio Guerra de Almeida assumed the coordination of the few HMB in Brazil in 1985, he and his team developed a new paradigm on HMB in Brazil, helping develop laws and norms to unify HMB procedures based on ongoing academic research.
Based on these examples, I assume that the key to fast translation of science in action is the strong engagement of the researchers to dedicate their time not only to solve problems that emerge from the real needs of the health system, but also to become personally involved in the process to make their findings produce an immediate effect on the current practices. This is the initial spark, and the correct political environment, society involvement, and the constant advocacy, can make this ideas happen.
Q: What are your thoughts on the advertising campaign from the Pediatric Society of Rio Grande?
A: At the first glance it is shocking to see a child suckling a burger/soda instead of a breast, and this image initially brings the wrong (and dangerous) idea that mothers with unhealthy feeding habits produces ‘unhealthy milk.’
However, the small letters in the mother’s breast brings another message: “Your habits in the first thousand days of gestation can prevent your child from developing serious diseases,” aiming to promote healthy food habits since pregnancy, what I think was the main objective of this campaign.
In conclusion, the disquieting images prejudiced the healthy habits message; but, let’s make a lemonade with those lemons and use this campaign repercussion to keep debating the importance of nutrition in the first thousand days of life as an opportunity to promote healthy feeding habits.
Q: What are you most looking forward to at the International Breastfeeding Conference?
A: I am counting the days to participate at the International Breastfeeding Conference. The theme is inspiring and I am enthusiastic to share some of our experiences of breastfeeding promotion in Brazil and to learn more with the other panelists. It will be also a great opportunity to meet other professionals and establish productive networking.