Former WHO Coordinator of Nutrition contributes to advances in breastfeeding

Not long ago, I was invited to teach my first breastfeeding class at one of my community’s freestanding birth centers. Along with mothering my daughters, teaching the class was one of the most rewarding opportunities I’ve experienced. I must admit though that preparing for the class was exhausting.

I found myself anticipating questions from participants, so I compiled a ridiculously long list of resources to share. Amongst many other noteworthy organizations, one in particular kept coming up: the World Health Organization.

Creating my curriculum, could have been painful if it weren’t for the easily accessible WHO guidelines on maternal, reproductive and women’s health and guidelines on child health.

I am beyond thankful that these recommendations are a Google search away. The essential content in these documents comes from countless hours of planning, researching, organizing and dedication from remarkable people.

unnamedRanda Saadeh, a former Coordinator of Nutrition in the Life Course Unit at WHO’s Department of Nutrition for Health and Development has worked to ensure proper nutrition recommendations throughout the entire life cycle for nearly three decades.

She highlights the 67th World Health Assembly where more than 20 resolutions on public health issues of global importance were adopted. Of those is a draft action plan for newborn health:

“The first-ever global plan to end preventable newborn deaths and stillbirths by 2035 calls for all countries to aim for fewer than 10 newborn deaths per 1000 live births and less than 10 stillbirths per 1000 total births by 2035,” it states.

Most of these deaths could be prevented by cost-effective interventions, it continues.

“Maternal health and …Breastfeeding is at the core of all of this,” Saadeh says. “It’s not the only and sole answer to much of the mortality we see, but it’s definitely one way of saving lives.”image001

Since beginning her work in nutrition in the early 80s, Saadeh has witnessed many changes in the maternal health care field.

“Back when I started…there was a lot of interest in breastfeeding, but the main focus was on child spacing,” she explains.

Sufficient child spacing reduces the risk of adverse maternal, perinatal and infant outcomes.

“At that time we didn’t know about the importance of exclusive breastfeeding; we mentioned exclusive [breastfeeding] but there was no clear definition,” she says.

Since then, WHO has defined exclusive breastfeeding: “Exclusive breastfeeding means that the infant receives only breast milk. No other liquids or solids are given – not even water – with the exception of oral rehydration solution, or drops/syrups of vitamins, minerals or medicines.” [Retrieved from:]

Once focusing on the Lactational Amenorrhea Method to improve maternal child health outcomes, Saadeh’s work transitioned to prioritize “not only the benefits of breastfeeding but the risk of formula feeding.”

In 1991, WHO and its close partner UNICEF launched the Baby-Friendly Hospital Initiative (BFHI) to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding and mother/baby bonding.

Saadeh was instrumental in the creation of BFHI as it launched in Turkey and 11 other pilot countries.

Saadeh says there was a big interest in the initiative, but many countries took time to understand what changing practices would require.

“The U.S. is one of these countries that took time to start, but once health workers and policy makers saw what Baby-Friendly is all about, the progress is quite good,” she says.

As of May 2014, there are 179 Baby-Friendly facilities in the U.S. and “many, many more in the pipeline,” Saadeh reports. “I have no doubt the progress will be great.”

Saadeh sees the 2011 Surgeon General’s Call to Action to Support Breastfeeding a turning point for BFHI.

She reports continual improvements in the program as evidence surfaces.

For instance, Baby-Friendly’s Ten Steps to Successful Breastfeeding remain the same, but interpretations are added as new evidence is gathered.

Saadeh has also played a key role in defining appropriate, exclusive breastfeeding duration.

“It was only in the mid 90s that we had enough evidence to revise the definitions,” she says.

Numerous systematic and Cochrane reviews later, exclusive breastfeeding duration has changed from an old recommendation of 4-6 months to a full 6 months, Saadeh explains.

The infant feeding recommendation has changed for HIV positive mothers as well.

“…In the 80s and 90s…the HIV epidemic really put a hold on breastfeeding progress, because at that time we didn’t have the scientific evidence about what to advise mothers to do,” Saadeh says. “In the early 2000s, various researchers published studies showing that exclusive breastfeeding was an appropriate option for HIV- positive women.”

A combination of exclusive breastfeeding and the use of antiretroviral treatment can significantly reduce the risk of HIV- positive mothers transmitting the virus to their babies through breastfeeding, according to a WHO Bulletin.

“This means that the child can benefit from breastfeeding with very little risk of becoming infected with HIV,” it states.

The status of maternal child health worldwide is becoming more and more transparent. A 2014 Save the Children report called Ending Newborn Deaths: Ensuring Every Baby Survives reveals that 1 million newborns die on their first and only day of life.

“40 million. The number of mothers across the world who give birth each year without any help from a midwife or other trained and equipped health worker. 2 million women report that when they last gave birth they were completely alone…

$5. Increasing health expenditure by just US$5 per person per year could prevent the deaths of 147 million children and 5 million women, and 32 million stillbirths – and result in economic and social benefits worth up to nine times that investment by 2035…

6.6 million. The number of children who died before their fifth birthday in 2012, most from preventable causes. This number has almost been halved since 1990, but still means that 18,000 children died every day.”

The report goes on.

“They told a story in numbers; I thought that was smart,” Saadeh comments. “It tells us how much work…we have to do. With breastfeeding and appropriate, complementary feeding [methods], many lives [can be] saved.”

Like Save the Children, WHO also publishes figures about essential health services. They see breastfeeding as one of the most cost effective interventions to reduce child mortality under five.image002

“We are saying that based on very solid evidence.”

Moving forward, Saadeh is excited about WHO’s Global targets for 2025 “for improving maternal, infant and young child nutrition [which are] vital for identifying priority areas for action and catalysing global change.” [Retrieved from:]

Training health workers is of paramount importance so that we can properly inform mothers of their choices.

“I always say I don’t think any mother will decide not to breastfeed if she is fully informed,” Saadeh declares.

It is also health workers’ responsibility to know how we can uphold and support the International Code of Breast-milk Substitutes.

Although there is plentiful work ahead of us, the challenges are not insurmountable. Despite the sometimes upsetting nature of the state of global health, Saadeh remains optimistic.

“I love it all,” she says. “I love working with health workers, with mothers, with babies. I’ve worked with many hospitals before and after BFHI and I see the enthusiastic faces there and all that makes a difference in child health; not only in the hospital but way after discharge.”

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