Accreditation under Baby Friendly Hospital Initiative

Thank you. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of a baby's

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life as it provides all the energy and nutrients needed for optimal growth, development and protection against infectious and chronic diseases. The promotion of exclusive breastfeeding among mothers, by educating and supporting them in breastfeeding, before birth, during their hospital stay and after they are discharged, can contribute towards improving infants' health.

HPB and the Association for Breastfeeding Advocacy (Singapore) (ABAS) have been working with five hospitals – National University Hospital (NUH), KK Women's and Children's Hospital (KKH), Singapore General Hospital (SGH), Mount Alvernia Hospital and Thomson Medical Centre – to implement the Baby Friendly Hospital Initiative (BFHI) guidelines and achieve BFHI certification. HPB and ABAS are working with the five identified hospitals as they account for 80% of the births in Singapore. Currently, NUH and SGH have achieved BFHI certification. All five hospitals are committed to the principles outlined in the BFHI guidelines and have implemented initiatives such as the provision of training to all maternity ward staff to provide breastfeeding counselling, consultation and support to mothers.

Promotion of breastfeeding is also accompanied by measures to protect parents from excessive marketing of infant formula targeted at children aged 0-6 months. In this respect, the Sale of Infant Foods Ethics Committee Singapore (SIFECS)'s Code of Ethics was established to safeguard ethical standards on appropriate marketing and distribution of breast milk substitutes. Adherence to the Code is obligatory on the entire infant food industry operating in Singapore.

Breastfeeding puts an infant on the right start to life. MOH will work together with stakeholders to ensure that mothers are provided with the appropriate skills and support to ensure that they are motivated to continue breastfeeding their babies for the recommended period.

Mdm Speaker, I thank the Senior Minister of State for the answer. I have three supplementary questions. The experience of other countries has shown that what is important is community support after the mother is discharged from hospital because that is critical in ensuring that the breastfeeding practice continues. So, my question is what has MOH done or will want to do to build upon such peer support to increase breastfeeding awareness amongst mothers in the community, and have there been any funding and, if so, what has been the impact of such activities.

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Secondly, with the Baby Friendly Hospital Initiative (BFHI) being implemented, how does the Government plan to monitor the effectiveness of such a scheme, especially in increasing breastfeeding rates in Singapore? And what kind of a feedback system is in place?

Lastly, with regards to the Sale of Infant Foods Ethics Committee Singapore (SIFECS)'s Code of Ethics, does MOH intend to do more in terms of introducing penalties for companies which do not comply?

I will go in the reverse order. Firstly, for the SIFECS' Code of Ethics, as I have noted, the major infant food industry players are all committed to subscribe to the Code of Ethics. In fact, HPB is the agency that oversees compliance with this Code of Ethics. Generally, there has been good compliance with a handful of violations. What we do really is for HPB to send a warning letter to those who have violated the guidelines, firstly, to the regional HQ, and, if necessary, to the global HQ. And, generally, they will rectify the violations. We have observed that there are no continued or consistent violations by the same company. Generally, this approach has worked well, and we intend to continue with this approach, promotional as well as getting the major players involved with compliance. In fact, all of them are committed to complying with the Code.

The other question on BFHI – plans to monitor the effectiveness after implementation, and then the feedback regarding the breastfeeding rate. First, let me share that between 2001 and 2011, the percentage of women who have taken to breastfeeding their infants upon delivery and then discharge from hospital, that is at initiation, has increased. In 2011, the rate was 99.1% at initiation. Continued breastfeeding, partial breastfeeding, at six months has also improved. In 2001, it was 21%. It has improved to 42% in 2011.

The exclusive breastfeeding rate is still very low. We continue to see how we can encourage exclusive breastfeeding, which means that only breast milk for the first six months, excluding water. I think one of the problems really is cultural practices and beliefs that you should supplement it with water, which is not in accordance with the definition of exclusive breastfeeding.

We conduct a national survey for breastfeeding periodically and that will be one of the ways that we can monitor the effectiveness. For hospitals which do not have certification, as I have noted, they have already implemented many of the guidelines in the BFHI and they are committed to getting certification. For the three hospitals that have not gotten it, we are working with them, and we

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are in communication with other hospitals, too.

Regarding support for mothers who want to breastfeed, HPB actually has been working with Association for Breastfeeding Advocacy to encourage and advise employers on the establishment of breastfeeding friendly workplaces. For instance, having a lactation room as well as, of course, organising talks for women on successful breastfeeding. The "Project Liquid Gold" initiative by NTUC U Family has the same objectives. MOM has funding under WorkPro where you can get subsidies for expenditure on lactation rooms.

Besides that, HPB also produces a one-stop parent toolkit called "Healthier Child Brighter Future" and it has information on the benefits of breastfeeding for mother and child and knowledge to help the women onto successful breastfeeding. We continue to work with partners to promote breastfeeding.

One last supplementary question, please. I think in the National Breastfeeding Survey 2011, only 0.9% of mothers were still exclusively breastfeeding when the baby was six months, which is really, really low. In fact, the experience of other countries shows that if you have trained peer breastfeeding counsellors, it really, really helps the rate to go up. So, my last question is: what has MOH done or want to do to ensure that there are trained peer breastfeeding counsellors, whether within the community or somebody from the agencies?

We are aware that the exclusive breastfeeding rate is low but, as I have noted, two out of five women are breastfeeding partially at six months. Therefore, for exclusive breastfeeding, some of the issues could be that cultural practices and beliefs are such that you cannot comply with the definition of what exclusive breastfeeding means. Nonetheless, HPB is working with the hospitals. Under the BFHI initiative, all staff in the maternity ward, the healthcare professionals, would be trained to provide counselling and support for breastfeeding mothers, that is, teach them how to breastfeed, and so on and so forth. We will continue with that. HPB also will work towards providing more support in this area.

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