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      <h1 id="top">9.4 Local initiatives</h1>
      <div class="section" id="Breastfeeding_in_public"><h2>Breastfeeding in public</h2>
    <div class="section" id="Baby_Friendly_Point_6"><h3>Baby Friendly Point 6</h3>
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        <div><span style="font-weight: bold;">Point 6</span> of the Seven-point Plan for Sustaining Breastfeeding in the Community states:</div>
        <blockquote>
          <div>
            <span style="font-style: italic;">Provide a welcoming atmosphere for breastfeeding families</span>
          </div>
        </blockquote>
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      <p>
		   The health care facility should welcome breastfeeding in all public areas and this should be indicated by appropriately worded signs. Suitable facilities should be available for mothers who prefer to feed in privacy.
		 </p>
      <p>
		 	Reception staff should be aware that mothers are welcome to breastfeed in all public areas and be able to describe how they would advise a mother who wished to feed in privacy.
		 </p>
    </div>
    <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><img src="design/thinker.gif" class="icon" alt="" /><h3>The normal act of breastfeeding seen in public</h3>
      <div>
        <p>Australia now has a law passed in Federal Parliament under the Sex Discrimination Act which makes it illegal for anyone to discriminate against breastfeeding mothers!</p>
        <p>Does your community health unit make it explicitly clear that breastfeeding is welcomed in all public areas? Do you have an area set aside should a mother prefer to breastfeed in privacy? </p>
      </div>
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    <div class="columns"><div class="column" style="width: 50%">
        <div class="captionBox"><img width="208" height="298" src="images/breastfeeding_welcome.jpg" alt="" /><p> <br />&copy; Australian Breastfeeding Association</p></div>
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        <div class="captionBox"><img width="276" height="415" src="images/bfiUKwelcome_sm.jpg" alt="" /><p> <br />&copy; BFI UK Breastfeeding Welcome</p></div>
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            <td class="body"><img src="design/group.png" class="icon" alt="" /><h3>Take a walk</h3>
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      <p>
			Go for a walk around your hospital or community health centre. Are there obvious signs in all the public areas making it clear that mothers may breastfeed in any them, AND referring her to a private area should she prefer it?
		</p>
      <p>
			If not design your own signs and display them until the organisation develops 'official' signs.
		</p>
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      <div class="section" id="Supporting_mothers_in_the_community"><h2>Supporting mothers in the community</h2>
    <div class="section" id="Baby_Friendly_Step_10_and_Point_7"><h3>Baby Friendly Step 10 and Point 7</h3>
      <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><h3></h3>
        <div><span style="font-weight: bold;">Step 10</span> of the Ten Steps to Successful Breastfeeding, and <span style="font-weight: bold;">Point 7</span> of the Seven-point Plan for Sustaining Breastfeeding in the Community state:</div>
        <blockquote>
          <div><span style="font-weight: bold;">Step 10</span>:<span style="font-style: italic;"> Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.</span></div>
        </blockquote>
        <blockquote>
          <div><span style="font-weight: bold;">Point 7</span>:<span style="font-style: italic;"> Promote co-operation between health care staff, breastfeeding support groups and the local community. </span></div>
        </blockquote>
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    <div>
      <p> A Cochrane database systematic review <sup><a href="#note1">1</a></sup> on the effect of lay health workers in the community found them to be "promising" in breastfeeding promotion. Attendance at mother-to-mother support groups or follow-up by peer counsellors has demonstrated significant increases in maintaining exclusive breastfeeding. <sup><a href="#note2">2</a></sup> The peer counsellor role is unique from a health professional role in that it brings a mother together with another mother - the experienced can share with the new, the new can be supported and learn from the experienced. <br /> </p>
      <p> A report on the effects of implementation of the Baby Friendly Hospital Initiative (BFHI) and community postnatal support on breastfeeding rates indicated an increase in breastfeeding initiation to one month of age in the BFHI group compared to the control.<sup><a href="#note3">3</a></sup> However, once breastfeeding support groups activity increased, breastfeeding at 6 months and 12 months was significantly increased. They concluded that activities aiming to promote breastfeeding in maternity hospitals had limited success on long-term breastfeeding. For far-reaching effect postnatal support is also required. </p>
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    <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><img src="design/books.png" class="icon" alt="" /><h3>Workbook Activity 9.5 </h3><p>Complete Activity 9.5  in your workbook.</p></td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
    <div>
      <p class="listTitle">UK Baby Friendly requires Community Health Units to address each of the following to meet the requirements of this point.</p>
      <ul>
        <li>All breastfeeding mothers should know which professional(s) to contact for breastfeeding support and how to access this help.</li>
        <li>All breastfeeding mothers should know how to contact a breastfeeding counsellor or support group for help with breastfeeding.</li>
        <li>All breastfeeding mothers should know how to access help with breastfeeding outside surgery/office hours.</li>
        <li>Relevant staff should be able to describe a procedure which ensures that information on the progress of breastfeeding is passed on during the handover of care between midwife and health visitor.</li>
        <li>Mothers should demonstrate an awareness that such a procedure exists.</li>
      </ul>
    </div>
    <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><img src="design/group.png" class="icon" alt="" /><h3>What procedures does your unit have in place to meet this standard?</h3>
      <div>
        <p>
					How is the availability of professional support <strong>and</strong> peer support communicated to mothers? Do you have a method of recording that mothers have received this information? How does your Unit encourage mothers to attend peer support organisations? If you are unsure of this could you form a group to look at what is done now, improve the procedure if necessary, and ensure the procedure is communicated to all staff at your Unit?
				</p>
        <p>
					If applicable, what handover procedures are in place between the birthing service and the community service?
				</p>
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    <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><img src="design/group.png" class="icon" alt="" /><h3>Peer support in unusual circumstances</h3>
      <div>
        <p> 
				As a sign of the changing times Gribble (2001)<sup><a href="#note4">4</a></sup> found that Internet breastfeeding support groups can provide mother-to-mother support to those breastfeeding in unusual circumstances.
			</p>
        <p>
				Consider forming a small group to research online support groups with the goal being to produce reference material for staff when counselling a mother whose situation may be unique (eg. adoptive breastfeeding, breastfeeding after reduction mammaplasty, etc). Contacting the facilitator of the group to determine their goals and the way the group functions would help to determine if their goals are consistent with those of your organisation.
			</p>
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    <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><img src="design/tip.png" class="icon" alt="" /><h3>You can't do it alone!</h3>
      <div>
        <p>
				Peer support offers mothers a different type of support to what she receives from health professionals. Both are needed by mothers and, working together, both will help her to give her baby the healthiest start in life.
			</p>
        <p>
				Engage the peer breastfeeding support organisations in your community.
			</p>
      </div>
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      <div class="section" id="Engaging_the_Community"><h2>Engaging the Community</h2>
    <div>
      <p> Each year the World Alliance for Breastfeeding Action (WABA) promotes World Breastfeeding Week. World Breastfeeding Week (WBW) is the greatest outreach vehicle for the breastfeeding movement, being celebrated in over 120 countries. Officially it is celebrated from 1-7 August. However, groups may choose other dates to make it a more successful event in their countries. </p>
      <p> Each year a theme is chosen and WABA produces resource materials to assist groups and individuals to celebrate this event, raising community and media awareness of breastfeeding. This is an ideal opportunity for your Unit to celebrate breastfeeding and use the occasion to educate your community about breastfeeding. <br /></p>
      <p>You will be able to get ideas and download resources from their website when they become available: <img alt="External" src="design/external.gif" /><a href="http://worldbreastfeedingweek.org/" target="_blank" title="External link">WABA World Breastfeeding Week</a>. <br /></p>
      <p>
        <br />
      </p>
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    <div class="columns"><div class="column" style="width: 50%">
        <div class="captionBox"><img width="216" height="360" src="images/WBWlogo07.png" alt="Logo for WBW 2007" /><p>Logo for WBW 2007</p></div>
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        <div class="captionBox"><img width="304" height="240" src="images/wbw2010logo_sm.jpg" alt="Logo for WBW 2010" /><p>Logo for WBW 2010</p></div>
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            <td class="body"><img src="design/group.png" class="icon" alt="" /><h3>Have fun this year!</h3>
    <div>
      <p> Start now! Get a group together to plan activities and promotions (of breastfeeding and your wonderful unit!) during Breastfeeding Awareness Week. The theme for this year is very modern and topical.<br /></p>
      <p>There are lots of resources available on the Internet and you could think up many others. Don't forget to involve the media in your celebrations. </p>
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      <div class="section" id="What_should_I_remember_"><h2>What should I remember?</h2>
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      <div>
        <ul>
          <li>Breastfeeding is a normal act which needs to be seen by everyone.</li>
          <li>The importance of welcoming breastfeeding mothers in public areas.</li>
          <li>How breastfeeding support groups play a vital role in continued support for breastfeeding mothers.</li>
          <li>That there are opportunities to become involved in breastfeeding promotion on a personal and professional level.</li>
        </ul>
      </div>
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      <div class="section" id="Self-test_quiz"><h2>Self-test quiz</h2>
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      <div></div><div class="activity" id="activity_rm">
<script type="text/javascript">
/* <![CDATA[ */
var rmqs = {settings : {type : 'mcq'}, questions : [
	new MCQ('Counselling and support by mother-to-mother support groups has been shown to increase months of exclusive breastfeeding.', [{text:'True',score:1},{text:'False',score:0}]),
	new MCQ('All breastfeeding mothers should be encouraged to contact a breastfeeding support group for ongoing peer counselling for the duration of breastfeeding.', [{text:'True',score:1},{text:'False',score:0}]),
	new MCQ('Breastfeeding in public will improve society education and acceptance of breastfeeding as normal.', [{text:'True',score:1},{text:'False',score:0}])
]};

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</div><script type="text/javascript">renderActivity('rm');</script>
    </td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
  </div>
      <div class="section" id="Assessment_Quiz"><h2>Assessment Quiz</h2>
    <div>
      <p>
		When you are happy that you've understood all the information in this topic you will be ready to complete the Module 9 Assessment. To do this, go to the course opening page, scroll down to the Assessment section and choose Module 9.
	</p>
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  </div>
      <div id="footnotes">
        <h3>Notes</h3>
        <ol>
          <li id="note1"><a href="references.html#lewi05" title="See full details">#</a> Lewin SA et al. (2005) Lay health workers in primary and community health care.</li>
          <li id="note2"><a href="references.html#hodd06" title="See full details">#</a> Hoddinott P et al. (2006) Effectiveness of a breastfeeding peer coaching intervention in rural Scotland</li>
          <li id="note3"><a href="references.html#bosn04" title="See full details">#</a> Bosnjak AP et al. (2004) The effect of baby friendly hospital initiative and postnatal support on breastfeeding rates - Croatian experience</li>
          <li id="note4"><a href="references.html#grib01" title="See full details">#</a> Gribble KD (2001) Mother-to-mother support for women breastfeeding in unusual circumstances: a new method for an old model.</li>
        </ol>
      </div>
      <div id="footer"><a href="topic_9-3.html" rel="prev" class="prev">&laquo; Previous</a><a href="topic_9-5.html" rel="next" class="next">Next &raquo;</a><br style="clear: both" /><a href="#top" id="topLink">Back to top</a><a href="javascript: window.print()" id="printLink">Print this page</a><span class="noPrint"> | </span>&copy; 2012 Health e-Learning<p class="printOnly">COPYRIGHT: You are permitted to print ONE (1) copy for your personal use only. No graphics, tables, quizzes, videos, etc, may be used in any form without express written consent. Author: Denise Fisher</p></div>
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    <div id="menu">
      <h1>Breastfeeding Essentials</h1>
      <ol>
        <li>1.0 <a href="topic_1-0.html">Why Breastfeeding is Important</a><ol><li>1.1 <a href="topic_1-1.html">Biochemistry</a></li><li>1.2 <a href="topic_1-2.html">Immunology</a></li><li>1.3 <a href="topic_1-3.html">Relative risks</a></li></ol></li>
        <li>2.0 <a href="topic_2-0.html">Communication Skills</a><ol><li>2.1 <a href="topic_2-1.html">Non-verbal</a></li><li>2.2 <a href="topic_2-2.html">Listening skills</a></li><li>2.3 <a href="topic_2-3.html">Building confidence</a></li><li>2.4 <a href="topic_2-4.html">An example</a></li></ol></li>
        <li>3.0 <a href="topic_3-0.html">Pregnancy Care</a><ol><li>3.1 <a href="topic_3-1.html">The feeding decision</a></li><li>3.2 <a href="topic_3-2.html">The barriers</a></li><li>3.3 <a href="topic_3-3.html">Physical preparation</a></li></ol></li>
        <li>4.0 <a href="topic_4-0.html">The Birth Experience</a><ol><li>4.1 <a href="topic_4-1.html">The first hours</a></li><li>4.2 <a href="topic_4-2.html">Labor interventions</a></li><li>4.3 <a href="topic_4-3.html">Postnatal interventions</a></li></ol></li>
        <li>5.0 <a href="topic_5-0.html">Breastfeeding the Baby</a><ol><li>5.1 <a href="topic_5-1.html">Positioning Principles</a></li><li>5.2 <a href="topic_5-2.html">Breastmilk transfer</a></li><li>5.3 <a href="topic_5-3.html">Assessing breastfeeding</a></li></ol></li>
        <li>6.0 <a href="topic_6-0.html">A time to learn</a><ol><li>6.1 <a href="topic_6-1.html">Practical skills</a></li><li>6.2 <a href="topic_6-2.html">Breastfeeding messages</a></li><li>6.3 <a href="topic_6-3.html">Normal growth</a></li><li>6.4 <a href="topic_6-4.html">Sleep</a></li><li>6.5 <a href="topic_6-5.html">Psychological support</a></li><li>6.6 <a href="topic_6-6.html">Discharge planning</a></li></ol></li>
        <li>7.0 <a href="topic_7-0.html">Infant Challenges</a><ol><li>7.1 <a href="topic_7-1.html">Late preterm infant; Non-latching</a></li><li>7.2 <a href="topic_7-2.html">Hypoglycemia; Jaundice</a></li><li>7.3 <a href="topic_7-3.html">Supplementation</a></li><li>7.4 <a href="topic_7-4.html">Crying baby</a></li><li>7.5 <a href="topic_7-5.html">Inadequate weight gain</a><ol><li>7.5.1 <a href="topic_7-5-1.html">Feeding-line device at the breast</a></li><li>7.5.2 <a href="topic_7-5-2.html">Cup feeding</a></li><li>7.5.3 <a href="topic_7-5-3.html">Finger Feeding</a></li><li>7.5.4 <a href="topic_7-5-4.html">Bottle feeding</a></li></ol></li></ol></li>
        <li>8.0 <a href="topic_8-0.html">Maternal Challenges</a><ol><li>8.1 <a href="topic_8-1.html">Engorgement</a></li><li>8.2 <a href="topic_8-2.html">Nipple Pain</a></li><li>8.3 <a href="topic_8-3.html">Breast Problems</a></li><li>8.4 <a href="topic_8-4.html">Insufficient breastmilk</a></li><li>8.5 <a href="topic_8-5.html">Medical, Surgical Issues</a></li></ol></li>
        <li>9.0 <a href="topic_9-0.html">Promotion, Protection and Support</a><ol><li>9.1 <a href="topic_9-1.html">The International Code of Marketing of Breastmilk Substitutes</a></li><li>9.2 <a href="topic_9-2.html">The Baby Friendly Initiative</a></li><li>9.3 <a href="topic_9-3.html">Young Child Feeding</a></li><li class="current">9.4 <img src="design/bullet_arrow_right.png" alt="*" title="You are here" /><a href="topic_9-4.html">Local initiatives</a></li><li>9.5 <a href="topic_9-5.html">Infant feeding in emergencies</a></li></ol></li>
        <li>10.0 <a href="topic_10-0.html">Closing session</a><hr /></li>
        <li class="appendix"> <a href="references.html">List of references</a></li>
        <li class="appendix"> <a href="contents.html">Course contents</a></li>
        <li class="appendix"> <a href="full.html">Print version</a></li>
      </ol>
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