The key to child survival

8 World Health • May-June 1992 The key to child survival Adelpha S. Mabulay & Vida Subingsubing Named after the local word for the youngest child in the family, BUNSO is a national coalition promoting and protecting the health and rights of mothers and children. Ten years ago, a dairy company dumped on the markets of the Philippines the time-expired and vitamin-deficient milk base of an infant fonnu la drink. When this became known, it sent consumers protesting on the streets and in parliament. While the movement fai led to stop the company from selling more of this product, it succeeded in raising consumer awareness . This later found expression in organizations and community actions which vigilantly kept watch over consumers ' health rights, particularly those pertaining to mothers and children. From these beginnings, a multisectoral coalition of community- based groups was born in 1981 to pursue the protection of infants' health . The group was named BUN SO, the Pilipino vernacular for the youngest child in the family. BUNSO was committed to promoting material and child health, with emphasis on breast-feeding as the superior mode of infant feeding . Infant mortality in the Philippines stood at 51.5 per 1000 live births in 1989. This meant that for every 1 000 live births, 52 would die before they reached the age of one year. Two- thirds of these deaths would be due to infectious diseases - with pneumonia Breast-feeding key to child survival. and diarrhoea diseases topping the li st- and malnutrition. Breast is best This situation was aggravated by the decline in breast-feeding rates which fell from 87% in 1973 to 80% in 1984. Despite the scientific recognition that breast-milk provides the ideal nourishment for infants, a BUNSO study of infant feeding practices in several government hospitals revealed that breast-feeding was practiced by a mere 41 % of the mothers sampled . Breast-feeding was lowest among women in urban areas . Conscious of thi s alann ing trend, BUNSO initiated various activities aimed at reviving the popularity of breast-feeding, a practice so essential to child survival and yet so gravely threatened with extinction. BUNSO's membership was drawn from such community-based groups as consumers, the church, health workers, women, and the urban poor, and thi s ensured widespread participation. Through the joint efforts of these groups, BUNSO struggled to get approval for the Philippine Milk Code, which seeks to regulate the marketing and distribution of breast- milk substitutes, supplements and related products. Designed by BUNSO, other nongovernmental World Health • May-June 1992 organizations and the Department of Health in 1983, the Code finally became operational in 1986. Now that the Code is in place, its sponsors are currently monitoring the In time, mothers were not only breast-feeding their infants but were also actively advocating breast- feeding within and outside their communities. Mothers figured Mothers play a key role in ensuring immunization against childhood diseases. marketing and advertising practices of dairy companies to ensure that its provisions are not violated. Milk Code advocacy is actively being pursued to make more consumers aware and assertive of their rights . Community participation in this field is not limited to Code monitoring and advocacy. In 1984, BUNSO conducted breast-feeding seminars for pregnant and lactating mothers in 11 poor urban areas in Metropolitan Manila. Some I 000 mothers underwent training on the advantages of breast-feeding, the disadvantages of bottle feeding, and correct breast- feeding techniques. prominently in BUNSO-sponsored motorcades calling for stricter implementation of the Code. Eventually, they received training to help them in planning and running their own community programmes. Mothers' best friend The success of BUNSO's community work led to the development of Breast-feeding Mothers' Counsellors. Each counsellor is trained to provide guidance and support to pregnant and lactating mothers: she invites mothers to a breast-feeding class, and later 9 makes house visits to advise them if they are having problems with breast- feeding or simply to make sure they get all the support they need. The counsellors, together with the mothers, represent a defence line to counter misleading information which might discourage pregnant and lactating mothers from breast-feeding. This system also encourages mother- to-mother counselling and support. In 1989, a lactation centre was set up in East Avenue Medical Centre, where Breast-feeding Mothers' Counsellors were able to aid women who gave birth in this Quezon City government hospital. Subsequently, facilities offering a similar package of services were set up in health centres near the community. BUNSO's breast-feeding programme continues to explore and expand into new spheres in order to make its activities more responsive to the needs of mother and child. It works in cooperation with the maternal and child health and nutrition programmes of BUNSO, distinct but part of the same mother and child concern. This year, BUNSO has targeted the setting up of support systems in communities and factories to make breast-feeding easier, especially for working mothers. It is also studying the possibility of income-generating projects to augment the community's income. The guiding principle of BUNSO's work is to support mothers' groups by getting them interested in counselling mothers, managing infant health care services, and starting livelihood projects. Through these, it is hoped that the community may regain self-reliance and self- esteem. Only through building community awareness about proper child health and nutrition, by equipping people with proper skills, and by actively engaging the community can BUNSO's objectives be achieved. • Ms Adelpha S Mabuloy is Secretary General of BUNSO and Ms Vida Subingsubing is the Resource Centre Coordinator. BUNSO's address is 5 Basi/an Street Philamlife, Homes, Quezon City, Philippines.