Transforming Health Colleagues into Breastfeeding Advocates

Item

Title: Transforming Health Colleagues
into Breastfeeding Advocates
extracted text: CH \.io
for a’! povuHe questions
»ubls that the lactating
naJ. An earnest effort *as
10 make their hospital
ucndly, where brea-seeding
orted and all the Ten Steps
ccssful Breastfeeding arc
J

months of life and sustained
breastfeeding in the second year.
(see fig. below)
--------------- ------

'gramme include' training of
:: to check mothers while
.•eding for proper positioning
r babies and no: to lake
even temporary stoppage of
ceding
Rebetation
is
ed whenever possible.
intent should also nuke us
y practise w-hat we preach.
•aid ensure that not only the
?. who come under our
ionaJ care, but also our own
r. and grandchildren get
e breastfeeding for the Grst

5. Creating opportunities for
others to lead:

A good leader is available and
remains responsive but facilitates
o'hers to lake more responsibility.
The leader doesn’t 'manipulate* or

Txploil <liners but iiispao and
creates opportunities for others to
take the lead. Such leaders ar: not
eager to take credit for successes
but arc rather ready io take
responsibility for failures
If difficulties arise, they carefully
examine the problem, especu.iy u
it
is
due
to
lack
cd
acknowledgement
of
ot.icrs
efforts. They arc ready to share
their
books,
articles,
transparencies or slides with
potential leaders, and invite them
to become “trainers in training" tor
the HLMT workshops Tx new
leaders finally become regular
trainers
who
then
take
independent
rcspousibHiiy
to
conduct training programme' in
the protection, promotion and
support of breastfeeding

urces

nstrcr.g H. Tra.nr.g Gu.de in Lactation Management. New York. UNICEF 1992 .

WOKLD^.I.IANCE for breastfeeding action

WABA ACTIVITY SHEET

PO Box 1200,10850 Penang, Malaysia. Tel: 60-4-884816; Fax: 60-4-872655

Transforming Health Colleagues
into Breastfeeding Advocates
“No one is more
dedicated to a cause
than a sceptic who
becomes convinced."
- Richard Hanland, in Ciba .Vchj.

orking "ogetne- coster A Quaker poster by TALC. PO Box 49, St Albans, UK

1. Respecting one’s colleagues:

. commenoations o' tne Spec.al Corrvtxr.ee of Indian Academy of Pediaircs. Indian Penar. 1938.25 873-874

That “Breast is Best” is now agreed
upon by all health professionals
YcL i: is being increasingly
recognised that doctors and nurses
could play a more effective role in
promoting breastfeeding - parti
cularly, exclusive breastfeeding in
the Grst four months of life,

and. RK et aL Mate-nity Home Practices and Breastfeeding. Bombay, ACASH, 1990

eastfeeong Paper of the Month. Local UNICEF office or UNICEF New Yo.-k,3 UN Plaza. New York, NY 10017. USA
sources foe Advocacy and Training in the Baby Friendty Hospital Initiative (Part V) New York, UNICEF 1992.

MT Workshops -C-' details contact Breastfeeding Promotion Network of India (BPNI). BP 33 Pcampura, Deft 110
•4. Inna or Dr F Savage. COD Programme. WHO/OMS. 1211 Geneva 27. Switzerland
;.n Diego Lactz.0". Program. 407 Fftn Avenue. San Diego. CA 92103. USA.

e Intemaeiona: Cose of Marketing of Breastmik Subsumes. Geneva, WHO. 1981.

"AN. PO Box 19. 10700 Penang. Malaysia.

ciivity sheet has been prepared by Dr Raj K Anand toe the World Alliance for Breastfeeding Action (WASA). Fortner
anon can oe cotamed from:
Anand 55 Kav: Apartments. Work. Bombay 400 018. India. Tel: 91-22-493 7358

ABA Secretariat. PO Box 1200. 10850 Penang. Malaysia Tel: 60-4-884 816. Fax 872 655

Anand is Sen.0' Paediatrician a Jaslok Hospital and Research Centre. Bombay. India He ts a former Hetessot
tfiatfics at the T N Medical College. Bombay and founder president o' Association for Consumers Action on Safety
.aftfi (ACASH;
•jvrty sneet ts pan c" a series from WA3A to assist groups wrtn their activities to protect, promote and support hreasc««Sng
□articular to pro»rse action ideas tnat could be focused on World Breastfeeding Week. August is: to 7m.

________________________________________________________________________ _____ __ ___ _________ 7

3

WTiilc some colleagues may lack
commitment to the cause, others
may not be fully equipped to help
mothers breastfeed successfully A
few may be sceptical about “this
whole business of breastfeeding".
However, most of them could
become our allies, provided we start
with the premise that love and
respect for others is essential before
expecting any kind of trans
formation in their behaviour.
In our eagerness to win a battle, we
have on occasion, lost the war by
being abrasive or by forgetting the
age-old dictum that love is the
greatest thing in the world. Lei us

• STEP ONE: Respecting
one’s colleagues

i

• STEP TWO: Providing
accurate information
• STEP THREE: Recognising
the stages of change in
ourselves and colleagues

• STEP FOUR: Personal
commitment
• STEP FIVE: Creating
opportunities for others to
lead

not lose our respect for our
colleagues if they tend to differ with
us. Let us hear their viewpoint.
They may have something important
to tell us.
It is also possible that what our
colleagues are advocating is not
consistent with the latest knowledge
of appropriate infant feeding
practices in such a situation, let us
remember that a!! of us have nude
mistakes in the past. “Every saint
has a past and every sinner a

Giturc." At times, the aulhor himself
has failed to give appropriate
support to mothers who were keen
to breastfeed.

The key word is Patience. We need
to be patient with our colleagues
especially when we face opposition
About 100 years’ ago, Swann
Vivekanand, the Indian sage said
that for any worthwhile cause. »e
may have to Grst face ridicule, then
opposition
and
finally
gam
acceptance. Although we must not
have spineless co-existence with
wrong, we should first accept our
collogues as they are and then work
towards the goal of transforming
them into breastfeeding advocates.

To listen carefully is the Grst step,
and to respond to the valuable
points in our colleague’s view- is the
second. This builds a foundation for
constructive discussion.
With this frame of mind, lei us sit
with them and discuss. Do not lake
a fixed position on exactly what
should be done. Listen to other s
point of view. In her manual on
Lactation Management. Helen
Armstrong1 has listed the following

basic negotiation skills. Il nuy be
worthwhile to keep these in mind
during the discussions.

^O^ilcagucs to our side. A

r

Basic Negotiation Skills
• Let us define our main
interests

"Wc would like to sec mast
newborns exclusively breastfed’
expresses our interest. It leaves
open to negotiation just how it
could be accomplished. It docs not
demand that everything be done
one’s own way.
• Find and define common
ground and shared
interests

So lei us start with the assumption
that our colleagues shall not
knowmgly harm the baby under their
arc. It is possible that some of them
nuv not have fully grasped the
importance of the subject and may
label us as fanatics. At times, we may
have really behaved like fanatics’
Ahcrnatrvcly, our colleagues may not
he -wefl-informed about certain facts.
.<■ they might have formed certain set
habits.

’THE TWO MULES*

For example. “We all want our
hospitals to be respected (or
granted
the
status
of
a
baby-friendly hospital). We hope
to reduce costs of maternity care.
We all want to reduce our infant
mortality rates."

• Watch your and their body
language and tone of
voice: try to limit negative
feelings
hast
difficult
Negotiations
moments. If emotions arc too high.
a period of group silence,
reflection and sharing mav help.
(see fig. Working Together)'
• Do not give in just to keep
the atmosphere pleasant
or because the other side
is of higher status
You arc speaking for thousands of
babies
and
mothers.
Keep
advocating their interests.

• Be sure that decisions
taken are net ambiguous
or vague
Do write down -hat has been
decided. Propose wording which rs
clear and exact.

-IPbrfang Together” - adapted from
a Quakerposter

2. Providing accurate
information:
(see Ust of resources) 3-9

Many textbooks contain conflicting
advice
on
breastfeeding.
For
appropriate consistent information,
lev to provide colleagues with
breastfeeding guidelines approved by
national and international academic
organisations of nurses, midwives,
pediatricians, obstetricians and
lactation consultants. Books which
provide accurate and supportive
information on breastfeeding could
be recommended.
“Breastfeeding Paper of the Month”
selected by UNICEF New York
could be made available to
colleagues with the help of local
UNICEF offices. Video films made
by UNICEF and others could be
provided.
Human
Lactation
Management Training (HLMT)
workshops
have
been
found
extremely helpful in winning many

Stage 1:
lactation centre where col lea
could refer problem cases, oi
international centre where a I
from a hospital could go for trai
should be considered. A dire
from the government to all hos{
for ensuring maternity prac
conducive to breastfeeding cat
used effectively to pul pressurcolleagues who are either not aor just do not bother to pul
instructions into practice. Collca
should be briefed about
International Code restricting
marketing of infant formula
feeding bottles. This has now bee
a legal document in sccountries.
They should also be made awai
the policy of the infant for.
industry which seems io be calc
the young medical students
conducting paediatric quizes
national level and assisting the el
in academic pursuits. Those
believe that there is no hare
accepting *help without sti
attached" may be cautioned
industry docs not spend
shareholders’ money without p
motive and that profit for
formula industry means more
more babies being displaced I
their mother’s breasts and hoc
onto the formula.

3. Recognising the stages of
change in ourselves and
colleagues:
(adapted from Lyra Srinivasan'
stages of change, published by
SARAH International and Woric
Neighbours in Action)
There is a danger that we may ex
our health system to ch;
overnight. This is not likely. Lc
learn from community dcvelopr
educators who have developed a
helpful representation of stage.
change, (see fig. stages of chang
8). They make us aware that
colleagues may go through
following predictable stages
resistance, doubt and change:

Stage 7:

"There is a problem, but I am air....
of the risk."
"There is no problem.“

Stage 3 and 4 reflect universal
feelings and could be accepted
without giving up the effort.

For instance, if we go to an
administrator of our health system
with a plan to conduct a series of
workshops on breastfeeding, be or
she may say that everyone
breastfeeds in our country, and
there is no problem.

“Wr can do it, and obstacles will not
stop us."

Stage 8:

Stage 2:

"I see the problem. I want to find
possible solutions."

With this really positive stage, the
individual begins to consider taking
on personal responsibility.

Stage 3:

T ha-.e doubt: about the possibii.y
of change. about myself and about
Others. ~

4. Personal commitment:

We have to first transform ourselves
before we can aspire to transform
others. Commitment comes out of
conviction.

“Tn ere is a problem but it is not my

At this stage, people often look for
someone else to put the blame on.
Nurses may blame doctors or
doctors may blame nurses. But if we
have provided facts to underline the
importance of exclusive breast
feeding and the extent of its dedine
in the country, we may help our
colleagues from “there is no
problem" to “there is a problem but
it is not my responsibility." This is
indeed progress.

“IFe were successful. Sow we want
to show the results to others.“

"lie believe that we can do it. ”

Solidarity is an important attitude to
encourage
among all
people
working for better infant feeding.
An international list of people
committed to the promotion of
breastfeeding is available from
WABA and the International Baby
Food Action Network (IBFAN).10
It helps develop solidarity among
colleagues around the globe. We
are part of a worldwide effort. We
can make constructive use of
national and international networks
to even get outside resource
persons for help.

Most of the breastfeeding advocates
got convinced from their close
observations that even the poor
could thrive well on exclusive
breastfeeding, and children of rich
parents could also become the
victims of artificial feeding due to
increased risk of infections and
allergic disorders. They also noticed
that they started having fewer night
calls and a much more peaceful life
because infants breastfed under
their care have serious problems
less frequently.

Once convinced, they tried to set an
example to their colleagues by
personally talking to each mother
during pregnancy, and soon after
deliver, in the presence of junior
colleagues and making themselves

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