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Menyusu Satu Jam Pertama Kehidupan, Menyelamatkan Lebih dari Satu Juta Bayi

July 31, 2007

Initiation of breastfeeding within the 1st hour of birth is the first

and most vital step towards reducing infant and under-five mortality,

by reducing the overwhelmingly high neonatal mortality rate. Save ONE

million babies – beginning with one action, one hour support and one

message: beginning breastfeeding within the 1st hour of birth!

Assalamualaikum

Menyambut pekan ASI sedunia 1 ~ 7 Agustus 2007 dengan Tema “Menyusu Satu Jam Pertama Kehidupan, Menyelamatkan Lebih dari Satu Juta Bayi”.

Yuk Kita dukung bersama….

Tidak banyak yang tahu bahwa Inisiasi Dini/ Early Latch On/ Breast Crawl begitu besar manfaatnya dalam Program ASI Ekslusive selama 6bulan.

Selain kurangnya informasi, bahkan tenaga kesehatanpun masih sedikit yang mengetahui akan hal ini, Alhasil inisiasi dini ini dianggap barang mewah atau sesuatu yang aneh sehingga amat sangat sulit untuk dapat menemui rumah sakit yang dapat memberikan layanan ini apalagi diperparah dengan promosi susu formula yang sudah sangat jelas melanggar kode etik internasional.

India saja mampu menyelamatkan 250.000 bayi hanya dengan satu aksi yaitu inisiasi dini.

Kenapa kita tidak…..!!!

Yuk kita bergandengan tangan bersama berbagi ilmu pengetahuan yang kita tahu meskipun hanya sebasar biji zarah-pun…Insya Allah kalau kita ikhlas memberikannya akan dicatat sebagai amal kebaikan.

Yuk kita selamatkan generasi kedepan dengan inisiasi dini ini/ early latch on/ breast crawl.

Hidup ASI……

Wassalamualaikum
—————————————————————————————-

Sukses Menyusui dengan Inisiasi Dini

Pekan ASI se-Dunia akan kembali digelar pekan ini. Temanya adalah

‘Menyusu Satu Jam Pertama Kehidupan, Menyelamatkan Lebih dari Satu

Juta Bayi’.

Saat ini, angka kematian bayi di seluruh dunia setiap tahun mencapai

empat juta. Bila inisiasi dini diterapkan, angka kematian bisa

dikurangi 22 persen atau sekitar satu juta jiwa.

Ketua Umum Sentra Laktasi Indonesia, dr Utami Roesli SpA MBA IBCLC,

menuturkan pada tahun 1997 lalu, dokter dari Swedia meneliti 72 ibu

dan bayi. Bayi yang tali pusarnya dipotong, dilap, dan langsung

diletakkan di perut ibunya dengan kulit bersentuhan memperlihatkan

perkembangan menarik. ‘’Ternyata, pada usia 20 menit, bayi merangkak

di atas perut ibunya dalam keadaan mata tertutup, persis anak kucing.

Pada usia 50 menit, dia bisa menemukan payudara ibunya sendiri,'’

tutur Utami.

Adapun bayi yang tali pusarnya dipotong, dipisahkan dari ibunya untuk

ditimbang, dibersihkan, dicap, dan seterusnya, 50 persen tidak bisa

menemukan payudara ibunya.

Penelitian berikutnya menyimpulkan, bayi yang diberi kesempatan

menyusu dini dengan skin to skin contact, masa menyusunya dua kali

lebih lama dibanding yang tidak diberi perlakuan itu. ‘’Jadi,

kegagalan menyusui bisa karena ini,'’ kata Utami.

Tahun 2003-2004, sekelompok peneliti dari Inggris meneliti 10.947 bayi

yang diberi inisiasi yang benar di Ghana. Hasilnya, bayi-bayi itu

bukan hanya lebih mudah menyusui, tapi juga menurunkan 22 persen angka

kematian bayi usia di bawah 28 hari.

Kurang tepat
Inisiasi dini sebenarnya telah dilaksanakan di Indonesia. Namun,

ternyata belum benar. Sebab bayi baru lahir bisanya sudah dibungkus

sebelum diletakan di dada ibunya. Akibatnya tak terjadi skin to skin

contact. Kesalahan kedua, kata Utami, bayi bukan menyusu, melainkan

disusui. ‘’Bayi memang diletakkan di dada ibunya, tapi 5-10 menit

kemudian disusui oleh ibunya. Beda sekali dong antara menyusu dengan

disusui.'’

Seorang dokter di Indonesia yang telah menerapkan inisiasi dini secara

benar, kata Utami, hampir tak percaya melihat bayi yang selama 15

menit tak bergerak, kemudian mencari payudara ibunya, dan minum

sendiri. ‘’Dokter itu sampai bilang subhanallah,'’ kata Utami.

Ada satu keuntungan lain dari penerapan inisiasi dini ini. Karena pada

jam-jam pertama saat melahirkan, ayah, ibu, dan bayi bisa bersatu.

Sambil bayi mencari puting susu ibunya, ayahnya bisa mengazankan bayi

itu di dada ibunya. ‘’Itu indah sekali. Itu sebuah unity. Sebuah

kesatuan dari sebuah keluarga.'’

Sebelumnya, pada jam-jam pertama melahirkan, keluarga tercerai-berai.

‘’Ibunya entah di mana, anaknya entah di mana. Dan seorang ayah lebih

sering mengazankan anaknya di tempat tidur yang dingin,'’ katanya.

Direktur Bina Gizi Masyarakat Departemen Kesehatan, dr Ina Hernawati

MPH, mengatakan inisiasi dini penting agar bayi mendapat kekebalan.

Sebab saat bayi bersentuhan langsung dengan ibunya, bayi tertular

kuman. Dan karena ibu telah memiliki kekebalan, kekebalan itu kemudian

disalurkan lewat ASI. ‘’Kalau baru lahir digendong orang lain, yaa

kena kuman orang lain.'’

Inisiasi dini juga bermanfaat agar ibu lebih mudah terstimulus

menyusui. Bayi yang menyentuh dada ibu akan membuat ibu mendapatkan

rangsangan sensorik yang kemudian memerintah otak untuk memproduksi

hormon oksitosin dan prolaktin. ‘’Jadi, secara teoretis semua ibu

sebenarnya bisa menyusui.

Mencegah kanker
Aktivitas menyusui juga sangat bermanfaat karena mencegah kematian ibu

melahirkan, kanker rahim, kanker payudara, dan menjarangkan kelahiran

secara alami.

Aktivitas menyusui membuat payudara berganti sel dengan baik. ‘’Ini

mencegah mencegah kanker payudara,'’ kata dr Detty S Nurdiati MPH PhD

SpOG dari SMF Obstetri dan Ginekologi RS Dr Sardjito/FK UGM.

Isapan bayi saat menyusui, kata Detty, juga membuat ibu mengeluarkan

hormon oksitosin yang memacu kontraksi rahim. Kontraksi rahim kemudian

menjepit pembuluh darah dan menghentikan pendarahan di rahim.

‘’Sehingga kematian ibu karena perdarahan akan berkurang,'’ katanya.

Kontraksi rahim juga disebutnya mempercepat masa nifas.

Bahwa menyusui bisa mencegah kanker payudara, telah dibuktikan

penelitian terhadap 147 ibu di 30 negara. ‘’Ibu-ibu yang menyusui

sampai dua tahun akan 50 persen drop dari kanker payudara. Hasil itu

saya rasa sudah cukup bermakna. Itu adalah bonus dari Allah buat

ibu-ibu. Karena menyusui berarti mengurus titipan Allah dengan

benar.'’
(nri/run )

sumber: Republika

World Breastfeeding Week (WBW) 2007 Action Folder

Breastfeeding: The 1st Hour
Early initiation and exclusive breastfeeding for six months can
Save more than ONE million babies!

Objectives:
• To mobilise the world to the potential for saving ONE million babies starting with ONE simple action: allowing the baby to initiate breastfeeding in the first hour of life
• To promote immediate skin-to-skin contact of the mother and baby and continuing with exclusive breastfeeding for six months
• To encourage ministers of health and other authorities to include the initiation of breastfeeding in the first hour as a key indicator for preventive health
• To ensure that families know how important a baby’s first hour is, so that they can make sure that their babies are given this opportunity
• To support the newly revised and revitalised Baby Friendly Hospital Initiative (BFHI), with its emphasis on integration and expansion, and on the early initiation of breastfeeding.

“It begins at birth. Our very first act after birth is to suck our mother’s…milk. This is an act of affection, of compassion. Without that act, we cannot survive. That’s clear…That’s the way of life. That’s reality.”
Dalai Lama and Howard C. Cutler, The Art of Happiness A Handbook for Living.1998


[PHOTO CAPTION]
In the first hour of life,
a baby finds her mother’s breast.
Together they can do it on their own, when we respect maternal/infant
physiology as we provide expert maternal child care.
This is the beginning of a life-sustaining breastfeeding
relationship between mother and child.

The Remarkable First Hour of Life
When healthy infants are placed skin-to-skin on their mother’s abdomen and chest immediately after birth, they exhibit remarkable capabilities. They are alert. They can crawl, stimulated by mother’s gentle touch, across her abdomen, reaching her breast.13 They begin to touch and massage the breast. This first gentle touch of a baby’s hand or head at the breast stimulates release of maternal oxytocin,9 thus beginning both the flow of milk and enhancing the feelings of love for the baby. Then the baby smells, mouths and licks the mother’s nipple. Finally, he or she attaches to the breast and feeds. This sequence of events is important for the survival of human young.

Although many authors describe these normal infant behaviours,7,13 we are just now discovering the importance of providing the opportunity for a mother and baby to have the experience. For the first time, researchers have assessed the effect of the timing of the first breastfeed on newborn mortality – showing that mortality may be less if infants start to breastfeed in the first hour. (See Research Bulletin box)

Optimal breastfeeding
The WHO/UNICEF Global Strategy for Infant and Young Child Feeding recommends that children breastfeed exclusively for the first 6 months of life, and then continue breastfeeding with adequate complementary food up to 2 years or beyond. Normal initiation of breastfeeding in the first minutes to first hours of life begins with skin-to-skin contact, and helps mothers and infants to achieve optimal breastfeeding. This is required in the BFHI, specifically in Step 4 of the WHO/UNICEF 10 Steps to Successful Breastfeeding.

Breastfeeding Rights
The Convention on the Rights of the Child recognises that every child has the inherent right to life and aims to ensure their survival and development. Breastfeeding within the first hour after delivery helps to ensure child survival. Women have a right to this knowledge and to receive the support that they need to initiate breastfeeding accordingly.

Why is skin-to-skin contact after birth and breastfeeding within the first hour of life so important?

1. The mother’s body helps to keep the baby appropriately warm, which is especially important for small and low birth weight babies.4

2. The baby is less stressed, calmer and has steadier breathing and heart rates.7

3. The baby is exposed first to the bacteria from the mother which are mostly harmless, or against which the mother’s milk contains protective factors. The mother’s bacteria colonise the baby’s gut and skin and compete with more harmful bacteria from health providers and the environment, and so prevent them from causing infection. .5

4. The baby receives colostrum for the first feeds – liquid gold, sometimes called the gift of life.5
• Colostrum is rich in immunologically active cells, antibodies and other protective proteins. Thus it serves as the baby’s first immunization. It protects against many infections. It helps to regulate the baby’s own developing immune system
• It contains growth factors, which help the infant’s intestine to mature and function effectively. This makes it more difficult for micro-organisms and allergens to get into the baby’s body
• It is rich in Vitamin A, which helps protect the eyes and reduce infection
• It stimulates the baby to have bowel movements so that meconium is cleared quickly from the gut. This helps get rid of the substances in the baby’s body that produce jaundice and therefore may help reduce it
• It comes in small volumes, just right for the new baby.

5. Touching, mouthing and suckling at the breast stimulates oxytocin release – this is important for many reasons:
• Oxytocin causes the uterus to contract. This may help delivery of the placenta and reduce maternal bleeding after the birth10
• Oxytocin stimulates other hormones which cause a mother to feel calm, relaxed, and some would say “in love” with her baby 9
• Oxytocin stimulates the flow of milk from the breast.

6. Women experience incredible joy with this first meeting of their child! And fathers often share this delight. The process of bonding between mother and baby begins.

Overall, skin-to-skin contact and early feeds with colostrum are associated with reduced mortality in the first month of life. They are also associated with increased exclusive breastfeeding and longer duration of breastfeeding in the following months, leading to improved health and reduced mortality later on as well.6,12

Is normal breastfeeding initiation in the first hour all that is needed to guarantee continued exclusive breastfeeding?
Absolutely not! Mothers need continued support to breastfeed exclusively for 6 months. The family, health workers, traditional healers and others in the community are all important contributors to their network of support. Health providers, health visitors and others need clinical training in assessment of breastfeeding, identification of problems, as well as knowledge and skills for helping the mother to resolve difficulties. Follow-up by a health worker within 48-72 hours after the birth, again after one week, and at appropriate times thereafter provides the opportunity to intervene early if there are problems, as well as to reassure the mother when things are going well.

Implementation of the newly revised and revitalised BFHI with its 10 Steps to Successful Breastfeeding along with adherence to The International Code of Marketing of Breast-milk Substitutes and Subsequent World Health Assembly Resolutions provide the support structure needed to protect, promote and support optimal breastfeeding.

Policy Matters
We do not know how many babies experience skin-to-skin contact and initiation of breastfeeding in the first hour of life.

The 10 Steps for Successful Breastfeeding as embodied in the BFHI includes a step that calls for helping a mother to initiate breastfeeding within the first half hour of life. The newly revised BFHI materials clarify this step to indicate the need for immediate skin-to-skin contact and ongoing support to achieve breastfeeding within the first hour. We now understand that all babies should have skin to skin contact immediately after birth and the opportunity to breastfeed as soon as they show readiness to do so.

Other steps increase the likelihood of continued exclusive breastfeeding: help the mother to position and attach the baby at the breast; keep them together after delivery; encourage feeding on infant’s cue (demand feeding); avoid the use of artificial teats or pacifiers; and avoid any other food or drink unless medically indicated. In Baby-Friendly hospitals, rates of breastfeeding initiation, exclusive breastfeeding and duration of breastfeeding are improved.6,12 Policy matters.


BOX: #1 Research Bulletin
IF BABIES BREASTFED WITHIN THE FIRST HOUR, 1 MILLION LIVES MIGHT BE SAVED

Researchers in rural Ghana, where early initiation of breastfeeding was not the norm, found that babies who started to breastfed in the first hour of life were more likely to survive the neonatal period than those who did not (Edmond et al, 2006).
• Babies who did not start breastfeeding until after 24 hours of age were 2.5 times more likely to die than babies who started within the first hour of life, whether they were partially or exclusively breastfed.
• 30% of babies in the study were fed solids or other milk before one month of age
• These infants were 4 times more likely to die than babies who were exclusively breastfed
• Conclusions:
For rural Ghana:
• 16% of newborn deaths could be prevented if newborns were breastfed exclusively from day one
• 22% of newborn deaths could be prevented if newborns initiated breastfeeding within one hour of birth.

Edmond K et al (2006) Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality. Pediatrics, 117:380-386

Edmond KM, Bard EC, Kirkwood BA. Meeting the child survival millennium development goal. How many lives can we save by increasing coverage of early initiation of breastfeeding? Poster presentation at the Child Survival Countdown Conference, London UK. December 2005.

BOX#2 How to Initiate Breastfeeding in the First Hour of Life1,7,11

1. Provide appropriate, culturally sensitive and supportive labour companionship to mothers
2. Encourage non-pharmacologic measures to help support women through labour (massage, aromatherapy, water injections, movement)3
3. Allow delivery to occur in the position preferred by the mother7
4. Dry the baby quickly, preserving the natural white cream (vernix) that soothes a baby’s new skin
5. Place the baby naked skin-to-skin on mother’s naked chest, facing her, and cover them together
6. Allow the baby to seek the breast. The mother will stimulate the baby with her touch and may help position the baby closer to the nipple (Do not force the baby to the nipple)
7. Keep the baby skin-to-skin with the mother until the first feeding is accomplished and as long as she desires thereafter
8. Women who have surgical births should also have their infants skin-to-skin after delivery
9. Delay intrusive or stressful procedures. The baby should be weighed, measured, and given preventive medications AFTER the feed1,11
10. No pre-lacteal liquids or feeds should be given unless there is a clear medical indication1,11

BOX #3 Mistaken Beliefs: Barriers to Normal Breastfeeding Initiation

1. Colostrum is not good, or even dangerous for babies. NO!
Colostrum is essential for normal growth and development5:
• First immunization – protects against intestinal and other infections
• Purgative to reduce severity of jaundice

2. Infants need special teas or other fluids before breastfeeding. NO!
Any pre-lacteal feeds (feed given before breastfeeding has started) increase the infant’s risk of infection, reduce the likelihood of exclusive breastfeeding and shorten the duration of breastfeeding.6,8,11

3. Babies will not get enough food or fluid with only colostrum and breastmilk. NO!
Colostrum is sufficient for a baby’s first feeds.5 It is normal for a newborn to lose 3-6% of birth weight. They are born with a store of water and sugar in their bodies to use at this time.

4. Baby will get too cold. NO!
Babies are at safe temperatures when skin-to-skin with their mothers.4 Amazingly, the mother’s breast temperature rises 0.5 degrees C within 2 minutes of having the baby on her chest.2

5. Mothers are too exhausted after labour and delivery to feed their baby immediately. NO!
The surge of oxytocin that comes with skin-to-skin contact and breastfeeding helps to calm a mother after the birth of her baby.

6. It is very important to suction the baby’s mouth, nose, and oropharynx before the first breath to prevent inhaling birth fluids, especially if the baby had a bowel movement during the labour. NO!
Suctioning the normal healthy newborn does not reduce the occurrence of meconium aspiration, and may injure the tissue of the mouth, throat or vocal cords. Gastric suction also interferes with breastfeeding.13

7. Vitamin K and medication to prevent gonorrhea eye infection must be given immediately after birth. NO!
The American College of Obstetrics and Gynaecology and the Academy of Breastfeeding Medicine state that these important preventive measures can be delayed for as long as an hour, until after the baby has breastfed, without risk to the infant.1,11 They should not in any case require separation of mother and baby.

8. Women require pharmacologic intervention to cope with the pain of labour. Normally, NO!
Use of labour analgesia/anaesthesia may sedate the baby, hindering breast-seeking behaviour and delaying initiation of breastfeeding for hours or days.7 Use of complementary therapies including having a companion during labour help women to cope with the pain, and the obstetric outcome may be improved.3

9. It requires too much work and time to help the mother during this time. NO!
While the baby is on the mother’s chest, the birth attendant can continue to do the usual assessment of mother and baby or other duties.11 The baby will find his or her own way to the breast.

MAP CENTRE PAGE

Title: Countries that Track Initiation of Breastfeeding within ONE Hour

Key:
No colour Data was not reported
Red Below 29%
Yellow 30-49%
Blue 50-89%
Green 90% and above
Note: It is important to include the timing of first breastfeeding as an indicator of best practices. However, very few countries do so. Of the 60 countries with the highest rates of malnutrition, only 38 reported the frequency of initiating breastfeeding in the first hour of life.

BOX: #4 Does skin-to-skin contact matter for women who are HIV positive?

Even women for whom replacement feeding is Acceptable, Feasible, Affordable, Sustainable and Safe (AFASS), and who choose not to breastfeed, should have skin-to-skin contact with their babies. These mother-infant couples are particularly vulnerable. Skin-to-skin contact provides a special closeness, beginning the mother-child relationship.

If conditions are not AFASS, it is very important for mothers and infants to have skin-to-skin contact immediately after birth and to start breastfeeding in the first hour. For these babies, exclusive breastfeeding carries a lower risk of mother to child transmission of HIV than mixed feeding.

Remember: for women of unknown HIV status, exclusive breastfeeding is recommended.

See http://www.who.int/child-adolescent-health/publications/NUTRITION/consensus_statement.htm and /HIV_IF_Framework.htm

BOX #5
Help Achieve Important Millennium Development Goals (MDGs): Facilitate breastfeeding in the first hour of life

At the United Nations Millennium Summit in September 2000, world leaders agreed on critical goals related to child mortality and hunger. Many of the poorest nations are lagging behind in reaching these MDGs. Initiating breastfeeding in the first hour can help achieve MDG #1 and #4. This was reconfirmed at the UN Standing Committee on Nutrition in 2003, where those assembled called for a global indicator for early initiation of breastfeeding.

MDG #1: Eradicate extreme poverty and hunger - reduce by half the proportion of people who suffer from hunger

Starting to breastfeed in the first hour of life is associated with increased rates of exclusive breastfeeding and longer duration of breastfeeding. This contributes significantly to meeting children’s nutritional needs during the first two years of life, thus preventing malnutrition and stunting which usually have their origin at this age.

MDG #4: Reduce child mortality - reduce by two-thirds the mortality rate among children under five
Most child deaths are caused by diarrhoea and respiratory illness, which are more common and more serious with suboptimal breastfeeding.8 About 40% of the deaths occur in the first month of life, which is a major barrier to attaining this MDG. Breastfeeding in the first hour could reduce newborn deaths (see Research Bulletin box) and increasing optimal breastfeeding could reduce overall child mortality.

United Nations The Millennium Development Goals: 2006 Report UN New York

ACTION IDEAS:
Initiation of breastfeeding within the first hour of life has the potential to make a major contribution to the health of the world’s children. It can significantly contribute to meeting MDG #1 and #4. Policy changes that encourage promotion of timely breastfeeding initiation must improve locally and globally.

For hospitals and maternity facilities
• Assess birthing sites – what are the barriers to normal breastfeeding initiation? Develop action plans to address any barriers that are identified
• Encourage all facilities to keep records on whether or not initiation proceeds in the first hour
• Carry out monthly “rounds” on early breastfeeding initiation to consider what can be done programmatically and practically to improve the rates
• Implement the newly revised BFHI materials
• Review the impact of birthing practices on breastfeeding initiation so that disruptive practices can be modified.

For health workers
• Teach birth attendants in health facilities and in the community how to facilitate breastfeeding initiation in the first hour
• Review curricula of health providers and traditional birth attendants related to labour, birth and breastfeeding to assure that information about this important step is included
• Support at least ONE mother a day!

For family and community members
• Provide education to families regarding the importance of breastfeeding during pregnancy and soon after birth. Include grandmothers and other influential family members in this discussion
• Identify the natural community leaders and communicators as persons who can bring this message to every woman and man, young and old, to support mothers in breastfeeding initiation and exclusive breastfeeding
• Enlist the popular press in bringing the message to the people. Give ONE coverage per month for breastfeeding!

For policy makers
• Encourage maternities, health ministries and other influential bodies such as United Nations agencies and the Joint Commission on Accreditation of Healthcare Organizations to include timing of breastfeeding initiation as an indicator of best practices in maternal child care.

REFERENCES

1. American College of Obstetrics and Gynecology. (2007). Breastfeeding: Maternal and infant aspects. Special report from ACOG. ACOG Clin Rev, 12(supp), 1s-16s.
2. Bergstrom, A., Okong, P., & Ransjo-Arvidson, A. (2007). Immediate maternal thermal response to skin-to-skin care of newborn. Acta Paediatr, 96(5), 655-658.

3. Dimkin, P., & O’Hara, M. (2002). Nonpharmacologic relief of pain during labor: Systematic reviews of five methods. American Journal of Obstetrics and Gynecology, 186(5, Supp), S131-S159.
4. Fransson, A., Karlsson, H., & Nilsson, K. (2005). Temperature variation in newborn babies: Importance of physical contact with the mother. Arch Dis Child Fetal Neonatal Ed, 90, F500-F504.
5. Hanson, L. (2004). Immunobiology of Human Milk: How Breastfeeding Protects Infants. Amarillo, TX: Pharmasoft Publishing.
6. Kramer, M., Chalmers, B., Hodnett, E., & PROBIT Study Group. (2001). Promotion of breastfeeding intervention trial (PROBIT): A randomized trial in the republic of Belarus. JAMA, 285, 413-420.
7. Kroeger, M., & Smith, L. (2004). Impact of birthing practices on breastfeeding: Protecting the mother and baby continuum. Boston: Jones and Bartlett.
8. Lauer JA, Betran AP, Barros AJ, de Onis M. (2006). Deaths and years of life lost due to suboptimal breast-feeding among children in the developing world: a global ecological risk assessment. Public Health Nutr, 9(6):673-85.
9. Matthiesen, A., Ranjo, A., Nissen, E., & Uvnas-Moberg, K. (2001). Post-partum maternal oxytocin release by newborns: Effects of infant hand massage and sucking. Birth, 28, 13-19.

10. Sobhy, S. M., NA. (2004). The effect of earl initiation of breastfeeding on the amount of vaginal blood loss during the fourth stage of labor. Egypt Public Health Association, 79(1-2), 1-12.
11. The Academy of Breastfeeding Medicine Protocol Committee. (2003). Protocol #5: Peripartum breastfeeding management for the healthy mother and infant at term. Retrieved May 1, 2007, from www.bfmed.org
12. Vaidya, K., Sharma, A., & Dhungel, S. (2005). Effect of early mother-baby close contact over the duration of exclusive breastfeeding. Nepal Medical College Journal, 7(2), 138-140.
13. Widstrom, A., Ransjo-Arvidson, A.-B., Christensson, K., & et al. (1987). Gastric suction in healthy newborn infants: Effects on circulation and developing feeding behaviour. Acta Paediatr, 76, 566-572.

Policies
Breastfeeding protocols: www.bfmed.org
BFHI & revisions: www.unicef.org/nutrition/index_24850.html
Global Strategy for Infant and Young Child Feeding: www.who.int/child-adolescent-health/publications/pubnutrition.htm
Low-birth weight babies: www.who.int/reproductive-health/publications/kmc/text.pdf
and www.who.int/child-adolescent-health/New_Publications/NUTRITION/ISBN_92_4_159509_4.pdf

Labour and Birthing
Midwifery: www.internationalmidwives.org
Doula: www.dona.org
Maternity Services: www.motherfriendly.org

Protecting Breastfeeding
Code: www.ibfan.org

Supporting Breastfeeding
Lactation Consultant: www.ilca.org
Mother Support: www.lalecheleague.org


Acknowledgements
Written by: Arun Gupta. Edited by: Sallie Page-Goertz and Radha Holla Bhar. Many thanks to reviewers: Alice Barbiere, Elaine Petitat-Cote, Felicity Savage, Fernando Vallone, Lida Lhotska, Liew Mun Tip, Linda Parry, Luann Martin, Michael Latham, Miriam Labbok, Nicette Jukelevics, Pamela Dunne, Pamela Morrison, Pauline Kisanga, Rebecca Magalhães, Nutrition Section UNICEF, and Departments of Child and Adolescent Health and Development (CAH) and Nutrition for Health and Development (NHD) at World Health Organization.
Production: Liew Mun Tip and Adrian Cheah.
This project is funded by the Dutch Ministry of Foreign Affairs (DGIS).

The World Alliance for Breastfeeding Action (WABA) is a global network of individuals and organisations concerned with the protection, promotion and support of breastfeeding worldwide based on the Innocenti Declarations, the Ten Links for Nurturing the Future and the WHO/UNICEF Global Strategy for Infant and Young Child Feeding. Its core partners are International Baby Food Action Network (IBFAN), La Leche League International (LLLI), International Lactation Consultant Association (ILCA), Wellstart International and Academy of Breastfeeding Medicine (ABM). WABA is in consultative status with UNICEF and an NGO in Special Consultative Status with the Economic and Social Council of the United Nations (ECOSOC).

WABA does not accept sponsorship of any kind from companies producing breastmilk substitutes, related equipment and complementary foods. WABA encourages all
participants of World Breastfeeding Week to respect and follow this ethical position.

OVERALL COORDINATION
WABA Secretariat
P O Box 1200
10850 Penang, Malaysia
Fax: 60-4-657 2655
waba@streamyx.com
www.waba.org.my
www.worldbreastfeedingweek.org

Anak-anak, Merokoklah!

July 28, 2007

Oleh : Seto Mulyadi

Jangan kaget! Ini adalah seruan lantang industri rokok kepada
anak-anak dan remaja kita.

Sayang, banyak orangtua tampaknya masih terlelap dan tidak sadar.
Tahu-tahu, jutaan anak kita telah tercemar asap tembakau dan akan
menjadi perokok aktif di masa depan. Dengan sistematis, industri rokok
mengajak jutaan anak untuk sejak dini mulai gemar merokok.

Coba lihat iklan-iklan rokok di mana-mana, seolah tidak ada lagi ruang
kosong yang ramah anak dan bebas dari dominasi iklan rokok. Mulai dari
billboard, spanduk, umbul-umbul, iklan di media cetak ataupun
elektronik, kaset atau film sampai ke seminar-seminar pendidikan pun
tak luput dari promosi rokok.

Materi iklan pun menunjukkan segmentasi pasar yang dibidik. Bahwa
merokok adalah baik. Merokok identik dengan nikmat, berani, macho,
trendi, kebersamaan, santai, optimistis, penuh petualangan, kreatif,
dan segudang istilah lain lagi yang membanggakan.

Tidak tanggung-tanggung, idola remajaâ?”penyanyi, grup musik, atau para
tokoh yang memenuhi selera pasar konsumenâ?” dilibatkan sebagai model.

Industri rokok paham teori psikologi perkembangan anak bahwaâ?”menurut
teori perkembangan psikososial Erik Eriksonâ?”remaja sedang pada tahap
the sense of identity, tahap mencari identitas, termasuk meniru dan
mengikuti perilaku model yang menjadi idolanya. Dengan “serangan”
iklan dan menampilkan identitas yang dicari remaja, otomatis mereka
larut dalam pengaruh iklan, merasa lebih hebat dengan merokok.

Metode komunikasi persuasif yang digunakan pun memakai classical
conditioning, yaitu mengubah sikap dengan mengondisikan antara
perasaan positif dan benda yang diiklankan. Remaja pun tergiur saat
disuguhi pesan-pesan seperti “Apa Obsesimu?”, “X-presikan Aksimu!”,
dan “U are U!”.

Bahan adiktif

Kalangan industri rokok sering berkilah, iklan rokok tidak akan
menimbulkan perokok baru, tetapi hanya menjaga agar perokok aktif
tetap mengonsumsi produksinya atau agar tidak pindah ke merek lain.
Namun, kenyataannya iklan rokok telah menjebak ratusan ribu anak dan
remaja untuk mulai mencoba merokok, lalu menjadi pengguna tetap yang
aktif.

Mereka menutup mata terhadap kenyataan bahwa mengiklankan rokok sama
dengan mempromosikan bahan adiktif terhadap anak-anak. Saat merokok,
mereka akan mengisap sekitar 4.000 racun kimia dengan tiga komponen
utama yang berbahaya, yaitu nikotin, tar, dan karbon monoksida.

Organisasi Kesehatan Dunia (WHO) menyatakan, tembakau membunuh lebih
dari lima juta orang per tahun, dan diproyeksikan akan membunuh 10
juta sampai tahun 2020. Dari jumlah itu, 70 persen korban berasal dari
negara berkembang.

Lembaga Demografi UI mencatat, angka kematian akibat penyakit yang
disebabkan rokok tahun 2004 adalah 427.948 jiwa, berarti 1.172 jiwa
per hari atau sekitar 22,5 persen dari total kematian di Indonesia.

Remaja akan tetap menjadi sasaran utama untuk menggantikan perokok
senior yang memiliki ketergantungan tinggi terhadap rokok, yang konon
sekitar 30 juta akan wafat karena penyakit yang berhubungan dengan
tembakau.

Coba simak laporan perusahaan rokok di AS, Philip Morris (1981),
“Remaja hari ini adalah pelanggan tetap yang potensial untuk hari
esok! Pola merokok remaja amat penting bagi Philip Morris….”

Hak anak

Melalui Sidang Ke-56 WHO, 192 negara anggotanya telah mengadopsi
Kerangka Kerja Konvensi Pengendalian Tembakau (Framework Convention on
Tobacco Control/FCTC) untuk melindungi generasi muda dari kerusakan
kesehatan dan asap tembakau. Pasal 13 FCTC mensyaratkan negara anggota
untuk melaksanakan larangan total terhadap segala jenis iklan,
pemberian sponsor dan promosi produk tembakau, baik secara langsung
maupun tidak dalam kurun waktu lima tahun setelah meratifikasi konvensi.

Sayang, Indonesia merupakan satu-satunya negara di Asia Pasifik yang
belum meratifikasi konvensi ini dan belum memiliki undang-undang yang
mengatur dampak bahaya tembakau, sementara Undang-Undang Nomor 32
Tahun 2002 tentang Penyiaran tetap mengizinkan iklan rokok di media
elektronik dengan berbagai bentuknya.

Ketika kita semua tahu bahwa rokok ialah zat adiktif dan merupakan
salah satu pembunuh hak hidup anak, pemerintah tampaknya belum tegas
dalam melindungi anak dari bahaya tembakau. Padahal UU No 23/2002
tentang Perlindungan Anak menyatakan, pemerintah wajib dan bertanggung
jawab untuk memberikan perlindungan khusus kepada anak termasuk yang
menjadi korban zat adiktif (Pasal 59). Pasal 89 Ayat 2 menegaskan,
“Setiap orang yang dengan sengaja menempatkan, membiarkan, menyuruh
melibatkan anak dalam penyalahgunaan, produksi atau distribusi alkohol
dan zat adiktif lainnya dipidana dengan pidana penjara paling lama 10
(sepuluh) tahunâ?¦.”

Bagaimana nasib RUU Pengendalian Dampak Rokok dan Tembakau yang konon
sudah disetujui 41 persen anggota DPR?

Badan POM mencatat 14.249 iklan rokok tersebar di media elektronik
(9.230), media luar ruangan (3.239), dan media cetak (1.780). Hingga
kini, tanpa kendala, iklan rokok terus mempromosikan bahan yang sarat
pelanggaran hak anak, baik hak hidup, hak tumbuh dan berkembang,
maupun hak untuk memperoleh perlindungan.

Kongres Anak Indonesia sebagai pemenuhan hak partisipasi anak tahun
lalu telah mendesak pemerintah untuk membatasi iklan rokok di media
massa sebagai bagian dari bentuk kekerasan terhadap anak.

Akankah kita terus membiarkan tingkah pembunuh berwajah santun
berkeliaran di mana-mana menghiasi ruang-ruang publik kita? Lupakah
kita kepada kesepakatan yang dicanangkan Sidang Umum Perserikatan
Bangsa-Bangsa tahun 2002 untuk menciptakan a world fit for children?

Tampaknya kita semua harus jujur untuk berani mengakui bahwa kita
belum siap untuk memenuhi hak anak, agar nantinya mereka bisa berkata,
“Tubuhku sehat, jiwaku kuat, siap menjadi pemimpin masa depan!”

Seto Mulyadi Ketua Komnas Perlindungan Anak

Sumber : Kompas

ASI Anugerah Yang Tak Tertandingi

July 26, 2007

Assalamualaikum

Alhamdulillah sedikit demi sedikit manusia dapat mengambil hikmah dari pemanasan global atau bahasa kerennya global warming.

Ambil contoh kasus kekeringan yang melanda New Zeland dan Australia beberapa bulan ini, membuat hewan ternaknya kekurangan air sehingga negara terbesar pengekspor bahan baku susu sapi tidak mampu memenuhi kebutuhan luar negeri seperti di Indonesia.

Dampaknya sangat nyata sekali, harga susu naik sangat signifikan.
Orang tua yang mempunyai bayi dan balita kelabakan bahkan air susu-pun digantikan dengan air tajin.

Sungguh sangat disayangkan memang kondisi carut marutnya bangsa ini.
belum lagi mind set masyarakat ini yang sudah terbalik bukan lagi 4 sehat 5 sempurna, tapi 5sehat 4 sempurna.

Orang tua masih tenang kalau anaknya susah makan, akan tetapi pusing alang kepalang kalau anaknya ngga suka susu sapi.

Sangat dimaklumi karena minimnya informasi akan hal ini, belum lagi serangan bertubi-tubi dari produsen susu formula.

Alhamdulillah…ada harapan terbesit dalam diri ini….sedikit demi sedikit masyarakat mulai sadar akan pentingnya ASI, meskipun sebanrnya agak terlambat jika dibandingkan dengan negara Asia lainnya.

Alhamdulillah dalam beberapa minggu terakhir ini…berbagai macam media cetak dan elektronik mengupas masalah ASI…alhasil sedikit demi sedikit masyarakat mulai paham akan hal ini.

Sayang media elektronik wabil khusus televisi masih sangat jarang sekali mempublikasikan hal ini.

Alhamdulillah setiap Rabu malam Jam 22:00 ~ 23:00wib ada program khusus untuk konsumen yang di motori oleh Pak Agus Pambagio sebagai Policy Public Defender dengan nama Dinamika Publik yang disiarkan secara Live oleh Jak-TV.

Untuk anda warga Jakarta…silakan pergunakan publik ini dengan sebaik-baiknya.

Anda bisa berpartisipasi di :

email : dinamikapublik@jak-tv.com
atau
sms : 0817 726 726

Alhamdulillah pemerintah melalui Depkes juga cukup responsif dengan kondisi ini..alhasil bulan agustus nanti akan ada pendidikan tenaga konselor untuk ASI baik untuk tenaga medis seperti dokter,bidan,suster dan banyak juga LSM yang juga ikut peduli.

Sementara draf RPP Pemasaran Susu Formula yang sudah 3tahun ini-pun mulai menemukan titik terangnya.

3 Agustus 2007 nanti Depkumham dan Depkes akan meeting lagi membahas tentang hal ini.

Yuk mari kita sama-sama berdoa demi masa depan bangsa ini.
Semoga keputusan yang akan diambil adalah kuputusan yang berpihak pada rakyat bukan pada pengusaha.amiiin

Yuk kita sampaikan apa yang kita ketahui secuilpun tentang ASI kepada lingkungan disekitar Kita.

Sungguh ASI anugerah Allah SWT yang tak tertandingi.

Salam ASI

Wassalamualaikum