Reproductive Health and Breastfeeding in Mexico

The Health Ministry of Mexico has gained an international reputation for the advances it has made in reproductive health. The new integral concept of Reproductive Health was instituted in 1995, based on World Health Organisation recommendations. Protection and promotion of breastfeeding is one important component. Here are summaries of interviews conducted with 4 leading experts in maternal-child health and with reference to what Nestlé Mexico has done in the area of protection and promotion of breastfeeding and improvement of infant nutrition.

Dr. Gregorio Pérez Palacios, Director of Reproductive Health, Ministry of Health

One of the main activities of the perinatal health component of the Ministry of Health's Reproductive Health programme is the rescue of the culture and practice of breastfeeding. During the 60's and 70's, breastfeeding had declined because of industrialisation and the incorporation of women into the work force. Thus, at the beginning, the programme was focused on urban areas but soon came to cover rural and indigenous communities. This programme includes training all health personnel, epidemiological monitoring, participation of the community, and the WHO/UNICEF Baby Friendly Hospital Initiative.

Mexico is now number 4 in the world in number of Baby Friendly hospitals, and 1st in Latin America. Our latest survey shows that 88% of infants are breastfed up to about 8 months of age.

"Under no circumstances are we claiming success but we have to recognise that we have had an important impact, a product of Mexican mothers' goodwill and the health staff promotion of campaigns with the involvement of the community." "I would like to stress that the private sector has also made an important contribution...Nestlé Mexico has become an extraordinary partner for breastfeeding, perinatal health and Reproductive Health programmes… I would like to emphasise the interest they have shown not only in words but real support to assure compliance to the International Code and the Mexican official standards regarding breastfeeding."

Dr. Graciela Contreras, Chief of Paediatrics Department, Hospital Nicolás San Juan - Baby & Mother Friendly Hospital.

The Nicolás San Juan Hospital provides assistance to people who are not covered by the benefits of the Mexican social security system and who may have other risk factors: very young or old mothers, malnourished, having had multiple births, etc. Hospital Nicolás San Juan has been certified as a Baby & Mother Friendly Hospital for many years. (To be designated as Baby and Mother Friendly in Mexico, there are 28 steps which a hospital must implement.) We were re-certified 3 years ago. This is a team effort, which joins people, through teaching and learning, for the service of the community.

The use of infant formulas is justified only when it is indicated by the physician and has a diagnostic reason. However, being a Baby & Mother Friendly Hospital does not mean being opposed to companies that manufacture infant formulas. To the contrary, it is something that can help us under certain circumstances, when there is justification to substitute or complement breast milk. Nestlé has a strong commitment to respect the WHO Code. During the many years I have had the opportunity to lead this paediatric service, we have always had the support of Nestlé in regards to complying with the national criteria and Mexican norms, following the recommendations of the WHO.

"I want to thank all the support that we have also been given in research and education, and congratulate this company, hoping that they continue to support research. Above all I hope that its support continues to be unconditional, and that it never asks us to do anything which violates the policies of the Baby and Mother Friendly Hospital."

Dr. Romeo S.Rodríguez Suárez , Director of the Hospital Infantil de Mexico Federico Gómez

The Federico Gómez Children's Hospital of Mexico, known as the birthplace of Mexican paediatrics, is mainly supported by federal government resources. It is a leading edge hospital with a highly significant influence in the development of human resources at international level. This hospital has trained more than 5,000 paediatricians and attends to around 600 patients per day.

"Nestlé supports the Hospital Infantil Medical Bulletin, scientific congresses and health campaigns. The main thing about Nestlé is that it doesn't cause any harm. If it was to promote the early intake of baby formulas, it would cause serious damage, but it does not. I can assure you that Nestlé has strictly followed the WHO Code for Breast-milk Substitutes and acts in an ethical way."

Dr. Jorge A. Cardona Pérez , Co-ordinator for the Reproductive and Mother-Child Health Division, Mexican Social Security Institute (IMSS)

Baby and Mother Friendly Hospital

The Mexican Social Security Institute (IMSS) includes the Compulsory and the Voluntary Health System. Its coverage is of approximately 38 million people. IMSS-Solidarity, which is also part of the IMSS, covers about another 10 million. Together, that is approximately 48 million, which represents 50% of the country's population.

Regarding obstetric assistance, the IMSS has 201 hospitals that, during 1998, attended 648 000 births. 187 of these hospitals were enrolled to carry out the WHO/UNICEF initiative, 'Baby and Mother Friendly Hospital', because of their infrastructure and number of births per year. At the moment, all 187 have been certified.

Exclusive breastfeeding

Exclusive breastfeeding for the first four to six months is promoted at the Baby and Mother Friendly Hospitals. However, depending on the nutritional conditions of the infant, the doctor can prescribe a breast-milk substitute.

The health care personnel in charge of monitoring nutrition, growth and development of children less than 5 years old, are responsible for the continuity of exclusive breastfeeding. They provide infant formula when it is necessary, e.g. when mothers have to go back to work or when they are ill and cannot breastfeed.

The co-ordination between all different levels of medical assistance, in order to promote and protect exclusive breastfeeding, has allowed 92.3% of the children who are born in our hospitals to be breastfed for eight months on average. The average duration of exclusive breastfeeding is 2.7 months, according to a 1998 National Survey on Reproductive Health carried out on people who are covered by this Institute.

This information is consistent with the 1998 data from the Statistics and Information Services Department of the Health Ministry, which stated that 93% of new-borns are breastfed while 76% are exclusively breastfed for the first three months.

Benefits in kind

In addition to obstetric assistance, Article 94 of the Social Security Law establishes other benefits such as infant formula supplies for six months.

Supplies for the 6-month period consist of infant formula for the children of those entitled to Social Security. This benefit is provided for the first 6 months of the child's life, based on the doctor's opinion.

It is worth mentioning that this benefit has been given since the creation of this Institute in 1943, in line with the then worldwide trend of feeding infants with formula and bottles. Nevertheless, in 1991 with the Baby Friendly Hospital initiative proposed by WHO and UNICEF for the Health Sector of our country, the Institute made an operative change to eradicate formulas and bottles from hospitals with obstetrics services and substituting them with exclusive breastfeeding, so that all nutritional and health benefits are given to the babies.

WHO International Code of Marketing of Breast-milk Substitutes "One of the most important supports that infant formula manufacturers can provide is compliance with the WHO Code. We haven't had any problem with Nestlé; it is not like other companies who do not abide by it."

Weaning period

Although weaning is usually recommended at four months of age, Institutional standards establish that the infant should be breastfed at will, until it is four to six months old and that this should be the only source of nutrition, depending on its weight and size. Therefore, weaning of healthy children should begin at six months if these parameters are adequate or before if necessary. The food we recommend to mothers is seasonal fruits and vegetables. We also give recommendations on hygiene and preparation, feeding methods, quantities and frequency of feeding.