14cbb2c1 0044 4d69 85cd 1254a83ec0d8

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Overview of good practices on

immediate and exclusive breastfeeding

Excerpt from Tata Kelola IMD dan ASI Eksklusif (Kinerja 2014)

Kinerja 2015

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Introduction

Follo i g its su ess i ultiple part er distri ts, Ki erja s odel for supporti g i ediate a d

exclusive breastfeeding has been widely replicated in 2014 and 2015. In Singkawang City, for example, the government expanded the breastfeeding program from 3 community health centers to all 5 health centers, while in Makassar City, the program was replicated from 3 health centers to all 20 centers. The same expansion process has occurred in Sambas, in far northwest West Kalimantan, where the local government has progressively expanded the program from 6 community health centers in 2012, to 13 in 2013, and to all 27 health centers in 2014 and 2015.

The driving factors for the success of immediate and exclusive breastfeeding programs vary from one district to a other. Ho e er, it is lear fro Ki erja s e perie e that the prese e of stro g leadership from district leaders is key, as is the participation of agents of change such as NGOs and community members. With these elements, breastfeeding programs are virtually guaranteed to show results after 1 to 2 years.

In Probolinggo, Sambas, Makassar, and Singkawang, for example, the assistance provided to local

go er e ts Ki erja staff, part er NGOs a d lo al go er e t staff that had astered Ki erja s

approach as ru ial to tur i g the distri t heads high le els of o it e t i to a tual ha ge. I Singkawang, mid-level staff from the district health office worked hard to develop a strong

u dersta di g of Ki erja s approa h, hi h ea t that the ere a le to work closely with the community multi-stakeholder forums in order to bring about change. Another district, Bengkayang, on the other hand, relied heavily on the role of the local media and young citizen journalists to advocate to the legislative assembly to institute changes.

How has good governance in maternal

health been applied in Kinerja’s

partner districts?

1. Government officials formulate policies, plans, regulations, procedures and standards based on evidence of the effectiveness of health interventions, resource allocation, spending patterns, and other elements.

2. Government officials make evidence-based decisions on the allocation of resources for healthcare services in accordance with policies.

3. Policy makers seek input from technical experts in government and civil society organizations and from healthcare users regarding proposed laws on health, including on the role of the community, civil society, and the private sector.

4. Service providers regularly review and renew healthcare services on the basis of evidence on effectiveness, patient needs, and health issues.

5. Protocols, standards, and codes of conduct, including certification procedures for training institutes, healthcare facilities, and healthcare providers, have been developed for actors involved in the provision of healthcare and have widely been distributed.

3 6. Public sector organizations, volunteers and the private sector monitor compliance with protocols,

standards, and codes of conduct.

7. Structures (for example, regulatory agencies with appropriate human resources) and procedures for supervision enable service providers, patients and other stakeholders to pursue problems when regulations, protocols, standards, and/or codes of conduct are not fulfilled.

8. Systems of financing and supervision in place that offer incentives for public, private and NGO-run health facilities to improve their healthcare performance.

9. Structures and procedures available to encourage technical experts and the local community to review and contribute to the government strategic planning process on heath priorities, decisions on allocation of resources, and quality of services.

10. Allocation and utilization of resources are regularly monitored, and information on results is available to be reviewed by the public and relevant stakeholders.

11. This system exists to report, investigate and judge misallocation and misuse of resources.

12. The government and healthcare provider organizations regularly hold forums to ask for the input and opinion of public stakeholders and beneficiaries (vulnerable groups, groups with certain health problems, etc) on health priorities, services and resources.

13. Civil society organizations (including professional organizations relating to health and media) monitor how healthcare services are delivered and paid for.

14. Relevant actors and stakeholders have regular opportunities to meet with healthcare service management (hospitals, health centers, clinics) to raise issues on the quality and efficiency of services.

15. Relevant actors and stakeholders have the financial means, tools, materials, and abilities to support and effectively participate with public officials in the formulation of policies, plans and budgets for healthcare services.

16. Information is available for the public on the quality and cost of healthcare to assist patients in making choices on which healthcare unit is the most suitable to their needs and desires.

17. Procedures or systems are available to reduce, eliminate and control bias and injustice in accessing healthcare.

18. There is a structure for civil society and the private sector to participate equally in the planning and budgeting process for health programs at the national and local levels.

19. There are breastfeeding rooms in community health centers, district health offices, and other local government offices.

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Examples of Kinerja-supported Good Practices

1. Community-led Breastfeeding Campaigns, Makassar City, South Sulawesi

Beginning with awareness raising activities, various groups came together to carry out campaigns on the importance of exclusive breastfeeding, including community forums, health volunteers, the Indonesian Midwives Association, the Fathers who Support Breastfeeding group, Aisyiyah, and citizen journalists.

Duri g the ele ratio of Makassar Cit s a i ersar , the groups a paig ed together o the

importance of immediate and exclusive breastfeedi g. The groups ere supported Ki erja s NGO partner, Kinerja staff, and the community multi-stakeholder forum.

The formal and non-formal advocacy and awareness raising activities culminated in the development of a District Head Decree to support exclusive breastfeeding. Prior to the Kinerja program, the mayor had already campaigned on the First 1000 Days of Life movement that also covered the importance of exclusive breastfeeding.

After the District Head Decree on exclusive breastfeeding came into law, it was followed up with the development of an easily-understandable module to be used by breastfeeding activists.

2. Immediate Initiation of Breastfeeding in South Singkawang Community

Health Center, Singkawang City, West Kalimantan

Since worki g ith Ki erja a d Ki erja s NGO part er i West Kali a ta , PKBI, the o u it feels more empowered to request their healthcare rights.

o Families of patients protest to the head midwife if mothers are not assisted to immediately breastfeed their baby after delivery.

o _{Demand for pregnancy classes has increased} significantly. In 2011, there were no classes at all, yet by 2012, 26 classes were held and another 28 in 2013.

o In many places, pregnancy classes are facilitated by health volunteers and other mothers, reducing dependency on midwives/health workers.

o _{Requests for counseling from breastfeeding} counselors have increased.

o Exclusive breastfeeding rates in Singkawang City have increased. In 2011, when Kinerja began working in the region, the percentage of babies being exclusively breastfed was only 22.2%.

0

26 28

0 5 10 15 20 25 30

2011 2012 2013

Number of pregnancy classes,

South Singkawang 2011-13

5 Exclusive breastfeeding rates rose to 38.1% after 1 year of Ki erja s assistance (2012), and rose again to 48.7% in 2013.

o _{All childbirths assisted by health workers are required to include immediate breastfeeding in} Community Health Centers in South Singkawang.

o Local policies have been reformed as a result of community and multi-stakeholder forum advocacy.

o _{The District health Office and partner Community Health Centers were supported to apply} aspects of good governance into their services, including public participation, transparency and accountability through innovation, incentives, and sanctions.

o Patient service flowcharts which illustrate how, where and from whom patients receive healthcare are now displayed at community health centers in easily-understandable language. o _{Service providers/health workers understand and are capable of carrying out tasks in}

accordance with national standards and technical SOPs.

o _{Multi-stakeholder forums function as forums for public participation in planning processes,} resource prioritization, and monitoring service quality.

o Complaint management systems now include multi-stakeholder forums and service users. o National Minimum Service Standards are used as a goal on which healthcare performance

indicators are based.

3. Fathers who Care about Breastfeeding, Makassar City, South Sulawesi

The development of groups called Bapak Peduli ASI or Fathers ho Care a out Breastfeedi g ega i Makassar with a focus group discussion (FGD). The FGD involved public figures, legislative members, and fathers, and discussed the importance of immediate and exclusive breastfeeding. The fathers agreed that breastfeeding is not only the responsibility of mothers and health workers, but also the responsibility of fathers. They decided to band together and form a number of community based groups

u der the Fathers ho Care a out Breastfeedi g a e.

The groups are made up of civil servants, university lecturers, Islamic teachers, and many other local citizens. Together, they undertook a series of advocacy meetings with legislative members and the district government in order to build commitment on allocating budget funds and developing activities to support immediate and exclusive breastfeeding. The groups also began working with Muslim and Christian

religious figures and encouraged them to discuss exclusive breastfeeding in their sermons and lectures. They also push companies to cease promoting and selling formula milk in their neighborhoods, and provide support and assistance to breastfeeding mothers.

We felt o pelled [to start our own group] since the formation of other multi-stakeholder forums

M“F , lai ed o e of the

6 The results of advocacy and commitment of ASI Concerned Fathers are already visible in Makassar. From an initial survey conducted at Cenderawasih Community Health Centers in 2012, only 43% of mothers were aware of the concept of exclusive breastfeeding. However, in 2014, 80% of post-partum mothers had decided to exclusively breastfeed their babies. Mothers also now feel braver to oppose and reject formula milk, and often provide advice to other mothers on the benefits of immediate and exclusive breastfeeding.

4. Exclusive Breastfeeding in Probolinggo, East Java

The government of Probolinggo has been a strong supporter of the exclusive breastfeeding movement. o _{The District Head of Probolinggo was inaugurated as the dist}ri t s first reastfeedi g

ambassador. She also issued a District Head Decree on Safe Childbirth and Immediate & Exclusive Breastfeeding that was developed in consultation with multi-stakeholder forums. o Formula milk at health facilities and at private midwifery clinics was banned throughout the

district.

o The District Head, together with the District Health Office, actively carries out spot checks on health facilities and private midwifery clinics to see whether they still provide formula milk. Sanctions are then imposed on those violating the ban.

o _{Community health centers declared that the katuk leaf (sauropus androgynous) is useful in} boosting breast milk production, and subsequently provided katuk leaf dishes for mothers giving birth in community health centers and hospitals.

o The local government worked together with the private sector to develop breastfeeding rooms at workplaces.

5. Exclusive Breastfeeding Campaign, Beji Community Health Center,

Tulangagung District, East Java

As part of a wider campaign to increase rates of exclusive breastfeeding in Tulangagung district, Beji Community Health Center cancelled an agreement with a formula milk company. Since May 2013, staff at the health center are no longer allowed to promote or distribute formula milk products. This brave decision made by the head of this community health center is in line with demands of public supervision agencies and also in accordance with new local regulations that prohibit the circulation of formula milk in public healthcare facilities.

The impact on breastfeeding rates has been significant. Between May and July 2013, the rate of exclusive breastfeeding amongst new mothers at Beji Community Health Center rose from 54.65% to 87.5%.

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6. Batua Community Health Center, Makassar City, South Sulawesi

In December 2012, the District Head of Makassar signed District Head Decree no.48/2012 on Exclusive Breastfeeding. This decree requires all healthcare units, including community health centers and hospitals, to have breastfeeding rooms so that there are comfortable and safe areas for mothers who want to breastfeed their babies.

The following month (January 2013), the community health centers of Makassar City started preparing breastfeeding rooms at their facilities. In these rooms, health center staff provide everything that could be required by breastfeeding mothers: washbasins, chairs, cribs, bottles, pumps, televisions, fans, fridges, tissues, and drinking water. The funds for these items come both from the local government

udget a d fro the health e ters operatio al fu ds.

7. Nanga Pinoh Community Health Center, Melawi District, West Kalimantan

In Melawi District, in West Kalimantan, there remains a serious lack of breastfeeding facilities at community health centers and hospitals.

However, there is one community health center that has provided a breastfeeding space for mothers, without incurring huge expense. This community health center is Nanga Pinoh,

here the e ter s head and staff have turned a spare bed into a comfortable spot for mothers to breastfeed.

This bed is available in the e ter s nutrition room. This shows thaty not all community health centers are required to dedicate a whole separate room for breastfeeding; any space can be used by breastfeeding mothers, as long as they can feel comfortable and safe, and will not be disturbed. Therefore, Nanga Pinoh Community Health Center staff have installed a curtain in front of the bed, so that breastfeeding mothers cannot be seen by the staff or other patients. Tissues and

8 drinking water are also provided for free.

The head of Nanga Pinoh Community Health Center stated that there are already many patients that use the breastfeeding corner when they come for an examination. Those who most often use the space are the actually the staff of the health center themselves – so in fact there are twice as many benefits as were expected!

8. Implementation of a Suggestion Box in Batua Community Health Center,

Makassar City

Makassar has implemented a suggestion box in every Community Health Center throughout the city. The suggestion boxes are opened and discussed every month with the involvement of health volunteers and multi-stakeholder forums, in order for a resolution and follow up actions to be agreed on and carried out together. This suggestion boxes are locked, and the keys held by health staff such as midwives or health volunteers.

9. Implementation of an SMS Gateway, Sungai Raya Kepulauan Community

Health Center, Bengkayang District, West Kalimantan

Sungai Raya Kepulauan Community Health Center, in a coastal area in Bengkayang District, West Kalimantan Province, has had a suggestion box for a long time. However, the Community Health Center staff admits that there are seldom any suggestions and complaints inside.

Therefore, the Head of the Community Health Center decided to implement an SMS Gateway in the Community Health Center. All the staff agreed to publish three mobile phone numbers so that patients are able to convey their complaints directly and quickly to the center. The mobile phones are held one each by the head of the center, the head midwife, and the head of administration.

Since the printing of banners with information about the SMS Gateway and listing the mobile phone numbers, an increased number of suggestions have been received by the health center. All the suggestions and complaints are recorded in a complaint book, and if they cannot be held with immediately,, the suggestions are discussed in a monthly mini workshop.

9

10. District Regulation on Immediate & Exclusive Breastfeeding, Singkawang

City, West Kalimantan

With the assistance and support from USAID-KINERJA, the District Health Office of Singkawang City decided to increase their efforts on Safe Delivery and Immediate & Exclusive Breastfeeding programs. Various awareness raising and dissemination activities on the benefits of immediate and exclusive breastfeeding have been incorporated into the District Health Offi e s utritio progra , a d are implemented by the District Health Office in collaboration with the Family Welfare Movement, the District Education Office, and the Ministry of Religion. The Singkawang government is determined to raise a healthy and intelligent generation of children that will benefit the whole city.

To guarantee the consistent and sustainable implementation of immediate and exclusive breastfeeding as a local priority program, the District Health Office developed a district head decree on immediate and exclusive breastfeeding. The decree formulation process involved various government agencies and community representatives, including the Maternal and Child Health Care Forum. Prior to ratification, the decree draft was consulted through a public test as a form of high local commitment to public participation.

With the ratification of the decree, the Department of Health in Singkawang City is also more confident in working together with other sectors and agents such as NGOs and community forums to support the

de ree s i ple e tatio . Additional policies have also been developed, instructing health workers to assist mothers to carry out immediate breastfeeding after childbirth and forbidding health workers giving newborns formula milk.

The main focus of activities has been on raising awareness, understanding, and willingness around immediate and exclusive breastfeeding, not just for mothers but also for religious figures, community leaders, high school teachers, and staff from the Religious Affairs Office. The community multi-stakeholder forum also frequently carries out campaigns, consultations, and counseling. Information and education are also provided at arious ig e e ts su h as the ele ratio of Mother s Da a d Kartini Day, where the breastfeeding ambassador (currently the wife of the District Head) actively campaigns on the importance of breastfeeding. As the breastfeeding ambassador, she speaks out about the rights of babies to receive breast milk and the rights of mothers to have the time and facilities that support breastfeeding.

The results of “i gka a g s stro g promotion of breastfeeding are evident in the increased demand for immediate and exclusive breastfeeding assistance in health centers (Hospitals, Maternity Clinics, and Community Health Centers); increased demand for pregnancy classes; and increased demand for consultation and counseling with breastfeeding counselors, both through SMS and direct communication (face to face and telephone). Counseling on breastfeeding from religious figures has also become more popular, as has the inclusion of breastfeeding information in marriage sermons given by Religious Affairs Office staff.

10

11. Seven Minute Lecture Contest in Bondowoso District, East Java

Bondowoso District in East Java chose to work with Kinerja on three areas relating to maternal health: safe delivery; immediate & exclusive breastfeeding; and child marriage prevention. The District Head developed District Head Decree no.41/2012 to ensure these three issues are covered by policies. The District Head was also appointed as Ummi Persameda, the other of safe deli er , i ediate & exclusive breastfeeding, and reproductive health.

Traditional beliefs and the use of dukun bayi or traditional birth attendants remain popular in Bondowoso. Practices such as child marriage and giving newborns food other than milk are common, and require strategic innovation to overcome. One of the efforts made by the Bondowoso District Government is a campaign through religious figures, where the figures (scholars and teachers) take part in supporting breastfeeding awareness raising efforts through incorporating information into their sermons, as well as through taking part in giving lectures on safe delivery, breastfeeding, and delayed marriage at community events. Religious figures have shown excellent commitment in combating these issues, and they are highly-skilled in delivering information in a populist and easy-to-understand manner. One activity that has been held up by the government as being particularly successful was the Seven Minute Sermon Contest, where religious scholars and teachers competed to give the best seven minute sermon on the theme on maternal and child health.

12. Health Education for Bridal Makeup Artists, Market Sellers, Herbal

Medicine Sellers and Motorbike Taxi Drivers, Probolinggo City and Jember

District, East Java

One of the most creative campaigns Kinerja witnessed in its partner districts was developed in Probolinggo City in East Java, where perias manten or bridal makeup artists committed to support safe delivery and immediate & exclusive breastfeeding. The women were trained on maternal and child health issues so that they were able to provide advice to the brides-to-be under their care to ensure they had a good understanding of the benefits of safe delivery and breastfeeding.

Some of the multi-stakeholder forums in Jember and Probolinggo City have also been very innovative in raising awareness of the importance of exclusive breastfeeding and safe delivery. The forums have been training market sellers and herbal medicine sellers, for example, so that they are able to provide health advice to expecting mothers. These sellers frequently come into contact with pregnant women and women with young babies, so they are uniquely placed to deliver crucial messages on maternal and child health, such as encouraging women to get antenatal checkups, to give birth at a health facility, and to breastfeed their child exclusively for the first six months.

11

13. Local Dialect Banners

A final type of campaign carried out by multi-stakeholder forums is through creating and displaying banners in local dialects. The banners contain information about maternal and child health, or simply just encourage women to come to the health facility to get an antenatal checkup. The aim of using local dialects is to be able to deliver a message that is easily understood by the whole community.

6 The results of advocacy and commitment of ASI Concerned Fathers are already visible in Makassar. From an initial survey conducted at Cenderawasih Community Health Centers in 2012, only 43% of mothers were aware of the concept of exclusive breastfeeding. However, in 2014, 80% of post-partum mothers had decided to exclusively breastfeed their babies. Mothers also now feel braver to oppose and reject formula milk, and often provide advice to other mothers on the benefits of immediate and exclusive breastfeeding.

4. Exclusive Breastfeeding in Probolinggo, East Java

The government of Probolinggo has been a strong supporter of the exclusive breastfeeding movement. o _{The District Head of Probolinggo was inaugurated as the dist}ri t s first reastfeedi g

ambassador. She also issued a District Head Decree on Safe Childbirth and Immediate & Exclusive Breastfeeding that was developed in consultation with multi-stakeholder forums. o Formula milk at health facilities and at private midwifery clinics was banned throughout the

district.

o The District Head, together with the District Health Office, actively carries out spot checks on health facilities and private midwifery clinics to see whether they still provide formula milk. Sanctions are then imposed on those violating the ban.

o _{Community health centers declared that the katuk leaf (sauropus androgynous) is useful in} boosting breast milk production, and subsequently provided katuk leaf dishes for mothers giving birth in community health centers and hospitals.

o The local government worked together with the private sector to develop breastfeeding rooms at workplaces.

5. Exclusive Breastfeeding Campaign, Beji Community Health Center,

Tulangagung District, East Java

As part of a wider campaign to increase rates of exclusive breastfeeding in Tulangagung district, Beji Community Health Center cancelled an agreement with a formula milk company. Since May 2013, staff at the health center are no longer allowed to promote or distribute formula milk products. This brave decision made by the head of this community health center is in line with demands of public supervision agencies and also in accordance with new local regulations that prohibit the circulation of formula milk in public healthcare facilities.

The impact on breastfeeding rates has been significant. Between May and July 2013, the rate of exclusive breastfeeding amongst new mothers at Beji Community Health Center rose from 54.65% to 87.5%.

7

6. Batua Community Health Center, Makassar City, South Sulawesi

In December 2012, the District Head of Makassar signed District Head Decree no.48/2012 on Exclusive Breastfeeding. This decree requires all healthcare units, including community health centers and hospitals, to have breastfeeding rooms so that there are comfortable and safe areas for mothers who want to breastfeed their babies.

The following month (January 2013), the community health centers of Makassar City started preparing breastfeeding rooms at their facilities. In these rooms, health center staff provide everything that could be required by breastfeeding mothers: washbasins, chairs, cribs, bottles, pumps, televisions, fans, fridges, tissues, and drinking water. The funds for these items come both from the local government

udget a d fro the health e ters operatio al fu ds.

7. Nanga Pinoh Community Health Center, Melawi District, West Kalimantan

In Melawi District, in West Kalimantan, there remains a serious lack of breastfeeding facilities at community health centers and hospitals.

However, there is one community health center that has provided a breastfeeding space for mothers, without incurring huge expense. This community health center is Nanga Pinoh, here the e ter s head and staff have turned a spare bed into a comfortable spot for mothers to breastfeed.

This bed is available in the e ter s nutrition room. This shows thaty not all community health centers are required to dedicate a whole separate room for breastfeeding; any space can be used by breastfeeding mothers, as long as they can feel comfortable and safe, and will not be disturbed. Therefore, Nanga Pinoh Community Health Center staff have installed a curtain in front of the bed, so that breastfeeding mothers cannot be seen by the staff or other patients. Tissues and

8 drinking water are also provided for free.

The head of Nanga Pinoh Community Health Center stated that there are already many patients that use the breastfeeding corner when they come for an examination. Those who most often use the space are the actually the staff of the health center themselves – so in fact there are twice as many benefits as were expected!

8. Implementation of a Suggestion Box in Batua Community Health Center,

Makassar City

Makassar has implemented a suggestion box in every Community Health Center throughout the city. The suggestion boxes are opened and discussed every month with the involvement of health volunteers and multi-stakeholder forums, in order for a resolution and follow up actions to be agreed on and carried out together. This suggestion boxes are locked, and the keys held by health staff such as midwives or health volunteers.

9. Implementation of an SMS Gateway, Sungai Raya Kepulauan Community

Health Center, Bengkayang District, West Kalimantan

Sungai Raya Kepulauan Community Health Center, in a coastal area in Bengkayang District, West Kalimantan Province, has had a suggestion box for a long time. However, the Community Health Center staff admits that there are seldom any suggestions and complaints inside.

Therefore, the Head of the Community Health Center decided to implement an SMS Gateway in the Community Health Center. All the staff agreed to publish three mobile phone numbers so that patients are able to convey their complaints directly and quickly to the center. The mobile phones are held one each by the head of the center, the head midwife, and the head of administration.

Since the printing of banners with information about the SMS Gateway and listing the mobile phone numbers, an increased number of suggestions have been received by the health center. All the suggestions and complaints are recorded in a complaint book, and if they cannot be held with immediately,, the suggestions are discussed in a monthly mini workshop.

9

10. District Regulation on Immediate & Exclusive Breastfeeding, Singkawang

City, West Kalimantan

With the assistance and support from USAID-KINERJA, the District Health Office of Singkawang City decided to increase their efforts on Safe Delivery and Immediate & Exclusive Breastfeeding programs. Various awareness raising and dissemination activities on the benefits of immediate and exclusive breastfeeding have been incorporated into the District Health Offi e s utritio progra , a d are implemented by the District Health Office in collaboration with the Family Welfare Movement, the District Education Office, and the Ministry of Religion. The Singkawang government is determined to raise a healthy and intelligent generation of children that will benefit the whole city.

To guarantee the consistent and sustainable implementation of immediate and exclusive breastfeeding as a local priority program, the District Health Office developed a district head decree on immediate and exclusive breastfeeding. The decree formulation process involved various government agencies and community representatives, including the Maternal and Child Health Care Forum. Prior to ratification, the decree draft was consulted through a public test as a form of high local commitment to public participation.

With the ratification of the decree, the Department of Health in Singkawang City is also more confident in working together with other sectors and agents such as NGOs and community forums to support the de ree s i ple e tatio . Additional policies have also been developed, instructing health workers to assist mothers to carry out immediate breastfeeding after childbirth and forbidding health workers giving newborns formula milk.

The main focus of activities has been on raising awareness, understanding, and willingness around immediate and exclusive breastfeeding, not just for mothers but also for religious figures, community leaders, high school teachers, and staff from the Religious Affairs Office. The community multi-stakeholder forum also frequently carries out campaigns, consultations, and counseling. Information and education are also provided at arious ig e e ts su h as the ele ratio of Mother s Da a d Kartini Day, where the breastfeeding ambassador (currently the wife of the District Head) actively campaigns on the importance of breastfeeding. As the breastfeeding ambassador, she speaks out about the rights of babies to receive breast milk and the rights of mothers to have the time and facilities that support breastfeeding.

The results of “i gka a g s stro g promotion of breastfeeding are evident in the increased demand for immediate and exclusive breastfeeding assistance in health centers (Hospitals, Maternity Clinics, and Community Health Centers); increased demand for pregnancy classes; and increased demand for consultation and counseling with breastfeeding counselors, both through SMS and direct communication (face to face and telephone). Counseling on breastfeeding from religious figures has also become more popular, as has the inclusion of breastfeeding information in marriage sermons given by Religious Affairs Office staff.

10

11. Seven Minute Lecture Contest in Bondowoso District, East Java

Bondowoso District in East Java chose to work with Kinerja on three areas relating to maternal health: safe delivery; immediate & exclusive breastfeeding; and child marriage prevention. The District Head developed District Head Decree no.41/2012 to ensure these three issues are covered by policies. The District Head was also appointed as Ummi Persameda, the other of safe deli er , i ediate & exclusive breastfeeding, and reproductive health.

Traditional beliefs and the use of dukun bayi or traditional birth attendants remain popular in Bondowoso. Practices such as child marriage and giving newborns food other than milk are common, and require strategic innovation to overcome. One of the efforts made by the Bondowoso District Government is a campaign through religious figures, where the figures (scholars and teachers) take part in supporting breastfeeding awareness raising efforts through incorporating information into their sermons, as well as through taking part in giving lectures on safe delivery, breastfeeding, and delayed marriage at community events. Religious figures have shown excellent commitment in combating these issues, and they are highly-skilled in delivering information in a populist and easy-to-understand manner. One activity that has been held up by the government as being particularly successful was the Seven Minute Sermon Contest, where religious scholars and teachers competed to give the best seven minute sermon on the theme on maternal and child health.

12. Health Education for Bridal Makeup Artists, Market Sellers, Herbal

Medicine Sellers and Motorbike Taxi Drivers, Probolinggo City and Jember

District, East Java

One of the most creative campaigns Kinerja witnessed in its partner districts was developed in Probolinggo City in East Java, where perias manten or bridal makeup artists committed to support safe delivery and immediate & exclusive breastfeeding. The women were trained on maternal and child health issues so that they were able to provide advice to the brides-to-be under their care to ensure they had a good understanding of the benefits of safe delivery and breastfeeding.

Some of the multi-stakeholder forums in Jember and Probolinggo City have also been very innovative in raising awareness of the importance of exclusive breastfeeding and safe delivery. The forums have been training market sellers and herbal medicine sellers, for example, so that they are able to provide health advice to expecting mothers. These sellers frequently come into contact with pregnant women and women with young babies, so they are uniquely placed to deliver crucial messages on maternal and child health, such as encouraging women to get antenatal checkups, to give birth at a health facility, and to breastfeed their child exclusively for the first six months.

11

13. Local Dialect Banners

A final type of campaign carried out by multi-stakeholder forums is through creating and displaying banners in local dialects. The banners contain information about maternal and child health, or simply just encourage women to come to the health facility to get an antenatal checkup. The aim of using local dialects is to be able to deliver a message that is easily understood by the whole community.