THE INDIAN SCENARIO
Despite the immense benefits of optimal breastfeeding and complementary feeding practices during first two years of life, in India practices remain largely suboptimal. According to the NFHS 4,(1) only 41% women are able to begin breastfeeding within an hour of birth, 54.9% are able to practice exclusive breastfeeding 0-6 months and 42% begin complementary feeding along with continued breastfeeding. Further, only 1 out of 10 children between 6 months to 23 months get minimum acceptable diet (at least 4 types of foods). Optimal infant and young child feeding practices are dependent on how women are supported in their caring role.

WHY THIS COURSE?
Government of India’s National Guidelines on Infant and young child feeding and guidelines on ‘MAA Programme’ and ‘Lactation Management Centres’ clearly recognise the need to improve feeding practices as a preventive strategy for malnutrition and child mortality in India. Not many health facilities (both in public and private sector) provide this service. To ensure optimal breastfeeding and infant and young child feeding practices, women require structural support at work, home or in the health systems.

In the health system, women need accurate information and discussion right during pregnancy to make proper feeding decisions, practical help and support at birth and later, and protection from exploitative commercial baby food industry. This means, accurate information about optimal infant and young child feeding and timely counselling. Health workers need to help mothers to decide what is best form of feeding their babies during 3rd trimester of pregnancy, build mother's confidence to increase breastmilk flow from the mother to the baby, assist her to initiate breastfeeding within one hour, assist her in making proper suckling position (to allow effective suckling, which will help in preventing breast problems like sore nipples and engorgement), solve problems if they do arise, build her confidence when she has a 'feeling' of 'not enough milk', education and guidance on breastfeeding, counsel mothers and families on adequate and appropriate complementary feeding, and finally be able to counsel HIV positive mothers about infant feeding options and support their choice. They also need to help mothers who decided to give formula feeding for ensuring safe infant feeding. Use of formula feeding in the early postpartum period is common in the hospitals and health workers have to minimise its use.

Unfortunately, most health care providers have barely acquired these 'skills' in counselling and lactation management. Inadequate knowledge and skills of these workers complicates the situation making them ambivalent and switch to alternatives. Mothers follow their advice. Commercial pressures add to this problem in a significant manner.

It is, therefore, imperative to skill train all health care providers who work in maternity area of all health facilities to enable them for counselling and support mothers on appropriate feeding, manage lactation problems and protect from commercial factors. BPNI has developed '4 in 1 course' particularly for this purpose.

THE EVIDENCE
There is evidence providing antenatal and post-natal counselling support to mothers by a dedicated, trained breastfeeding and lactation management counsellor can significantly enhance rates of early initiation of breastfeeding and help mothers to sustain exclusive breastfeeding for 6 months and reduce rates of bottle feeding at 6 months. (2)

THE COURSE OBJECTIVES

• To train and build the skills of health care providers for counselling on breastfeeding and lactation management, complementary feeding, HIV, and growth monitoring.
• To enable the trainees to prevent and manage breastfeeding difficulties e.g. sore nipples, engorgement, mastitis and not enough milk, manage effective lactation and
• To enable participants to establish lactation counselling/support clinics (within the ambit of local legal frameworks)

THE COURSE CONTENT
BPNI is a pioneering agency working on development of such training programmes since 1992.BPNI has already certified more than 1300 counsellors who have completed this course. The '4 in 1' training course is unique world-class course for imparting clinical and counselling skills to enable participants in helping mothers and babies to succeed in breastfeeding and infant and young child feeding practices including HIV-Infant feeding and growth monitoring. It has the most updated technical content.
This course is based on following WHO/UNICEF courses:

1. “Breastfeeding Counselling- A Training Course”    (Duration: 5 days)
2. “HIV and Infant Feeding Counselling - A Training Course”    (Duration: 3 days)
3. “Complementary Feeding Counselling - A Training Course”    (Duration: 3 days)
4. “Training Course On Child Growth Assessment”    (Duration: 3½ days)

The “4 in 1” course incorporated materials from the above training courses and BPNI’s pioneering team helped combine them into one. The MOHFW Government of India’s MAA programme has recognised BPNI to be its technical partner for this purpose. This course seeks to bridge the skill gap in the health services. BPNI provides following resources during the training.

• Participants Manual
• Counselling Guide for Frontline Workers
• Book titled ‘The law to protect, promote and support breastfeeding’
• Book titled ‘Complementary Foods for Infants and young Children’
• Book titled ‘Breastfeeding and Complementary Feeding- A Guide for Parents’

DURATION AND CERTIFICATION 
The duration of the course is 7-days (9 am-6 pm everyday). Four national trainers of BPNI train 24 participants. This includes 10 hours of clinical training (2 hours x 5 times).  Those who complete it successfully, become eligible to be certified as “BPNI’s certified counsellor on Breastfeeding, Lactation Management & Infant and Young Child Feeding”. This certification is VALID for 3 years.

RE-CERTIFICATION AFTER 3 YEARS
The certificate will be valid for three years from the day it has been issued. All certified counsellors will be required to renew their certificate every three years after following a specified process and paying a fee to BPNI. Recertification will be based on online examination set up by BPNI. Certified persons will undergo a periodic online monitoring of their performance and practice.

WHO CAN DO THIS COURSE
To be eligible, participants should be a graduate in medicine, nursing, nutrition, science, home science, dietetics and related fields. Those who have been appointed as lactation counsellors in health facilities are eligible to join. BPNI encourages the administrators of the hospitals with maternity services to appoint the nurses or dedicated counsellors to improve their service delivery.

SCOPE OF PRACTICE
The certified counsellors can practice the knowledge gained during the course such as management of breastfeeding and lactation support to women. They should refrain from and are not permitted to take other medical actions such as prescribing any treatments /medications for which they are not qualified.  If they are themselves health care professionals they may act accordingly. A detailed note on scope of practice will be provided at the time of certification.

ETHICAL POLICY
Certified counsellors will be expected to follow a clear ethical policy. It includes:strictly adhering to Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act 1992, and Amendment Act 2003, and providing this information to mothers/clients & fellow colleagues, maintain their standards in their capacity or identity as BF counsellor, remain proficient in professional practice through continuing education, associated with networks and organizations, seeing to the primacy of mother and baby’s interests, confidentiality & privacy, reliability to the sources provided and charge the fees being fair and reasonable to the services provided. Further, the counsellors need to maintain integrity of the profession, practice equality, for every mother who needs it, and provide informed consent for the photographs, videos or for any promotional activity.

AVAILABILITY FOR THE BPNI-APP “STANPAN SURAKSHA”
Those counsellors, who act according to scope of practice and ethics, will be offered to be included in the BPNI’s Mobile APP for purpose of linking with parents who may need such services.

WHO WILL CONDUCT TRAINING AND HOW?
BPNI has trained more than 200 “National Trainers” who will conduct such courses. They have the skills, experience and knowledge to conduct quality training.

The training course is highly participatory. It has classroom sessions, lectures, discussions, demonstrations, exercises, role-plays, group work and hospital practices etc. The clinical practice is hallmark of this course; five times during one-week participants practice their skills with mother and baby pairs in the wards. Participants work with mothers and babies in the maternity wards or outdoors for actually practicing the learned skills. In different clinical practice sessions, the participants observe and assess breastfeeding using listening and learning skills. Building confidence, giving support to mother where required and checking the understanding of mothers are also practiced. Building confidence of the mother is one of the keys to success of lactation; therefore participants are given hands on experience of using this skill and build women's confidence in themselves to improve lactation performance.

The clinical sessions help participants to assist mothers to position their baby at the breast and correct it if feeding was not going on well. They are also involved in teaching mothers how to express breastmilk through this approach to enhance milk flow. The participants also practice counselling in different breast conditions and use of dietary recall form for the baby. One session is also devoted on complementary feeding where they discuss appropriate complementary feeding with the mothers and make them able to decide what's the best food for the babies. Finally, they also learn providing different infant feeding options for mothers who may be HIV positive, and to support the decision of mother.

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COMPETENCE AFTER RECEIVING TRAINING
At the end of the training course, the participants will become eligible to be certified as “BPNI’s certified counsellor on Breastfeeding, Lactation Management & Infant and Young Child Feeding” and will be able to,

1. Set up lactation support units/counselling centres in both private and government hospitals.
2. Provide skilled counselling during antenatal and postnatal period.
3. Help mothers achieve comfortable position for herself and effective suckling position of the baby at the breast.
4. Provide practical help to breastfeeding mothers who have problems like sore nipples, engorgement or “not enough milk” and solve these problems through counselling, confidence building, and demonstration.
5. Teach mothers the techniques of expressing breastmilk.
6. Help mothers and family members to know how to prepare and when to begin complementary feeding from locally available ingredients.
7. Help working women to continue breastfeeding when they join work.
8. Teach family members how to keep infant feeding safe.
9. Counsel HIV +ve mothers.
10. Help in organizing local training courses, seminars & CME programme.
11. Monitor programmes.
12. Assess hospital practices if they adhere to MAA programme or BFHI 10 steps.
13. Analyse local situation or data on breastfeeding and Infant and young child feeding.
14. Technical support on Breastfeeding & IYCF to government and other agencies without conflict of interest.

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LANGUAGE 
The course is presently conducted in English/Hindi and other local languages where the course is held, as counselling practices with mothers are held in local languages.

COURSE AND RENEWAL FEE
1.    Course Fee is INR 20,400 (Rupees Twenty Thousand Four Hundred only) per participant for courses upto December 2020. (includes Course Fees INR 16,949 + GST (18%) INR 3,051 + Payment Gateway charges INR 400)

• It includes cost of training material, lunch and 2 teas for seven days. It includes fee for trainers as well as admin costs of BPNI. It does not include accommodation or travel. 

2.    Fee for renewal after 3 years will be INR 5000, which will include periodic monitoring and examination at the end of three years.

CANCELLATION AND REFUND POLICY
In case of withdrawal, the participant must request the cancellation of the registration to the Director Training through an e-mail at bpni@bpni.org, bpni.india@gmail.com. Money will be refunded as follows:
If a participant cancels the registration

• Before 30 days: 90% Refund
• Between 7-29 days: 60% Refund
• Less than 7 days of training: No refund

The refund amount will be transferred to the account of the participant after completion of the training.

COMPLAINTS/WITHDRAWAL OF CERTIFICATE
BPNI will set up a mechanism to receive complaints. An independent task force will examine it. If a participant is found indulging in unethical practices and violates IMS Act. BPNI reserves the right to cancel the certification, which may be done after following a due process.

HOW TO APPLY? 
•    Those interested may apply ONLINE 
•    BPNI reserves the rights to accept or reject an application to attend the training workshop.
•    Application will be incomplete without payments.

References
1.    National Family Health Survey-4. http://rchiips.org/NFHS/NFHS-4Reports/India.pdf
2.    Arun Gupta and Neelima Thakur. Infant and young feeding practices in India: current status and progress towards SDG targets. Proc Indian Natn Sci Acad 84 No. 4 December 2018 pp. 853-865

 

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