1. Infant Young Child Feeding in Emergency Daisy Nyaga Nutrition consultant-UNICEF

2. What is IYCF E Promotion, protection and support of breast feeding to both the breast fed and non breast feed infant in emergency. Children 6-24 months are fed with foods from 4 or more food groups per day. Proper hygiene and safe food handling practices adhered to.

3. Why breastfeeding matters • The younger a child, the more vulnerable they are. • The younger a child, the more the value of breast milk. Thus the requirement to introduce breast milk within 1st hour of birth. • Breast milk comes ready to use, with up todate nutritive value .

4. Risks of death highest for the youngest at therapeutic feeding centres in Afghanistan, 1999 IFE 1/2 Deaths as % of admissions Age (months) Golden M. Comment on including infants in nutrition surveys: experiences of ACF in Kabul City. Field Exchange 2000;9:16-17

5. Protection by breastfeeding is greatest for the youngest infants WHO Collaborative Study Team. Effects of breastfeeding on infant and child mortality due to infectious disease in less developed countries: a pooled analysis. The Lancet 2000;355:451-5 IFE 1/4 Times more likely to die if not breastfed Risk of death if breastfed is equivalent to one. Age in months

6. Misconception “Stress makes the milk dry up” “Malnourished mothers cannot breastfeed” “Once breastfeeding has stopped, it cannot be resumed” Fact / Recommendation Stress might temporarily affect the milk let down reflex, but does not affect milk production. Mothers need reassurance and support Feed the mother and let her feed her infant. All mothers need extra fluids, food to maintain strength and breastfeeding. It is usually possible to re-lactate. Mothers need support to do this. Common misconceptions on infant feeding in emergencies IFE PAK 1/8

7. Misconception “If the mother is stressed, she will pass the tension on to the baby”. “Babies with in warm climate, get thirst and need water.” Women formula-fed here before the crisis & ‘know how to do it’ (We are ‘developed’ and only formula feed) Fact / Recommendation Breastfeeding will relax both mother and baby. Mothers need reassurance and support. Breast milk provides all the fluids an infant under 6 months needs, also when it has diarrhea The emergency means that the circumstances that made formula-feeding acceptable, feasible, affordable, sustainable & safe have gone. Breastfeeding is best anyway – but especially in an emergency Common misconceptions on infant feeding in emergencies IFE PAK 1/9

8. Improving conditions to make breastfeeding easier in emergency IFE 1/8 Staff should ensure priority access Shelters, breastfeeding havens groups of women who support each other effective controls on availability • Mothers’ difficulties • time constraints • long time to fetch water, • queue for food • lack of protection, security, and (where valued) privacy • lack of social support and the familiar social network • free availability of breastmilksubstitutes,undermining mothers’ confidence in breastfeeding

9. Problems of artificial feeding in emergencies • lack of water • poor sanitation • inadequate cooking utensils • shortage of fuel • daily survival activities take more time and energy • uncertain, unsustainable supplies of breastmilk substitutes • lack of knowledge on preparation and use of artificial feeding IFE 1/11

10. IFE PAK 1/15 Inappropriate donations of milk products Pakistan 2005 Lebanon, 2006 Ali Maclaine, Nutrition Consultant, Lebanon Maaike Arts, UNICEF Pakistan Maaike Arts, UNICEF Pakistan

11. Some important points from the • International Code of Marketing of Breast milk Substitutes • no advertising or promotion to the public • no free samples to mothers or families • no donation of free supplies to the health care system • health care system obtains breast milk substitutes through normal procurement channels, not through free or subsidised supplies • labels in appropriate language, with specified information and warnings IFE 1/13

12. Points of agreement on how to protect, promote and support breastfeeding 1. Emphasise that breastmilk is best. 2. Actively support women to breastfeed. 3. Avoid inappropriate distribution of breastmilk substitutes. 4. When necessary (following assessment) use infant formula if available. It must be targeted only to those who need it. IFE 1/16 HONDURAS. UNICEF/HQ98-0639/BULAGUER RWANDA. UNICEF/DOI94-1056/PRESS NGARA, TZ/LUNG’AHO

13. More points of agreement on how to protect, promote and support breastfeeding IFE 1/17 5. Do not distribute feeding bottles/teats; promote cup feeding. 6. Do not distribute dried skim milk unless mixed with cereal. 7. Add complementary foods to breastfeeding after 6 full months. 8. Avoid commercial complementary foods. 9. Include pregnant and lactating women in supplementary feeding when general ration is insufficient. EX-Yugoslavia UNICEF/HQ-95-0505/LEMOYNE

14. Thus, what do we need to do

15. Scale up IYCF E interventions

16. Adaptation /development of tools and materials for use in IYCF E programming Form IYCF TWG at national and state levels Orientation of partners /MoH staff in IYCF E programming. Develop IYCF E monitoring tool Advocacy on IYCF E Monitor the use and distribution of BMS