Briefing on the Operational Guidance on Infant and Young Child Feeding in Emergencies.

1. Briefing on the Operational Guidance on Infant and Young Child Feeding in Emergencies. A. Maclaine, Philippines 2009

2. WHY is IYCF-E important?BECAUSE INFANTS & YOUNG CHILDREN ARE EXTREMELY VULNERABLE

3. Even in healthy populations child morbidity and crude mortality can increase by 20% in 2 weeks

4. In emergencies rates of child mortality can soar from 2 to 70 times higherthan average

5. YOUNG infants are particularly vulnerable Asad Zaidi, Unicef, A. Maclaine. Philippines, 2009

6. WHOSE RESPONSIBILITY IS IYCF-E?

7. YOURS!

8. Operational Guidance on Infant and Young Child Feeding in Emergencies • Non-technical • Set of basic “dos” and “don’ts” to protect infants in emergencies • Key audience: • National governments • UN agencies • National and INGOs (all levels) • Donors

9. Realistic and practical guidance on how to ensure appropriate IYCF-E • Based on ‘best practice’. • Aims to ensure that in emergencies: - breastfeeding is protected, promoted & supported • non-breastfed infants are protected • feeding of infants and young children >6 months is supported • The Code embedded in it • Emergency situations in all countries & all types Picture: Asad Zaidi UNICEF Pakistan

10. Emergency Nutrition Network (ENN) coordinator of IFE Core Group IFE Core Group: UNICEF, WFP, WHO, UNHCR, ENN, IBFAN-GIFA, CARE USA, ACF, SC (UK), SC (US), Associate members: Swiss IFRC, Fondation Tdh REALITY IN EMERGENCIES Breastfed Non-breastfed Complementary fed

11. Operational Guidance – Summary of Key Points(Version 2.1) • Appropriate & timely support of IYCF-E saves lives • Every agency should endorse or develop a policy on IYCF-E – widely disseminate & adapt procedures • Agencies should ensure training or orientation of ALL staff in IYCF-E. • Within UN IASC cluster approach UNICEF is the likely UN agency responsible for IYCF-E in the field. Other agencies also have a role... • Key IYCF information needs to be integrated into routine rapid assessment procedures. More systematic assessments if needed....

12. In early stages of emergency measures to support mothers, infants & young children should be put in place. Support for vulnerable groups also at outset. • Breastfeeding and IYCF support should be integrated into other services for mothers, infants & young children • Foods suitable to meet the nutrient needs of older infants & child must be included in the general ration for food aid dependent populations • Donated (free) or subsidised supplies of BMS (e.g. Infant formula) should be avoided. Donations of bottles & teats should be refused. Any donations of BMS, bottles & teats should be placed under the control of a single designated agency.

13. The decision to accept, procure, use or distribute infant formula must be made by informed technical personnel in consultation with the co-ordinating agency, lead technical areas & governed by strict criteria • BMS, other milk products, bottles & teats must never be included in general rations. BMS and other milk products must only be distributed according to strict criteria and only provided to mothers or caregivers for those infants who need them. The use of bottles and teats should be avoided. X Bottles should be avoided Felicity Savage • Cup feeding is safer A. Maclaine. Lebanon 2006

14. Operational Guidance for IFE 6 Practical Steps

15. Endorse or Develop Policies • Train Staff • - Basic orientation of all staff • - Technical training for all health and nutrition staff • Access to expertise on breastfeeding counseling and support • 3. Co-ordinate Operations. (UNICEF?) • 4. Assess and monitor • Integrate IYCF-E questions into rapid assessments • Undertake more detailed assessments

16. 5. Protect, Promote & Support Optimal IYCF with Integrated Multi-Sectoral Interventions • For the exclusively breastfed infant 0-6 months pre-emergency = keep breastfeeding • For the mixed feeding infant 0-6 months = start exclusive breastfeeding Overall aim: DO NO HARM! Protect and support breastfeeding – safest & breastfeeding, especially in emergencies, can contribute to feelings of: Independence, Confidence, Self-worth Not always enough just to tell women to exclusively breastfeed….

17. 5. Protect, Promote & Support Optimal IYCF with Integrated Multi-Sectoral Interventions Basic Interventions e.g. • Ensure nutritional needs of the general population • Multiple micronutrients for pregnant and lactating women and children 6-59 months • Appropriate foods for complementary feeding ALL SECTORS should determine their role in ACTIVELY supporting women to breastfeed and providing: General support - establish an environment that makes breastfeeding easy

18. 5. Protect, Promote & Support Optimal IYCF with Integrated Multi-Sectoral Interventions continued…. Technical Interventions • Train health/nutrition/community workers on optimal IYCF • Integrate IYCF training into health & reproductive care • Set up areas for individual support of IYCF • Services for orphans and unaccompanied infants • Support for correct preparation and feeding of complementary foods • Primary prevention of HIV and support for women with HIV

19. Individual support - for mothers and families through breastfeeding counselling, help with difficulties, appropriate health care Lebanon post-conflict 2006

20. Support is key to exclusive breastfeeding Effect of breastfeeding support household visits by trained local mothers Haider R, Ashworth A, Kabir I et al.. Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised, controlled trial. The Lancet 2000;356:1643-1647 IFE 1/6 Received support visits Control group Percent of infants exclusively breastfed Infant age in months

21. Mother concerned about lack of food / fluids - try to ensure extra rations / fluids and counsel. • Time constraints (e.g. food queues) – priority access, provide water. • Lack of protection, security & (where valued) privacy – Shelter • Need support – (Mother and baby corners / tents). Grandmother to mother support; mothers groups, community support, peer to peer • Should be integrated multi-sectoral interventions – simple measures introduced EARLY on. An evacuee feeds her baby after fighting between government forces and rogue Muslim rebels. Thailand

22. HOW CAN YOU SUPPORT BREASTFEEDING?

23. Care for the individual breastfeeding mother • Concerns for motherStaff should ensure • her own nutrition and fluid intakeextra rations and fluids • her own healthattentive health care • physical difficulties (e.g. sore nipples)skilled breastfeeding counsellors • misinformation, misconceptionsprovide correct info / SUPPORT IFE 1/7

24. Improving conditions to make breastfeeding easier IFE 1/8 Staff should ensure priority access shelters 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, & (where valued) privacy • lack of social support & family • free availability of BMS undermining mothers’ confidence in breastfeeding

25. COMPLEMENTARY FED INFANTS / CHILDREN IN EMERGENCIES

26. Complementary foods that could be used in emergencies (general ration or targeted): • ‘Real’ complementary foods – local / imported foods • Locally available micronutrient-rich foods • Industrial fortified blended foods e.g. CSB, WSB. • Fortified foods e.g. vegetable oil fortified with vitamin A, iodized salt,fortified high-energy biscuits e.g. BP5/HEB • Commercial / industrial baby foods (As a rule these relatively expensive foods have no place in emergency relief (Ops G 5.1.6) • Complementary Food Supplements (at home): (i) Water soluble or crushable micronutrient tablets, (ii) Micronutrient ‘sprinkles’ added to food just before feeding (iii) Fortified fat-based spreads added to food just before feeding or fed as a snacks e.g. Nutributter • Complementary food vouchers. Exchangeable for certain commodities suitable for complementary foods Note: Ready to use foods formulated for the management of malnutrition are not an appropriate infant complementary food (Op G 5.1.5).

27. SUMMARY: Operational Guidance emphasis is based on supporting optimal infant and young child feeding: • Initiation of breastfeeding within 1 hour of birth • Support for exclusive breastfeeding until 6m • Support mixed feeding mothers to exclusively breastfeed • Support mothers >6 months to continue breastfeeding at high level for 2yrs or more • Ensure children >6m have safe and appropriate complementary foods

28. What about the non-breastfed infant? Relactation, Wet nurses, Milk banks are preferred options as safer than infant formula Breastfeeding supplementer Photo credit: Yvonne Hughes, ACF, Afghanistan Relactation using supplemental-suckling by Grandmother in Afghanistan - ACF

29. 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

30. Flooding in BOTSWANANov 2005 – Feb 2006: Unusually heavy rains, flooding

31. Risk factors for diarrhoea & death Amongst children hospitalised (n=154): • Not breastfeeding: 50.0 (4.5 – 100) • Storing drinking water: 3.7 (1.5 – 9.1) • Overflowing latrines: 3.0 (1.1 – 8.6) • Standing water near home: 2.6 (1.1 – 6.3) • Caregivers not washing hands: 2.5 (1.1 – 5.0) Risk factors for death amongst admissions • Not breastfed (OR 8.5, p=0.04) • Kwashiorkor (OR 2.6, p=0.03). National under 5 mortality increased by 18% compared to previous years

32. 6. Minimize the Risks of Any Artificial Feeding Handling of BMS donations and supplies • Donations not accepted. • Collection of existing donated supplies • Designated agency – store and ‘get rid’ Establish and implement criteria for targeting and use • TARGETED provision of PURCHASED BMS only • Caregivers ALSO need: • supporting resources (water, fuel, cooking equipment, etc) – or ‘wet’ feeding? • practical training about safe preparation, etc • Follow up

33. SO WHY IS IYCF-E IMPORTANT?

34. Because while infants have always got caught up in emergencies.. Ukranian Mother in World War 2 Nagasaki, Japan. World War 2

35. Too many have got sick & died due to poor feeding practices in emergencies

36. IYCF-E AIMS TO STOP THAT

37. IN ALL YOUR WORK IN AN EMERGENCY THINK: HOW YOU CAN SUPPORT APPROPRIATE IYCF-E

38. For information, resources, advice and support on IFE contact: ife@ennonline.net For additional resources see: www.ennonline.net/ife THANK YOU!