South Asia Breastfeeding Partners Forum 4

1. South Asia Breastfeeding Partners Forum 4 Dr. Zakia Maroof Nutrition Officer, UNICEF Afghanistan Habitat centre , new Delhi, India 10-12 December 2007

2. How IYCF contributes to MDGs

3. Two Major Recent Studies confirm that improved Breastfeeding and Complementary Feeding Save Lives • EACH YEAR NEARLY 3 MILLION CHILDREN (56%X45% X10.8 Mill.=2.7 Mill.) • OVER 6 MONTHS OF AGE DIE DUE TO MALNUTRITION • Pelletier, Frongillo et al • NEARLY 2 MILLION DEATHS OF CHILDREN <5 COULD BE PREVENTED BY IMPROVED BREASTFEEDING (1.3 MILLION) AND COMPLEMENTARY FEEDING (0.6 MILLION) ALONE • Lancet Child Survival Series

4. Risk of neonatal mortality according to time of initiation of breastfeeding within ONE hour Pediatrics 2006;117:380-386

5. Actions • National nutrition policy is revised • Four maternity hospitals in Eastern region trained on BFHI • Final draft of Code of marketing of BMS submitted to MoJ for ratification • 30 master trainers and 50 health staff trained on BFCC • Training manual on management of SAM is developed and finalized • 65master trainers and 194health staff trained on management of SAM • Community Based Management of SAM is started as pilot project in four provinces • WBW is observed at national level including production of BF communication material

6. Actions cont’ • Local research on initiation of BF within first hour of birth by Kabul medical university (250 mothers) • 84.7 % of mothers not initiating BF in 1st hour of birth (more than 60% of them believe colustrom is harmful for baby) • 10% of mothers start BF in first four hour of birth • 5.3% of mothers initiate BF in first hour of birth • More than 70% of mothers start complementary feeding before 6 months of age

7. Integrated C-SAM (CTC): Partnership and Advocacy Nutrition Breast feeding Household Food Security Birth Spacing ANC/PNC Vit A/FeFo • C-SAM (CTC) • -Com mob/Screen • -OPT • -TFU PMTCT Breastfeeding EPI Vitamin A Sprinkle De-worming …link to CCD

8. Community support • Effective outreach services in some pilot provinces • Community Health Workers (CHWs) • Community health Shoras • Involvement of religious leaders in nutrition/BF • Afghanistan Breastfeeding Promotion Partners (ABPP)

9. Challenges • Inadequate knowledge and appreciation of benefits of exclusive breastfeeding and appropriate complementary with family foods among policy makers, health workers and communities • Inappropriate marketing and distribution of infant formulae and baby foods. • Lack of national data on BF • Poor monitoring of Code of Marketing of Breastmilk Substitutes • Labor laws and regulations that make it difficult for working mothers to rest adequately and breast feed their babies exclusively for the first six months of delivery • Traditional and cultural practices that impact negatively on breastfeeding in general • Inadequate resources for infant and young child interventions • No coordination between different stakeholders • Difficulty in monitoring of activities

10. Next Steps: Afghanistan • Accelerate and scale up capacity building for breastfeeding counselling among health workers and communities • Implement and monitor BFHI in all health facilities that provide maternity services. • Ratify, implement and monitor Code of Marketing of Breastmilk Substitutes • Encourage paid maternity leave for working mothers up to six months of delivery both in public and private sector • Advocate and create awareness of IYCF through observation of World Breastfeeding Week • Commitment to provide enabling policies, human and financial resources for implementation and promotion of appropriate child feeding interventions • Address attitude issues among health care providers and communities on exclusive breastfeeding • Maximizing use of resources through integrated programming

11. Thank You