Infant & Young Child Feeding Assessment & Scoring Tool: Practices, Policies & Programs

1. Infant & Young Child Feeding Assessment & Scoring Tool: Practices, Policies & Programs Mother-friendly Aspects

2. What is the Tool? • It is an assessment tool designed to assist countries in assessing the strengths & weaknesses of their policies & programs to promote, protect, & support optimal feeding practices. • It can help in determining where improvements may be needed to meet the aims & objectives of the new WHOGlobal Strategy for Infant & Young Child Feeding.

3. Who can use the Tool and when? • It can be used by a team of key national policy-makers, program managers and staff, and local NGOs to undertake a “self-assessment” as a first step in formulating a plan for strengthening I&YCF policies and programs. • A country planning to implement the Global Strategy for I&YCF can use the Tool for needs assessment and planning purposes.

4. What is included in the Tool? Part One: Infant & Young Child Feeding Practices,& Background Data assesses how well countries are doing on key feeding practices by reviewing practice indicators and background data. Practice Indicators: • Time of initiation of breastfeeding • Exclusive breastfeeding • Duration of breastfeeding • Bottle feeding • Complementary feeding

5. Background Data: Key health, nutrition & economic indicators, including some related to maternal health such as: • HIV prevalence among women 15-49 yrs of age • Mothers with low body mass index • Maternal mortality rate (per 100,000) • Births attended by trained health personnel • etc.

6. Part Two: National Infant &Young Child Feeding Policies and Targetsfocuses on the key actions and targets identified by the Innocenti Declaration and explores what steps countries are taking to implement the new Global Strategy. Part Two Indicators: • National Infant & Young Child Feeding Policies • National Coordinators and Committees • “Baby-Friendly Hospital Initiative” Achievements • International Code of Marketing of BM Substitutes • Legislation Protecting BF among Working Women • Operational Targets in the New Global Strategy

7. Part Three: National Infant and Young Child Feeding Programfocuses on other important aspects of a comprehensive national program. Part Three Indicators: • National infant & young child feeding program • An active & sustainable BFHI • Mother-friendly childbirth strategies • Health provider (pre-service) education • In-service training for health providers • Community outreach and support

8. Part Three Indicators (continued): • Information, education and communication • Contraceptive support for BF women • HIV and infant feeding • Infant & young child feeding in emergencies • Research for decision-making • Monitoring and evaluation

9. Why is a “mother-friendly childbirth” component included? • The 1989 Joint Statement by WHO/UNICEF on “The Special Role of Maternity Services” [10] includes a section on care of the mother during labor, delivery, and immediate post partum and discusses the routines and procedures (support in labor, minimizing invasive routines and medications) which best support breastfeeding. • In 2001 WABA, through its Global Initiative on Mother Support (GIMS), called for “support to mothers during pregnancy, labor and delivery”.and “...transformation of birthing practices that affect breastfeeding into those that are more humanand gender sensitive...”

10. Criteria Score Circle all that apply • A national mother friendly childbirth strategy has been developed. 2 • There is a program that promotes appropriate mother friendly birth procedures that are supportive of breastfeeding. (See Annex 4) 2 • There is a national coordinator or other official responsible for promoting birth procedures that are supportive of breastfeeding. 2

11. Criteria Score Circle all that apply • Standards and guidelines for mother-friendly child birth procedures and support have been developed and disseminated to all facilities and personnel providing maternity care. 2 • Both health personnel involved in facility births and homebirth attendants are trained in “mother friendly” practices. 2 Total Score: _____

12. ADDITIONAL INFORMATION (NOT RATED) (Use multiple sheets or adapt the form, as necessary.) • Name of national coordinator for mother friendly initiative (or equivalent): • Describe the key components of the mother friendly initiative (or equivalent): • Describe who receives training on mother-friendly practices, who provides it, & what type of training is given:

13. GUIDELINES FOR RATING Score on criteria for “mother friendly” childbirth strategies: ____ points ScoreRating 0 – 3 Poor 4 – 6 Fair 7 – 8 Good 9 – 10 Very Good Rating: ___________

14. CONCLUSIONS & RECOMMENDATIONS (To be completed by the assessment team.)

15. Annex 4: Example of criteria for mother-friendly care (Adapted with permission from the Mother-Friendly Childbirth Initiative (CIMS) and from the ten priorities for perinatal care developed by the WHO-Euro Child Health & Dev Unit for the Bologna meeting, 2000.)

16. A woman in labor, regardless of birth setting, should have: • Access to care that is sensitive and responsive to the specific beliefs, values, and customs of the mother's culture, ethnicity and religion. • Access to birth companions of her choice who provide emotional and physical support throughout labor and delivery. • Freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication). The use of the lithotomy position(flat on back with legs elevated) is discouraged.

17. Care that minimizes routine practices and procedures that are not supported by scientific evidence (e.g., withholding nourishment; early rupture of membranes, IVs (intravenous drip); routine electronic fetal monitoring; enemas; shaving). •  Care that minimizes invasive procedures, such as rupture of membranes or episiotomy. •  Care by staff trained in non-drug methods of pain relief and who do not promote the use of analgesic or anesthetic drugs unless required by a medical condition. 

18. A health facility that provides delivery services should have: • Supportive policies that encourage mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions. • Clearly defined policies and procedures for: collaborating and consulting throughout the peri-natal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary; linking the mother and baby to appropriate community resources, including prenatal and post-discharge follow-up and breastfeeding support.

19. A policy on mother-baby friendly services (as outlined above) and staff who are trained to understand that the health and well-being of the mother, her fetus, her newborn, and the successful initiation of breastfeeding, are all part of a continuum of care.

20. How can results from the Tool be used? • The results, including recommendations for action, should be presented to national decision-makers and, if desired, to potential donors. • Decision-makers will need to decide which areas for improvement are of highest priority in light of the new Global Strategy and set into motion the process of planning and implementation. • The “mother-friendly” component will hopefully sensitize decision-makers to the importance of a comprehensive approach, supporting both mother and child.