UNICEF Programme Division Nutrition Section

1. Integrated Early Childhood Development at UNICEF: Targeting the Mother-Child Dyad -Vital to MTSP Success UNICEF Programme Division Nutrition Section

2. What is Optimal Infant and Young Child Feeding? • Six months exclusive breastfeeding • Continued breastfeeding with appropriate complementary foods and feeding for 2 years and beyond • Related maternal nutrition and care • (Birth Interval of 3 years or more)

3. A World Fit for Children By 2010: • Reduction of child malnutrition among children under five years of age by at least one-third, with special attention to children under two years of age, and reduction in the rate of low birth weight by at least one third of the current rate. • Other Millenium Goals for <5MR and MMR

4. Nutrition related MTSP target indicators • Reduction in anemia prevalence among women of reproductive age by 15% • > 60% of pregnant women use adequate antenatal services • > 60% of children receive appropriate home care for prevention and treatment of malnutrition

5. Focus of I/ECD Integrated-ECD is based on child’s rights principles and the life-cycle approach, developed to co-ordinate actions at different levels, aiming to improve: • Quality of family care • Family access to good basic services and adequate livelihoods • Community & policy environment needed to support the previous points. General Goals: Survival, Growth and Development

6. “A good start on life” “Children under 3 y.o.” “Support women’s health, nutrition, and well-being” “Links to maternal health and survival” Maternal nutrition for birth weight and maternal survival, early initiation of exclusive breastfeeding (EBF) EBF, appropriate CF which includes responsive feeding, VitA, Birth spacing Mother-child vs Child orientation, empowering caretaker to act and interact If mom survives, the child is 3- 5 times more likely to survive I/ECD: Health, Nutrition, WES, ECD, & Child Protection: The Importance of the Mother-Child Dyad

7. Girl’s Education Immunisation Plus HIV/AIDS Child Protection Cognitive and psycho-social achievement highly associated with breastfeeding Breastfeeding provides first immune protection, and Vitamin A, among others, helps fight disease Strong nutrition link; EBF decreases transmission Nurtured and breastfed children less likely to be deserted and abused Other MTSP Strategies

8. Current and Planned I/ECD Interventions: The Same Target Audience for All FP(UNFPA) ECD LAM BF/CF ANTENATAL CARE AT LEAST THREE YEARS BIRTH SPACING VIA FAMILY PLANNING USE “Expanded Step Ten” CODE MNI CF IMCI/CIMCI IMM WES CARE SEEKING OPTIMAL AND RESPONSIVE INFANT AND YOUNG CHILD FEEDING Expanded MPS/SM BFHI SAFE DELIVERY ADEQUATE BIRTH WEIGHT MPS MNI Malaria Presumptive Tx/Nets ANTENATAL CARE

9. Mother-Child Dyad: The Heart of ECD Three years birth spacing for mother’s nutritional recovery Three years as youngest child Three years of stimulation and responsive feeding Three years of health-care seeking and preventive actions Optimal Breastfeeding Remains Central Maternal Protein, Calorie and Micronutrient Stores

10. Baby Friendly and Beyond • Is it time to expand beyond BFHI? • If so, in what direction? • How can we support the World Fit for Children goals, the new UNICEF priorities, the war on HIV, while maintaining support and interest in best start for children: the caring of an empowered mother? • What specific components would extend the effort towards increased empowerment of women while maintaining the focus on the importance of optimal breastfeeding? • Other ideas?

11. Countries that have adopted the Code into Law • 16 countries have measures drafted awaiting final approval, and a further 26 are studying how best to implement the Code.

12. Infant Feeding and HIV:Draft Action Framework 1.Create comprehensive Infant and Young Child Feeding policies 2. Support the International Code of Marketing of Breastmilk Substitutes 3. Promote, protect and support optimal infant and young child feeding practices, especially in HIV prevalent areas 4. Support HIV-positive women to succeed in their infant feeding choice 5. Support country level learning, monitoring and evaluation, and operational research

13. Conclusion: Breastfeeding support is central to the helath of the mother-child dyad, and central to I/ECD!

14. Thank you Asante-sana Salamat po Merci Gracias Danke Spasibo Abrigato Barakallaofik

15. Breastfeeding -> Early Childhood Development Increases in breastfeeding are associated with: • Decreased child desertion in hospitals • Best growth in first 6 months • Improved elements of neuro-psycho-motor development at age 1-2, and up to 12 • Improved vision from a few months to years • Increased independence and parental trust • Increased intelligence quotient (IQ) assessed at ages 8 and 9 years; at age 18 years • Decreased infectious and chronic illness, and decreased impact of several metabolic conditions, supporting continued thriving

16. Breastfeeding -> Early Childhood Development • Increased adolescent perceptions of maternal caring • Higher reading comprehension, mathematical ability, and scholastic ability assessed during the period from 10 to 13 years; • Higher teacher ratings of reading and mathematics assessed at 8 and 12 years; • Higher levels of attainment in school leaving examinations • Contribution to birth intervals, allowing more attention to care and feeding, and maternal nutritional recovery: Result: children are alive and thrive!

17. Conclusions • Interactive Breastfeeding and Responsive feeding are major elements in the life of the 0-3 year old • Early, Exclusive and Sustained Breastfeeding are responsive to intervention programs • Survival, growth and development benefit inescapably from the presence of a living, health, and well-informed mother who is supported by her community - breastfeeding is empowering • If optimal infant and young child feeding is programmed, nearly all aspects of ECD are addressed and supported. • Targeting the maternal-child dyad may be a key to cross-sectoral integration