Regional Challenges in IFE: Emergency Preparedness and Implications for UNICEF

1. Regional Challenges in IFE: Emergency Preparedness and Implications for UNICEF Flora Sibanda-Mulder UNICEF-New York

2. What is optimal IYCF? • Optimal IYCF involves: • Early initiation of exclusive breastfeeding • Exclusive breastfeeding in the first six months of life • Timely introduction of nutrient-rich complementary foods at six months, in order to meet the energy and other nutrient requirements of the infant, in addition to breastfeeding • Continuation of breastfeeding until the child is two years of age and beyond.

3. Infants (<6mos) exclusively breastfed (%) Source: SOWC 2008, UNICEF

4. Why is IYCF important for child survival? • Children under 5 are more likely to become ill and die from malnutrition and disease. • In general, the younger they are, the more vulnerable they are. • Over half of the 9.7 million deaths per year in children under 5 occur during the first year of life and are often linked with inappropriate feeding practices. • It is estimated that 1.45 million childhood deaths each year are attributable to suboptimal breastfeeding practices - which is more than any other preventative measure.

5. Why is IFE important? Emergencies can lead to: • Population displacement • Over-crowding • Food insecurity • Poor water and sanitation • A stretched health care system • All the above increase the chances of morbidity and mortality of infants and young children, especially through diarrhoeal diseases. Exclusively breastfeeding provides: • A safe and secure food supply • Protects against disease causing bacteria and parasites in contaminated water supplies • Antibodies and other disease fighting factors that help to prevent and fight illness even after breastfeeding has stopped.

6. Why is IFE important? (2) • Emergency response to protect and support infant and young child feeding is often characterised in practice by: • A total lack of attention to breastfeeding; • Inadequate skilled breastfeeding support; • Mass donation and distribution of powdered milk; • Poor management of artificial feeding; and • Lack of support and attention to appropriate and timely complementary feeding.

7. IFE reflects normal situation • Inappropriate infant feeding in emergencies does not happen in isolation – it reflects normal situation in a country characterised by: • Absence of coherent, consistent and strong policy on infant and young child feeding • Lack of national policy on infant feeding in emergencies prior to an emergency • Absence of legislation on the International Marketing of Breastmilk Substitutes, accompanied by political commitment to support implementation • Only six of the 16 countries represented in meeting have exclusive breastfeeding rates >50% - why should IF practices in Emergencies be any better?

8. IFE experiences in recent emergencies • Humanitarian response to the tsunami • Indonesia - absence of mechanisms for implementation of policies on: • Infant and young child feeding • Legislation on the International Code on Breastmilk Substitutes • Sri Lanka – well defined IYCF policy implementation mechanisms prevented distribution of BMS • Pakistan earthquake – IFE guidelines endorsed and disseminated which minimised the distribution of BMS • Lack of privacy - establishment of safe havens for breastfeeding • Lebanon crisis – untargeted distribution of BMS in areas where bombing destroyed water supply and sanitation facilities • Delays in endorsement of IFE policy • Code violation • Lack of leadership from UNICEF • UNICEF’s poor performance shared in international meetings

9. IFE experiences in recent emergencies (2) • Jogjakarta and Central Java earthquake - large quantities of BMS, powdered milk and various commercial complementary foods distributed • 4 out of 5 children under-two years received infant formula donations • Consumption of infant formula during the emergency increased by two-fold, despite a huge breastfeeding campaign • Diarrhoeal diseases post earthquake went up four-fold (7% compared to 29%) • Diarrhoea prevalence was double among those who received donations of BMS (25% compared to 12%) • Formula feeding practice was exacerbated by a hygienically challenging situation following the disaster. • Cyclone Sidr (Bangladesh) – IFE policy developed prior to and endorsed at the beginning of the emergency • Use of Operational Guidance prevented donation of BMS

10. Implications for UNICEF • Nutrition Cluster Lead:as designated by the Inter-Agency Standing Committee (IASC) • UNICEF needs to earn Leadership role through support to credible assessments and policy development • With national and international partners, identify priorities, leverage resources, and support development of rational national plans • MDGs: Good nutrition important for attainment of six of the MDGs • Highly elevated risk of death attributable to inappropriate feeding practices • IYCF needs to be a policy and programme priority for governments and their partners for attainment of MDG4 • Link between IYCF and HIV and AIDS • Support to acceleration of child survival, growth and development actions

11. UNICEF’s role in IFE:Emergency Preparedness • Facilitate and support: • Development of IYCF policies with well defined implementation mechanisms • Adoption of Legislation on the International Code on BMS, including mechanisms for monitoring implementation • Endorsement of IFE policy before an emergency strikes • Training of health workers and breastfeeding counsellors • Training of Health and Nutrition programme staff • Adoption of Operational Guidance on Infant and Young Child Feeding in Emergencies

12. UNICEF’s role in IFE: Early response • Ensure IFE in and support rapid assessments and follow up surveys • Provision of multiple micronutrients for pregnant and lactating women and children 6-59 months • Support establishment of rest areas and safe havens for breastfeeding • Support for correct preparation and feeding of complementary foods • With Child Protection, support services for orphans and unaccompanied infants • Support for women with HIV, including guidance in appropriate IF • With WASH and WFP collaboration, support secure access to water and sanitation, food and non-food items

13. UNICEF’s role in IFE: IYCF in emergencies • Promotion and Support for breastfed infants • Early initiation (ErBF1) • Exclusive breastfeeding (ExBF6) • Support for non-breastfed infants • Targeted distribution of breast milk substitutes (BMS) • Education of mothers and families on appropriate use of BMS • Ensure access to water and sanitation facilities • Monitor use of BMS • Promotion of timely and age-appropriate complementary feeding • Ensure age-appropriate micronutrient fortified blended foods as part of general ration (WFP) • Advocate for additional nutrient-rich foods in supplementary feeding programmes

14. Thank You