Infant & Young Child Feeding - Caribbean Situation Paula Trotter Caribbean Food & Nutrition Institute October 13

1. Infant & Young Child Feeding - Caribbean Situation Paula Trotter Caribbean Food & Nutrition Institute October 13-14,2005 Martinique

2. Overview • Infant and young child feeding practices • Infant and young child feeding policies & targets • Infant and young child feeding programs • Adapted from Infant and Young Child Feeding. A tool for assessing national practices, policies and programmes. WHO (2003)

3. IYCF PRACTICES

4. Exclusive Breastfeeding Rates

5. IYCF Indicators(MICS,2000)

6. Other IYCF Indicators • Percentage of babies breastfed within one hour of birth:……. % • Percentage of babies 0–<6 months of age exclusively breastfed in the last 24 hours:……… % • Median duration of breastfeeding of children under 36 months: ……… months (The age in months when 50% of children are no longer breastfed ) • Percentage of breastfed babies 6–<10 or 7–<10 months of age who received complementary foods in the last 24 hours:……… %

7. IYCF POLICIES & TARGETS

8. BF policies - Approved & Implemented Barbados (Hosp.) Dominica (Hosp.) St. Vincent & Gren. Guyana In Draft Anguilla Antigua Bahamas BVI Cayman Is. Grenada Haiti Jamaica (IYCF) St. Kitts & Nevis St. Lucia Suriname Trinidad (Hosp.) National IYCF Policies

9. Criteria for effective policies on IYCF • National in scope and officially adopted by the government • Promotes IYCF practices consistent with international guidelines • Addresses provision of skilled counselling and support in the health system and communities • Covers guidelines for HIV and infant feeding and provides for counselling and support related to this issue

10. Criteria for effective policies on IYCF • Addresses the management of IYCF in emergency situations • Covers the other policy issues in the Global Strategy • Is routinely distributed and communicated to those managing and implementing relevant programs • Is appropriately integrated into other relevant national policies (health, nutrition, AIDS, family planning, integrated child health & education policies, etc.)  

11. Active BF/IYCF* committees BVI Cayman Is.* Guyana Jamaica St. Kitts & Nevis St. Vincent & Gren.* Haiti Criteria A national coordinator is responsible for IYCF Meets on a regular basis (at least twice a year) Provides guidance to national program (s) Coordination takes place between sectors and relevant initiatives dealing with IYCF National Coordinators & committees

12. “Baby-Friendly” Hospitals Barbados (1) Dominica (1) of 3 Guyana (3) of 12 Haiti Jamaica (10) of 23 St. Vincent & Gren. (1) of 6 TT (1) of 5 Actively working towards target Trinidad (2) St Kitts & Nevis (2) Guyana (11) BVI (1) Jamaica* Baby-friendly Hospital Initiative achievements

13. Active & sustainable BFHI-Criteria • Integrated within the health care system • Coordinator – leadership role • Ongoing training • Assessment of additional health facilities • Monitoring and/or reassessment of designated facilities • Availability of technical support when improvements are needed • Public education

14. International Code of Marketing of Breast-milk Substitutes • Lack of attention to adoption of national legislation or regulations • Promotion in health system prohibited • MCH norms or unwritten regulations • inadequate monitoring systems • General lack of awareness of the rationale and relevance of the Code

15. Suggested actions to promote Code Implementation: • Raise awareness – link to CRC • Build consensus on the preparation of national regulations & system of monitoring • Training of health workers • Public education • Request support at regional level

16. Legislation protecting and supporting breastfeeding among working mothers • The ILO Maternity Protection Convention (No.183) has not been fully ratified or enacted • Access to health care – good coverage in some countries • Maternity leave – entitlements linked to social security contributions

17. ILO Convention 183 - at least 14 weeks of paid maternity leave daily breastfeeding breaks job protection and security ILO Recommendation 191– at least 16 weeks of paid maternity leave; parental leave should be given; breastfeeding facilities in the workplace. Legislation protecting and supporting breastfeeding among working mothers

18. NATIONAL IYCF PROGRAMS

19. National Programs Belize Guyana Grenada St. Vincent & Gren.* Haiti Some aspects of IYCN promotion may form part of MCH services Criteria Comprehensive, national in scope Has targets or measurable objectives Has adequate funds for its implementation Is multisectoral with coordination among programs and initiatives at different levels National Program/Plan of Action for IYCN

20. Do the training curricula of medical, nursing, midwifery, allied/public health, and nutrition education programs provide students with the attitudes, knowledge and skills necessary to protect, promote, and support optimal IYCF? See WHO checklist for a list of objectives and content/skills that should be covered WHO/UNICEF have developed a number of courses Health care provider (pre-service) education

21. WHO/UNICEF Breastfeeding Counseling course conducted in – Antigua Anguilla BVI Belize Dominica Haiti St. Kitts & Nevis St. Vincent Suriname Trinidad & Tobago Grenada - 1 trainer WHO/UNICEF HIV/Infant Feeding Counselling course conducted in – Antigua Belize Guyana Suriname Trinidad & Tobago Also regional course by UNICEF In-service training for health care providers

22. In-service training for health care providers Criteria • Provided throughout the country • Covers most of the essential topics related to IYCF (see WHO checklist) • Clinical and counselling skills are integrated into the content of the training programs - at least 30% of training time • Content and skills related to IYCF are integrated, as appropriate, into relevant training programs (including diarrhoeal disease, ARI, IMCI, well-child care, family planning, nutrition, early childhood education, child care services, HIV/AIDS)

23. Policies Antigua Bahamas Barbados Belize* Dominica Guyana Jamaica Suriname* Policy development not integrated with other IYCF related policies or guidelines Mainly avoidance of breastfeeding Inadequate attention to infant feeding counselling HIV and infant feeding

24. HIV and infant feedingCriteria • Training given on HIV and IFC • Antenatal VCT is offered routinely to pregnant women and, where possible, to their partners • Locally appropriate infant feeding counselling offered with follow-up • Special efforts are made to protect, promote, and support breastfeeding in the general population • Ongoing monitoring is in place • The national BFHI provides guidance on support to HIV-positive mothers.

25. Includes - Individual/group counselling cooking demonstrations community education mother-to-mother support groups Criteria National in scope Non-health organizations (e.g. education, day care services) & CBOs involved Are integrated into an overall infant and child health strategy Community outreach and support

26. Activities: Individual/group counselling Sporadic use of electronic media Preparation of print materials WBW*- a variety of media and channels Absence of comprehensive national IEC strategy WBW Antigua Cayman Is. Grenada, Guyana, Jamaica, Montserrat St. Vincent Suriname Trinidad Information, education & communication

27. GMP On-going in all countries Coverage good in first 2 yrs Based on wt/age Closer monitoring needed Equipment Counselling & follow-up Revision of charts necessary Surveillance On-going in 7 (ANU, BEL,GUY, JAM, HAI, MON, SKN) To facilitate timely & targeted actions – Indicators & coverage Data quality Collection & reporting procedures Growth Monitoring & Nutrition Surveillance

28. Research for decision-making To guide policy development & program planning • Trends in nutrition problems & practices (e.g. Jamaica, Guyana, Haiti, MICS • KAPs re IYCF (e.g. Guyana, Dominica, St. Kitts & Nevis) Other needs – • Information on IYCF practices (foods, amounts, frequency, energy & nutrient densities) • Planning & evaluation of behavioral change interventions • Impact & quality of training programs

29. Research for decision-makingCriteria • A national research advisory group exists • Development of a national inventory of applied and basic research on key topics related to IYCF • Priority needs for infant and young child feeding related information are identified • Data gathered, when feasible, from existing studies and other data sources (either domestic or international). • Research on priority topics is financed by the national IYCF program and/or by other appropriate donors • Research results are routinely disseminated to key decision-makers - to guide policy and program decisions as part of the planning and management process.

30. Other important areas • Mother-friendly childbirth strategies • Contraceptive support for breastfeeding women • Infant and young child feeding in emergencies