International Instruments and Strategies for Infant and Young Child Feeding in Emergencies

1. Lesson 2: Making it Matter Marie McGrath, Emergency Nutrition Network

2. Learning Objectives • Identify global instruments(conventions, strategies, recommendations) andinternational collaborations of interest for IFE • Look at the main provisions of key policy guidance on IFE

3. regulated and detailed in key guidance mandated by international law promoted by international collaborations necessary for meeting international standards IFE is…

4. Global instruments: • Reflect collective will • Set ‘big picture’ • Identify responsibilities • Incite action Left: Venezuelan president talking to flood victim

5. 1966 The International Covenant on Economic, Social and Cultural Rights 1979 The Convention on the Elimination of all forms of Discrimination Against Women (CEDAW) 1989 The Convention on the Rights of the Child (CRC) Article 24 The rights of women and children …right of children to the highest attainable standard of health…including the importance of breastfeeding.

6. UNICEF conceptual framework Immediate causes - the individual level Underlying causes – the household and community level Root causes – the regional and/or national level

7. Millennium Development Goals The benefit of strategies targeting infant and young child feeding are reflected in all eight of the UN Millennium Development Goals. For example, MDG 4: Reduce child mortality MDG target: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate

8. Global Strategy on IYCF The right of children to the highest attainable standard of health The right of women to be informed about infant feeding and adequate health and nutrition.

9. Global Strategy on IYCF Global Strategy on IYCF Exceptionally difficult circumstances for appropriate feeding………….where infants are of low-birth-weight, where mothers are HIV positive and in emergency situations……..calls for appropriate feeding support for infants and young children in these circumstances and the development of the knowledge of health workers in such situations. UNICEF/WHO, 2002

10. Innocenti Declaration “Organisations providing humanitarian relief need to follow appropriate guidelines, train their staff to support breastfeeding and relactation, and avoid general distribution of any breastmilk substitute.”

11. Baby Friendly Initiative (BFI) BFI encompasses Baby Friendly Hospital Initiative (BFHI) and ongoing post-natal community support for breastfeeding BFHI: Implement the Ten Steps to Successful Breastfeeding and to practise in accordance with the International Code of Marketing of Breastmilk Substitutes

12. Ten steps to successful breastfeeding 1. Have a written breastfeeding policy that is routinely communicated to all health care staff. 2. Train all health care staff in skills necessary to implement this policy. 3. Inform all pregnant women about the benefits and management of breastfeeding. 4. Help mothers initiate breastfeeding within a half-hour of birth. 5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants. Slide 3.12

13. Ten steps to successful breastfeeding 6. Give newborn infants no food or drink other than breast milk, unless medically indicated. 7. Practise rooming-in — allow mothers and infants to remain together — 24 hours a day. 8. Encourage breastfeeding on demand. 9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants. 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic. Slide 3.13

14. The Sphere Project

15. Minimum standard Indicators Guidance note 1 • Infants < 6 months exclusively breastfed • Children 6-24 months have access to nutritious foods • Pregnant and breastfeeding women have access to additional nutrients and support • Appropriate nutritional information, education and training is given on infant and child feeding practices • Feeding bottles should never be used as they are unhygienic General nutrition support standard 2: at-risk groups: The nutritional and support needs of identified at-risk groups are met The Sphere Project

16. The Sphere Project Sphere indicator Minimum standard Correction of malnutrition standard 2: severe malnutrition Severe malnutrition is addressed As much attention is attached to breastfeeding and psychosocial support, hygiene and community outreach as to clinical care Food aid planning standard 2: appropriateness and acceptability The food items are appropriate and acceptable to recipients and can be used efficiently at the household level There is no distribution of free or subsidised milk powder or of liquid milk as a single commodity

17. Nutrition Cluster

18. Why is the Operational Guidance needed? Putting policy into practice

20. Who is the Operational Guidance on IFE for?

21. Key points of the Operational Guidance on IFE • Appropriateand timely support of infant and young child feeding in emergencies (IFE) saves lives. • Every agency should develop a policy on IFE. • Training and orientation of all technical and non-technical staff in IFE • UNICEF is likely co-ordination agency on IFE in the field. • Integrate key information on infant and young child feeding into routine rapid assessment procedures

22. Key provisions of the Operational Guidance on IFE • Simple measures put in place early in response • Integrated support • Include foods suitable for older infants and young children • Avoid donations or subsidised supplies of breastmilk substitutes, bottles and teats • Technical personnel must decide whether to accept, procure, use or distribute infant formula • Breastmilk substitutes, other milk products, bottles and teats must never be included in a general ration distribution.

23. We gratefully acknowledge the support of UNICEF -led IASC Global Nutrition Cluster in developing this content