Recommendations for Infant and Young Child Feeding Early initiation of breastfeeding: Early initiation of breastfeeding: start breastfeeding within one hour of birth start breastfeeding within one hour of birth Breastfeed exclusively for 6 completed months Breastfeed exclusively for 6 completed months From about 6 months of age, introduce complementary foods (appropriate, energy and nutrient dense) From about 6 months of age, introduce complementary foods (appropriate, energy and nutrient dense) Continue breastfeeding up to 2 years or beyond Continue breastfeeding up to 2 years or beyond Continum of care: -9 to 24 months Continum of care: -9 to 24 months Pregnant and lactating women Pregnant and lactating women

Global Strategy on IYCF (WHO/UNICEF, 2003) Global Strategy on IYCF (WHO/UNICEF, 2003) WHO Guiding Principles: on breastfed, non- breastfed, in emergencies, complementary feeding, HIV and infant feeding WHO Guiding Principles: on breastfed, non- breastfed, in emergencies, complementary feeding, HIV and infant feeding The International Code of the Marketing of Breastmilk Substitutes (WHA 1981) and subsequent WHA Resolutions (‘The Code’). The International Code of the Marketing of Breastmilk Substitutes (WHA 1981) and subsequent WHA Resolutions (‘The Code’). The Operational Guidance on IFE The Operational Guidance on IFE (IFE Core Group) Key policy guidance on IFE

Breastfeeding ‘support’ in emergencies Needs to be active and operate on many levels Needs to be active and operate on many levels Protect and remove obstacles create a supportive/enabling environment for caregivers to make informed decisions on infant and young child feeding. Protect and remove obstacles create a supportive/enabling environment for caregivers to make informed decisions on infant and young child feeding. This frontline defence includes: Protection from marketing practices that violate the International Code Protection from marketing practices that violate the International Code Prevention of donations, inappropriate distribution and use of breastmilk substitutes in emergencies. Prevention of donations, inappropriate distribution and use of breastmilk substitutes in emergencies. Handling donations that do arrive. Handling donations that do arrive. Timely access to breastfeeding and infant feeding support in the form of skilled counselling by appropriately trained staff. Timely access to breastfeeding and infant feeding support in the form of skilled counselling by appropriately trained staff. Structural support for breastfeeding, e.g. (e.g. slings, shelter, privacy) - keep mothers and babies together. Structural support for breastfeeding, e.g. (e.g. slings, shelter, privacy) - keep mothers and babies together.

Lebanon, Tale of mother who ‘tried’ her sample tin of formula. Code Article 7.7 – Health workers should not give samples of infant formula (‘sample’ means ‘single or small quanitities of a product provided without cost) Common Code Violations in Emergencies

Operational Guidance on IFE All emergencies in all countries. Key audience: National governments National governments UN agencies UN agencies National and INGOs National and INGOs Donors Donors Military Military The CODE embedded in this document The CODE embedded in this document Nine languages Nine languages Produced and distributed by ENN Produced and distributed by ENN ENN ‘hub’ collate experiences ENN ‘hub’ collate experiences

Foster-mum, Myanmar, 2008

Role of military French Navy donated 2 tons of food including milk to Pakistan following earthquake Delivered on US military ships U.S. Navy photo by Petty Officer 2nd Class Phillip Nickerson Jr. This needs to STOP

Hurricane Katrina, USA 2005 Patrolling areas where there are infants and caregivers

Orientation/Training

Coordination OCHA created in 2005 to coordinate UNs response to complex emergencies and natural disasters OCHA created in 2005 to coordinate UNs response to complex emergencies and natural disasters UN Inter Agency Standing Committee (IASC) initiated cluster approach UN Inter Agency Standing Committee (IASC) initiated cluster approach Partnerships on key areas of humanitarian response Partnerships on key areas of humanitarian response Nutrition Cluster efforts: Nutrition Cluster efforts: Coordination, capacity building, emergency preparedness, assessment, monitoring and surveillance Coordination, capacity building, emergency preparedness, assessment, monitoring and surveillance

Standards, monitoring, evaluation Sphere nutrition, food security and food aid standards Sphere nutrition, food security and food aid standards Stricter and improved procedures for monitoring interventions, strengthen accountability Stricter and improved procedures for monitoring interventions, strengthen accountability Yet to be defined for newer areas, eg cash programming Yet to be defined for newer areas, eg cash programming No organisation with overall mandate to oversee effectiveness, impact, cost No organisation with overall mandate to oversee effectiveness, impact, cost Ongoing challenges – impartiality, operational environment, lack of evidence base, lack of staff skills and expertise, HIV/AIDS and nutiriton Ongoing challenges – impartiality, operational environment, lack of evidence base, lack of staff skills and expertise, HIV/AIDS and nutiriton

Advances in nutrition in emergencies Standardisation of assessments Standardisation of assessments Nutrition surveys to establish prevalence of MN. Nutrition surveys to establish prevalence of MN. Nutrition causal analysis Nutrition causal analysis Food insecurity, poor health and unhealthy environment, lack of caring capacity Food insecurity, poor health and unhealthy environment, lack of caring capacity Early warning systems Early warning systems Food production, access and availability (eg coping strategies, markets) Food production, access and availability (eg coping strategies, markets) Baseline data, trends, eg FEWSNET in Somalia Baseline data, trends, eg FEWSNET in Somalia Standardisation of ration scales Standardisation of ration scales Adequate basic ration provides 2,100 kcal/p/day of a range of foods acceptable, broadly familiar and fit for human consumption Adequate basic ration provides 2,100 kcal/p/day of a range of foods acceptable, broadly familiar and fit for human consumption Therapeutic care in the community Therapeutic care in the community Ready to Use Therapeutic Foods Ready to Use Therapeutic Foods Micronutrient nutrition Micronutrient nutrition Development of blended foods (fortified with vitamins and minerals) in general ration/targeted to vulnerable groups Development of blended foods (fortified with vitamins and minerals) in general ration/targeted to vulnerable groups Micronutrient supplementation (Vitamin A) Micronutrient supplementation (Vitamin A) Expansion in non-food interventions Expansion in non-food interventions Livelihoods protection and support Livelihoods protection and support Infant feeding in emergencies Infant feeding in emergencies Breastfeeding life-saving response Breastfeeding life-saving response Operational guidance and Capacity building Operational guidance and Capacity building Lesson learning Lesson learning

Initiatives and Resources MAMI (Management of Acute Malnutrition in young Infants) Project MAMI (Management of Acute Malnutrition in young Infants) Project ENN, CIHD UCL, Action Contre la Faim ENN, CIHD UCL, Action Contre la Faim Management of moderate malnutrition Management of moderate malnutrition Defaulter Study Defaulter Study Minimum reporting standards Minimum reporting standards Nutrition Cluster Nutrition Cluster Harmonised training package on NiE Harmonised training package on NiE Toolkit of essential nutrition interventions in emergencies Toolkit of essential nutrition interventions in emergencies Field Exchange Field Exchange Register free Register free Online search database from Jan 2009 Online search database from Jan 2009

Rita Plotnikova / ICRC 2001