1. Shelter/NFI/CCCM Cluster
IYCF ORIENTATION
Shelter/NFI/CCCM Cluster
Date:
Location: Sana’a, Yemen

2. Session Objectives
By the end of this session, you will be able to:
Understand why IYCF(E) is important.
Know the recommended IYCF practices.
Understand that integration of IYCF in different sectors is crucial due to multi- sectoral causes of malnutrition.
Understand how you can support IYCF.

3. What is IYCF? I = Infant Y = Young C = Child F = Feeding
Infant = completed months
Young child = completed months
SAY:
We know that today we have gathered to discuss about IYCF, and specifically the “IYCF Framework: A multi-sectoral Framework for Action” and how YOU fit into this as a ‘champion’. So, let us first cover some basics. What is IYCF?
DO:
Now show the slide and go over the acronyms one by one.
And now let us go over the age range of an infant and young child.
Now, show the age ranges and the picture.
Therefore, the focus of IYCF is always children under two, and the mother and/or any other caregiver of that child because a child this age is dependent on their caregiver. Pregnant women are also a target group, because they will become a mother of a baby and that baby’s health hinges on his mother’s health, as we will demonstrate later in this session. So, you cannot ignore the caregiver/mother if your focus is a child under two years.

4. EMEGENCIES INCREASE RISK
Why focus on IYCF?
Extremely Vulnerable to
Illness
Malnutrition
Death
Increased risk
Chronic diseases
Lower productivity
Long term Consequences
EMEGENCIES INCREASE RISK
SAY:
The first two years of life is a period of rapid growth and body demands are high. Which is why when those needs are not met, children get malnourished. Their body lacks nutrients and energy. Children under two are also vulnerable to illnesses and death. You may have seen malnutrition yourself. See if you recognize any of the signs in the pictures.
DO:
Show the pictures one by one, as you name the manifestations.
Children can become extremely thin or wasted (mouse click), have water-retention or edema (mouse click), become short for age or stunted (mouse click) (Both the girls are 3 and half years of age but we can clearly see that one of the girls is shorter than the other girl) and have micronutrient deficiencies such as anemia (mouse click), which is deficiency of a micronutrient called iron.
But it doesn’t end there (mouse click), children suffer long term consequences (mouse click). Children who fail to catch up on their growth suffer illness and death later in life. And if they gain weight, for example, in later years, it increases their likelihood of chronic diseases such as heart disease. Children who do not attain their full growth, also have lower productivity as adults and therefore have lower wages.
(mouse click)
Emergencies put children under increased risk of dying. In emergencies, children are 2-70 times more likely to die. Even in previously healthy populations, death rates can increase 20fold and malnutrition can set-in in just 2 weeks.
FANTA, 2008
Mayaclinic, 2014
FANTA, 2008
Rae Galloway, 2006
Source: Programming guide for IYCF by UNICEF, 2011
Source: Guiding principles for IYCF during emergencies, WHO , 2004.

5. Recommended IYCF Practices
ONLY breastmilk
Other solids, semi-solids, liquids at 6 months with continued breastfeeding up to 2 years
SAY:
This brings us to the question: what are the recommendations for optimal IYCF practices? We talked about breastfeeding and complementary feeding in the last slide. Lets take a closer look at them.
DO:
Now, show the slide.
Optimal IYCF recommendations are:
Early initiation of breastfeeding – this means breastfeeding within 1 hour of birth
Mouse Click to show definition of EBF.
Exclusive Breastfeeding for 6 months – exclusive breastfeeding means an infant receives only breastmilk, no other liquids or solids, not even water, with the exception of necessary vitamins, mineral supplements or medicines. It is recommended to not to use any artificial feeding which includes feeding breastmilk substitute or infant formula, unless it is medically necessary. Also, no use of feeding bottles, treats or pacifiers.
Continued breastfeeding to 2 years or beyond - Complementary feeding encompasses continued breastfeeding, the introduction of complementary foods at six months, and how that is done in the nutritional and developmental interests of the child.
Mouse Click to show definition of CF.
Source: GNC IFE training 2011

6. Recommended IYCF Practices
DO:
Show the first picture.
SAY:
This is how artificial feeding or feeding infant formula with a bottle is advertised and it actually may look like this in reality under normal circumstances.
Show the next picture.
But, this is how it actually is during emergencies. The risks of artificial feeding are heightened in emergencies, with constraints on water and sanitation, fuel, preparation, storage and supplies. Therefore, infant formula or breastmilk substitutes should not be given unless there is a medical reason to do so. Bottles, teats and pacifiers should not be used.
Priyanka.guru
The Guardian, 2010

7. Breastmilk Substitutes (BMS)
Breast Milk Substitute (BMS):
Any food being marketed or otherwise presented as a partial or total replacement for breast milk, whether or not suitable for that purpose.
Infant Formula Other milk products
Follow-on milks Baby Teas & Juices
Infant Cereals Vegetable Mixes
The code also applies to feeding bottles and teats.
Artificial Feeding: where an infant or young child is fed with a BMS (partial or exclusive)

8. International Code on Marketing of BMS
Yemen Breastfeeding Legislation adapted from International Code
Advertising, Samples, Health Care, Facilities, Health Workers, Supplies,
Information, Labels, Products

9. Reporting Code Violations
NO untargeted distribution of BMS
Code Violations to:
SAY: In emergencies, targeting and use, procurement, management and distribution of BMS, milk products, bottles and teats should be strictly controlled based on technical advice

10. Recommended IYCF Practices
Its TRUE!
Even malnourished mothers can breastfeed.
Stress does not prevent mothers from producing milk.
Infant Formula is NEVER as good as breast milk.
Donations and untargeted distribution of breast milk substitutes may undermine a mother’s confidence and motivation to breastfeed.
SAY:
Even Malnourished mothers can breastfeed.
Stress does not prevent mothers from producing milk.
Infant Formula is NEVER as good as breast milk.
Donations and untargeted distribution of breast milk substitutes may undermine a mother’s confidence and motivation to breastfeed.

11. Multi-Sectoral Approach EMEGENCIES INCREASE RISK
What can We Do?
Multi-Sectoral Approach
EMEGENCIES INCREASE RISK
Increased impact and reach
Efficiency and cost-effective
Synergy and complementarity
Accountability
SAY:
Infant and young child malnutrition and death is not just caused by disease and lack of food. Food insecurity, poor WASH and inadequate care are underlying causes. Lack of political commitment, inadequate education and poor infrastructure are some of the basic causes. Therefore, in order to address IYCF, we need to embrace a multisectoral approach in our work and thinking. This is actually the causal framework of malnutrition, which helps to understand the need and importance of integrating IYCF with other sectors.
Can you link it to your sector? Let somebody answer.
What can be some potential benefits of integration of IYCF-E with other sectors?
DO:
Mouse click to show.
Increased impact and reach
Efficiency and cost-effective use of resources
Synergy and complementarity of services
Accountability to beneficiaries
Mouse click.
In emergencies the risk to appropriate IYCF is increased because normal ways to cope are compromised and basic necessities like clean water, food, shelter, safety are scarce or unavailable.
Source: FAO, Redrawn from UNICEF (1990) 11

12. What can We Do? IYCF IYCF-E Promote, protect and support optimal IYCF
Improve IYCF practices
Do NO harm
Immediately save lives
Improve IYCF practices (if possible)
SAY:
What can we do? We can:
Promote, Protect and support optimal IYCF practices and Improve them. In emergencies, doing no harm and immediately saving lives takes precedence.
IYCF-E operational guidance 2007

13. How can We Do It?
SAY:
How can we do it? This is where YOU come in! 13

14. IYCF Framework: A Multi-sectoral Framework for Action
How can We Do It?
IYCF Framework: A Multi-sectoral Framework for Action
SAY:
The “IYCF Framework: A Multi-Sectoral Framework for Action” is a tool for UNHCR and partners, which has been designed for national and international staff working in refugee operations to provide guidance to managers and technical staff across all sectors on what needs to be considered to create an ‘infant and young child friendly’ environment and facilitate optimal IYCF. This Framework enlists key and overarching activities that each sector can adopt to integrate IYCF in their respective sectors.

15. Possibilities for integration with Shelter/NFI/CCCM
IDENTIFY
PROTECT
Advocate for disaggregated data and ensure PLW, and children under 2 years, are accurately recorded
Report uncontrolled BMS distributions (all sectors)
Ensure newborns are registered
Include PLW and children 0-23 months in shelter vulnerability criteria
Conduct joint mapping of available services relevant for PLW, infants and young children
Never include infant formula in bottles / teats / pacifiers in GFD/NFI distribution
Protect PLW, infants and young children during mass distributions
Design registration and data collection tools to collect relevant information for children 0-23 months old and PLW. Disaggregate information collected by camp management by age and vulnerable group (i.e. 0-5 months, 6-11 months, months, months, pregnant women, lactating women). Ensure infants <6 months are identified upon arrival to camps, new births are registered, and all new arrivals and births are referred to IYCF services;
IYCF staff to participate in camp management working groups to raise awareness of IYCF and ensure the needs of PLW, infants and young children are considered;
Advocate for disaggregated data and ensure PLW, and children under 2 years, are accurately recorded in data management systems;
Encourage sectors to conduct joint mapping of available services relevant for PLW, infants and young children;
Design assistance modalities and fair distribution of services with PLW and children months in mind; consider whether modalities place these vulnerable groups at a disadvantage (i.e. cash for work related to debris removal may be hard for PLW);
Ensure proper management of donations of BMS, including disposal:
Camp management to coordinate to ensure distributions are for targeted beneficiaries and regulation mechanisms are communicated and applied;
IYCF actors should provide communication/guidelines for donation management along with education on the increased risks posed to infants resulting from untargeted BMS donations;
Identify the focal point agency responsible for management of BMS and other nutrition commodities and ensure coordination with them;
Consider requesting assistance from general food distribution agency in management (storage, handling and accounting) of BMS in contexts with a high prevalence of non-breastfed infants. Note: BMS should never be distributed through any general distribution mechanism to avoid negatively influencing breastfeeding mothers.

16. Multi-sectoral Framework for Action
Possibilities for integration with Shelter/NFI/CCCM
Multi-sectoral Framework for Action
PROMOTE
SUPPORT
Establish working group among relevant sectors on the needs of PLW/breastfed and non-breastfed infants
Allocate space for IYCF activities - plan for safe breastfeeding corners / spaces
Provide hygiene promotion and related NFIs at IYCF sites
Locate Child Friendly Spaces near Baby Friendly Spaces
In NFI distributions, consider special needs of children 0-23 months and PLW
- When discussing the needs of infants 0-5 months, consider the needs of non-breastfed infants. It is essential that IYCF teams work with Camp Management or relevant coordination bodies to establish a working group among relevant sectors (Camp Management, non-food items (NFI), Logistics, WASH, Nutrition, Public Health, Child Protection) on the needs of non-breastfed infants, including the management of breast-milk substitutes (BMS) and associated programming (refer to UNHCR SOP on breast-milk substitutes);
In NFI distributions, consider special needs of children 0-23 months and PLW (i.e. insecticide treated mosquito nets; hygiene items including soap and washing containers; cooking and eating items; breastfeeding shawls; blankets and infant/young child clothing and shoes with thermal needs considered; potties, diapers), with a particular preference for items that can be locally sourced:
Ensure NFI distribution mechanisms reflect the needs/circumstances of PLW and caregivers of children 0-23 months:
Ensure there are protective spaces for PLW and infants e.g. WASH facilities or protected space for breastfeeding;
PLW should have priority/separate lines for any distributions (which will include separate verification tables/areas and distribution points) with shade and access to drinking water and sanitary facilities while they wait;
Prioritize transportation allowance for PLW (identify personnel from the community to provide this service; such volunteers can be provided with a small cash incentive);
Coordinate with NFI managers to develop a system to replenish target NFIs for PLW and children 0-23 months as new infants are born – items should be distributed immediately after birth to be most useful. PLW and caregivers involved in planning committees can also flag to NFI managers the changing needs of young children as they grow.
Allocate sufficient space for IYCF activities (baby-friendly spaces, breastfeeding corners, etc.) and ensure maintenance and appropriate services such as WASH in collaboration with site planning and WASH (see settlement and shelter and WASH chapters);
It is important to understand here that being an infant or a PLW does not, in itself, make a person vulnerable or at increased risk. Rather, it is the interplay of factors that does so: for example, a three month old baby whose body is still unable to maintain optimal body temperature on its own will be at increased risk of hypothermia when exposed to cold as a result of compromised shelter or inadequate covering. Similarly, mothers may limit or abandon breastfeeding their babies if there is no place available that allows privacy for breastfeeding. In these cases, a safe and dedicated place for breastfeeding becomes crucial to meet the needs of children under two years of age. Children and PLW, whose bodies are sensitive to the drastic changes in the environment, may be prone to adverse health outcomes if they are left exposed to environmental elements. Therefore, provision of shelter and non-food items that provide privacy and protection from cold or high temperatures become a priority.
The Sphere Project (2011). Humanitarian Charter and Minimum Standards in Humanitarian Response, p Available online: [18 Dec 2014]
Settlement and Shelter is in charge of camp design, making critical decisions early in a response. It is important to consider that settlement and shelter teams manage multiple, sometimes competing, priorities from all sectors at early stages of an emergency, especially if the crisis implicates that communities settle in non-built areas. Colleagues promoting the well-being of PLW, infants and young children must respect this pressure but, at the same time, communicate clearly and early the needs of these groups.

17. THANK YOU QUESTIONS?