1. IYCF ORIENTATION Health Cluster Date: 02-08-2017
Location: Sana’a, Yemen

2. Session Objectives
By the end of this session, you will be able to:
Understand why IYCF(E) is important
Understand the importance of IYCF(E) during Cholera
Understand the key concepts of the International Code of Marketing of BMS and know how to report Code Violations
Understand how you can support IYCF(E)

3. What is IYCF? I = Infant Y = Young C = Child F = Feeding
Infant = completed months
Young child = completed months
SAY:
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.
Address misconceptions: Even malnourished mothers can breastfeed.
Stress does not prevent mothers from producing milk.
Source: GNC IFE training 2011

6. BREASTFEEDING IS A SHIELD THAT PROTECTS AND SAVES INFANTS LIVES, ESPECIALLY IN EMERGENCIES.
BUT… BREASTFEEDING CAN EASILY BE UNDERMINED WITHOUT EVERYONE’S ACTIVE SUPPORT

7. Higher RISKS for non-breastfed children
SAY:
This graph shows that the highest risks of morbidity and mortality are consistently among anfants who are not breastfed.
For example, the highest risk of mortality and pneumonia, which is around 16%, is among infants who are not breastfed at all from 0-5 months. However, this risk is reduced up to only 1% when infants are exclusively breastfed. Even if the infant is partially breastfed, this risk is still very low, around 3%.
Infants who are not exclusively breastfed are 11 times more likely to die of diarrhoea
Breastfeeding could prevent 72% of admissions for diarrhoea

8. Artificial feeding and bottle feeding is even more dangerous during emergencies
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.
Infant Formula is NEVER as good as breast milk.
Priyanka.guru
The Guardian, 2010

9. IYCF and Cholera Cholera is NOT transmitted in breastmilk
Key Messages from UNICEF Cholera Toolkit (2013)
Cholera is NOT transmitted in breastmilk
Breastmilk helps to prevent both dehydration and malnutrition
Breastmilk is always the safest source of nutrition for infants and young children, especially during a cholera outbreak
A mother with cholera should continue to breastfeed as long as she is conscious – even while receiving IV fluids
If a mother is severely dehydrated she must be rehydrated with IV fluids or ORS – this is important for her to continue breastfeeding her baby
Bottles and teats should NEVER be used
SAY: IYCF TWG is developing guidance on IYCF and Cholera

10. 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
Artificial Feeding: where an infant or young child is fed with a BMS (partial or exclusive)

11. International Code on Marketing of BMS
Yemen Breastfeeding Legislation adapted from International Code
Advertising, Samples, Health Care, Facilities, Health Workers, Supplies,
Information, Labels, Products
The code also applies to feeding bottles and teats.

12. 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
Donations and untargeted distribution of breast milk substitutes may undermine a mother’s confidence and motivation to breastfeed.
DO: Explain the Code Violations Reporting Form

13. A Multi-Sectoral Framework for Action
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.
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.

14. Possibilities for integration with Health
Report uncontrolled BMS distributions
Organise joint needs assessments
Allocate space for IYCF activities in HFs - plan for safe breastfeeding spaces
Cross train health and IYCF staff (also in DTCs/ORCs)
Develop clear procedures for identification and referral
Inclusion of IYCF counselling as part of ANC/PNC
Delivery services and maternity wards to protect, promote, and support IYCF

15. THANK YOU QUESTIONS?