1. Infant and Young Child Feeding in Emergencies. Operational Guidance.
VERSION 3.0 – UPDATE

2. The Operational Guidance on IFE
Aim
To provide concise, practical guidance on how to ensure appropriate infant and young child feeding in emergencies (IFE)
Scope
Applies to emergency preparedness, response and recovery worldwide
Target Groups
Infants and young children aged 0-23 months and pregnant and lactating women (PLW)
Intended for
Policy-makers, decision-makers and programmers working in emergency preparedness, response and recovery across sectors and disciplines.
Aim
The OG-IFE aims to provide concise, practical guidance on how to ensure appropriate infant and young child feeding in emergencies.
Scope
The OG-IFE applies to emergency preparedness, response and recovery worldwide to minimise infant and young child morbidity and/or mortality risks associated with feeding practices and to maximise child nutrition, health and development.
Target groups
The target groups are infants and young children aged 0-23 months and pregnant and lactating women (PLW).
Intended for: *TAILOR TO YOUR AUDIENCE*
The OG-IFE is intended for policy-makers, decision-makers and programmers working in emergency preparedness and response, including governments, United Nations (UN) agencies, national and international non-governmental organisations (NGOs), donors, volunteer groups and the private/business sector.
The OG-IFE is relevant across sectors and disciplines, particularly nutrition, but also health (including reproductive health, maternal, newborn and child health (MNCH), curative services, mental health and psychosocial support services (MHPSS); HIV; infectious disease management); adolescent services; water, sanitation and hygiene (WASH); food security and livelihoods (FSL); child protection; early childhood development (ECD); disability; shelter; cash transfer programmes; social protection; agriculture; and logistics.

3. 2001 Version 1.0 2006 Version 2.0 2007 Version 2.1 2010 Addendum 2017
Updated by: The IFE Core Group
Co-led: ENN and UNICEF
Coordinated by: ENN
Funded by: USAID/OFDA (ENN)
2001
Version 1.0
2006
Version 2.0
2007
Version 2.1
2010
Addendum
2017
Version 3.0
The OG-IFE was first developed in 2001 by operational agencies to meet an identified need for a ‘do’s and don’ts’ on infant feeding in emergencies. It is based on existing guidance, expert input and operational experience and has had a number of updates since the first iteration in The OG-IFE was endorsed in a WHA Resolution (23.23) in Version 3 has proved the most significant given the 10 year time lag between 2007 and There has been significant development in guidance, programmatic tools and resources since v2.1 (2007) which was drawn upon for the 2017 version.
Endorsed
WHA resolution 23.23

4. Experiences & resources
V 3.0 Process
March 2016
IFE Core Group Meeting: Interview findings shared, gaps in content and process agreed
Feb 16 – Sept 17
Consultation
Dec 2017
IFE Core Group Meeting: Dissemination & roll out action plan
Experts
Experiences & resources
IFE Core Group
Gaps in content and process agreed at IFE Core Group meeting in Jan 2016.
Regional practitioners had been interviewed beforehand on experiences implementing the OF-IFE, complementary feeding in emergencies (summary report available) and artificial feeding in emergencies. Findings were shared at the meeting.
The development of version 3 was a consultative process, involving IFE Core Group members (working groups) and broader community of practitioners and experts across sectors, disciplines (including WASH, reproductive health, HIV) and regions.
The process has also drawn heavily on agency experiences and considerable tools and resources that have developed in the 10 years since 2007
The IFE Core Group meeting in Dec 2017 will consolidate a rollout action plan and roles and responsibilities in 2018 and beyond
OFDA funding ends in December 2017
The process has been closely connected to the Sphere update process
SPHERE

5. V 3.0 What has stayed the same?
Layout
Headings
Most of existing guidance
Terminology of IFE
Availability in English, French and Arabic
KEY POINTS
PRACTICAL STEPS (1 – 6)
1. Endorse or develop policies
2. Train staff
3. Co-ordinate operations
4. Assess and monitor
5. Protect, promote and support optimal IYCF with integrated multi-sector interventions
6. Minimise the risks of artificial feeding
EMERGENCY PREPAREDNESS ACTIONS  New
KEY CONTACTS
REFERENCES  Expanded
DEFINITIONS  Expanded
ANNEX 1: Multi-sectoral content  New
ACRONYMS  New
There have been no major changes to previous guidance – mostly addition / expansion
The decision was taken to keep IFE (rather than IYCF-E) as an acronym for consistency with previous editions and to avoid implying a change where there is none. Note that IFE and IYCF-E mean the same.
The English version is available as of September Arabic and French versions will be available by December The previous version was available in 12 languages; this will be a key target area to address in 2018.

6. V 3.0 Revisions - Programming
Updated to reflect latest global guidance (published and upcoming)
Greater programmatic detail in all sections
Greater and more balanced content to address needs of non-breastfed infants
More comprehensive content on complementary feeding
Introduction of new concepts e.g. human milk banks
Considers situations where OG-IFE recommendations cannot be immediately met
More content on emergency preparedness
Summary key points updated
Updated to reflect latest guidance, including WHO 2016 guidance on HIV and infant feeding and WHO 2017 Guidance on Ending the Inappropriate Promotion of Foods for Infants and Young Children. Note that it also reflects discussions held on HIV and Infant Feeding in Emergencies.
As part of the update process, a WHO/UNICEF/ENN meeting was convened by WHO in Sept 2016 to examine challenges of putting existing WHO HIV and Infant Feeding guidance into practice in emergencies; proceedings from the meeting informed the content of the Ops G. WHO is finalising operational guidance on infant feeding and HIV in emergencies as a key output of the meeting – coming soon.
Greater programmatic detail in all sections
Greater and more balanced content to address of needs of non-breastfed infants in their own right
More comprehensive content on complementary feeding
Considers situations where OG-IFE recommendations cannot be immediately met and how to handle this
More content on emergency preparedness, including summary table of key actions. KEY POINT: Emergency preparedness is critical to a timely, efficient and appropriate IFE response.
The 14 summary key points have all been revised to reflect the updated content.

7. V 3.0 Revisions – Roles & Responsibilities
Greater emphasis on the lead role of government in preparedness and response
Greater clarity on the respective roles and responsibilities of UN agencies
Greater coverage of sectors beyond nutrition and more explicit actions to take
Incorporated accountability to affected populations
Reflects significantly evolved operational environment
Greater emphasis on the lead role of government in emergency preparedness and response
Greater clarity on the respective roles and responsibilities of UN agencies
Greater coverage of sectors beyond nutrition and more explicit actions to take
Incorporated accountability to affected populations
Reflects significantly evolved operational environment e.g. cluster approach well established, much more attention to IFE

8. V 3.0 Revisions – References, Resources, Terminology
More extensive list of supporting references and resources
Greater referencing of recommendations and definitions
More extensive list of definitions
Changes, and additions, to terminology
Optimal IYCF  Recommended IYCF
HIV Risk Assessment
Donor Human Milk
Human Milk Bank
Cluster Lead Agency
Lipid-based nutrient supplement (LNS)
As reflected in the extensive references / resources section, there has been significant development in guidance, programmatic tools and resources since v2.1 (2007). 200 resources are listed – key references are available in print; the full list is available online. Throughout the Ops Guidance, reference is made to the resources listed at the end.
*CHECK UNDERSTANDING FOR NEW TERMINOLOGY AND EXPLAIN / REFER TO DEFINITIONS IF NECESSARY*

9. 1: Endorse or develop policies
Key provisions regarding IFE should be reflected in government, multi-sector and agency policies and should guide emergency responses.
2: Train staff
Sensitisation and training on IFE is necessary at multiple levels and across sectors.

10. 3: Coordinate operations
Capacity to coordinate IFE should be established in the coordination mechanism for every emergency response. Government is the lead IFE coordination authority. Where this is not possible or support is needed, IFE coordination is the mandated responsibility of UNICEF or UNHCR, depending on context, in close collaboration with government, other UN agencies and operational partners. Where all provisions of OG-IFE cannot be immediately met, context-specific guidance on appropriate actions and acceptable ‘compromises’ should be provided by the IFE coordination authority and mandated UN agencies. Timely, accurate and harmonised communication to the affected population, emergency responders and the media is essential

11. 4: Assess & Monitor
Needs assessment and critical analysis should determine a context specific IFE response
Pre-crisis data
Rapid decision-making and action
Early needs assessment
In depth assessment
Monitoring
It is essential to monitor the impact of humanitarian actions and inaction on IYCF practices, child nutrition and health; to consult with the affected population in planning and implementation; and to document experiences to inform preparedness and future response.

12. 5: Protect, promote and support optimal IYCF with integrated multi-sector interventions
Immediate action to protect recommended infant and young child feeding (IYCF) practices and minimise risks is necessary in the early stages of an emergency, with targeted support to higher risk infants and children
General
Breastfeeding support
Infants who are not breastfed – incl. relactation, wet nursing, donor human milk, BMS
Complementary feeding
Micronutrient supplementation
HIV and infant feeding
Infectious disease outbreaks
Under infants who are not breastfed, we deal with relactation, wet nursing, donor human milk, BMS

13. 5: Protect, promote and support optimal IYCF with integrated multi-sector interventions
In every emergency, it is necessary to assess and act to protect and support the nutrition needs and care of both breastfed and non-breastfed infants and young children. It is important to consider prevalent practices, the infectious disease environment, cultural sensitivities and expressed needs and concerns of mothers/caregivers when determining interventions In every emergency, it is important to ensure access to adequate amounts of appropriate, safe, complementary foods and associated support for children and to guarantee nutritional adequacy for pregnant and lactating women.

14. 5: Protect, promote and support optimal IYCF with integrated multi-sector interventions
Multi-sector collaboration is essential in an emergency to facilitate and complement direct infant and young child feeding (IYCF) interventions. Actions are included for:
Health
Adolescent Services
WASH
FSL
Child Protection
ECD
Disability
Shelter
Cash
Social Protection
Agriculture
Logistics
Key sectors and disciplines to sensitise and work with on IYCF include health (reproductive health; MNCH; MHPSS; HIV; infectious disease management); adolescent services; WASH; FSL; child protection; ECD; disability; shelter; cash transfer programmes; social protection; agriculture; and logistics. Examples of integrated activities are provided.
WASH: Water, Sanitation and Hygiene, FSL: Food Security and Livelihoods, ECD: Early Childhood Development

15. 6: Minimise the risks of artificial feeding
In emergencies, the use of breastmilk substitutes (BMS) requires a context-specific, coordinated package of care and skilled support to ensure the nutritional needs of non- breastfed children are met and to minimise risks to all children through inappropriate use
Donations in emergencies
Artificial feeding management
BMS supplies
BMS specification
Procurement of BMS supplies, feeding equipment and support
Distribution of BMS
Donations of BMS, complementary foods and feeding equipment should not be sought or accepted in emergencies; supplies should be purchased based on assessed need. BMS, other milk products, bottles and teats should never be included in a general distribution.

16. Emergency preparedness
…is critical to a timely, efficient and appropriate IFE response
Examples from Box 1: Emergency Preparedness Actions
POLICY
Develop preparedness plans on IFE
TRAINING
Prepare orientation material for use in early emergency response
COORDINATION
Develop terms of reference for IFE coordination in a response
ASSESS AND MONITOR
Prepare key questions to include in early needs assessment
MULTI-SECTOR INTERVENTIONS
Examine national legislation related to food and drugs, particularly importation
ARTIFICIAL FEEDING
Communicate government position on not seeking or accepting donations
Preparedness has been integrated throughout the OG-IFE.

17. **INSTRUCTION SLIDE**
The following slides cover implications of the revisions in the Operational Guidance on IFE for stakeholders involved with GOVERNMENT. Please delete slides that are not applicable to your audience and cross reference to internal documents and processes where relevant.

18. Implications for government
Endorse or develop policies
1.1 Governments and agencies should have up-to-date policies which adequately address all of the following elements in the context of an emergency:
protection, promotion and support of breastfeeding;
the management of artificial feeding;
complementary feeding;
the nutrition needs of PLW;
compliance with the International Code of Marketing of Breastmilk Substitutes (BMS) and subsequent relevant World Health Assembly (WHA) Resolutions (the Code);
prevention and management of donations of BMS;
infant feeding in the context of public health emergencies and infectious disease outbreaks
Additional context-specific provisions may be necessary, such as for refugees or internally displaced persons (IDP). Provisions may exist as a standalone policy and/or may be integrated into other relevant policies.

19. Implications for government
Endorse or develop policies 1.2 In early response, consult national/sub-national preparedness plans, policies and procedures and uphold relevant legislation and international standards. In an emergency, where existing policy guidance is absent, outdated or does not adequately address the context, rapid policy guidance updates or ‘stop-gap’ guidance development may be necessary, led by the IFE coordination authority and in consultation with WHO, other relevant UN agencies and national/regional/global technical groups 1.3 Develop missing and update existing policy guidance in close collaboration with government authorities and seek to strengthen relevant national/sub-national policies. Develop and update policies and associated procedures in preparedness.

20. Implications for government
Endorse or develop policies
1.4 Disseminate key policy guidance to all relevant responders across sectors, including media groups, private sector, donors, military and volunteer groups
1.5 An inter-agency joint statement, issued and endorsed by relevant authorities, may be used to highlight relevant guidance, provide context-specific rapid guidance, and harmonise communication. Development of the statement should be led by the IFE coordination authority; UNICEF and WHO have key roles to catalyse and support development. In preparedness, develop a draft joint statement and secure preliminary approval with relevant authorities

21. Implications for government
Endorse or develop policies 1.6 The Code expresses the collective will of governments regarding the marketing of BMS and sets out the responsibilities of the manufacturers and distributors of products covered by the Code, health workers, national governments and concerned organisations. Enact the Code into national legislation in preparedness and enforce at all times, including during emergency response. Ensure that existing legislation is fully in line with the Code. Report Code violations
The International Code of Marketing of Breast-milk Substitutes. WHO, and subsequent relevant World Health Assembly Resolutions

22. Implications for government
Endorse or develop policies
1.7 Enact legislation and adopt policies in line with the WHA Resolution: Guidance on Ending the Inappropriate Promotion of Foods for Infants and Young Children (69th WHA A69/7 Add )
In preparedness, UN, civil society and government policy-makers should develop national legally binding policies regarding private sector engagement in emergency response to enable constructive collaboration and avoid undue influence and conflicts of interest
Safeguarding against possible conflicts of interest in nutrition programmes: Approach for the prevention and management of conflicts of interest in the policy development and implementation of nutrition programmes at country level. WHO, 2016.

23. Implications for government
Train staff
2.1 Sensitise relevant personnel across sectors to support IFE, including those dealing directly with affected women and children; those in decision-making positions; those whose operations affect IYCF; those handling any donations; and those mobilising resources for the response. Target groups for sensitisation include government staff, sector/cluster leads, donors, rapid-response personnel, camp managers, communications teams, logisticians, the media, volunteers, among others.
2.2 Train personnel on IFE in preparedness and during emergency response, as necessary. Target personnel may include government staff; NGO staff and volunteers delivering health and nutrition services and support at facility or community level; and frontline staff in other sectors

24. Implications for government
Coordinate Operations
3.1 Government is the lead coordination authority on IFE.
Where this is not possible or support is needed, among UN agencies and in accordance with mandates, IFE coordination is the responsibility of:
UNICEF - in IDP responses
UNHCR – in refugee responses
WFP is responsible for mobilising food assistance in emergencies in a manner that upholds the provisions of the OG-IFE.
WHO is responsible for supporting Member States to prepare for, respond to and recover from emergencies with public health consequences.

25. Implications for government
Coordinate Operations
3.2 Ensure there is capacity to coordinate IFE within coordination mechanisms in an emergency response.
Assess and support development of government coordination capacity as necessary. Determine or clarify coordination responsibilities and roles in preparedness and in early response. UNICEF country offices have a key responsibility to prepare for coordination needs in an emergency and as necessary, to support government capacity and skills development in this regard.
3.3 The IFE coordination authority must directly coordinate the IFE response or ensure adequate coordination mechanisms and capacity are in place
The IFE coordination authority must directly coordinate the IFE response or ensure adequate coordination mechanisms and capacity are in place. This may involve recruitment or secondment of additional staff or collaboration/partnership with another agency or agencies. Country/regional/global technical support mechanisms or working groups may be identified or formed to support coordination. Where a partner agency is identified to undertake coordination activities, the IFE coordination authority remains accountable for ensuring an adequate, appropriate, timely IFE response.

26. Implications for government
Coordinate Operations
3.8 In some emergencies, it may not be possible to meet all the provisions of the OG-IFE immediately, such as where access to those affected is limited or impossible, or capacity is lacking to deliver necessary support.
In such circumstances, critical analysis by the IFE coordination authority, government, UNICEF, WHO and, where applicable, UNHCR is essential to provide context-specific guidance on appropriate actions and acceptable compromises.
Adapted programming may fall short of OG-IFE recommendations and should be temporary. The unmet needs and risks of compromised programming should be used to inform proactive advocacy for humanitarian access, resourcing and capacity. Decision-making should be recorded and lessons learned should be documented and shared.

27. Implications for government
Pre-crisis data and early needs assessment
4.4 Use pre-crisis background information (secondary data) to develop an IYCF situation profile to inform early decision-making and immediate actions. Collate key information in preparedness or as necessary, in early response.
4.5 Pre-crisis information sources include existing government, NGO and UN country programmes; Multiple Indicator Cluster Surveys (MICS) and Demographic Health Surveys (DHS); sub-national surveys; national institutions (ministries, local offices for emergency preparedness, drugs and food standards authorities); Knowledge, Attitudes and Practices (KAP) studies; World Breastfeeding Trends Initiative (WBTi) country profiles; WHO and UNICEF databases; Nutrition Landscape Information System; post-emergency evaluations; previous flash appeals and Humanitarian Response Plans (HRP). Nutrition information may also be obtained through joint nutrition and food security assessments.

28. Implications for government
Monitoring
4.16 Monitor for Code violations and report them to national authorities, the IFE coordination authority, and international monitors.
Support government to develop policies and procedures to monitor for and act on Code violations; WHO and UNICEF country offices have key responsibilities in this regard.
Typical Code violations in emergencies relate to infant formula labelling, supply management, and donations.

29. Implications for government
Protect, promote and support optimal infant and young child feeding with integrated multi-sector interventions
5.1 At national level, UNICEF has a key responsibility to define, advocate for and provide guidance on essential IYCF interventions in close collaboration with government and other stakeholders. This responsibility extends to both preparedness and recovery, using and building on existing capacities, networks, policies, systems and requires multi-sector engagement.
In refugee settings, UNHCR holds this responsibility. WFP has a responsibility to ensure that the nutrition of infants and young children and PLW is considered in food assistance response and that necessary data are gathered to inform related programming.

30. Implications for government
Infants who are not breastfed 5.14 To date, there is little experience with the use of formal and informal donor human milk in emergency settings. Donor human milk is likely a more viable option where there are existing human milk banks in an emergency-affected area, that are integrated into broader newborn/infant feeding programmes, and where key conditions are met. Key conditions that need to be in place for the safe use of donor human milk in an emergency are: government policy (preparedness) or, in the absence of policy, agreement between authorities on its use; an estimate of need, defined eligibility criteria and duration of provision; adequacy of supply for the response; quality assurance including donor screening and pasteurisation; and the establishment and maintenance of a cold chain to preserve quality and safety.

31. Implications for government
Complementary Feeding
5.20 The designated IFE coordination authority should provide clear direction on complementary feeding needs and interventions. Government is the lead coordination authority to guide the response on complementary feeding. Where this is not possible or support is needed, coordination on complementary feeding is the mandated responsibility of UNICEF or UNHCR, depending on context, in close collaboration with government, other UN agencies and operational partners.
In all contexts, UNICEF has a key responsibility to provide guidance on appropriate complementary foods and feeding practices and to help define essential interventions. In food assistance programmes, WFP has a responsibility to provide or enable access to appropriate nutrient-rich food for children aged 6-23 months and PLW when significant food and nutrient gaps are identified.

32. Implications for government
Artificial Feeding Management
6.7 Plan appropriate procurement, distribution, targeting and use of BMS and associated support (artificial feeding management) in close consultation with the IFE coordination authority and UNICEF.
6.9 The IFE coordination authority and/or UNICEF should determine if and where capacity to manage artificial feeding exists in government and among humanitarian providers.
Plan appropriate procurement, distribution, targeting and use of BMS and associated support (artificial feeding management) in close consultation with the IFE coordination authority and UNICEF (where UNICEF is not acting as the IFE coordination authority). In accordance with mandates, WHO and UNHCR also have key responsibilities. Establish terms of reference, responsibilities and roles for artificial feeding management for use by the IFE coordination authority, in preparedness.
The IFE coordination authority and/or UNICEF should determine if and where capacity to manage artificial feeding exists in government and among humanitarian providers. Where capacity is limited, the IFE coordination authority and/or UNICEF should identify appropriate BMS provider(s), including a BMS supply chain and associated support services. In the absence of an appropriate provider, the IFE coordination authority and/or UNICEF will ensure coordinated provision of BMS supplies. The IFE coordination authority and/or UNICEF will provide clear terms of reference, technical support and close oversight of procurement, monitoring and use.

33. Implications for government
BMS Supplies
6.11 In refugee settings and in accordance with UNHCR policy, UNHCR will only source infant formula after review and approval by its HQ technical units.
6.12 In non-refugee settings and in accordance with UNICEF policy, UNICEF will only procure infant formula as the provider of last resort and at the request of the host government and/or the national humanitarian coordination structure.

34. INSTRUCTION SLIDE
You may find it useful to have a discussion on how the revised guidance can be dissemination within your working group / cluster / agency etc.
Suggestions have been made for roll out at:
Individual agency level
National level
Regional level
Select the appropriate slide. Suggested roll out actions will have to be contextualised prior to presenting. Following the discussion, it is recommended to set SMART objectives and work out a timeline to implement the recommended roll-out actions. Consider what resources are required to support the roll-out.

35. Recommendations for dissemination (Agency)
Wide dissemination of Ops Guidance on IFE within <agency>
What does this mean for you and your agency? Roles, responsibilities, agency activities, programming, strategies, position papers etc.
Training for technical staff from health, nutrition and other sectors
Sensitisation for all staff including senior management and communication, logistics, resource mobilization, rapid response and volunteer teams
Inclusion of V 3.0 in induction reading materials, agency resource libraries, training materials etc.
Dissemination and roll out to regional, country and field offices
Update training materials
Training: Target especially nutrition, health, adolescent services, WASH, FSL, CP, ECD, disability, cash transfer, social protection, agriculture and logistics staff.
Sensitisation: relevant personnel across sectors to support IFE, including those dealing directly with affected women and children; those in decision-making positions; those whose operations affect IYCF; those handling any donations; and those mobilising resources for the response. Target groups for sensitisation include sector/cluster leads, donors, rapid-response personnel, government staff, camp managers, communications teams, logisticians and volunteers, among others.
Note that this should not be limited to induction for nutrition staff but also technical staff working in other sectors as well as support services (finance, admin logistics etc.) and senior management.

36. Recommendations for dissemination(National/Cluster)
Wide dissemination to <NiEWG / nutrition cluster members, all other sectors, intercluster, relevant government agencies and authorities, advocacy groups, policymakers>
What does this mean for you? Preparedness and response plans, roles and responsibilities etc.
Dissemination of / sensitisation on update
Translation of Operational Guidance on IFE text into local language
Adaptation of Operational Guidance on IFE to local context
Incorporation of V 3.0 revisions into national guidance & policy
Inclusion into background reading materials
Check at regional / HQ level if translation already exists / is in process

37. Recommendations for dissemination (Regional)
Wide dissemination of Ops Guidance on IFE at <regional level>
What does this mean for you? Preparedness and response plans, roles and responsibilities etc.
Training and sensitisation for regional offices
Translation into regional languages
Dissemination to country offices
Incorporation of V3.0 updates into regional strategies, funding etc.
Arabic, English and French will be available

38. Appropriate and timely support of infant and young child feeding in emergencies (IFE) saves lives, protects child nutrition, health and development and benefits mothers.