1. CDC/UNICEF IYCF Assessment in IDPs in Kharkiv oblast April 16, 2015

2. Methods 2 Focus Group Discussions with IDP mothers of children 0-24 months: – IDPs living in rented housing in Kharkiv (more educated, urban, better SES): 7 mothers – IDPs living in collective center on the outskirts of Kharkiv (less educated, more rural, poor SES): 10 mothers

3. Methods 2 Key Informant interviews – Pediatrician, chief of section (zav. otdelom) in child polyclinic – Pediatrician, head of private child clinic – see http://www.pediatrplus.com.ua/ http://www.pediatrplus.com.ua/ Standard instruments (semi-structured questionnaires/checklists) for KII and FGD

4. Information and services in health system Updated guidance on BF/CF is available and generally known (prikaz 434, 149) Mandatory home visits post-partum by doctor and nurse in 1 st month, then monthly visits to polyclinic Generally no difficulties for IDPs to register for medical services Courses for future mothers exist both pre-natal and post-natal, but may not be communicated to all Pediatricians are used and trusted by more educated Medical staff in some areas seem to provide incorrect advice (early intro of water, early complementary feeding)

5. Information and services in health system Rural mother seem to have less access and use of medical staff and courses/services Mothers with prior children rely on own prior experiences Less educated seem to rely more on grandma’s advice Residents of collective centers if remote have difficulty accessing services (transportation cost, time)

6. Breastfeeding Initiation – almost universal Early introduction of water, especially in less educated, those whom did so with previous children Some health workers seem to advise to introduce water and teas very early If breast milk perceived as “not enough” introduce formula

7. Breastfeeding problems Stress – major problem, many perceive to lose milk because of stress of war and displacement Support BF in birth clinic in the first few days – major problem (esp. for first mothers) More educated – difficulties of adhering to “hypoallergenic diet” (expensive) Maternal nutrition is not perceived as a major problem, although mentioned Working schedule of the mother – not a major problems since IDP mothers rarely work

8. Complementary feeding Early introduction of complementary feeding (at 3-4 mo) in some in less educated, rural mothers Standard MoH advice – from 6 months, table for portion sizes and intro schedule for food groups Most common foods currently used: mashed potatoes, baby porridges, semolina, buckwheat, fruit/vegetable purees

9. Complementary feeding No problems with introducing meats, liver, yolk at 6 mon or earlier Meat well liked and accepted by children Some mothers prefer milk-free, some with- milk porridges Semolina is less preferred by some mothers, but generally common, buckwheat is also common ad well liked

10. Complementary feeding problems Mothers try hard not to impact child’s diet due to lack of money, prioritize the child Use less preferred meats (chicken) Lack of access to milk and milk products and fresh fruits/vegetables in collective center Lack of capacity to cook, boil water in some

11. Assistance Mostly sporadic one-time assistance depending on ad hoc donations, no systematic consistent assistance packages Mostly “Stantsia Kharkiv” and Red Cross No information materials on BF/CF No counseling on BF/CF at (or linked to) the point of distribution

12. Implications -- counseling Additional counseling capacity, especially in collective shelters and at the point of assistance distribution Availability of skilled consultants for on-the phone advice (free hotline) Counseling system in polyclinics is available and functioning according to doctors Perhaps refresher training of MoH staff teaching courses to assure consistency of messages

13. Implications -- counseling Entrenched beliefs about early water introduction (including some medical staff), reliance on experience with prior children a major challenge Handling of early postpartum BF support in birth clinics is a major challenge, need strengthening (perhaps with added staff)

14. Implications – complementary foods Advocate for timely (at 6 mo) introduction, no complementary foods in <6 mo-targeted assistance Commercial porridges, buckwheat, are well accepted, semolina may be less preferred by some, but very common Meat is perceived valuable and well accepted, including commercial purees