1. “Strengthening Infant and Young Child Feeding Policies and Programmes in South Asia Region”
Maldives Country Presentation
9th to 12th December 2014 , Parwanoo, Himachal Pradesh

2. INTRODUCTION Country Context Breastfeeding and Nutrition Situation
National Policies and Strategies
WHO Code
Maternity Protection
BFHI
IYCF activities
World Breastfeeding Week
Challenges
WBTi

3. Country Context Population : 298,842 (Census 2006)
Number of Atolls: 20
Number of islands: 1120 islands
195 (inhabited)
The health care delivery system : four-tier referral system

4. Child Nutrition Situation
Rates of malnutrition has gradually declined from to 2009
Nutrition situation has not improved in pace with other health developments
Rates of malnutrition has gradually declined from to 2009
Nutrition situation has not improved in pace with other health developments

5. Breastfeeding Situation
Early Initiation : 64 %, within the first hour of life , 92% of newborns within the first day
Exclusive Breastfeeding for first 6 months: 48% (10% (MICS II ,2001)
Median duration of Breastfeeding : 2.2 months
Bottle-feeding :12 % of last born are reported to have received pre-lacteal feeds
Complementary Feeding :
89.9 percent infants are given timely semi-solid or solid food ,
47 percent is introduced to infant formula at age 6-8 months
58 % of children age 6-23 months met the minimum standard with respect to all three IYCF practices
Source: DHS 2009
Early Initiation : 64 %, within the first hour of life , 92% of newborns within the first day
Exclusive Breastfeeding for first 6 months: 48% (10% (MICS II ,2001)
Median duration of Breastfeeding : 2.2 months
Bottle-feeding :12 % of last born are reported to have received pre-lacteal feeds
Complementary Feeding :
89.9 percent infants are given timely semi-solid or solid food , 47 percent is introduced to infant formula at age 6-8 months
58 % of children age 6-23 months met the minimum standard with respect to all three IYCF practices
Source: DHS 2009

6. IYCF Policies and Strategy
Government advocates exclusive breastfeeding for 6 months and complementary feeding with foods that provide for optimal growth to be introduced to the infant after 6 months and continue breastfeeding for up to 2 years.
The National Strategy for infant and Young Child Feeding is dated
The Integrated National Nutrition Strategic Plan (INNSP ) :
Government advocates exclusive breastfeeding for 6 months and complementary feeding with foods that provide for optimal growth to be introduced to the infant after 6 months and continue breastfeeding for up to 2 years.
The National Strategy for infant and Young Child Feeding is dated
The Integrated National Nutrition Strategic Plan (INNSP ) : The 5th strategic plan is a five year plan ( ) endorsed in 2012 which has a multi-sectoral approach and measures to address IYCF, malnutrition and micronutrient deficiencies.

7. IYCF Policies and Strategy
Other supportive polices:
Health Master Plan ( ), new plan being drafted to be aligned with INNSP
National Reproductive Health Strategy (focuses on newborn feeding , child and maternal nutrition including eliminating ,micronutrient deficiencies)
Micronutrient Policy to be endorsed.
NCD Prevention action Plan, Food inspection Guidelines , Food Bill and Youth health strategy are in draft stage or remains to be endorsed.
Other supportive polices:
Health Master Plan ( ), new plan being drafted to be aligned with INNSP
National Reproductive Health Strategy (focuses on newborn feeding , child and maternal nutrition including eliminating ,micronutrient deficiencies)
Micronutrient Policy to be endorsed.
NCD Prevention action Plan, Food inspection Guidelines , Food Bill and Youth health strategy are in draft stage or remains to be endorsed.

8. Breast Milk Substitute (BMS) Code
Adopted some of the provisions of the International Code of Marketing of Breast-milk Substitutes (BMS) into the National Code of BMS
Approved by the parliament but not legalized into an Act and implemented.
The Code is being enforced as a part of food safety regulations “Regulation on Import, Produce and Sale of Breast Milk Substitutes in the Maldives”
Traders and stakeholders, healthcare workers sensitized.
BMS Code is being re-examined by the government ( Since August 2014)
Adopted some of the provisions of the International Code of Marketing of Breast-milk Substitutes (BMS) into the National Code of BMS
Approved by the parliament but not legalised into an Act and implemented.
The Code is being enforced as a part of food safety regulations “Regulation on Import, Produce and Sale of Breast Milk Substitutes in the Maldives”
Traders and stakeholders, healthcare workers sensitized.
BMS Code is being re-examined by the government ( Since August 2014)

9. MATERNITY PROTECTION
Women following secondary school education are getting increasingly employed.
46 percent married women are employed (MDHS, 2009)
Maternity leave 60 days ( excluding public holidays) with full pay.
1 hour nursing break till the baby is 1 year old
1 year of leave without pay may be granted
1 week paternal leave
There is no law/ regulation applicable to private sector. Varies among the private sector.
‘Flexi hours’- recently introduced by civil service
Only MMA (Maldives Monetary Authority) has introduced 6 months paid maternity leave (Voluntarily)
Women following secondary school education are getting increasingly employed.
46 percent married women are employed (MDHS, 2009)
Maternity leave 60 days ( excluding public holidays) with full pay.
1 hour nursing break till the baby is 1 year old
1 year of leave without pay may be granted
1 week paternal leave
There is no law/ regulation applicable to private sector. Varies among the private sector.
Only MMA (Maldives Monetary Authority) has introduced 6 months paid maternity leave.

10. Baby Friendly Hospital Initiative ( BFHI)
BFHI launched in Total 9 hospitals declared BFHI- monitoring not undertaken.
5 hospitals declared as Baby-friendly-2005
2 more regional hospitals- 2001
2 atoll hospitals- 2005
Last external review of BFHI in 2003
BFHI – programme needs to be further strengthened
Breast feeding counselling, IYCF training, awareness sessions on programming – ongoing.
BFHI certifications needs to be reinstated
BFHI launched in Total 9 hospitals declared BFHI- monitoring not undertaken.
5 hospitals declared as Baby-friendly-2005
2 more regional hospitals- 2001
2 atoll hospitals- 2005
Last external review of BFHI in 2003
BFHI – programme needs to be further strengthened
Breast feeding counselling, IYCF training, awareness sessions on programming – ongoing.
BFHI certifications needs to be reinstated

11. IYCF Activities
The National Infant and Young Child Feeding Guideline drafted
BCC Strategy for Maternal and Child Nutrition developed
MCN BCC Campaign Plan -
Maternal and Child Nutrition Guide for caregivers
Maternal and Child Nutrition Manual for Community health workers
Pretesting of Guide and Manual in three atolls
IEC and Advocacy tools under development- leaflets, posters, banners, Mass media spots. (TV/radio)
Orientation to MCN Guide completed in 3 atolls ( incolloboration with NGOS- SHE, ARC)
The National Infant and Young Child Feeding Guideline drafted
BCC Strategy for Maternal and Child Nutrition developed
MCN BCC Campaign Plan -
Maternal and Child Nutrition Guide for caregivers
Maternal and Child Nutrition Manual for Community health workers
Pretesting of Guide and Manual in three atolls
IEC and Advocacy tools under development- leaflets, posters, banners, Mass media spots. TV/radio
Orientation to MCN Guide completed in 3 atolls ( incolloboration with NGOS- SHE, ARC)

12. IYCF components integrated into Newborn care and IMCI trainings.
IYCF Activities
MCH – online surveillance system for monitoring nutrition interventions including growth monitoring, vaccination and IYCF information,
IYCF components integrated into Newborn care and IMCI trainings.
Micronutrient Supplementation: Vit A and Deworming program
National Nutrition Council
MCH – surveillance system for monitoring nutrition interventions including growth monitoring, vaccination and IYCF information
IYCF components integrated into newborn care and IMCI trainings.
National Nutrition Council
Capacity building of healthcare providers :
Breast feeding counselling trainings :( 87 trained since 2012)
IYCF trainings ( 181 trained, 49 since 2012)
BMS code Orientation/ sensitization:
private sector, government, agency partners
health care providers
Newborn care trainings
Growth monitoring
IMCI
PMTC

13. IYCF Activities
Bottle-neck analysis on Infant and Young Child nutrition situation- ongoing
Project on ‘Strengthening GMP’- Situation Analysis, Training, SOPS, resource materials development
Capacity building of healthcare providers :
Breast feeding counselling trainings :( 87 trained since 2012)
IYCF trainings ( 181 trained, 49 since 2012)
BMS code Orientation/ sensitization:
private sector, government, agency partners
health care providers
Newborn care trainings
Growth monitoring and promotion
IMCI
PMTCT Guideline

14. World Breastfeeding Week 2014
World Breastfeeding Week is being marked each year at National Level.
Awareness / IEC: Radio / TV programmes, Friday Prayer Lecture, leaflets and information disseminated
Special counselling classes: on exclusive breastfeeding mothers, support for working mothers on the concept of expressed milk, complimentary feeding through out the week
Advocacy event: With the theme of WBW 2014: Breast feeding: A Winning goal for life, a foot ball match and Health Fair(focused on Breast feeding and IYCF awareness)
Trainings : Growth monitoring, IYCF, Breastfeeding counselling, newborn care, IMCI, PMTC sensitization
Training on ‘Mobilization of Religious Leaders on MCH’
Support: UNICEF /WHO, Government Organizations and NGOs
World Breastfeeding Week is being marked each year at National Level.
Awareness / IEC: Radio / TV programmes, Friday Prayer Lecture, leaflets and information disseminated
Special counselling classes: on exclusive breastfeeding mothers, support for working mothers on the concept of expressed milk, complimentary feeding through out the week
Advocacy event: With the theme of WBW 2014 Breast feeding: A Winning goal for life, a foot ball match and Health Fair(focused on Breast feeding and IYCF awareness)
Trainings : Growth monitoring, IYCF, Breastfeeding counselling, newborn care, IMCI, PMTC sensitization
Support: UNICEF /WHO, Government Organizations and NGOs

15. World Breastfeeding Week 2014
NGO’s involvement
Society for Health Education (SHE)
Training of HWs on IYCF training at Addu City
WBCI tool training at Addu city
Roll out training of Maternal and Child Nutrition Guide
Society for Health Education (SHE)
Training of HWs on IYCF training
WBCI tool in Addu City
Roll out training of Maternal and Child Nutrition Guide

16. CHALLENGES Limited national level capacity on IYCF
High staff turn over rate
High expatriate staff- doctors, nurses
Dependency on imported food- High lobby group of infant milk formulas and commercial infant foods
Difficulty in implementing and enforcing existing policies and strategies
Due to changing political climate, limited resources (HR, technical, funds)
Changing policy priorities (which is dynamic), changing leaderships
The support of pediatricians, Obstetricians, in promoting exclusive breast feeding has diminished
Delay in enforcement of the regulation on BMS and infant food.
Limited national level capacity on IYCF
High staff turn over rate
High expatriate staff- doctors, nurses
Dependency on imported food- High lobby group of infant milk formulas and commercial infant foods
Difficulty in implementing and enforcing existing policies and strategies
Due to changing political climate, limited resources (HR, technical, funds)
Changing policy priorities (which is dynamic), changing leaderships
The support of pediatricians, healthcare providers in promoting exclusive breast feeding has diminished
Delay in enforcement of the regulation on BMS and infant food.

17. Next Steps Country level assessment WBTi
Training Health workers on WBCi
Plan of action for
Country level assessment WBTi
Training Health workers on WBCi
Plan of action for

18. Thank you