1. Working together for the nutritional health of vulnerable populations Nutrition Sub-Cluster of the Health and Nutrition Cluster Кластерная группа по питанию Кластера здравоохранения и питания https://www.humanitarianresponse.info/operations/ukraine/nutrition

2. Health Cluster The overall objective of the Health Cluster Response is to reduce avoidable morbidity and mortality associated with the conflict and subsequent displacement. Objective 3: To prevent excessive nutrition-related morbidity and mortality of vulnerable groups including acutely malnourished children pregnant and lactating women (PLW) and elderly. Indicator: Number of vulnerable groups including children pregnant and lactating women (PLW) and elderly reached out with interventions to support, protect and promote appropriate nutrition

3. Why this presentation? Importance of protecting, promoting and supporting safe and appropriate infant & young child feeding (IYCF) -& the nutrition of other vulnerable groups (PLW; elderly) Inform what the current context in eastern Ukraine means for nutrition Identify the need for nutrition-specific & nutrition- sensitive approaches, targeting the most nutritionally vulnerable groups

4. Protecting, promoting & supporting nutrition  Children <2 years most vulnerable to illness & death -Critical period for physical, mental & emotional development -Age-specific nutrition needs; risk of infection; complete dependency on others for care  Infants should receive breast milk exclusively until the age of 6 months, followed by the introduction of soft, semi-solid & solid complementary foods, while continuing breast-feeding up to the age of two years or beyond Appropriate and timely support of IYCF-E saves lives

5. Context in eastern Ukraine Suboptimal young child feeding practices -Low rates exclusive breastfeeding, infants <6 months (mean 13.8% ; 25.8%) -Mixed feeding –breastfeeding and infant formula (intro mean 3.1 mo; 4.2 mo) -Use of teas & water for infants <6 months (intro mean 3.1 mo) -High use of bottles/teats (mean 68.1% - 72.5%) -Early introduction of complementary foods (mean 4-5 mo) -Duration of continued breastfeeding (mean 31.8%; 53.5% at 1 year) Indiscriminate distributions of infant formula by agencies No elevated wasting in children 6-23 months (prevalence below 1%)

6. Context in eastern Ukraine (cont.) Financial/ affordability constraints Disruption to social support networks Low capacity of health services to support optimal feeding (HR; finance) Maternal psychosocial stress (UNICEF - Save the Children IYCF-E Assessment June 2015: IDPs. Kramatorsk; Sloviansk; Svytahirsk; Kharkiv; Dnipropetrovsk; Zaporizhia)

7. Reasons for stopping breastfeeding of child <2 years: (HHQ n=114) (UNICEF - Save the Children IYCF-E Assessment June 2015: IDPs. Kramatorsk; Sloviansk; Svytahirsk; Kharkiv; Dnipropetrovsk; Zaporizhia) 28.1% caregivers children <2yrs (45% infants <6 mo) stopped breastfeeding due to stress related to conflict “Stress made my milk dry up”. …No time to wait in queues …Lack of social interaction with other mothers/friends…

8. 9 KEYS MESSAGES

9. ‘Nutrition-sensitive’ & ‘Nutrition-specific’ Nutrition-specific interventions address the immediate causes of under-nutrition, like inadequate dietary intake and some of the underlying causes like feeding practices and access to food Nutrition-sensitive interventions can address some of the underlying and basic causes of under/malnutrition by incorporating nutrition goals and actions from a wide range of sectors. They can also serve as delivery platforms for nutrition- specific interventions ”Seek to integrate psychosocial considerations as relevant into all sectors of humanitarian assistance” (IASC. 2007)

10. IYCF - MHPSS Sector Linkages

11. Formulating integration of sectoral activities Assess/monitor/evaluate mental health/psychosocial issues & needs of mothers with young children Promote gender- & age-disaggregated information systems incl registration Know & communicate the linkages between mental health & nutrition Collaborate with nutrition sector to develop key messages & resources Promote exclusive & continued breast-feeding & responsive feeding Support the controlled distribution & use of infant formula Support activities for caregivers (peer support & action-oriented groups Build staff capacities to integrate psychosocial support & infant feeding Ensure caregiving support for dependants of maternal mental health concern Train staff on identification of cases of feeding concern Establish coordinated referral systems for cases of concern

12. Nutrition sector A minimum response on Nutrition Emergency Interventions must be coupled with a specific set of complementary psychosocial and emotional relief interventions to greatly enhance a positive outcome of interventions Nutrition programmes that contain a psychosocial component are more effective in promoting growth and positive child development than nutritional programmes without a psychosocial component. They may also help to decrease maternal depression

13. Integrating MHPSS activities into the Nutrition sector Support training of nutrition/IYCF staff on basic psychosocial counselling Psychosocial support and education for appropriate feeding practices be provided to caregivers Integrate psychological and social impacts into nutrition analysis Implement activities that strengthen mothers coping adaptation mechanisms & psychosocial well-being, to improve feeding practices (e.g. peer support & action-oriented activities; counselling) Ensure referral of caregivers with potential mental health issues or depression to appropriate psychosocial services Collaborate with the MHPSS sector for development of communication strategies, design of activities, capacity-buildings…

14. THANK YOU Nutrition Sub-Cluster of the Health and Nutrition Cluster Кластерная группа по питанию Кластера здравоохранения и питания https://www.humanitarianresponse.info/operations/ukraine/nutrition