2. 1 Breastfeeding Support in Early Emergency Response Utami Roesli & Sri Sukotjo Indonesian Breastfeeding Center / UNICEF

3. 2 Background Background Un-controlled donations of infant formula Un-controlled donations of infant formula Higher consumption of infant formula among those who received donations compared to those who did not receive donations Higher consumption of infant formula among those who received donations compared to those who did not receive donations Increased of diarrhea rates after the Earthquake and significant association between formula fed in the previous 24 hrs and diarrhea in infants Increased of diarrhea rates after the Earthquake and significant association between formula fed in the previous 24 hrs and diarrhea in infants

4. 3 MOTHER NEEDS SUPPORT How to reach large numbers of mothers rapidly?

5. 4 Managing The Training UNICEF commissioned Indonesian Breastfeeding Center to conduct the training in the most affected district of Klaten & Bantul UNICEF commissioned Indonesian Breastfeeding Center to conduct the training in the most affected district of Klaten & Bantul Worked with the District Health Office to ensure the sustainability of the programme Worked with the District Health Office to ensure the sustainability of the programme 12 facilitators BFC-C placed inside the communities (at the village level) 12 facilitators BFC-C placed inside the communities (at the village level) Participants were Community Workers/Volunteers & village Midwives Participants were Community Workers/Volunteers & village Midwives

6. 5 II AABB 1122334455 aaaa 66 aaaaaa bbbb CCDDEEFF 6 sub-village Trained 6 BF MOTIVATORS / sub village To graduate, each MOTIVATOR need to counsel at least 5 mothers. These mother recruited as peer educators in their communities Each PE required to promote BF to at least 2 or 3 families One facilitator based inside the community for 6 weeks would bring benefit for up to 360 families

7. 6 The Module WHO/UNICEF’s 40 hours Breastfeeding Counseling Course module WHO/UNICEF’s 40 hours Breastfeeding Counseling Course module Flip-Chart is developed to train mothers Flip-Chart is developed to train mothers

8. 7 1. Session 1 Why breastfeeding is important 2. Session 3 How breastfeeding work 3. Session 4 Assessing a breastfeed 4. Session 5 Observing a breastfeed 5. Session 6 Listening and learning 6. Session 7 Listening and learning exercises 7. Session 9 Clinical Practice 1 8. Additional 1 Food hygiene and feeding techniques 9. Additional 2 Preparation of milk feeds - practical 10. Session 11 Building confidence and giving support 11. Session 12 Building confidence exercises 12. Session 10 Positioning a baby at the breast 13. Session 13 Clinical Practice 2 14. Session 16 Refusing breastfeeding 15. Session 20 Expressing breastmilk 16. Session 21 “ Not enough milk “ 17. Session 22 Crying 18. Session 23 “ Not enough milk “ Crying exercises 19. Session 24 CLINICAL PRACTICE 3 20. Session 27 Increasing breastmilk and relactation 21. Session 28 Sustaining breastfeeding 22. Session 32 Wonen and work 23. Session 33 Commercial promotion of breastmilk subtitutes 24. Session 29 CLINICAL PRACTICES 4

9. 8 For clinical practices, breastfeeding and pregnant mothers were brought-in into the training session For clinical practices, breastfeeding and pregnant mothers were brought-in into the training session Facilitators meet every evening to evaluate the process of the training on that day. Facilitators meet every evening to evaluate the process of the training on that day.

10. 9 Every Sundays the Facilitators helped breastfeeding mothers with difficulties Every Sundays the Facilitators helped breastfeeding mothers with difficulties

11. 10 Course Director Course Director IIIIIIIIIIIIIVIV AABB 1122334455 159 sub-village 2130 moms Peer educators aaaa 4260 aware of breastfeeding RESULTS 66 aaaaaa bbbb CCDD 426 motivator 2130+ 4260 = 6390 Supporting Mom Communities EEFF VVIVIIVIIIIX X XIXII

12. 11 Training conducted in a Tent

13. 12 Training conducting in a Village Center

14. 13 Clinical practices at the community

15. 14 IS THE TRAINING DIFFICULT ? 89% NO 11% YES

16. 15 Challenges Many community workers and health workers were in the “traumatic” phase Many community workers and health workers were in the “traumatic” phase Difficult to find community workers who have commitment to participate in the training Difficult to find community workers who have commitment to participate in the training Different level of education also provided challenges in facilitating the training Different level of education also provided challenges in facilitating the training Facilitators/Trainers need to ensure that they are able to follow the course Facilitators/Trainers need to ensure that they are able to follow the course Private one-to-one training was conducted if they are not able to come to the training Private one-to-one training was conducted if they are not able to come to the training Minimal support from the local health office– Minimal support from the local health office– More focus on building new premises, health system, and other health issues More focus on building new premises, health system, and other health issues

17. 16 Result Of 50 mothers assessed and who gave birth after the Earth Quake, most (63%) are exclusively breastfeed regardless of access to free formula - mainly due to the counseling / support they received from trained health workers and volunteers Of 50 mothers assessed and who gave birth after the Earth Quake, most (63%) are exclusively breastfeed regardless of access to free formula - mainly due to the counseling / support they received from trained health workers and volunteers

18. 17 Result Result Introduction of early initiation to breastfeeding during the training Introduction of early initiation to breastfeeding during the training Early initiation to breastfeeding were successfully conducted by trained village midwives and community health workers. Early initiation to breastfeeding were successfully conducted by trained village midwives and community health workers.

19. 18 Lesson Learned-1 The training reached a large number of mothers The training reached a large number of mothers Facilitators placed in the community, provided breastfeeding counseling services to mothers who have difficulties in the affected areas Facilitators placed in the community, provided breastfeeding counseling services to mothers who have difficulties in the affected areas Sustainability of the breastfeeding services in the community Sustainability of the breastfeeding services in the community

20. 19 Lesson Learned-2 Klaten District, one of the affected areas : Klaten District, one of the affected areas : Facilitators : 8 Facilitators : 8 Counselors : 190 Counselors : 190 Motivators : 310 Motivators : 310 Next week they plan to add 8 more facilitators, at least 20 more counselors and 350 motivators Next week they plan to add 8 more facilitators, at least 20 more counselors and 350 motivators

21. 20 Information received by motivators for such an extended period has increased the confidence of the motivators to assist breastfeeding mothers (although most of them did not have any health related background)

22. 21 THANK YOU CD from the field on the counseling services experiences is on your folder