1. South Asia Breastfeeding Forum-3. 20-22 Nov. 2006. Kabul, Afghanistan Current Situation Infant and Young Child Feeding Current Situation BHUTAN

2. South Asia Breastfeeding Forum-3. 20-22 Nov. 2006. Kabul, Afghanistan Infant and Young Child Feeding practices IndicatorExisting status 1.Percentage of babies breastfed within one hour of birth81% (hospital based) (only 24% institutional delivery ) 2. Percentage of babies exclusively breastfed for 4 months.42% (National health survey, 2000) 3. Duration of breast feeding.28 months (Bohler et al,95 Situation Analysis) 4. Age at introduction of complimentary foodsNo data available but anecdotally very early introduction.

3. South Asia Breastfeeding Forum-3. 20-22 Nov. 2006. Kabul, Afghanistan Protein Energy Malnutrition status in under 5 (1999) IndicatorsPrevalence Weight/Age Height/Age Weight/Height 18.7 % 40 % 2.6 %

4. South Asia Breastfeeding Forum-3. 20-22 Nov. 2006. Kabul, Afghanistan Coordinating Mechanisms AchievementsProgress National breast feeding committee formed 2000 Sensitization of all parliamentarians on BF policy BFHI strongly advocated 1993. JDWNR Hospital declared baby friendly Adopted SAARC code for protection on BF and YCF Never met, transfer of members One time activity with no reinforcement No monitoring. Baby friendly status not expanded to other hospitals No monitoring. Other sectors not actively involved

5. South Asia Breastfeeding Forum-3. 20-22 Nov. 2006. Kabul, Afghanistan Baby Friendly Hospital Initiatives 1 hospital certified baby friendly Study conducted on BFHI in 2006, data collected from 3 referral hospitals Preliminary analysis: –None of the hospitals following ten steps –Lack of knowledge among health workers –No support groups (Ten steps posters printed and distributed to all the health centers) Lactation manual developed, and training will be conducted during the 1 st quarter of the 2007.

6. South Asia Breastfeeding Forum-3. 20-22 Nov. 2006. Kabul, Afghanistan Infant feeding in Emergencies/Difficult situation Main Achievements: Infant feeding guideline in HIV + mothers in place Severe Malnutrition manual developed and national level training held in 2003. Flip chart on feeding among the HIV +ive mothers. Main Gaps:LBW: no guideline Emergencies: Lack of experience, required training and technical support, collaborate with other sectors and program

7. South Asia Breastfeeding Forum-3. 20-22 Nov. 2006. Kabul, Afghanistan BFHI and PMTCT Main Achievements: Strong political will and commitment towards PMTCT Training and advocacy conducted in western region, 2006. (58 VCT counselors trained) Provision of free drugs and formula feeds ensured. Main Gaps:– No coordination between different programs (RHU, Nutrition, IMCI, and HIV/AIDS) – Intervention not yet implemented (lack of experience) – Issue of confidentiality, stigma and discrimination

8. South Asia Breastfeeding Forum-3. 20-22 Nov. 2006. Kabul, Afghanistan Infant and Young Child feeding No policy on IYCF National Breastfeeding Policy incorporates -Breastfeeding -Advice on complimentary feeds -Maternal and paternal leave -Advocacy and social mobilization Calls for: Guidelines for HIV & BF Training of Health workers Formation of national committee

9. South Asia Breastfeeding Forum-3. 20-22 Nov. 2006. Kabul, Afghanistan Marketing of Breast milk substitute Main Achievements:Adopted the SAARC code ?No domestic market Main Gaps:Implementation of the code not fully in practice Difficulty monitoring No coordination with other sectors No committee formed No authority for compliance

10. South Asia Breastfeeding Forum-3. 20-22 Nov. 2006. Kabul, Afghanistan Maternity protection Main Achievements: Exclusive BF for 4 months and continue for 2yrs Maternal leave 3 months (paternal 5 days) Establishment of NCWC, RENEW with support from highest authority. Main Gaps:Lack of uniformity between Govt. and Private sectors in supporting mothers. Lack of counselors or support groups Health workers not aware/trained Lack of coordination- NCWC, RH, Nutrition, RCSC, Private Sectors, NGOs RENEW

11. South Asia Breastfeeding Forum-3. 20-22 Nov. 2006. Kabul, Afghanistan Community support Effective outreach program VHW: 1200 well placed Traditional birth attendants NWAB and RENEW ICB Requires focus and establish common goals in terms of infant feeding

12. South Asia Breastfeeding Forum-3. 20-22 Nov. 2006. Kabul, Afghanistan Constraints Defining priorities: Policy level Coordination between all stakeholders and lack of an authoritative body Political will and commitment Funding Technical resources Monitoring and Evaluation IYCF not in curriculum of health school

13. South Asia Breastfeeding Forum-3. 20-22 Nov. 2006. Kabul, Afghanistan Achievements Three personnel trained Ten Steps of BFHI Printed and distributed Lactation manual developed Guidelines on feeding of Infant of HIV mothers Flip chart on feeding of HIV mothers PMTCT and VCT

14. South Asia Breastfeeding Forum-3. 20-22 Nov. 2006. Kabul, Afghanistan Cont.. Maternity leave ….3 months

15. South Asia Breastfeeding Forum-3. 20-22 Nov. 2006. Kabul, Afghanistan