IYCF ORIENTATION WASH Date: Location: Sana’a, Yemen Photo: Save the Children, Yemen

Session Objectives By the end of this session, you will be able to: Understand why IYCF(E) is important. Know the recommended IYCF practices. Know how to report untargeted distributions of breastmilk substitutes. Understand that integration of IYCF in different sectors is crucial due to multi- sectoral causes of malnutrition. Understand how you can support IYCF.

What is IYCF? I = Infant Y = Young C = Child F = Feeding Infant = 0 - 11 completed months Young child = 12 - 23 completed months SAY: We know that today we have gathered to discuss about IYCF, and specifically the “IYCF Framework: A multi-sectoral Framework for Action” and how YOU fit into this as a ‘champion’. So, let us first cover some basics. What is IYCF? DO: Now show the slide and go over the acronyms one by one. And now let us go over the age range of an infant and young child. Now, show the age ranges and the picture. Therefore, the focus of IYCF is always children under two, and the mother and/or any other caregiver of that child because a child this age is dependent on their caregiver. Pregnant women are also a target group, because they will become a mother of a baby and that baby’s health hinges on his mother’s health, as we will demonstrate later in this session. So, you cannot ignore the caregiver/mother if your focus is a child under two years.

EMEGENCIES INCREASE RISK Why focus on IYCF? Extremely Vulnerable to Illness Malnutrition Death Increased risk Chronic diseases Lower productivity Long term Consequences EMEGENCIES INCREASE RISK SAY: The first two years of life is a period of rapid growth and body demands are high. Which is why when those needs are not met, children get malnourished. Their body lacks nutrients and energy. Children under two are also vulnerable to illnesses and death. You may have seen malnutrition yourself. See if you recognize any of the signs in the pictures. DO: Show the pictures one by one, as you name the manifestations. Children can become extremely thin or wasted (mouse click), have water-retention or edema (mouse click), become short for age or stunted (mouse click) (Both the girls are 3 and half years of age but we can clearly see that one of the girls is shorter than the other girl) and have micronutrient deficiencies such as anemia (mouse click), which is deficiency of a micronutrient called iron. But it doesn’t end there (mouse click), children suffer long term consequences (mouse click). Children who fail to catch up on their growth suffer illness and death later in life. And if they gain weight, for example, in later years, it increases their likelihood of chronic diseases such as heart disease. Children who do not attain their full growth, also have lower productivity as adults and therefore have lower wages. (mouse click) Emergencies put children under increased risk of dying. In emergencies, children are 2-70 times more likely to die. Even in previously healthy populations, death rates can increase 20fold and malnutrition can set-in in just 2 weeks. Save the Children, Yemen, 2017 Mayaclinic, 2014 FANTA, 2008 Rae Galloway, 2006 Source: Guiding principles for IYCF during emergencies, WHO , 2004.

Recommended IYCF Practices ONLY breastmilk Other solids, semi-solids, liquids at 6 months with continued breastfeeding up to 2 years SAY: This brings us to the question: what are the recommendations for optimal IYCF practices? We talked about breastfeeding and complementary feeding in the last slide. Lets take a closer look at them. DO: Now, show the slide. Optimal IYCF recommendations are: Early initiation of breastfeeding – this means breastfeeding within 1 hour of birth Mouse Click to show definition of EBF. Exclusive Breastfeeding for 6 months – exclusive breastfeeding means an infant receives only breastmilk, no other liquids or solids, not even water, with the exception of necessary vitamins, mineral supplements or medicines. It is recommended to not to use any artificial feeding which includes feeding breastmilk substitute or infant formula, unless it is medically necessary. Also, no use of feeding bottles, treats or pacifiers. Continued breastfeeding to 2 years or beyond - Complementary feeding encompasses continued breastfeeding, the introduction of complementary foods at six months, and how that is done in the nutritional and developmental interests of the child. Mouse Click to show definition of CF. In Yemen the EBF rate is only 10%. Source: GNC IFE training 2011

Higher RISKS for non-breastfed children SAY: This graph shows that the highest risks of morbidity and mortality are consistently among anfants who are not breastfed. For example, the highest risk of mortality and pneumonia, which is around 16%, is among infants who are not breastfed at all from 0-5 months. However, this risk is reduced up to only 1% when infants are exclusively breastfed. Even if the infant is partially breastfed, this risk is still very low, around 3%. Infants who are not exclusively breastfed are 11 times more likely to die of diarrhoea Breastfeeding could prevent 72% of admissions for diarrhoea

Recommended IYCF Practices DO: Show the first picture. SAY: This is how artificial feeding or feeding infant formula with a bottle is advertised and it actually may look like this in reality under normal circumstances. Show the next picture. But, this is how it actually is during emergencies. The risks of artificial feeding are heightened in emergencies, with constraints on water and sanitation, fuel, preparation, storage and supplies. Therefore, infant formula or breastmilk substitutes should not be given unless there is a medical reason to do so. Bottles, teats and pacifiers should not be used. Priyanka.guru The Guardian, 2010

Breastmilk Substitutes (BMS) Breast Milk Substitute (BMS): Any food being marketed or otherwise presented as a partial or total replacement for breast milk, whether or not suitable for that purpose. Infant Formula Other milk products Follow-on milks Baby Teas & Juices Infant Cereals Vegetable Mixes Artificial Feeding: where an infant or young child is fed with a BMS (partial or exclusive)

International Code on Marketing of BMS NO untargeted distribution of BMS Email Code Violations to: bms.codeviolations.yemen@gmail.com SAY: In emergencies, targeting and use, procurement, management and distribution of BMS, milk products, bottles and teats should be strictly controlled based on technical advice. provide examples of violations Yemen Breastfeeding Legislation adapted from International Code International Code: Advertising, Samples, Health Care, Facilities, Health Workers, Supplies, Information, Labels, Products

Recommended IYCF Practices Its TRUE! Even malnourished mothers can breastfeed. Stress does not prevent mothers from producing milk. Infant Formula is NEVER as good as breast milk. Donations and untargeted distribution of breast milk substitutes may undermine a mother’s confidence and motivation to breastfeed. Cholera is NOT transmitted in breastmilk. The ultimate way for cholera prevention in infant < 6 months is the exclusive breastfeeding. SAY: Even Malnourished mothers can breastfeed. Stress does not prevent mothers from producing milk. Infant Formula is NEVER as good as breast milk. Donations and untargeted distribution of breast milk substitutes may undermine a mother’s confidence and motivation to breastfeed.

Why is WASH so important? Pregnancy: Food and waterborne diseases can harm unborn baby Delivery: Women who give birth in households with poor sanitation are more likely to die 0-23 months: Especially vulnerable to poor WASH, 50% of underweight in children is due to poor water, sanitation, and hygiene. Excreta: Young children’s excreta more dangerous (pathogen load up to 6 times higher. Young children more likely and more vulnerable to faecal exposure. Say: mention UNICEF Framework of Malnutrition Mention Emergency Sanitation for <5 – a report published by Save the Children.

Water Breastmilk is 88% water Many mothers feel thirsty during & after breastfeeding *Varies depending on metabolism, environment, level of activity etc. Safe water is needed to: Wash & prepare food (complementary feeding) Clean cooking and feeding utensils Give children >6 months to drink Wash hands Average Water Consumption Breastfeeding mother Pregnant woman Not pregnant or lactating 3.1 Litres/Day 2.3 Litres/Day 2.2 Litres/Day

Why is WASH so important?

IYCF Framework: A Multi-Sectoral Framework for Action Multi-Sectoral Approach IYCF Framework: A Multi-Sectoral Framework for Action SAY: The “IYCF Framework: A Multi-Sectoral Framework for Action” is a tool for UNHCR and partners, which has been designed for national and international staff working in refugee operations to provide guidance to managers and technical staff across all sectors on what needs to be considered to create an ‘infant and young child friendly’ environment and facilitate optimal IYCF. This Framework enlists key and overarching activities that each sector can adopt to integrate IYCF in their respective sectors.

Integrated Activities Report uncontrolled BMS distributions (all sectors) Provide hygiene promotion at HFs Ensure handwashing facilities are available at HFs Prioritize PLW for interventions. Put this as one of the criteria of targeting. Ensure caregivers of artificially fed children have access to a safe water supply and prioritize breastfeeding mothers for provision of potable water

THANK YOU QUESTIONS?