Global Strategy On Infant and Young Child Feeding State of Implementation in the context of MDG4 Country: Nepal Presentation by: Raj Kumar Pokharel Chief, Nutrition Section Child Health Division/DoHS, MoHP

MDG –4 Mortality Rates Indicator Status 1991 Target 2015 Status 2006 Under Five Population 2751353 4825567 4038702 Under Five Mortality 162 54 61 IMR 108 34 48 NMR 52.4 17 33 Ref.: HMIS Report 2001 & NDHS 2006, State World’s Newborns, Nepal 2002

MDG 1 Nutritional Status of Children U5 Indicator Status in 2001 Status in 2006 % low birth weight 20-35% (Various Hospital Based Studies) 15-30% (Various Hospital Based Studies) % under-fives stunted 57 49 % under-fives underweight 43 39 Ref. : NDHS 2001 & 2006

MDG 4 Tracking 92 Indicator Coverage Level DPT immunization 89 Measles immunization 85 Use of improved drinking water facility 81.9 Use of improved sanitation facility 22.7 Skilled attendant at delivery 43.7 TT protection at birth 78.1 ORT for Diarrhea 92 Ref.: NDHS 2006

IYCF Practices Indicator Status in 2001 Status in 2006 Initiation of breastfeeding within 1 hour 31.1 35.4 Exclusive Breastfeeding for first 6 months 68.3 53 Median Duration of Breastfeeding 33 34 Bottle Feeding (< 6 mo.) 3.9 4 Complementary Feeding (6 - 9 mo.) 66.2 75 Ref. : NDHS 2001 & 2006

IYCF Policy Development In line with Global Strategy, National Strategy on IYCF, was approved in 2004 in Nepal and one of the major element is; “Reduction of PEM situation through promoting BF practice in under five children”

Breastfeeding: Policy Early Initiation of Breastfeeding within one hour of Birth. Exclusive Breastfeeding up to 6 months. Continuous Breastfeeding for at least for 2 years with timely introduction of complementary feeding after 6 months. Ref.: Infant & Young Child Feeding Strategy, 2004

Development of Human Resources as per Policy Masters Trainers at National Level in 2005 Trainers for Training in Regional Level in 2006. District level training on IYCF has been planned and will be conducted in all 75 districts of Nepal up to community level HWs from 2008 within 3 years Aimed to provide training/orientation also to community level health volunteers (FCHVs)

Ref.: Infant & Young Child Feeding Strategy, 2004 Program Advocacy for Maternal leave for 4 months and paternal leave with full pay, and implementation in all working places Promotion of early initiation of breastfeeding and exclusive breastfeeding for 6 months through : Celebration of breastfeeding week Media orientation and mobilization Intensive promotion in community level through partners like UNICEF and other NGOs. Advocacy for protection from commercial promotional practices which undermine optimal BF practices by strengthening the implementation of the Breastmilk (Marketing Control) Substitutes Act. Ref.: Infant & Young Child Feeding Strategy, 2004

Ref.: Infant & Young Child Feeding Strategy, 2004, Program Awareness raising to Health Workers about exclusive Breastfeeding in relation to HIV with emphasise on special counselling to HIV positive mothers (PMTCT). Promotion of mother and children friendly environment in health facilities in relation to maternity services (ANC, birthing practices and postpartum care) through reactivation of BFHI concept Creation of baby friendly communities supportive of mothers, fostered by family/community support groups and trained counsellors. Ref.: Infant & Young Child Feeding Strategy, 2004,

Coordination A committee on IYCF constituted representing members from program partners and stakeholders like UNICEF, Baby Friendly Hospitals, WHO, NEPAS and NGOs. National IYCF polices and strategies developed in coordination with concerned partners and stakeholders. Review, translation and printing of IYCF modules of WHO in Nepali for district level training is in process. Certification of breastmilk substitute products is being approved by Department of Food Technology and Quality Control and Breast milk Substitute Sub Committee on label approval.

Baby Friendly Hospital Initiative 7 Hospitals were declared as Baby Friendly Hospitals. Training provided to Doctors and Nurses on BFHI. Medical staffs encourage new mothers for early initiation and exclusive breast feeding.

Implementation of the International Code National Policies and Strategies formulated in line with the international code. Breastfeeding messages standardized according to international code, and monitored by Nutrition Program of MoHP. Orientation provided to implementing partners about the international code. Media personals were oriented about the international code in 2007.

Maternity Protection Nepal Government passed the rule of 60 days maternity leave and 15 days paternity leave for maternity protection.

Health and Nutrition Care Early initiation of breastfeeding and exclusive breastfeeding promoted through neonatal health strategy, MNH strategy. Importance of Postpartum mother’s nutrition is being promoted through different IEC channel. Continued support for the community nutrition program in DACAW districts.

Community Outreach Breastfeeding messages promoted through out reach clinics and health facilities. FCHVs and mothers group mobilized to disseminate breastfeeding message and encouraged communities to improve Breast feeding practices. Social Mobilizers of implementing partners mobilized to disseminate breastfeeding message and encouraged communities to improve Breast feeding practices.

Information Support Growth monitoring & counseling booklet developed for supporting health workers and community level volunteers. Breastfeeding manual is already in place for health workers. Development of IYCF manual in Nepali is in process. Different IEC materials on breastfeeding promotion developed and distributed through government and non government channels. Breastfeeding messages integrated into other health communication materials.

Infant Feeding and HIV UN recommendations for breast feeding practices in the context of HIV included in the “National Guidelines on PMTCT of HIV, 2005”. However, orientation on PMTCT package up to community level yet has to be conducted.

Infant Feeding During Emergencies Rehabilitation Centers located at various parts of country is supported with GON budget and therapeutic foods. Expansion of NRH is in process and will be established at 5 more hospitals within 2008 During recent flooding in Terai regions, emergency medical package was given.

Monitoring and Evaluation Growth Monitoring with counseling through health facility is under mainstream health program. HMIS is regularly collecting GM reports, and accordingly feedback is providing during regional review meetings. Periodic Surveys e.g. NDHS, MNSS, IDDSS

Gaps in Exclusive Breastfeeding Majority of mothers at community have lack of knowledge and skills on exclusive BF e.g. early initiation, non-use of Prelacteal food, techniques, duration of BF etc. Majority of mothers at community have lack of knowledge and skills on BF+ Complementary Feeding e.g. types, frequency, quantity etc. Inadequate awareness raising efforts to community for family support to mother for promotion of BF and sharing workload Lack of baby friendly environment Insufficient maternity leave Aggressive commercial promotional practices Lack of awareness of legal provision among people and multisectoral assistance is required for strong initiation and effective law implementation Slow expansion of IYCF Counseling Training to district and community level HWs and health volunteers.

Gaps In Complementary Feeding Lack of knowledge on nutritional value enriched food, practice and attitude Low feeding frequency Poor hygiene, food taboos Inappropriate feeding practice Lack of enabling environment Lack of time for mothers and care givers Lack of efforts for media motivation for awareness raising Lack of monitoring on implementation of policies Poverty

Thank you