1. Infant & Young Child Feeding - Caribbean Situation Paula Trotter
Caribbean Food & Nutrition Institute
October 13-14, 2005
Martinique

2. Overview Infant and young child feeding practices
Infant and young child feeding policies & targets
Infant and young child feeding programs
Adapted from Infant and Young Child Feeding. A tool for assessing national practices, policies and programmes. WHO (2003)

3. IYCF PRACTICES

4. Exclusive Breastfeeding Rates
Country
Rate (Year)
Age of Child
Source of Data
Antigua
41.1 (2000)
6 wks
HIS
Dominica
33.9 (2000)
4 mos
Survey (not routinely collected through HIS)
Guyana
15.3 (2000)
< 4 mos
MICS
Jamaica
47.3 (2002)
35.6 (2002)
3 mos
MCSR
Montserrat
82.0 (2002)
70.0 (2002)
St. Kitts
(2003)
(2003)
2.5 (2003)
4 -6 mos
HIS (monthly data available)
Belize
(2004)
MCH report
Suriname
(2000)
< 4 mos
Trinidad & Tobago
1.8 (2000)

5. IYCF Indicators (MICS,2000)
Guyana
Suriname
Trinidad
Adequate Complementary feeding rate
(6 – 9 months)
42.3
24.5
19.2
Continued breastfeeding rate (1 year)
49.6
42.9
26.2
Continued breastfeeding rate (2 years)
30.5
11.1
10.0

6. Other IYCF Indicators
Percentage of babies breastfed within one hour of birth: ……. %
Percentage of babies 0–<6 months of age exclusively breastfed in the last 24 hours: ……… %
Median duration of breastfeeding of children under 36 months: ……… months (The age in months when 50% of children are no longer breastfed )
Percentage of breastfed babies 6–<10 or 7–<10 months of age who received complementary foods in the last 24 hours: ……… %

7. IYCF POLICIES & TARGETS

8. National IYCF Policies
In Draft
Anguilla
Antigua
Bahamas
BVI
Cayman Is.
Grenada
Haiti
Jamaica (IYCF)
St. Kitts & Nevis
St. Lucia
Suriname
Trinidad (Hosp.)
BF policies - Approved & Implemented
Barbados (Hosp.)
Dominica (Hosp.)
St. Vincent & Gren.
Guyana

9. Criteria for effective policies on IYCF
National in scope and officially adopted by the government
Promotes IYCF practices consistent with international guidelines
Addresses provision of skilled counselling and support in the health system and communities
Covers guidelines for HIV and infant feeding and provides for counselling and support related to this issue

10. Criteria for effective policies on IYCF
Addresses the management of IYCF in emergency situations
Covers the other policy issues in the Global Strategy
Is routinely distributed and communicated to those managing and implementing relevant programs
Is appropriately integrated into other relevant national policies (health, nutrition, AIDS, family planning, integrated child health & education policies, etc.)  

11. National Coordinators & committees
Active BF/IYCF*
committees
BVI
Cayman Is.*
Guyana
Jamaica
St. Kitts & Nevis
St. Vincent & Gren.*
Haiti
Criteria
A national coordinator is responsible for IYCF
Meets on a regular basis (at least twice a year)
Provides guidance to national program (s)
Coordination takes place between sectors and relevant initiatives dealing with IYCF
National Programs – GUY, SVG, BEL, HAI

12. Baby-friendly Hospital Initiative achievements
“Baby-Friendly” Hospitals
Barbados (1)
Dominica (1) of 3
Guyana (3) of 12
Haiti
Jamaica (10) of 23
St. Vincent & Gren. (1) of 6
TT (1) of 5
Actively working towards target
Trinidad (2)
St Kitts & Nevis (2)
Guyana (11)
BVI (1)
Jamaica*

13. Active & sustainable BFHI- Criteria
Integrated within the health care system
Coordinator – leadership role
Ongoing training
Assessment of additional health facilities
Monitoring and/or reassessment of designated facilities
Availability of technical support when improvements are needed
Public education

14. International Code of Marketing of Breast-milk Substitutes
Lack of attention to adoption of national legislation or regulations
Promotion in health system prohibited
MCH norms or unwritten regulations
inadequate monitoring systems
General lack of awareness of the rationale and relevance of the Code

15. Suggested actions to promote Code Implementation:
Raise awareness – link to CRC
Build consensus on the preparation of national regulations & system of monitoring
Training of health workers
Public education
Request support at regional level

16. Access to health care – good coverage in some countries
Legislation protecting and supporting breastfeeding among working mothers
The ILO Maternity Protection Convention (No.183) has not been fully ratified or enacted
Access to health care – good coverage in some countries
Maternity leave – entitlements linked to social security contributions
The Global Strategy for Infant and Young Child Feeding calls for adopting and monitoring the application of a policy of maternity entitlements, consistent with the ILO Maternity Protection Convention No.183 (29) and recommendations.

17. Legislation protecting and supporting breastfeeding among working mothers
ILO Convention 183 -
at least 14 weeks of paid maternity leave
daily breastfeeding breaks
job protection and security
ILO Recommendation
191 –
at least 16 weeks of paid maternity leave;
parental leave should be given;
breastfeeding facilities in the workplace.
International Labour Conventions have the legal status of international treaties. The Constitution governs conditions for their drawing up and adoption by a two-thirds majority of Conference delegates. Once adopted, a Convention must be submitted to the competent authorities of each member State for ratification or other appropriate action. At the request of the Governing Body, member States must report on the state of their law and practice within the area covered by a Convention, whether it has been ratified or not. The ratification of a Convention involves a commitment by the member State to render its provisions effective within its national legal system, and to provide information to relevant ILO supervisory mechanisms for this purpose.

18. NATIONAL IYCF PROGRAMS

19. National Program/Plan of Action for IYCN
National Programs
Belize
Guyana
Grenada
St. Vincent & Gren.*
Haiti
Some aspects of IYCN
promotion may form part of
MCH services
Criteria
Comprehensive, national in scope
Has targets or measurable objectives
Has adequate funds for its implementation
Is multisectoral with coordination among programs and initiatives at different levels
National Programs – GUY, SVG, BEL, HAI

20. Health care provider (pre-service) education
Do the training curricula
of medical, nursing,
midwifery, allied/public
health, and nutrition
education programs
provide students with the
attitudes, knowledge and
skills necessary to
protect, promote, and
support optimal IYCF?
See WHO checklist for a list of objectives and content/skills that should be covered
WHO/UNICEF have developed a number of courses

21. In-service training for health care providers
WHO/UNICEF Breastfeeding
Counseling course conducted
in –
Antigua
Anguilla
BVI
Belize
Dominica
Haiti
St. Kitts & Nevis
St. Vincent
Suriname
Trinidad & Tobago
Grenada - 1 trainer
WHO/UNICEF HIV/Infant
Feeding Counselling course
conducted in –
Antigua
Belize
Guyana
Suriname
Trinidad & Tobago
Also regional course by
UNICEF

22. In-service training for health care providers
Criteria
Provided throughout the country
Covers most of the essential topics related to IYCF (see WHO checklist)
Clinical and counselling skills are integrated into the content of the training programs - at least 30% of training time
Content and skills related to IYCF are integrated, as appropriate, into relevant training programs (including diarrhoeal disease, ARI, IMCI, well-child care, family planning, nutrition, early childhood education, child care services, HIV/AIDS)

23. HIV and infant feeding Policies Antigua Bahamas Barbados Belize*
Dominica
Guyana
Jamaica
Suriname*
Policy development not integrated with other IYCF related policies or guidelines
Mainly avoidance of breastfeeding
Inadequate attention to infant feeding counselling

24. HIV and infant feeding Criteria
Training given on HIV and IFC
Antenatal VCT is offered routinely to pregnant women and, where possible, to their partners
Locally appropriate infant feeding counselling offered with follow-up
Special efforts are made to protect, promote, and support breastfeeding in the general population
Ongoing monitoring is in place
The national BFHI provides guidance on support to HIV-positive mothers.
effects of interventions to prevent HIV transmission
health outcomes for mothers and infants

25. Community outreach and support
Includes -
Individual/group counselling
cooking demonstrations
community education
mother-to-mother support groups
Criteria
National in scope
Non-health organizations (e.g. education, day care services) & CBOs involved
Are integrated into an overall infant and child health strategy
Community outreach and support is an essential component of a comprehensive national infant and young child feeding programme. Community outreach and support activities related to breastfeeding and complementary feeding may be health-facility based (as called for in Step 10 of the BFHI) and/or community-based. They can also be integrated into existing non-health activities, where appropriate.

26. Information, education & communication
Activities:
Individual/group counselling
Sporadic use of electronic media
Preparation of print materials
WBW*- a variety of media and channels
Absence of comprehensive national IEC strategy
WBW
Antigua
Cayman Is.
Grenada,
Guyana,
Jamaica,
Montserrat
St. Vincent
Suriname
Trinidad
There is a comprehensive national IEC strategy for improving IYCF
.A national IEC campaign or programme using electronic, print and event media and activities has channelled messages on infant and young child feeding to targeted audiences during the past 12 months.
IEC programmes (either governmental or nongovernmental) that include infant and young child feeding issues are being actively implemented at local levels.
Individual counselling and group education services related to IYCF are available within the health care system or through community outreach. T
he content of IEC messages is technically and clinically sound, based on national or international guidelines.
The focus and wording of messages is based on formative research and pretested with target audiences before use.
A mechanism is in place, involving all major players, to assure that IEC messages provided through electronic, print and event media as well as education and counselling activities, are coordinated and consistent.

27. Growth Monitoring & Nutrition Surveillance
GMP
On-going in all countries
Coverage good in first 2 yrs
Based on wt/age
Closer monitoring needed
Equipment
Counselling & follow-up
Revision of charts necessary
Surveillance
On-going in 7 (ANU,
BEL,GUY, JAM, HAI,
MON, SKN)
To facilitate timely &
targeted actions –
Indicators & coverage
Data quality
Collection & reporting procedures

28. Research for decision-making
To guide policy development & program planning
Trends in nutrition problems & practices (e.g. Jamaica, Guyana, Haiti, MICS
KAPs re IYCF (e.g. Guyana, Dominica, St. Kitts & Nevis)
Other needs –
Information on IYCF practices (foods, amounts, frequency, energy & nutrient densities)
Planning & evaluation of behavioral change interventions
Impact & quality of training programs
The effectiveness of policy and programme decisions can be greatly enhanced if policy-makers, managers, and staff have access to up-to-date information on the issues and strategies being considered. Well-designed and timely research can provide some of the information needed. Priority needs for information should be identified at the national level and mechanisms developed for dissemination, review, and utilization of research results and other information to guide policy and programme decisions

29. Research for decision-making Criteria
A national research advisory group exists
Development of a national inventory of applied and basic research on key topics related to IYCF
Priority needs for infant and young child feeding related information are identified
Data gathered, when feasible, from existing studies and other data sources (either domestic or international).
Research on priority topics is financed by the national IYCF program and/or by other appropriate donors
Research results are routinely disseminated to key decision-makers - to guide policy and program decisions as part of the planning and management process.

30. Other important areas Mother-friendly childbirth strategies
Contraceptive support for breastfeeding women
Infant and young child feeding in emergencies