1. IYCF-E ASSESSMENT PRELIMINARY FINDINGS DONETSK NGCA APRIL 6-8, 2015 Save the Children International Ukraine

2. 2 Assessment Methodology Location: Donetsk, Hoorlivka, Yenakyve Key Informant Interviews: Donetsk: Executive Director, Mother and Child Care Center Hoorlivka: Head of Health, City of Hoorlivka; Head Pedeatrician, City of Hoorlivka Yenakyve: Head Nurse, Polyclinic; Matron, Polyclinic Focus Group Discussions: Hoorlivka: 14 mothers (4 with children <6 mos; 10 with children 6-23 mos) Tools: KII Interview Guide FGD Interview Guide Both Tools based on IYCF-E Toolkit. Tools adapted to Ukranian context; reviewed and revised with assistance from nutrition subcluster.

3. 3 Infant Feeding Practices (0-6 mos) Knowledge of optimal infant feeding behaviors seems to be known (ie – EBF through 6 months with preference for EBF vs use of infant formula) Pre-crisis – all respondents in KII and FGD suggested EBF rates were closer to 50% (vs 20% in MICS 2012) Since Crisis – all respondents believed EBF rates had dropped to 10-20% EBF at the highest. Current practices reported were mixed feeding. One mother suggested “order of preference” being (1) breastfeeding (2) infant formula (3) animal milk mixed with water (4) semolina mixed with water. Semolina prepared with water was the most common breastmilk substitute mentioned after infant formula.

4. 4 Infant Feeding Practices (0-6 mos) cont. Primary challenges for breastfed infants: (mentioned by all respondents) Stress “drying up mother’s milk” Poor maternal nutrition Primary challenges for non-breastfed infants (mentioned by all respondents) Availability – limited availability for purchase; (donations on future slide) Cost – Price of Infant Formulas now 2x higher than pre-crisis Variety – frequent mention of limited variety of infant formula (and baby products more generally.) Mothers mentioned this as a problem b/c of a tolerance issue to various products, ie – if your baby can’t tolerate a certain formula (vomiting, refusal to eat), there are no other options to offer. Coping Strategies Access to Infant Formula: Use of savings to purchase BMS when available, request from relatives/friends from Russia, Replacement of Infant Formula: Use of animal milk and water or early initiation of complementary feeding (ie - use of semolina mixed with water)

5. 5 Young Child Feeding Practices (6-23 mos) Pre-Crisis – (reported) Initiation of complementary feeding between 6-9 months introducing a new food group each month; starting with veg, followed by kashki, then by juice, next meat and eggs, and finally fruit. After Crisis (report) Introduction varied based on breastfeeding/infant formula availability, etc Heavily reliant on starches; some veg available (carrots, cabbage) (1x/wk) Limited dairy available No meat, juice or fruit accessible due to availability and cost Coping Strategy: Limited dietary diversity Impact on meal frequency

6. 6 Sources of Support Pre-Crisis and Post –crisis All respondents reported their first and primary source of information and advice were the polyclinic pediatricians. Secondary sources of information are family and friends and/or internet Pre-crisis – Hoorlivka reported having started Mother-to-Mother Support Groups however these have been suspended since the war started. IYCF Programming Reports of USAID IYCF Programming pre-crisis Reports of UNICEF IYCF Programming precrisis: ie – Hoorlivka main hospital and polyclinic awarded with Baby Friendly Hospital Initiative certificate in 2004 and 2010 Polyclinics did offer support and advice, however, currently there is a need to provide more intensive IYCF Counselling support to prevent the movement from EBF to BMS.

7. 7 Humanitarian Aid Donations of infant formula and baby foods Primary source of foods and products for <2s was Akhmetov Foundation – Coverage and targeting varied between Donetsk (100% coverage of 3 children) Provided with accompanying literature. As of April 1 st, packages in Donetsk have been revised to include infant formula 6-12 months (no longer <6 months) Other sources: “one off donations” of BMS (infant formula and animal milk) provided through polyclinic system with no or limited accompanying literature

8. 8 Preliminary Recommendations Full IYCF-E Assessment in NGCA and GCA of Donetsk (Save the Children, May 2015) Programming 0-6 months olds including: IYCF programming including one-on-one skilled support Mother-to Mother Support Groups Targeting Breastmilk Substitute Programming Inclusion of PLW in blanket food distributions Programming for 6-23 month olds including: Food baskets designed considering complementary feeding needs. Special inclusion of meats and fresh fruit/vegetables Support for continued breastfeeding through 2 years. Integrated programming entry points to support “Basic IYCF Interventions” Child Protection (Psychosocial First Aid) Education (Early Childhood Care and Development), FSL (Food baskets, Vouchers and Cash/Food for Work), WASH (provision of diapers and specialized hygiene items)

9. 9 ANY QUESTIONS?