1. Integrated Early Childhood Development at UNICEF: How does breastfeeding fit in? UNICEF Programme Division Nutrition Section

2. UNICEF Objectives of this Session Understand the general principles of I/ECD Explore how to introduce breastfeeding in discussion of I/ECD Explore how to introduce breastfeeding in discussions addressing the other 4 Strategic priorities Understand the 3 sectors enhanced by LAM Discuss the development of new “hooks” to increase interest in breastfeeding

3. UNICEF A World Fit for Children By 2010: Reduction of child malnutrition among children under five years of age by at least one-third, with special attention to children under two years of age, and reduction in the rate of low birth weight by at least one third of the current rate.

4. UNICEF Nutrition related MTSP target indicators Reduction in anemia prevalence among women of reproductive age by 15% > 60% of children receive appropriate home care for prevention and treatment of malnutrition > 60% of pregnant women use adequate antenatal services

5. UNICEF Focus of I/ECD Integrated ECD is based on child’s rights principles and the life-cycle approach, developed to co-ordinate actions at different levels, aiming to improve: – Quality of family care – Family access to good basic services and adequate livelihoods – Community & policy environment needed to support the previous points. General Goals: Child Survival, Growth and Development

6. UNICEF What is Integrated Early Childhood Development? The Importance of the Mother-Child Dyad “A good start on life” “Children under 3 y.o.” “Support women’s health, nutrition, and well-being” “Links to maternal health and survival”  Maternal nutrition for birth weight and maternal survival, early initiation of exclusive breastfeeding (EBF)  EBF, appropriate CF which includes responsive feeding, VitA, Birth spacing  Mother-child vs Child orientation, empowering caretaker to act and interact  If mom survives, the child is 3- 5 times more likely to survive

7. UNICEF Breastfeeding is the Heartbeat of Primary Health Logo, Breastfeeding Division, IRH Oral Rehydration Growth and Development Immunization Maternal Health and Survival Nutrition Birth Spacing and Fertility Reduced Cancer and Chronic Disease Breastfeeding supports:

8. UNICEF What is Optimal Breastfeeding? Six months exclusive breastfeeding Continued breastfeeding with appropriate complementary foods and feeding for 2 years and beyond Related maternal nutrition and care (Birth Interval of 3 years or more)

9. UNICEF Breastfeeding -> Early Childhood Development Decreased child desertion in hospitals Best growth in first 6 months Improved elements of neuro-psycho-motor development at age 1-2, and up to 12 Improved vision from a few months to years Increased independence and parental trust Increased intelligence quotient (IQ) assessed at ages 8 and 9 years; at age 18 years Decreased infectious and chronic illness, and decreased impact of several metabolic conditions, supporting continued thriving Increases in breastfeeding are associated with :

10. UNICEF Breastfeeding -> Early Childhood Development Increased adolescent perceptions of maternal caring Higher reading comprehension, mathematical ability, and scholastic ability assessed during the period from 10 to 13 years; Higher teacher ratings of reading and mathematics assessed at 8 and 12 years; Higher levels of attainment in school leaving examinations Contribution to birth intervals, allowing more attention to care and feeding, and maternal nutritional recovery: Result: children are alive and thrive!

11. UNICEF Mother-Child Dyad: The Heart of ECD Three years birth spacing for mother’s nutritional recovery Three years as youngest child Three years of stimulation and responsive feeding Three years of health-care seeking and preventive actions Maternal Protein, Calorie and Micronutrient Stores

12. UNICEF Current and Planned Interventions: The Same Target Audience for All ANTENATAL CARE SAFE DELIVERY ADEQUATE BIRTH WEIGHT OPTIMAL AND RESPONSIVE INFANT AND YOUNG CHILD FEEDING AT LEAST THREE YEARS BIRTH SPACING VIA FAMILY PLANNING USE ANTENATAL CARE MPS MNI Malaria Presumptive Tx/Nets Expanded MPS/SM BFHI “Expanded Step Ten” CODE MNI CF IMCI/CIMCI IMM FP(UNFPA) ECD LAM BF/CF CARE SEEKING

13. UNICEF Other MTSP Strategies Girl’s Education Immunisation Plus HIV/AIDS Child Protection  Cognitive and psycho-social achievement highly associated with breastfeeding  Breastfeeding provides first immune protection, and Vitamin A, among others, helps fight disease  Strong nutrition link; EBF decreases transmission  Nurtured and breastfed children less likely to be deserted and abused

14. UNICEF Conclusion: Supporting consistent OBF messages for the mother-child dyad at all contacts is I/ECD and yields MTSP results!

15. UNICEF Current and Planned Interventions: The Same Target Audience for All ANTENATAL CARE SAFE DELIVERY ADEQUATE BIRTH WEIGHT OPTIMAL AND RESPONSIVE INFANT AND YOUNG CHILD FEEDING AT LEAST THREE YEARS BIRTH SPACING VIA FAMILY PLANNING USE ANTENATAL CARE MPS MNI Malaria Presumptive Tx/Nets Expanded MPS/SM BFHI “Expanded Step Ten” CODE MNI CF IMCI/CIMCI IMM FP(UNFPA) ECD LAM BF/CF CARE SEEKING

16. UNICEF Birth Spacing Saves Children’s Lives: Relative risk of mortality with various birth intervals compared to a 3 year birth interval Months Birth Interval

17. UNICEF 1. Have your menses returned? 2. Are you supplementing regularly or allowing long periods without breastfeeding, either day or night? 3. Is your baby more than six months old? 4. The mother’s chance of pregnancy is increased. For continued protection, and to achieve a healthy three (3) years of child spacing, advise the mother to begin using a complementary family planning method and to continue breastfeeding for the child’s health, adding complementary feeding at about 6 months.. When the answer to one of these questions becomes YES.... NO There is only a one to two percent chance of pregnancy at this time. Ask the mother, or advise her to ask herself these three questions: YES The Lactational Amenorrhea Method -- LAM

18. UNICEF Approximate Annual Pregnancy Rate If: Non-lactating = 60% Lactating = 40% Lactating and amenorrheic = 15% Fully lactating and amenorrheic = 5% Fully lactating, amenorrheic, <6 months postpartum = 2% LAM users = <2%

19. UNICEF Why does LAM have improved efficacy? * Slightly, but significantly, shorter intervals * Slightly, but significantly, more feeding episodes per day * Greater attention to night feeds * Dedication to breastfeeding patterns for fertility impact * Conclusion: Women who choose LAM will practice closer to optimal breastfeeding behaviors

20. UNICEF Bellagio II CONFIRMED efficacy of LAM SUGGESTED further study might enable “relaxing” the fully breastfeeding and 6 month requirements DEFINED menses return as 2 consecutive days of bleeding or a vaginal bleed that the woman perceives of as a menses (after 8 weeks pp) ENCOURAGED worldwide implementation fo LAM for all of its positive impacts

21. UNICEF Breastfeeding vs LAM: Influencing other Sectors LAMBF  BF Patterns  Birth Spacing  Fertility  MTCT Increased Child Health and Survival  LAM use  FP Uptake

22. UNICEF Try to develop a new “hook”!! Select another sector (e.g., environment, food security, micronutrient programme, malaria, or other intervention area) that does not currently emphasize optimal breastfeeding Consider what intervention or concept could be “socially marketed” that would “hook” those from this other discipline that are not currently supporting optimal breastfeeding into being supporters of breastfeeding.

23. UNICEF Objectives of this Session Understand the general principles of I/ECD Explore how to introduce breastfeeding in discussion of I/ECD Explore how to introduce breastfeeding in discussions addressing the other 4 Strategic priorities Understand the 3 sectors enhanced by LAM Discuss the development of new “hooks” to increase interest in breastfeeding

24. UNICEF Thank you Asante-sana Salamat po Merci Gracias Danke Spasibo Abrigato Barakallaofik