GSIYCF IYCF

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

Overview: 

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)

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IYCF PRACTICES

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Exclusive Breastfeeding Rates

IYCF Indicators (MICS,2000): 

IYCF Indicators (MICS,2000)

Other IYCF Indicators: 

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: ……… %

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IYCF POLICIES & TARGETS

National IYCF Policies: 

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

Criteria for effective policies on IYCF : 

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

Criteria for effective policies on IYCF: 

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.)  

National Coordinators & committees: 

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

Baby-friendly Hospital Initiative achievements : 

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*

Active & sustainable BFHI-Criteria: 

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

International Code of Marketing of Breast-milk Substitutes : 

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

Suggested actions to promote Code Implementation: : 

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

Legislation protecting and supporting breastfeeding among working mothers : 

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

Legislation protecting and supporting breastfeeding among working mothers: 

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.

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NATIONAL IYCF PROGRAMS

National Program/Plan of Action for IYCN: 

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

Health care provider (pre-service) education : 

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

In-service training for health care providers : 

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

In-service training for health care providers: 

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)

HIV and infant feeding: 

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

HIV and infant feedingCriteria: 

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.

Community outreach and support : 

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

Information, education & communication: 

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

Growth Monitoring & Nutrition Surveillance: 

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

Research for decision-making : 

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

Research for decision-makingCriteria: 

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.

Other important areas: 

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