What is the problem?
Emergencies responses are often characterized by large influxes of unsolicited donations of breastmilk substitutes, bottles, teats, and other baby food and milk products. Generous donations often do more harm than good in emergencies- read the IBFAN 2000 briefing paper. Also see “Donated breastmilk substitutes and incidence of diarrhea among infants and young children after the May 2006 earthquake in Yogyakarta and Central Java” https://www.ibfan.org/art/2011_BMS-and-diarrhoea-PHN.pdf (Public Health Nutrition September 2010, Hipgrave & co).
The International Code of Marketing of Breastmilk Substitutes and relevant subsequent World Health Assembly Resolutions are all the more important in emergencies. Monitoring IBFAN monitoring form and reporting Code violations IBFAN-ICDC Focus publication in emergency situations are key components of all emergency responses.
What can be done?
Breastfeeding plays a vital role in emergencies, protecting infant and young child survival, health and development, as well as maternal health and the bonding between mother and baby, so precious in difficult situations. Yet protection promotion and support of breastfeeding is lacking in emergencies, and humanitarian agencies lack information and training on how to protect promote and support breastfeeding, as well as how to support non breastfed children while not undermining breastfeeding.
See the calendar and action folder from the World Alliance for Breastfeeding (WABA) World Breastfeeding week 2009: Breastfeeding- a vital emergency response. Breastfeeding – a vital emergency response written by ENN and IBFAN, as key members of the “IFE core group”, with input from other key collaborators.
See presentation on “Breastfeeding- a vital emergency response” given at the Canadian National Breastfeeding congress, October 2011 Attach Canada presentation Pdf
The IBFAN BPNI 2010 “State of Breastfeeding in 33 countries- Tracking Infant and Young Child feeding policies and programmes worldwide” report, concluded that “infant feeding in emergencies is not a priority in most countries” and “countries are generally ill-equipped to handle infant feeding in emergencies”. This report summarized the situation of 33 countries with regard to infant and young child feeding. IFE is included as one of the 10 indicators for action on infant and young child feeding.
Yet, emergency preparedness is essential and emergencies can actually end up being opportunities for public health.
see full report at http://www.worldbreastfeedingtrends.org/report/The-state-of-breastfeeding-in-33-countries-2010.pdf
IFE Core Group
IBFAN, represented by IBFAN-GIFA, is an active member of the interagency working group on Infant Feeding in Emergencies (the IFE core group).
The IFE Core group is coordinated by the Emergency Nutrition Network (ENN). Members of the IFE Core group include non-governmental and UN agencies (for the list of members of the IFE Core group seewww.ennonline.net/ife).
The IFE Core group represented by the ENN is a member of the IASC Inter-agency Standing Committee Nutrition cluster
Aim of the IFE Core group: To develop policy guidance and capacity building in the field of Infant Feeding in Emergencies.
Key documents developed by the IFE Core group over the past 10 years include:
The Operational Guidance on Infant and Young child feeding in emergencies
(version 2.1, February 2007)
For the protection and support of appropriate infant and young child feeding in emergencies, this is a key document. The aim of the Operational Guidance is to ensure optimal infant and young child feeding practices in emergencies. The International Code of Marketing of Breastmilk Substitutes and relevant subsequent World Health Assembly resolutions is embedded throughout the Operational Guidance. There is also a clear statement on the importance of preventing and avoiding donations of breastmilk substitutes, bottles, teats and other milk products in emergencies.There is also a whole section on how to minimize the risks of artificial feeding. It is also reflected in the new Sphere guidelines (see below).
Translated into 11 languages
Supported by a large number of NGOs, donors, and UN agencies (see www.ennonline.net/ife).
Adopted in May 2010 by resolution 63.23 of the World Health Assembly (WHA):
” urges Member states to ensure that national and international preparedness plans and emergency responses follow the evidence-based Operational Guidance for Emergency Relief Staff and Programme Managers2 on infant and young child feeding in emergencies, which includes the protection, promotion and support for optimal breastfeeding, and the need to minimize the risks of artificial feeding, by ensuring that any required breast-milk substitutes are purchased, distributed and used according to strict criteria”;
WHA Resolutions text 2010 http://apps.who.int/gb/ebwha/pdf_files/WHA63-REC1/WHA63_REC1-P2-en.pdf
This policy development is excellent news and gives all NGOs working on infant feeding and in emergencies an opportunity to advocate with their governments for implementation of the Operational Guidance into relevant national policies. IBFAN will be always happy to hear about such efforts.
Reflected in the new Sphere 2011 Humanitarian Charter and Minimal Standards for Disaster Response. The cornerstone of the book is the Humanitarian Charter, which describes the core principles that govern humanitarian action, and asserts the right of populations to protection and assistance. The Sphere project promotes quality and accountability in the humanitarian response. Sphere proposes a common language and criteria to guarantee humanitarian interventions, and promotes a humanitarian ideal with criteria for efficiency and accountability http://www.sphereproject.org/
Regularly updated: This Operational Guidance was first produced by the Interagency Working Group on Infant and Young Child Feeding in Emergencies in 2001. It has since evolved to reflect experiences in the field and the latest version of this document is from February 2007.
NEW Operational Guidance Addendum on the type and source of Breastmilk Subsitutes to be considered (Operational Guidance 6.2.3).
An addendum was made to the Operational Guidance in June 2010, to reflect on the procurement and management of ready to use infant formula (RUIF). This product was widely used in the response to the Haïti earthquake which took place in January 2011. Its use has yet to be evaluated. Seehttp://www.ennonline.net/pool/files/ife/insert-operational-guidance-6-3-2-addendum-2010-final.pdf
Tools and training modules on Infant feeding in emergencies.
IFE Orientation Package: IFE Module 1 for all emergency relief staff, developed by the IFE Core Group, was initially published in 2001.
see http://www.ennonline.net/resources/1 to see the old version of Module 1
This module has now been updated and renamed the IFE Orientation Package (2010). seehttp://www.ennonline.net/ife/orientation
This is a package of resources to help in orientation on infant and young child feeding in emergencies (IFE). These resources are targeted at emergency relief staff, program managers, and technical staff involved in planning and responding to emergencies, at national and international level. The updated content has been developed by the Emergency Nutrition Network (ENN), IFE Core Group members, and collaborators. IFE Module 1 uses the Operational Guidance on IFE as a guiding framework to support its implementation. http://www.ennonline.net/resources/6
This training package includes e-learning lessons, training resources and technical notes. The e-learning lessons can be used in self learning, in preparation for a face-to-face training, or as a group exercise. The lessons do not have to be completed at the one time, but ‘remember’ where you’ve stopped so that you can return and continue. The e-learning lessons are free. A CD version is also available to download, or from the ENN. The lessons are currently being translated into Spanish and French translation is also planned.
Training Module for health/nutrition staff: IFE Module 2, version 1.1, 2007, developed by the IFE Core group and additional contributors. This module includes additional chapters on relactation (chapter 6), on breast conditions (chapter 7), on the young severely malnourished infant (chapter 8), and on when infants are not breastfed (chapter 9). This module is available in English, French, Bahasa and also Arabic. http://www.ennonline.net/resources/4
Integration of IYCF support into CMAM (Community based management of acute malnutrition)- Facilitator’s guide (2009). The purpose of this facilitator’s guide is to train health care personnel and community health workers in the integration of recommended infant and young child feeding (IYCF) practices within CMAM. These health workers will support mothers/caregivers in prevention as well as rehabilitation. http://www.ennonline.net/resources/772
IASC Harmonized Training Package (HTP) Cluster module 17 on Infant Feeding in Emergencies(Module 17 on IFE in the set of Nutrition Cluster modules) developed by some members of the IFE Core group for the Capacity building working group of the Nutrition Cluster. The HTP is an initiative of the Global Nutrition Cluster of the United Nations Inter-Agency Standing Committee.
Updated version 2011 http://www.ennonline.net/resources/888
This is a complete set of documentation and tools for training on the subject of infant and young child feeding in emergencies. This package includes a fact sheet, technical notes, training tips and tools, and a list of resources, to enable development of trainings on this theme. This package is not a ready-to-use training module, but is intended for use by experienced trainers.
The Media Guide on IFE For other languages see http://www.ennonline.net/resources/126
Developed by the IFE core group.
The media has an important role to play in protecting babies in emergency situations by disseminating information that will protect breastfeeding and promote the appropriate use of infant formula and powdered milk.
The messages that the media present about the needs of infants in emergencies can have a far-reaching impact on the babies who are unfortunate enough to be affected by an emergency. Members of the public, NGOs and donor agencies want to assist babies and giving them good information about infant and young child feeding in emergencies will help to prevent harmful practices and help to protect the most vulnerable from malnutrition and death.
Monitor the press for donations of bms, bottles, teats, and other milk products in emergencnies and write and complain using this media guide (see also guide for the public for more information on how to take action). Also Contact Karleen Gribble with any press article on the subject of Infant and young child feeding in emergencies email@example.com
For an example of a letter sent by UNICEF to the Guardian in response to the stories about Reza, the little boy in flood-affected Pakistan (‘It’s been a month since he had any milk’ – the human face of Pakistan’s deadly flood, 6 September; ‘He’s not crying any more’ – milk at last for refugee boy, 8 September), express UNICEF’s concern about the potential impact of this story on the emergency response and the health and survival of young children in Pakistan – a concern shared by many other humanitarian agencies.
Protecting babies in emergencies: A guide for the Public on IFEhttp://www.breastfeedinggateway.org/pdf/the-role-of-the-public.pdf
WABA 2009 Action folder and IBFAN-ICDC Focus publication on infant and young child feeding in emergencies (see higher up for websites)
Meetings organized by the IFE Core group
A number of international meetings have been organised by the IFE Core group on IFE and include:
– Bali 2008: Infant and young child feeding in emergencies. Making it happen. Proceedings of a Regional strategy workshop, Bali, 2008
– Oxford November 2010, IFE core group strategy meeting http://www.ennonline.net/pool/files/ife/ife-core-group-strategy-meeting-oxford-2010-final-report.pdf
Read articles in IFE dans Field Exchange, the Emergency Nutrition Network publication.
IFE articles in Field Exchange:
IFE in Pakistan 2006 http://fex.ennonline.net/27/asia.aspx
Supporting breastfeeding among Tanzanian réfugees 2007http://fex.ennonline.net/31/refugeecamps.aspx
Indonesia IFE and Lebanon 2006 et 2007 experienceshttp://fex.ennonline.net/29/infantfeeding.aspx
Special Field Exchange on IFE 2008 http://fex.ennonline.net/34/contents.aspx
Experience IFE Myanmar 2010 http://fex.ennonline.net/36/putting.aspx
Haïti general and IFE experience 2010 et 2011 http://fex.ennonline.net/39/haiti.aspx et pages 64-68 de http://www.ennonline.net/pool/files/fex/fx-41-web.pdf
other articles: chercher dans ressources de Field Exchange
See presentation on Protecting and supporting IFE in the aftermath of the Haïti earthquake, given in October 2011, at the Canadian National breastfeeding conference.
Other key documents related to IFE
Guidance on Infant feeding and HIV in the context of refugees and displaced populations, June 2009, version 1.1 Attach link PDF French and English
UNCHR Policy Related to the Acceptance, Distribution and Use of Milk Products in Refugee Settings,2006 version
Visit the ENN website for many more related documents. Search the ENN website for articles on IFE published in Field Exchange. Join discussion groups on IFE via the En-Nethttp://www.ennonline.net/resources/tag/124
On the subject of Ready-to-use Foods, and in particular Ready-to-use-Therapeutic-Foods RUTFs, and their potentially negative impact on breastfeeding and on local and appropriate complementary feeding, and the need to use them in very strict conditions, considering them as medicines, et ensuring that they are not promoted to vulnerable populations, and that health claims are not used as means to promote them to these same populations.
See following links, and contact IBFAN-GIFA, and/or IBFAN-BPNI and or Baby Milk Action, for fresh news and to find out about current advocacy campaigns.
Discussion paper on infant and young child feeding on current initiatives to address moderate malnutrition http://www.ennonline.net/pool/files/ife/ife-core-group-discussion-paper-final-250908.pdf
IBFAN FEX article 2011 see pages 50 and 51 for IBFAN comment on the “Draft guidelines on the marketing of ready-to-use supplementary foods” http://www.ennonline.net/pool/files/fex/fx-41-web.pdf
IBFAN position paper on Ready-to-use foods 2011
See website of IBFAN Asia/ Breastfeeding Promotion Network of India for other articles
Foundation Terre des hommes position paper on RUTFs.