South Asia Breastfeeding Partners Forum 4

Dr. Zakia Maroof

Nutrition Officer, UNICEF Afghanistan

Habitat centre , new Delhi, India 10-12 December 2007

How IYCF contributes to MDGs MDG Contribution of IYCF

Goal 1 Eradicate extreme poverty and hunger Goal 4: Reduce child mortality

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Breastmilk is zero cost & high quality food that provides sustainable food security for the child.

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Exclusive BF & continued BF for 2 years is associated with a reduction in child malnutrition.

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By reducing incidence of infectious disease and its severity, BF reduces under 5 child mortality by 13% and improved complementary feeding by about 6%.

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About 50-60% of under 5 child mortality is caused by malnutrition due to poor BF practices and inadequate complementary feeding.

Goal 5: Improve maternal health

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BF associated with lower maternal postpartum blood loss and less breast/ovarian/endometrial cancers.

BF increases duration of birth intervals, lowering risks to mother of closely spaced pregnancies.

BF promotes return of the mother’s body to pre-pregnancy status, rapid involution of the uterus and postpartum weight loss ( prevents obesity ).

Two Major Recent Studies confirm that improved Breastfeeding and Complementary Feeding Save Lives 1. EACH YEAR NEARLY 3 MILLION CHILDREN (56%X45% X10.8 Mill.=2.7 Mill.) OVER 6 MONTHS OF AGE DIE DUE TO MALNUTRITION

Pelletier, Frongillo et al

2. NEARLY 2 MILLION DEATHS OF CHILDREN <5 COULD BE PREVENTED BY IMPROVED BREASTFEEDING (1.3 MILLION) AND COMPLEMENTARY FEEDING (0.6 MILLION) ALONE

Lancet Child Survival Series

Risk of neonatal mortality according to time of initiation of breastfeeding within ONE hour

4.5

4 3.5

3 2.5

2 1.5

1 0.5

0.7

1.2

0 With in 1 hour From 1 hour to end of day 1

Pediatrics 2006;117:380-386

2.3

Day 2 2.6

4.2

Day 3 After day 3

Actions

• National nutrition policy is revised • Four maternity hospitals in Eastern region trained on BFHI • Final draft of Code of marketing of BMS submitted to MoJ for ratification • 30 master trainers and 50 health staff trained on BFCC • Training manual on management of SAM is developed and finalized • 65master trainers and 194health staff trained on management of SAM • Community Based Management of SAM is started as pilot project in four provinces • WBW is observed at national level including production of BF communication material

Actions cont’

• Local research on initiation of BF within first hour of birth by Kabul medical university (250 mothers)

– 84.7 % of mothers not initiating BF in 1 st hour of birth (more than 60% of them believe colustrom is harmful for baby) – 10% of mothers start BF in first four hour of birth – 5.3% of mothers initiate BF in first hour of birth – More than 70% of mothers start complementary feeding before 6 months of age

Integrated C-SAM (CTC): Partnership and Advocacy

Birth Spacing ANC/PNC Vit A/FeFo EPI Vitamin A Sprinkle Nutrition Breast feeding Household C-SAM (CTC) Com mob/Screen -OPT -TFU Food Security PMTCT Breastfeeding De-worming

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link to CCD

Community support

• Effective outreach services in some pilot provinces • Community Health Workers (CHWs) • Community health Shoras • Involvement of religious leaders in nutrition/BF • Afghanistan Breastfeeding Promotion Partners (ABPP)

Challenges

• • • • • • • • • Inadequate knowledge and appreciation of benefits of exclusive breastfeeding and appropriate complementary with family foods among policy makers, health workers and communities Inappropriate marketing and distribution of infant formulae and baby foods. Lack of national data on BF Poor monitoring of Code of Marketing of Breastmilk Substitutes Labor laws and regulations that make it difficult for working mothers to rest adequately and breast feed their babies exclusively for the first six months of delivery Traditional and cultural practices that impact negatively on breastfeeding in general Inadequate resources for infant and young child interventions No coordination between different stakeholders Difficulty in monitoring of activities

Next Steps: Afghanistan

– Accelerate and scale up capacity building for breastfeeding counselling among health workers and communities – Implement and monitor BFHI in all health facilities that provide maternity services. – Ratify, implement and monitor Code of Marketing of Breastmilk Substitutes – Encourage paid maternity leave for working mothers up to six months of delivery both in public and private sector – Advocate and create awareness of IYCF through observation of World Breastfeeding Week – Commitment to provide enabling policies, human and financial resources for implementation and promotion of appropriate child feeding interventions – Address attitude issues among health care providers and communities on exclusive breastfeeding – Maximizing use of resources through integrated programming