Infant

1
Infant Young Child Feeding - Caribbean
Situation Paula Trotter Caribbean Food
Nutrition Institute October 13-14,
2005 Martinique
2
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)

3
IYCF PRACTICES
4
Exclusive Breastfeeding Rates
Country Rate (Year) Age of Child Source of Data
Antigua 41.1 (2000) 6 wks HIS
Dominica 33.9 (2000) 4 mos Survey (not routinely collected through HIS)
Guyana 15.3 (2000) lt 4 mos MICS
Jamaica 47.3 (2002) 35.6 (2002) 6 wks 3 mos MCSR
Montserrat 82.0 (2002) 70.0 (2002) 3 mos 4 mos HIS
St. Kitts 70.8 (2003) 23.8 (2003) 2.5 (2003) 6 wks 3 mos 4 -6 mos HIS (monthly data available)
Belize 60.0 (2004) lt 4 mos MCH report
Suriname 12.8 (2000) lt 4 mos MICS
Trinidad Tobago 1.8 (2000) 4 mos MICS
5
IYCF Indicators (MICS,2000)
Indicator Guyana Suriname Trinidad
Adequate Complementary feeding rate (6 9 months) 42.3 24.5 19.2
Continued breastfeeding rate (1 year) 49.6 42.9 26.2
Continued breastfeeding rate (2 years) 30.5 11.1 10.0
6
Other IYCF Indicators

• Percentage of babies breastfed within one hour of
  birth .
• Percentage of babies 0lt6 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 6lt10 or 7lt10
  months of age who received complementary foods in
  the last 24 hours

7
IYCF POLICIES TARGETS
8
National IYCF Policies

• In Draft
• Anguilla
• Antigua
• Bahamas
• BVI
• Cayman Is.
• Grenada
• Haiti
• Jamaica (IYCF)
• St. Kitts Nevis
• St. Lucia
• Suriname
• Trinidad (Hosp.)

• BF policies - Approved Implemented
• Barbados (Hosp.)
• Dominica (Hosp.)
• St. Vincent Gren.
• Guyana

9
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

10
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.)  

11
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

12
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

13
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

14
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

15
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

16
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

17
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.

18

• NATIONAL IYCF PROGRAMS

19
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

20
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

21
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

22
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)

23
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

24
HIV and infant feedingCriteria

• 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.

25
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

26
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

27
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

28
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

29
Research for decision-makingCriteria

• 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.

30
Other important areas

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