Breastfeeding%20Support%20in%20Early%20Emergency%20Response

1
Breastfeeding Support in Early Emergency Response

• Utami Roesli Sri Sukotjo
• Indonesian Breastfeeding Center / UNICEF

2
Background

• Un-controlled donations of infant formula
• Higher consumption of infant formula among those
  who received donations compared to those who did
  not receive donations
• Increased of diarrhea rates after the Earthquake
  and significant association between formula fed
  in the previous 24 hrs and diarrhea in infants

3

• MOTHER NEEDS SUPPORT
• How to reach large numbers of mothers
• rapidly?

4
Managing The Training

• UNICEF commissioned Indonesian Breastfeeding
  Center to conduct the training in the most
  affected district of Klaten Bantul
• Worked with the District Health Office to ensure
  the sustainability of the programme
• 12 facilitators BFC-C placed inside the
  communities (at the village level)
• Participants were Community Workers/Volunteers
  village Midwives

5
One facilitator based inside the community for 6
weeks would bring benefit for up to 360 families
I
6 sub-village
A
B
C
D
E
F
1
2
3
4
5
6
Trained 6 BF MOTIVATORS / sub village
a
a
a
a
a
To graduate, each MOTIVATOR need to counsel at
least 5 mothers. These mother recruited as peer
educators in their communities
b
b
Each PE required to promote BF to at least 2 or
3 families
6
The Module

• WHO/UNICEFs 40 hours Breastfeeding Counseling
  Course module
• Flip-Chart is developed to train mothers

7

• 
  
  
• Session 1 Why breastfeeding is important
  
• Session 3 How breastfeeding work
  
• Session 4 Assessing a breastfeed
  
• Session 5 Observing a breastfeed
  
  
• Session 6 Listening and learning
• Session 7 Listening and learning exercises
  
• Session 9 Clinical Practice 1
• Additional 1 Food hygiene and feeding techniques
• Additional 2 Preparation of milk feeds -
  practical
• Session 11 Building confidence and giving
  support
• Session 12 Building confidence exercises
• Session 10 Positioning a baby at the breast
  
• Session 13 Clinical Practice 2
• Session 16 Refusing breastfeeding
• Session 20 Expressing breastmilk
• Session 21 Not enough milk
• Session 22 Crying

8

• For clinical practices, breastfeeding and
  pregnant mothers were brought-in into the
  training session
• Facilitators meet every evening to evaluate the
  process of the training on that day.

9

• Every Sundays the Facilitators helped
  breastfeeding mothers with difficulties

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RESULTS
Course Director
III
II
I
IV
X
V
VI
VII
VIII
IX
XI
XII
A
B
C
D
E
F
159 sub-village
1
2
3
4
5
6
426 motivator
a
a
a
a
a
2130 moms Peer educators
2130 4260 6390 Supporting Mom Communities
b
b
4260 aware of breastfeeding
11
Training conducted in a Tent
12
Training conducting in a Village Center
13
Clinical practices at the community
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IS THE TRAINING DIFFICULT ?
11 YES
89 NO
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Challenges

• Many community workers and health workers were in
  the traumatic phase
• Difficult to find community workers who have
  commitment to participate in the training
• Different level of education also provided
  challenges in facilitating the training
• Facilitators/Trainers need to ensure that they
  are able to follow the course
• Private one-to-one training was conducted if they
  are not able to come to the training
• Minimal support from the local health office
• More focus on building new premises, health
  system, and other health issues

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Result

• Of 50 mothers assessed and who gave birth after
  the Earth Quake, most (63) are exclusively
  breastfeed regardless of access to free formula -
  mainly due to the counseling / support they
  received from trained health workers and
  volunteers

17
Result

• Introduction of early initiation to breastfeeding
  during the training
• Early initiation to breastfeeding were
  successfully conducted by trained village
  midwives and community health workers.

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Lesson Learned-1

• The training reached a large number of mothers
• Facilitators placed in the community, provided
  breastfeeding counseling services to mothers who
  have difficulties in the affected areas
• Sustainability of the breastfeeding services in
  the community

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Lesson Learned-2

• Klaten District, one of the affected areas
• Facilitators 8
• Counselors 190
• Motivators 310
• Next week they plan to add 8 more facilitators,
  at least 20 more counselors and 350 motivators

20
Information received by motivators for such an
extended period has increased the confidence of
the motivators to assist breastfeeding mothers
(although most of them did not have any health
related background)
21
THANK YOU
CD from the field on the counseling services
experiences is on your folder