Protection and support of infant and young child feeding
Infant feeding practices including exclusive breastfeeding, the timely and appropriate introduction of complementary feeding to children around six completed months of age, and continued breastfeeding alongside other foods for children until two years of age and beyond is an essential part of infant and young child health.
Proactive interventions and education of mothers, caregivers and staff is needed to protect and support appropriate infant and young child feeding practices. Good infant and child feeding can help to reduce the possibility of micronutrient deficiencies through exclusive breastfeeding during the first six months of life followed by the introduction of micronutrient rich foods. Interventions may include food preparation demonstrations of locally available foods and where appropriate, use of fortified blended foods. It has been recognized that children who are engaged and stimulated during feeding benefit more highly from micronutrients, and so aspects to enhance mother's skills in feeding young children must also be addressed. UNHCR will build on a pilot already undertaken jointly with CARE International in Kenya to train refugee health outreach workers, as well as national health and nutrition staff, to become infant and young child feeding promoters As well as help disseminate essential breastfeeding and young child feeding information to the refugee community.
Inadequate support to infant feeding has been identified as one of the main causes of malnutrition in a recent analysis conducted by UNHCR jointly with WFP on causes of malnutrition in protracted refugee situations.
Natural disasters and complex emergencies have a devastating impact on people's lives. The impact on women can be tremendous mentally, as well as physically. Some women may become malnourished themselves; others may have lost the confidence to breastfeed their infants. There may be even more demands on a mothers time to get food for her family, source shelter and deal with insecurity. Her family support may be have been disrupted. All of these factors may undermine infant feeding practices without protection and support of the mother that addresses all these issues.
Past experience has shown that when there is an emergency, massive amount of infant formula and powdered milk are commonly donated. Some donations are a direct result of media appeals for infant formula. These may originate with aid agencies, governments or from individual efforts to help. Media coverage may generate public pressure on governments to bring in formula. In the confusion that surrounds emergencies, these products are often distributed in an uncontrolled way and used by mothers who would otherwise breastfeed their babies. This results in unnecessary illness and death for many infants. In order to harmonize policy and practices, in 2006 UNHCR in collaboration with other agencies has revised its policy on procurements, distribution and use of milk products in refugee settings which included an element on infant feeding and HIV as well as use of therapeutic milk.
Infants and children need adequate nutrition in the first two years of life for their wellbeing and development; otherwise the child will suffer irreversible damage.
Infant Feeding and HIV
HIV has posed a new challenge for feeding children especially during an emergency. Recommendations from 2006 WHO consensus statement are intended to supplement, clarify and update existing UN guidance and do not replace it. These include:
- Exclusive breastfeeding is recommended for HIV-infected women for the first six months of life unless replacement feeding is 'Acceptable, Feasible, Affordable, Sustainable and Safe' (AFASS) for them and their infants before that time.
- When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected women is recommended.
- Infant and young child feeding practices: Standard Operating Procedures for the Handling of Breastmilk Substitutes (BMS) in Refugee Situations for children 0-23 months
- Infant and young child feeding practices: Standard Operating Procedures for the Handling of Breastmilk Substitutes: ANNEXES
- Infant screening questionnaire
- Guidance on infant feeding and HIV in the context of refugees and displaced populations, June 2009 Version 1.1
- Indicators for assessing infant and young child feeding practices: Part 1 Definitions