Protection, Promotion and Support of Healthy Maternal, Infant and Young Child Feeding
Protection, Promotion and Support of healthy maternal, infant and young child Feeding
Underlying Principles of Protection, Promotion and Support of Healthy Nutrition
Protection of healthy maternal, infant and young child Feeding
Nutritional needs of pregnant / lactating women and young children 6-35 months should be prioritized and met through access to the minimum required healthy diet in terms of frequency, energy content and variety. In situations where nutritional needs are not met, a general ration that is appropriate in quantity and quality or a cash-transfer safety-net should be advocated for.
Newborn should be initiated to breastfeeding within one hour from birth and no pre-lacteal foods like water or glucose should be given by health workers or birth attendants.
Lactating mothers who experience breast feeding problems should be timely assisted by a trained health or nutrition worker to start, maintain, enhance or re-establish breastfeeding by means of re-lactation, when necessary.
Targeting and use, procurement, management and distribution of Breast-Milk Substitute (BMS) for infants 0-5.9 months should be strictly controlled, based on technical advice, and comply with the International Code and all relevant WHA Resolutions. Infant formula should only be targeted to infants requiring it, as determined by assessment from a trained health or nutrition worker. In the event that infant formula is provided to caregivers who need it, careful attention must be taken to protect against spillover effects by using separate and discrete distribution channels directly linked to one-to-one demonstrations, practical training on safe preparation and follow-ups by skilled personnel. Supply should be continued for as long as the infant concerned needs it. In accordance with International Code, no promotion of BMS should be made at the point of distribution, including product promotional displays or items bearing milk company logos.
Pregnant women and lactating mothers should be legally protected from hazardous or obstructing working conditions that impair the delivery and/or the exclusive breastfeeding for the first six months.
Lactating working mothers who are daily separated from their infants in the first six months should be taught on how to express Breast-milk (manually or mechanically) through one-to-one demonstrations. Lactating working mothers should be able to instruct caregivers on how to safely store and give expressed Breast-milk during their absence.
All pregnant and lactating mothers should be informed on modalities and risks of HIV transmission and enabled to access Individual counselling and Testing (ICT) services.
HIV positive mothers should be enabled by trained health or nutrition workers to make an informed decision about the best infant feeding option in their own situation based on what is Acceptable, Feasible, Affordable, Sustainable and Safe (AFASS). In most resource-constrained areas, however, risks of infections or malnutrition from using alternatives to Breast-milk are likely to be greater than the risk of HIV transmission through breastfeeding. Early initiation and exclusive breastfeeding for the first six months may provide the best chance of survival for HIV exposed infants.
Home-modified animal milks should not be recommended as Breast-Milk Substitutes in the first six months because of difficulties in obtaining nutritional adequacy particularly regarding micronutrients. A micronutrient formulation to fortify home-modified milks is not available at present, but work on developing a micronutrient supplement that could be given once a day to children is ongoing. Thus home-modified animal milk should be used in non-breastfed infants before completion of 6 months of age only as a last resort when there is really no other feasible alternative option, such as generic infant formula or commercial infant formula.
Supplementation of Iron-Folic Acid for pregnant women and young children and Vitamin A for children 6-59 months should be pursued through routine services. Child Health Days for Vitamin A supplementation and de-worming should be regarded as a catch-up strategy that complements routine efforts.
Quality control of iodized salt should be ensured through market monitoring. Partnership with schools and the private sector may result in a wider coverage.
Feeding a child during and after sickness should be an integral part of management of child illnesses to prevent the onset of acute malnutrition. Local high-energy nutrient-dense recipes should be developed and promoted for sick children to support their home-based recovery. Similar recipes should be applied to improve the nutritional status of pregnant and lactating women who are at risk of acute malnutrition or are HIV positive / chronically ill.
Early detection of acute malnutrition and timely referral for treatment should be regarded as a life saving measure. In addition to routine growth monitoring, specific devices need to be put in place at facility and community level for acute malnutrition screening including Mid-Upper Arm Circumference (MUAC) tape and recognition of
bilateral pitting oedema and other clinical signs.
MUAC Resources - Sources for MUAC Straps
Promotion of healthy maternal, infant and young child feeding
All groups of people have customs and traditions concerning feeding infants and young children. It is important to recognize and understand these and work with them sensitively while promoting best practice.
Frontline practitioners should be able to access updated recommendations on healthy maternal, infant and young child feeding. Policies and guidelines need to be simplified and translated into user-friendly job-aids for easy reference.
Appropriate messages and actions on healthy maternal, infant and young child feeding should be promoted at all levels of health care including ante and post-natal care, delivery, immunization, growth monitoring and promotion, child clinic, family planning, community health services and selective feeding programs (supplementary and therapeutic).
Appropriate messages and actions should be promoted using a multi-channel strategy that also involves private and civic partners. The media, non-government organizations, community-based organizations, faith-based organizations and companies can play a crucial role to reach families with appropriate messages and actions on healthy maternal, infant and young child feeding. They are also crucial in promoting the use of preventive routine services like Iron-Folic Acid supplementation for pregnant women, bi-annual de-worming for children aged 12-59 months and Vitamin A supplementation for children aged 6-59 months.
Appropriate messages and actions should be promoted using a multi-sector strategy that involves different sectors like health, education, women and children welfare, production, trade and manufacturing. Nutrition is a cross-cutting issue that can not be dealt by the health sector alone.
Support of healthy maternal, infant and young child feeding
Community involvement and ownership is crucial to overcome cultural barriers to recommended maternal, infant and young child feeding practices. behavioural Change Communication (BCC) takes place through negotiation, acceptance and adoption of good practices demanding time and commitment from those involved in the process. Examples of community-based initiatives include: awareness-raising drama, school activities and group activities like peer-education, cooking sessions, demonstration gardens, food exhibitions and home-base care and support. The involvement of community-based structures should aim to strengthen the referral and follow-up link between clients and available nutrition services.
Mothers and caregivers should be empowered in appreciating nutrient dense local foods and valuable traditional complementary feeding practices. Knowledge and skills should support mothers and caregivers to apply a balanced diet using locally available resources. FADUA criteria of frequency, amount, density, use of foods and active feeding can help to define the meaning of adequate complementary feeding for children 6-35 months.
The emphasis on behavioural change should go along with an understanding and commitment to address the economic constraints on caregiver's appropriate behaviour. Safety-net programs through food aid or direct cash transfer should target pregnant / lactating women and children 6-35 months with priority to poor and vulnerable households. The nutritional requirements for low-income people with special conditions (HIV/AIDS, TB, cancer or other chronic illnesses) should be addressed as well because appropriate diet can slow the disease's progress and improve drugs? compliance and effectiveness.
6 March, 2016