Integrated Early Childhood Development at UNICEF: How does breastfeeding fit in?

UNICEFProgramme Division

Nutrition Section

UNICEF

Objectives of this Session

Understand the general principles of I/ECD Explore how to introduce breastfeeding in discussion

of I/ECD Explore how to introduce breastfeeding in

discussions addressing the other 4 Strategic priorities

Understand the 3 sectors enhanced by LAM Discuss the development of new “hooks” to increase

interest in breastfeeding

UNICEF

A World Fit for Children

By 2010: Reduction of child malnutrition among children

under five years of age by at least one-third, with special attention to children under two years of age, and reduction in the rate of low birth weight by at least one third of the current rate.

UNICEF

Nutrition related MTSP target indicators

Reduction in anemia prevalence among women of reproductive age by 15%

> 60% of children receive appropriate home care for prevention and treatment of malnutrition

> 60% of pregnant women use adequate antenatal services

UNICEF

Focus of I/ECD

Integrated ECD is based on child’s rights principles and the life-cycle approach, developed to co-ordinate actions at different levels, aiming to improve:– Quality of family care

– Family access to good basic services and adequate livelihoods

– Community & policy environment needed to support the previous points.

General Goals: Child Survival, Growth and Development

UNICEF

What is Integrated Early Childhood Development?

The Importance of the Mother-Child Dyad “A good start on life”

“Children under 3 y.o.”

“Support women’s health, nutrition, and well-being”

“Links to maternal health and survival”

Maternal nutrition for birth weight and maternal survival, early initiation of exclusive breastfeeding (EBF)

EBF, appropriate CF which includes responsive feeding, VitA, Birth spacing

Mother-child vs Child orientation, empowering caretaker to act and interact

If mom survives, the child is 3- 5 times more likely to survive

UNICEF

Breastfeeding is the Heartbeat of Primary Health

Logo, Breastfeeding Division, IRH

Oral Rehydration

Growthand Development

ImmunizationMaternal Health and Survival

Nutrition

Birth Spacing and Fertility

Reduced Cancer and Chronic Disease

Breastfeeding supports:

UNICEF

What is Optimal Breastfeeding?

Six months exclusive breastfeeding Continued breastfeeding with appropriate

complementary foods and feeding for 2 years and beyond

Related maternal nutrition and care (Birth Interval of 3 years or more)

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Breastfeeding -> Early Childhood Development

Decreased child desertion in hospitals Best growth in first 6 months Improved elements of neuro-psycho-motor development

at age 1-2, and up to 12 Improved vision from a few months to years Increased independence and parental trust Increased intelligence quotient (IQ) assessed at ages 8

and 9 years; at age 18 years Decreased infectious and chronic illness, and decreased

impact of several metabolic conditions, supporting continued thriving

Increases in breastfeeding are associated with:

UNICEF

Breastfeeding -> Early Childhood Development Increased adolescent perceptions of maternal caring Higher reading comprehension, mathematical ability,

and scholastic ability assessed during the period from 10 to 13 years;

Higher teacher ratings of reading and mathematics assessed at 8 and 12 years;

Higher levels of attainment in school leaving examinations

Contribution to birth intervals, allowing more attention to care and feeding, and maternal nutritional recovery:

Result: children are alive and thrive!

UNICEF

Mother-Child Dyad:The Heart of ECD

Three years birth spacing for mother’s nutritional recovery Three years as youngest child

Three years of stimulation and responsive feedingThree years of health-care seeking and preventive actions

Maternal Protein, Calorie and Micronutrient Stores

UNICEF

Current and Planned Interventions: The Same Target Audience for All

ANTENATAL CARE

SAFE DELIVERYADEQUATE BIRTH WEIGHT

OPTIMAL AND RESPONSIVEINFANT AND

YOUNG CHILD FEEDING

AT LEAST THREE YEARSBIRTH SPACING VIA

FAMILY PLANNING USE

ANTENATAL CARE

MPSMNI

Malaria Presumptive Tx/Nets

Expanded MPS/SMBFHI

“Expanded Step Ten”CODEMNICF

IMCI/CIMCIIMM

FP(UNFPA)ECDLAM

BF/CF

CARE SEEKING

UNICEF

Other MTSP Strategies

Girl’s Education

Immunisation Plus

HIV/AIDS

Child Protection

Cognitive and psycho-social achievement highly associated with breastfeeding

Breastfeeding provides first immune protection, and Vitamin A, among others, helps fight disease

Strong nutrition link; EBF decreases transmission

Nurtured and breastfed children less likely to be deserted and abused

UNICEF

Conclusion: Supporting

consistent OBF messages for the

mother-child dyad at all contacts is I/ECD

and yields MTSP results!

UNICEF

Current and Planned Interventions: The Same Target Audience for All

ANTENATAL CARE

SAFE DELIVERYADEQUATE BIRTH WEIGHT

OPTIMAL AND RESPONSIVEINFANT AND

YOUNG CHILD FEEDING

AT LEAST THREE YEARSBIRTH SPACING VIA

FAMILY PLANNING USE

ANTENATAL CARE

MPSMNI

Malaria Presumptive Tx/Nets

Expanded MPS/SMBFHI

“Expanded Step Ten”CODEMNICF

IMCI/CIMCIIMM

FP(UNFPA)ECDLAM

BF/CF

CARE SEEKING

UNICEF

0

0.5

1

1.5

2

2.5

3

3.5

4

<17 18-23

24-29

30-35

36-41

42-47

48-53

54-59

60+

Relative Risk, 0<5 yoMortality 1-4 yo

1mo-12mo

<1mo

Birth Spacing Saves Children’s Lives: Relative risk of mortality with various birth intervals compared to a 3 year birth interval

Months Birth Interval

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1. Have your menses returned?

2. Are you supplementing regularly or allowing long

periods without breastfeeding, either day or night?

3. Is your baby more than six months old?

4. The mother’s chance of pregnancy is increased. For continued protection, and to achieve a healthy three (3) years of child spacing, advise the mother to begin using a complementary family planning method and to continue breastfeeding for the child’s health, adding complementary feeding at about 6 months.. When the answer to one of these

questions becomes YES....

NO

NO

NO

There is only a one to two percent chance of pregnancy

at this time.

Ask the mother, or advise her to ask herself these three questions:

YES

YES

YES

The Lactational Amenorrhea Method -- LAM

UNICEF

Approximate Annual Pregnancy Rate If:

Non-lactating = 60%Lactating = 40%Lactating and amenorrheic = 15%Fully lactating and amenorrheic = 5%Fully lactating, amenorrheic, <6 months

postpartum = 2%LAM users = <2%

UNICEF

Why does LAM have improved efficacy?

Slightly, but significantly, shorter intervals Slightly, but significantly, more feeding

episodes per day Greater attention to night feeds Dedication to breastfeeding patterns for

fertility impact

Conclusion: Women who choose LAM will practice closer to optimal breastfeeding behaviors

UNICEF

Bellagio II

CONFIRMED efficacy of LAM SUGGESTED further study might enable

“relaxing” the fully breastfeeding and 6 month requirements

DEFINED menses return as 2 consecutive days of bleeding or a vaginal bleed that the woman perceives of as a menses (after 8 weeks pp)

ENCOURAGED worldwide implementation fo LAM for all of its positive impacts

UNICEF

Breastfeeding vs LAM:Influencing other Sectors

LAM BF

BF Patterns

Birth SpacingFertility MTCT

Increased Child Healthand Survival

LAMuse

FP Uptake

UNICEF

Try to develop a new “hook”!!

Select another sector (e.g., environment, food security, micronutrient programme, malaria, or other intervention area) that does not currently emphasize optimal breastfeeding

Consider what intervention or concept could be “socially marketed” that would “hook” those from this other discipline that are not currently supporting optimal breastfeeding into being supporters of breastfeeding.

UNICEF

Objectives of this Session

Understand the general principles of I/ECD Explore how to introduce breastfeeding in discussion

of I/ECD Explore how to introduce breastfeeding in

discussions addressing the other 4 Strategic priorities

Understand the 3 sectors enhanced by LAM Discuss the development of new “hooks” to increase

interest in breastfeeding

UNICEF

Thank you

Asante-sana

Salamat po

Merci

Gracias

Danke

Spasibo

Abrigato

Barakallaofik