Ukraine summary of lessons learned and essential documents on Infant and Young Child Feeding in Emergencies

KEY MESSAGES

Pre-crisis Infant and Young Child Feeding (IYCF) Practices:

• The Code has not been adequately implemented and enforced in Ukraine.
• Multiple Indicator Cluster Survey (MCIS) data from 2012: Child ever breastfed (95.4%); early initiation of breastfeeding (EIBF) within 1 hr of birth (65.7%); children under 6 months exclusively breastfed (EBF)(19.7%); continued breastfeeding at 1 (37.9%) and 2 years of age (22%); children under 6 months predominantly breastfed (51.6%); children 0-23 months bottle fed (66.6%); introduction of solid, semi-solid or soft foods for children 6-8 months (43.2%).

Key learnings from the 2015 Ukraine Crisis:

• There were widespread violations of the Code.
• Providing breast milk substitutes (BMS), water and early complementary foods to children under 6 months of age was very common among IDPs.
• Several reports found that one of the primary reasons mothers stop breastfeeding was because of a perceived drop in breast milk due to increased stress.
• Due to the absence of acute malnutrition and the lack of understanding of the importance of IYCF, nutrition was not perceived as a priority.
• It is important to conduct early assessments to understand the context and to be able to advocate / raise the nutrition profile of the country.
• Managing non-breastfed infants was a key challenge. There were challenges around preventing the untargeted distribution of BMS, especially by local and small civil society and volunteer organizations. A high demand for BMS alongside low availability and limited cash reserves led to the dilution of BMS by mothers to prolong use. Actors reported that there were no guidelines on what to do for non-breastfed infants and limited authority/leadership on the ground to be able to make recommendations.
• Organizations involved in the untargeted distribution of BMS need to be engaged in coordination activities. The untargeted distribution of BMS needs to be handled in a sensitive and diplomatic fashion, simply telling organizations not to distribute BMS, but not providing them with other programming options in such a high-demand context, will have little impact.
• It is critical to build the capacity and educate national actors on IYCF-E; this includes building the capacity of primary healthcare workers and humanitarian/civil society/volunteer organizations.
• There is a need for clear context-specific and evidence-based communication on IYCF delivered through a variety of different channels.
• Among mothers there was a lack of confidence in local doctors and access to chaotic and no sustainable information about breastfeeding.
• In Severodonetsk, Ukraine, breastfeeding was considered as a practice for the most vulnerable people who are not able to pay for BMS. This should be taken into consideration in messaging and counselling
• Programs should provide a special focus on new mothers who give birth to their children in the active phase of the conflict. It is important to put a special attention to the bonding and its crucial importance in child development.

Key learnings from other emergencies in the region:

• In contexts with a high percentage of mothers already bottle feeding, rapid transit, and low contact time, it may be more realistic to focus on risk minimisation and make clean bottles readily available for mothers who are unable to breastfeed, rather than relying solely on the promotion of cup feeding, which mothers were reluctant to uptake.
• Leaflets with pictures helped overcome language barriers. ○ Short training for key aid workers on essential phrases in different languages could have further helped facilitate good relationships between mothers and healthcare workers and helped the uptake of positive IYCF messages.
• Key learnings from Croatia are the importance of cross-border coordination, standardization of practices and the need for clarity regarding target age for infant formula when in common use.