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Infant & Young Child Feeding - Caribbean Situation Paula Trotter Caribbean Food & Nutrition Institute October 13-14, 2005 Martinique. Overview. Infant and young child feeding practices Infant and young child feeding policies & targets Infant and young child feeding programs

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Infant & Young Child Feeding -

Caribbean Situation

Paula Trotter

Caribbean Food & Nutrition Institute

October 13-14,2005


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  • Infant and young child feeding practices

  • Infant and young child feeding policies & targets

  • Infant and young child feeding programs

  • Adapted from Infant and Young Child Feeding. A tool for assessing national practices, policies and programmes. WHO (2003)

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IYCF Indicators(MICS,2000)

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Other IYCF Indicators

  • Percentage of babies breastfed within one hour of birth:……. %

  • Percentage of babies 0–<6 months of age exclusively breastfed in the last 24 hours:……… %

  • Median duration of breastfeeding of children under 36 months: ……… months (The age in months when 50% of children are no longer breastfed )

  • Percentage of breastfed babies 6–<10 or 7–<10 months of age who received complementary foods in the last 24 hours:……… %

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BF policies - Approved & Implemented

Barbados (Hosp.)

Dominica (Hosp.)

St. Vincent & Gren.


In Draft





Cayman Is.



Jamaica (IYCF)

St. Kitts & Nevis

St. Lucia


Trinidad (Hosp.)

National IYCF Policies

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Criteria for effective policies on IYCF

  • National in scope and officially adopted by the government

  • Promotes IYCF practices consistent with international guidelines

  • Addresses provision of skilled counselling and support in the health system and communities

  • Covers guidelines for HIV and infant feeding and provides for counselling and support related to this issue

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Criteria for effective policies on IYCF

  • Addresses the management of IYCF in emergency situations

  • Covers the other policy issues in the Global Strategy

  • Is routinely distributed and communicated to those managing and implementing relevant programs

  • Is appropriately integrated into other relevant national policies (health, nutrition, AIDS, family planning, integrated child health & education policies, etc.)  

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Active BF/IYCF*



Cayman Is.*



St. Kitts & Nevis

St. Vincent & Gren.*



A national coordinator is responsible for IYCF

Meets on a regular basis (at least twice a year)

Provides guidance to national program (s)

Coordination takes place between sectors and relevant initiatives dealing with IYCF

National Coordinators & committees

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“Baby-Friendly” Hospitals

Barbados (1)

Dominica (1) of 3

Guyana (3) of 12


Jamaica (10) of 23

St. Vincent & Gren. (1) of 6

TT (1) of 5

Actively working towards target

Trinidad (2)

St Kitts & Nevis (2)

Guyana (11)

BVI (1)


Baby-friendly Hospital Initiative achievements

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Active & sustainable BFHI-Criteria

  • Integrated within the health care system

  • Coordinator – leadership role

  • Ongoing training

  • Assessment of additional health facilities

  • Monitoring and/or reassessment of designated facilities

  • Availability of technical support when improvements are needed

  • Public education

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International Code of Marketing of Breast-milk Substitutes

  • Lack of attention to adoption of national legislation or regulations

  • Promotion in health system prohibited

    • MCH norms or unwritten regulations

    • inadequate monitoring systems

  • General lack of awareness of the rationale and relevance of the Code

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Suggested actions to promote Code Implementation:

  • Raise awareness – link to CRC

  • Build consensus on the preparation of national regulations & system of monitoring

  • Training of health workers

  • Public education

  • Request support at regional level

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Legislation protecting and supporting breastfeeding among working mothers

  • The ILO Maternity Protection Convention (No.183) has not been fully ratified or enacted

  • Access to health care – good coverage in some countries

  • Maternity leave – entitlements linked to social security contributions

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ILO Convention 183 - working mothers

at least 14 weeks of paid maternity leave

daily breastfeeding breaks

job protection and security

ILO Recommendation


at least 16 weeks of paid maternity leave;

parental leave should be given;

breastfeeding facilities in the workplace.

Legislation protecting and supporting breastfeeding among working mothers

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National Programs working mothers




St. Vincent & Gren.*


Some aspects of IYCN

promotion may form part of

MCH services


Comprehensive, national in scope

Has targets or measurable objectives

Has adequate funds for its implementation

Is multisectoral with coordination among programs and initiatives at different levels

National Program/Plan of Action for IYCN

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Do the training curricula working mothers

of medical, nursing,

midwifery, allied/public

health, and nutrition

education programs

provide students with the

attitudes, knowledge and

skills necessary to

protect, promote, and

support optimal IYCF?

See WHO checklist for a list of objectives and content/skills that should be covered

WHO/UNICEF have developed a number of courses

Health care provider (pre-service) education

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WHO/UNICEF Breastfeeding working mothers

Counseling course conducted

in –







St. Kitts & Nevis

St. Vincent


Trinidad & Tobago

Grenada - 1 trainer


Feeding Counselling course

conducted in –





Trinidad & Tobago

Also regional course by


In-service training for health care providers

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In-service training for health care providers working mothers


  • Provided throughout the country

  • Covers most of the essential topics related to IYCF (see WHO checklist)

  • Clinical and counselling skills are integrated into the content of the training programs - at least 30% of training time

  • Content and skills related to IYCF are integrated, as appropriate, into relevant training programs (including diarrhoeal disease, ARI, IMCI, well-child care, family planning, nutrition, early childhood education, child care services, HIV/AIDS)

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Policies working mothers









Policy development not integrated with other IYCF related policies or guidelines

Mainly avoidance of breastfeeding

Inadequate attention to infant feeding counselling

HIV and infant feeding

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HIV and infant feeding working mothersCriteria

  • Training given on HIV and IFC

  • Antenatal VCT is offered routinely to pregnant women and, where possible, to their partners

  • Locally appropriate infant feeding counselling offered with follow-up

  • Special efforts are made to protect, promote, and support breastfeeding in the general population

  • Ongoing monitoring is in place

  • The national BFHI provides guidance on support to HIV-positive mothers.

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Includes - working mothers

Individual/group counselling

cooking demonstrations

community education

mother-to-mother support groups


National in scope

Non-health organizations (e.g. education, day care services) & CBOs involved

Are integrated into an overall infant and child health strategy

Community outreach and support

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Activities: working mothers

Individual/group counselling

Sporadic use of electronic media

Preparation of print materials

WBW*- a variety of media and channels

Absence of comprehensive national IEC strategy



Cayman Is.





St. Vincent



Information, education & communication

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GMP working mothers

On-going in all countries

Coverage good in first 2 yrs

Based on wt/age

Closer monitoring needed


Counselling & follow-up

Revision of charts necessary


On-going in 7 (ANU,



To facilitate timely &

targeted actions –

Indicators & coverage

Data quality

Collection & reporting procedures

Growth Monitoring & Nutrition Surveillance

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Research for decision-making working mothers

To guide policy development & program planning

  • Trends in nutrition problems & practices (e.g. Jamaica, Guyana, Haiti, MICS

  • KAPs re IYCF (e.g. Guyana, Dominica, St. Kitts & Nevis)

    Other needs –

  • Information on IYCF practices (foods, amounts, frequency, energy & nutrient densities)

  • Planning & evaluation of behavioral change interventions

  • Impact & quality of training programs

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    Research for decision-making working mothersCriteria

    • A national research advisory group exists

    • Development of a national inventory of applied and basic research on key topics related to IYCF

    • Priority needs for infant and young child feeding related information are identified

    • Data gathered, when feasible, from existing studies and other data sources (either domestic or international).

    • Research on priority topics is financed by the national IYCF program and/or by other appropriate donors

    • Research results are routinely disseminated to key decision-makers - to guide policy and program decisions as part of the planning and management process.

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    Other important areas working mothers

    • Mother-friendly childbirth strategies

    • Contraceptive support for breastfeeding women

    • Infant and young child feeding in emergencies