““Strengthening Infant and Young Strengthening Infant and Young Child Feeding Policies and Child Feeding Policies and Programmes in South Asia Programmes in South Asia

Region”Region”

Maldives Country PresentationMaldives Country Presentation99thth to 12 to 12thth December 2014 , Parwanoo, Himachal Pradesh December 2014 , Parwanoo, Himachal Pradesh

INTRODUCTION

• Country Context• Breastfeeding and Nutrition Situation• National Policies and Strategies• WHO Code• Maternity Protection• BFHI• IYCF activities • World Breastfeeding Week• Challenges• WBTi

Country Context

• Population : 298,842 (Census 2006)

• Number of Atolls: 20• Number of islands: 1120 islands • 195 (inhabited)

• The health care delivery system : four-tier referral system

Child Nutrition Situation

• Rates of malnutrition has gradually declined from 1996 to 2009

• Nutrition situation has not improved in pace with other health developments

Breastfeeding Situation

• Early Initiation : 64 %, within the first hour of life , 92% of newborns within the first day

• Exclusive Breastfeeding for first 6 months: 48% (10% (MICS II ,2001)• • Median duration of Breastfeeding : 2.2 months

• Bottle-feeding :12 % of last born are reported to have received pre-lacteal feeds

• Complementary Feeding :• 89.9 percent infants are given timely semi-solid or solid food , • 47 percent is introduced to infant formula at age 6-8 months

• 58 % of children age 6-23 months met the minimum standard with respect to all three IYCF practices

Source: DHS 2009

IYCF Policies and Strategy

• Government advocates exclusive breastfeeding for 6 months and complementary feeding with foods that provide for optimal growth to be introduced to the infant after 6 months and continue breastfeeding for up to 2 years.

• The National Strategy for infant and Young Child Feeding is dated 2006-2010.

• The Integrated National Nutrition Strategic Plan (INNSP )2013-2017 :

IYCF Policies and Strategy

Other supportive polices: •Health Master Plan (2006-2015), new plan 2015-25 being drafted to be aligned with INNSP•National Reproductive Health Strategy 2014-18 (focuses on newborn feeding , child and maternal nutrition including eliminating ,micronutrient deficiencies)•Micronutrient Policy to be endorsed.•NCD Prevention action Plan, Food inspection Guidelines , Food Bill and Youth health strategy are in draft stage or remains to be endorsed.

• Adopted some of the provisions of the International Code of Marketing of Breast-milk Substitutes (BMS) into the National Code of BMS

• Approved by the parliament but not legalized into an Act and implemented.

• The Code is being enforced as a part of food safety regulations “Regulation on Import, Produce and Sale of Breast Milk Substitutes in the Maldives”

• Traders and stakeholders, healthcare workers sensitized.• BMS Code is being re-examined by the government ( Since August 2014)

Breast Milk Substitute (BMS) Code

MATERNITY PROTECTION

• Women following secondary school education are getting increasingly employed.

• 46 percent married women are employed (MDHS, 2009)• Maternity leave 60 days ( excluding public holidays) with full

pay.• 1 hour nursing break till the baby is 1 year old• 1 year of leave without pay may be granted • 1 week paternal leave• There is no law/ regulation applicable to private sector. Varies

among the private sector.• ‘Flexi hours’- recently introduced by civil service

• Only MMA (Maldives Monetary Authority) has introduced 6 months paid maternity leave (Voluntarily)

• BFHI launched in 1995- Total 9 hospitals declared BFHI- monitoring not undertaken. 5 hospitals declared as Baby-friendly-2005 2 more regional hospitals- 2001 2 atoll hospitals- 2005

• Last external review of BFHI in 2003• BFHI – programme needs to be further strengthened– Breast feeding counselling, IYCF training, awareness sessions on

programming – ongoing. – BFHI certifications needs to be reinstated

Baby Friendly Hospital Initiative ( BFHI)

IYCF Activities 2012-2014

• The National Infant and Young Child Feeding Guideline drafted

• BCC Strategy for Maternal and Child Nutrition developed• MCN BCC Campaign Plan -

Maternal and Child Nutrition Guide for caregiversMaternal and Child Nutrition Manual for Community health

workersPretesting of Guide and Manual in three atollsIEC and Advocacy tools under development- leaflets, posters,

banners, Mass media spots. (TV/radio)Orientation to MCN Guide completed in 3 atolls ( incolloboration

with NGOS- SHE, ARC)

IYCF Activities 2012-2014

• MCH – online surveillance system for monitoring nutrition interventions including growth monitoring, vaccination and IYCF information,

• IYCF components integrated into Newborn care and IMCI trainings.

• Micronutrient Supplementation: Vit A and Deworming program

• National Nutrition Council - 2012

• Bottle-neck analysis on Infant and Young Child nutrition situation- ongoing

• Project on ‘Strengthening GMP’- Situation Analysis, Training, SOPS, resource materials development

• Capacity building of healthcare providers : Breast feeding counselling trainings :( 87 trained since 2012) IYCF trainings ( 181 trained, 49 since 2012) BMS code Orientation/ sensitization:

private sector, government, agency partners health care providers

Newborn care trainings Growth monitoring and promotion IMCI PMTCT Guideline

IYCF Activities 2012-2014

• World Breastfeeding Week is being marked each year at National Level.

• Awareness / IEC: Radio / TV programmes, Friday Prayer Lecture, leaflets and information disseminated

• Special counselling classes: on exclusive breastfeeding mothers, support for working mothers on the concept of expressed milk, complimentary feeding through out the week

• Advocacy event: With the theme of WBW 2014: Breast feeding: A Winning goal for life, a foot ball match and Health Fair(focused on Breast feeding and IYCF awareness)

• Trainings : Growth monitoring, IYCF, Breastfeeding counselling, newborn care, IMCI, PMTC sensitization

• Training on ‘Mobilization of Religious Leaders on MCH’

Support: UNICEF /WHO, Government Organizations and NGOs

World Breastfeeding Week 2014

World Breastfeeding Week 2014

NGO’s involvementSociety for Health Education (SHE)•Training of HWs on IYCF training at Addu City•WBCI tool training at Addu city•Roll out training of Maternal and Child Nutrition Guide

CHALLENGES

• Limited national level capacity on IYCF• High staff turn over rate• High expatriate staff- doctors, nurses• Dependency on imported food- High lobby group of infant milk

formulas and commercial infant foods• Difficulty in implementing and enforcing existing policies and strategies– Due to changing political climate, limited resources (HR, technical, funds)– Changing policy priorities (which is dynamic), changing leaderships

• The support of pediatricians, Obstetricians, in promoting exclusive breast feeding has diminished

• Delay in enforcement of the regulation on BMS and infant food.

Next Steps 1. Country level assessment WBTi 2. Training Health workers on WBCi3. Plan of action for 2015-2016

Thank you