World Breastfeeding Week 2009 • 1-7 August 2009
WBW around the World
World Breastfeeding Week Activities 2009
For this year's World Breastfeeding Week, the Window of Opportunity program at CARE joined partners around the globe to highlight the critical role of breastfeeding before and during emergencies worldwide.
Window of Opportunity Program
The window of opportunity for impacting child growth and development is short - from conception through the first two years of life. That is why CARE places special focus on infant and young child feeding (IYCF) and related maternal nutrition (rMN) practices. The Window of Opportunity program works to promote, protect and support optimal infant and young child feeding practices and related maternal nutrition practices by improving the enabling environment, strengthening health system support for infant and young child feeding and related maternal nutrition practices and empowering communities and individuals to make optimal infant and young child feeding and maternal nutrition choices. Because of programs like this, CARE is saving and improving thousands of lives in the world's poorest places through proven, effective and affordable solutions.
Since 2004, CARE USA has implemented an initiative to increase capacity to improve infant and young child feeding in emergency settings. CARE's program sites include three refugee camps outside the town of Dadaab, in northeastern Kenya. The camps, established in mid-1992, are home to refugee communities from throughout the region (e.g., Ethiopia, Burundi, the DRC and Sudan), with Somalis making up the great majority of the population.
This year CARE partnered with various organizations on World Breastfeeding Week activities that included a traveling road show, infant and young child feeding counseling sessions, and mother-to-mother support group sessions.
Maternal malnutrition, inadequate breastfeeding and inappropriate complementary feeding constitute a big risk to the health of the children under the age of two in Sierra Leone. The Window of Opportunity program began in two districts (Koinadugu and Tonkolili) in Sierra Leone in January of 2009 and follows a successful USAID- funded, community-based health initiative (Child Survival Project (CSP) - For Di Pikin Dem Wel Bodi (The Health of the Child)) implemented in the Koinadugu District, Sierra Leone.
This year's World Breastfeeding Week activities included airing of a radio jingle throughout the week on a community radio station in the Koinadugu District, community rallies, live performances from a drama club and a quiz competition for pregnant and lactating mothers. Prizes offered during the quiz competition included, baby diapers, cups, spoons, soap and baby powder.
year CARE's Window of Opportunity program and US Agency for International
Development's (USAID) Infant and Young Child Nutrition Project
(IYCN) being implemented by PATH collaborated on putting messages out
during World Breastfeeding Week.
Interview: Feeding Infants and Young Children during Emergencies
In an interview with Abigail Beeson, a technical coordinator, and Mary Lung'aho, a Special Advisor, the two provide some insights into the programmatic challenges and lessons learned from their time spent working to integrate breastfeeding support skills and promotion capacity into CARE's emergency program in Dadaab, Kenya.
Q: What attracts you to working on nutrition programming in emergency settings?
AB: The same thing that attracts me to nutrition in general, if you cannot support an environment where a child has the best start in life, how will we ever have an impact on infectious disease, education and economics.
Q: Tell me a little about the program you worked on.
ML: Since 2004, CARE USA has implemented an initiative to increase capacity to improve infant and young child feeding in emergency settings. CARE's program sites include three refugee camps outside the town of Dadaab, in northeastern Kenya. The camps, established in mid-1992, are home to refugee communities from throughout the region (e.g., Ethiopia, Burundi, the DRC and Sudan), with Somalis making up the great majority of the population. Due to ongoing insecurity in Somalia, regular influx into the camps has continued throughout the period of the CARE initiative, with the population increasing at an average rate of 5000 per month during 2008. The camp population, which was approximately 134,000 in 2005, now stands at approximately 240,000. Many of the new arrivals are pregnant and lactating mothers, and children.
From 2005 through the present, CARE, UNHCR, GTZ, IRC, NCCK and other partners have worked in an interagency collaboration, the Dadaab IYCF Team, to provide support for infant and young child feeding in the camps. The objective is to integrate IYCF into ongoing, multi-sectoral programming rather than create a stand-alone system. Activities include orientation for all staff to ensure their understanding of their responsibilities in supporting appropriate IYCF practices, including emergency preparedness; on-going training; training of facility and community-based IYCF counselors, and mother-to-mother support group leaders/facilitators, and provision of on-going support through mentoring activities; implementation of behavior change communications approaches, which include the camp-wide annual celebration of World Breastfeeding Week; tracking program coverage and monitoring program process and results; and advocacy and feedback to the community on progress in improving IYCF practices and child nutritional status.
AB: In addition to providing program support to the IYCF-E initiative as outlined above, I did a qualitative study that looked at the breastfeeding practices of Somali breastfeeding women in all three of the Dadaab refugee camps in 2006. Focus group discussions and key informant interviews were held with mothers, pregnant and lactating women, men, youth (over the age of 18), grandmothers, traditional birth attendants and community health workers to better understand breastfeeding practices in particular initiation and to compare them to previous practices from Somalia in order to understand if coping mechanisms had at all impacted a mothers perceptions of her ability and desire to breastfeed in the refugee camps in Dadaab.
Q: What was your role?
ML: I assisted with program planning, training, development and review of technical materials, coaching and support of staff, support for improved tracking of process and results.
AB: From a program perspective I was responsible for grants management, reviewing and editing technical materials and supporting other program requests. As for the research, I headed the study with support from the CARE Kenya staff and refugee assistants.
Q: Tell me a time when you discovered that the programming in Dadaab was having a positive impact.
ML: I'm really impressed at the rate that the mother-to-mother support groups have spread. As of the last quarterly report there were 679 active groups. These aren't groups that belong to the agencies either- they are groups women in Dadaab started themselves. I think that is why they are so popular, the women themselves really have taken ownership of the groups.
AB: While doing my research, I got to know some of the women in one of the camps. It was interesting to observe breastfeeding practices in that area as without prompting or recognition, women on there own began to exclusively breastfeed and provide support to one another. During a visit to a household, I observed a woman asking another woman questions and observing her as she breastfed about positioning and about how the woman breastfeeding handled work and breastfeeding. Anecdotally, it seemed to be the best mechanism for the Somali's in the refugee camps as emotions often ran high and there were incidences of people being stoned by other refugees who had been identified by the NGO's as being model individuals. It gave reassurance to me that without coaxing communities on their own initiative can change if they feel the desired behavior does have positive impacts.
Q: What were some of the challenges and lessons you learned from working on that program?
ML: There are many challenges to working in a setting such as Dadaab. One in particular was working with emergency-assisting staff who come from different backgrounds and cultures and who speak multiple languages (which also differ from those spoken by emergency-affected population). This poses huge challenges especially when training and adapting materials and implementing activities. Additionally, there is frequent staff turnover, which is a feature of many 'difficult' situations. And of course working in coordination with multiple sectors and agencies to provide an integrated response is always challenging. Nevertheless, we developed pictorial training materials for lower literacy staff and carried out on-going orientation and capacity-building trainings in order to keep all the staff up-to-date and in the loop.
AB: The language barriers and literacy levels as indicated by Mary have been major challenges. During my research it was a challenge and it has been a challenge with our projects as indicated. Measures are in place through the education system in the refugee camps and the hiring of recent graduates to try and rectify the problem, but identifying people who can translate with the appropriate technical background still remains an issue. It is not uncommon in situations such as this one and I do think attempts are being made to try and address the issue, but given the nature of emergencies it will likely be something that remains without a solution for some time.
Q: Do you have any advice for others working on nutrition programs in emergency settings?
ML: Don't forget to bring a flashlight!
Have patience, flexibility and do not forget to have fun!
The World Alliance for Breastfeeding Action
(WABA) is a global network of individuals and organisations concerned
with the protection, promotion and support of breastfeeding worldwide.
WABA action is based on the Innocenti
Declaration, the Ten
Links for Nurturing the Future and the Global
Strategy for Infant & Young Child Feeding. Its core
partners are IBFAN, LLLI, ILCA, Wellstart International and ABM. Find
out more at the WABA.
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