Concept note on IYCF strategy

Strategy Concept Note on Infants and Young Child Feeding [IYCF] Strategy Initiative for KSA

Edited by

Professor Osama Awad Salih

September 2017

INTRODUCTION Breastfeeding as the best start in life.

Breastfeeding not only provides children with the best start in life, it also benefits maternal health, protects against non-communicable diseases and contributes to environmental sustainability. Despite impressive gains in many countries over the last decade, global breastfeeding rates have seen only slow progress since 1995. Improvements in breastfeeding rates are critical to the attainment of the Millennium Development Goals and Post- 2015 Sustainable Development Goals. 

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Breastfeeding is of critical importance, and evidence for this continues to grow: o Breastfeeding protects against illness and death. o Suboptimal breastfeeding practices resulted in more deaths among children under five years of age. o Immediate skin to skin contact and breastfeeding within the first hour of life significantly reduces newborn mortality.

Breastfeeding is essential for early childhood development. o It supports healthy brain development, increased I.Q. scores, and better school performance.

Breastfeeding benefits maternal health by improving birth spacing and reducing the risk of postpartum hemorrhage. o Women who breastfeed have a decreased risk of breast and ovarian cancers and of some cardiovascular diseases.

Breastfeeding decreases the risk of non-communicable diseases, including childhood asthma, obesity, and diabetes and heart disease later in life.

Breastfeeding provides a natural, renewable food that needs no packaging, transportation, storage, or cooking, making it environmentally friendly.

Breastfeeding is explicitly recognized by the International Convention on the Rights of the Child as a key component of every child’s human right to the highest attainable standard of health.

Yet, only 44% per cent of the KSA newborns are put to the breast within one hour of birth. Even fewer (3.5%) infants under six months of age are exclusively breastfed.

Patterns of Breastfeeding in the Kingdom of Saudi Arabia Child Age

Frequency

(Months)

Not

% of Breastfed and given

Breastfed

Plain Water

Supplements

(%)

only

(other foods

% Bottle-fed

and/or drinks)

2

1-2

98

22

11.2

66.8

64

3-4

302

26

5.0

69.0

78

5-6

110

29

6.4

64.6

91

7 - 12

433

31

0.2

68.8

89

KSA Women Face Many Barriers to Breastfeed Notwithstanding high political commitment many factors have limited the adoption of strong laws and policies, as well as implementation of comprehensive programmes, to protect, promote and support breastfeeding. Women also face many barriers and challenges to breastfeeding, which encompass varied social, cultural, political, economic, commercial and educational factors. One emerging issue, given the increasing participation of women in the labor force, is adequate maternity protection and the necessary time, support and accommodation to enable them to continue breastfeeding once they return to work.

Rapid Progress Is Possible While national trends in breastfeeding rates remain stagnant, rapid progress in raising national breastfeeding rates is possible. Worldwide significant improvements have been achieved and sustained in a wide range of countries in diverse regions with varying levels of development. The progress was a result of strategic programmatic efforts that included strong national leadership and adequate funding to support breastfeeding. In addition, several of these countries provided counseling and support for mothers in health facilities and through peer support networks, approving protective laws and policies while leveraging mass communications to promote breastfeeding in culturally appropriate and relevant ways.

Infants and Young Child Feeding [IYCF] Strategy Initiative In KSA This document sets out a strategic framework to galvanize national stakeholder strategy for breastfeeding.

Breastfeeding practices have improved rapidly in countries that have implemented comprehensive laws, policies and programmes. Such encouraging gains raise a question: Why are we not seeing systematic progress in KSA? Seeking answers, our study conducted a landscape analysis to assess priority for breastfeeding interventions. Diverse stakeholders uniformly agreed that breastfeeding has not benefited from political and donor commitments commensurate with its potential to save lives and promote children’s welfare and national development.

The study pointed to many reasons contributing to the low-profile breastfeeding has received on the development agenda, including inadequate national leadership, the failure to frame and communicate clearly the importance of breastfeeding and risks of not breastfeeding and the influence of and aggressive marketing by breastmilk substitute companies.

Vision A nation where all mothers and families are empowered, enabled and supported to optimally breastfeed their children, and where early initiation, exclusive breastfeeding for the first six months of life and continued breastfeeding for up to two years or beyond, together with appropriate, adequate and safe complementary foods, become the social norm that helps children survive and develop to their full potential.

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The study voiced the need for several urgent actions: Make use of the main outputs of the study [ development of the IYCF Indicators for the first time in KSA].

Indicators are considered as a powerful evidence-based tool for developing policy and creating strategies about IYCF situation in the country.

Outcomes of the study bring attention to the scale of the problem and spotlight solutions generated from the families and communities. These outcomes should be used to develop effective advocacy and communication strategies and programs to various audiences; the outcomes of the study call for work across sectors and relevant initiatives to develop a more integrated approach to improving breastfeeding practices.

There is thus a pressing need to encourage the value of breastfeeding nationally and at the community level, accentuating the vital link between breastfeeding and achieving the MDGs and the future Post2015 Sustainable Development Goals.

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Annex 1.

Infant and Young Child Feeding Indicators Seven core indicators and 6 optional indicators were computed according to WHO standards, using the WHO questionnaire that had been adapted to the context of Saudi Arabia. Out of the 8 core indicators only the consumption of the iron-rich or iron-fortified food was excluded due to the data limitations, on the other hand, in optional indicators, only the duration of breastfeeding was excluded as it requires studying the children aged 0-36 month and it is out of the domain of the present study.

Infant and Young Child Feeding: Core Indicators This include 1. Early Initiation of Breastfeeding (EIBF); 2. Exclusive Breastfeeding (EBF); 3. Continued breastfeeding at one year; 4. Introduction of the Solid, Semi-Solid and Soft food (ISSSF); 5. Minimum Dietary Diversity (MDD); 6. Minimum Meal Frequency (MMF); 7. Minimum Acceptable Diet (MAD

IYCFI Indicators in Saudi Arabia Riyadh

Hail

Jeddah

Dammam

Jazan

KSA

Indicator

38.4

23

45

49

63

44

2.9

0

1.3

7.8

5.3

3.5

Continued Breast Feeding at one year

63.8

79

66

70

88

74.5

Introduction of Solid, Semi-Solid or Soft Foods

100

100

99

96

84

97

Minimum dietary Diversity

76

69

68

58

59

67

Minimum Meal Frequency

68

51

59

53

49

58

Minimum Acceptable Diet

43

31

33

28

35

35

Child Ever Breastfed

90

83

95

97

94

92

Continued Breastfeeding at 2 years of age

65

74

49

66

59

64

Age-appropriate breastfeeding

50

65

45

50

63

54

Predominant breastfeeding under 6 months

10

0

3

25

39

16

Bottle Feeding

93

81

88

73

74

83

Milk feeding frequency for non-breastfed children (MFFNBFC)

96

83

86

93

88

91

Early Initiation of Breast Feeding (EIBF) Exclusive Breast Feeding (3/103)

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Annex 2.

Breastfeeding Ceasing 1. Early ceasing of breastfeeding is widely common in context Saudi Arabia.

2. About 29% of the study sample have ceased breastfeeding. Out of the total number of those who ceased breastfeeding, 33% percent were during the first week after delivery and 75% during the first four months of age. Contrary to expectation and the recommended, ceasing showed a decreasing trend with child age. As the child age increase the ceasing percent decreased.

3. The major reasons for sooner termination of the breastfeeding in Saudi Arabia were 1.

Insufficient and failure to produce breastmilk (42%); 2. breastfeeding burden and stress (17%); 3. Baby denial breastfeeding (13%); 4. Difficulties to breastfed babies at work places (11%) in addition to other reasons such as mother sickness, next pregnancy and advice by the doctor.

Ceasing of Breastfeeding

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Ceasing Breastfeeding (Days)

Frequency

%

0 -7

163

33

8 - 30

87

18

31 - 60

59

12

61 - 120

67

14

121-180

38

8

181- 360

58

12

361 - 540

13

3

> 540

9

2

Total

494

100

Annex 3.

Information Source and Community Support 1. In Saudi Arabia the major sources of breastfeeding information were (1) Mother/mother in-law (30%); (2) Health personnel (21%); (3) Internet (21%); (4) friends (10%); and TV (8%).

2. The role of the husband in providing breastfeeding information was negligible (4%) compared to the other main sources of breastfeeding information.

3. Only 18% of the working mother reported that the maternity leave is enough 4. The majority (98%) of the working mothers mentioned that there are no places for breastfeeding during the working hours.

5. Approximately 95% of the working mother didn’t breastfed their babies during the working hours.

6. To support breastfeeding during the working hours, 61 % of the respondents suggested establishing and availing a well stablished breastfed room; increasing breastfeeding hours (20%) and availability of a well-trained servants in breastfeeding rooms (16%).

7. Almost all the respondents (95%) reported that they are no specific breastfeeding facilities in the public places 8. Percentage of the mothers who received antenatal (93%) and postnatal care (86%).

9. During antenatal care provision about three quarters of the mother received messages and information about breastfeeding (76%) and mother nutrition (72%).

10. Breastfeeding messages major providers during antenatal care are doctor ( 54%); dietitian (13% ) and midwives (9%). While during postnatal care: 79% from the health personnel; Mother (11%) and midwives (8%) 11. During postnatal care infants’ mother received messages and information about breastfeeding (20%); both child feeding and reproductive mother diet (18%); food to be avoided (11%); foods encouraged to eat (14%)

This document is based on the Assessment of the Patterns and Determinants of Breast and Complementary Feedings in Infants in Saudi Arabia.

Dr, Adam Elhag Ahmed (PI); Prof. Osama A. Salih (COI); Dr. May Almuammar (COI)

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