There are no breastfeeding friendly spaces in any of the refugee camps in Greece, period. None. Nothing. There are no maternal child friendly spaces either. Everything has been closed by the Greek government and even before closure, there was nothing. I have run an NGO in Greece since 2018, and I know this to be correct. I am therefore calling for a reality check. People ask what interventions work, how the spaces are used etc. There are no interventions and no spaces and no knowledge at all about infant feeding.

hello

Thank you to you to start this investigation!

I want to clarify that baby-friendly spaces are not mostly on promoting breastfeeding but on protecting and supporting breastfeeding. Breastfeeding women should have a safe space there for breastfeeding, for receiving information, support and counseling. Counselling should cover shifting from partial/mixed feeding to exclusive breastfeeding. It should also be a place to start relactation with all the support needed for women who are formula feeding.

In order to navigate aggressivev marketing it is important to have Code awareness and implementation, frefuse donations and follow the operational guidance!  

Hello Savita Potarazu ,

I implemented an ANJE-U project in Burkina in which we set up Baby Friendly Spaces in several localities in the center-north of the country (Kaya, Barsalogho, Kongoussi)

I benefited from the experience of Diane Moyer.

On May 04 and 05, 2023, a training will be organized in Burkina Faso on this theme.

Abel Illa - Nutrition Training Reminder. ANJE-U: Management of... | Facebook

my Contact: illaabel7@gmail.com; whatsapp: 0022670405061.

Hello Savita,

This sounds like an interesting project!

In case you have not yet seen it, I wanted to bring your attention to the following brief: 

Supportive Spaces for Infant and Young Child Feeding in Emergencies. Technical Brief September 2020.

At the end of the brief you will find plenty of references to inform your research paper, including country experiences in relation to your request for examples. As you will see, ACF have been doing interesting work on assessing impact. 

I also wanted to echo Maryse's important note that the objective of these spaces is mostly to protect and support breastfeeding.

All the best,

Isabelle 

Hi Savita,

Warmest greetings from Pakistan.

So many great questions! I'll do my best to answer them.

1. How commonly are baby friendly spaces being utilized to promote breastfeeding as opposed to other maternal and child health-related activities? 

I can only speak from my experience as the founder of Breastfeeding International (BI). We have been able to successfully implement the WHO & UNICEF framework of Nurturing Care (NC) in emergencies, which integrates Maternal Child Health (MCH) and Infant Young Child Feeding (IYCF), using evidence-based best practices, including mass breastfeeding rescue and relactation. But generally, I’d say that it’s not very common, and it is very much needed, considering our children under 5 years are the MOST at risk of morbidity and mortality, especially the younger they are. Sadly, we live in a patriarchal world, and the needs of women and children aren’t always the top priority for decision makers in emergencies. There is a patriarchal/misogynistic tendency to state that “breastfeeding isn’t a priority in emergencies”, and just advocating for it can raise some bushy brows. Those of us that work on the ground are constantly finding ourselves fighting for lives, and advocating to have safe spaces for mothers and children, because we know that providing skilled breastfeeding and nutrition support can mean the difference between life and death.

So, regarding your question related to promoting breastfeeding as opposed to other MCH activities, I don’t think it should be ‘and or’. Nurturing environments in emergencies is possible and scalable; it is especially in emergencies that mothers deserve excellence. We know this to be possible because we have multi-country piloted NC safe spaces. I developed the bespoke ‘Nurturing Care Centers of Excellence’ NCCE for humanitarian emergencies in Timor-Leste and currently supporting colleagues in Pakistan, Turkey and Syria. NCCE is an integrated full package of care. It is innovative, low cost, ultracompact, established for emergencies and beyond, that fit in a small space for easy transportation. It was first piloted in the Timor-Leste 2021 flood response, then Ministry of Health requested UNICEF support for its replication in all 20 evacuation centers. Today NCCE is part of the national Mother Support Group (MSG) programs directive (Alola). WHO will be featuring BI’s NCCE in their upcoming Nurturing Care Brief as an example for emergencies. I can share the link when it’s published.

The ‘Mother Baby Area guidance’ that was recently sent to me, described children in terms of being “disruptive” and may need some minor revisions, because currently it is not family friendly for mothers and their children. These basic spaces focus on babies under 2 years (when WHO recommends breastfeeding 2 years and beyond – and in many countries outside of the Western world, it is common to see 3,4,5 and 6 year old’s breastfeeding to biological/anthropological norm). Separating mothers from their children can cause additional maternal stress, which could negatively impact breastfeeding and reduce oxytocin levels, so finding innovative ways to keep mothers and children together while receiving counselling and skilled support is important (see the early learning component of NCCE – integrating early play with breastfeeding and nutrition counseling – links to reports below). Zero separation is also important, because when children are separated from their mothers, they risk being abused or trafficked in emergencies. Another option that we know works well and is mentioned in the MBA guidance is collaboration with UNICEF ECD teams in emergencies, where children are educated and entertained in close proximity to their mothers.

2. What kinds of research methodologies are utilized to assess the effectiveness of breastfeeding promotion during crisis?

I think ENN colleagues have written a great paper in 2021 entitled “Effectiveness of Breastfeeding Support Packages in Low- and Middle-Income Countries for Infants under Six Months” so you might want to review their systematic review for information on methodology. Here’s the link:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924359/

In terms of Government’s methodology, Timor-Leste’s Ministry of Health with MSG and UNICEF support, conducted regular screening for malnutrition, including MUAC readings, so it was because of this methodology, which showed children significantly improved in their nutritional status (Red MUACs turning to green), clearly benefitting from NCCE that they requested my technical support and capacity building trainings to make NCCE scalable.

3. How do you navigate aggressive marketing of breast milk substitutes and promote optimal breastfeeding practices during emergencies and in refugee settings?

Rapid and effective action in the early days is vital to save lives. Being too slow - detrimental and leads to a deadly situation of ‘mopping up’ the mass formula influx. One of the first actions should be the release of an IYCFE Statement from Government with WHO/UNICEF, which needs to be disseminated widely. There should also be oversight and support from health agencies including the UN, because industry will try and hinder the release of the government statement (using typical industry delay tactics).

Having skilled and compassionate MSG counselors, ready to be deployed will help not only navigate the aggressive donations/marketing, but help sensitise communities on the Code and Operational Guidance for Infant and Young Child Feeding in Emergencies (OG-IFE). Philippines is a good example and Ministry of Health work closely and rapidly with the MSG’s and the network of human milk banks. In some country contexts, where MSGs might not be available, it is possible to rapidly train peer counselors in affected communities. Many of the women appreciate having something positive to do, as boredom and stress is a common experience in IDP camps. Ensuring peer counselors receive supportive supervision, opportunities to debrief and counseling themselves is important. Ideally countries prior to emergencies should have skilled MSGs trained in emergency response and Breastfeeding International is working on this.

You might be interested in watching this webinar from IFE Core Group, GBC and UNICEF/WHO, where we discuss ways to manage and intercept inappropriate donations related the Operational Guidance for Infant and Young Child Feeding in Emergencies (OG-IFE) and the Code: https://www.globalbreastfeedingcollective.org/strategies-infant-and-young-child-feeding-climate-related-emergencies

The key I’ve found is that its always about community empowerment and ownership. An empowered community will be Code Heroes and prevent dangerous donations entering camps, therefore rapid good capacity building on the Code and OG-IFE makes a huge difference. Also, as we leave emergencies, the communities are themselves empowered to handle future emergencies with the knowledge and capacity to navigate aggressive marketing/distributions (and become skilled breastfeeding counsellors).

Regarding your question on how we “promote optimal breastfeeding practices during emergencies and in refugee settings”… we provide mass breastfeeding counselling, breastfeeding rescue (including wet nursing), skilled relactation, promotion of skin-to-skin contact and nutrition support (hungry mothers doubt their milk supply).

4 What challenges do you face in implementing baby friendly spaces and/or breastfeeding initiatives in humanitarian settings? 

Interestingly, as we always adapt to the local needs, cultures and context and empower communities, I’ve never had any issues in the local context in supporting emergency affected communities to implement NCCE safe spaces. Our biggest advocates are always the mothers, their families and community leaders. The major challenges I’ve faced, have been from Western/er interference, for example with attempts made to stop breastfeeding rescue and halt our work for safe spaces; spreading misinformation and even threats placed on my life to stop our life saving work, which is really unethical. Another major challenge we faced in several countries have been industry front groups and lobby groups (again Western) attempting to sabotage efforts through the political setting.

When communities are empowered and they see for themselves the results of their children improving in health and nutrition, the community (grandmothers especially) will ensure Code and OG-IFE compliant environments. It’s amazing to see in action that the predatory companies and their proxies have feared the protective grannies and other Code Hero community members, and thus avoid IDP camps where the community have been OG-IFE and Code trained. After our mass capacity building, the community members understand whether donations are well intentional or are from predatory companies, and report appropriately to the contact at Ministry of Health and IBFAN. Seeing community Code Heroes handle inappropriate, but well intentional donations with compassion is wonderful. They rapidly and gently sensitise the person about to donate the products, explaining the risks, and the well intentional donor often thanks them because they didn’t realise the risks, and donations then don’t enter the camp. This also helps cascade IYCFE education to the wider community.

 5. Please provide examples of baby friendly spaces being implemented in recent conflict settings:

Here are BI reports, which are in the public domain that you are free to access:

Timor-Leste:

https://drive.google.com/file/d/1sUbwhh16YDNM79VaROqGHvlELnmS9OS6/view?usp=sharing

Pakistan:

https://www.babymilkaction.org/wp-content/uploads/2022/08/Breastfeeding-International-Emergency-Response-with-IBFAN-Pakistan-Report-3.pdf

Turkey-Syria:

https://drive.google.com/file/d/1OVbodPlNfBsZCHpN84w4rRzgagMhst5u/view?usp=sharing

Regarding your request for interviews, you’re welcome to email me, but I would need to know your research funding source, because BI has strict rules on engagement and collaborations: breastfeedinginternational@gmail.com

*Breastfeeding International does not seek or accept funds, donations, gifts or sponsorship from manufacturers or distributors (or their trusts or foundations) of infant and young child feeding and related products.

Hope this info is helpful to you.

Magdalena