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!

AB: Have patience, flexibility and do not forget to have fun!

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This document presents the guiding principles for feeding infants in emergencies. Each principal is presented individually with an explanation of the significance of each, its implications during emergencies, and suggested action.

The Operational Guidance for Emergency Relief Staff and Programme Managers was first produced by the Interagency Working Group on Infant and Young Child Feeding in Emergencies in 2001. This Working Group included members of the Infant and Young Child Feeding in Emergencies (IFE) Core Group, an inter-agency collaboration of more than 30 agencies including CARE concerned with the development of training materials and related policy guidance on infant and young child feeding in emergencies. The Operational Guidance is now in available in ten languages including Spanish, French, and Swahili. Infant and Young Child Feeding in Emergencies: Operational Guidance for Emergency Relief Staff and Program Managers (Version 2.1, 2007)
Operational Guidance for Emergency Relief

Module 1 for Emergency Relief Staff- Manual for Orientation, Reading and Reference
Module 1

Infant Feeding in Emergencies Module 2 for Health and Nutrition Workers in Emergency Situations was developed through interagency collaboration and consultation with many experts and field workers. It aims to provide those directly involved with infants and young children with the basic knowledge and skills to support safe and appropriate infant and young child feeding. Module 2 comprises four parts - a core manual, additional material (including sections on artificial feeding and management of acute malnutrition in infants under six months), annexes and slides content. These are available to download separately or as a complete document.
Module 2 for Health and Nutrition Workers in Emergency Situations for Training, Practice and Reference
Module 2
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