Alimentazione infantile nelle emergenze 'Perché é importante' Rome, 16 novembre 2009 Lida Lhotska IBFAN – GIFA Member of the IFE Core Group

Current members and associate members: The IFE Core Group Current members and associate members: WHO WFP IBFAN-GIFA represents IBFAN on a larger group called IFE Core Group. IBFAN has become involved in the work on IFE because the key focus of its work is on protection of breastfeeding and optimal infant feeding. All members of the IFE Core Group are presented on this slide. The group's focus is in two key areas: Policy Guidance and capacity building. The Group is also a member of the Nutrition Cluster of the Inter-Agency Standing Committee. This Cluster approach was introduced in 2005 as a means to strengthen predictability, response capacity, coordination and accountability by strengthening partnerships in key sectors of humanitarian response, and by formalising the lead role of particular agencies/organisations in each of these sectors. www.ennonline.net/ife 2 2

Obiettivi Quali sono le pratiche ottimali per l’alimentazione di lattanti e bambini piccoli I rischi associati a pratiche di alimentazione sub-ottimali, specialmente nelle emergenze 3

Raccomandazioni per l’alimentazione ottimale di lattanti e bambini piccoli Avvio precoce dell’allattamento al seno (entro 1 ora dalla nascita) Allattamento esclusivo (0-<6m) Alimentazione sicura e appropriata per lattanti e bambini piccoli nelle emergenze Allattamento continuato (2 anni e oltre) Alimentazione complementare (6-<24m) Optimal IYCF recommendations are: Early initiation of exclusive breastfeeding (EBF) – this means breastfeeding within 1 hour of birth EBF for first completed 6 months – exclusive breastfeeding means an infant receives only breastmilk, no other liquids or solids, not even water, with the exception of necessary vitamins, mineral supplements or medicines. Continued breastfeeding to 2 years or beyond. Complementary feeding encompasses continued breastfeeding, the introduction of safe and adequate complementary foods, and how that is done in the nutritional and developmental interests of the child. Cibi complementari 4

Liberarsi della zavorra Before going any further, an important point which has to do perhaps more with psychology than with anything else needs to be made. Often, when presenting or discussing infant 'breastfeeding-friendly' policies and programmes with decision-makers and implementers, or when talking to mothers, fathers, family members, they are in agreement on early initiation, exclusivity and continuation of breastfeeding. But then one probes deeper and often learns : "Well, I know it is the best, but it did not work for me, my daughter, my mother, my cousin…" "Yes-yes, it is important to promote 6 months of exclusive breastfeeding….but it is difficult to do and it does not quite work, I think". Whether we like it or not, we all come to the subject with some sort of baggage of personal experience or influenced through various means and sources. And even if we ourselves had become aware of this dead weight and had managed to get rid of it ourselves, we need to keep in mind that those policy-makers, colleagues, health professionals etc. with who we are trying to advocate for optimal infant feeding practices are likely to also carry such a baggage. It is thus important to acknowledge this and help them throw their prejudices overboard, just like this illustration implies. © Jon Berkeley

Avvio precoce dell’allattamento Supporting early initiation of exclusive and continued breastfeeding is the most effective intervention to reduce U5 deaths. One fifth of neonatal deaths (22%) could be avoided by breastfeeding within the recommended 1st hour after birth and 16% of neonatal deaths could be saved if all infants were breastfed from day 1. (Edmond, 2006) Early initiation of breastfeeding also reduces the risk of post-partum haemorrhage in the mother – a leading cause of maternal mortality worldwide. Edmond, K.M., et al. Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality. Pediatrics, 2006. 117(3): p. e380-386. BONUS SLIDE (information could be shared when describing summary slide on optimal IYCF recommendations) Allattamento al seno esclusivo entro un’ora dalla nascita salva la vita a madri e bambini 6

Allattamento esclusivo Solo latte materno, nessun altro liquido o solido, nemmeno acqua, con la sola eccezione delel vitamine, Sali minerali di supplemento o farmaci. The Feeding practice of Exclusive breastfeeding requires that the infant receives breastmilk (including milk expressed or from a wet nurse) ORS, drops, syrups (vitamins, minerals, medicines) Does not allow the infant to receive anything else. 0-6 mesi compiuti

Introduzione di alimenti complementari sicuri e appropriati Alimentazione complementare 6-<24 mesi Supporto per il proseguimento dell’allattamento al seno per due anni ed oltre Introduzione di alimenti complementari sicuri e appropriati Poppate frequenti, cibo adeguato, consistenza appropriata e varietà, alimentazione attiva, preparazione igienica (FATVAH) It concerns the introduction of safe, appropriate and nutritious foods to complement continued breastmilk. Older infants need these foods to grow and develop healthily and to get used to eating habits of the family and community. True complementary foods would add to the baby's diet such nutrients which breastmilk did not evolve to provide. Sources of iron and zinc are especially important from complementary foods. Breastmilk provides some but total supply depends on the individual birth stores and as these run out, the baby needs exogenous sources. Many so-called complementary foods do not fulfil this function. (Gabrielle Palmer, 2009) Breastmilk continues to significantly contribute to energy and nutrient intake in children to 2 years of age or beyond. Complementary feeding involves not what is fed to the child but how it is fed – Frequent feeding, adequate food, appropriate texture and variety, active feeding, hygienically prepared (FATVAH)

Zanzariere impregnate con insetticida Vaccino contro la meningite Qual’é, secondo voi, l’intervento più efficace per prevenire la mortalità dei bambini <5 anni di vita? Zanzariere impregnate con insetticida Vaccino contro la meningite Allattamento al seno e alimentazione complementare Vitamina A e Zinco Hib vaccine = Meningitis vaccination 9

Risposta: Allattamento al seno e alimentazione complementare Interventi preventivi Proporzione di decessi <5 anni evitati Allattamento esclusivo e continuato fino all’anno di età 13% Zanzariere impregnate con insetticida 7% Alimentazione complementare adeguata 6% Zinco 5% Parto in condizioni di igiene 4% Vaccino contro la meningite Igiene dell’acqua e dell’ambiente 3% Somministrazione prenatale di steroidi Gestione della temperatura del neonato 2% Vitamina A Even in non-emergency situations, breastfeeding and complementary feeding interventions combined will prevent 19% (i.e. 1 in 5) of deaths in children under 5 years. This figure is already adjusted for HIV/AIDS, otherwise it would be 21%. Source: Jones et al. How many child deaths can we prevent this year? Lancet 2003; 362: 65–71 10

Cause di morte in mabini <5 anni, 2000-2003 La denutrizione di mamma e bambino contribuisce per il 35% dei decessi <5 UNDERNUTRITION underlies 53% of under five deaths Why are optimal IYCF practices important? Maternal and child undernutrition is not an infectious disease, yet underlies 35% of U 5 deaths worldwide. Neonatal mortality is the biggest U5 killer. Outside the neonatal period, the cause of death is often related to the disease pattern - diarrhoea & RTI, followed by malaria, measles, HIV Sub-optimal breastfeeding accounts for 1.4 million deaths and 10% disease burden in U5s. Black et al, 2008. REFERENCES ‘Fried egg’ modified from: WHO estimates of the causes of death in children Lancet 2005; 365: 1147–52 Jennifer Bryce, Cynthia Boschi-Pinto, Kenji Shibuya, Robert E Black, & WHO Child Health Epidemiology Reference Group* 35% from: Black et al, 2008. Maternal and child undernutrition: global and regional exposures and health consequences. The Lancet. Published Online January 17, 2008. DOI:10.1016/S0140 Reference for 1.5 million severe wasting: Caulfield LE, de Onis M, Black RE. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Am J Clin Nutr 2002; 80: 193-198. PubMed Adapted from Bryce et al, Lancet 2005; Black et al, Lancet 2008 & Caulfield et al, Am J Clin Nutr 2002 11

Rischio di morte se il rischio in allattamento é equivalente a 1 The younger the infant, the more vulnerable Più piccolo é il bambino, più è vulnerabile se non allattato Rischio di morte se il rischio in allattamento é equivalente a 1 Infants who are not breastfed are at risk - the younger infants are, the more vulnerable they are, even in non-emergencies. This is reflected in these findings from a WHO collaborative study. Infants <2 months are nearly 6 times more likely to die if not breastfed. The risk falls but remains for older infants. WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality, Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. The Lancet, 2000. 355(9202): p. 451–455. Turning our attention to emergencies  next slide Età (mesi) WHO Collaborative Study, Lancet, 2000 12

per il benessere dei loro bambini. Cos’é l’alimentazione di lattanti e bambini piccoli nelle emergenze (AINE)? L’AINE riguarda la protezione e il sostegno dell’alimentazione sicura e appropriata (ottimale) per i lattanti e i bambini piccoli in qualsiasi tipo di emergenza, ovunque accada nel mondo. Il benessere delle madri è cruciale per il benessere dei loro bambini. IFE concerns the protection and support of safe and appropriate (optimal) feeding for infants and young children in all types of emergencies, wherever they happen in the world. The well-being of mothers is critical to the well-being of infants and young children. So the needs of mothers - or primary caregivers – is also a key consideration in IFE. 13

Un’emergenza é una situazione straordinaria, di origine naturale o causata dall’uomo, che mette a repentaglio la salute e la sopravvivenza delle popolazioni. First, let's define emergencies so that we are all talking about the same scenario. Natural disasters include earthquakes, hurricanes, floods, volcano erruptions, tsunami etc. Man-made emergencies include armed conflicts betweenor within countries or territories 14

Un’emergenza può accadere ovunque This picture is from the PHILIPPINES, Pasig, Manila_2009_10_12_WFP-Veejay_Villafranca_0639 But everyone will recall hurricane Katrina in the US or, closer to home, earthquake in Abruzzo.

Reasons for risky feeding practices Ragioni che sono all’origine di pratiche alimentari pericolose Una proporzione di lattanti potrebbe non essere allattata al manifestarsi dell’emergenza Le pratiche alimentari pre-emergenza potrebbero essere sub-ottimali Durante un’emergenza, aiuti inappropriati possono aumentare l’alimentazione artificiale. In an emergency, there are many reasons why risky feeding practices may prevail. A proportion of infants may be artificially fed when an emergency hits. A population may have sub-optimal feeding practices, for example, low exclusive breastfeeding rates and mixed feeding, few iron and zinc rich complementary foods. Risky feeding practices may be reinforced or brought about by the emergency itself, e.g. untargeted distribution of infant formula leading to increased artificial feeding rates. One key principle is clear: Emergency preparedness is key. Emergency response should build upon non-emergency programming. If you are not addressing optimal IYCF in non-emergency times, then you are really going to get caught out in emergency ones. 16

Allattamento al seno - il modo normale?… DRC 2003, The context is so important to the appropriateness of emergency response. This is why you – at country level – are best placed to prepare. And as a result, a responsibility to meet. DRC 2003, Kent Oage UNICEF Incontro con le vittime dell’alluvione (Venenzuela 2005)

O…allattamento al seno – ultima spiaggia? • Già indebolita dal parto, fu costretta ad allattare anche il suo bambino di 21 mesi. “Ho dovuto, non avevo altro da dargli.” [Mark Coultan, The Age, New Orleans, 6 Settembre 2005]

I rischi del non allattamento sono più elevati nelle emergenze Conflitto, Guinea-Bissau, 1998 In seguito al conflitto, i bambini di 9-20 mesi non più allattati al seno avevano avuto probabilità 6 volte maggiore di morire durante i primi tre mesi di guerra, comparati ai bambini allattati al seno. Prima del conflitto, non c’erano differenze di mortalità tra gli allattati e i non allattati. Jacobsen, 2003. The risks of not breastfeeding are even higher in emergency contexts, and not just in infants. For example, in the months following conflict in Guinea-Bissau in 1998, there was a 6 fold difference in mortality between breastfed and non-breastfed children aged 9-20 months. Before the conflict, there was no difference in mortality between 9-20 month old children who were not breastfed before the conflict in Guinea-Bissau. Pre-conflict, these children may have been sicker and less healthy than their breastfeeding peers, but not to the degree as to impact on survival. This changed in the riskier enviornment of the emergency. So the same feeding pattern pre and post conflict carried a much higher risk in the emergency context. 19

Aumento della mortalità dei bambini <5 nelle emergenze Decessi giornalieri per 10,000 persone rifugiate 1998 e 1999 persone di tutte le età Bambini <5 anni Decessi/10,000/Giorno Anot6her example to demonstrate the vulnerability of children U5 in is on this slide which reflects mortality rates of children U5 compared to the total population in refugee camps. As you can see, the mortality is consistently higher in the children so protection and support of appropriate feeding is crucial. Localizzazione del campo Refugee Nutrition Information System, ACC/SCN at WHO, Geneva

Defourny et al, Field Exchange, 2006. I bambini <2 anni contribuiscono al volume complessivo di malnutrizione acuta Molte emergenze sono caratterizzate dall’aumento della prevalenza della denutrizione acuta Niger, 2005 95% dei 43,529 casi di denutrizione ammessi per il trattamento erano bambini <2 anni Defourny et al, Field Exchange, 2006. La protezione e il sostegno dell’alimentazione ottimale di lattanti e bambini piccoli é essenziale sia per la prevenzione sia per il trattamento della denutrizione acuta Children under 2 years are especially vulnerable in emergencies. The prevalence of acute malnutrition in children is often measured to indicate the nutritional state of the population. The problem of acute malnutrition in emergencies is reflected in admissions to selective feeding programmes that treat severe malnutrition. For example, in MSFs programme in Niger in 2005, 95% of 43,529 malnourished cases admitted for therapeutic care were under 2 years of age. Infant and young child feeding practices are a key consideration in U2s – both in how sub-optimal feeding practices contribute to malnutrition, and in terms of skilled feeding support as part of nutritional rehabilitation for children who are already malnourished. 21

L’allattamento al seno é l’ancora di salvezza nelle emergenze Ukrainian Mother in World War II Nagasaki, Japan. World War II L’allattamento al seno é l’ancora di salvezza nelle emergenze

Immunologici/Fisiologici L’allattamento al seno é l’ancora di salvezza nelle emergenze FATTORI Nutritivi Immunologici/Fisiologici Pratici Breastfeeding is a lifeline for infants and young children in emergencies. Nutritional Immunlogical/Phsiological Practical Psychological There are advantages for the mother: Maternal. Breastfeeding also benefits the family and wider community: can you propose some? Psicologici Materni 23

L’alimentazione artificiale é sempre rischiosa Nessuna protezione attiva Il latte artificiale non é sterile, può contenere batteri mortali Aumenta l’incertezza alimentare e la dipendenza La scarsa qualità dell’acqua e la quantità inadeguata Artificial feeding carries risk even in non-emergencies. It does not have the protection of breastmilk, powdered infant formula is not sterile and may contain deadly bacteria, e.g. Enterobacter sakazakii alis Cronobacter, it increases food insecurity and dependency, it is costly in time, resources and care, and bottle feeding as a feeding method increases risk further due to difficulties in cleaning of these utensils and potential for adding a source of infection. Biberon e tettarelle sono una fonte extra di infezione Bottle feeding increases risk Costa tempo, risorse e attenzioni 24

L’alimentazione artificiale é più rischiosa nelle emergenze Contaminazione batterica Forniture limitate e scarse risorse Acqua contaminata The risks of artificial feeding are heightened in emergencies, with constraints on water and sanitation, fuel, preparation, storage and supplies. Emergencies are characterized by extremely infectious environments. Considerable skilled and well resourced support are needed to minimise the risks of artificial feeding in this environment. 25

Lezioni dal Botswana Molti lattanti non allattati (alimentazione sostitutiva) Nov 2005 – Feb 2006: Piogge insolitamente abbondanti, alluvione, diarrea, epidemia Anno Tempo Casi diarrea <5 Decessi <5 2004 Q1 8,478 24 2005 9,166 21 2006 35,046 532++ The vulnerability of infants who are artificially fed were reflected in Botswana in 2006. Here many infants were on replacement feeding as part of a national prevention of mother to child transmission (PMTCT) programme. In a country that was considered safe for artificial feeding, shift from 'normal' to 'emergency' situation demonstrated the risks of artificial feeding when in the autumn 2005 flooding led to contamination of water supplies and a largescale outbreak of diarrhoea which resulted in the death of many infants and young children. This table shows the escalation in cases of U5 diarrhoea and U5 death. CDC investigators of the outbreak found that the greatest risk for hospital admission for diarrhoea was not being breastfed. Many of those admitted had developed severe malnutrition, and had a history of recurrent diarrhoea. REF: Creek et al, 2006. Role of infant feeding and HIV in an outbreak of severe diarrhoea and malnutrition among young children, Botswana, 2006. Creek et al, 2006

Photo credit: Marie McGrath As mentioned earlier, during an emergency, inappropriate aid may increase artificial feeding and thus risk for survival and health of infants and young children. Two examples of some unsolicited donations of baby foods. Photo credit: Marie McGrath Kosovo Crisis, 1999

Photo credit: Ali Maclaine, 2006 Donazioni al Libano Can you tell what's wrong with these products? Labels! And note the 1,2,3—we all may know the difference between these three types of povdered milk– but will mothers, who cannot read the labels know? Foreign governments donated formula to the Lebanese government (HRC) that were not in Arabic. INGOs & local NGOs distributed this formula to mothers. Photo credit: Ali Maclaine, 2006

Non casi isolati: La pubblicazione di IBFAN ICDC Focus sul Codice nelle emergenze (2009) é parte del materiale prodotto in occasione della SAM e offre ulteriori esempi.

Yogyakarta Indonesia post-terremoto 2006 Rischi innescati dalla distribuzione indiscriminata di donazioni di latte artificiale Yogyakarta Indonesia post-terremoto 2006 Relazione fra la prevalenza della diarrea nei bambini <2 e la ricezione di latte artificiale donato Here is an example of negative impact of such and inappropriate aid on child health following the 2006 earthquake in Indonesia. Donated infant formula was distributed to all children. This led to a significant increase in the prevalence of diarrhoea in children under 2. The rate of diarrhoea in children U2 who had received donations was more than double that of children who had not. 30

Sostenere il Codice diventa ancora più vitale in caso di emergenza. Il Codice Internazionale per la commercializzazione dei sostituti del latte materno Codice Internazionale = Assemblea Mondiale della Salute (AMS) Risoluzione (1981) + Risoluzioni successive Protezione dalle influenze commerciali per le scelte relative all’alimentazione infantile. Non proibisce l’uso di latte artificiale o biberon. Controlla come vengono prodotti, confezionati, promossi e forniti SLM, biberon e tettarelle. Il codice proibisce la fornitura gratuita/a basso costo in ogni ambito del servizio sanitario. I Governi sono invitati ad adottare misure legislative. L’adozione e l’aderenza al Codice é un requisito minimo in tutto il mondo. Sostenere il Codice diventa ancora più vitale in caso di emergenza. How to ensure that such donations do not happen? There is an international policy tool, adopted in 1981 by the World Health Assembly intended to protect the mothers/carers of both breastfed and non-breastfed infants and young children from commercial influences on their infant feeding choices: The International Code of Marketing of Breastmilk Substitutes amd its 13 resolutions, which have equal weight. The Code and resolutions do not ban the use of infant formula or bottles, but controls how they are produced, packaged, promoted and provided. The Code prohibits free/low cost supplies in any part of the health care system. Governments encouraged to incorporate the Code in legislation. However compliance with the Code does not depend on legislation - adoption and adherence to the Code is a minimum requirement worldwide. The Code is even more critical in emergencies. 31

Le violazioni del Codice Internazionale nelle emergenze Violations of the International Code in Emergencies Sostituti del latte materno (SLM): “ogni cibo commercializzato o comunque rappresentato come una sostituzione parziale o totale del latte materno, anche se non adatto allo scopo” Le emergenze possono esser viste come un’opportunità per aprire o rafforzare un mercato di latti artificiali e “alimenti per l’infanzia” o come un esercizio di pubbliche relazioni per migliorare la propria immagine di responsabilità sociale nel Paese donatore e nel circuito ONU/ONG. Le compagnie che producono SLM Spesso le violazioni del Codice Internazionale in situazione di emergenza non sono intenzionali, ma riflettono scarsa consapevolezza delle disposizioni del Codice Coloro che sono coinvolti nella risposta umanitaria Products that meet the Code definition of a breastmilk substitute are said to be within the scope of the Code. For the purpose of the Code, a breastmilk substitute is: “any food being marketed or otherwise represented as a partial or total replacement of breastmilk, whether or not suitable for that purpose.” Violations of the Code may be perpetrated by companies who see it as a marketing opportunity, or by those actors directly involved in the humanitarian response. So active upholding the provisions of the Code is essential in emergencies. 32

In sintesi, ciò che vediamo nelle emergenze Donazioni e distribuzioni non mirate di sostituti del latte materno con frequenti violazioni del Codice Con… Miti e credenze sull’allattamento al seno Personale non specificamente qualificato Carenza di politiche e programmi (e fondi) per proteggere, promuovere e sostenere i bambini allattati e non allattati al seno Mancanza di coordinamento (CLUSTER) Myths: Malnourished mothers cannot breastfeed Stress prevents mothers from producing milk Once a mother stops breastfeeding, she cannot restart When a woman has been raped, she cannot breastfeed HIV-infected mothers should never breastfeed Refer to the WBW 2009 Action Folder

Di cosa si occupa l’AINE? Protezione e sostegno Bambini allattati al seno: avvio precoce, allattamento esclusivo e continuato Bambini non allattati: riduzione al minimo dei rischi dell’alimentazione artificiale Tutti i lattanti e i bambini piccoli: alimentazione complementare appropriata e sicura Benessere delle madri: salute fisica, mentale e nutrizionale Breastfed infants: early initiation, exclusive and continued breastfeeding Non-breastfed infants: minimise the risks of artificial feeding All infants and young children: appropriate and safe complementary feeding Well-being of mothers: nutritional, mental & physical health Given all these considerations, we can now appreciate more closely what IFE is about. At the very beginning of this session, we began by saying that IFE is concerned with protection and support of safe and appropriate infant and young child feeding in emergencies. More specifically we’ve now learned that this concerns protection and support of breastfed and non-breastfed infants and young children. For breastfed infants, this means early initiation, exclusive and continued breastfeeding For non-breastfed infants, this means minimising the risks of artificial feeding For all infants and young children, this means appropriate and safe complementary feeding The well-being of mothers is critical to the well-being of infants and young children. So the needs of mothers - or primary caregivers – is also a key consideration in IFE. How can we meet these needs? To help, there are some key policy guidance and frameworks and strategies to be aware of. 34

La risposta minima necessaria in ogni emergenza One such guidance is the Operationa Guidance on IFE. It is a brief non-technical guidance for all those involved or concerned with emergency response anywhere in the world. The Operational Guidance on IFE was developed by the IFE Core Group with the aim to help to put various relevant global policies, strategies and frameworks into practice. It is informed by emergency experiences over the past 10 years. The OG is built on the WHO guiding principles for infant feeding in emergencies and the Global Strategy on IYCF, in particular. The International Code is integrated in the Operational Guidance on IFE and built upon to respond to the particular challenges of upholding the provisions and spirit of the Code in emergencies. In every emergency, there are risks from sub-optimal feeding practices. The degree of risk will depend on the situation (including the nutritional status of the population affected, the water and sanitation conditions, the food security of the population, etc). So every emergency needs a minimum response on IFE. This minimum response is reflected in the Operational Guidance on IFE. My colleagues managed to secure Italian translation but if anyone feels more comfortable with Chinese , ki-swahili, Japanese or Bahasa, all these translations and others in European languages are easy to find on the website of the IFE Core group coordination agency: the Emergency Nutrition Network (www.ennonline.net) This website also contains many other IFE materials, including training modules. Very good news is that the OG is also now going to be reflected in the SPHERE Project.

Il progetto Sfera L’alimentazione di lattanti e bambini piccoli é inclusa negli indicatori Sfera, per garantire standard minimi negli aiuti alimentari, nutrizione e sicurezza alimentare. L’alimentazione di lattanti e bambini piccoli é un fattore chiave per altri settori, ad es. acqua e igiene ambientale, salute, sicurezza, Sostenere il Codice Internazionale e la Guida Operativa sull’Alimentazione Infantile Nelle Emergenze sono elementi centrali per raggiungere gli standard previsti da Sfera The Sphere Project was launched in 1997 by a group of humanitarian NGOs and the Red Cross. It aims to improve the quality of assistance to people affected by disaster and improve the accountability of states and humanitarian agencies to their constituents, donors and the affected populations The Sphere Project has developed a humanitarian charter and a set of standards that specify the minimum acceptable levels to be attained in humanitarian response. Infant and young child feeding is included in Sphere indicators to meet minimum standards in food security, nutrition and food aid Infant and young child feeding is a key consideration for other sectors, e.g. WASH, health, security Upholding the International Code and the next policy guidance we review, the Operational Guidance on IFE, are central to meeting Sphere standards in emergency response. Ultimately, the kind of response desired in a given emergency will depend on the starting point, the 'breastfeeding baseline'

Una domanda da porsi insieme Cosa posso fare per proteggere e sostenere un’alimentazione infantile nelle emergenze che sia sicura e appropriata? Everyone can play a positive and important role as a member of public, as a professional, policy-maker or hand on programme manager in emergency preparedness and/or repornce in his/her own country as well as in the far away places we get to see only on TV. Solidarity and understanding are key. Although you may not ever become directly involved in emergency response in some African, Asian or Latin American country, not even anywhere in Europe or your own country, there is still a lot you can do. The ENN website I talk about contains 2 document, one is Media guide, a 2 page information for the media to help them report correctly on infant feeding in emergencies, to not call for automatically baby food donations . This guide now exist in Italian. So you can actively monitor your media and as a prevention or response, depending on the case, you can actively disseminate it to the media. The other documentexists only in English for the moment. It is aimed at informing public, telling them about IFE so that they also do not, when hearing about collection of aid for some emergency situation do not immediately think INFAN FORMULA or BABY FOOD. And there is much more anyone can do and you, if I manage to get you interested in the subject, will no doubt think of other ways of becoming actively engaged. This is where my presentation of Why IFE matters and making it matter ends. I will now hand over to Angela to explain how we can make IFE happen