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Breastfeeding Support Breastfeeding Support in Early Emergency in Early Emergency

ResponseResponse

Utami Roesli & Sri SukotjoUtami Roesli & Sri Sukotjo

Indonesian Breastfeeding Center / UNICEFIndonesian Breastfeeding Center / UNICEF

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BackgroundBackground

Un-controlled donations of infant formula Un-controlled donations of infant formula

Higher consumption of infant formula Higher consumption of infant formula among those who received donations among those who received donations compared to those who did not receive compared to those who did not receive donationsdonations

Increased of diarrhea rates after the Increased of diarrhea rates after the Earthquake and significant association Earthquake and significant association between formula fed in the previous 24 between formula fed in the previous 24 hrs and diarrhea in infantshrs and diarrhea in infants

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MOTHER NEEDS SUPPORTMOTHER NEEDS SUPPORT

How to reach large numbers of mothers How to reach large numbers of mothers rapidly?rapidly?

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Managing The TrainingManaging The Training

UNICEF commissioned UNICEF commissioned Indonesian Breastfeeding Indonesian Breastfeeding Center to conduct the Center to conduct the training in the most affected training in the most affected district of Klaten & Bantuldistrict of Klaten & Bantul

Worked with the District Worked with the District Health Office to ensure the Health Office to ensure the sustainability of the sustainability of the programmeprogramme

12 facilitators BFC-C placed 12 facilitators BFC-C placed inside the communities (at inside the communities (at the village level)the village level)

Participants were Community Participants were Community Workers/Volunteers & village Workers/Volunteers & village Midwives Midwives

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Trained 6 BF Trained 6 BF MOTIVATORS / sub MOTIVATORS / sub villagevillage

To graduate, each MOTIVATOR To graduate, each MOTIVATOR need to counsel at least 5 need to counsel at least 5 mothers. These mother recruited mothers. These mother recruited as peer educators in their as peer educators in their communitiescommunities

Each PE required to promote BF to at least 2 or 3 familiesEach PE required to promote BF to at least 2 or 3 families

One facilitator based inside One facilitator based inside the community for 6 weeks the community for 6 weeks

would bring benefit for up to would bring benefit for up to 360 families360 families

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The Module The Module

WHO/UNICEF’s 40 hours WHO/UNICEF’s 40 hours Breastfeeding Counseling Breastfeeding Counseling Course moduleCourse module

Flip-Chart is developed to Flip-Chart is developed to train mothers train mothers

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1.1. Session 1 Why breastfeeding is important Session 1 Why breastfeeding is important 2.2. Session 3 How breastfeeding work Session 3 How breastfeeding work 3.3. Session 4 Assessing a breastfeedSession 4 Assessing a breastfeed 4.4. Session 5 Observing a breastfeed Session 5 Observing a breastfeed 5.5. Session 6 Listening and learning Session 6 Listening and learning 6.6. Session 7 Listening and learning exercisesSession 7 Listening and learning exercises 7.7. Session 9 Session 9 Clinical Practice 1Clinical Practice 18.8. AdditionalAdditional 1 Food hygiene and feeding techniques 1 Food hygiene and feeding techniques9.9. AdditionalAdditional 2 Preparation of milk feeds - practical 2 Preparation of milk feeds - practical 10.10. Session 11 Building confidence and giving supportSession 11 Building confidence and giving support11.11. Session 12 Building confidence exercises Session 12 Building confidence exercises 12.12. Session 10 Positioning a baby at the breast Session 10 Positioning a baby at the breast 13.13. Session 13 Session 13 Clinical Practice 2 Clinical Practice 2 14.14. Session 16 Refusing breastfeeding Session 16 Refusing breastfeeding 15.15. Session 20 Expressing breastmilk Session 20 Expressing breastmilk 16.16. Session 21 “ Not enough milk “ Session 21 “ Not enough milk “ 17.17. Session 22 CryingSession 22 Crying 18.18. Session 23 “ Not enough milk “ Crying exercisesSession 23 “ Not enough milk “ Crying exercises 19.19. Session 24 Session 24 CLINICAL PRACTICE 3CLINICAL PRACTICE 320.20. Session 27 Increasing breastmilk and relactation Session 27 Increasing breastmilk and relactation 21.21. Session 28 Sustaining breastfeedingSession 28 Sustaining breastfeeding22.22. SessionSession 32 Wonen and work 32 Wonen and work 23.23. SessionSession 33 Commercial promotion of breastmilk subtitutes 33 Commercial promotion of breastmilk subtitutes 24.24. Session 29 Session 29 CLINICAL PRACTICES 4CLINICAL PRACTICES 4

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For clinical practices, For clinical practices, breastfeeding and breastfeeding and pregnant mothers were pregnant mothers were brought-in into the brought-in into the training sessiontraining session

Facilitators meet every Facilitators meet every evening to evaluate the evening to evaluate the process of the training process of the training on that day.on that day.

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Every Sundays the Every Sundays the Facilitators helped Facilitators helped breastfeeding breastfeeding mothers with mothers with difficulties difficulties

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CourseDirector

CourseDirector

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159 sub-village159 sub-village

2130 momsPeer educators

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4260 aware of breastfeeding

RESULTSRESULTS

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426 motivator

2130+ 4260 = 6390 Supporting Mom Communities 2130+ 4260 = 6390 Supporting Mom Communities

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Training conducted in a Training conducted in a TentTent

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Training Training conducting in a conducting in a Village CenterVillage Center

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Clinical practices at the Clinical practices at the communitycommunity

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IS THE TRAINING IS THE TRAINING DIFFICULT ?DIFFICULT ?

89% NO89% NO

11% YES11% YES

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ChallengesChallenges

Many community workers and health workers Many community workers and health workers were in the “traumatic” phasewere in the “traumatic” phase Difficult to find community workers who have Difficult to find community workers who have

commitment to participate in the training commitment to participate in the training Different level of education also provided challenges in Different level of education also provided challenges in

facilitating the training facilitating the training Facilitators/Trainers need to ensure that they are able to Facilitators/Trainers need to ensure that they are able to

follow the coursefollow the course Private one-to-one training was conducted if they are not Private one-to-one training was conducted if they are not

able to come to the trainingable to come to the training Minimal support from the local health office– Minimal support from the local health office–

More focus on building new premises, health system, More focus on building new premises, health system, and other health issuesand other health issues

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ResultResult

Of 50 mothers assessed and Of 50 mothers assessed and who gave birth after the Earth who gave birth after the Earth Quake, most (63%) are Quake, most (63%) are exclusively breastfeed exclusively breastfeed regardless of access to free regardless of access to free formula - mainly due to the formula - mainly due to the counseling / support they counseling / support they received from trained health received from trained health workers and volunteersworkers and volunteers

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ResultResult

Introduction of early Introduction of early

initiation to breastfeeding initiation to breastfeeding during the training during the training

Early initiation to Early initiation to breastfeeding were breastfeeding were successfully conducted successfully conducted by trained village by trained village midwives and community midwives and community health workers. health workers.

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Lesson Learned-1Lesson Learned-1

The training reached a large number of The training reached a large number of mothersmothers

Facilitators placed in the community, Facilitators placed in the community, provided breastfeeding counseling provided breastfeeding counseling services to mothers who have difficulties services to mothers who have difficulties in the affected areasin the affected areas

Sustainability of the breastfeeding services Sustainability of the breastfeeding services in the communityin the community

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Lesson Learned-2Lesson Learned-2

Klaten District, one of the affected areas Klaten District, one of the affected areas :: Facilitators : 8 Facilitators : 8 Counselors : 190Counselors : 190 Motivators : 310Motivators : 310

Next week they plan to add 8 more Next week they plan to add 8 more facilitators, at least 20 more counselors and facilitators, at least 20 more counselors and 350 motivators 350 motivators

2020

Information Information received by received by motivators for motivators for such an extended such an extended period has period has increased the increased the confidence of the confidence of the motivators to motivators to assist assist breastfeeding breastfeeding mothers (although mothers (although most of them did most of them did not have any not have any health related health related background)background)

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THANK YOU

CD from the field on the counseling services

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