Infant and Young Child Feedingin Emergencies. Operational Guidance.
VERSION 3.0 – UPDATEThe Operational Guidance on IFE
AimTo provide concise, practical guidance on how to ensure appropriate infant
and young child feeding in emergencies (IFE)

ScopeApplies to emergency preparedness, response and recovery worldwide

Target Groups

Infants and young children aged 0-23 months and pregnant and lactating
women (PLW)Intended for

Policy-makers, decision-makers and programmers working in emergency
preparedness, response and recovery across sectors and disciplines.

Version 3
Updated by:
Co-led:Coordinated by:Funded by:

The IFE Core Group
ENN and UNICEF
ENN
USAID/OFDA (ENN)

2001

2006

2007

2010

2017

Version 1.0

Version 2.0

Version 2.1

Addendum

Version 3.0

V 3.0 Process
March 2016

• IFE Core Group
Meeting:
Interviewfindings shared,
gaps in contentand processagreedFeb 16 – Sept 17

Dec 2017• Consultation

IFE CoreGroup

Experts

Experiences &resources
SPHERE• IFE Core Group
Meeting:
Dissemination& roll out
action planV 3.0 What has stayed the same?
• Layout• Headings• Most of existingguidance• Terminology of IFE• Availability in English,
French and Arabic

KEY POINTSPRACTICAL STEPS (1 – 6)
1. Endorse or develop policies
2. Train staff
3. Co-ordinate operations
4. Assess and monitor
5. Protect, promote and support optimal IYCF with integrated
multi-sector interventions
6. Minimise the risks of artificial feeding

EMERGENCY PREPAREDNESS ACTIONS  New
KEY CONTACTSREFERENCES  Expanded
DEFINITIONS  Expanded
ANNEX 1: Multi-sectoral content  New
ACRONYMS  New

V 3.0 Revisions - Programming• Updated to reflect latest global guidance (published and upcoming)• Greater programmatic detail in all sections• Greater and more balanced content to address needs of non-breastfed infants• More comprehensive content on complementary feeding• Introduction of new concepts e.g. human milk banks• Considers situations where OG-IFE recommendations cannot be immediately met• More content on emergency preparedness• Summary key points updated

V 3.0 Revisions – Roles & Responsibilities• Greater emphasis on the lead role of government in preparedness and response• Greater clarity on the respective roles and responsibilities of UN agencies• Greater coverage of sectors beyond nutrition and more explicit actions to take
• Incorporated accountability to affected populations• Reflects significantly evolved operational environmentV 3.0 Revisions – References, Resources, Terminology• More extensive list of supporting references and resources• Greater referencing of recommendations and definitions• More extensive list of definitions• Changes, and additions, to terminology• Optimal IYCF → Recommended IYCF
• HIV Risk Assessment• Donor Human Milk
• Human Milk Bank
• Cluster Lead Agency• Lipid-based nutrient supplement (LNS)1: Endorse or develop policies
Key provisions regarding IFE should be reflected in government, multi-sector and agency
policies and should guide emergency responses.

2: Train staff
Sensitisation and training on IFE is necessary at multiple levels and across sectors.

3: Coordinate operations
Capacity to coordinate IFE should be established in the coordination mechanism for every
emergency response. Government is the lead IFE coordination authority. Where this is notpossible or support is needed, IFE coordination is the mandated responsibility of UNICEF
or UNHCR, depending on context, in close collaboration with government, other UN
agencies and operational partners.
Where all provisions of OG-IFE cannot be immediately met, context-specific guidance on
appropriate actions and acceptable ‘compromises’ should be provided by the IFE
coordination authority and mandated UN agencies.
Timely, accurate and harmonised communication to the affected population, emergency
responders and the media is essential

4: Assess & Monitor
Needs assessment and critical analysis should determine a context specific IFE response▪ Pre-crisis data
▪ Rapid decision-making and action▪ Early needs assessment▪ In depth assessment▪ Monitoring
It is essential to monitor the impact of humanitarian actions and inaction on IYCF
practices, child nutrition and health; to consult with the affected population in planningand implementation; and to document experiences to inform preparedness and future
response.

5: Protect, promote and support optimal IYCF with integrated multi-sector interventions
Immediate action to protect recommended infant and young child feeding (IYCF) practices
and minimise risks is necessary in the early stages of an emergency, with targeted support
to higher risk infants and children▪ General▪ Breastfeeding support▪ Infants who are not breastfed – incl. relactation, wet nursing, donor human milk, BMS▪ Complementary feeding▪ Micronutrient supplementation▪ HIV and infant feeding▪ Infectious disease outbreaks

5: Protect, promote and support optimal IYCF with integrated multi-sector interventions

In every emergency, it is necessary to assess and act to protect and support the nutritionneeds and care of both breastfed and non-breastfed infants and young children. It is
important to consider prevalent practices, the infectious disease environment, culturalsensitivities and expressed needs and concerns of mothers/caregivers when determining
interventions
In every emergency, it is important to ensure access to adequate amounts of appropriate,
safe, complementary foods and associated support for children and to guarantee
nutritional adequacy for pregnant and lactating women.

5: Protect, promote and support optimal IYCF with integrated multi-sector interventions
Multi-sector collaboration is essential in an emergency to facilitate and complement
direct infant and young child feeding (IYCF) interventions. Actions are included for:HealthAdolescentServices

WASH

FSLChildProtection

ECD

Disability

ShelterCashSocialProtection

Agriculture

Logistics

WASH: Water, Sanitation and Hygiene, FSL: Food Security and Livelihoods, ECD: Early Childhood Development

6: Minimise the risks of artificial feeding
In emergencies, the use of breastmilk substitutes (BMS) requires a context-specific,
coordinated package of care and skilled support to ensure the nutritional needs of nonbreastfed children are met and to minimise risks to all children through inappropriate use▪ Donations in emergencies▪ Artificial feeding management▪ BMS supplies▪ BMS specification▪ Procurement of BMS supplies, feeding equipment and support▪ Distribution of BMS

Donations of BMS, complementary foods and feeding equipment should not be sought or
accepted in emergencies; supplies should be purchased based on assessed need. BMS,
other milk products, bottles and teats should never be included in a general distribution.

Emergency preparedness…is critical to a timely, efficient and appropriate IFE response
Examples from Box 1: Emergency Preparedness Actions
POLICYTRAINING

COORDINATION

Develop preparedness plans on IFE Prepare orientation material foruse in early emergency response

Develop terms of reference for IFE
coordination in a response

ASSESS AND MONITORARTIFICIAL FEEDING

MULTI-SECTOR INTERVENTIONS

Prepare key questions to include in Examine national legislation
early needs assessment
related to food and drugs,
particularly importation

Communicate government
position on not seeking or
accepting donations

**INSTRUCTION SLIDE**
The following slides cover implications of the revisions in the Operational Guidance on
IFE for stakeholders involved with GOVERNMENT.
Please delete slides that are not applicable to your audience and cross reference tointernal documents and processes where relevant.

Implications for government
Endorse or develop policies
1.1 Governments and agencies should have up-to-date policies which adequately address all ofthe following elements in the context of an emergency:• protection, promotion and support of breastfeeding;• the management of artificial feeding;• complementary feeding;• the nutrition needs of PLW;
• compliance with the International Code of Marketing of Breastmilk Substitutes (BMS) and subsequent
relevant World Health Assembly (WHA) Resolutions (the Code);• prevention and management of donations of BMS;
• infant feeding in the context of public health emergencies and infectious disease outbreaks

Additional context-specific provisions may be necessary, such as for refugees or internally displaced
persons (IDP). Provisions may exist as a standalone policy and/or may be integrated into otherrelevant policies.

Implications for government
Endorse or develop policies
1.2 In early response, consult national/sub-national preparedness plans, policies
and procedures and uphold relevant legislation and international standards.
In an emergency, where existing policy guidance is absent, outdated or does notadequately address the context, rapid policy guidance updates or ‘stop-gap’guidance development may be necessary, led by the IFE coordination authority andin consultation with WHO, other relevant UN agencies and national/regional/global
technical groups
1.3 Develop missing and update existing policy guidance in close collaboration withgovernment authorities and seek to strengthen relevant national/sub-nationalpolicies. Develop and update policies and associated procedures in preparedness.

Implications for government
Endorse or develop policies
1.4 Disseminate key policy guidance to all relevant responders across sectors,
including media groups, private sector, donors, military and volunteer groups
1.5 An inter-agency joint statement, issued and endorsed by relevant authorities,
may be used to highlight relevant guidance, provide context-specific rapid
guidance, and harmonise communication. Development of the statement shouldbe led by the IFE coordination authority; UNICEF and WHO have key roles tocatalyse and support development. In preparedness, develop a draft jointstatement and secure preliminary approval with relevant authorities

Implications for government
Endorse or develop policies
1.6 The Code expresses the collective will of governments regarding the marketingof BMS and sets out the responsibilities of the manufacturers and distributors ofproducts covered by the Code, health workers, national governments andconcerned organisations.
Enact the Code into national legislation in preparedness and enforce at all times,
including during emergency response.
Ensure that existing legislation is fully in line with the Code. Report Code violations
The International Code of Marketing of Breast-milk Substitutes. WHO,1981
and subsequent relevant World Health Assembly Resolutions

Implications for government
Endorse or develop policies
1.7 Enact legislation and adopt policies in line with the WHA Resolution: Guidanceon Ending the Inappropriate Promotion of Foods for Infants and Young Children(69th WHA A69/7 Add.1. 2016)

In preparedness, UN, civil society and government policy-makers should develop
national legally binding policies regarding private sector engagement in emergency
response to enable constructive collaboration and avoid undue influence andconflicts of interest
Safeguarding against possible conflicts of interest in nutrition programmes: Approach for the preventionand management of conflicts of interest in the policy development and implementation of nutrition
programmes at country level. WHO, 2016.

Implications for government
Train staff
2.1 Sensitise relevant personnel across sectors to support IFE, including thosedealing directly with affected women and children; those in decision-making
positions; those whose operations affect IYCF; those handling any donations; andthose mobilising resources for the response. Target groups for sensitisation include
government staff, sector/cluster leads, donors, rapid-response personnel, camp
managers, communications teams, logisticians, the media, volunteers, among
others.
2.2 Train personnel on IFE in preparedness and during emergency response, asnecessary. Target personnel may include government staff; NGO staff andvolunteers delivering health and nutrition services and support at facility orcommunity level; and frontline staff in other sectors

Implications for government
Coordinate Operations
3.1 Government is the lead coordination authority on IFE.
Where this is not possible or support is needed, among UN agencies and in accordancewith mandates, IFE coordination is the responsibility of:• UNICEF - in IDP responses• UNHCR – in refugee responses
WFP is responsible for mobilising food assistance in emergencies in a manner that upholds
the provisions of the OG-IFE.
WHO is responsible for supporting Member States to prepare for, respond to and recoverfrom emergencies with public health consequences.

Implications for government
Coordinate Operations
3.2
Ensure there is capacity to coordinate IFE within coordination mechanisms
in an emergency response.
Assess and support development of government coordination capacity asnecessary. Determine or clarify coordination responsibilities and roles in
preparedness and in early response. UNICEF country offices have a key
responsibility to prepare for coordination needs in an emergency and as necessary,to support government capacity and skills development in this regard.
3.3 The IFE coordination authority must directly coordinate the IFE response or
ensure adequate coordination mechanisms and capacity are in placeImplications for government
Coordinate Operations
3.8 In some emergencies, it may not be possible to meet all the provisions of theOG-IFE immediately, such as where access to those affected is limited orimpossible, or capacity is lacking to deliver necessary support.
In such circumstances, critical analysis by the IFE coordination authority,government, UNICEF, WHO and, where applicable, UNHCR is essential to provide
context-specific guidance on appropriate actions and acceptable compromises.

Implications for government
Pre-crisis data and early needs assessment
4.4 Use pre-crisis background information (secondary data) to develop an IYCF
situation profile to inform early decision-making and immediate actions. Collate key
information in preparedness or as necessary, in early response.
4.5
Pre-crisis information sources include existing government, NGO and UN
country programmes; Multiple Indicator Cluster Surveys (MICS) and Demographic
Health Surveys (DHS); sub-national surveys; national institutions (ministries, local
offices for emergency preparedness, drugs and food standards authorities);
Knowledge, Attitudes and Practices (KAP) studies; World Breastfeeding Trends
Initiative (WBTi) country profiles; WHO and UNICEF databases; Nutrition Landscape
Information System; post-emergency evaluations; previous flash appeals andHumanitarian Response Plans (HRP). Nutrition information may also be obtained
through joint nutrition and food security assessments.

Implications for government
Monitoring
4.16 Monitor for Code violations and report them to national authorities, the IFE
coordination authority, and international monitors.
Support government to develop policies and procedures to monitor for and act on
Code violations; WHO and UNICEF country offices have key responsibilities in thisregard.
Typical Code violations in emergencies relate to infant formula labelling, supply
management, and donations.

Implications for government
Protect, promote and support optimal infant and young child feeding withintegrated multi-sector interventions
5.1 At national level, UNICEF has a key responsibility to define, advocate for andprovide guidance on essential IYCF interventions in close collaboration withgovernment and other stakeholders. This responsibility extends to bothpreparedness and recovery, using and building on existing capacities, networks,policies, systems and requires multi-sector engagement.
In refugee settings, UNHCR holds this responsibility. WFP has a responsibility toensure that the nutrition of infants and young children and PLW is considered infood assistance response and that necessary data are gathered to inform relatedprogramming.

Implications for government
Infants who are not breastfed
5.14 To date, there is little experience with the use of formal and informal donor
human milk in emergency settings. Donor human milk is likely a more viable option
where there are existing human milk banks in an emergency-affected area, that are
integrated into broader newborn/infant feeding programmes, and where key
conditions are met.
Key conditions that need to be in place for the safe use of donor human milk in an
emergency are: government policy (preparedness) or, in the absence of policy,agreement between authorities on its use; an estimate of need, defined eligibility
criteria and duration of provision; adequacy of supply for the response; quality
assurance including donor screening and pasteurisation; and the establishment andmaintenance of a cold chain to preserve quality and safety.

Implications for government
Complementary Feeding
5.20 The designated IFE coordination authority should provide clear direction oncomplementary feeding needs and interventions. Government is the leadcoordination authority to guide the response on complementary feeding. Where
this is not possible or support is needed, coordination on complementary feeding isthe mandated responsibility of UNICEF or UNHCR, depending on context, in closecollaboration with government, other UN agencies and operational partners.

Implications for government
Artificial Feeding Management
6.7 Plan appropriate procurement, distribution, targeting and use of BMS andassociated support (artificial feeding management) in close consultation with theIFE coordination authority and UNICEF.
6.9 The IFE coordination authority and/or UNICEF should determine if and wherecapacity to manage artificial feeding exists in government and among humanitarianproviders.

Implications for government
BMS Supplies
6.11 In refugee settings and in accordance with UNHCR policy, UNHCR will only
source infant formula after review and approval by its HQ technical units.
6.12 In non-refugee settings and in accordance with UNICEF policy, UNICEF will only
procure infant formula as the provider of last resort and at the request of the hostgovernment and/or the national humanitarian coordination structure.

INSTRUCTION SLIDE
You may find it useful to have a discussion on how the revised guidance can be dissemination withinyour working group / cluster / agency etc.
Suggestions have been made for roll out at:
1.

Individual agency level

2.

National level3.

Regional level

Select the appropriate slide. Suggested roll out actions will have to be contextualised prior topresenting. Following the discussion, it is recommended to set SMART objectives and work out atimeline to implement the recommended roll-out actions. Consider what resources are required tosupport the roll-out.

Recommendations for dissemination (Agency)• Wide dissemination of Ops Guidance on IFE within <agency>• What does this mean for you and your agency? Roles, responsibilities, agency activities,programming, strategies, position papers etc.
• Training for technical staff from health, nutrition and other sectors• Sensitisation for all staff including senior management and communication, logistics,
resource mobilization, rapid response and volunteer teams• Inclusion of V 3.0 in induction reading materials, agency resource libraries, training
materials etc.

• Dissemination and roll out to regional, country and field offices• Update training materials

Recommendations for dissemination(National/Cluster)• Wide dissemination to <NiEWG / nutrition cluster members, all other sectors, intercluster,relevant government agencies and authorities, advocacy groups, policymakers>• What does this mean for you? Preparedness and response plans, roles and responsibilities etc.
• Dissemination of / sensitisation on update• Translation of Operational Guidance on IFE text into local language• Adaptation of Operational Guidance on IFE to local context• Incorporation of V 3.0 revisions into national guidance & policy• Inclusion into background reading materials

Recommendations for dissemination (Regional)• Wide dissemination of Ops Guidance on IFE at <regional level>• What does this mean for you? Preparedness and response plans, roles and responsibilities etc.

• Training and sensitisation for regional offices• Translation into regional languages• Dissemination to country offices• Incorporation of V3.0 updates into regional strategies, funding etc.

Appropriate and timely support of infant and young child feedingin emergencies (IFE) saves lives, protects child nutrition, healthand development and benefits mothers.