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 FUNDING in Emergencies.
Please delete slides that are not applicable to your audience and cross reference tointernal documents and processes where relevant.

Implications for donors
Endorse or develop policies
1.4 Disseminate key policy guidance to all relevant responders acrosssectors, including media groups, private sector, donors, military andvolunteer groups

Implications for donors
Train Staff
2.1 Sensitise relevant personnel across sectors to support IFE, including
those dealing directly with affected women and children; those indecision-making positions; those whose operations affect IYCF; thosehandling any donations; and those mobilising resources for theresponse. Target groups for sensitisation include government staff,
sector/cluster leads, donors, rapid-response personnel, camp
managers, communications teams, logisticians, the media, volunteers,among others.

Implications for donors
Coordinate operations
3.5 It is the responsibility of the IFE coordination authority to :• ensure that IFE interventions are included and accurately reflected in emergency
funding calls and flash appeals.
• Be alert to, avoid and manage conflicts of interest, such as when cooperating withthe private sector and when securing funding for IFE interventions.

Implications for donors
Breastmilk Substitute (BMS) Supplies
6.13 Funders of BMS and milk products should ensure that all the provisions of theOG-IFE and the Code can be met by the implementing agency.
Include compliance indicators in funding agreements.
Grant applications should include, and funders should accept, costs for associatedsupplies, such as feeding and cooking equipment, and hygiene measures.
The International Code of Marketing of Breast-milk Substitutes. WHO,1981
and subsequent relevant World Health Assembly Resolutions

Implications for donors
BMS Supplies
6.14 An agency should only directly supply another agency with BMS if both are
working as part of the nutrition and health emergency response.
Both the supplier and the implementer are responsible for ensuring the provisionsof the OG-IFE and the Code are met and continue to be met for the duration of theintervention.

Implications for donors
Complementary Feeding
5.28 Do not send or accept donations of complementary foods in an emergency.
Risks include donated complementary foods may not meet nutritional and safety
standards, Code labelling requirements, or recommendations of WHO Guidance on
Ending the Inappropriate Promotion of Foods for Infants and Young Children; maybe culturally inappropriate; and may undermine local food use and recommended
IYCF practices. For donated foods that are not designed as complementary foods
but can be used for complementary feeding, it is important to prevent theemergency response from being used to create a potential market for specificfoods; to ensure interventions are needs based rather than donor-driven; and toguarantee adequate quality and safety of the diet. Where any donations are being
considered or have been received, consult with the designated IFE coordination
authority regarding their appropriateness and/or managementImplications for donors
Donations in emergencies
6.1 Do not donate or accept donations of BMS, other milk products or feeding
equipment (including bottles, teats and breast pumps) in emergencies. Donated
BMS are typically of variable quality; of the wrong type; supplied disproportionate
to need; labelled in the wrong language; not accompanied by an essential packageof care; distributed indiscriminately; not targeted to those who need them; do notprovide a sustained supply; and take excessive time and resources to manage tomitigate risks.
6.3 Do not send supplies of donor human milk to emergencies that are not basedon identified need and a part of a coordinated, managed interventionImplications for donors
Donations in emergencies
6.4 Communicate a clear position on donations in preparedness and in early
emergency response, such as in a joint statement.
Investigate reasons for donation requests to inform messaging and assessment.
Target key actors, including donors, development partners and civil society groups,
among others. Target groups that may not be engaged in official coordination
mechanisms, e.g. media, the military and voluntary groups.
6.5 Identify and inform potential donors and distributors regarding the risks
associated with donated supplies in emergencies. Provide information on how thenutritional needs of non-breastfed infants are being met. Give guidance on
appropriate alternative items or support.

Implications for donors
Preparedness
Engage development agencies and donors in preparedness planning that includes• adaptation of existing programmes to meet emergency needs,• negotiating funder flexibility to meet new needs,• priming sources of surge funding to accommodate increased demands.

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.