Infant and Young Child Feedingin Emergencies. Operational Guidance.
VERSION 3.0 – UPDATEThe Operational Guidance on IFE
Aim

To 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 content
and 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, cultural
sensitivities 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

FSL

Child
Protection

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 UN Agencies including UNICEF, UNHCR, WFP and WHO.
Please delete slides that are not applicable to your audience and cross reference tointernal documents and processes

Implications for UNICEF
The OG-IFE offers practical guidance which assists decision-makers, planners anddonors to implement UNICEF global strategy and guidance documents e.g.
UNICEF/WHO Global Strategy on IYCF

1. Endorse or Develop Policies
1.1 UNICEF and WHO have key responsibilities in supporting national/sub-national
policy preparedness
1.5 UNICEF and WHO have key roles to catalyse and support development of an interagency joint statement on IFE.

Implications for UNICEF
2. Train Staff
UNICEF can support the identification and use of existing national expertise andnetworks
See: Section 8 – References

•
•
•
•
•

Breastfeeding Counselling: A Training Course. UNICEF and WHO, 1993.
IYCF Counselling: An Integrated Course. UNICEF, 2006
Programming for IYCF – a Training Course. UNICEF and Cornell University. Online.
Supportive Supervision / Mentoring and Monitoring for Community IYCF. UNICEF, 2013.
The Community IYCF Counselling Package. UNICEF, 2013.

WFP

Implications for UNICEF
3. Coordinate Operations

UNHCR

UNICEF• Refugee• IDP• Government is the lead coordination authority on IFE

WHO• Where this is not possible, IFE coordination is the responsibility of UNICEF or UNHCR• UNICEF’s coordination authority may be as:• cluster lead agency within the IASC cluster approach• as the UN agency with mandated responsibility for IFE• In IDP responses, UNICEF is responsible for IFE coordination“In all settings, UNICEF and UNHCR will maximize synergies between their respective technical andmanagement capacities, availability of resources and response capacities.”Implications for UNICEF
2. Coordinate operations
3.2 UNICEF country offices have a key responsibility to prepare for coordinationneeds in an emergency and as necessary, to support government capacity and skills
development in this regard.
3.8 In some emergencies, it may not be possible to meet all the provisions of the
OG-IFE immediately. Critical analysis by the IFE coordination authority, government,
UNICEF, WHO and, where applicable, UNHCR is essential to provide context-specificguidance on appropriate actions and acceptable compromises.
3.10 Gaps in IFE coordination capacity in an emergency response should bereported to UNICEF or UNHCR country or regional office and to agency
headquarters as necessaryImplications for UNICEF
4. Monitoring
4.16 WHO and UNICEF country offices have key responsibilities to support
government to develop policies and procedures to monitor for and act on Codeviolations.

Code violations may be reported to UNICEF as the IFE coordination authority

Implications for UNICEF
5. Protect, Promote and Support Optimal Infant and Young Child Feedingwith Integrated Multi-Sectoral Interventions
UNICEF has a key responsibility to define, advocate for, and provide guidance on,
essential IYCF interventions in close collaboration with government and otherstakeholders (Preparedness and Recovery)

UNICEF has a key role to advocate for and provide guidance on appropriatequantities of quality complementary foods and to help define essential interventions.

Implications for UNICEF
Complementary Feeding
The designated IFE coordination authority should provide clear direction oncomplementary feeding needs and interventions
Coordination on complementary feeding is the mandated responsibility of UNICEF or
UNHCR
In all contexts, UNICEF has a key responsibility to provide guidance on appropriate
complementary foods and feeding practices and to help define essential
interventions.
See: UNICEF Core Commitments to Children in Humanitarian Action

Implications for UNICEF
6. Minimise the Risks of Artificial Feeding
6.6 UNICEF is likely to receive reports of offers or donations of BMS, donor human
milk, complementary foods and feeding equipment and should be prepared todetermine and oversee a management plan.

6.7 UNICEF is expected to be able to support planning for appropriate
procurement, distribution, targeting and use of BMS and associated support
6.9 UNICEF may need to determine if and where capacity to manage artificial
feeding exists in government and amongst humanitarian providers or, where
capacity is limited, identify appropriate BMS provider(s) including a BMS supply
chain and associated support services.

Implications for UNICEF
6. BMS Supplies
UNICEF and / or the coordinating agency, will ensure coordinated provision of
BMS supplies in the absence of an appropriate provider.
“In non-refugee settings and in accordance with UNICEF policy, UNICEF will only
procure infant formula as the provider of last resort and on the request of thehost government and/or the national humanitarian coordination structure.”
Seek agreement from UNICEF HQ Nutrition Section and Supply Division

See: UNICEF SOP on BMS (under development)

WFP

Implications for UNHCR
3. Coordinate Operations• Government is the lead coordination authority on IFE

UNHCR

UNICEF• Refugee

• IDP

WHO

• Where this is not possible, IFE coordination is the responsibility of UNICEF or UNHCR• In IDP responses - UNICEF• In refugee responses – UNHCR“In all settings, UNICEF and UNHCR will maximize synergies between their respective technical andmanagement capacities, availability of resources and response capacities.”Implications for UNHCR
3. Coordinate Operations
3.8 In some emergencies, it may not be possible to meet all the provisions of the OGIFE immediately. Critical analysis by the IFE coordination authority, government,
UNICEF, WHO and, where applicable, UNHCR is essential to provide context-specificguidance on appropriate actions and acceptable compromises.
3.10 Gaps in IFE coordination capacity in an emergency response should be reported
to UNICEF or UNHCR country or regional office and to agency headquarters asnecessary.
Technical or coordination issues regarding IFE in the context of UNHCR operations should be addressedto the appropriate UNHCR regional or country office. Where necessary, contact the Public Health
Section at UNHCR HQ: hqphn@unhcr.org

Implications for UNHCR
5. Protect, promote and support optimal infant and young child feeding withintegrated multi-sector interventions*
5.1 In refugee settings, UNHCR has the responsibility to define, advocate for andprovide guidance on essential IYCF interventions in close collaboration withgovernment and other stakeholders
This responsibility extends to both preparedness and recovery, using and building on
existing capacities, networks, policies, systems and requires multi-sector engagement.
*See: IYCF Framework – UNHCR and Save the Children, 2017www.unhcr.org/nutrition-and-food-security

Implications for UNHCR
5. Protect, promote and support optimal infant and young child feeding withintegrated multi-sector interventions
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 thisis not possible or support is needed, coordination on complementary feeding is the
mandated responsibility of UNICEF or UNHCR, depending on context, in close
collaboration with government, other UN agencies and operational partners.
UNHCR Operational Guidance on the Use of Special Nutritional Products to Reduce Micronutrient
Deficiencies and Malnutrition in Refugee Populations. UNHCR, UCL, ENN, 2011. English.

Implications for UNHCR
6. Minimise the risk of artificial feeding
6.6 Offers or donations of BMS donor human milk, complementary foods and feeding equipment may
be reported to UNHCR. UNHCR should de prepared to determine and oversee a context specificmanagement plan to minimise risks.
6.7 UNHCR has key responsibilities in artificial feeding management.
6.11 In refugee settings and in accordance with UNHCR policy*, UNHCR will only source infant formulaafter review and approval by its HQ technical units.
6.25 WFP in consultation with UNICEF and UNHCR is responsible for controlling the distribution of milk
powders and BMS in general rations*See:

UNHCR Policy Related to the Acceptance, Distribution, and Use of Milk Products in Refugee Settings. 2006
UNHCR IYCF Practices: Standard Operating Procedures for the Handling of Breastmilk Substitutes (BMS) in Refugee
Situations for Children 0-23 months. 2015

Implications for…WFP
3. Coordinate Operations

WFP is responsible for mobilising food assistance in emergencies
in a manner that upholds the provisions of the OG-IFE.

Implications for…WFP
5. Multisectoral Interventions
5.1 WFP has a responsibility to ensure that the nutrition of infants and young children
and PLW is considered in food assistance response and that necessary data aregathered to inform related programming.
5.20 WFP has a responsibility to provide/enable access to appropriate nutrient-richfood for children aged 6-23 months and PLW when significant food and nutrient gaps
are identified.
Managing the Supply Chain of Specialised Nutritious Foods. WFP, 2013

Implications for…WFP
5.23 Complementary food support options/considerations include:• Cash or voucher schemes to purchase nutrient-rich foods and/or fortified foods that are locally available.
• Distribution of nutrient-rich foods or fortified foods at household level.
• Provision of multiple-micronutrient fortified foods to children aged 6-23 months and PLW through BSFP
• Home fortification with micronutrient supplements, e.g. MNPs or other supplements.
• Livelihood programmes and safety net programmes for families with children < 2 and/or PLW.
• Use of animal milk and products. (see 5.25)• Provision of non-food items and cooking supplies (including domestic energy);• Access to communal food preparation areas where household facilities are lacking;• Advice on safe food handling;• Protected eating and playing spaces.

Implications for…WFP
Micronutrient Supplementation
5.29 For children aged 6-59 months, multiple-micronutrient supplements may benecessary to meet nutrition requirements where fortified foods are not being
provided, in conjunction with other interventions to improve complementary foods
and feeding practices. In malaria-endemic areas, the provision of iron in any form,
including MNPs, should be implemented in conjunction with measures to prevent,diagnose and treat malaria. Provision of iron through these interventions should not
be made to children who do not have access to malaria prevention strategies; prompt
diagnosis of malaria illness; and treatment with effective antimalarial drug therapy.
Vitamin A supplementation is recommended for children aged 6-59 months. For PLW,
iron and folic acid or multiple-micronutrient supplementation should be provided inaccordance with the latest guidance.
Joint Statement on Preventing and Controlling Micronutrient Deficiencies in Populations affectedby an Emergency. WHO, WFP and UNICEF, 2007.

Implications for…WFP
6. Donations
6.6 Report offers or donations of BMS, donor human milk, complementary foods andfeeding equipment to UNICEF or UNHCR as appropriate, and to the IFE coordination
authority, who will determine and oversee a context-specific management plan tominimise risks. Donations involving WFP food assistance should also be reported to
WFP
6.25 WFP in consultation with UNICEF and UNHCR is responsible for controlling the
distribution of milk powders and BMS in general rations

Use of milk in WFP operations. Position paper. WFP, June 2017.

Implications for…WHOThe OG-IFE offers practical guidance which assists decision-makers, planners and donors to implement
WHO global strategy and guidance documents e.g. UNICEF/WHO Global Strategy on IYCF

1. Endorse or develop policies:• Key responsibility in supporting national/sub-national policy preparedness• Key role to catalyse and support development of an inter-agency joint statement• Support development/updating and dissemination of key IFE policy guidance• Support enactment of the Code and WHO guidance on ending inappropriate promotion of foods for
infants and young children into national legislation• Develop national legally binding policies regarding private sector engagement in emergency response

2. Train staff• WHO country offices may provide information on existing national expertise and networks

Implications for…WHO
3. Coordinate Operations
WHO is responsible for supporting Member States to prepare for, respond to andrecover from emergencies with public health consequences.
WHO may be called upon to provide to provide context-specific guidance on
appropriate actions and acceptable compromises when it is not possible to meet theprovisions of the OG-IFE.

Implications for…WHO
4. Monitoring
WHO and UNICEF country offices have key responsibilities in supporting government
to develop policies and procedures to monitor for and act on Code violations.

Code violations may be reported to WHO at country or regional level (Contacts)

5. Integrated multi-sector interventions• Support integration of Ten Steps to Successful Breastfeeding (WHO/UNICEF BFHI)
into maternity services• Ensure complementary feeding interventions comply with the WHO Guidance on
ending inappropriate promotion of foods for infants and young childrenImplications for…WHO
5. Integrated multi-sector interventions (cont.)• Ensure that national/sub-national policies on HIV and Infant Feeding are in line withlatest WHO recommendations:✓ 2010 Guidelines on HIV and Infant Feeding: Principles and recommendations for infant feeding in
the context of HIV and a summary of evidence.
✓ 2016 Guideline Updates on HIV and Infant Feeding✓ 2017 HIV and Infant Feeding in Emergencies: Operational Guidance (coming soon)• WHO named as go-to agency for up-to-date advice during infectious disease
outbreaks

Implications for…WHO
5. Integrated multi-sector interventions (cont.)

Artificial Feeding Management
Key responsibility in supporting appropriate procurement, distribution, targeting anduse of BMS and associated support, in close consultation with the IFE coordination
authority and/or UNICEF.
→ Terms of reference, responsibilities and roles for artificial feeding management for use by the IFE
coordination authority to be established in preparedness.

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

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.