Breastfeeding Support
in Early Emergency Response
Utami Roesli & Sri Sukotjo
Indonesian Breastfeeding Center / UNICEF
1
Background



Un-controlled donations of infant formula
Higher consumption of infant formula among
those who received donations compared to
those who did not receive donations
Increased of diarrhea rates after the Earthquake
and significant association between formula fed
in the previous 24 hrs and diarrhea in infants
2
MOTHER NEEDS SUPPORT
How to reach large numbers of mothers
rapidly?
3
Managing The Training




UNICEF commissioned
Indonesian Breastfeeding
Center to conduct the training
in the most affected district of
Klaten & Bantul
Worked with the District Health
Office to ensure the
sustainability of the programme
12 facilitators BFC-C placed
inside the communities (at the
village level)
Participants were Community
Workers/Volunteers & village
Midwives
4
One facilitator based inside the
community for 6 weeks would
bring benefit for up to 360
families
I
A
B
C
D
E
F
1
2
3
4
5
6
a
a
a
a
a
b
b
6 sub-village
Trained 6 BF MOTIVATORS
/ sub village
To graduate, each MOTIVATOR need to
counsel at least 5 mothers. These
mother recruited as peer educators in
their communities
Each PE required to promote BF to at least 2 or 3 families
5
The Module


WHO/UNICEF’s 40 hours
Breastfeeding Counseling
Course module
Flip-Chart is developed to
train mothers
6
1. Session 1 Why breastfeeding is important
2. Session 3 How breastfeeding work
3. Session 4 Assessing a breastfeed
4. Session 5 Observing a breastfeed
5. Session 6 Listening and learning
6. Session 7 Listening and learning exercises
7. Session 9
Clinical Practice 1
8. Additional 1 Food hygiene and feeding techniques
9. Additional 2 Preparation of milk feeds - practical
10. Session 11 Building confidence and giving support
11. Session 12 Building confidence exercises
12. Session 10 Positioning a baby at the breast
13. Session 13
Clinical Practice 2
14. Session 16 Refusing breastfeeding
15. Session 20 Expressing breastmilk
16. Session 21 “ Not enough milk “
17. Session 22 Crying
18. Session 23 “ Not enough milk “ Crying exercises
19. Session 24 CLINICAL PRACTICE 3
20. Session 27 Increasing breastmilk and relactation
21. Session 28 Sustaining breastfeeding
22. Session 32 Wonen and work
23. Session 33 Commercial promotion of breastmilk subtitutes
24. Session 29 CLINICAL PRACTICES 4
7


For clinical practices,
breastfeeding and pregnant
mothers were brought-in
into the training session
Facilitators meet every
evening to evaluate the
process of the training on
that day.
8

Every Sundays the
Facilitators helped
breastfeeding mothers
with difficulties
9
RESULTS
Course
Director
I
II
III
IV
A
B
C
D
E
F
1
2
3
4
5
6
a
a
a
a
a
V
VI
VII
VIII
IX
X
XI
XII
159 sub-village
426 motivator
2130 moms
Peer educators
2130+ 4260 = 6390 Supporting Mom Communities
b
b
10
4260 aware of breastfeeding
Training conducted in a Tent
11
Training conducting
in a Village Center
12
Clinical practices at the
community
13
IS THE TRAINING
DIFFICULT ?
11% YES
89% NO
14
Challenges

Many community workers and health workers were in
the “traumatic” phase





Difficult to find community workers who have commitment to
participate in the training
Different level of education also provided challenges in
facilitating the training
Facilitators/Trainers need to ensure that they are able to follow
the course
Private one-to-one training was conducted if they are not able to
come to the training
Minimal support from the local health office–

More focus on building new premises, health system, and other
health issues
15
Result

Of 50 mothers assessed and who
gave birth after the Earth Quake,
most (63%) are exclusively
breastfeed regardless of access to
free formula - mainly due to the
counseling / support they received
from trained health workers and
volunteers
16
Result


Introduction of early
initiation to breastfeeding
during the training
Early initiation to
breastfeeding were
successfully conducted by
trained village midwives and
community health workers.
17
Lesson Learned-1



The training reached a large number of mothers
Facilitators placed in the community, provided
breastfeeding counseling services to mothers
who have difficulties in the affected areas
Sustainability of the breastfeeding services in the
community
18
Lesson Learned-2

Klaten District, one of the affected areas :




Facilitators : 8
Counselors : 190
Motivators : 310
Next week they plan to add 8 more
facilitators, at least 20 more counselors and
350 motivators
19
Information received
by motivators for
such an extended
period has increased
the confidence of the
motivators to assist
breastfeeding
mothers (although
most of them did not
have any health
related background)
20
THANK YOU
CD from the field on the
counseling services
experiences is on your
folder
21