MOM. Innovating in empowering women to reduce malnutrition in emergencies. An ultimate mother and child nutrition plan to increase survival and healthy life

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Description

Intro

5.9 million children die every year around the world. Nearly half of all deaths in children under 5 are linked to malnutrition. At the same time, an unprecedented 68.5 million people have been forced to flee their home. Among them are nearly 22.5 million refugees. 80% are women and children. "la Caixa" Foundation, together with its partners, is strongly committed, through MOM Project, to increase child survival in refugee camps and host communities by improving the nutritional status of children and mothers, introducing innovative methodologies that promote women empowerment and knowledge. The MOM Project started in 2017 and is beginning now its third year.

Objective of the practice

MOM Project is an innovative initiative, both technologically and methodologically. From the technological standpoint, the project combines different applications, such as, the establishment of a digital register of refugees to speed up the distribution of food to women and children and enables better follow up of individual refugees’ nutrition status (Last Mile Mobile Solution). The project is also innovative methodologically, as it provides comprehensive care in all aspects that affect children’s health and diet. In this way, with nutrition as the key factor, the project responds to all needs, improving refugees’ lives and helping them to become more self-sufficient, thanks to the IYCF approach.

Partners

This is a paratnership between UNHCR and "la Caixa" Foundation. We are building a methodology of tackling malnutrition that can be a model to be used by International organizations, NGOs, Humanitarian organizations, Philanthropic/private organizations, etc. interested in improving women leadership in protecting infants and young children in refugee situations and other emergency contexts and enhance their chances of survival, healthy growth and development.

Implementation of the Project/Activity

The methodology has been applied focusing on pregnant and lactating women as key factors of the response. The goal is to protect infants and young children in refugee situations and enhance their chances of survival, healthy growth and development. Optimal infant and young child feeding means initiation of breastfeeding within one hour of birth, exclusive breastfeeding for the first six months and continued breastfeeding for two years or more, together with nutritionally adequate, safe, age appropriate, responsive complementary feeding starting at six months. Exclusive breastfeeding is the perfect way to provide the best food for a baby’s first six months of life, benefiting children the world over. However, breastfeeding is so much more than food alone; breastfed infants are much less likely to die from diarrhea, acute respiratory infections and other diseases. Breastfeeding supports infants’ immune systems and helps protect from chronic conditions later in life such as obesity and diabetes. Adequate complementary feeding of children from 6 months onwards, in combination with continued breastfeeding, is particularly important for growth and development and safeguarding the health of the young child.

We have been evaluating through nutritional studies both the knowledge and the attitude of the mothers to understand the reasons why they are not carrying out proper nutritional care practices for their children, in order to be able to propose improvement measures, comparing them with previous year's indexes. The project has been implemented thanks to the training and support provided to pregnant and lactating women, the development of baby friendly spaces, mother to mother support groups, the implementation of last mile mobile solution, the nutritional studies carried out, and the preventive response to tackle malnutrition and treatment of cases.

The reduction of malnutrition rates and improvement of infant and young child feeding practicces prove the impact that the MOM project is reaching on the nutritional conditions of children, pregnant and lactating women among refugees in Ethiopia.

Results/Outputs/Impacts

We work to achieve the reduction of the prevalence of global acute malnutrition (children under 5) from 24,1% in 2016 to the WHO standard of <15.0%, in the refugee camps in Ethiopia, by introducing tested and innovative methodologies, including increasing breastfeeding.
More than 22.000 mothers received monthly training on the benefits of breastfeeding in the first 6 months of the baby and advice on complementary feeding activities. The existence of these dynamics on a regular basis in the camps has fostered the empowerment of women within their own communities, having a positive impact on the fight against child malnutrition since it favors their being directly involved in the identification and direct treatment of cases.

31 Baby Friendly Spaces have been implemented, where women have been able to promote breastfeeding practices together and learn about nutrition and protection issues. Mothers have also received psychosocial assistance from qualified staff in cases of trauma. This practices have ensured a calm and continuous breastfeeding. They are strategically located close to the supplementary food delivery sites so that, after the moment of breastfeeding, the mothers can spend to collect these products assiduously without major inconveniences or to travel long distances. These spaces also foster cohesion among refugee women in the camps. These spaces represent, in turn, an intersection of joint work between pre- and post-natal care staff such as midwives and BFS workers as well as community health workers, who are all focused essentially on meeting the needs of the babies from 0 to 23 months.

Another best practice of the MOM project is the integration of “Mother to Mother Support Group (MtMSG)”. There are 1.077 active groups in the camps of implementation of this project.These are groups of refugee women, many of them pregnant and lactating, who spontaneously organize themselves animated by a facilitator, also a refugee, who is trained by UNHCR’s implementing partners and UNHCR staff to transmit it to their refugee’s colleagues and, thus, disseminate knowledge among them.

Worldwide, over 820 000 children's lives could be saved every year if all children 0–23 months were optimally breastfed. The key measurable results will be the improvement of the prevalence of Timely initiation of breastfeeding, Exclusive breastfeeding under 6 months, Continued breastfeeding at 1 year, Continued breastfeeding at 2 years, Introduction of solid, semi-solid or soft foods, Consumption of iron-rich or iron-fortified foods, Bottle Feeding-.

Enabling factors and constraints

After 2 years of implementation of the MOM project, one of the innovative elements of the IYCF approach such as the creation of mother to mother support groups, has been established as a fundamental link between the nutrition sector, child protection, food security and self-sustainability. New activities carried out within these groups such as cooking demonstrations, the identification of cases of malnutrition through the MUAC method by mothers or the setting up of backyard gardens, have become part of the regular program of community management of malnutrition, assuming them as a key element from a prevention perspective by 2018. This is key for the IYCF practice to succeed.

Also, an enabling factor is the innovation that the practice has brought about: The Last Mile Mobile Solution. LMMS is a technology solution that combines software applications with custom hardware to digitize and simplify the processes of remote data collection, beneficiary management, food commodity distribution, and beneficiary reporting. It allows to move from paper data to electronic data for beneficiaries of food products and saves time and resources, allowing a faster and fairer distribution of aid. Thanks to the advantages of this system, such as better delivery of food rations to beneficiaries, improved accountability in the UNHCR assistance programs in Ethiopia with comprehensive case-by-case monitoring of beneficiaries, savings in waiting time for families that allows mothers to carry out other activities. The use of the LMMS has a direct impact on the nutritional status of children and pregnant and lactating women: due to the current lengthy registration process, they have to wait long hours to collect the products, which interrupts feeding practices. Consequently, there is a direct link with IYCF practices.

The specific constraints that needed to be overcome are the food rations that are reduced due to lack of funding. This is why, investing on women empowerment to improve their breastfeeding and nutrition status of their children is key.

Sustainability and replicability

The project adopts an innovative, multi-sector approach that not only addresses the problem of lack of food, but also includes improved childcare practises, support to pregnant and lactating women, access to health care and adequate shelter, access to energy as well as integration into the community.
By focusing on women and their improved knowledge, we make the project sustainable since they have the tools to improve the nutritional status of their children. UNHCR has the plan to extend the practice to other refugee contexts in Rwanda and Uganda.

Conclusions

- Optimal breastfeeding and complementary feeding can reduce child mortality in children under five more than any other preventive measure - by up to 26% (Lancet). Translating this knowledge into practice has been challenging, especially during emergencies.<br />
- Appropriate IYCF practices are key to saving lives, preventing malnutrition and are an essential part of infant and young child health, especially in the early stages of an emergency,<br />
- Malnutrition increases dramatically, and kills most rapidly, in emergencies. Most children do not die due to conflicts or natural disasters themselves, but rather to resulting food shortages, lack of safe water, inadequate health care, and poor sanitation and hygiene. Emergencies distinguish themselves by their frequently soaring crude mortality rates, which can be two to 70 times higher than average.<br />
- The use of the LMMS has a direct impact on the nutritional status of children and pregnant and lactating women, since it reduces the time that families expend to collect the food rations and allow mother to carry out other activities, as well as improved the case by case monitoring of beneficiaries. <br />
- Thanks to this methodology, we protect infants and young children in refugee situations and enhance their chances of survival, healthy growth and development.

Other sources of information

https://www.proyectomom.org/en/

ABOUT THE ATTACHED PHOTO in next section:
Photo description “ A South Sudanese refugee mother with her newborn. As mothers and babies represent a refugee group vulnerable to protection risks, UNHCR, in collaboration with its partners, delivers several specific services, ranging from health and nutrition services for pregnant and lactating women and children to Baby Friendly Spaces and Mother to Mother Support Groups.

SDGS & Targets