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Background CARE’s Window of Opportunity program is a privately funded infant, young child and maternal nutrition project that focuses on the promotion, protection and support of optimal feeding practices. Globally the program works in five countries – Nicaragua, Peru, Sierra Leone, Bangladesh and Indonesia. Following is a report of this years activities sponsored by Window teams around the world. Indonesia The Window of Opportunity program is called Prima Bina in Indonesia. CARE has organized WBFW activities in Indonesia since 2007. This year the Prima Bina team expanded WBFW to cover the entire month of August. The three main activities included: Activity 1: Talk Show on the Radio Date: August 10, 2010 Where: National radio Duration: 60 minutes Speaker: Dr. Utami Roesli, CARE This show was aired on a national radio station and proved to be very popular this year. Dr. Roesli made time to take questions from callers. Surprisingly, many of the calls ended up being from fathers that had questions about formula. As a response, Dr. Roesli provided information on the advantages of breastfeeding over formula feeding and the many disadvantages and dangers of formula feeding. One man also called in to express his support of his future wife’s breastfeeding goals. The show was followed by a news release (following page) in the Jakarta Globe regarding CARE Indonesia’s breastfeeding campaign.

World Breastfeeding Week 2010

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It’s Time for Dads to Play Part in Breast-Feeding: Expert Nurfika Osman | August 10, 2010 http://www.thejakartaglobe.com/news/its-time-for-dads-to-play-part-in-breast-feeding-expert/390524 Indonesia. While the government campaigns for mothers to take up breast-feeding, a child nutrition expert says the father plays an equally crucial role. “It’s safe to say that if a mother fails to breast-feed her child, then it’s the father’s fault,” Utami Roesli, the chairwoman of the Indonesian Lactation Center, said on Tuesday. “The father has the power to support the breast-feeding habit. It’s very important to get his support in order to raise a healthy generation of children and boost maternal health,” she said. Utami said the father was key in reducing the strain on the mother, who, if more relaxed, would produce more of the hormone oxytocin, which is vital in the production of breast milk. “When the mother is stressed, she doesn’t produce as much milk, and as a result she can’t feed the baby properly,” she said. “Around 80 percent of breast-milk production is linked to the mother’s psychological condition.” Utami said fathers could help out by providing moral support or even back rubs. “Massaging the mother’s back helps stimulate milk production, but unfortunately not many people know this,” she said. Prevailing cultural mores are among the main reasons many Indonesian fathers are reluctant to get involved in the breast-feeding process, Utami said. “Conservative traditions teach us that taking care of children is only the mother’s business, but it’s not,” she said. Many new fathers have the belief that their role extends no further than putting food on the table. “Children are the responsibility of both parents,” Utami said. She added the problem also extended to the type of milk produced, pointing out that in West Timorese communities, the yellowish milk first produced by mothers was considered bad for the baby. However, Utami said, that milk is rich in colostrum, which is beneficial for babies. Ludol Don Bosco Seran, a 43-year-old father from Atambua in East Nusa Tenggara, said on Tuesday that he used to be critical of breast-feeding for those very reasons. “I used to have my doubts about it, because it went against everything I’d been told,” he said. “But my wife insisted on exclusively breast-feeding our son Joshua until he was 6 months old.” It was difficult, Ludol went on, to flout the lessons ingrained in him from an early age, but he stood

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by his wife and encouraged her to continue breast-feeding their son. “I even quit smoking, and with the money I save I can now buy more nutritious food for my wife,” he said. Santi Wulandari, project manager for the CARE Indonesia, agreed that fathers must be involved in the breast-feeding campaign if it was to prove effective. “Mothers will feel more confident when they have their family’s support,” she said. West Timor, in East Nusa Tenggara, is particularly prone to food shortages, and this has led to declining nutritional and health figures there, particularly among women and children younger than 5. An estimated 18 percent of infants there between the ages of 6 to 23 months suffer from acute malnutrition, according to a 2007 CARE study on 4,800 infants. In the same year, the government-sponsored National Socioeconomic Survey (Susenas) revealed that 13 percent of children nationwide under the age of 5 were malnourished, while 5.4 percent were undernourished. Nineteen of the country’s 33 provinces had rates higher than this average, suggesting that malnutrition was more widespread than initially believed. CARE is currently carrying out a campaign in two districts in East Nusa Tenggara to promote healthier practices among 1,600 pregnant women and mothers with infants under the age of 2. Launched in July 2008, the Prima Bina campaign now covers 23 villages. “The national health law stipulates that babies have the right to be fed breast milk exclusively for the first six months of their lives, and we need everyone to support this,” Utami said.

Activity 2: 1000+ Breastfeeding Commitment Ceremony Date: August 24- September 4th, 2010 Where: Three communities in the district of Belu and five communities in the district of TTU in West Timor Target Audience: 1000 + pregnant and lactating women, community members, government officials, NGO staff, community leaders Duration: Each ceremony took approximately one hour CARE enlisted the help of three local families and five village health volunteers (a.ka. Kaders) to join CARE at the various commitment ceremonies and give testimonials regarding the benefits and disadvantages regarding breastfeeding, and their perceptions of both the short-term and long-term effects of exclusive breastfeeding. CARE provided transportation for the invited speakers. The invited mothers and other family members, including fathers were able to share their experience of how they handled any problems they encountered with breastfeeding and told the participants how they best supported the mother to breastfeed. Kaders shared stories about being health volunteers and some of the struggles and joys they encounter with that role including how they go about giving advice to older women when they themselves are not married and mothers yet. Each commitment

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ceremony started with a family and a kader sharing their experiences. Following was a question and answer session. At one ceremony a participant asked the local “Custom Leader” that happened to be in the audience about the increasing trend of new mothers breaking with tradition and not secluding herself and her baby and being “smoked” after giving birth. The participant was concerned that now it seems that moms who break with tradition go out and often time their babies get sick. The tradition leader responded by talking about how the people of West Timor used to be more in tune with nature- that they ate healthy, nutritious food that they grew themselves instead of instant noodles and processed foods like now. Additionally, the tradition leader talked about how breastmilk is “nature’s food” and much better than formula. A priest soon after spontaneously stood up and talked about the importance of fathers being involved in infant and young child feeding and supporting their wives so that they can make time to breastfeed. After the Q & A sessions were completed, the Prima Bina team facilitated a quiz session with prizes (i.e., a baby towel with the Prima Bina logo on it). At the end of each ceremony, participants were asked to sign a banner stating that they were making a commitment to support breastfeeding in their community. Surprisingly, one man who had made a commitment in 2007 came back this year with wife and young child and stated the child has been exclusively breastfed and developing very well. He seemed appreciative of CARE’s work. Activity 3: Workshop for District-Level Health Officers and other Decision-Makers Date: August 30, 2010 in TTU and August 31, 2010 in Belu Keynote Speakers: Dr. Utami Roesli Target Audience: 20 Managers from Primary Care Clinics (a.ka. Puskesmas) CARE, and two other NGOS (Plan and World Vision) sponsored a workshop held by the District Health Office in two districts in West Timor (i.e., Belu and TTU). Participants included religious leaders, directors from local hospitals, and police and military personnel. Each workshop started with a brief presentation by a district health officer regarding the current situation of child nutrition in the district. Following Dr. Roesli presented on the benefits of breastfeeding, the history of the International Code of Marketing of Breast-milk Subsitutes and formula use in Indonesia. Dr. Roesli ended her presentation with a question and answer session. Each workshop ended with a facilitated group session where the participants were divided into teams and asked to develop suggestions on how they could support breastfeeding in their communities. Religious leaders suggested using marriage counseling as platform to work with families on optimal feeding behaviors.

Nicaragua The Window of Opportunity program is called Ventana de Oportunidad in Nicaragua. Again this year the Ventana de Oportunidad team organized activities for World Breastfeeding Week. During the month of August activities took place in rural clinics, hospitals and birth waiting homes in the four intervention municipalities in the districts of Jinotega and Matagalpa. Additionally a national-level breastfeeding fair was held in the capital of Managua to help raise awareness about the importance of providing a supportive pathway to enable women to achieve their breastfeeding intentions.

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Activity 1: Breastfeeding Promotion Activities Birth-waiting homes Breastfeeding educational sessions and breastfeeding knowledge contest sessions were conducted by Window of Opportunity staff at five birth waiting homes in Jinotega, Waslala, Rio Grande, San Jose Bocay, El Cúa. All the

participants received promotional bags branded with key messages about breastfeeding.

Rural Clinics The Window of Opportunity also supported four smaller breastfeeding fairs that took place in four rural clinics in the Window programming area. Materials were supplied for community members to create murals to promote breastfeeding in the health center. Additionally, banners promoting key breastfeeding messages referring were developed for the fairs Hospitals Educational sessions were developed by nursing staff, in collaboration with CARE staff, from Victoria Motta Hospital in Jinotega. Approximately 150 mothers were in attendance. Banners and materials for a mural were donated by CARE.

Banner in birth waiting home, San José de Bocay

Birth waiting home in Jinotega, Nicaragua

Education session with mothers at Victoria Motta Hospital, Jinotega

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SILAIS Level (Integrated Health Care Local System) Window provided two breastfeeding promotional banners to SILAIS in Jinotega and Matagalpa. Activity 2: SOYNICA Association: Forum “Breastfeeding is also a mans’ responsibility” The goal of this forum was to sensitize men to the importance of supporting woman in their breastfeeding intentions, Twenty-six fathers and six journalists participated in the forum. Two presentations were given. The first presentation was on breastfeeding as a strategy to reduce stunting given by Freddy Espinoza the program manager for Window of Opportunity in Nicaragua.

Mural in Victoria Motta Hospital, Jinotega Education session with mothers at Victoria Motta Hospital, Jinotega

Education session with mothers at Victoria Motta Hospital, Jinotega

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The second presentation given by Armando Arguello from the Interest Group on Food Sovereignty, Security and Nutrition (GISSAN) regarding the positive impact breastfeeding has on family and country economy. Activity 3: National Level Breastfeeding Fair

Window of Opportunity participated in the National Breastfeeding Fair that was held in Managua and organized by the Breastfeeding National Alliance. Window staff gave presentations and distributed pencils, posters, brochures and notebooks with messaging about the benefits of breastfeeding.

CARE staff in the National Breastfeeding Fair, organized by the Breastfeeding National Alliance

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Peru The Window of Opportunity program is called Ventana de Oportunidad in Peru. This year’s events included informational sessions, print materials dissemination, contests and much more. Many of the activities were held in collaboration with the Ministry of Health. Activities included:

Information Dissemination 1. Launch of World Breastfeeding Week in Peru World Breastfeeding Week was launched in a big way in Peru with the participation of the Minister of Health and Regional Presidents. Launch events were held in the capital city of Lima and in the two districts where Ventana de Oportunidad is working. The launch events were covered by the press. Photographs of the event in Lima appear on page 10 of this report. The following article appeared in a local newspaper in Apurimac, Peru.

2. Disseminating print materials regarding World Breastfeeding Week CARE distributed posters (10,000 units), books about the 10 steps to successful breastfeeding (5,000 units) and brochures about the breastfeeding week in Peru 2010 (5,000 units). These print materials were distributed in the two districts where Ventana de Oportunidad is being implemented. 3. Printing and distribution of the National Child Feeding Regulation CARE supported the Ministry of Health in printing the National Child Feeding Regulation which was distributed in the rural clinics and health centers located in Ventana de Oportunidad intervention

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areas. The Regulation provides guidelines on how to achieve adequate child feeding for up to two years of age in conjunction with Ministry of Health activities, surveillance and supervision.

4. Exhibition of messages in the Ministry of Health building Posters, banners and informational boards regarding breastfeeding were exhibited in the Ministry of Health building in Lima, as well as in the Ministry of Health Regional Offices and Regional Hospitals in the Ayacucho and Apurimac regions.

5. Broadcasting radio and television messages to promote breastfeeding. In collaboration with the Ministry of Health, radio and television messages focused on promoting breastfeeding were broadcasted in the project intervention areas.

Training Activities

6. Breastfeeding Education for Health Workers CARE along with the Ministry of Health Regional Office in Apurimac organized an educational session for 30 health workers. The goal of the session was to provide health workers with skills and knowledge to promote breastfeeding. 7. Informational session on the Baby Friendly Hospital Initiative In collaboration with the Ministry of Health, CARE provided an informational session to health workers on Baby Friendly Hospital Initiative. Additionally community volunteers and high school students also were trained on the same issue.

Activities at the Community Level

Longest breastfeed session contest In Apurimac and Ayacucho CARE collaborated with the Ministry of Health, local NGOs, local government officials, the Peruvian Conditional Cash Transfer Program and others to host a particularly fun contest. This contest has been held by the Ministry of Health in August for the past few years as part of the breastfeeding week activities. It consists in rewarding mothers and their infants who display good attachment and feed the longest. Photos from this event can be found on page 11 -12.

High School Art Contest In collaboration with regional offices of the Ministry of Education (Apurimac and Ayacucho regions), CARE organized two high schools art contests. Students submitted banners and posters promoting breastfeeding and breastfeeding support.

Parade In collaboration with regional offices of the Ministry of Health (Apurimac and Ayacucho region), CARE organized two parades in support of breastfeeding. A large number of people participated in the parades. Photos can be seen on page 13.

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Photos from World Breastfeeding Week, 2010

Minister of Health launched the WBW Apurimac Regional President awarding the contest winner

Posters and banners in the Ministry of Health

Posters and banners in the Health Centers

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Longest breastfeed session contest

Longest breastfeed session contest

Longest breastfeed session contest

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Longest breastfeed session contest

Longest breastfeed session contest

Longest breastfeed session contest

Longest breastfeed session contest

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High Schools Contests of Breastfeeding Banner and Posters

Breastfeeding Parade

Sierra Leone This year’s World Breastfeeding Week (1st -7th August 2010) was commemorated in the two Window of Opportunity operational districts (Koinadugu and Tonkolili) with a total of 157 participants (52 in Tonkolili and 105 in Koinadugu). Participants included mother-to- mother support group members including mother facilitators, youth and women representatives, peripheral health unit staff, local council representatives, paramount chiefs, and other NGO representatives. District level activities The following activities were carried out at district level from the 1st -7th August 2010:

33 slots of jingles on breastfeeding provided by UNICEF were aired on three local radio stations in Tonkolili and Koinadugu districts.

In collaboration with the district health management team staff, 3 radio panel discussions and phone-in program on barriers to breastfeeding were carried out.

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Community level activities

Several parades of mother-to-mother support group members toured the host chiefdom headquarter towns using banners with the theme for this years commemoration “Ten steps to successful breastfeeding”.

Golden Bow pins from UNICEF were distributed by peripheral health unit staff to mother-to-mother support group members and other mothers not affiliated with the support groups. The golden bow is a symbol for the protection, promotion and support of breastfeeding. One loop represents the mother, the other represents the child. The knot symbolizes the father, family and society who play a pivotal role in creating a favorable environment for breastfeeding. The gold color shows that breastfeeding is the gold standard (Safe, Sound and Sustainable) for infant feeding.

Advocacy statements in support of breastfeeding were delivered by chiefdom authorities, CARE staff, peripheral health unit staff, local council representatives, mother facilitators of support groups and UNICEF staff.

A discussion forum on issues around barriers to

breastfeeding and community perceptions and beliefs about breastfeeding was facilitated by CARE staff.

Viewings of a video of early initiation were shown to all participants. Viewings were followed

by discussions. During the discussions it came out clearly that birth attendants play a very important role in effecting timely initiation of breast feeding.

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A quiz competition was organized for mother-to-mother support group members. Prizes for the competition were distributed by UNICEF representatives.

The seven days worth of activities were concluded by a vote of thanks from Local Councilors who encouraged mothers to inculcate the habit of breastfeeding and pledged the council and chiefdom authorities’ commitment to improving breastfeeding behavior in the district.