Rencana Pembangunan Jangka Menengah Nasional (RPJMN) 2010-2014secara tegas telah memberikan arah Pembangunan Pangan dan Gizi yaitumeningkatkan ketahanan pangan dan status kesehatan dan gizimasyarakat. Selanjutnya dalam Instruksi Presiden No. 3 tahun 2010tentang Program Pembangunan yang Berkeadilan yang terkait denganRencana Tindak Upaya Pencapaian Tujuan Pembangunan Milenium(MDGs), ditegaskan perlunya disusun dokumen Rencana Aksi NasionalPangan dan Gizi (RAN-PG) 2011-2015 dan Rencana Aksi Daerah Pangandan Gizi (RAD-PG) 2011-2015 di 33 provinsi.Keluaran rencana aksi diharapkan dapat menjembatani pencapaian MDGsyang telah disepakati dalam RPJMN 2010-2014 yaitu menurunnyaprevalensi gizi kurang anak balita menjadi 15,5 persen, menurunnyaprevalensi pendek pada anak balita menjadi 32 persen, dan tercapainyakonsumsi pangan dengan asupan kalori 2.000 Kkal/orang/hari.

berdasarkan Data Riset Kesehatan Dasar (Riskesdas) 2013, prevalensi balita gizi buruk dan kurang di Indonesia mencapai 19,6 persen. Angka tersebut meningkat dibandingkan dengan data Riskesdas 2010 sebesar 17,9 persen dan Riskesdas 2007 sebesar 18,4%.

Unicef

Infant and Young Child Feeding – UNICEF response

GoalIn accordance with the Global Strategy on Infant and Young Child Feeding (WHO-UNICEF 2003), the overall goal of UNICEF’s infant and young child feeding programming is to protect, promote and support optimal infant and young child feeding, in order to improve nutrition status, growth and development, health and thus the survival of infants and young children.

ActionIt is estimated that reaching all infants with a package of interventions to protect, promote and support optimal infant and young child feeding practices  - breastfeeding and complementary feeding -  can contribute to preventing 1.4 million and 600,000  child deaths respectively, or just over a fifth of the total annual child deaths. The good news is that breastfeeding rates are no longer declining on a global level and have increased during the last decade in many countries, thanks to concerted programming efforts. Recent data highlights that there has been substantial and encouraging progress over the last 10 years in over a dozen countries, where exclusive breastfeeding rates increased by 20 percentage points or more (UNICEF database, 2007). Many of these countries are in sub-Saharan Africa. These successes show that progress is possible, even in challenging situations. Positive outcomes are achieved when countries implement, at scale, a comprehensive approach to improving infant feeding practices. This could include efforts at the level of policy and legislation, health system strengthening and capacity building, community-level action and behaviour change communication initiatives.

UNICEF's strategy and actions in support of infant and young child feeding, through its Medium Term Strategic Plan, underline the importance of multi-sectoral approach to improve health and nutrition. The strategy is based upon the Convention on the Rights of the Child - Article 24 - which states that governments must ensure that all sectors of society are informed, have access to education and are supported in the use of basic knowledge of child health and nutrition, including the advantages of breastfeeding. Further policy basis for the strategy includes the 1990 and 2005 Innocenti Declarations on breastfeeding and infant and young child feeding respectively and the 2003 Global Strategy for Infant and Young Child Feeding. In addition, optimal infant and young child feeding supports all of the Millennium Development Goals and directly responds to the World Fit for Children goals (Paragraph 37.5).

UNICEF efforts will recognize children’s and families’ rights and responsibilities and include suggested proven activities for advocacy and support of government and non-governmental actions at three levels: national, health system and community. As per the strategies outlined in the Global Strategy for Infant and Young Child Feeding, UNICEF’s main areas of support include:

1. Support multi-sectoral national commitment and partnership by encouraging the development and implementation of: 

National level coordination structures  Strategic public and private partnerships with other international and country-level actors in

improving infant and young child nutrition  National infant and young child feeding policies, standards, strategy frameworks, guidelines and

training tools Programme plans to operationalize the strategy at scale  Advocacy materials addressing policy and legislation, new and ongoing, to all relevant groups, such

as health workers, political leadership, stakeholders and partners.  Legislation and enforcement of the International Code of Marketing of Breastmilk Substitutes,

subsequent relevant WHA Resolutions, the ILO Maternity Protection Convention and  new legislation or other suitable measures for maternity protection and baby friendly workplaces as requiredMonitoring and evaluation

2. Enhance implementation of health services and training reform (baby-friendly health care):

Support for full implementation of the Baby-Friendly Hospital Initiative in all maternity services Advocacy and technical assistance in the development of standards for baby friendly health care Support for inclusion of IYCF monitoring and evaluation into the National Health Information

Systems.  Review of all health system contacts to ensure that each contact includes age-appropriate feeding

counseling and support for mother and child.  Technical assistance for revision of pre-service and in-service training curricula to include

appropriate breastfeeding and complementary feeding counseling and support skills, and appropriate job aids to support improved healthcare practices at all levels.

Support for building-service training of health workers. Integration of maternal nutrition interventions, including micronutrient supplementation, nutrition

assessment, nutrition rehabilitation and counseling integrated within antenatal care and healthy child consultations and other contacts with pregnant and lactating mothers.

3.  Provide support for community level programming:

Support for IYCF actions within community based health and nutrition care through lay counselors, community health workers and other community cadres

Emphasis on community social support for the mother (e.g. mother to mother support groups) and the ability to refer for medical support when needed, and on family and societal support for an optimal infant and young child feeding norm. 

4.   Support communication for social and behaviour change and advocacy:

Support for national communication and social mobilization activities using multiple channels and aimed at behavior and social change related to optimal infant feeding practices.

5. Address IYCF in exceptionally difficult circumstances:

Provision of guidance and operational support on feeding infants and young children in exceptionally difficult circumstances and on the related support required by mothers, families, and other

caregivers, in unstable situations such as in families/communities living with HIV/AIDS or in emergencies.

Community based infant and young child feeding

Accelerating interventions aimed at improving infant and young child feeding (IYCF) at community level is a key priority in the effort to improve survival, growth, and development of children with equity. However, in many communities IYCF practices remain far from optimal. Caregivers often lack the practical support, one-to-one counselling and correct information. Community-based IYCF counselling and support can play an important role in improving these practices: it can ensure access to these services in the poorest and the most vulnerable communities with limited access to health care, and therefore become an important strategy for programming with an equity focus. 

In 2010, UNICEF developed a new set of generic tools for programming and capacity development on community based IYCF counselling. Aimed for use in diverse country contexts, the package of tools guides local adaptation, design, planning and implementation of community based IYCF counselling and support services at scale. It also contains training tools to equip community workers (CWs), using an interactive and experiential adult learning approach, with relevant knowledge and skills on the recommended breastfeeding and complementary feeding practices for children from 0 up to 24 months, enhance their counselling, problem solving, negotiation and communication skills, and prepare them to effectively use the related counselling tools and job aids. To date, some 30 countries are at various stages of adapting the materials to the local context, building capacity and rolling out community based IYCF counseling and communication using the package.

The generic package components are living documents. Lessons learned from training sessions across Africa and Asia were incorporated into the 2012 second edition, which also includes some additional components such as home fortification of complementary foods and early childhood development, and a supervision, mentoring and monitoring module was developed and field tested, with a final version dated October 2013. Further updates to the Facilitator Guide and Participant materials were made in 2013.

Infant and Young Child Feeding

Goal

In accordance with the Global Strategy on Infant and Young Child Feeding, UNICEF’s overall goal in this programme area is to protect, promote and support optimal infant and young child feeding practices.  The expected results are improved nutrition status, growth, development, health and ultimately the survival of infants and young children.

It is well recognized that the period from birth to two years of age is the “critical window” for the promotion of good growth, health, and behavioral and cognitive development. Therefore, optimal infant and young child feeding is crucial during this period. Optimal infant and young child feeding means that mothers are empowered to initiate breastfeeding within one hour of birth, breastfeed exclusively for the first six months and continue to breastfeed for two years or more, together with nutritionally adequate, safe, age appropriate, responsive complementary feeding starting at six months.  Maternal nutrition is also important for ensuring good nutrition status of the infant as well as safeguarding women's health.

Issue

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. But breastfeeding is so much more than food alone; breastfed infants are much less likely to die from diarrhoea, acute respiratory infections and other diseases: a non-breastfed child is 14 times more likely to die in the first six months than an exclusively breastfed child. Breastfeeding supports infants’ immune systems and helps protect from chronic conditions later in life such as obesity and diabetes. Suboptimum breastfeeding still accounts for an estimated 800,000 deaths in children under five

annually (about 13% of total child deaths), according to the Lancet 2013 Nutrition Series. Data from 2011 indicate that only 39 per cent of 0-5 month olds in low-income countries are exclusively breastfed.

Adequate complementary feeding of children from 6 months onwards is particularly important for growth and development and the prevention of undernutrition. Childhood undernutrition remains a major health problem in resource-poor settings. in 2011, over a quarter of children less than five years of age in low-income countries, or 165 million children under five years, are stunted (low height-for-age), and large proportions are also deficient in one or more micronutrients. That means they require the addition of nutrient dense, high quality foods in sufficient quantities to their diet along with continued breastfeeding.  There is evidence that complementary feeding practices are generally poor in most developing countries, meaning that many children continue to be vulnerable to largely irreversible outcomes such as stunting and poor cognitive development, as well as to significantly increased risks of infectious diseases like diarrhea and pneumonia.

Action

UNICEF's strategy and actions in support of infant and young child feeding, through its new Nutrition Strategy and new Strategic Plan, underlines the importance of a multi-sectoral approach to improve health and nutrition, by taking evidence based packages of interventions to scale. The strategy is based on the 1990 Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding, the 2005 Innocenti Declaration on Infant and Young Child Feeding and the 2003 WHO-UNICEF, Global Strategy on Infant and Young Child Feeding. UNICEF efforts recognize the rights of children and families and include proven activities for advocacy as well as support of government and non-governmental actions at four levels: national policy, health system, community and cross-cutting communication. Guidance on assessment, design, planning and implementation of a comprehensive IYCF strategy is contained in UNICEF's  Programming Guide on Infant and Young Child Feeding.   Click on these links to read more on the issues and actions related to:

Who

Infant and young child feeding

Fact sheet N°342Updated July 2015

Key facts

Every infant and child has the right to good nutrition according to the Convention on the Rights of the Child.

Undernutrition is associated with 45% of child deaths. Globally in 2013, 161.5 million children under 5 were estimated to be stunted, 50.8 million were

estimated to have low weight-for-height, and 41.7 million were overweight or obese. About 36% of infants 0 to 6 months old are exclusively breastfed. Few children receive nutritionally adequate and safe complementary foods; in many countries less

than a fourth of infants 6–23 months of age meet the criteria of dietary diversity and feeding frequency that are appropriate for their age.

About 800 000 children's lives could be saved every year among children under 5, if all children 0–23 months were optimally breastfed1 .

Overview

Undernutrition is estimated to cause 3.1 million child deaths annually or 45% of all child deaths. Infant and young child feeding is a key area to improve child survival and promote healthy growth and development. The first 2 years of a child’s life are particularly important, as optimal nutrition during this period lowers morbidity and mortality, reduces the risk of chronic disease, and fosters better development overall.

Optimal breastfeeding is so critical that it could save about 800 000 under 5 child lives every year.

WHO and UNICEF recommend:

early initiation of breastfeeding within 1 hour of birth; exclusive breastfeeding for the first 6 months of life; and the introduction of nutritionally-adequate and safe complementary (solid) foods at 6 months

together with continued breastfeeding up to 2 years of age or beyond.

However, many infants and children do not receive optimal feeding. For example, only about 36% of infants aged 0 to 6 months worldwide are exclusively breastfed over the period of 2007-2014.

Recommendations have been refined to also address the needs for infants born to HIV-infected mothers. Antiretroviral drugs now allow these children to exclusively breastfeed until they are 6 months old and continue breastfeeding until at least 12 months of age with a significantly reduced risk of HIV transmission.

Breastfeeding

Exclusive breastfeeding for 6 months has many benefits for the infant and mother. Chief among these is protection against gastrointestinal infections which is observed not only in developing but also industrialized countries. Early initiation of breastfeeding, within one hour of birth, protects the newborn from acquiring infections and reduces newborn mortality. The risk of mortality due to diarrhoea and other infections can increase in infants who are either partially breastfed or not breastfed at all.

Breast milk is also an important source of energy and nutrients in children aged 6 to 23 months. It can provide half or more of a child’s energy needs between the ages of 6 and 12 months, and one third of energy needs between 12 and 24 months. Breast milk is also a critical source of energy and nutrients during illness, and reduces mortality among children who are malnourished.

Adults who were breastfed as babies are less likely to be overweight/obese. Children and adolescents that have been breastfed perform better on intelligence tests. Breastfeeding also contributes to the health and well-being of mothers; it reduces the risk of ovarian and breast cancer and helps space pregnancies–exclusive breastfeeding of babies under 6 months has a hormonal effect which often induces a lack of menstruation. This is a natural (though not fail-safe) method of birth control known as the Lactation Amenorrhoea Method.

Mothers and families need to be supported for their children to be optimally breastfed. Actions that help protect, promote and support breastfeeding include:

adoption of policies such as the International Labour Organization’s Maternity Protection Convention 183 and Recommendation No. 191, which complements Convention No. 183 by suggesting a longer duration of leave and higher benefits;

the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolutions;

implementation of the Ten Steps to Successful Breastfeeding specified in the Baby-Friendly Hospital Initiative, including:

o skin-to-skin contact between mother and baby immediately after birth and initiation of breastfeeding within the first hour of life;

o breastfeeding on demand (that is, as often as the child wants, day and night);o rooming-in (allowing mothers and infants to remain together 24 hours a day);o not giving babies additional food or drink, even water, unless medically necessary;

provision of supportive health services with infant and young child feeding counselling during all contacts with caregivers and young children, such as during antenatal and postnatal care, well-child and sick child visits, and immunization; and

community support, including mother support groups and community-based health promotion and education activities.

Complementary feeding

Around the age of 6 months, an infant’s need for energy and nutrients starts to exceed what is provided by breast milk, and complementary foods are necessary to meet those needs. An infant of this age is also developmentally ready for other foods. If complementary foods are not introduced around the age of 6 months, or if they are given inappropriately, an infant’s growth may falter. Guiding principles for appropriate complementary feeding are:

continue frequent, on-demand breastfeeding until 2 years of age or beyond; practise responsive feeding (e.g. feed infants directly and assist older children. Feed slowly and

patiently, encourage them to eat but do not force them, talk to the child and maintain eye contact); practise good hygiene and proper food handling; start at 6 months with small amounts of food and increase gradually as the child gets older; gradually increase food consistency and variety; increase the number of times that the child is fed: 2-3 meals per day for infants 6-8 months of age

and 3-4 meals per day for infants 9-23 months of age, with 1-2 additional snacks as required; use fortified complementary foods or vitamin-mineral supplements as needed; and during illness, increase fluid intake including more breastfeeding, and offer soft, favourite foods.

Feeding in exceptionally difficult circumstances

Families and children in difficult circumstances require special attention and practical support. Wherever possible, mothers and babies should remain together and get the support they need to exercise the most appropriate feeding option available. Breastfeeding remains the preferred mode of infant feeding in almost all difficult situations, for instance:

low-birth-weight or premature infants; HIV-infected mothers; adolescent mothers; infants and young children who are malnourished; and families suffering the consequences of complex emergencies.

HIV and infant feeding

Breastfeeding, and especially early and exclusive breastfeeding, is one of the most significant ways to improve infant survival rates. However, HIV can pass from mother to child during pregnancy, labour or delivery, and also through breast milk. In the past, the challenge was to balance the risk of infants acquiring HIV through breastfeeding versus the higher risk of death from causes other than HIV, in particular malnutrition and serious illnesses such as diarrhoea and pneumonia, among HIV-exposed but still uninfected infants who were not breastfed.

The evidence on HIV and infant feeding shows that giving antiretroviral drugs (ARVs) to HIV-infected mothers can significantly reduce the risk of transmission through breastfeeding and also improve her health. This enables infants of HIV-infected mothers to be breastfed with a low risk of transmission (1-2%). HIV-infected mothers and their infants living in countries where diarrhoea, pneumonia and malnutrition are still common causes of infant and child deaths can therefore gain the benefits of breastfeeding with minimal risk of HIV transmission.

Since 2010, WHO has recommended that mothers who are HIV-infected take ARVs and exclusively breastfeed their babies for 6 months, then introduce appropriate complementary foods and continue breastfeeding up to the child’s first birthday. Breastfeeding should only stop once a nutritionally adequate and safe diet without breast milk can be provided.

Even when ARVs are not available, mothers should be counselled to exclusively breastfeed for 6 months and continue breastfeeding thereafter unless environmental and social circumstances are safe for, and supportive of, feeding with infant formula.

WHO's response

WHO is committed to supporting countries with implementation and monitoring of the "Comprehensive implementation plan on maternal, infant and young child nutrition", endorsed by Member States in May 2012. The plan includes 6 targets, one of which is to increase, by 2025, the rate of exclusive breastfeeding for the first 6 months up to at least 50%. Activities that will help to achieve this include those outlined in the "Global Strategy for Infant and Young Child Feeding", which aims to protect, promote and support appropriate infant and young child feeding.

WHO has formed a Network for Global Monitoring and Support for Implementation of the International Code of Marketing of Breast-milk Substitutes and subsequent relevant WHA resolutions called NetCode. The goal of NetCode is to protect and promote breastfeeding by ensuring that breastmilk substitutes are not marketed inappropriately. Specifically, NetCode is building the capacity of Member States and civil society to strengthen national Code legislation, continuously monitor adherence to the Code, and take action to stop all violations. In addition, WHO and UNICEF have developed courses for training health workers to provide skilled support to breastfeeding mothers, help them overcome problems, and monitor the growth of children, so they can identify early the risk of undernutrition or overweight/obesity.

In addition, WHO and UNICEF have developed courses for training health workers to provide skilled support to breastfeeding mothers, help them overcome problems, and monitor the growth of children, so they can identify early the risk of undernutrition or overweight/obesity.

WHO provides simple, coherent and feasible guidance to countries for promoting and supporting improved infant feeding by HIV-infected mothers to prevent mother-to-child transmission, good nutrition of the baby, and protect the health of the mother.

Country implementation of the International Code of Marketing of Breast-milk Substitutes

Status Report 2011

Authors:World Health Organization

Publication details

Editors: World Health OrganizationNumber of pages: 60Publication date: 2013

Languages: EnglishISBN: 978 92 4 150598 7

Downloads

Full text pdf 610.80kB

Overview

Globally, breastfeeding has the potential to prevent about 800 000 deaths among children under five each year if all children 0–23 months were optimally breastfed. WHO recommends that all infants should be exclusively breastfed for the first six months of life, but actual practice is low (38%).

The implementation and enforcement of International Code of Marketing of Breast-milk Substitutes and subsequent relevant Health Assembly Resolutions (the Code) are critical for an environment that supports proper infant and young child feeding and for the attainment of Millennium Development Goal 4 (reduce child mortality).

This report summarizes the progress countries have made in implementing the Code. It is based on data received from WHO Member States between 2008 and 2010 and on information for 2011 from UNICEF. WHO recognizes ongoing progress being made in various countries since 2011, in terms of passing laws, strengthening existing laws or improving monitoring mechanisms. Updates will be included on an ongoing basis in the WHO Global database on the Implementation of Nutrition Action (GINA). In addition, WHO will publish status reports periodically.

There has been a dramatic rise in the numbers of children under 5 years of age who are overweight. According to the new 2013 United Nations Children’s Fund (UNICEF), World Health Organization (WHO) and World Bank estimates (4), between 2000 and 2013, the number of overweight children worldwide increased from 32 million to 42 million. The prevalence of childhood overweight is increasing in all regions of the world, particularly in Africa and Asia.

Between 2000 and 2013, the prevalence of overweight in children under 5 years of age increased from 1% to 19% in southern Africa, and from 3% to 7% in south-east Asia. In terms of regional breakdowns in numbers of overweight children in 2013, there were an estimated 18 million overweight children under 5 years of age in Asia, 11 million in Africa and 4 million in Latin America and the Caribbean.

Low levels of overweight in children under 5 years of age were observed in the regions of Latin America and the Caribbean, with little change over the last 13 years. Nevertheless, countries with large populations, such as Argentina, Brazil, Chile, Peru and the Plurinational State of Bolivia, observed levels of 7% and higher. If these increasing trends continue, it is estimated that the prevalence of overweight in children under 5 years of age will rise to 11% worldwide by 2025, up from 7% in 2012.

Global Targets 2025

To improve maternal, infant and young child nutrition

WHO's Member States have endorsed global targets for improving maternal, infant and young child nutrition and are committed to monitoring progress. The targets are vital for identifying priority areas for action and catalysing global change.

Global nutrition targets 2025: Policy briefs

Overview

Stunting

TARGET: 40% reduction in the number of children under-5 who are stunted

Anaemia

TARGET: 50% reduction of anaemia in women of reproductive age

Low birth weight

TARGET: 30% reduction in low birth weight

Childhood overweight

TARGET: No increase in childhood overweight

Breastfeeding

TARGET: Increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%

Wasting

TARGET: Reduce and maintain childhood wasting to less than 5%

Global Nutrition Targets 2025: Policy brief series

Authors:World Health Organization

Publication details

Editors: World Health OrganizationNumber of pages: 2Publication date: 2014Languages: EnglishWHO reference number: WHO/NMH/NHD/14.2

Overview

Recognizing that accelerated global action is needed to address the pervasive and corrosive problem of the double burden of malnutrition, in 2012 the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan on maternal, infant and young child nutrition, which specified a set of six global nutrition targets that by 2025 aim to:

achieve a 40% reduction in the number of children under-5 who are stunted; achieve a 50% reduction of anaemia in women of reproductive age; achieve a 30% reduction in low birth weight; ensure that there is no increase in childhood overweight; increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%; reduce and maintain childhood wasting to less than 5%.

Overview

Childhood stunting is one of the most significant impediments to human development, globally affecting approximately 162 million children under the age of 5 years. Stunting, or being too short for one’s age, is defined as a height that is more than two standard deviations below the World Health Organization (WHO) child growth standards median.

It is a largely irreversible outcome of inadequate nutrition and repeated bouts of infection during the first 1000 days of a child’s life. Stunting has long-term effects on individuals and societies, including: diminished cognitive and physical development, reduced productive capacity and poor health, and an increased risk of degenerative diseases such as diabetes.

If current trends continue, projections indicate that 127 million children under 5 years will be stunted in 2025. Therefore, further investment and action are necessary to attain the 2025 World Health Assembly target of reducing that number to 100 million.

berdasarkan Data Riset Kesehatan Dasar (Riskesdas) 2013, prevalensi balita gizi buruk dan kurang di Indonesia mencapai 19,6 persen. Angka tersebut meningkat dibandingkan dengan data Riskesdas 2010 sebesar 17,9 persen dan Riskesdas 2007 sebesar 18,4%.