IBFAN-GIFA

Colleagues from the IBFAN Latin America and Carribean region together with mothers involved in a programme on prevention of malnutrition in Chiapas, Mexico

Interview by Jeremy Shoham

The ENN interviewed Rebecca Norton and Lida Lhotska from the Geneva Infant Feeding Association (GIFA) as part of the Field Exchange agency profile slot. GIFA was originally set up in 1979 and was the first International Baby Food Action Network (IBFAN) office. Rebecca, a London School of Hygiene and Tropical Medicine nutrition graduate, worked for a few years in the field for Médecins Sans Frontières Holland, with further training in tropical community medicine and health. She first worked for IBFAN-GIFA in 1999, trained in Breastfeeding Policy and Practice at the Institute of Child Health, London and then did a seven year stint in the Swiss Fondation Terres des hommes (Tdh) before rejoining IBFAN-GIFA in 2008. Lida, who has a PhD in anthropology and trained in community based programming in Stanford university, co-founded the first Czech IBFAN group in 1990. She then worked as a senior advisor on infant and young child feeding in UNICEF New York for seven years and moved to IBFAN-GIFA in 2001.

IBFAN was founded on October 12, 1979 following the Joint WHO/UNICEF meeting on infant and young child feeding. This meeting adopted a statement and recommendations to improve breastfeeding worldwide and also to create a marketing code to protect populations from unethical marketing of breastmilk substitutes by commercial companies. IBFAN was formed as a coalition of six non-governmental organisations (NGOs) present at the meeting. Its initial role was to follow up on the meeting recommendations and to ensure NGO involvement, as well as provide a voice for NGOs to feed back on the various drafts of the code. In 1981 the International Code of Marketing of Breast-milk Substitutes was adopted by the World Health Assembly. IBFAN stayed together as a growing global network to see how the infant feeding industry complied with the Code and how governments translated the Code into national legislation.

IBFAN hoped that its mandate would be temporary, i.e. there would no longer be a need for its work, however "29 years on and it is still there". IBFAN-GIFA was IBFAN's first central office and still serves as the host office for the IBFAN network in Geneva, including the fundraising and administrative function for the network's global funding projects.

Within the IBFAN network, IBFAN-GIFA has three main roles:

1. International liaison office with the UN agencies
2. Host to two regional offices (IBFAN Europe and IBFAN Arab World)
3. Work on infant and young child feeding issues in Switzerland.

IBFAN is a global network with a horizontal structure. It is formed by over 200 groups in more than 100 countries - South, North, East and West. There is no head office, but a structure of eight Regional Coordinating Offices and two technical support offices, of which IBFANGIFA is one. Each of these offices is represented on IBFAN's Coordinating Council (IBCoCo) which meets every 2 years and elects 5 members to the IBFAN Global Council (G-5). The G- 5 meets between IBCoCo meetings to work on policy and strategic issues. IBFAN-GIFA is the Secretariat of the G-5.

IBFAN-GIFA reflects the horizontal flat structure of the network and thus does not really have an overall 'boss or director'. Most IBFANGIFA work is undertaken in a consensual manner amongst its seven part-time staff members in Geneva (equivalent to 4.9 full time positions).

The Infant Feeding in Emergencies (IFE) Core Group grew out of a series of meetings starting in 1994 and culminating in the IBFANorganised meeting in Croatia in 1998, attended by WHO, UNICEF and a number of NGOs. Two major recommendations emerged from this meeting. First, that the political aspects of IFE needed to be urgently addressed as there was inadequate policy guidance on IFE. Secondly, that training tools on IFE needed to be developed as a priority for different audiences, e.g. technicians/health professionals, donors, media, etc. The coordination council of IBFAN delegated that IBFAN-GIFA act as the working face of IBFAN in the IFE Core Group.

The IFE Core Group has made a lot of headway since the Croatia meeting. First, on the policy side, the IFE Core Group has helped produce operational guidance on IFE. This is very much a living document (currently on version 2.1 produced in 2007) that always endeavours to be up to date. The most recent version has, for example, taken account of recent experiences in Indonesia, Pakistan and Lebanon. The IFE Core Group actively seeks out new information from the field which can feed into revised drafts. On the capacity building side, the IFE Core Group has now produced two training modules. One is for decision makers and the other for more 'hands on' practitioners dealing with critical issues around lactation management and how to support babies who aren't breastfed.

Other key achievements of the IFE Core Group include their collaborative policy work with UN agencies and donors, for example, working closely with UNHCR to develop their policy on milk product distribution and guidance for their staff on infant feeding in contexts of HIV infection. The group have also worked closely with the Department for International Development (DFID). The Swiss government policy on the Standards governing the use of milk products in the context of food aid was also updated in 2006 with important contributions from Tdh and GIFA.

Rebecca (who has worked for a previous NGO member of the IFE Core Goup - Fondation Tdh) feels that IBFAN-GIFA and the ENN have been the main movers and shakers in the IFE Core Group and to some extent have kept the group "afloat" - especially when funding has been an issue. "However, with recent main-stream funding through the nutrition cluster, things are definitely looking up".

Funding for IBFAN comes largely from governments and church related groups. Private sector funding is restricted, i.e. IBFAN cannot accept money from the baby food and infant feeding products industry nor from arms, tobacco or most pharmaceutical industries. During the most difficult funding period, GIFA managed to still fundraise for the IFE Core Group and although Nutrition Cluster funding is now in place, long-term funding still remains an issue. UN members of the IFE Core Group have not been that successful in fundraising, although UNICEF and UNHCR have provided some funds while WHO and WFP have provided in kind support. Unfortunately, agencies keep changing their funding priorities so support can never be assumed or relied upon.

ENN asked Lida and Rebecca about some of the challenges the IFE Core Group and IBFANGIFA have faced over the years, especially with regard to dilemmas posed by the spread of HIV/AIDS and risks of transmission through breastfeeding. Both acknowledged how, at first, it was very difficult to negotiate a "neutral and acceptable line". Breastfeeding up until that point had been the gold standard and it was quite a shock when data started coming in on risks of HIV transmission through that route. There was a lot of hostility in some meetings towards the position, supported by IBFAN/GIFA and the IFE Core Group, that the advent of HIV should not mean an end to breastfeeding promotion and support, even in situations of high HIV prevalence. IBFAN-GIFA and the IFE Core Group joined voices with experts who increasingly emphasised the need to consider other factors like patterns of breastfeeding, in the knowledge that exclusive breastfeeding was protective towards the gut. Eventually, when the 1999 study from South Africa was published showing that exclusive breastfeeding significantly reduced the risk of transmission, there was no real surprise amongst IBFAN-GIFA and the IFE Core Group members. The IFE Core Group continued working on this issue and developed thinking around AFASS and nuancing options in HIV endemic and emergency contexts. Rebecca and Lida now hope that advances in breastfeeding and complementary drug protocols can make exclusive breastfeeding even safer in HIV contexts.

Another more recent challenge to occupy the IFE Core Group and IBFAN-GIFA relates to the increasing interest and support amongst humanitarian agencies to use Ready to Use Foods (RUFs) in the treatment and prevention of moderate and severe malnutrition. The fear is that indiscriminate use of these products may undermine breastfeeding. There are also concerns over the sustainability of this type of intervention - "there is a need for a balance between immediate response and the longterm" and issues of quality control if lots of different products are flooding the market. Other technical issues and challenges currently facing the IFE Core Group relate to treatment of severe malnutrition in infants and the different protocols being adopted by practitioner agencies. The lack of evidence base for best practice is a major concern.

Lida feels that working for IBFAN-GIFA and the IFE Core Group has been one of her most rewarding professional experiences. She has found sustained commitment and endeavour from colleagues, as well as friendship. "People trust each other, are open and honest and there are no egos". Interestingly, members of the IFE Core Group and technical staff at GIFA are all women. As Lida put it, "when you talk breastfeeding you can count on 90% females to be involved. Once you start talking products and technology, the balance mysteriously shifts".

Both Rebecca and Lida were keen to emphasise how much of a network IBFAN is and how this plays out in practice. Recent experiences during the Georgia emergency epitomise this. Here, IBFAN put national groups and colleagues in touch with each other. This contributed to the set up of 12 mobile lactation clinics. The IFE Core Group were able to provide all the necessary tools to ensure that best practice was promoted and adopted during this emergency.

Over the years, groups like IBFAN and GIFA have come in for their fair share of criticism - particularly with regard to a certain singlemindedness where breastfeeding is concerned. Some have even suggested that such groups are too ideologically driven. However, even from a brief discussion with Rebecca and Lida, it is clear that their own modus operandi and that of the organisations they work for, is essentially pragmatic, scientific and nuanced. It is therefore no fluke that there has been enormous progress in the IFE field and that outputs have been highly practical and relevant to those caught up in emergencies. Furthermore, the process by which policies and operational tools have been developed and continue to be updated and strengthened is commendably transparent and accountable. Whatever it is that has allowed this to happen needs to be bottled and dare I say it - marketed!