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Table 2 IYCF Policy Documents with Respect to Four Domains

From: Overview of the infant and young child feeding policy environment in Pakistan: Federal, Sindh and Punjab context

Policy Description of Policy - Support for IYCF Further details on IYCF in policy
   General support for IYCF) Provision of correct information to mothers Training of health workers to counsel mothers Enable mothers to engage with health care workers Other aspects related to IYCF but not falling in these four domains?  
NATIONAL
The Protection of Breastfeeding and Child Nutrition Ordinance, 2002 [14] The ordinance is based on international code of marketing of breast milk substitutes.    Penalties for promotion of breast milk substitutes After devolution it has been adopted by individual legislations at the Provincial levels with Punjab and Sindh amongst the first of the provinces to adopt it.
Pakistan Vision 2030 strategy (Planning Commission, 2007, approved by the National Economic Council) [24] Encompasses inter sectoral efforts to improve malnutrition like health and nutrition, education and social development      In article 6 there is a section on improving food security. Increase in food availability of the food will increase the diversity of the complementary food
Poverty Reduction Strategy Paper II (2008–2010, Finance Division, Government of Pakistan) [21] Includes development of a practical program to reduce child under-nutrition.      Includes promotion of breast feeding and development of a programme for improving nutrition status of children under 3 years
Food and Agriculture Security Policy (2013, Ministry of National Food Security and Research) [25] The key elements of the policy is access of food to children and women through measures like strengthening education of nutrition      Increased availability of food at the household level will increase the diversity of the complementary food.
Pakistan’s Integrated Nutrition Strategy (PINS, 2009–2010) [30] The goal is to have a well-nourished nation with sound human resource that effectively contributes to the National Development and Prosperity.    Increase the knowledge and skills of service providers, caregivers, households and communities in IYCF through communication strategy and civic education.
Provide knowledge and skill to service providers, in nutrition management and IYCF through in-service and on job trainings.
Up-scaling micro-nutrients (sprinkles) to children in line with CMAM interventions
National Strategy for Infant and Young Child Feeding in Pakistan (Ministry of Health- 2008) [18] Institute of Public Health and Nutrition and Ministry of Health and Family Welfare are the responsible bodies.
Implementation level policy support
   To improve the nutritional status, growth and development, health and survival of infants and young children through optimal IYCF practices
The National Nutrition Cluster Preparedness and Response Plan (2014) [27] It is a common framework to guide the actions of all partners in the nutrition sector in the event of a disaster. It is a flexible and dynamic document that will be updated based on lessons learnt in future emergency responses.      Protection and promotion of appropriate IYCF practices through strengthening caring capacity of family members, and health care provider at community and facility levels; and protection of breastfeeding
National Action Plan for Children (2007) [23]        Promotion of Breast Feeding, exclusive breast feeding, supplementary feeding and caring practices at community level through media, HCP including LHWs
Growth monitoring and maintaining growth charts.
National Program for Family Planning and primary healthcare; The Lady Health Workers Program(2010–2015, Ministry of Health) [29] Approved by the Cabinet the programme runs through a network of community health workers    Counselling of mothers on IYCF by lady health workers.
PUNJAB
PC-1 Punjab; Punjab Integrated Reproductive Maternal Newborn and Child Health (RMNCHRN) & Nutrition Program 2013–2016. [18] To be implemented by Health Department with departments of Food, Agriculture, Livestock and Education.   Increasing the proportion of children 6–23 months fed in accordance with all 3 IYCF practices (food diversity, feeding frequency, consumption of breast milk or milk), up to 40% in 2016.
Mid Term Development Framework and Program Punjab (2014–17, Government of Punjab) [20] Focus on reduction of nutrition generally in Punjab through an integrated maternal, newborn and child health program       Includes amongst various interventions an Integrated Reproductive, maternal, newborn and child health and nutrition program.
Nutrition Policy Guidance Notes- Punjab (2012, Government of Punjab) [26] Guidelines for protocols to be followed for IYCF and CMAM     Increase measures to promote exclusive breastfeeding for 6 months, dietary diversity for young children, intensified self-care and IYCF counselling of pregnant women and mothers at the community and facility levels.
Punjab Protection of Breast-Feeding and Child Nutrition
(Amendment) Act 2012. [15]
Legislation approved by the Provincial Assembly Punjab.
Based on international code of marketing of breast milk substitutes.
High level support.
It has replaced ‘The Protection of Breast- Feeding and Child Nutrition Ordinance, 2002’
    Dissemination of information and educational materials on infant feeding.
Punjab Maternity Benefit Rules [28] Approved by the Provincial Assembly of Punjab.
It has replaced “Punjab Maternity Benefit Ordinance,1958”
    Provision of leave to breastfeed children Although the act does not mention IYCF practices but indirectly it does show support to IYCF in a sense that it enforces organizations to provide a 6 weeks pre and postnatal paid leave to any woman who has worked in that organization for more than 4 months. However there is no mention of availability of feeding rooms.
SINDH
PC-1 Sindh; Nutrition Support Program for Sindh (NSP) (2013) The overall goal of the Nutrition Support Programme Sindh (NSP) is to improve the nutritional status of children less than 5 years and that of pregnant and lactating women, with a priority focus on malnourished.   Includes training of community health workers on IYCF, and lactation management.
Nutrition Policy Guidance Notes- Sindh.       Intensified counselling of pregnant women and mothers on IYCF at the community and facility levels reinforced by media and mobile phones.
Health Sector Strategy Sindh 2012–2020 [20] Guides the operational plans of medium and long term programs and projects with a special focus on nutrition. Mainstreaming key evidence based nutrition interventions through health sector and coordination with other department on nutrition as part of a larger provincial inter-sectoral strategy on nutrition inclusive of micro-nutrient supplementation, community based awareness and counselling     Counselling of mothers by HCP
The Sindh Protection And Promotion Of Breast- Feeding and Child Nutrition Act, 2013. [16] Legislation approved by the Provincial Assembly Sindh.
Based on international code of marketing of breast milk substitutes.
It has replaced ‘The Protection of Breast- Feeding and Child Nutrition Ordinance, 2002’
    Dissemination of informational and educational materials on infant feeding.
Integrated Nutrition Strategy Sindh The strategy aims to promote health and quality of life through an inter-sectoral approach to food and nutrition, environment, education, social protection and health in Sindh province so that it contributes to the reduction of stunting in children aged 0–24 months by 10 percentage points (from an estimated 49.8% to 39.8% by the end of 2016.    Target audience includes minus 9 months to 2 years children.
Training of HCP in communities on IYCF