INFANT FORMULA AND THE PDS IN BASRAH GOVERNORATE

UNCLAS SECTION 01 OF 04 KUWAIT 002100

SIPDIS

STATE ALSO PASS USAID/W
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ANKARA FOR AMB WRPEARSON, ECON AJSIROTIC AND DART
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E.O. 12958: N/A
TAGS: EAID PREF IZ WFP
SUBJECT: INFANT FORMULA AND THE PDS IN BASRAH GOVERNORATE


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SUMMARY
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1. UNICEF recently released a policy paper recommending
that infant formula be immediately deleted from the OFF
general ration. The following report summarizes information
gathered by the DART from WFP local female staff, home
interviews, and IDP interviews in Basrah Governorate between
4 and 11 May. Although a more thorough investigation of the
use of infant formula is necessary in Basrah and other Iraqi
governorates, the issues raised during interviews indicate
to the DART that the risks involved in removing this
commodity from the OFF general food ration for children
under one year of age cannot be justified prior to the
establishment of a functioning maternal and child safety net
and health education program. End Summary

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USE OF INFANT FORMULA
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2. Basrah is Iraq's second largest city, with an estimated
population of 1.2 million people. The population of Basrah
governorate is estimated at 1.8 million. Although overall
rates of exclusive breastfeeding in Iraq increased during
the sanctions period (from 17 percent to 30 percent),
interviews of U.N. World Food Program (WFP) local staff who
have sampled Basrah's urban and rural populations indicate
that there is significant variance in the rates of
breastfeeding between rural and urban and uneducated versus
educated women. WFP indicates that there is almost
universal breastfeeding in rural areas of Basrah
governorate, while in the city more than 75 percent of women
bottle-feed for at least a portion of an infant's first
year.


3. According to WFP, bottle-feeding is particularly common
to women working outside the home, even though most women
are provided six months to a year of maternity leave after
giving birth. Bottle-feeding among working and educated
women appears to be largely a matter of preference.


4. In interviews with poorer women, and with internally
displaced persons (IDPs) in Al Zubayr, bottle-feeding was
linked to a mother's perception that her own milk supply was
insufficient. Among the seven IDP families interviewed by
the DART, three reported using infant formula (IF) because
their own milk was insufficient, with two of these estimated
that they did not eat enough to be able to produce milk. A
fourth indicated that she was on medication, and was worried
that the drug would pass to her baby if she tried to nurse.


5. All women indicated that they used either bottled or
boiled water to prepare IF, and in the absence of
refrigeration, discarded any milk that was not consumed
immediately. However, when asked how bottles were cleaned,
it became apparent that a significant risk of contamination
of the IF was common to these women. Bottles are washed in
unsafe water with other household dishes, and they are not
dried thoroughly prior to use. When asked whether diarrhea
or other digestive complaints were common to their infants,
three of the seven reported that their infants currently had
diarrhea and vomiting.


6. One infant, six days old, whose mother had reported
having very little breast-milk and insufficient food for
herself, was clearly dehydrated. This particular family
grouping (one male, two females, and four children) was the
most needy of the IDPs visited in Al Zubayr, with
malnutrition apparent in three of the four children (one
with oedema),and respiratory infections in two of these
three. When asked why the children had not been taken to
the hospital or clinic, the mother reported that they did
not have the money. Other IDP families living in the same
building had provided some IF and other commodities to this
family, but supplies among this group were obviously
limited. WFP's partner for vulnerable group and IDP feeding
in Basra governorate will coordinate with IOM to provide
these families assistance.


7. For those who can afford to buy IF, it is available in
local markets. Pre-war market prices for IF in Basra city
ranged from 450 to 500 Iraqi dinars for 450 grams. By
contrast, the PDS food ration is 250 dinars per person.
Post-war prices stand at 1,400 to 1,500 Iraqi dinar. Three
percent of women receiving IF report selling it. The most
common reason for sale is to purchase a different brand of
formula. WFP reports that brands and respective quantities
of half-fat and whole-fat IF have varied from distribution
to distribution. Mothers report that the variation causes
diarrhea and other digestive disorders in their infants, so
if previously distributed brands are available on the
market, they will sell or swap newly distributed brands
and/or formulations.

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AVAILABILITY OF INFANT FORMULA AND OTHER USES
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8. The United Nations Children's Fund (UNICEF) recently
released a policy paper, following a meeting in Amman, that
recommends the immediate deletion of IF from the Oil for
Food (OFF) general ration. Approximately 20 percent of
Iraq's total estimated IF requirements would continue to be
imported under OFF for distribution through medical centers
and UNICEF's Targeted Nutrition Program. The policy paper
cites the monthly distribution of double rations since
November as evidence that sufficient quantities of IF have
been distributed to last through August. In their planning
framework, this date would provide UNICEF and its partners
ample time to establish/re-establish a nutritional safety-
net for mothers and infants. The plan includes the
provision of IF only when medically prescribed and otherwise
removes IF from the OFF food basket immediately. WFP local
staff strongly disagree with this analysis for the following
reasons:
-- Not enough weaning cereals and powdered milk were
distributed before the war. Distribution of powdered milk
has ranged from 13 percent to 25 percent of a full ration
since the "April-May" distributions, and was not complete in
earlier distributions. In many cases, IF has been used to
supplement the lack of powdered milk. (Note: Powdered milk
is one of the most valued commodities in the OFF food basket
because it is the sole "breakfast" commodity. WFP staff
from all southern governorates indicate powdered milk
provides urban families their primary source of yogurt-a
staple in the Iraqi diet. End Note.) Staff report that in
urban areas particularly, where other options for the
procurement of milk are limited, mothers have been
using/purchasing IF to complement the diets of weaning-age
and older children.

-- WFP staff report that when a child is born, it can take
from two to four months for him or her to be registered in
the PDS system. This means that families with children born
since January are unlikely to have received infant formula
during the multi-month distributions provided in January,
February, or March. With the interruption of the PDS
registration and tracking systems, this trend is likely to
continue for several more months. Under these
circumstances, families with an excess of IF will give IF to
families with unregistered infants, either through sale or
exchange. Further, WFP staff doubt that existing stores
will meet even minimum requirements through June.

-- WFP monthly monitoring post-distribution prior to the
conflict consistently indicated that the OFF food basket
provided families between 20 to 25 days of their monthly
food requirements. WFP staff indicate that the war, and the
assumption of power by Coalition forces, has raised hopes
that the ration will be increased. Deleting any item from
the food basket now risks being interpreted as disregard for
the Iraqi people by the Coalition, and deleting something
that is considered to be necessary will generate even more
distrust of Iraq's interim administration. WFP points to
the last time an attempt was made to remove IF from the food
basket, and the politicized debate it caused as evidence
that the issue is too sensitive to approach now as a
unilateral policy decision.

(Comment: The first two reasons above question the
assumption that previously distributed quantities of IF will
tide over bottle-fed infants over until August, and they
underscore the importance of ensuring that viable
alternatives and assistance exist for Iraqi women PRIOR to
the removal of IF from the OFF basket. The third reason,
while meaningless in the analysis of the benefits of breast
feeding over bottle feeding, is certainly relevant to
attempts to reestablish the PDS as a way of providing the
population a sense of stability and security during this
uncertain time. It also highlights the necessity of
ensuring a "fit" between sectoral programmatic decisions and
the political realities of a volatile environment for which
they are being made. End Comment.)

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RECOMMENDATION
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9. Given the considerations above, the DART strongly
recommends that WFP attempt to ensure that 100 percent of
the IF ration is included in the OFF food basket throughout
the planned EMOP program period (September).

JONES