Armenia Assessment Report 2 R   EPORT International Baby Food Action Network (IBFAN) Asia BP-33, Pitam Pura, Delhi-110034, India Phone: 91-11-27343608, 42683059 Fax : 91-11-27343606, E-mail: [email protected] , [email protected] Website : www.worldbreastfeedingtrends.org Confidencen Health NGO- Member of IBFAN 9 Khatchatryan str, apt. 21, Yerevan, Armenia Phone: +37491450318, +37455453045 E-mail:[email protected] Website: www.mankik.am 3 The World Breastfeeding Trends Initiative (WBTi) R A   EPUBLIC OF  RMENIA 2015  4 INTRODUCTION  This report presents the results of the assessment of policy and programs in the Republic of Armenia regarding Infant and Young Child Feeding. The assessment was completed according to the World Breastfeeding Trends Initiative (WBTi) Assessment Tool developed by the Breastfeeding Promotion Network of India (BPNI) / International Baby Food Action Network (IBFAN) Asia.   ACKNOWLEDGEMENTS  “Confidence” Health NGO would like to thank the following organizations: BPNI / IBFAN Asia, MOH of RA, UNICEF Armenia country office, Mother and Child Health (MCH) Alliance of Armenia and World Vision Armenia. Without them, this assessment would not have been possible. Prepared by: Dr. Susanna Harutyunyan, President of Confidence Health NGO – member of IBFAN Data sourced from: • Statistical Yearbook of Armenia, 2015 • Armenia Demographic and Health Survey 2010 (ADHS 2010), • The Law of the RA on “Breastfeeding Promotion and Regulation of Marketing of Baby Food” • The concept of improving child nutrition • “National strategy for improving child nutrition for 2015-2020” • Standards on health care, MOH • Armenia CRC report 2013 • Decree of the supreme council of the Republic of Armenia on “Priority measures to protect women, maternity and childhood and strengthening of the family” • The Labor Code of RA • Implementation of baby friendly practices in health care system in Armenia, New Armenian Medical Journal, Volume 5 • National Program on the Response to the HIV Epidemic, 2013-2016     5 ACRONIMS   BFHI Baby Friendly Hospital Initiative BFPI Baby Friendly Polyclinic Initiative BPNI Breastfeeding Promotion Network of India ADHS Armenian Demographic and Health Survey GSIYCF Global Strategy for Infant and Young Child Feeding IBFAN International Baby Food Action Network ICDC International Code Documentation Centre WV Armenia World Vision Armenia country office IFE Infant and Young Child Feeding in Emergencies ILO International Labour Organization IYCF Infant and Young Child Feeding MPC Maternity Protection Convention MSG Mother Support Groups WABA World Alliance for Breastfeeding Action WBCi World Breastfeeding Costing Initiative WBTi World Breastfeeding Trends Initiative WHO World Health Organization WHA World Health Assembly MOH Ministry of Health RA Republic of Armenia YSMU Yerevan State Medical University after Mkhitar Heratsi 6 WORLD BREASTFEEDING TRENDS INITIATIVE (WBTI) BACKGROUND  The World Breastfeeding Trends Initiative (WBTi) is an innovative initiative, developed by IBFAN Asia, to assess the status and benchmark the progress of the implementation of the Global Strategy for Infant and Young Child Feeding at national level. The tool is based on two global initiatives, the first is WABA's (GLOPAR) and the second the WHO's “Infant and Young Child Feeding: A tool for assessing national practices, policies and programs". The WBTi is designed to assist countries in assessing the strengths and weaknesses of their policies and programs to protect, promote and support optimal infant and young child feeding practices. The WBTi has identified 15 indicators in two parts, each indicator having specific significance. Part-I deals with policy and programs Part –II deals with infant feeding practices (indicator 1-10) (indicator 11-15) 1. National Policy, Program and Coordination 11. Early Initiation of Breastfeeding 2. Baby Friendly Hospital Initiative (Ten steps 12. Exclusive breastfeeding to successful breastfeeding) 13. Median duration of breastfeeding 3. Implementation of the International Code of 14. Bottle feeding Marketing of Breastmilk Substitutes 15. Complementary feeding 4. Maternity Protection 5. Health and Nutrition Care Systems (in support of breastfeeding & IYCF) 6. Mother Support and Community Outreach 7. Information Support 8. Infant Feeding and HIV 9. Infant Feeding during Emergencies 10. Mechanisms of Monitoring and Evaluation System Once assessment of gaps is carried out, the data on 15 indicators is fed into the questionnaire using the WBTi web based toolkit© which is specifically designed to meet this need. The toolkit objectively quantifies the data to provide a colour- coded rating in Red, Yellow, Blue or Green. The toolkit has the capacity to generate visual maps or graphic charts to assist in advocacy at all levels e.g. national, regional and international. Each indicator used for assessment has following components; • The key question that needs to be investigated. 7 • Background on why the practice, policy or program component is important. • A list of key criteria as subset of questions to be considered in identifying achievements and areas needing improvement, with guidelines for scoring, colour-rating, and ranking how well the country is doing. Part I: A set of criteria has been developed for each target, based on Global Strategy for Infant and Young Child Feeding (2002) and the Innocenti Declaration on Infant and Young Child Feeding (2005). For each indicator, there is a subset of questions. Answers to these can lead to identify achievements and gaps in policies and program to implement Global Strategy for Infant and Young Child Feeding. This shows how a country is doing in a particular area of action on Infant and Young Child Feeding. Part II: Infant and Young Child Feeding Practices in Part II ask for specific numerical data on each practice based on data from random household survey that is national in scope. Once the information about the indicators is gathered and analyzed, it is then entered into the web- based toolkit through the ' WBTi Questionnaire'. Further, the toolkit scores and colour- rate each individual indicator as per IBFAN Asia's Guidelines for WBTi 8 1. BACKGROUND  1.1 GENERAL BACKGROUND DATA ABOUT THE REPUBLIC OF ARMENIA   Republic of Armenia is a mountainous country in the Caucasus region straddling Asia and Europe. Located in Western Asia, it is bordered by Turkey to the west, Georgia to the north, the de facto independent Nagorno-Karabakh Republic and Azerbaijan to the east, and Iran to the south. One of the world's oldest civilizations, Armenia once included Mount Ararat, which biblical tradition identifies as the mountain that Noah's ark rested on after the flood. It was the first country in the world to officially embrace Christianity as its religion (c. A.D. 300). The Armenian language is part of the Indo-European family, but its alphabet is unique and was invented by Mesrop Mashtots in 405 AD. Situated along the route of the Great Silk Road, it has fallen within the orbit of a number of cultural influences and empires. In the 6th century B.C., Armenians settled in the kingdom of Urartu, which was in decline. Under Tigrane the Great (fl. 95–55 B.C.) the Armenian empire reached its height and became one of the most powerful in Asia, stretching from the Caspian to the Mediterranean seas. Throughout most of its long history, however, Armenia has been invaded by a succession of empires: Greeks, Romans, Persians, Byzantines, Mongols, Arabs, Ottoman Turks, and Russians. From the 16th century through World War I, major portions of Armenia were controlled by their most brutal invader, the Ottoman Turks, under whom the Armenians experienced the first genocide of the 20th century. In April 1915 during World War I the Turks ordered the deportation of the Armenian population to the deserts of Syria and Mesopotamia. According to the majority of historians 1.5 million Armenians were murdered or died of starvation. Turkey denies that a genocide took place and claims that a much smaller number died in a civil war. The eastern area of Armenia was ceded by the Ottomans to Russia in 1828; this portion declared its independence in 1918, but was conquered by the Soviet Red Army in 1920. After independence from the Soviet Union in 1991, Armenia quickly became drawn into a bloody conflict with Azerbaijan over the primarily Armenian-populated region, assigned to Soviet Azerbaijan in the 1920s by Moscow. Armenia and Azerbaijan began fighting over the area in 1988; the struggle escalated after both countries attained independence from the Soviet Union in 1991. Full-scale war broke out the same year as ethnic Armenians in Karabakh fought for independence, supported by troops and resources from Armenia proper. A ceasefire in place since 1994 has failed to deliver any lasting solution. Currently Armenia is a member of the Eurasian Economic Union, the Council of Europe and the Collective Security Treaty Organization. 9 1.2 GENERAL INFORMATION ABOUT THE COUNTRY REGARDING CHILD NUTRITION &  SURVIVAL, INITIATIONS TO IMPROVE IYCF PRACTICES   The following statistical data are available from the National Statistical Services of the Republic of Armenia for the beginning of the year 20151 (1-6) and the World Factbook2 (7-14). Table 1. General Statistical data    1.  Total population (January 2015 est.)  3,010.600  2.  Birth rate: (2014 est.)   14.28 births/1,000 population   3.  Death rate: (2014 est.)   9,2 deaths/1,000 population  4.  Life expectancy at birth (2013 est.)      Total population:  74.2 years                                                                      Male:   71.5 years                                                                       Female:   77.9 years  5.  Maternal mortality rate: (2014 est.)   18,6 deaths/100,000 live births 6.  Infant mortality rate: (2014 est)  8.76 deaths/1,000 live births  7.  Total fertility rate: (2014 est.)  1.64 children born/woman  8.  HIVAIDS adult prevalence rate (2014 est.)   0.2% 9.  Number of people living with HIV (2012) 3500  10.  New cases of HIV infection registered during 2014 334 11.  Children under the age of 5 years underweight: (2010) 5.3% 12.  Physicians density: (2011)  2.85 physicians/1,000 population 13.  Health expenditures (2011)  4.3% of GDP 14.  Net migration rate: (2014 est.)  ‐5.88 migrant(s)/1,000 population   DATA ON BREASTFEEDING AND INFANT HEALTH Proper nutrition is the guarantee for healthy growth and development of each child. Article 24 of the CRC – the child’s right to health and health care – requires countries to take appropriate measures to “combat disease and malnutrition” through, inter alia, the “provision of adequate nutritious foods”, and to “ensure that all segments of society, in particular parents and children, are informed (…) and supported in the use of basic knowledge of child health and nutrition, the advantages of breastfeeding (…)”. Breastmilk is the optimal source of nutrients for infants, exclusively for the first six months of a child’s life, and complemented with timely, adequate and appropriate complementary feeding up to two years of beyond. Optimal breastfeeding has the greatest potential impact on child survival of all preventive interventions. Suboptimum breastfeeding, especially non-exclusive breastfeeding in the first 6 months of life, results in 800 000 deaths deaths and 10% of disease burden in children younger than 5 years. Non breastfed infants are 14,4 times more likely to die during the first six months of life, 1 Statistical Yearbook of Armenia, 2015, available at http://armstat.am 2 http://www.indexmundi.com/armenia 10